Increased Langerhan cell density and corneal nerve damage in diabetic patients : role of immune mechanisms in human diabetic neuropathy

Tavakoli, Mitra, Boulton, Andrew J., Efron, Nathan, & Malik, Rayaz A. (2011) Increased Langerhan cell density and corneal nerve damage in diabetic patients : role of immune mechanisms in human diabetic neuropathy. Contact Lens and Anterior Eye, 34(1), pp. 7-11.

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Abstract

Aim/hypothesis

Immune mechanisms have been proposed to play a role in the development of diabetic neuropathy. We employed in vivo corneal confocal microscopy (CCM) to quantify the presence and density of Langerhans cells (LCs) in relation to the extent of corneal nerve damage in Bowman's layer of the cornea in diabetic patients.

Methods

128 diabetic patients aged 58±1 yrs with a differing severity of neuropathy based on Neuropathy Deficit Score (NDS—4.7±0.28) and 26 control subjects aged 53±3 yrs were examined. Subjects underwent a full neurological evaluation, evaluation of corneal sensation with non-contact corneal aesthesiometry (NCCA) and corneal nerve morphology using corneal confocal microscopy (CCM).

Results

The proportion of individuals with LCs was significantly increased in diabetic patients (73.8%) compared to control subjects (46.1%), P=0.001. Furthermore, LC density (no/mm2) was significantly increased in diabetic patients (17.73±1.45) compared to control subjects (6.94±1.58), P=0.001 and there was a significant correlation with age (r=0.162, P=0.047) and severity of neuropathy (r=−0.202, P=0.02). There was a progressive decrease in corneal sensation with increasing severity of neuropathy assessed using NDS in the diabetic patients (r=0.414, P=0.000). Corneal nerve fibre density (P<0.001), branch density (P<0.001) and length (P<0.001) were significantly decreased whilst tortuosity (P<0.01) was increased in diabetic patients with increasing severity of diabetic neuropathy.

Conclusion

Utilising in vivo corneal confocal microscopy we have demonstrated increased LCs in diabetic patients particularly in the earlier phases of corneal nerve damage suggestive of an immune mediated contribution to corneal nerve damage in diabetes.

Impact and interest:

21 citations in Scopus
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15 citations in Web of Science®

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ID Code: 39402
Item Type: Journal Article
Refereed: Yes
Keywords: Langerhans cells, Corneal confocal microscopy, Diabetic neuropathy
DOI: 10.1016/j.clae.2010.08.007
ISSN: 1367-0484
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Optometry & Vision Science
Copyright Owner: Copyright 2011 Elsevier
Copyright Statement: This is the author’s version of a work that was accepted for publication in Contact Lens and Anterior Eye. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Contact Lens and Anterior Eye, [VOL 34, ISSUE 1, (2011)] DOI: 10.1016/j.clae.2010.08.007
Deposited On: 06 Jan 2011 00:31
Last Modified: 04 Nov 2013 01:19

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