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Shu XS, Zhu H, Huang X, Yang Y, Wang D, Zhang Y, Zhang W, Ying Y. Loss of β-catenin via activated GSK3β causes diabetic retinal neurodegeneration by instigating a vicious cycle of oxidative stress-driven mitochondrial impairment. Aging (Albany NY) 2020; 12:13437-13462. [PMID: 32575075 PMCID: PMC7377872 DOI: 10.18632/aging.103446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023]
Abstract
Synaptic neurodegeneration of retinal ganglion cells (RGCs) is the earliest event in the pathogenesis of diabetic retinopathy. Our previous study proposed that impairment of mitochondrial trafficking by hyperphosphorylated tau is a potential contributor to RGCs synapse degeneration. However, other molecular mechanisms underlying mitochondrial defect in diabetic retinal neurodegeneration remain to be elucidated. Here, using a high-fat diet (HFD)-induced diabetic mouse model, we showed for the first time that downregulation of active β-catenin due to abnormal GSK3β activation caused synaptic neurodegeneration of RGCs by inhibiting ROS scavenging enzymes, thus triggering oxidative stress-driven mitochondrial impairment in HFD-induced diabetes. Rescue of β-catenin via ectopic expression of β-catenin with a recombinant adenoviral vector, or via GSK3β inhibition by a targeted si-GSK3β, through intravitreal administration, abrogated the oxidative stress-derived mitochondrial defect and synaptic neurodegeneration in diabetic RGCs. By contrast, ablation of β-catenin by si-β-catenin abolished the protective effect of GSK3β inhibition on diabetic RGCs by suppression of antioxidant scavengers and augmentation of oxidative stress-driven mitochondrial lesion. Thus, our data identify β-catenin as a part of an endogenous protective system in diabetic RGCs and a promising target to develop intervention strategies that protect RGCs from neurodegeneration at early onset of diabetic retinopathy.
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Affiliation(s)
- Xing-Sheng Shu
- Department of Physiology, School of Basic Medical Sciences, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, China
| | - Huazhang Zhu
- Department of Physiology, School of Basic Medical Sciences, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, China
| | - Xiaoyan Huang
- Department of Physiology, School of Basic Medical Sciences, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, China
| | - Yangfan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Dandan Wang
- Department of Physiology, School of Basic Medical Sciences, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, China.,Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Yiling Zhang
- Department of Physiology, School of Basic Medical Sciences, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, China
| | - Weizhen Zhang
- Department of Physiology and Pathophysiology, Peking University Health Science Center, Beijing, China
| | - Ying Ying
- Department of Physiology, School of Basic Medical Sciences, Shenzhen University Health Sciences Center, Shenzhen, Guangdong, China
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Effects of Prolonged Type 2 Diabetes on the Inner Retinal Layer and Macular Microvasculature: An Optical Coherence Tomography Angiography Study. J Clin Med 2020; 9:jcm9061849. [PMID: 32545794 PMCID: PMC7355838 DOI: 10.3390/jcm9061849] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose: To identify the effects of prolonged type 2 diabetes (T2DM) on macular microcirculation and the inner retinal layer in diabetic eyes without clinical diabetic retinopathy (DR). Methods: 97, 92, and 57 eyes in the control, patients with T2DM < 10 years (DM group one), and patients with T2DM ≥ 10 years (DM group two) were enrolled. The ganglion cell-inner plexiform layer (GC-IPL) thickness and superficial vessel density (VD) were compared. Linear regression analyses were performed to identify factors associated with VD in T2DM patients. Results: GC-IPL thicknesses in the control, DM group one, and DM group two were 84.58 ± 0.89, 83.49 ± 0.70, and 79.04 ± 0.96 μm, respectively (p < 0.001). The VDs of the full area were 20.32 ± 0.15, 19.46 ± 0.17, and 18.46 ± 0.23 mm−1 (p < 0.001). Post-hoc analyses revealed that the VDs of the full area was significantly different in the control vs. DM group one (p = 0.001), control vs. DM group two (p < 0.001), and DM group one vs. DM group two (p = 0.001). Multivariate linear regression analyses revealed that DM duration (p = 0.037), visual acuity (p = 0.013), and GC-IPL thickness (p < 0.001) were significantly associated with the VD of T2DM patients. Conclusions: We confirmed GC-IPL thinning and decreased superficial VD in the macular areas using OCTA in T2DM patients. Patients with T2DM ≥ 10 years exhibited significantly more severe macular microcirculation impairment compared to patients with T2DM < 10 years and normal controls.
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Ding XW, Li R, Geetha T, Tao YX, Babu JR. Nerve growth factor in metabolic complications and Alzheimer's disease: Physiology and therapeutic potential. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165858. [PMID: 32531260 DOI: 10.1016/j.bbadis.2020.165858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/11/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023]
Abstract
As the population ages, obesity and metabolic complications as well as neurological disorders are becoming more prevalent, with huge economic burdens on both societies and families. New therapeutics are urgently needed. Nerve growth factor (NGF), first discovered in 1950s, is a neurotrophic factor involved in regulating cell proliferation, growth, survival, and apoptosis in both central and peripheral nervous systems. NGF and its precursor, proNGF, bind to TrkA and p75 receptors and initiate protein phosphorylation cascades, resulting in changes of cellular functions, and are associated with obesity, diabetes and its complications, and Alzheimer's disease. In this article, we summarize changes in NGF levels in metabolic and neuronal disorders, the signal transduction initiated by NGF and proNGF, the physiological and pathophysiological relevance, and therapeutic potential in treating chronic metabolic diseases and cognitive decline.
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Affiliation(s)
- Xiao-Wen Ding
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL 36849, USA
| | - Rongzi Li
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL 36849, USA
| | - Thangiah Geetha
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL 36849, USA; Boshell Metabolic Diseases and Diabetes Program, Auburn University, Auburn, AL 36849, USA
| | - Ya-Xiong Tao
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA.
| | - Jeganathan Ramesh Babu
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL 36849, USA; Boshell Metabolic Diseases and Diabetes Program, Auburn University, Auburn, AL 36849, USA.
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Early structural and functional neurovascular changes in the retina in the prediabetic stage. Eye (Lond) 2020; 35:858-867. [PMID: 32461566 DOI: 10.1038/s41433-020-0984-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE This study was undertaken to investigate the neurovascular changes in the retina of prediabetic subjects. METHODS Subjects enroled in a prospective study were separated into prediabetic and normal control groups based on their glycosylated haemoglobin (HbA1C) levels, fasting and postprandial blood sugar levels and glucose tolerance test. All the subjects underwent detailed ophthalmic evaluation, which included fundus examination, fundus photography, optical coherence tomography angiography (OCTA), and multifocal electroretinogram (mfERG). Comparisons were done between the groups using the Wilcoxon signed rank test. RESULTS The median age was 48 years for the normal controls (n = 40), and 49.5 years for prediabetic subjects (n = 45) (p = 0.306). There was no difference in the vision, contrast sensitivity, thickness of the ganglion cell complex or the foveal avascular zone parameters between the groups. But the central foveal thickness and subfoveal choroidal thickness were significantly reduced in prediabetics (p < 0.01). The mfERG showed significant differences in the amplitude. The average amplitude was 35 ± 12 nv/deg2 in the normals and 29 ± 11 nv/deg2 in the prediabetics (p = 0.003). A weak positive correlation was noted between the mfERG and vascular parameters in the prediabetic group. CONCLUSIONS The prediabetic stage reveals earliest functional neuronal changes in the retina. The neuronal function seems to be affected much earlier than clinically appreciable structural changes in the ganglion cell complex and precedes vascular changes in the retina.
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Li HY, Yuan Y, Fu YH, Wang Y, Gao XY. Hypoxia-inducible factor-1α: A promising therapeutic target for vasculopathy in diabetic retinopathy. Pharmacol Res 2020; 159:104924. [PMID: 32464323 DOI: 10.1016/j.phrs.2020.104924] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/04/2020] [Accepted: 05/10/2020] [Indexed: 02/07/2023]
Abstract
Diabetic retinopathy (DR) is a serious condition that can cause blindness in diabetic patients. It is a neurovascular disease, but the pathogenesis leading to the onset of this disease is still not completely understood. However, hypoxia with subsequent neovascularization is a characteristic phenomenon observed with DR. Cellular response to hypoxia is mediated by the transcriptional regulator hypoxia-inducible factor (HIF). Long-term research has shown that one isotype of HIF, HIF-1α, may play a pivotal role under hypoxic conditions, and an increasing number of studies have shown that HIF-1α and its target genes contribute to retinal neovascularization. Therefore, targeting HIF-1α may lead to more effective DR treatments. This review describes the possible mechanisms of HIF-1α in neovascularization of DR. Furthermore, various inhibitors of HIF-1α that may have viable potential in the treatment of DR are also discussed.
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Affiliation(s)
- Hui-Yao Li
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Yue Yuan
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Yu-Hong Fu
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Ying Wang
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Xin-Yuan Gao
- Department of Endocrinology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, China.
