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Metabolic and Vascular Factors in the Pathogenesis of Diabetic Neuropathy
Abstract
Reduced nerve perfusion is an important factor in the etiology of diabetic neuropathy. Studies in streptozotocin-induced diabetic rats show that nerve conduction velocity (NCV) and blood flow deficits are corrected by treatment with vasodilator drugs, with angiotensin II and endothelin-1 antagonists being particularly important. The AT1 antagonist ZD7155 also prevents diabetic deficits in regeneration following nerve damage, indicating that hypoperfusion is an important limitation for nerve repair. Metabolic changes include high polyol pathway flux, increased advanced glycosylation, elevated oxidative stress, and impaired ω-6 essential fatty acid metabolism. Aldose reductase inhibitors (ARIs) restore NCV via their effects on perfusion. ARI action probably depends on blocking the conversion of glucose to sorbitol, thus preventing depletion of vasa nervorum glutathione, an important endogenous free radical scavenger. Free radicals cause vascular endothelium damage and reduced nitric oxide vasodilation. Inhibition of advanced glycosylation and autoxidation (autoxidative glycosylation), major sources of free radicals, by aminoguanidine or transition metal chelators, corrects neurovascular dysfunction. Evening primrose oil supplies γ-linolenic acid (GLA) to improve vasodilator eicosanoid synthesis in diabetes, correcting nerve blood flow and NCV deficits. Interactions between some of these mechanisms have therapeutic implications. Thus, combined ARI and evening primrose oil treatment produced a 10-fold amplification of NCV and blood flow responses. Similarly, GLA effects are markedly enhanced when given in combination with ascorbate as ascorbyl-GLA. Thus, metabolic abnormalities combine to produce deleterious changes in nerve perfusion that make a major contribution to the etiology of diabetic neuropathy. The potential importance of multi-action therapy is stressed.
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“Because metal chelators and hydroxyl radical scavengers have also been demonstrated to be effective in preventing diabetes-induced vascular and neural dysfunction, it is likely that the formation of hydroxyl radicals also contributes to impairment of vascular reactivity and nerve function in diabetes (46–51, 145).”
From Mitochondrial Dysfunction in Diabetes: From Molecular Mechanisms to Functional Significance and Therapeutic Opportunities (2010) · cites this paper as [47]
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Balcıoğlu, A. S., Akıncı, S., Çiçek, D., Eldem, H. O., Çoner, A., Bal, U. A., & Müderrisoğlu, H. (2015) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2015.09.001 · Cited by 12
Treatment of diabetic neuropathy with baicalein: Intervention at multiple sites
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“…aminoguanidine and transition metal chelators, or antioxidants and free radical scavengers improves endoneurial blood flow and neural dysfunction (Cameron et al., 1993; Cameron and Cotter, 1995; 1997; 1999; Coppey et al., 2001a,b, 2002; Karasu et al., 1995; Keegan et al., 1999; Yorek et al., 2002).”
Backgroundvan Westrhenen, R., Aten, J., Aberra, M., et al. (2005) · Peritoneal Dialysis International · doi:10.1177/089686080502503s05 · Cited by 12
Zangiabadi, N., Ahrari, M. N., & Nakhaee, N. (2007) · American Journal of Pharmacology and Toxicology · doi:10.3844/ajptsp.2007.1.3 · Cited by 11
Singleton, J. R., Foster-Palmer, S. C., & Marcus, R. L. (2021) · Current Diabetes Reviews · doi:10.2174/1573399817666210923125832 · Cited by 14
Becker, M., Benromano, T., Shahar, A., Nevo, Z., & Pick, C. G. (2014) · Journal of Molecular Neuroscience · doi:10.1007/s12031-014-0424-2 · Cited by 11
“In addition, hyperglycemia causes oxidative stress (Cameron and Cotter, 1997), non-enzymatic glycation (Ryle et al., 1997; Cameron and Cotter, 1999), and abnormal neurotropism (Tomlinson and Fernyhough, 1999), which lead to nerve damage.”
Activation of IL‐1 Signaling Pathway in Schwann Cells during Diabetic Neuropathy
Skundric, D. S., Dai, R., JAMES, J., & Lisak, R. P. (2002) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2002.tb03011.x · Cited by 11
Acute effects of adrenergic-mediated ischemia on nerve conduction in subjects with type 2 diabetes
Hogikyan, R. V., Wald, J. J., Feldman, E. L., Greene, D. A., Halter, J. B., & Supiano, M. A. (1999) · Metabolism · doi:10.1016/s0026-0495(99)90110-5 · Cited by 11
Diabetic Hyperglycemia: A Facilitating Factor in Systemic Capillary Leak
Lawson, S., Ward, D. T., Conner, C., et al. (2002) · Journal of Surgical Research · doi:10.1006/jsre.2002.6370 · Cited by 11
“The deficiency in nitric oxide reflects the competition for NADPH, a cofactor used by both NOS and aldose reductase [18].”
BackgroundGriffiths, G., & Morse, N. (2006) · Journal of the American Oil Chemists Society · doi:10.1007/s11746-006-1191-1 · Cited by 10
β2-adrenoceptor agonists as potential therapeutic drugs in diabetic peripheral neuropathy
Baraka, A., Darwish, I. E., Ghoneim, M. T., & Korayem, H. K. (2014) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2014.11.004 · Cited by 10
Nwankwo, M. J., Okoye, C. G., Victor, E. A., & Ezeukwu, A. O. (2014) · Cited by 10
Role of protein kinase C in diabetic complications
King, G. L., & Daş-Evcimen, N. (2010) · Expert Review of Endocrinology & Metabolism · doi:10.1586/eem.09.74 · Cited by 9
Metadata
- Authors
- Cameron, N. E., & Cotter, M. A.
- Affiliations
- University of Aberdeen (GB)
- Venue
- Diabetes
- Publisher
- American Diabetes Association
- Published
- 1997-09-01
- Volume
- 46
- Issue
- Supplement_2
- Pages
- S31-S37
- ISSN
- 0012-1797 (ISSN-L)
- 1939-327X
- OpenAlex
- W2151689386
- Cited by
- 312
- References
- 0
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 5 · 2023: 7 · 2022: 5 · 2021: 7 · 2020: 11 · 2019: 9 · 2018: 7 · 2017: 9 · 2016: 7 · 2015: 12 · 2014: 12 · 2013: 10 · 2012: 8
- FWCI
- 4.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Wellcome Trust
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Aldose Reductase and Taurine
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Clinical Neurology › Peripheral Neuropathies and Disorders
- Keywords
- diabetic neuropathy, nerve blood flow, nerve conduction velocity, polyol pathway, advanced glycation end products, oxidative stress, aldose reductase inhibitors, sorbitol, glutathione, vasa nervorum, angiotensin receptor blockers, nerve regeneration, aminoguanidine, evening primrose oil, gamma-linolenic acid, nitric oxide, vasodilation, free radicals, endothelial injury
- MeSH terms
- Animals, Carnitine, Diabetes Mellitus, Experimental, Diabetic Neuropathies, Endothelium, Vascular, Fatty Acids, Essential, Glycosylation, Humans, Nerve Tissue, Oxidation-Reduction, Regional Blood Flow, Sugar Alcohols, Vasodilator Agents, Reactive Oxygen Species, Rats
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