title: Corneal confocal microscopy detects early nerve regeneration in diabetic neuropathy after simultaneous pancreas and kidney transplantation.
abstract: Diabetic neuropathy is associated with increased morbidity and mortality. To date, limited data in subjects with impaired glucose tolerance and diabetes demonstrate nerve fiber repair after intervention. This may reflect a lack of efficacy of the interventions but may also reflect difficulty of the tests currently deployed to adequately assess nerve fiber repair, particularly in short-term studies. Corneal confocal microscopy (CCM) represents a novel noninvasive means to quantify nerve fiber damage and repair. Fifteen type 1 diabetic patients undergoing simultaneous pancreas-kidney transplantation (SPK) underwent detailed assessment of neurologic deficits, quantitative sensory testing (QST), electrophysiology, skin biopsy, corneal sensitivity, and CCM at baseline and at 6 and 12 months after successful SPK. At baseline, diabetic patients had a significant neuropathy compared with control subjects. After successful SPK there was no significant change in neurologic impairment, neurophysiology, QST, corneal sensitivity, and intraepidermal nerve fiber density (IENFD). However, CCM demonstrated significant improvements in corneal nerve fiber density, branch density, and length at 12 months. Normalization of glycemia after SPK shows no significant improvement in neuropathy assessed by the neurologic deficits, QST, electrophysiology, and IENFD. However, CCM shows a significant improvement in nerve morphology, providing a novel noninvasive means to establish early nerve repair that is missed by currently advocated assessment techniques.
authors.affiliation: Division of Cardiovascular Medicine, University of Manchester and Wellcome Trust Clinical Research Facility, Manchester, UK.
authors.forename: Mitra
authors.initials: M
authors.lastname: Tavakoli
authors.forename: Maria
authors.initials: M
authors.lastname: Mitu-Pretorian
authors.forename: Ioannis N
authors.initials: IN
authors.lastname: Petropoulos
authors.forename: Hassan
authors.initials: H
authors.lastname: Fadavi
authors.forename: Omar
authors.initials: O
authors.lastname: Asghar
authors.forename: Uazman
authors.initials: U
authors.lastname: Alam
authors.forename: Georgios
authors.initials: G
authors.lastname: Ponirakis
authors.forename: Maria
authors.initials: M
authors.lastname: Jeziorska
authors.forename: Andy
authors.initials: A
authors.lastname: Marshall
authors.forename: Nathan
authors.initials: N
authors.lastname: Efron
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Boulton
authors.forename: Titus
authors.initials: T
authors.lastname: Augustine
authors.forename: Rayaz A
authors.initials: RA
authors.lastname: Malik
mesh_terms: D000328:Adult; D003315:Cornea / Q000294:innervation* / Q000473:pathology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009416:Nerve Regeneration; D009431:Neural Conduction; D016035:Pancreas Transplantation