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257
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Ali A, Qadri S, Khan Mashwani W, Kumam W, Kumam P, Naeem S, Goktas A, Jamal F, Chesneau C, Anam S, Sulaiman M. Machine Learning Based Automated Segmentation and Hybrid Feature Analysis for Diabetic Retinopathy Classification Using Fundus Image. ENTROPY 2020; 22:e22050567. [PMID: 33286339 PMCID: PMC7517087 DOI: 10.3390/e22050567] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022]
Abstract
The object of this study was to demonstrate the ability of machine learning (ML) methods for the segmentation and classification of diabetic retinopathy (DR). Two-dimensional (2D) retinal fundus (RF) images were used. The datasets of DR-that is, the mild, moderate, non-proliferative, proliferative, and normal human eye ones-were acquired from 500 patients at Bahawal Victoria Hospital (BVH), Bahawalpur, Pakistan. Five hundred RF datasets (sized 256 × 256) for each DR stage and a total of 2500 (500 × 5) datasets of the five DR stages were acquired. This research introduces the novel clustering-based automated region growing framework. For texture analysis, four types of features-histogram (H), wavelet (W), co-occurrence matrix (COM) and run-length matrix (RLM)-were extracted, and various ML classifiers were employed, achieving 77.67%, 80%, 89.87%, and 96.33% classification accuracies, respectively. To improve classification accuracy, a fused hybrid-feature dataset was generated by applying the data fusion approach. From each image, 245 pieces of hybrid feature data (H, W, COM, and RLM) were observed, while 13 optimized features were selected after applying four different feature selection techniques, namely Fisher, correlation-based feature selection, mutual information, and probability of error plus average correlation. Five ML classifiers named sequential minimal optimization (SMO), logistic (Lg), multi-layer perceptron (MLP), logistic model tree (LMT), and simple logistic (SLg) were deployed on selected optimized features (using 10-fold cross-validation), and they showed considerably high classification accuracies of 98.53%, 99%, 99.66%, 99.73%, and 99.73%, respectively.
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Affiliation(s)
- Aqib Ali
- Department of Computer Science & IT, The Islamia University of Bahawalpur, Bahawalpur 61300, Pakistan; (A.A.); (S.Q.); (S.N.)
| | - Salman Qadri
- Department of Computer Science & IT, The Islamia University of Bahawalpur, Bahawalpur 61300, Pakistan; (A.A.); (S.Q.); (S.N.)
| | - Wali Khan Mashwani
- Institute of Numerical Sciences, Kohat University of Sciences & Technology, Kohat 26000, Pakistan;
| | - Wiyada Kumam
- Program in Applied Statistics, Department of Mathematics and Computer Science, Faculty of Science and Technology, Rajamangala University of Technology Thanyaburi (RMUTT), Thanyaburi, Pathumthani 12110, Thailand
- Correspondence: (W.K.); (P.K.)
| | - Poom Kumam
- Center of Excellence in Theoretical and Computational Science (TaCS-CoE) & KMUTT Fixed Point Research Laboratory, Room SCL 802 Fixed Point Laboratory, Science Laboratory Building, Departments of Mathematics, Faculty of Science, King Mongkut’s University of Technology Thonburi (KMUTT), 126 Pracha-Uthit Road, Bang Mod, Thrung Khru, Bangkok 10140, Thailand
- Department of Medical Research, China Medical University Hospital, Taichung 40402, Taiwan
- Correspondence: (W.K.); (P.K.)
| | - Samreen Naeem
- Department of Computer Science & IT, The Islamia University of Bahawalpur, Bahawalpur 61300, Pakistan; (A.A.); (S.Q.); (S.N.)
| | - Atila Goktas
- Department of Statistics, Mugla Sıtkı Koçman University, Mugla 48000, Turkey;
| | - Farrukh Jamal
- Department of Statistics, Govt S.A Post Graduate College Dera Nawab Sahib, Bahawalpur 63351, Pakistan;
| | - Christophe Chesneau
- Department of Mathematics, Université de Caen, LMNO, Campus II, Science 3, 14032 Caen, France;
| | - Sania Anam
- Department of Computer Science, Govt Degree College for Women Ahmadpur East, Bahawalpur 63350, Pakistan;
| | - Muhammad Sulaiman
- Department of Mathematics, Abdul Wali Khan University Mardan, Mardan 23200, Pakistan;
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258
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van de Kreeke JA, Darma S, Chan Pin Yin JMPL, Tan HS, Abramoff MD, Twisk JWR, Verbraak FD. The spatial relation of diabetic retinal neurodegeneration with diabetic retinopathy. PLoS One 2020; 15:e0231552. [PMID: 32298369 PMCID: PMC7161968 DOI: 10.1371/journal.pone.0231552] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 03/25/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose Diabetic retinal neurodegeneration (DRN) has been demonstrated in eyes of patients with diabetes mellitus (DM), even in the absence of diabetic retinopathy (DR). However, no studies have looked at the rate of change in retinal layers and presence/development of DR over time per quadrant of the macula. In this longitudinal study, we aimed to clarify whether the rate of DRN is associated with the development/presence of DR within 4 different quadrants of the retina. Methods 80 eyes of 40 patients with type 1 DM and no/minimal DR were included. At 4 visits over 6 years, SD-OCT and fundus images were acquired. Thickness of the Retinal Nerve Fiber Layer (RNFL), Ganglion Cell Layer (GCL) and Inner Plexiform Layer (IPL) was measured in a 1-6mm circle around the fovea overall and for each quadrant (superior, nasal, inferior, temporal). Fundus images were scored for the presence/absence of DR in these areas. Multilevel analyses were performed to determine the rate of change for each layer overall and per quadrant for eyes/quadrants without and with DR during the follow-up period. Results RNFL and GCL showed significant thinning over time, IPL significant thickening. These changes were more pronounced for GCL and IPL in eyes/quadrants with DR during the follow-up period. Conclusions RNFL and GCL both showed thinning over time, which was more pronounced in eyes with DR for GCL. This holds true even in regional parts of the retina, as quadrant analyses showed similar results, showing that structural DRN is associated with DR per quadrant independently.
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Affiliation(s)
- Jacoba A. van de Kreeke
- Department of Ophthalmology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- * E-mail:
| | - Stanley Darma
- Department of Ophthalmology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | | | - H. Stevie Tan
- Department of Ophthalmology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Department of Ophthalmology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Michael D. Abramoff
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospital & Clinics, Iowa City, Iowa, United States of America
- VA Medical Center, Iowa City, Iowa, United States of America
- IDx, Iowa City, Iowa, United States of America
| | - Jos W. R. Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Frank D. Verbraak
- Department of Ophthalmology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Department of Ophthalmology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
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259
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Shivashankar G, Lim JC, Acosta ML. Proinflammatory cytokines trigger biochemical and neurochemical changes in mouse retinal explants exposed to hyperglycemic conditions. Mol Vis 2020; 26:277-290. [PMID: 32300272 PMCID: PMC7155896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 04/09/2020] [Indexed: 12/04/2022] Open
Abstract
PURPOSE Diabetic retinopathy (DR) is one of the most frequent complications of diabetes affecting the retina and eventually causing vision impairment. Emerging evidence suggests that inflammation plays a vital role in DR progression. In this study, we evaluated the early biochemical and neurochemical changes in mouse retinal explants to understand the contribution of proinflammatory cytokines to disease progression. METHODS DR was modeled in vitro by incubating mouse retinal explants in a physiological buffer supplemented with high glucose and the proinflammatory cytokines TNF-α and IL-1β. Key metabolites of retinal energy metabolism, including glucose, lactate, ATP, glutamate, glutamine, and enzymes supporting retinal ATP levels were assessed 40 min after the application of high glucose and proinflammatory cytokines. As retinal energy metabolism is tightly coupled to retinal neurochemistry, we also determined the short-term effect on the amino acid distribution of glutamate, gamma aminobutyric acid (GABA), glutamine, and glycine. RESULTS The results indicated that the combined application of high glucose and proinflammatory cytokines increased retinal glucose, lactate, and ATP levels, and decreased retinal glutamate, without affecting glutamine levels or the enzymes supporting ATP levels. Moreover, we observed a statistically significant increase in ATP and glutamate release. Correspondingly, statistically significant alterations in amino acid distribution were observed in retinal explants coexposed to high glucose and proinflammatory cytokines. CONCLUSIONS These data suggest that short-term exposure to proinflammatory cytokines contributes to the early biochemical and neurochemical changes caused by hyperglycemia, by affecting retinal energy metabolism and amino acid distribution. These data are consistent with the idea that early intervention to prevent inflammation-triggered loss of metabolic homeostasis in patients with diabetes is necessary to prevent DR progression.
