Pressure-adjusted static compression: aerobic metabolism and microvascular perfusion in the context of chemotherapy-induced neuropathy.

Abstract

Background: Chemotherapy-induced peripheral neuropathy (CIPN) involves impaired microvascular neuronal perfusion and reduced bioenergetics. Compression and cryotherapy are potential preventive measures, yet their mechanism of acral temperature reduction remains unclear. This study aims to unravel the effects of pressure-adjusted static compression (PSC) on aerobic metabolic and endothelial responses in patients undergoing chemotherapy (CTX).

Methods: Cancer patients with CTX above the CIPN-threshold dose (n = 24, 50% male; age 64 [61-71] years) and healthy controls (n = 53, 45% male; age 23 (18 to 87) years) had PSC applied on upper extremities. Tissue oxygenation and metabolism were derived by measuring oxygen supply (O₂Hb), oxygen demand (HHb), tissue oxygenation (TOI) and microvascular perfusion (THb) with quantitative time-resolved near-infrared spectroscopy (NIRS) and temperature with thermography. Effects were compared to cryoapplication and intermittent pneumatic compression (IPC). Endothelial function was quantified during vascular occlusion test (VOT).

Results: PSC, in contrast to undersized surgical gloves (SG), uniformly creates pressure on hands and leads to a more pronounced reduction of hand temperature. Furthermore, PSC significantly increased microvascular perfusion, O₂-supply and reduced O₂-demand and aerobic metabolism, thus raised local tissue oxygenation (p < 0.05 each). CTX lead to impaired metabolic and vascular reaction to PSC with only significant reduction of O₂-demand (p < 0.05) during PSC. PSC is preferable regarding comfort (p < 0.05) compared to SG. Cooling of hands (cooling gloves) had different action (p < 0.001) to PSC with significantly reduced microvascular perfusion, O₂-supply and O₂-demand (p < 0.05 each). Comparable local significant effects (p < 0.05) were seen during IPC. CTX exhibited endothelial dysfunction with impaired microvascular reactivity, which limited their capacity to enhance tissue oxygenation.

Conclusions: Reduction of oxygen demand represents an important mechanism in interventions targeting prevention of CIPN. PSC, comparable to cryoapplication and IPC attenuates energy metabolism and enhances tissue oxygenation. PSC's impact on the combination of vascular and energy metabolism suggests its potential to alleviate CIPN burden. These findings support PSC's role in reducing acral CIPN through distinct mechanisms.