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One of the many dreaded symptoms of diabetes is nerve inflammation, which can manifest in two ways: it either causes pain or it doesn't. Common to either case is the unfortunate fact that nerve inflammation causes major problems.

A young researcher at Aarhus University, Xiaoli Hu, MSc, has been given time to work exclusively on trying to find an answer to what is happening in the skin: she received 1.1 million Danish kroner from the Danish Diabetes Academy to work on this issue in her PhD project.

The problem for patients who don't experience pain – or feeling – is that they can't feel the difference, for example, between hot and cold water. They also can't feel their feet when they walk—which increases their risk of falls—and they can't feel, for example, foot massages, which so many people enjoy.

In contrast, the other group of patients has an increased sensation of pain and touching their feet or hands can be a very painful experience for them. They experience chronic pain daily, which is described as a burning and/or tingling sensation.

The current treatment options are limited, not least because we do not have a good enough understanding of what is happening. Xiaoli Hu will work to find the answer to this question. It is one of the issues that she will investigate specifically: whether nerve fibres in patients with pain have more "pain molecules" than patients without pain.

Supported by an international collaboration with some of the world's leading research groups studying inflammation, this project will:

1) Describe in detail the functions of small and large sensory nerve fibres and their relation to neuropathic pain using optogenetics on mice with type 1 diabetes.

2) Identify biomarkers for neuropathic pain and consequent new treatment goals using a large panel of antibodies on skin biopsies from patients with type 1 diabetes, painless type 1 diabetic polyneuropathy and painful type 1 diabetic polyneuropathy.

3) Investigate the clinical significance of axonal bulbs in type 1 diabetes by comparing the number of bulbs among the patient groups above and by describing what these bulbs consist of using electron tomography.

Xiaoli Hu has two supervisors, Assistant Professor Pall Karlsson and Professor Jens Randel Nyengaard from Det danske Smertecenter (the Danish Pain Centre) at Aarhus University, and the Institut for Klinisk Medicin (Institute for Clinical Medicine), respectively. They expect that the trials will enable us to better understand why some, but not all, diabetic patients develop neuropathic pain and thus, in the long run, assist in the development of better treatment options for patients. The experiment is expected to be of benefit to future patients and to science in general.

CONTACT:
Assistant Professor, PhD Pall Karlsson
The Danish Pain Centre, Aarhus University
Email pall@clin.au.dk
+45 6166 9980

Danish Diabetes Academy
Managing Director Tore Christiansen
tore.christiansen@rsyd.dk
+45 2964 6764