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Affiliation(s)
- Gaganashree Shivashankar
- School of Optometry and Vision Science and New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Julie C. Lim
- Department of Physiology, School of Medical and Health Sciences and New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Monica L. Acosta
- School of Optometry and Vision Science and New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
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The Single Administration of a Chromophore Alleviates Neural Defects in Diabetic Retinopathy. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:1505-1512. [PMID: 32275905 DOI: 10.1016/j.ajpath.2020.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/04/2020] [Accepted: 03/24/2020] [Indexed: 12/20/2022]
Abstract
Diabetic retinopathy (DR) is a common complication of diabetes and a leading cause of blindness among the working-age population. Diabetic patients often experience functional deficits in dark adaptation, contrast sensitivity, and color perception before any microvascular pathologies on the fundus become detectable. Previous studies showed that the regeneration of 11-cis-retinal and visual pigment is impaired in a type 1 diabetes animal model, which negatively affects visual function at the early stage of DR. Here, Akita mice, type 1 diabetic model, were treated with the visual pigment chromophore, 9-cis-retinal. This treatment rescued a- and b-wave amplitudes of scotopic electroretinography responses, compared with vehicle-treated Akita mice. In addition, the administration of 9-cis-retinal alleviated oxidative stress significantly as shown by reduced 3-nitrotyrosine levels in the retina of Akita mice. Furthermore, the 9-cis-retinal treatment decreased retinal apoptosis as shown by the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling and DNA fragment enzyme-linked immunosorbent assay. Overall, these findings showed that 9-cis-retinal administration restored visual pigment formation and decreased oxidative stress and retinal degeneration, which resulted in improved visual function in diabetic mice, suggesting that chromophore deficiency plays a causative role in visual defects in early DR.
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261
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López-Bernal Á, García-Tejera O, Testi L, Villalobos FJ. Genotypic variability in radial resistance to water flow in olive roots and its response to temperature variations. TREE PHYSIOLOGY 2020; 40:445-453. [PMID: 32031664 DOI: 10.1093/treephys/tpaa010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/30/2019] [Accepted: 01/23/2020] [Indexed: 06/10/2023]
Abstract
As radial root resistance (Rp) represents one of the key components of the soil-plant-atmosphere continuum resistance catena modulating water transport, understanding its control is essential for physiologists, modelers and breeders. Reports of Rp, however, are still scarce and scattered in the scientific literature. In this study, we assessed genetic variability in Rp and its dependence on temperature in five widely used olive cultivars. In a first experiment, cultivar differences in Rp at 25 °C were evaluated from flow-pressure measurements in excised roots and subsequent analysis of root traits. In a second experiment, similar determinations were performed continually over a 5-h period in which temperature was gradually increased from 12 to 32 °C, enabling the assessment of Rp response to changing temperature. Despite some variability, our results did not show statistical differences in Rp among cultivars in the first experiment. In the second, cultivar differences in Rp were not significant at 12 °C, but they became so as temperature increased. Furthermore, the changes in Rp between 12 and 32 °C were higher than those expected by the temperature-driven decrease in water viscosity, with the degree of that change differing among cultivars. Also, Rp at 25 °C reached momentarily in the second experiment was consistently higher than in the first at that same, but fixed, temperature. Overall, our results suggest that there is limited variability in Rp among the studied cultivars when plants have been exposed to a given temperature for sufficient time. Temperature-induced variation in Rp might thus be partly explained by changes in membrane permeability that occur slowly, which explains why our values at 25 °C differed between experiments. The observed cultivar differences in Rp with warming also indicate faster acclimation of Rp to temperature changes in some cultivars than others.
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Affiliation(s)
- Á López-Bernal
- Departamento de Agronomía, Universidad de Córdoba, Campus de Rabanales, Edificio C4, 14071 Córdoba, Spain
| | - O García-Tejera
- Efficient Use of Water Program, Institut de Recerca i Tecnologia Agroalimentàries (IRTA), Parc de Gardeny, Edifici Fruitcentre, 25003 Lleida, Spain
| | - L Testi
- Instituto de Agricultura Sostenible (IAS), Consejo Superior de Investigaciones Científicas (CSIC), Av. Menéndez Pidal s/n, 14080 Córdoba, Spain
| | - F J Villalobos
- Departamento de Agronomía, Universidad de Córdoba, Campus de Rabanales, Edificio C4, 14071 Córdoba, Spain
- Instituto de Agricultura Sostenible (IAS), Consejo Superior de Investigaciones Científicas (CSIC), Av. Menéndez Pidal s/n, 14080 Córdoba, Spain
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262
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Sadikan MZ, Abdul Nasir NA, Agarwal R, Mohd Ismail N. Protective Effect of Palm Oil-Derived Tocotrienol-Rich Fraction Against Retinal Neurodegenerative Changes in Rats with Streptozotocin-Induced Diabetic Retinopathy. Biomolecules 2020; 10:biom10040556. [PMID: 32260544 PMCID: PMC7226502 DOI: 10.3390/biom10040556] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/29/2020] [Accepted: 04/02/2020] [Indexed: 12/13/2022] Open
Abstract
Oxidative stress plays an important role in retinal neurodegeneration and angiogenesis associated with diabetes. In this study, we investigated the effect of the tocotrienol-rich fraction (TRF), a potent antioxidant, against diabetes-induced changes in retinal layer thickness (RLT), retinal cell count (RCC), retinal cell apoptosis, and retinal expression of vascular endothelial growth factor (VEGF) in rats. Additionally, the efficacy of TRF after administration by two different routes was compared. The diabetes was induced in Sprague-Dawley rats by intraperitoneal injection of streptozotocin. Subsequently, diabetic rats received either oral or topical treatment with vehicle or TRF. Additionally, a group of non-diabetic rats was included with either oral or topical treatment with a vehicle. After 12 weeks of the treatment period, rats were euthanized, and retinas were collected for measurement of RLT, RCC, retinal cell apoptosis, and VEGF expression. RLT and RCC in the ganglion cell layer were reduced in all diabetic groups compared to control groups (p < 0.01). However, at the end of the experimental period, oral TRF-treated rats showed a significantly greater RLT compared to topical TRF-treated rats. A similar observation was made for retinal cell apoptosis and VEGF expression. In conclusion, oral TRF supplementation protects against retinal degenerative changes and an increase in VEGF expression in rats with streptozotocin-induced diabetic retinopathy. Similar effects were not observed after topical administration of TRF.
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Affiliation(s)
- Muhammad Zulfiqah Sadikan
- Centre for Neuroscience Research (NeuRon), Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor 47000, Malaysia;
| | - Nurul Alimah Abdul Nasir
- Centre for Neuroscience Research (NeuRon), Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor 47000, Malaysia;
- Correspondence: ; Tel.: +603-61267230
| | - Renu Agarwal
- School of Medicine, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia; (R.A.); (N.M.I.)
| | - Nafeeza Mohd Ismail
- School of Medicine, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia; (R.A.); (N.M.I.)
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263
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Vujosevic S, Aldington SJ, Silva P, Hernández C, Scanlon P, Peto T, Simó R. Screening for diabetic retinopathy: new perspectives and challenges. Lancet Diabetes Endocrinol 2020; 8:337-347. [PMID: 32113513 DOI: 10.1016/s2213-8587(19)30411-5] [Citation(s) in RCA: 240] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022]
Abstract
Although the prevalence of all stages of diabetic retinopathy has been declining since 1980 in populations with improved diabetes control, the crude prevalence of visual impairment and blindness caused by diabetic retinopathy worldwide increased between 1990 and 2015, largely because of the increasing prevalence of type 2 diabetes, particularly in low-income and middle-income countries. Screening for diabetic retinopathy is essential to detect referable cases that need timely full ophthalmic examination and treatment to avoid permanent visual loss. In the past few years, personalised screening intervals that take into account several risk factors have been proposed, with good cost-effectiveness ratios. However, resources for nationwide screening programmes are scarce in many countries. New technologies, such as scanning confocal ophthalmology with ultrawide field imaging and handheld mobile devices, teleophthalmology for remote grading, and artificial intelligence for automated detection and classification of diabetic retinopathy, are changing screening strategies and improving cost-effectiveness. Additionally, emerging evidence suggests that retinal imaging could be useful for identifying individuals at risk of cardiovascular disease or cognitive impairment, which could expand the role of diabetic retinopathy screening beyond the prevention of sight-threatening disease.
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Affiliation(s)
- Stela Vujosevic
- Eye Unit, University Hospital Maggiore della Carità, Novara, Italy
| | - Stephen J Aldington
- Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Paolo Silva
- Beetham Eye Institute, Joslin Diabetes Centre, Harvard Medical School, Boston, MA, USA; Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
| | - Cristina Hernández
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain; Department of Medicine and Endocrinology, Autonomous University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Peter Scanlon
- Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Rafael Simó
- Diabetes and Metabolism Research Unit, Vall d'Hebron Research Institute, Barcelona, Spain; Department of Medicine and Endocrinology, Autonomous University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain.
