Defining Small Fibre Neuropathy & Neuropathic Pain in Idiopathic Fibre Neuropathy & Chemotherapy-Induced Peripheral Neuropathy

Precis
Small nerve fibre pathology in idiopathic small fibre neuropathy (ISFN) and chemotherapy-induced neuropathy (CIPN) is well-recognised as a pivotal part of the pathogenesis which results in debilitating pain. This studentship will investigate the pathology of small nerve fibres in relation to pain phenotypes in these two disorders through accurate phenotyping of the peripheral nervous system and pain and through the novel non-invasive ophthalmic technique of corneal confocal microscopy (CCM).

Background
Patients with ISFN have significant intra-epidermal nerve fibre loss reflective of small fibre pathology. ISFN with its associated neuropathic pain remains a major clinical problem and determining biomarkers of disease remains paramount to future therapeutic success. Due to the lack of widely available diagnostic modalities diagnosis is often made only on clinical grounds with no objective measure of pathology or progression. CIPN is a common treatment-related adverse side effect and is detrimental to the long-term quality of life. Platinum-induced peripheral neuropathy is reported to be at least partially reversible in approximately 80% of patients, however, symptoms and signs may continue to develop and progress in a subset of individuals post-therapy and thus continues as a long-term problem. For this reason, longitudinal studies of detailed pain/symptom phenotyping in relation to nerve fibre quantification are warranted. For ISFN and in the majority of CIPN, the pathological basis of the disorder lies in small nerve fibres.

Aim
The primary aim of this PhD studentship is to quantify small nerve fibre pathology as detected with CCM and skin biopsy in people with ISFN and CIPN compared to healthy volunteer controls.
The secondary objectives are:

1. To determine if corneal nerve pathology relates to phenotypes of neuropathic pain in ISFN and CIPN.
2. To determine if intra-epidermal nerve fibre pathology relates to phenotypes of neuropathic pain in ISFN and CIPN.
3. To determine longitudinal changes in small nerve fibres and quantitative sensory testing in ISFN and CIPN quantified by corneal confocal microscopy at 1 year.

Environment
The Institute of Ageing and Chronic Disease and Pain Research Institute at the University of Liverpool has an excellent track record in delivering world-leading vision research. The proposed study will take place in the Clinical Sciences Centre, a partnership between Aintree University Hospital, University of Liverpool and The Walton Centre. The project will benefit from supervisory expertise in image analysis, pain phenotyping and neurophysiology. The student will work within a multidisciplinary team with extensive experience in diabetes complications research, peripheral neuropathies and painful neuropathies and corneal nerve imaging.
The Institute of Ageing and Chronic Disease is fully committed to promoting gender equality in all activities. In recruitment we emphasise the supportive nature of the working environment and the flexible family support that the University provides. The Institute holds a silver Athena SWAN award in recognition of on-going commitment to ensuring that the Athena SWAN principles are embedded in its activities and strategic initiatives.

Training and Support
This project is suitable for either an allied health clinical professional ideally with evidence of previous research experience or a non-clinician scientist from a background in health sciences. It is ideally suited to an individual with an interest or previous experience in neuroscience. The successful candidate will obtain skills in clinical pain phenotyping, corneal nerve imaging, immunohistochemistry of skin biopsy specimens, study design, data collection and management, epidemiological analysis and writing research manuscripts. Full training in the analysis of corneal nerve images will be provided by Dr Uazman Alam and Professor Stephen Kaye. Clinical examination skills training will also be provided.

To apply please send your CV and a covering letter to Dr Alam with a copy to [Email Address Removed]