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Cardiac Sympathetic Neuropathy and Effects of Aldose Reductase Inhibitor in Streptozotocin-Induced Diabetic Rats

Department of Medicine III, Hamamatsu University School of Medicine
Department of Medicine, Hamamatsu Red Cross Hospital, Hamamatsu, Japan

Correspondence: For correspondence or reprints contact: Chinori Kurata, MD, Department of Medicine III, Hamamatsu University School of Medicine, 3600 Handa-cho, Hamamatsu 431-31, Japan.

ABSTRACT

Cardiac autonomic neuropathy can be a cause of sudden death in patients with diabetes mellitus. Clinical evaluation methods for diabetic cardiac sympathetic neuropathy have not been established. Using ¹²⁵I-metaiodobenzylguanidine (MIBG) and streptozotocin (STZ)-induced diabetic rats, we evaluated cardiac sympathetic neuropathy and the effects of aidose reductase inhibitor (ARI). Methods: Myocardial MIBG uptake was measured 4 hr after injection in the following groups: control rats, rats treated with insulin or ARI (epalrestat, 100 mg/kg/day) from immediately to 4 wk after STZ injection and rats treated wfth insulin or ARt from 4–8 wk. Myocardial MIBG distribution and norepinephrine content were evaluated in the control and diabetic rats with or without ARI therapy started immediately after STZ injection. Results: Myocardial MIBG uptake was significantly lower in diabetic rats than in control rats; the reduction was marked in the subendocardial myocardium. Myocardiel norepinephrine content was increased significantly in diabetic rats compared with control rats. Decreased MIBG uptake and increased norepinephrine content in diabetic myocardium were completely prevented by insulin therapy started immediately after STZ injection and partially, but significantly, by ARI administered from immediately after STZ injection. Heterogeneous MIBG distribution also disappeered with the ARI therapy. In contrast, diabetic rats treated with insulin or ARI therapy started 4 wk after STZ injection showed no improvement in MIBG uptake. Conclusion: These results suggest that MIBO abnormalities observed in diabetic rats may reflect diabetic cardiac sympathetic neuropathy independently of cardiomyopathy, nephropathy or coronary heart disease secondary to diabetes and that MIBG imaging may be useful for clinical assessment of cardiac sympathetic neuropathy.

Key Words: diabetic neuropathy • MIBG • cardiac sympathetic nerve system • diabetic cardiomyopathy • aldose reductase inhibitor

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