Mittal Rahul, McKenna Keelin, Keith Grant, McKenna Evan, Sinha Rahul, Lemos Joana R N, Hirani Khemraj
Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, Florida, United States of America.
Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America.
PLoS One. 2024 Aug 8;19(8):e0308556. doi: 10.1371/journal.pone.0308556. eCollection 2024.
Diabetic Peripheral Neuropathy (DPN) is a prevalent and debilitating complication of diabetes, affecting a significant proportion of the diabetic population. Neuromodulation, an emerging therapeutic approach, has shown promise in the management of DPN symptoms. This systematic review aims to synthesize and analyze the current advancements in neuromodulation techniques for the treatment of DPN utilizing studies with preclinical animal models. A comprehensive search was conducted across multiple databases, including PubMed, Scopus, and Web of Science. Inclusion criteria were focused on studies utilizing preclinical animal models for DPN that investigated the efficacy of various neuromodulation techniques, such as spinal cord stimulation, transcranial magnetic stimulation, and peripheral nerve stimulation. The findings suggest that neuromodulation significantly alleviated pain symptoms associated with DPN. Moreover, some studies reported improvements in nerve conduction velocity and reduction in nerve damage. The mechanisms underlying these effects appeared to involve modulation of pain pathways and enhancement of neurotrophic factors. However, the review also highlights the variability in methodology and stimulation parameters across studies, highlighting the need for standardization in future research. Additionally, while the results are promising, the translation of these findings from animal models to human clinical practice requires careful consideration. This review concludes that neuromodulation presents a potentially effective therapeutic strategy for DPN, but further research is necessary to optimize protocols and understand the underlying molecular mechanisms. It also emphasizes the importance of bridging the gap between preclinical findings and clinical applications to improve the management of DPN in diabetic patients.
糖尿病周围神经病变（DPN）是糖尿病常见且使人衰弱的并发症，影响着相当一部分糖尿病患者。神经调节作为一种新兴的治疗方法，已在DPN症状管理方面显示出前景。本系统评价旨在综合和分析利用临床前动物模型研究的神经调节技术在治疗DPN方面的当前进展。在多个数据库中进行了全面检索，包括PubMed、Scopus和Web of Science。纳入标准集中于利用DPN临床前动物模型研究各种神经调节技术（如脊髓刺激、经颅磁刺激和周围神经刺激）疗效的研究。研究结果表明，神经调节可显著减轻与DPN相关的疼痛症状。此外，一些研究报告了神经传导速度的改善和神经损伤的减轻。这些效应的潜在机制似乎涉及疼痛通路的调节和神经营养因子的增强。然而，该评价也强调了各研究在方法学和刺激参数方面的差异，凸显了未来研究中标准化的必要性。此外，虽然结果很有前景，但将这些发现从动物模型转化为人类临床实践需要仔细考虑。本评价得出结论，神经调节为DPN提供了一种潜在有效的治疗策略，但需要进一步研究以优化方案并了解潜在的分子机制。它还强调了弥合临床前研究结果与临床应用之间差距对于改善糖尿病患者DPN管理的重要性。
