Early nerve fibre regeneration in individuals with type 1 diabetes after simultaneous pancreas and kidney transplantation

Shazli Azmi, Maria Jeziorska, Maryam Ferdousi, Ioannis N. Petropoulos, Georgios Ponirakis, Andrew Marshall, Uazman Alam, Omar Asghar, Andrew Atkinson, Wendy Jones, Andrew J.M. Boulton, Michael Brines, Titus Augustine, Rayaz Malik

Research output: Contribution to journalArticle

Abstract

Aims/hypothesis: The study aimed to assess the impact on neuropathy of simultaneous pancreas and kidney transplantation (SPK) in individuals with type 1 diabetes. Methods: This longitudinal observational study examined neuropathic symptoms, deficits, quantitative sensory testing, neurophysiology, corneal confocal microscopy and skin biopsy results in 32 healthy (non-diabetic) control participants, 29 individuals with type 1 diabetes and severe diabetic peripheral neuropathy [DPN] and 36 individuals with type 1 diabetes after SPK. Results: Following SPK, HbA1c, eGFR, triacylglycerols and HDL improved significantly (all p < 0.05). Compared with the DPN group, which remained unchanged over the 36 month study period, corneal confocal microscopy assessments improved over 36 months following SPK, with increasing corneal nerve fibre density of 5/mm2 (95% CI 1.8, 8.2; p = 0.003) and corneal nerve fibre length of 3.2 mm/mm2 (95% CI 0.9, 5.5; p = 0.006). The Neuropathy Symptom Profile and peroneal nerve conduction velocity also improved significantly by 36 months compared with DPN (2.5; 95% CI 0.7, 4.3; p = 0.008 and 4.7 m/s; 95% CI 2.2, 7.4; p = 0.0004, respectively), but with a temporal delay compared with the corneal confocal microscopy assessments. Intraepidermal nerve fibre density did not change following SPK; however, mean dendritic length improved significantly at 12 (p = 0.020) and 36 (p = 0.019) months. In contrast, there were no changes in the Neuropathy Disability Score, quantitative sensory testing or cardiac autonomic function assessments. Except for a small decrease in corneal nerve fibre density in the healthy control group, there were no changes in any other neuropathy measure in the healthy control or DPN groups over 36 months. Conclusions/interpretation: SPK is associated with early and maintained small nerve fibre regeneration in the cornea and skin, followed by an improvement in neuropathic symptoms and peroneal nerve conduction velocity.

Original languageEnglish
JournalDiabetologia
DOIs
Publication statusPublished - 1 Jan 2019

Fingerprint

Pancreas Transplantation
Nerve Regeneration
Type 1 Diabetes Mellitus
Nerve Fibers
Kidney Transplantation
Diabetic Neuropathies
Peripheral Nervous System Diseases
Confocal Microscopy
Peroneal Nerve
Neural Conduction
Skin
Neurophysiology
Cornea
Observational Studies
Longitudinal Studies
Triglycerides
Biopsy
Control Groups

Keywords

  • Corneal confocal microscopy
  • Diabetic neuropathy
  • Pancreas and kidney transplantation
  • Skin biopsy

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Early nerve fibre regeneration in individuals with type 1 diabetes after simultaneous pancreas and kidney transplantation. / Azmi, Shazli; Jeziorska, Maria; Ferdousi, Maryam; Petropoulos, Ioannis N.; Ponirakis, Georgios; Marshall, Andrew; Alam, Uazman; Asghar, Omar; Atkinson, Andrew; Jones, Wendy; Boulton, Andrew J.M.; Brines, Michael; Augustine, Titus; Malik, Rayaz.

In: Diabetologia, 01.01.2019.

