Summary
Nerve biopsies were obtained from 27 patients with diabetic neuropathy. All had a symmetric distal sensory and autonomic neuropathy or a purely sensory neuropathy. Mean age was 39.8 years (range 23–57 years). Two patients had Type 2 (non-insulin-dependent) diabetes mellitus and the remainder Type 1 (insulin-dependent) diabetes. Morphometric observations on endoneurial capillaries were compared with results from organ donor control cases and from patients with type 1 hereditary motor and sensory neuropathy. The area of the lumen of the capillaries did not differ between the three groups. The area occupied by the capillary endothelial cells in transverse section and the number of endothelial cell nuclei were increased both in the patients with diabetic neuropathy and hereditary motor and sensory neuropathy, as was the thickness of the surrounding basal laminal zone. ‘Closure’ of endoneurial capillaries in diabetic neuropathy, reported in another study, was not confirmed. Capillary density and nearest-neighbour distances were similar in the diabetic and organ donor control cases. Capillary density was reduced in the patients with hereditary motor and sensory neuropathy, this being related to increased fascicular area consequent upon the presence of hypertrophic changes. The presence of thickening of the pericapillary basal laminal zone and endothelial cell hyperplasia both in diabetic and hereditary motor and sensory neuropathy, the latter being a neuropathy in which a vascular basis can be discounted, makes it difficult to use such changes as an argument favouring a vascular cause for diabetic neuropathy. There were differences in the basal laminal zone between the diabetic and hereditary motor and sensory neuropathy cases suggesting that the reduplicated basal lamina was more persistent in the diabetic patients.
Article PDF
Similar content being viewed by others
References
Asbury AK, Aldredge H, Hershberg R, Fisher CM (1970) Oculomotor palsy in diabetes mellitus: a clinicopathological study. Brain 93: 555–566
Pryce TD (1893) On diabetic neuritis, with a clinical and pathological description of three cases of diabetic pseudo-tabes. Brain 16: 416–424
Woltman HW, Wilder RM (1929) Diabetes mellitus: pathological changes in the spinal cord and peripheral nerves. Arch Int Med 44: 576–603
Thomas PK, Eliasson SG (1981) Diabetic neuropathy. In: Dyck PJ, Thomas PK, Lambert EH, Bunge R (eds) Peripheral neuropathy, 2nd edn. Saunders, Philadelphia, pp 1773–1810
Low PA, Tuck RR, Dyck PJ, Schmelzer JD, Yao JK (1984) Prevention of some electrophysiologic and biochemical abnormalities with oxygen supplementation in experimental diabetic neuropathy. Proc Natl Acad Sci USA 81: 6894–6898
Tuck RR, Schmelzer JD, Low PA (1984) Endoneurial blood flow and oxygen tension in the sciatic nerve of rats with experimental diabetic neuropathy. Brain 107: 935–950
Dyck PJ, Hansen S, Karnes J, O'Brien P, Yasuda H, Windebank A, Zimmerman B (1985) Capillary number and percentage closed in human diabetic sural nerve. Proc Natl Acad Sci USA 82: 2513–2517
Dyck PJ, Karnes JL, O'Brien P, Okazaki H, Lais A, Engelstad J (1986) The spatial distribution of fiber loss in diabetic polyneuropathy suggests ischemia. Ann Neurol 19: 440–449
Dyck PJ, Lais A, Karnes JL, O'Brien P, Rizza R (1986) Fiber loss is primary and multifocal in sural nerves in diabetic polyneuropathy. Ann Neurol 19: 425–439
Johnson PC, Doll SC, Cromer DW (1986) Pathogenesis of diabetic neuropathy. Ann Neurol 19: 450–457
Korthals JK, Gieron MA, Dyck PJ (1988) Intima of epineurial arterioles is increased in diabetic polyneuropathy. Neurology (Cleveland) 38: 1582–1586
