Severe radicular pathology in rats with longstanding diabetes

There few pathological abnormalities in nerves from animals with diabetes. Reported changes consist of mild distal axonal atrophy, axoglial disjunction and minimal segmental demyelination and remyelination. These changes are seen in distal nerves but no studies of radicular pathology in diabetic animals have been reported. We therefore studied peripheral nerve and radicular pathology in rats with longstanding, severe, chemically-induced diabetes. We found marked interstitial edema and severe changes of myelin in the roots of diabetic rats, particularly in the dorsal root. The earliest changes consist of myelin splitting, occurring at the intraperiod line. This progresses to myelin ballooning, accompanied by both tubulovescicular myelin degeneration and macrophage stripping, all of which tend to predominate in large myelinated fibers. There is minimal axonal degeneration. Despite these severe changes in nerve roots, the distal peripheral nerves show no discernible edema and only minimal myelin splitting without demyelination or axonal degeneration. The radicular changes are almost identical to those seen in much older nondiabetic animals. This suggests that they may represent an acceleration of the normal aging process, perhaps related to increased glycation of myelin proteins induced by accumulation of glucose rich interstitial endoneurial edema.