Research output: Contribution to journalArticle

Azmi, S, Jeziorska, M, Ferdousi, M, Petropoulos, IN, Ponirakis, G, Marshall, A, Alam, U, Asghar, O, Atkinson, A, Jones, W, Boulton, AJM, Brines, M, Augustine, T & Malik, R 2019, 'Early nerve fibre regeneration in individuals with type 1 diabetes after simultaneous pancreas and kidney transplantation', Diabetologia. https://doi.org/10.1007/s00125-019-4897-y
Azmi, Shazli ; Jeziorska, Maria ; Ferdousi, Maryam ; Petropoulos, Ioannis N. ; Ponirakis, Georgios ; Marshall, Andrew ; Alam, Uazman ; Asghar, Omar ; Atkinson, Andrew ; Jones, Wendy ; Boulton, Andrew J.M. ; Brines, Michael ; Augustine, Titus ; Malik, Rayaz. / Early nerve fibre regeneration in individuals with type 1 diabetes after simultaneous pancreas and kidney transplantation. In: Diabetologia. 2019.
@article{55f705be5c644d709ed0f5bedf24ca65,
title = "Early nerve fibre regeneration in individuals with type 1 diabetes after simultaneous pancreas and kidney transplantation",
abstract = "Aims/hypothesis: The study aimed to assess the impact on neuropathy of simultaneous pancreas and kidney transplantation (SPK) in individuals with type 1 diabetes. Methods: This longitudinal observational study examined neuropathic symptoms, deficits, quantitative sensory testing, neurophysiology, corneal confocal microscopy and skin biopsy results in 32 healthy (non-diabetic) control participants, 29 individuals with type 1 diabetes and severe diabetic peripheral neuropathy [DPN] and 36 individuals with type 1 diabetes after SPK. Results: Following SPK, HbA1c, eGFR, triacylglycerols and HDL improved significantly (all p < 0.05). Compared with the DPN group, which remained unchanged over the 36 month study period, corneal confocal microscopy assessments improved over 36 months following SPK, with increasing corneal nerve fibre density of 5/mm2 (95{\%} CI 1.8, 8.2; p = 0.003) and corneal nerve fibre length of 3.2 mm/mm2 (95{\%} CI 0.9, 5.5; p = 0.006). The Neuropathy Symptom Profile and peroneal nerve conduction velocity also improved significantly by 36 months compared with DPN (2.5; 95{\%} CI 0.7, 4.3; p = 0.008 and 4.7 m/s; 95{\%} CI 2.2, 7.4; p = 0.0004, respectively), but with a temporal delay compared with the corneal confocal microscopy assessments. Intraepidermal nerve fibre density did not change following SPK; however, mean dendritic length improved significantly at 12 (p = 0.020) and 36 (p = 0.019) months. In contrast, there were no changes in the Neuropathy Disability Score, quantitative sensory testing or cardiac autonomic function assessments. Except for a small decrease in corneal nerve fibre density in the healthy control group, there were no changes in any other neuropathy measure in the healthy control or DPN groups over 36 months. Conclusions/interpretation: SPK is associated with early and maintained small nerve fibre regeneration in the cornea and skin, followed by an improvement in neuropathic symptoms and peroneal nerve conduction velocity.",
keywords = "Corneal confocal microscopy, Diabetic neuropathy, Pancreas and kidney transplantation, Skin biopsy",
author = "Shazli Azmi and Maria Jeziorska and Maryam Ferdousi and Petropoulos, {Ioannis N.} and Georgios Ponirakis and Andrew Marshall and Uazman Alam and Omar Asghar and Andrew Atkinson and Wendy Jones and Boulton, {Andrew J.M.} and Michael Brines and Titus Augustine and Rayaz Malik",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00125-019-4897-y",
language = "English",
journal = "Diabetologia",
issn = "0012-186X",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - Early nerve fibre regeneration in individuals with type 1 diabetes after simultaneous pancreas and kidney transplantation

AU - Azmi, Shazli

AU - Jeziorska, Maria

AU - Ferdousi, Maryam

AU - Petropoulos, Ioannis N.

AU - Ponirakis, Georgios

AU - Marshall, Andrew

AU - Alam, Uazman

AU - Asghar, Omar

AU - Atkinson, Andrew

AU - Jones, Wendy

AU - Boulton, Andrew J.M.