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264
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Mendonça HR, Carpi-Santos R, da Costa Calaza K, Blanco Martinez AM. Neuroinflammation and oxidative stress act in concert to promote neurodegeneration in the diabetic retina and optic nerve: galectin-3 participation. Neural Regen Res 2020; 15:625-635. [PMID: 31638084 PMCID: PMC6975153 DOI: 10.4103/1673-5374.266910] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/01/2019] [Accepted: 06/11/2019] [Indexed: 02/07/2023] Open
Abstract
Diabetes is a lifelong disease characterized by glucose metabolic imbalance, in which low insulin levels or impaired insulin signaling lead to hyperglycemic state. Within 20 years of diabetes progression, 95% of patients will have diabetic retinopathy, the leading cause of visual defects in working-age people worldwide. Although diabetes is considered a microvascular disease, recent studies have shown that neurodegeneration precedes vascular changes within the diabetic visual system, albeit its mechanisms are still under investigation. Neuroinflammation and oxidative stress are intrinsically related phenomena, since macrophage/microglia and astrocytes are the main sources of reactive oxygen species during central nervous system chronic degenerative diseases, and both pathological processes are increased in the visual system during diabetes. The present review will focus on recent findings of the contribution of oxidative stress derived from neuroinflammation in the early neurodegenerative aspects of the diabetic visual system and their relationship with galectin-3.
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Affiliation(s)
- Henrique Rocha Mendonça
- Laboratório de Neurodegeneração e Reparo, Departamento de Patologia, Programa de Pós-graduação em Anatomia Patológica, Faculdade de Medicina, Hospital Universitrio Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Pólo Universitário Macaé, Unidade Integrada de Pesquisa em Produtos Bioativos e Biociências, Federal University of Rio de Janeiro, Macaé, Brazil
- Laboratório Integrado de Morfologia, Instituto de Biodiversidade e Sustentabilidade, Núcleo de Pesquisas Ecológicas de Macaé, Federal University of Rio de Janeiro, Macaé, Brazil
| | - Raul Carpi-Santos
- Laboratório de Neurobiologia Celular, Instituto de Ciências Biomédicas, Centro de Ciências da Saúde, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Karin da Costa Calaza
- Laboratório de Neurobiologia da Retina, Departamento de Neurobiologia, Programa de Pós-Graduação em Neurociências, Fluminense Federal University, Niterói, Brazil
| | - Ana Maria Blanco Martinez
- Laboratório de Neurodegeneração e Reparo, Departamento de Patologia, Programa de Pós-graduação em Anatomia Patológica, Faculdade de Medicina, Hospital Universitrio Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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265
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Potilinski MC, Lorenc V, Perisset S, Gallo JE. Mechanisms behind Retinal Ganglion Cell Loss in Diabetes and Therapeutic Approach. Int J Mol Sci 2020; 21:ijms21072351. [PMID: 32231131 PMCID: PMC7177797 DOI: 10.3390/ijms21072351] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 02/07/2023] Open
Abstract
Diabetes produces several changes in the body triggered by high glycemia. Some of these changes include altered metabolism, structural changes in blood vessels and chronic inflammation. The eye and particularly the retinal ganglion cells (RGCs) are not spared, and the changes eventually lead to cell loss and visual function impairment. Understanding the mechanisms resulting in RGC damage and loss from diabetic retinopathy is essential to find an effective treatment. This review focuses mainly on the signaling pathways and molecules involved in RGC loss and the potential therapeutic approaches for the prevention of this cell death. Throughout the manuscript it became evident that multiple factors of different kind are responsible for RGC damage. This shows that new therapeutic agents targeting several factors at the same time are needed. Alpha-1 antitrypsin as an anti-inflammatory agent may become a suitable option for the treatment of RGC loss because of its beneficial interaction with several signaling pathways involved in RGC injury and inflammation. In conclusion, alpha-1 antitrypsin may become a potential therapeutic agent for the treatment of RGC loss and processes behind diabetic retinopathy.
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Affiliation(s)
- María Constanza Potilinski
- Instituto de Investigaciones en Medicina Traslacional (IIMT), Facultad de Ciencias Biomedicas, Universidad Austral-CONICET, Av. J.D. Perón 1500, 1629 Pilar, Buenos Aires, Argentina; (M.C.P.); (V.L.); (S.P.)
| | - Valeria Lorenc
- Instituto de Investigaciones en Medicina Traslacional (IIMT), Facultad de Ciencias Biomedicas, Universidad Austral-CONICET, Av. J.D. Perón 1500, 1629 Pilar, Buenos Aires, Argentina; (M.C.P.); (V.L.); (S.P.)
| | - Sofía Perisset
- Instituto de Investigaciones en Medicina Traslacional (IIMT), Facultad de Ciencias Biomedicas, Universidad Austral-CONICET, Av. J.D. Perón 1500, 1629 Pilar, Buenos Aires, Argentina; (M.C.P.); (V.L.); (S.P.)
| | - Juan Eduardo Gallo
- Instituto de Investigaciones en Medicina Traslacional (IIMT), Facultad de Ciencias Biomedicas, Universidad Austral-CONICET, Av. J.D. Perón 1500, 1629 Pilar, Buenos Aires, Argentina; (M.C.P.); (V.L.); (S.P.)
- Departamento de Oftalmologia, Hospital Universitario Austral, Av. Juan Perón 1500, 1629 Pilar, Buenos Aires, Argentina
- Correspondence: ; Tel.: +54-91164038725
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266
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Satue M, Cipres M, Melchor I, Gil-Arribas L, Vilades E, Garcia-Martin E. Ability of Swept source OCT technology to detect neurodegeneration in patients with type 2 diabetes mellitus without diabetic retinopathy. Jpn J Ophthalmol 2020; 64:367-377. [PMID: 32157484 DOI: 10.1007/s10384-020-00729-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 02/07/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate neurodegeneration in patients with type 2 Diabetes Mellitus (DM2) without diabetic retinopathy, and to assess the possible role of chronic systemic ischaemia and disease duration in retinal changes. STUDY DESIGN Observational cross sectional study. METHODS Sixty eyes of 60 patients with DM2 without signs of diabetic retinopathy (DR), and 60 eyes of 60 healthy controls underwent retinal (ganglion cell layer (GCL), and retinal nerve fiber layer (RNFL) and choroidal evaluation using Swept source Optical coherence tomography, which allows high quality analysis of the different retinal layers and the choroidal plexus. Comparison between patients with presence/absence of systemic vascular complications and different disease duration time was performed. RESULTS Macular GCL and RNFL were reduced in patients compared to controls (p < 0.001). In the peripapillary area, a reduction of the RNFL (p < 0.001) was observed in patients with DM2. There were no significant changes observed in the choroidal plexus of these patients. Patients with systemic ischaemia presented significant thinning of the choroid and further reduction of the temporal RNFL (p = 0.014) and GCL (p = 0.016) thickness. The GCL and the choroid were also thinner in patients with longer disease duration. CONCLUSIONS Patients with early DM2 present retinal neurodegeneration prior to the appearance of clinically observable vascular retinal changes. In these patients chronic systemic ischaemia caused reduction of the choroidal plexus and further damage to the retinal layers, adding new information on systemic chronic ischaemia and retinal neurodegeneration in patients with DM2 without DR.
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Affiliation(s)
- Maria Satue
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain. .,Miguel Servet Ophthalmology Innovative and Research Group (GIMSO), Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain. .,C/ Padre Arrupe. Consultas Externas de Oftalmología, 50009, Zaragoza, Spain.
| | - Marta Cipres
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Innovative and Research Group (GIMSO), Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain
| | - Isabel Melchor
- Endocrinology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Laura Gil-Arribas
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Innovative and Research Group (GIMSO), Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain
| | - Elisa Vilades
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Innovative and Research Group (GIMSO), Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain
| | - Elena Garcia-Martin
- Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain.,Miguel Servet Ophthalmology Innovative and Research Group (GIMSO), Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain
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267
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Katsuyama A, Kusuhara S, Asahara SI, Nakai SI, Mori S, Matsumiya W, Miki A, Kurimoto T, Imai H, Kido Y, Ogawa W, Nakamura M. En face slab optical coherence tomography imaging successfully monitors progressive degenerative changes in the innermost layer of the diabetic retina. BMJ Open Diabetes Res Care 2020; 8:8/1/e001120. [PMID: 32238364 PMCID: PMC7170410 DOI: 10.1136/bmjdrc-2019-001120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/31/2020] [Accepted: 03/09/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the usefulness of en face slab optical coherence tomography (OCT) imaging for monitoring diabetic retinal neurodegeneration with supporting animal experimental data. RESEARCH DESIGN AND METHODS We retrospectively examined 72 diabetic eyes over 3 years using Cirrus-HD OCT. Two-dimensional en face slab OCT images of the innermost retina were reconstructed and graded according to the ratio of dark area to total area, and relative red, green, and blue color area ratios were calculated and used as indexes for each en face slab OCT image. Values from en face OCT images were used for statistical analyses. To obtain insight into the pathogenesis of diabetic retinal neurodegeneration, we used the InsPr-Cre;Pdk1flox/flox diabetic mouse model. RESULTS Both OCT grade and relative red color area ratio significantly increased with the advancing stage of diabetic retinopathy (p=0.018 and 0.006, respectively). After a mean follow-up period of 4.6 years, the trend was unchanged in the analyses of 42 untreated eyes (p<0.001 and 0.001, respectively). Visual acuity showed a weak but significant negative correlation with the red color ratio on en face slab OCT images, but central retinal thickness did not exhibit a clinically meaningful correlation with values obtained from en face slab OCT images. Immunohistochemical analyses of InsPr-Cre;Pdk1flox/flox diabetic mice demonstrated the loss of ganglion axon bundles and thinning of laminin without apparent retinal vascular change at the age of 20 weeks. CONCLUSIONS En face slab OCT imaging would be a novel useful modality for the assessment of diabetic retinal neurodegeneration as it could detect subtle optical changes occurring in the innermost retina in diabetic eyes. Our animal experimental data suggest that dark areas observed on en face slab OCT images might be the impairment of the extracellular matrix as well as neurons.
