Accelerated diabetic neuropathy in axons without neurofilaments

Diabetic neuropathy is characterized by slowing of conduction velocity and axonal atrophy. Both of these cardinal features of neuropathy might be linked to impaired neurofilament investment of axons. Since neurofilaments form the critical structural latticework of axons, their importance in neuropathy is of interest. We tested directly the relationship of neurofilaments to diabetic neuropathy by superimposing streptozotocin-generated diabetes on a unique but viable transgenic mouse described by Eyer and Peterson. These mice express a fusion protein in which the carboxyl terminus of the high molecular weight neurofilament protein (Nf-H) was replaced by beta-galactosidase, in turn blocking normal neurofilament export and rendering axons completely lacking neurofilaments. Despite similar levels of hyperglycaemia, diabetic mice lacking neurofilaments developed progressive slowing of conduction velocity in their motor and sensory fibres between 4 and 8 weeks after the onset of diabetes (P < 0.05), unlike diabetic mice with normal neurofilaments, who developed only mild evidence of neuropathy over the same time-frame. Diabetic mice without neurofilaments, but not those with neurofilaments, had a progressive decline in the amplitude of the caudal nerve compound action potential and there were trends toward increased axonal atrophy in diabetics lacking neurofilaments. Single daily doses of insulin that restored normoglycaemia (0.1 IU subcutaneous insulin daily 5 of 7 days weekly for 4 weeks) reversed conduction slowing and restored sensory axon calibre. Our findings indicate that abnormalities in neurofilament export or transport alone cannot account for features of diabetic neuropathy. Instead, neurofilaments may allow axons to better resist the ravages of diabetes. Our findings also confirm the impact of insulin on reversing the phenotype.