AU - Brines, Michael

AU - Augustine, Titus

AU - Malik, Rayaz

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aims/hypothesis: The study aimed to assess the impact on neuropathy of simultaneous pancreas and kidney transplantation (SPK) in individuals with type 1 diabetes. Methods: This longitudinal observational study examined neuropathic symptoms, deficits, quantitative sensory testing, neurophysiology, corneal confocal microscopy and skin biopsy results in 32 healthy (non-diabetic) control participants, 29 individuals with type 1 diabetes and severe diabetic peripheral neuropathy [DPN] and 36 individuals with type 1 diabetes after SPK. Results: Following SPK, HbA1c, eGFR, triacylglycerols and HDL improved significantly (all p < 0.05). Compared with the DPN group, which remained unchanged over the 36 month study period, corneal confocal microscopy assessments improved over 36 months following SPK, with increasing corneal nerve fibre density of 5/mm2 (95% CI 1.8, 8.2; p = 0.003) and corneal nerve fibre length of 3.2 mm/mm2 (95% CI 0.9, 5.5; p = 0.006). The Neuropathy Symptom Profile and peroneal nerve conduction velocity also improved significantly by 36 months compared with DPN (2.5; 95% CI 0.7, 4.3; p = 0.008 and 4.7 m/s; 95% CI 2.2, 7.4; p = 0.0004, respectively), but with a temporal delay compared with the corneal confocal microscopy assessments. Intraepidermal nerve fibre density did not change following SPK; however, mean dendritic length improved significantly at 12 (p = 0.020) and 36 (p = 0.019) months. In contrast, there were no changes in the Neuropathy Disability Score, quantitative sensory testing or cardiac autonomic function assessments. Except for a small decrease in corneal nerve fibre density in the healthy control group, there were no changes in any other neuropathy measure in the healthy control or DPN groups over 36 months. Conclusions/interpretation: SPK is associated with early and maintained small nerve fibre regeneration in the cornea and skin, followed by an improvement in neuropathic symptoms and peroneal nerve conduction velocity.

AB - Aims/hypothesis: The study aimed to assess the impact on neuropathy of simultaneous pancreas and kidney transplantation (SPK) in individuals with type 1 diabetes. Methods: This longitudinal observational study examined neuropathic symptoms, deficits, quantitative sensory testing, neurophysiology, corneal confocal microscopy and skin biopsy results in 32 healthy (non-diabetic) control participants, 29 individuals with type 1 diabetes and severe diabetic peripheral neuropathy [DPN] and 36 individuals with type 1 diabetes after SPK. Results: Following SPK, HbA1c, eGFR, triacylglycerols and HDL improved significantly (all p < 0.05). Compared with the DPN group, which remained unchanged over the 36 month study period, corneal confocal microscopy assessments improved over 36 months following SPK, with increasing corneal nerve fibre density of 5/mm2 (95% CI 1.8, 8.2; p = 0.003) and corneal nerve fibre length of 3.2 mm/mm2 (95% CI 0.9, 5.5; p = 0.006). The Neuropathy Symptom Profile and peroneal nerve conduction velocity also improved significantly by 36 months compared with DPN (2.5; 95% CI 0.7, 4.3; p = 0.008 and 4.7 m/s; 95% CI 2.2, 7.4; p = 0.0004, respectively), but with a temporal delay compared with the corneal confocal microscopy assessments. Intraepidermal nerve fibre density did not change following SPK; however, mean dendritic length improved significantly at 12 (p = 0.020) and 36 (p = 0.019) months. In contrast, there were no changes in the Neuropathy Disability Score, quantitative sensory testing or cardiac autonomic function assessments. Except for a small decrease in corneal nerve fibre density in the healthy control group, there were no changes in any other neuropathy measure in the healthy control or DPN groups over 36 months. Conclusions/interpretation: SPK is associated with early and maintained small nerve fibre regeneration in the cornea and skin, followed by an improvement in neuropathic symptoms and peroneal nerve conduction velocity.

KW - Corneal confocal microscopy

KW - Diabetic neuropathy

KW - Pancreas and kidney transplantation

KW - Skin biopsy

UR - http://www.scopus.com/inward/record.url?scp=85067240281&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067240281&partnerID=8YFLogxK

U2 - 10.1007/s00125-019-4897-y

DO - 10.1007/s00125-019-4897-y

M3 - Article

AN - SCOPUS:85067240281

JO - Diabetologia

JF - Diabetologia

SN - 0012-186X

ER -