Molecular and pathological studies in the posterior interosseous nerve of diabetic and non-diabetic patients with carpal tunnel syndrome

Moaz A. Mojaddidi, Mohammed S. Ahmed, Razwan Ali, Maria Jeziorska, Ahmed Al-Sunni, Niels O B Thomsen, Lars B. Dahlin, Rayaz Malik

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Aims/hypothesis: We sought to establish the molecular and pathological changes predisposing diabetic and non-diabetic patients to the development of carpal tunnel syndrome (CTS). Methods: The posterior interosseous nerve (PIN) was biopsied in 25 diabetic and 19 non-diabetic patients undergoing carpal tunnel decompression for CTS. Detailed morphometric and immunohistological analyses were performed in the nerve biopsy. Results: In diabetic patients median nerve distal motor latency was prolonged (p<0.05 vs non-diabetic patients), PIN myelinated fibre density (p<0.05), fibre area (p<0.0001) and axon area (p<0.0001) were reduced, the percentage of unassociated Schwann cell profiles (p<0.0001) and unmyelinated axon density (p<0.0001) were increased and the axon diameter was reduced (p<0.0001). Endoneurial capillary basement membrane area was increased (p<0.0001) in diabetic patients, but endothelial cell number was increased (p<0.01) and luminal area was reduced (p<0.05) in non-diabetic patients with CTS. There was no difference in the expression of hypoxia-inducible factor 1α between diabetic and non-diabetic patients with CTS. However, the expression of vascular endothelial growth factor A (VEGF) (p<0.05) and its receptors VEGFR-1 (p<0.01) and VEGFR-2 (p<0.05) was significantly increased in diabetic patients, particularly those with type 1 diabetes, and related to the severity of nerve fibre pathology. Conclusions/interpretation: This study demonstrates increased nerve fibre and microvascular pathology in relation to enhanced expression of VEGF and its receptors in a non-compressed nerve in diabetic compared with non-diabetic patients with CTS. It therefore provides a potential molecular and pathological basis for the predisposition of diabetic patients to the development of CTS.

Original languageEnglish
Pages (from-to)1711-1719
Number of pages9
JournalDiabetologia
Volume57
Issue number8
DOIs
Publication statusPublished - 2014

Fingerprint

Carpal Tunnel Syndrome
Axons
Nerve Fibers
Vascular Endothelial Growth Factor A
Pathology
Vascular Endothelial Growth Factor Receptor-1
Myelinated Nerve Fibers
Hypoxia-Inducible Factor 1
Vascular Endothelial Growth Factor Receptor-2
Median Nerve
Schwann Cells
Decompression
Wrist
Type 1 Diabetes Mellitus
Basement Membrane
Endothelial Cells
Cell Count
Biopsy

Keywords

  • Carpal tunnel syndrome
  • Diabetes
  • HIF-1α
  • Microangiopathy
  • Myelinated fibre
  • Neuropathy
  • Unmyelinated fibre
  • VEGF

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Molecular and pathological studies in the posterior interosseous nerve of diabetic and non-diabetic patients with carpal tunnel syndrome. / Mojaddidi, Moaz A.; Ahmed, Mohammed S.; Ali, Razwan; Jeziorska, Maria; Al-Sunni, Ahmed; Thomsen, Niels O B; Dahlin, Lars B.; Malik, Rayaz.

In: Diabetologia, Vol. 57, No. 8, 2014, p. 1711-1719.

Research output: Contribution to journalArticle

Mojaddidi, Moaz A. ; Ahmed, Mohammed S. ; Ali, Razwan ; Jeziorska, Maria ; Al-Sunni, Ahmed ; Thomsen, Niels O B ; Dahlin, Lars B. ; Malik, Rayaz. / Molecular and pathological studies in the posterior interosseous nerve of diabetic and non-diabetic patients with carpal tunnel syndrome. In: Diabetologia. 2014 ; Vol. 57, No. 8. pp. 1711-1719.
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AU - Mojaddidi, Moaz A.

AU - Ahmed, Mohammed S.

AU - Ali, Razwan

AU - Jeziorska, Maria

AU - Al-Sunni, Ahmed

AU - Thomsen, Niels O B

AU - Dahlin, Lars B.

AU - Malik, Rayaz

PY - 2014

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KW - HIF-1α

KW - Microangiopathy

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KW - Neuropathy

KW - Unmyelinated fibre

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