Diabetes Gets on the Nerves of the Bone Marrow Niche

  1. Marcello Rota
  1. Departments of Anesthesia and Medicine, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
  1. Corresponding author: Annarosa Leri, aleri{at}

Diabetes is one of the major risk factors of coronary artery disease and chronic heart failure in the Western world (1). Currently, there are ∼28 million patients at age 20 years and older affected by diabetes in the U.S. alone with an annual incidence of 180,000 new cases. Moreover, 186,000 individuals, younger than 20 years of age, have diabetes, and each year ∼15,000 new patients are diagnosed with type 1 diabetes (1). The systemic nature of the metabolic derangement caused by diabetes inevitably results in comorbidities in several organs. Diabetes is the most common cause of neuropathy, which, in turn, represents its most frequent complication, affecting up to 50% of diabetic patients (2,3). A particularly severe form of diabetic neuropathy consists of the impairment of the sympathetic and parasympathetic divisions of the autonomic nervous system. Diabetic autonomic neuropathy (DAN) can affect the cardiovascular, genitourinary, and gastrointestinal organs. Cardiovascular autonomic neuropathy is an early and frequent complication of diabetes, comprising 7–15% of newly diagnosed individuals and 90% of chronically ill patients (4). In the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, cardiovascular autonomic neuropathy has been shown to double the risk of death in diabetic patients (5).

In this issue, the findings discussed in the study by Albiero et al. (6) provide novel insights for the current understanding of the biology of DAN. The impact of DAN on the bone marrow (BM) and its niches is largely unknown. Stem cell niches are anatomical compartments constituted by cellular and extracellular components, which integrate local and systemic cues for the control of stem cell fate (7). The BM niche is a functional entity with a high degree of plasticity necessary for rapid adaptation to the needs of the organism. With aging and diseases, BM niches undergo extensive remodeling, …

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