Journal of the Neurological Sciences

1999

DOI: 10.1016/s0022-510x(98)00303-7

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Endoneurial microvascular abnormalities of sural nerve in non-diabetic chronic atherosclerotic occlusive disease

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André M. van Rij

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et al.

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Microangiopathy In Sural Nerve Biopsies From Patients With O1

Introduction1

Structural Changes Of Microvessels1

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Cited by 7 publications

(7 citation statements)

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“…Similar changes have been shown in patients with atherosclerotic peripheral vascular disease without diabetes ( 49 ). McKenzie et al showed increased endothelial cell area, as well as periendothelial cell area (including pericyte cells and basement membranes), and reduced lumen area in sural nerves from nine severely ischemic amputated legs in non-diabetic patients with chronic peripheral vascular disease and neuropathy compared to four controls ( 49 ).…”

Section: Microangiopathy In Sural Nerve Biopsies From Patients With Osupporting

confidence: 84%

Microangiopathy—A Potential Contributing Factor to Idiopathic Polyneuropathy: A Mini Review

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2018

Front. Neurol.

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Chronic idiopathic axonal polyneuropathy (CIAP) is a slowly progressive predominantly sensory axonal polyneuropathy. The prevalence of CIAP increases with age. The pathogenic cause of CIAP is unknown although there are several prevailing etiological hypotheses. In this mini review, we focus on the hypothesis of disturbed microcirculation in the vasa nervorum of peripheral nerves as a pathogenic cause of CIAP. There is an association between CIAP and metabolic risk factors. Furthermore, the phenotype of CIAP resembles diabetic neuropathy both clinically and electrophysiologically. In sural nerve biopsies from patients with diabetes mellitus, structural abnormalities indicating microangiopathy in the endoneurial microvessels are well documented. Similarly, sural microvessel abnormalities have been shown in patients with atherosclerotic non-diabetic peripheral vascular disease. However, the reported histopathological alterations of microvasculature in sural nerves of CIAP patients are inconsistent. Two studies report microangiopathic changes in CIAP sural nerves comparable with those found in patients with diabetic neuropathy. Conversely, another recent study showed no significant differences in the microangiopathic parameters in the endoneurial microvessels in the sural nerve biopsies from CIAP patients compared to controls without polyneuropathy. However, this CIAP patient group was younger compared to the patient groups in the other two studies. A general limitation with the published morphological studies are that different methods have been used in the assessment of microangiopathy, and there is also a risk of subjectivity in the results. Immunohistochemistry studies of sural nerves with verification of microangiopathy using specific biomarkers would be of great interest to develop.

“…Similar changes have been shown in patients with atherosclerotic peripheral vascular disease without diabetes ( 49 ). McKenzie et al showed increased endothelial cell area, as well as periendothelial cell area (including pericyte cells and basement membranes), and reduced lumen area in sural nerves from nine severely ischemic amputated legs in non-diabetic patients with chronic peripheral vascular disease and neuropathy compared to four controls ( 49 ).…”

Section: Microangiopathy In Sural Nerve Biopsies From Patients With Osupporting

confidence: 84%

Microangiopathy—A Potential Contributing Factor to Idiopathic Polyneuropathy: A Mini Review

¹

2018

Front. Neurol.

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Chronic idiopathic axonal polyneuropathy (CIAP) is a slowly progressive predominantly sensory axonal polyneuropathy. The prevalence of CIAP increases with age. The pathogenic cause of CIAP is unknown although there are several prevailing etiological hypotheses. In this mini review, we focus on the hypothesis of disturbed microcirculation in the vasa nervorum of peripheral nerves as a pathogenic cause of CIAP. There is an association between CIAP and metabolic risk factors. Furthermore, the phenotype of CIAP resembles diabetic neuropathy both clinically and electrophysiologically. In sural nerve biopsies from patients with diabetes mellitus, structural abnormalities indicating microangiopathy in the endoneurial microvessels are well documented. Similarly, sural microvessel abnormalities have been shown in patients with atherosclerotic non-diabetic peripheral vascular disease. However, the reported histopathological alterations of microvasculature in sural nerves of CIAP patients are inconsistent. Two studies report microangiopathic changes in CIAP sural nerves comparable with those found in patients with diabetic neuropathy. Conversely, another recent study showed no significant differences in the microangiopathic parameters in the endoneurial microvessels in the sural nerve biopsies from CIAP patients compared to controls without polyneuropathy. However, this CIAP patient group was younger compared to the patient groups in the other two studies. A general limitation with the published morphological studies are that different methods have been used in the assessment of microangiopathy, and there is also a risk of subjectivity in the results. Immunohistochemistry studies of sural nerves with verification of microangiopathy using specific biomarkers would be of great interest to develop.

“…Structural abnormalities in the endoneurial microvessels indicating microangiopathy, such as increased basal membrane area or basal lamina area thickness (BLAT), reduced lumen area, increased endothelial cell area, increased number of endothelial cell nuclei with increased basal lamina area as the most consistent finding, are well documented in sural nerve biopsies from patients with diabetes mellitus [ 20 – 24 ]. Similar changes have been shown in patients with atherosclerotic peripheral vascular disease without diabetes as an indication of attribution of chronic ischemia for the pathogenesis of the structural abnormalities [ 25 ]. Patients with CIAP and diabetic neuropathy share several clinical and electrophysiological hallmarks, so it is perceivable that microangiopathy could be the main cause of axonal damage even in CIAP.…”

Section: Introductionsupporting

confidence: 74%

Study of Autophagy and Microangiopathy in Sural Nerves of Patients with Chronic Idiopathic Axonal Polyneuropathy

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et al. 2016

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Twenty-five percent of polyneuropathies are idiopathic. Microangiopathy has been suggested to be a possible pathogenic cause of chronic idiopathic axonal polyneuropathy (CIAP). Dysfunction of the autophagy pathway has been implicated as a marker of neurodegeneration in the central nervous system, but the autophagy process is not explored in the peripheral nervous system. In the current study, we examined the presence of microangiopathy and autophagy-related structures in sural nerve biopsies of 10 patients with CIAP, 11 controls with inflammatory neuropathy and 10 controls without sensory polyneuropathy. We did not find any significant difference in endoneurial microangiopathic markers in patients with CIAP compared to normal controls, though we did find a correlation between basal lamina area thickness and age. Unexpectedly, we found a significantly larger basal lamina area thickness in patients with vasculitic neuropathy. Furthermore, we found a significantly higher density of endoneurial autophagy-related structures, particularly in patients with CIAP but also in patients with inflammatory neuropathy, compared to normal controls. It is unclear if the alteration in the autophagy pathway is a consequence or a cause of the neuropathy. Our results do not support the hypothesis that CIAP is primarily caused by a microangiopathic process in endoneurial blood vessels in peripheral nerves. The significantly higher density of autophagy structures in sural nerves obtained from patients with CIAP and inflammatory neuropathy vs. controls indicates the involvement of this pathway in neuropathy, particularly in CIAP, since the increase in density of autophagy-related structures was more pronounced in patients with CIAP than those with inflammatory neuropathy. To our knowledge this is the first report investigating signs of autophagy process in peripheral nerves in patients with CIAP and inflammatory neuropathy.

“…Capillary basement membrane thickening is widespread in diabetic neuropathy, although mild reduplication of basement membrane has been found with aging (McKenzie et al, 1999). These changes may lead to occlusive angiopathy and to tissue hypoxia and damage.…”

Section: Structural Changes Of Microvesselsmentioning

confidence: 99%

Ischemia and diabetic neuropathy

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2014

Handbook of Clinical Neurology

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