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Mechanisms of Disease: mitochondria as new therapeutic targets in diabetic neuropathy

Nature Clinical Practice Neurology volume 2, pages 620–628 (2006)Cite this article

Abstract

Diabetic neuropathy (DN) is the most common complication of diabetes mellitus, and it imposes a considerable burden on a patient's quality of life and the health-care system. Despite the prevalence and severity of DN, there are no effective treatments. Pathogenetic evidence suggests that DN is marked by degeneration of dorsal root ganglion (DRG) neurons in peripheral nerves, and that DRG mitochondria are particularly affected. DRG mitochondria are especially vulnerable because they are the origin of reactive oxygen species production in the hyperglycemic neuron. Accumulating evidence indicates that neuronal mitochondria are subject to damage at the level of their DNA, and their outer and inner membranes, and also via deregulation of mitochondrial fission and fusion proteins that control mitochondrial shape and number. This Review will survey the mechanisms of mitochondrial degeneration in the pathogenesis of DN, highlighting potential mitochondrial sites for therapeutic intervention.

Key Points

  • Diabetic neuropathy (DN) results from hyperglycemia-induced damage to the peripheral nervous system, as indicated by loss of Schwann cells, myelinated axons, and a population of sensory neurons located in the dorsal root ganglia

  • Hyperglycemia increases the production and stabilization of reactive oxygen species (ROS) that damage peripheral neurons, particularly at the level of mitochondria

  • ROS might compromise the integrity of the mitochondrial genome, thereby contributing to the mitochondrial dysfunction underlying DN

  • ROS induce local apoptosis in peripheral neurons via actions of caspases and proapoptotic Bcl proteins that damage mitochondria, and ultimately impair neuronal function and viability

  • As recently shown for several hereditary neuropathies, dysregulated mitochondrial fission and fusion might have a pathogenetic role in mitochondrial damage that underlies the neuronal degeneration and functional loss in DN

  • Therapies aimed at preserving mitochondrial structure and function could be beneficial treatments for DN

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Figure 1: Hyperglycemia increases production of reactive oxygen species (ROS) in mitochondria.
Figure 2: Model of hyperglycemia-induced metabolic and apoptotic fission.

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Author information

Authors and Affiliations

  1. postdoctoral fellows, JDRF Center for the Study of Complications in Diabetes and the Program for Understanding Neurological Diseases, all at the University of Michigan, Ann Arbor, MI, USA

    Gina M Leinninger & James L Edwards

  2. student, JDRF Center for the Study of Complications in Diabetes and the Program for Understanding Neurological Diseases, all at the University of Michigan, Ann Arbor, MI, USA

    Matthew J Lipshaw

  3. the Russell N. DeJong Professor of Neurology and director of the student, JDRF Center for the Study of Complications in Diabetes and the Program for Understanding Neurological Diseases, all at the University of Michigan, Ann Arbor, MI, USA

    Eva L Feldman

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  1. Gina M Leinninger
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  4. Eva L Feldman
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Correspondence to Eva L Feldman.

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Leinninger, G., Edwards, J., Lipshaw, M. et al. Mechanisms of Disease: mitochondria as new therapeutic targets in diabetic neuropathy. Nat Rev Neurol 2, 620–628 (2006). https://doi.org/10.1038/ncpneuro0320

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