DIAMARK

Sensory and Biomechanical Markers in Diabetic Neuropathy of the Gut. Basic Investigations and New Approaches for Treatment

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 Obiettivo del progetto (Objective)

'DIAMARK is focused on analysing the pathophysiology of diabetic neuropathy and to determine better biomarkers of the complications and approaches for intervention. Due to lack of standardisation, there are no accepted biomarkers to evaluate the neuropathy and its involvement in the GI tract. Diabetes mellitus (DM) is one of the most common endocrine disorders affecting almost 6% (app. 246 million people) worldwide (http://www.idf.org). DM is a chronic disease requiring lifelong attention in order to limit the development of potentially devastating complications and to manage them if they occur. Gastrointestinal (GI) disorders are common and closely associated with autonomic neuropathy. Several studies addressed the visceral sensory function in DM and demonstrated abnormalities in perception thresholds, vagal tone and evoked brain potentials in patients with autonomic neuropathy. Thus, DM-related changes may be located in the enteric, the peripheral and in the CNS. Several clinical, neurophysiological and biochemical test for neuropathy have been proposed but they are not reliable and valid. This makes is crucial to develop better biomarkers for GI neuropathy and associated complications, to test the reliability and validity under controlled circumstances using advanced multimodal methods and to follow the biomarkers during new treatments. This proposal aims at determining new biomarkers related to the enteric nervous system (response to stimulation), peripheral nerves (recordings from visceral nerves) and central nervous system (evoked brain potentials and computation of the brain sources activated). After reliability testing under controlled circumstances in the laboratory and the clinic, the validity of the biomarkers will be followed during the most promising new treatments with gastric pacing and bypass surgery. The highly skilled academic and industrial partners of the consortium are selected based on their work on various aspects of the proposed framework.'

Introduzione (Teaser)

One of the most common endocrine disorders, diabetes mellitus, is a chronic disease affecting some 246 million people worldwide. Gastrointestinal disorders commonly affect diabetes mellitus sufferers; it therefore seems likely that related changes can be traced to the enteric and peripheral and central nervous systems.

Descrizione progetto (Article)

Autonomic neuropathy, a set of symptoms presenting when there has been damage to the nerves managing everyday bodily functions, can affect blood pressure, bowel and bladder emptying, digestion and heart rate. Despite the existence of various tests for neuropathy, these are neither reliable nor valid, and lack of standardisation poses a problem.

This shortcoming highlights the need to develop better biomarkers for gastrointestinal neuropathy and related complications. Also, reliability and validity must be tested under controlled conditions, and improved multimodal methods and biomarkers must be followed during new treatments.

The 'Sensory and biomechanical markers in diabetic neuropathy of the gut. Basic investigations and new approaches for treatment' (Diamark) project has set out to identify new biomarkers for autonomic neuropathy so as to better predict the effects of gastric pacing in diabetic patients. Gastric pacing to treat morbid obesity uses an external pacemaker device and wires to penetrate gastric tissue and stimulate the cells, in order to facilitate gastric emptying.

Initial work in this EU-funded project concentrated on developing and validating methods, with new probes being developed to deliver electrical stimulations in the oesophagus. The probes were tested in various experiments to reveal the most reliable and robust method.

Researchers have also worked to evaluate the brain-gut axis with a range of imaging and neurophysiologic methods. Recording techniques for an electroencephalography (EEG) system has been optimised and algorithms for inverse modelling and classification of EEG traces have been successfully implemented. Two sets of experiments have been conducted to validate methods, with initial results showing the methods to be reliable and robust.

Diamark scientists are continuing to complete experimental protocol and assess test results.