Neuroprotective Effects of Choline Alfoscerate in Experimental Diabetic Peripheral Neuropathy

Background/Objectives: Diabetic peripheral neuropathy (DPN) is a common and debilitating complication of diabetes mellitus characterized by progressive nerve degeneration and chronic neuropathic pain. Current therapies, including pregabalin, primarily provide symptomatic pain relief and have limited effects on preventing structural nerve damage. Therefore, the development of disease-modifying therapies remains an important unmet clinical need. This study investigated the neuroprotective effects of choline alfoscerate (CA) and its ability to attenuate mechanical hypersensitivity in a streptozotocin (STZ)-induced rat model of DPN. Methods: Diabetes was induced in rats using STZ, and administration protocols were optimized to establish sustained hyperglycemia while minimizing mortality. CA treatment was initiated immediately after STZ administration and continued throughout the study period. Mechanical sensitivity was assessed using the von Frey test. Histopathological examination of sciatic nerves was performed to evaluate structural alterations, and serum biochemical and lipid parameters were analyzed to assess systemic metabolic changes. Results: STZ-treated diabetic rats developed persistent hyperglycemia, mechanical allodynia, elevated serum triglyceride levels, and marked structural deterioration of sciatic nerve fascicles. CA treatment significantly increased paw withdrawal thresholds despite sustained hyperglycemia, indicating attenuation of mechanical hypersensitivity independent of glycemic control. Histopathological evaluation demonstrated reduced nerve fiber degeneration, attenuation of edema-like changes, and preservation of sciatic nerve architecture in CA-treated animals. In addition, CA significantly reduced serum triglyceride levels compared with diabetic controls. Conclusions: CA attenuated mechanical hypersensitivity and exerted neuroprotective effects in STZ-induced diabetic rats. These benefits occurred independently of glucose lowering and were accompanied by improvements in nerve morphology and lipid metabolism. The findings suggest that CA may represent a promising therapeutic candidate for preserving peripheral nerve integrity and attenuating neuropathic progression in diabetic peripheral neuropathy.