OIPN Pathophysiology

Paclitaxel-induced and oxaliplatin-induced peripheral neuropathy resemble each other in clinical relevance but differ in their underlying biological mechanisms. Acute OIPN is mainly caused by increased sensory nerve excitability driven by rapid calcium chelation and changes in voltage-gated sodium channels. Chronic OIPN involves nuclear DNA damage in dorsal root ganglion cells, mitochondrial dysfunction, oxidative stress, and neuroinflammation caused by glial cell activation. At the peripheral nerve level, chronic OIPN is linked to axonal transport defects, progressive axonal degeneration, ion channel hyperactivity, and neurovascular barrier disruption. More severe acute OIPN is associated with later development of chronic OIPN.