Abstract
This study aims to demonstrate how the state of chronic hyperglycemia from experimental Diabetes Mellitus can influence the homeostatic imbalance of tendons and, consequently, lead to the characteristics of tendinopathy. Twenty animals were randomly divided into two experimental groups: control group, consisting of healthy rats and diabetic group constituted by rats induced to Diabetes Mellitus I. After twenty-four days of the induction of Diabetes type I, the Achilles tendon were removed for morphological evaluation, cellularity, number and cross-sectional area of blood vessel, immunohistochemistry for Collagen type I, VEGF and NF-κB nuclear localization sequence (NLS) and nitrate and nitrite level. The Achilles tendon thickness (µm/100g) of diabetic animals was significantly increased and, similarly, an increase was observed in the density of fibrocytes and mast cells in the tendons of the diabetic group. The average number of blood vessels per field, in peritendinous tissue, was statistically higher in the diabetic group 3.39 (2.98) vessels/field when compared to the control group 0.89 (1.68) vessels/field p = 0.001 and in the intratendinous region, it was observed that blood vessels were extremely rare in the control group 0.035 (0.18) vessels/field and were often present in the tendons of the diabetic group 0.89 (0.99) vessels/field. The immunohistochemistry analysis identified higher density of type 1 collagen and increased expression of VEGF as well as increased immunostaining for NFκB p50 NLS in the nucleus in Achilles tendon of the diabetic group when compared to the control group. Higher levels of nitrite/nitrate were observed in the experimental group induced to diabetes. We conclude that experimental DM induces notable structural, inflammatory and vascular changes in the Achilles tendon which are compatible with the process of chronic tendinopathy.
Highlights
Case reports and epidemiological studies suggest a relationship between Diabetes Mellitus (DM) and complications and ruptures of tendons from various regions of the human body [1,2,3,4,5,6]
The blood sugar levels of the control animals remained stable during all the analyses, the animals induced to DM group presented a significant increase in the measurements after the induction of DM in the seventh and the twenty-fourth day (p = 0.001) – Figure 1
Blood Vessels The blood vessels were present in peritendinous tissue of both groups, the average number of blood vessels per field was statistically higher in the diabetic group 3.39 (2.98) vessels/field when compared to the control group 0.89 (1.68) vessels/field p = 0.001
Summary
Case reports and epidemiological studies suggest a relationship between Diabetes Mellitus (DM) and complications and ruptures of tendons from various regions of the human body [1,2,3,4,5,6]. To evaluate this relationship in diabetic patients, studies have stopped at structural analysis of the tendon performed through diagnostic imaging methods, such as musculoskeletal ultrasound [1,4,5,7,8], computerized tomography [6] and magnetic resonance imaging [9]. An increase of microvascular density, proliferation of endothelial cells and an increase in perivascular mast cells in tendinopathies have been confirmed [24,25,26] which demonstrates a strong link between vascular hyperplasia and tendon dysfunction caused by overuse or by microtrauma
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