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Affiliation(s)
- Atsuko Katsuyama
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sentaro Kusuhara
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shun-Ichiro Asahara
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shun-Ichiro Nakai
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sotaro Mori
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Wataru Matsumiya
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akiko Miki
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takuji Kurimoto
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hisanori Imai
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiaki Kido
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
- Division of Metabolism and Disease, Department of Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Wataru Ogawa
- Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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268
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Gao Y, Ji Y, Luo Y, Sun J, Sun G, Sun X. Ginsenoside Rg1 prevents early diabetic retinopathy via reducing retinal ganglion cell layer and inner nuclear layer cell apoptosis in db/db mice. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:232. [PMID: 32309379 PMCID: PMC7154486 DOI: 10.21037/atm.2019.12.155] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Diabetic retinopathy (DR), a diabetic vascular complication, is prone to developing into blindness. Ginsenoside Rg1 (GRg1), a major saponin in ginseng, exerts high anti-apoptotic activity. Methods This study aimed to explore the protective effects of GRg1 against diabetes-induced retinal damage. Measurements of blood glucose, blood lipids and vascular permeability were performed, as well as assessments of pathological changes, and the retinal thickness of each layer. Retinal cell apoptosis related protein expression levels were measured by immunofluorescence and western blot assays. Results Our data demonstrated that GRg1 effectively reduced blood glucose and triglyceride levels and maintained normal retinal permeability and physiological structure. GRg1 maintained the thickness of the ganglion cell layer (GCL) and the inner nuclear layer (INL) by reducing cell apoptosis. Conclusions These data strongly indicate that GRg1 prevents diabetic retinal changes by decreasing GCL and INL cell apoptosis. GRg1 may be a promising drug for early DR treatment.
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Affiliation(s)
- Ye Gao
- College of Pharmacy, Harbin University of Commerce, Harbin 150076, China.,Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine; Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China
| | - Yubin Ji
- College of Pharmacy, Harbin University of Commerce, Harbin 150076, China
| | - Yun Luo
- College of Pharmacy, Harbin University of Commerce, Harbin 150076, China.,Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine; Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China
| | - Jiafu Sun
- College of Pharmacy, Harbin University of Commerce, Harbin 150076, China.,Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine; Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China
| | - Guibo Sun
- College of Pharmacy, Harbin University of Commerce, Harbin 150076, China.,Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine; Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China
| | - Xiaobo Sun
- College of Pharmacy, Harbin University of Commerce, Harbin 150076, China.,Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences; Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine; Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China
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269
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Nogo-A-targeting antibody promotes visual recovery and inhibits neuroinflammation after retinal injury. Cell Death Dis 2020; 11:101. [PMID: 32029703 PMCID: PMC7005317 DOI: 10.1038/s41419-020-2302-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 12/11/2022]
Abstract
N-Methyl-D-aspartate (NMDA)-induced neuronal cell death is involved in a large spectrum of diseases affecting the brain and the retina such as Alzheimer’s disease and diabetic retinopathy. Associated neurological impairments may result from the inhibition of neuronal plasticity by Nogo-A. The objective of the current study was to determine the contribution of Nogo-A to NMDA excitotoxicity in the mouse retina. We observed that Nogo-A is upregulated in the mouse vitreous during NMDA-induced inflammation. Intraocular injection of a function-blocking antibody specific to Nogo-A (11C7) was carried out 2 days after NMDA-induced injury. This treatment significantly enhanced visual function recovery in injured animals. Strikingly, the expression of potent pro-inflammatory molecules was downregulated by 11C7, among which TNFα was the most durably decreased cytokine in microglia/macrophages. Additional analyses suggest that TNFα downregulation may stem from cofilin inactivation in microglia/macrophages. 11C7 also limited gliosis presumably via P.Stat3 downregulation. Diabetic retinopathy was associated with increased levels of Nogo-A in the eyes of donors. In summary, our results reveal that Nogo-A-targeting antibody can stimulate visual recovery after retinal injury and that Nogo-A is a potent modulator of excitotoxicity-induced neuroinflammation. These data may be used to design treatments against inflammatory eye diseases.
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270
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Bao YK, Yan Y, Gordon M, McGill JB, Kass M, Rajagopal R. Visual Field Loss in Patients With Diabetes in the Absence of Clinically-Detectable Vascular Retinopathy in a Nationally Representative Survey. Invest Ophthalmol Vis Sci 2020; 60:4711-4716. [PMID: 31725170 PMCID: PMC6855391 DOI: 10.1167/iovs.19-28063] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose Neuroretinopathy is increasingly being recognized as an independent cause of vision loss in diabetes. Visual field loss, as detected by frequency doubling technology (FDT)-based visual perimetry, is a sign of neuroretinopathy and occurs in early stages of diabetic retinopathy (DR). Here, we hypothesized that FDT visual field testing could identify patients with diabetic neuroretinopathy in the absence of clinically detectable microvascular DR. Methods All National Health and Nutrition Examination Survey (NHANES) 2005–2008 participants receiving fundus photography and visual field screening by FDT were included in this study. Participants with self-reported glaucoma, use of glaucoma medications, or determination of glaucoma based on disk features were excluded. Visual fields were screened using FDT protocol in which participants underwent a 19-subfield suprathreshold test. Results Patients with diabetes but no DR were more likely to have ≥1 subfield defects at 5%, 2%, and 1% probability levels than patients without diabetes (41.3% vs. 28.6%; 27.4% vs. 17.5%; 15.9% vs. 9.4%; all P < 0.0008). Multivariable regression showed that each additional glycated hemoglobin % (HbA1c) was associated with 19% greater odds of having ≥1 visual subfield defects in those with diabetes without DR (odds ratio: 1.19, 95% confidence interval: 1.07–1.33; P = 0.0020). Conclusions Patients with diabetes have visual field defects in the absence of clinically detectable DR, suggesting neuroretinopathy precedes classical microvascular disease. These defects become more frequent with the onset of visible retinopathy and worsen as the retinopathy becomes more severe. Longitudinal studies are required to understand the pathogenesis of diabetic neuroretinopathy in relation to classic DR.
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Affiliation(s)
- Yicheng K Bao
- Department of Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States
| | - Yan Yan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Mae Gordon
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Janet B McGill
- Division of Metabolism, Endocrinology and Lipid Research, Department of Medicine, Washington University School of Medicine, Missouri, United States
| | - Michael Kass
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Rithwick Rajagopal
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, United States
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271
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Lim HB, Shin YI, Lee MW, Koo H, Lee WH, Kim JY. Ganglion Cell - Inner Plexiform Layer Damage in Diabetic Patients: 3-Year Prospective, Longitudinal, Observational Study. Sci Rep 2020; 10:1470. [PMID: 32001760 PMCID: PMC6992712 DOI: 10.1038/s41598-020-58465-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/15/2020] [Indexed: 12/13/2022] Open
Abstract
Diabetes is expected to accelerate age-related ganglion cell–inner plexiform layer (GC-IPL) loss, but there is limited information on the rate of reduction in GC-IPL thicknesses. We aimed to evaluate the reduction rate of GC-IPL thickness in diabetic patients, and to compare the rates between patients without and with diabetic retinopathy (DR). We included 112 eyes of 112 patients with diabetes [49 eyes without DR (no-DR group) and 63 eyes with mild to moderate non-proliferative DR (NPDR group)] and 63 eyes of 63 normal controls (control group) in this study. Macular GC-IPL thickness in all participants was measured for 3 years at 1-year intervals. The reduction rates of GC-IPL thickness were determined by linear mixed models and compared among the three groups. The estimated reduction rates of the average GC-IPL thickness in the no-DR (−0.627 μm/year) and NPDR (−0.987 μm/year) groups were 2.26-fold (p = 0.010) and 3.56-fold (p = 0.001) faster, respectively, than the control group (−0.277 μm/year). Age, duration of diabetes, and baseline average GC-IPL thickness were associated with longitudinal changes in average GC-IPL thickness. The GC-IPL reduction rate was significantly faster in diabetic patients, with and without DR. Physicians should therefore be aware that GC-IPL damage continues even if there is no DR.
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Affiliation(s)
- Hyung Bin Lim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Yong Il Shin
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Min Woo Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea.,Department of Ophthalmology, Konyang University Hospital, Daejeon, Republic of Korea
| | - Hyungmoon Koo
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Woo Hyuk Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jung Yeul Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea.