Malik RA, Newrick PG, Sharma AK, Jennings A, Ah-See AK, Mayhew TM, Jakubowski J, Boulton AJM, Ward JD (1989) Microangiopathy in human diabetic neuropathy: relationship between capillary abnormalities and the severity of neuropathy. Diabetologia 32: 92–102
Newrick PG, Wilson AJ, Jakubowski J, Boulton AJ, Ward JD (1986) Sural nerve oxygen tension in diabetes. Br Med J 293: 1053–1054
Powell HC, Rosoff J, Myers RR (1985) Microangiopathy in human diabetic neuropathy. Acta Neuropathol (Berl) 68: 295–305
Sugimura K, Dyck PJ (1982) Multifocal fiber loss in proximal sciatic nerve in symmetric distal diabetic neuropathy. J Neurol Sci 53: 501–509
Yasuda H, Dyck PJ (1987) Abnormalities of endoneurial micro-vessels and sural nerve pathology in diabetic neuropathy. Neurology (Cleveland) 37: 20–28
Harding AE, Thomas PK (1980) The clinical features of hereditary motor and sensory neuropathy, types 1 and 2. Brain 103: 259–280
Baur PS, Stacey TR (1977) The use of PIPES buffer in the fixation of mammalian and marine tissues for electron microscopy. J Microsc 109: 315–327
Bell MA, Weddell AGM (1984) A morphometric study of intrafascicular vessels in mammalian sciatic nerve. Muscle Nerve 7: 524–534
Sievers J (1971) Basic two-dye stains for epoxy-embedded 0.3–1 μm sections. Stain Technol 46: 195–199
Fagerberg SE (1959) Diabetic neuropathy: a clinical and histological study on the significance of vascular affections. Acta Med Scand 164 [Suppl 345]: 1–80
Bischoff A (1967) Die Ultrastruktur peripherer Nerven bei der diabetischen Neuropathie. Verh Dtsch Ges Inn Med 72: 1138–1141
Dolman CL (1963) The morbid anatomy of diabetic neuropathy. Neurology (Minneap) 13: 135–142
Harriman D (1962) Ischaemic factor in diabetic neuropathy. In: 4th Internat Cong Neuropathol 3. Thieme, Stuttgart, p 164
Llewelyn JG, Thomas PK, Gilbey SG, Watkins PJ, Muddle JR (1988) Pattern of myelinated fibre loss in the sural nerve in neuropathy related to Type 1 (insulin-dependent) diabetes. Diabetologia 31: 162–167
Timperley WR, Boulton AJ, Davies-Jones GA, Jarratt JA, Ward JD (1985) Small vessel disease in progressive neuropathy associated with good metabolic control. J Clin Pathol 38: 1030–1038
Behse F, Buchthal F, Carlsen F (1977) Nerve biopsy and nerve conduction studies in diabetic neuropathy. J Neurol Neurosurg Psychiatry 40: 1072–1082
Vital C, Le Blanc M, Vallat JM, Coquet M, Vallat M, Roques JC (1974) Etude ultrastructurale du nerf périphérique chez 16 diabétiques sans neuropathie clinique. Acta Neuropathol (Berl) 30: 63–72
King RHM, Llewelyn JG, Thomas PK, Gilbey SG, Watkins PJ (1989) Diabetic neuropathy: abnormalities of Schwann cell and perineurial basal laminae. Implications for diabetic vasculopathy. Neuropathol Appl Neurobiol 15: 339–355
Gaylarde PM, Fonseca VA, Llewelyn G, Sarkany I, Thomas PK, Dandona P (1988) Transcutaneous oxygen tension in legs and feet of diabetic patients. Diabetes 37: 714–716
Flynn MD, Edmonds ME, Tooke JE, Watkins PJ (1988) Direct measurement of capillary blood flow in the diabetic neuropathic foot. Diabetologia 31: 652–656
Sima AAF, Nathaniel V, Bril V, McEwen TAJ, Greene DA (1988) Histopathological heterogeneity of neuropathy in insulin-dependent and non-insulin-dependent diabetes, and demonstration of axo-glial dysjunction in human diabetic neuropathy. J Clin Invest 81: 349–364
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bradley, J., Thomas, P.K., King, R.H.M. et al. Morphometry of endoneurial capillaries in diabetic sensory and autonomic neuropathy. Diabetologia 33, 611–618 (1990). https://doi.org/10.1007/BF00400205
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF00400205