Highlights
- •In-vivo reflectance confocal microscopy (RCM) can non-invasively image skin.
- •RCM of glabrous skin enables quantification of Meissner's corpuscle (MC) density.
- •MC density via RCM is an objective marker of early sensory involvement in diabetes.
Abstract
Objective
To evaluate in-vivo reflectance confocal microscopy (RCM) of Meissner's corpuscles
(MC) in diabetic distal symmetric polyneuropathy (DSP).
Methods
Forty-three adults with diabetes and 21 control subjects underwent RCM of MC density
at the fingertip of digit V, thenar eminence (TE), and arch of the foot, ankle skin
biopsy for epidermal nerve fiber density (ENFD), electrophysiological studies, monofilament
threshold testing, and timed vibration at the toe. Subjects with diabetes were subdivided
into groups with and without clinical DSP using the American Academy of Neurology
(AAN) case definition and neuropathy outcomes were compared across groups.
Results
Both diabetic groups (with and without AAN clinical DSP criteria) had objective evidence
of peripheral sensory involvement using conventional sensory measures, although those
with clinical DSP criteria had greater abnormalities. MC densities were lower in the
entire diabetic group at the TE and digit V relative to controls. MC densities at
all imaging sites were associated with corresponding conventional sensory measures.
MC densities were reduced in subjects without AAN clinical DSP criteria at the TE
and digit V compared to controls whereas conventional upper limb sensory measures
did not differ between these groups.
Conclusions
In-vivo RCM of MC density at digit V is a non-invasive, painless, objective marker
in diabetes that offers a window into early large fiber sensory nerve terminal loss.
Further studies are needed to determine whether RCM of MCs can identify quantitative
changes in DSP associated with disease progression or treatment.
Abbreviations:
AAN (American Academy of Neurology), AMP (amplitude), ANCOVA (analysis of covariance), CMAP (compound motor action potential), CMT (Charcot-Marie-Tooth), CTSA (Clinical and Translational Science Award), CV (conduction velocity), ENFD (epidermal nerve fiber density), ICC (intraclass correlation coefficient), JDRF (Juvenile Diabetes Research Foundation), MC (Meissner's corpuscle), MDNS (Michigan Diabetic Neuropathy Score), MF (monofilament), NAP (nerve action potential), NCS (nerve conduction studies), RCM (reflectance confocal microscopy), SNAP (sensory nerve action potential), TE (thenar eminence)Keywords
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Article info
Publication history
Published online: May 12, 2017
Accepted:
May 11,
2017
Received in revised form:
April 19,
2017
Received:
December 20,
2016
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
