Michael Fleischer1, Inn Lee2, Friedrich Erdlenbruch1, Lena Hinrichs3, Ioannis N Petropoulos4,5, Rayaz A Malik4,5, Hans-Peter Hartung2,6,7,8, Bernd C Kieseier2, Christoph Kleinschnitz1, Mark Stettner9. 1. Department of Neurology and Center for Translational and Behavioral Neurosciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany. 2. Department of Neurology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany. 3. Department of Cardiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany. 4. Institute of Cardiovascular Science, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK. 5. Weill Cornell Medicine-Qatar, Educator City, Doha, Qatar. 6. Brain and Mind Centre, University of Sydney, Sydney, Australia. 7. Medical University Vienna, Vienna, Austria. 8. Department of Neurology, Palacky University, Olomouc, Czech Republic. 9. Department of Neurology and Center for Translational and Behavioral Neurosciences (C-TNBS), University Hospital Essen, University Duisburg-Essen, Essen, Germany. mark.stettner@uk-essen.de.
Abstract
BACKGROUND: Immune-mediated neuropathies, such as chronic inflammatory demyelinating polyneuropathy (CIDP) are treatable neuropathies. Among individuals with diabetic neuropathy, it remains a challenge to identify those individuals who develop CIDP. Corneal confocal microscopy (CCM) has been shown to detect corneal nerve fiber loss and cellular infiltrates in the sub-basal layer of the cornea. The objective of the study was to determine whether CCM can distinguish diabetic neuropathy from CIDP and whether CCM can detect CIDP in persons with coexisting diabetes. METHODS: In this multicenter, case-control study, participants with CIDP (n = 55) with (n = 10) and without (n = 45) diabetes; participants with diabetes (n = 58) with (n = 28) and without (n = 30) diabetic neuropathy, and healthy controls (n = 58) underwent CCM. Corneal nerve fiber density (CNFD), corneal nerve fiber length (CNFL), corneal nerve branch density (CNBD), and dendritic and non-dendritic cell density, with or without nerve fiber contact were quantified. RESULTS: Dendritic cell density in proximity to corneal nerve fibers was significantly higher in participants with CIDP with and without diabetes compared to participants with diabetic neuropathy and controls. CNFD, CNFL, and CNBD were equally reduced in participants with CIDP, diabetic neuropathy, and CIDP with diabetes. CONCLUSIONS: An increase in dendritic cell density identifies persons with CIDP. CCM may, therefore, be useful to differentiate inflammatory from non-inflammatory diabetic neuropathy.
BACKGROUND: Immune-mediated neuropathies, such as chronic inflammatory demyelinating polyneuropathy (CIDP) are treatable neuropathies. Among individuals with diabetic neuropathy, it remains a challenge to identify those individuals who develop CIDP. Corneal confocal microscopy (CCM) has been shown to detect corneal nerve fiber loss and cellular infiltrates in the sub-basal layer of the cornea. The objective of the study was to determine whether CCM can distinguish diabetic neuropathy from CIDP and whether CCM can detect CIDP in persons with coexisting diabetes. METHODS: In this multicenter, case-control study, participants with CIDP (n = 55) with (n = 10) and without (n = 45) diabetes; participants with diabetes (n = 58) with (n = 28) and without (n = 30) diabetic neuropathy, and healthy controls (n = 58) underwent CCM. Corneal nerve fiber density (CNFD), corneal nerve fiber length (CNFL), corneal nerve branch density (CNBD), and dendritic and non-dendritic cell density, with or without nerve fiber contact were quantified. RESULTS: Dendritic cell density in proximity to corneal nerve fibers was significantly higher in participants with CIDP with and without diabetes compared to participants with diabetic neuropathy and controls. CNFD, CNFL, and CNBD were equally reduced in participants with CIDP, diabetic neuropathy, and CIDP with diabetes. CONCLUSIONS: An increase in dendritic cell density identifies persons with CIDP. CCM may, therefore, be useful to differentiate inflammatory from non-inflammatory diabetic neuropathy.
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