Abstract
BackgroundTumor necrosis factor-α (TNF-α) is an adipocytokine locally produced by Schwann cells and has a role in nerve regeneration and regulation of apoptosis. The role of TNF-α in the development of diabetic peripheral neuropathy (DPN) is controversial.ObjectiveThe objective of this study was to evaluate TNF-α serum level in a group of type II diabetes mellitus (DM) patients with and without neuropathy in comparison with healthy age-matched control group.DesignThis is a cross-sectional case–control study.SettingsThe study was conducted in outpatient clinics of the diabetes and physical medicine, rheumatology, and rehabilitation departments.PatientsNinety patients diagnosed with type II diabetes were included in the study.Main outcome measuresAll patients were assessed for clinical neuropathy using neuropathy symptom score and neuropathy disability score. All patients underwent nerve conduction studies of both upper and lower limbs. They were divided into two groups: group I with confirmed DPN (n=60) and group II with DM but no peripheral neuropathy (n=30). Serum TNF-α level was measured in all previous DM patients (90 patients) in addition to 48 healthy age-matched controls.ResultsA statistically significant difference was detected between serum TNF-α level in controls and diabetic patients. Similarly, a significant difference was detected between its level in non-DPN patients and confirmed DPN patients, being higher in the latter. A positive significant correlation has been detected between TNF-α level and patients’ age, as well as blood cholesterol level. A positive significant correlation has been found between TNF-α level and both neuropathy symptom score and neuropathy disability score. A significant negative correlation had been detected between TNF-α level and motor amplitudes of both tibial nerves.ConclusionSerum TNF-α level might be a potential biomarker for peripheral neuropathy in type II DM.
Highlights
Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus (DM) that can have a serious impact on the quality of life [1].A number of neuropoietic cytokines that are produced locally by residual and infiltrating macrophages, lymphocytes, mast cells, Schwann cells, and sensory neurons exhibit pleiotrophic effects on glia cells and neurons, which is vital for the homeostasis of the peripheral, central, and autonomic nervous system
Group I consists of 60 DM patients with PN and group II consists of 30 DM patients with no PN in addition to 48 healthy age-matched and sex-matched controls
Statistically significant differences were found between groups in disease duration and both scores of neuropathy disability symptoms and of clinical PN
Summary
A number of neuropoietic cytokines that are produced locally by residual and infiltrating macrophages, lymphocytes, mast cells, Schwann cells, and sensory neurons exhibit pleiotrophic effects on glia cells and neurons, which is vital for the homeostasis of the peripheral, central, and autonomic nervous system. These neuropoietic cytokines include interleukin-1, interleukin-6, transforming growth factor β-1, leukemia inhibitory factors, ciliary neurotrophic factors, and tumor necrosis factor-α (TNF-α) [2]. Tumor necrosis factor-α (TNF-α) is an adipocytokine locally produced by Schwann cells and has a role in nerve regeneration and regulation of apoptosis. The role of TNF-α in the development of diabetic peripheral neuropathy (DPN) is controversial
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