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272
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Jiao C, Adler K, Liu X, Sun W, Mullins RF, Sohn EH. Visualization of Mouse Choroidal and Retinal Vasculature Using Fluorescent Tomato Lectin Perfusion. Transl Vis Sci Technol 2020; 9:1. [PMID: 32509436 PMCID: PMC7255627 DOI: 10.1167/tvst.9.1.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/27/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose To develop a reliable and simplified method to assess choroid and retinal vasculature on whole mount and cross sections in mice using tomato lectin (TL; Lycopersicon esculentum). Methods Albino mice (n = 27) received 1 mg/mL of TL (conjugated to Dylight-594) intravascularly through the tail vein, jugular vein, or cardiac left ventricle. Whole mounts of the retina and choroid were evaluated using fluorescence microscopy. Perfusion with GSL-IB4 conjugated to Dylight-594 and fluorescein isothiocyanate was performed to compare against labeling with TL. Co-labeling of choroidal endothelial cells with perfused TL on cross-sections with antibodies directed against the choriocapillaris-restricted endothelial cell marker CA4 was performed. The percentage of perfused choroidal and retinal vessels was assessed semiquantitatively. One mouse was subjected to thermal laser damage before perfusion to cause retinal and choroidal vasculature ablation. Results Intravascular injection of TL led to consistent, robust labeling of retinal and choroidal vascular walls. On cross-sections, choriocapillaris was co-labeled with CA4 and TL. On flat mount, TL perfusion resulted in better labeling of choroidal vessels using tail/jugular vein injection compared with cardiac perfusion (P < .01). More consistent labeling of the choroidal and retinal vascular trees was observed with TL than with GSL-IB4. Vascular damage caused by laser ablation was detected readily using this method. Conclusions TL injection intravascularly can reliably label normal and ablated choroid and retinal vasculature in mouse in a quick, simple manner. Translational Relevance These data will help to facilitate modeling in rodents for diseases such as age-related macular degeneration, diabetes, and other ischemic/angiogenic processes that can also be used for treatment evaluation.
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Affiliation(s)
- Chunhua Jiao
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.,Institute for Vision Research, Iowa City, IA, USA
| | - Kelsey Adler
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Xiuying Liu
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.,Institute for Vision Research, Iowa City, IA, USA
| | - Weize Sun
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.,Institute for Vision Research, Iowa City, IA, USA
| | - Robert F Mullins
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.,Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Elliott H Sohn
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.,Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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273
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Large-Scale Neuronal Network Dysfunction in Diabetic Retinopathy. Neural Plast 2020; 2020:6872508. [PMID: 32399026 PMCID: PMC7204201 DOI: 10.1155/2020/6872508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/26/2019] [Indexed: 12/19/2022] Open
Abstract
Diabetic retinopathy (DR) patients are at an increased risk of cognitive decline and dementia. There is accumulating evidence that specific functional and structural architecture changes in the brain are related to cognitive impairment in DR patients. However, little is known regarding whether the functional architecture of resting-state networks (RSNs) changes in DR patients. The purpose of this study was to investigate the intranetwork functional connectivity (FC) and functional network connectivity (FNC) of RSN changes in DR patients using independent component analysis (ICA). Thirty-four DR patients (18 men and 16 women; mean age, 53.53 ± 8.67 years) and 38 nondiabetic healthy controls (HCs) (15 men and 23 women; mean age, 48.63 ± 11.83 years), closely matched for age, sex, and education, underwent resting-state magnetic resonance imaging scans. ICA was applied to extract the nine RSNs. Then, two-sample t-tests were conducted to investigate different intranetwork FCs within nine RSNs between the two groups. The FNC toolbox was used to assess interactions among RSNs. Pearson correlation analysis was conducted to explore the relationship between intranetwork FCs and clinical variables in the DR group. A receiver operating characteristic (ROC) curve was conducted to assess the ability of the intranetwork FCs of RSNs in discriminating between the two groups. Compared to the HC group, DR patients showed significant decreased intranetwork FCs within the basal ganglia network (BGN), visual network (VN), ventral default mode network (vDMN), right executive control network (rECN), salience network (SN), left executive control network (lECN), auditory network (AN), and dorsal default mode network (dDMN). In addition, FNC analysis showed increased VN-BGN, VN-vDMN, VN-dDMN, vDMN-lECN, SN-BGN, lECN-dDMN, and AN-BGN FNCs in the DR group, relative to the HC group. Furthermore, altered intranetwork FCs of RSNs were significantly correlated with the glycosylated hemoglobin (HbA1c) level in DR patients. A ROC curve showed that these specific intranetwork FCs of RSNs discriminated between the two groups with a high degree of sensitivity and specificity. Our study highlighted that DR patients had widespread deficits in both low-level perceptual and higher-order cognitive networks. Our results offer important insights into the neural mechanisms of visual loss and cognitive decline in DR patients.
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274
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Thebeau C, Zhang S, Kolesnikov AV, Kefalov VJ, Semenkovich CF, Rajagopal R. Light deprivation reduces the severity of experimental diabetic retinopathy. Neurobiol Dis 2020; 137:104754. [PMID: 31978605 DOI: 10.1016/j.nbd.2020.104754] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/13/2020] [Accepted: 01/20/2020] [Indexed: 12/30/2022] Open
Abstract
Illumination of the retina is a major determinant of energy expenditure by its neurons. However, it remains unclear whether light exposure significantly contributes to the pathophysiology of common retinal disease. Driven by the premise that light exposure reduces the metabolic demand of the retina, recent clinical trials failed to demonstrate a benefit for constant illumination in the treatment of diabetic retinopathy. Here, we instead ask whether light deprivation or blockade of visual transduction could modulate the severity of this common cause of blindness. We randomized adult mice with two different models of diabetic retinopathy to 1-3 months of complete dark housing. Unexpectedly, we find that diabetic mice exposed to short or prolonged light deprivation have reduced diabetes-induced retinal pathology, using measures of visual function, compared to control animals in standard lighting conditions. To corroborate these results, we performed assays of retinal vascular health in diabetic Gnat1-/- and Rpe65-/- mice, which lack phototransduction. Both mutants displayed less diabetes-associated retinal vascular disease compared to respective wild-type controls. Collectively, these results suggest that light-induced visual transduction promotes the development of diabetic retinopathy and implicate photoreceptors as an early source of visual pathology in diabetes.
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Affiliation(s)
- Christina Thebeau
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Sheng Zhang
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Alexander V Kolesnikov
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Vladimir J Kefalov
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Clay F Semenkovich
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, Saint Louis, MO 63110, USA; Department of Cell Biology and Physiology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Rithwick Rajagopal
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, MO 63110, USA.
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275
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Park JC, Chen YF, Liu M, Liu K, McAnany JJ. Structural and Functional Abnormalities in Early-stage Diabetic Retinopathy. Curr Eye Res 2020; 45:975-985. [PMID: 31847599 DOI: 10.1080/02713683.2019.1705983] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the relationship between microperimetric (MP) sensitivity and retinal thickness measured at co-registered retinal locations in individuals who have mild or no diabetic retinopathy. METHODS Fifty non-diabetic control subjects and 50 type-2 diabetic subjects participated (25 had no clinically apparent DR [NDR] and 25 had mild nonproliferative DR [MDR]). MP sensitivity was measured at 36 retinal locations that were arranged in three concentric rings centered on the fovea (radii of 3°, 6°, and 12°). Optical coherence tomography (OCT) images were obtained, and total retinal thickness (TRT), inner retinal thickness (IRT), and outer retinal thickness (ORT) were quantified from the OCT images at locations that matched the MP measures. Linear quantile mixed models (LQMMs) and linear quantile models (LQMs) were used to compare MP and thickness values for the three subject groups and to quantify structure-function relationships. RESULTS The statistical models indicated significant TRT and IRT reductions in the NDR and MDR groups, relative to the controls, that were most apparent in the 3° ring. By contrast, ORT was not reduced significantly for either diabetic group. MP sensitivity was reduced significantly within each ring and for both diabetic groups. Despite reductions in both thickness and sensitivity, the structure-function associations were generally weak with borderline statistical significance. For example, a TRT or IRT reduction of approximately 27 µm was predicted to result in approximately 1 dB of MP sensitivity loss for the MDR group (p = .03 and 0.05, respectively). CONCLUSIONS The results support previous findings of early retinal neurodegeneration in diabetics who have NDR or MDR. Interestingly, the structural and functional deficits appear to be only weakly associated, suggesting that mechanisms in addition to retinal thinning underlie the functional defects in early-stage DR.
