Abstract
One of the most common complications of diabetes mellitus is diabetic neuropathy. It may be provoked by metabolic and/or vascular factors, and depending on duration of disease, various layers of nerve may be affected. Our aim was to investigate influence of diabetes on the epineurial, perineurial, and endoneurial connective tissue sheaths. The study included 15 samples of sural nerve divided into three groups: diabetic group, peripheral vascular disease group, and control group. After morphological analysis, morphometric parameters were determined for each case using ImageJ software. Compared to the control group, the diabetic cases had significantly higher perineurial index (P < 0.05) and endoneurial connective tissue percentage (P < 0.01). The diabetic group showed significantly higher epineurial area (P < 0.01), as well as percentage of endoneurial connective tissue (P < 0.01), in relation to the peripheral vascular disease group. It is obvious that hyperglycemia and ischemia present in diabetes lead to substantial changes in connective tissue sheaths of nerve, particularly in peri- and endoneurium. Perineurial thickening and significant endoneurial fibrosis may impair the balance of endoneurial homeostasis and regenerative ability of the nerve fibers. Future investigations should focus on studying the components of extracellular matrix of connective tissue sheaths in diabetic nerves.
Highlights
Diabetic polyneuropathy is the most common neurological complications of diabetes mellitus
Abnormalities reported in diabetic neuropathy include axonal degeneration in nerve fibers, primary demyelination resulting from Schwann cell dysfunction, secondary segmental demyelination related to impairment of the axonal control of myelination, remyelination, proliferation of Schwann cells, atrophy of denervated bands of Schwann cells, onion-bulb formations, and hypertrophy of the basal lamina [4]
After morphometric analysis we observed that the highest mean value of total neural and epifascicular area was in the diabetic group (Table 1), which was significant in comparison to nondiabetic peripheral vascular disease (PVD) group (P < 0.05 and P < 0.01, resp.)
Summary
Diabetic polyneuropathy is the most common neurological complications of diabetes mellitus. More than 80% of patients with diabetic neuropathy have developed distal symmetrical diabetic neuropathy (DSDN) [1], which is length dependent, due to early onset in the longest nerve fibers which are situated in the feet, affecting more proximal parts of the lower limbs and distal parts of upper limbs eventually. This form of polyneuropathy affects at least 50% of diabetic patients and is the leading cause of foot amputation [2]. Peripheral neuropathy can be caused by nondiabetic peripheral vascular disease in chronically ischaemic limbs [9]
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