Metabolic and Non-Metabolic Peripheral Neuropathy: Is there a Place for Therapeutic Apheresis?

Abstract

As the rate of obesity and the incidence of diabetes mellitus have been increasing, diabetic neuropathy has become the most common cause of peripheral neuropathy in developed countries. In addition, a variety of pathogenetically heterogeneous disorders can lead to impairment of the peripheral nervous system including amyloidosis, vitamin deficiencies, uremia and lipid disorders, alcohol abuse, autoimmune and infectious diseases as well as exposure to environmental toxins. We have noted that a combination of these disorders may aggravate the manifestations of peripheral diabetic neuropathy, an effect, which is most pronounced when metabolic and non-metabolic pathologies lead to cumulative damage. Current treatment options are limited and generally have unsatisfactory results in most patients. Therapeutic apheresis (INUSpherese®) allows the removal of metabolic, inflammatory, immunologic and environmental contributors to the disease process and may be an effective treatment option. We reviewed the developments in therapeutic apheresis for metabolic and non-metabolic peripheral neuropathy, including the current literature as well as data from our university diabetes center.

Effects of Tang Luo Ning on diabetic peripheral neuropathy in rats revealed by LC–MS metabolomics approach

“…The pathogenesis of DPN is related to long-term serious hyperglycemia and resulting metabolic disorders (Straube et al, 2019), microcirculation abnormalities (Samuelsson & Press, 2018), neurotrophic factor deficiency (Zhou et al, 2015), oxidative stress damage T A B L E 1 Parameters of the PCA and OPLS-DA models Intercept of Q2 was lower than 0.05, showing that the OPLS-DA model was valid (Kapucu, 2021), autoimmune disorders (Maekawa et al, 2019), and genetic genes (Vujkovic et al, 2020). At present, the pathogenesis of DPN mainly includes the polyol pathway, glycosylation end product pathway, protein kinase C pathway, hexosamine pathway, oxidative stress (Simeoli & Fierabracci, 2019), and endoplasmic reticulum stress (An et al, 2021).…”

Is There a Role for Environmental and Metabolic Factors Predisposing to Severe COVID-19?

“…Environmental apheresis ® is therefore useful to improve parameters of metabolic inflammation and hyperlipidemia, which have been shown to be major risk factors for the development of severe Coronavirus disease 2019. Furthermore, it has been shown to improve neuroinflammation and polyneuropathy [73,77]. Thus, the removal and reduction of environmental pollutants together with the reduction of lipids and inflammatory factors may provide a protective mechanism for prevention and mitigation of severe corona virus infections.…”

Acute Statin Administration Reduces Levels of Steroid Hormone Precursors

“…The potential interference of statins (HMG-CoA inhibitors) in steroidogenesis has been hypothesized since their discovery, but previous studies have been inconclusive about their effect on cortisol production [5][6][7]. Most reported studies focused on the established effects of statins after at least two-week administration; statins are used for their lipid-lowering and other effects in patients with coronary artery disease and diabetes [8,9], and several side effects have been noted [10][11][12][13][14][15]. We designed a small-scale study in a cohort of individuals not taking statins and in mice to test the hypothesis that statins could elicit acute changes in the steroidogenic pathway of the adrenal cortex.…”