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Affiliation(s)
- Jason C Park
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago , Chicago, Illinois, USA
| | - Yi-Fan Chen
- Center for Clinical and Translational Sciences, University of Illinois at Chicago , Chicago, Illinois, USA
| | - Michelle Liu
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago , Chicago, Illinois, USA
| | - Karen Liu
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago , Chicago, Illinois, USA
| | - J Jason McAnany
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago , Chicago, Illinois, USA.,Department of Bioengineering, University of Illinois at Chicago , Chicago, Illinois, USA
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276
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Augustine J, Troendle EP, Barabas P, McAleese CA, Friedel T, Stitt AW, Curtis TM. The Role of Lipoxidation in the Pathogenesis of Diabetic Retinopathy. Front Endocrinol (Lausanne) 2020; 11:621938. [PMID: 33679605 PMCID: PMC7935543 DOI: 10.3389/fendo.2020.621938] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/21/2020] [Indexed: 12/31/2022] Open
Abstract
Lipids can undergo modification as a result of interaction with reactive oxygen species (ROS). For example, lipid peroxidation results in the production of a wide variety of highly reactive aldehyde species which can drive a range of disease-relevant responses in cells and tissues. Such lipid aldehydes react with nucleophilic groups on macromolecules including phospholipids, nucleic acids, and proteins which, in turn, leads to the formation of reversible or irreversible adducts known as advanced lipoxidation end products (ALEs). In the setting of diabetes, lipid peroxidation and ALE formation has been implicated in the pathogenesis of macro- and microvascular complications. As the most common diabetic complication, retinopathy is one of the leading causes of vision loss and blindness worldwide. Herein, we discuss diabetic retinopathy (DR) as a disease entity and review the current knowledge and experimental data supporting a role for lipid peroxidation and ALE formation in the onset and development of this condition. Potential therapeutic approaches to prevent lipid peroxidation and lipoxidation reactions in the diabetic retina are also considered, including the use of antioxidants, lipid aldehyde scavenging agents and pharmacological and gene therapy approaches for boosting endogenous aldehyde detoxification systems. It is concluded that further research in this area could lead to new strategies to halt the progression of DR before irreversible retinal damage and sight-threatening complications occur.
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Affiliation(s)
- Josy Augustine
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Science, Queen’s University of Belfast, Belfast, United Kingdom
| | - Evan P. Troendle
- Department of Chemistry, King’s College London, London, United Kingdom
| | - Peter Barabas
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Science, Queen’s University of Belfast, Belfast, United Kingdom
| | - Corey A. McAleese
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Science, Queen’s University of Belfast, Belfast, United Kingdom
| | - Thomas Friedel
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Science, Queen’s University of Belfast, Belfast, United Kingdom
| | - Alan W. Stitt
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Science, Queen’s University of Belfast, Belfast, United Kingdom
| | - Tim M. Curtis
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry & Biomedical Science, Queen’s University of Belfast, Belfast, United Kingdom
- *Correspondence: Tim M. Curtis,
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277
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Xia Z, Chen H, Zheng S. Alterations of Retinal Pigment Epithelium-Photoreceptor Complex in Patients with Type 2 Diabetes Mellitus without Diabetic Retinopathy: A Cross-Sectional Study. J Diabetes Res 2020; 2020:9232157. [PMID: 32215275 PMCID: PMC7079236 DOI: 10.1155/2020/9232157] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/20/2020] [Indexed: 11/18/2022] Open
Abstract
AIM A cross-sectional study was performed to examine the alterations of the retinal pigment epithelium- (RPE-) photoreceptor complex layer in type 2 diabetes mellitus (DM) without diabetic retinopathy (DR), using spectral-domain optical coherence tomography (SD-OCT). METHODS Patients with type 2 DM without DR and healthy controls without DM were recruited. All participants underwent examinations including SD-OCT. The thickness measurements of the retinal neural layers were calculated after automatic segmentation. An independent-sample t-test was used to compare the means of the thickness of retinal neural layers in patients with DM and healthy controls. RESULTS Sixty-seven eyes from 67 patients with DM and 30 eyes from 30 healthy controls were included in this study. No significant differences were found in age (P = 0.601), gender (P = 0.601), gender (P = 0.601), gender (P = 0.601), gender (P = 0.601), gender (P = 0.601), gender (P = 0.601), gender (P = 0.601), gender (. CONCLUSION Lesions in the RPE-photoreceptor complex are present without vascular abnormalities, which may precede the alterations of ganglion cells in patients with type 2 DM.
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Affiliation(s)
- Zheren Xia
- Department of Ophthalmology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hao Chen
- Department of Ophthalmology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Suilian Zheng
- Department of Ophthalmology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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278
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Pillar S, Moisseiev E, Sokolovska J, Grzybowski A. Recent Developments in Diabetic Retinal Neurodegeneration: A Literature Review. J Diabetes Res 2020; 2020:5728674. [PMID: 34151902 PMCID: PMC7787838 DOI: 10.1155/2020/5728674] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/11/2020] [Accepted: 11/24/2020] [Indexed: 02/08/2023] Open
Abstract
Neurodegeneration plays a significant role in the complex pathology of diabetic retinopathy. Evidence suggests the onset of neurodegeneration occurs early on in the disease, and so a greater understanding of the process is essential for prompt detection and targeted therapies. Neurodegeneration is a common pathway of assorted processes, including activation of inflammatory pathways, reduction of neuroprotective factors, DNA damage, and apoptosis. Oxidative stress and formation of advanced glycation end products amplify these processes and are elevated in the setting of hyperglycemia, hyperlipidemia, and glucose variability. These key pathophysiologic mechanisms are discussed, as well as diagnostic modalities and novel therapeutic avenues, with an emphasis on recent discoveries. The aim of this article is to highlight the crucial role of neurodegeneration in diabetic retinopathy and to review the molecular basis for this neuronal dysfunction, its diagnostic features, and the progress currently made in relevant therapeutic interventions.
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Affiliation(s)
- Shani Pillar
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Moisseiev
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
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279
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Hafner J, Zadrazil M, Grisold A, Ricken G, Krenn M, Kitzmantl D, Pollreisz A, Gleiss A, Schmidt-Erfurth U. Retinal and Corneal Neurodegeneration and Their Association with Systemic Signs of Peripheral Neuropathy in Type 2 Diabetes. Am J Ophthalmol 2020; 209:197-205. [PMID: 31542341 DOI: 10.1016/j.ajo.2019.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To determine the extent of retinal and corneal neurodegeneration and investigate the association with intraepidermal neuronal loss and diabetic peripheral neuropathy (DPN) in type 2 diabetes. DESIGN Prospective, cross-sectional study. METHODS Single-center study of 94 patients with type 2 diabetes patients (157 eyes), divided into groups: the groups without diabetic retinopathy (DR) (n = 68); the nonproliferative DR (NPDR) group (n = 48); and the proliferative DR (PDR) group (n = 41). Patients were imaged with optical coherence tomography and confocal microscopy for macular and peripapillary neuroretinal layer thicknesses and corneal nerve length/density, respectively. Distal leg skin punch biopsies and 2 neurological scores were used to depict intraepidermal nerve fiber density (IENFD) and clinical DPN. RESULTS Among neuroretinal layers, solely the peripapillary retinal nerve fiber layer was decreased in PDR (96 μm; 95% confidence interval [CI], 92-100 μm) versus no DR (103 μm; 95% CI, 100-106 μm) eyes and only after exclusion of outliers (P = .01). Corneal nerve fiber length and density were statistically significantly reduced in the NPDR group (23.0 mm/mm2; 95% CI, 20.0-26.00 mm/mm2 and 14.3 mm; 95% CI, 14.5-16.63 mm, respectively) and the PDR group (18.6 mm/mm2; 95% CI, 14.9-22.30 mm/mm2 and 11.7 mm; 95% CI, 10.2-13-3 mm, respectively) versus the no DR group (25.5 mm/mm2; 95% CI, 23.3-27.70 mm/mm2 and 15.6 mm; 95% CI, 14.5-16.6 mm, respectively), and in the PDR versus the NPDR group. IENFD was statistically significantly reduced in the NPDR (2.0/mm; 95% CI, 1.4-2.7/mm) and PDR stage (1.4/mm; 95% CI, 0.9-2.1/mm) versus in eyes without DR (3.6/mm; 95% CI, 2.9-4.6/mm). A low correlation between intraepidermal and corneal fiber loss was found with both neurological scores (P < .05). CONCLUSIONS Retinal neurodegenerative changes may develop independently of the microvascular alterations defining DR. Corneal and intraepidermal neuronal loss is more pronounced in advanced stages of DR, indicating a positive severity correlation between DR and DPN.
