Corneal Confocal Microscopy Detects Early Nerve Regeneration in Diabetic Neuropathy After Simultaneous Pancreas and Kidney Transplantation

• Published in: Diabetes (New York, N.Y.) Vol. 62; no. 1; pp. 254 - 260
• Main Authors: Tavakoli, Mitra, Mitu-Pretorian, Maria, Petropoulos, Ioannis N., Fadavi, Hassan, Asghar, Omar, Alam, Uazman, Ponirakis, Georgios, Jeziorska, Maria, Marshall, Andy, Efron, Nathan, Boulton, Andrew J., Augustine, Titus, Malik, Rayaz A.
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.01.2013
• Subjects: Adult; Biological and medical sciences; Biopsy; Care and treatment; Clinical trials; Complications; Confocal microscopy; Cornea; Cornea - innervation; Cornea - pathology; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - physiopathology; Diabetes. Impaired glucose tolerance; Diabetic neuropathies; Diabetic Neuropathies - physiopathology; Diabetic Neuropathies - surgery; Diabetic neuropathy; Diagnosis; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Heart rate; Humans; Intervention; Kidney Transplantation; Kidney transplants; Kidneys; Male; Medical sciences; Methods; Microscopy; Microscopy, Confocal; Middle Aged; Morphology; Nerve Regeneration; Nervous system; Neural Conduction; Observations; Pancreas; Pancreas Transplantation; Patient outcomes; Patients; Regeneration; Transplantation; Australia; United Kingdom > UK; Endocrinopathy; Regeneration; Nervous system diseases; Urinary system; Diabetes mellitus; Confocal microscopy; Transplantation; Neuropathy; Pancreas; Kidney
• ISSN: 0012-1797; 1939-327X; 1939-327X
• DOI: 10.2337/db12-0574

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.