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Affiliation(s)
- Julia Hafner
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Markus Zadrazil
- Department of Anesthesiology, General Intensive Care and Pain Control, Medical University of Vienna, Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gerda Ricken
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Martin Krenn
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Daniela Kitzmantl
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Andreas Gleiss
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
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280
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Jia X, Zhong Z, Bao T, Wang S, Jiang T, Zhang Y, Li Q, Zhu X. Evaluation of Early Retinal Nerve Injury in Type 2 Diabetes Patients Without Diabetic Retinopathy. Front Endocrinol (Lausanne) 2020; 11:475672. [PMID: 33117270 PMCID: PMC7552190 DOI: 10.3389/fendo.2020.475672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/28/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives: To investigate the damage to the retinal nerve fiber layer (RNFL) and ganglion cell complex layer (GCL+) in diabetic patients without retinal microangioma and to determine the kind of nerve damage more likely to indicate early injury. Subjects and Methods: We included 360 patients (360 eyes) with type 2 diabetes mellitus and 168 healthy volunteers (168 eyes). Patients with retinal microangioma were excluded by fundus fluorescein angiography (FFA). The parameters around the optic disc and macular area were measured by optical coherence tomography (OCT). Results: The peripapillary RNFL thickness was thinner in the temporal (72.98 ± 13.76 μm, P < 0.0001) and inferior (120.71 ± 21.43 μm, P = 0.0103) sectors in patients with no diabetic retinopathy (NDR) compared to healthy controls. The reduction of retinal thickness in the macular region was prominent in the inferior sector in patients (34.74 ± 4.92 μm, P < 0.0001) compared to normal controls. Thinning of GCL+ in the second region of the macular area was significant in patients with NDR compared to normal controls (P < 0.05). However, no difference in the GCL+ and retinal thicknesses of the central macular region was observed between the patients with NDR and healthy controls. Using the 5th percentile (P5) of normal controls as the reference value, we found that the parameters with the highest indices in patients with NDR were the inferior and temporal peripapillary RNFL thickness (13.0%), the inferior RNFL thickness in the macular area (20%), the inferior retinal thickness in the outer ring of the macular area (10.8%), and the inferior GCL+ thickness in the macular area (10.6%). The GCL+ and RNFL thicknesses in the central macular area accounted for the smallest proportion in P5 of normal controls (3%). Conclusions: Retinal nerve injury can occur in patients without retinal microangioma. The inferior RNFL in the macular area and the inferior and temporal peripapillary RNFL were most sensitive to glucose damage. These areas might be associated with early detection of diabetic retinopathy (DR) as they are more likely to indicate early damage.
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Affiliation(s)
- Xiuhua Jia
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhijian Zhong
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tiancheng Bao
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shasha Wang
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ting Jiang
- Department of Radiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanling Zhang
- Department of Ultrasonography, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qigen Li
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Qigen Li
| | - Xiang Zhu
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Xiang Zhu
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281
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Fu Y, Wang Y, Gao X, Li H, Yuan Y. Dynamic Expression of HDAC3 in db/db Mouse RGCs and Its Relationship with Apoptosis and Autophagy. J Diabetes Res 2020; 2020:6086780. [PMID: 32190700 PMCID: PMC7071812 DOI: 10.1155/2020/6086780] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/29/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is a severe complication of diabetes mellitus. DR is considered as a neurovascular disease. Retinal ganglion cell (RGC) loss plays an important role in the vision function disorder of diabetic patients. Histone deacetylase3 (HDAC3) is closely related to injury repair and nerve regeneration. The correlation between HDAC3 and retinal ganglion cells in diabetic retinopathy is still unclear yet. METHODS To investigate the chronological sequence of the abnormalities of retinal ganglion cells in diabetic retinopathy, we choose 15 male db/db mice (aged 8 weeks, 12 weeks, 16 weeks, 18 weeks, and 25 weeks; each group had 3 mice) as diabetic groups and 3 male db/m mice (aged 8 weeks) as the control group. In this study, we examined the morphological and immunohistochemical changes of HDAC3, Caspase3, and LC3B in a sequential manner by characterizing the process of retinal ganglion cell variation. RESULTS Blood glucose levels and body weights of db/db mice were significantly higher than that of the control group, P < 0.01. Compared with the control group, the number of retinal ganglion cells decreased with the duration of disease increasing. HDAC3 expression gradually increased in RGCs of db/db mice. Caspase3 expression gradually accelerated in RGCs of db/db mice. LC3B expression dynamically changed in RGCs of db/db mice. HDAC3 was positively correlated with Caspase3 expression (r = 0.7424), P < 0.01. Compared with the control group, the number of retinal ganglion cells decreased with the duration of disease increasing. HDAC3 expression gradually increased in RGCs of db/db mice. Caspase3 expression gradually accelerated in RGCs of db/db mice. LC3B expression dynamically changed in RGCs of db/db mice. HDAC3 was positively correlated with Caspase3 expression (r = 0.7424), P < 0.01. Compared with the control group, the number of retinal ganglion cells decreased with the duration of disease increasing. HDAC3 expression gradually increased in RGCs of db/db mice. Caspase3 expression gradually accelerated in RGCs of db/db mice. LC3B expression dynamically changed in RGCs of db/db mice. HDAC3 was positively correlated with Caspase3 expression (Discussion. We clarified the dynamic expression changes of HDAC3, Caspase3, and LC3B in retinal ganglion cells of db/db mice. Our results suggest the HDAC3 expression has a positive correlation with apoptosis and autophagy.
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Affiliation(s)
- Yuhong Fu
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Ying Wang
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Xinyuan Gao
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Huiyao Li
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Yue Yuan
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
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282
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Furino C, Montrone G, Cicinelli MV, Balestra S, Grassi MO, Reibaldi M, Boscia F, Alessio G. Optical coherence tomography angiography in diabetic patients without diabetic retinopathy. Eur J Ophthalmol 2019; 30:1418-1423. [PMID: 31865774 DOI: 10.1177/1120672119895701] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate a subset of diabetic patients without diabetic retinopathy with optical coherence tomography angiography, assessing the differences in macular perfusion between diseased eyes and healthy controls. METHODS Monocentric cross-sectional study, including 86 eyes from 43 diabetic patients with no clinical signs of diabetic retinopathy and 78 eyes from 39 controls. Patients underwent 3.0 × 3.0 mm and 4.5 × 4.5 mm swept-source optical coherence tomography angiography. Vessel density (%), foveal avascular zone area (mm2), and avascular density (%) were provided for the superficial capillary plexus and the deep capillary plexus. RESULTS The foveal avascular zone area at the superficial capillary plexus was larger in the study group compared to controls, irrespective of the area of the slab considered. A meaningful difference was found in the vessel density at the deep capillary plexus of the 3.0 × 3.0 mm slab (p = 0.03). Almost all the variables considered in the study showed a significant within-subject effect. Age significantly correlated with vessel density of superficial capillary plexus on 4.5 × 4.5 mm in both control and diabetic eyes. CONCLUSION Diabetic patients with subclinical diabetic retinopathy feature a larger foveal avascular zone at the superficial capillary plexus compared with controls, as well as relative reduction of the vessel density at the deep capillary plexus. These findings might serve as the basis for screening between normal and diabetic subjects.
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Affiliation(s)
- Claudio Furino
- Department of Ophthalmology, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Bari, Italy
| | - Grazia Montrone
- Department of Ophthalmology, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Bari, Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Stefania Balestra
- Department of Ophthalmology, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Bari, Italy
| | - Maria Oliva Grassi
- Department of Ophthalmology, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Bari, Italy
| | | | | | - Giovanni Alessio
- Department of Ophthalmology, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Bari, Italy
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Karan A, Bhakkiyalakshmi E, Jayasuriya R, Sarada DVL, Ramkumar KM. The pivotal role of nuclear factor erythroid 2-related factor 2 in diabetes-induced endothelial dysfunction. Pharmacol Res 2019; 153:104601. [PMID: 31838079 DOI: 10.1016/j.phrs.2019.104601] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/23/2019] [Accepted: 12/11/2019] [Indexed: 02/07/2023]
Abstract
Endothelial dysfunction (ED) is a key event in the onset and progression of vascular complications associated with diabetes. Regulation of endothelial function and the underlying signaling mechanisms in the progression of diabetes-induced vascular complications have been well established. Recent studies indicate that increased oxidative stress is an important determinant of endothelial injury and patients with hypertension display ED mediated by impaired Nitric Oxide (NO) availability. Further, oxidative stress is known to be associated with inflammation and ED in vascular remodeling and diabetes-associated hypertension. Numerous strategies have been developed to improve the function of endothelial cells and increasing number of evidences highlight the indispensable role of antioxidants in modulation of endothelium-dependent vasodilation responses. Nuclear factor Erythroid 2-related factor 2 (Nrf2), is the principal transcriptional regulator, that is central in mediating oxidative stress signal response. Having unequivocally established the relationship between type 2 diabetes mellitus (T2DM) and oxidative stress, the pivotal role of Nrf2/Keap1/ARE network, has taken the center stage as target for developing therapies towards maintaining the cellular redox environment. Several activators of Nrf2 are known to combat diabetes-induced ED and few are currently in clinical trials. Focusing on their therapeutic value in diabetes-induced ED, this review highlights some natural and synthetic molecules that are involved in the modulation of the Nrf2/Keap1/ARE network and its underlying molecular mechanisms in the regulation of ED. Further emphasis is also laid on the therapeutic benefits of directly up-regulating Nrf2-mediated antioxidant defences in regulating endothelial redox homeostasis for countering diabetes-induced ED.
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Affiliation(s)
- Amin Karan
- Life Science Division, SRM Research Institute, SRM Institute of Science & Technology, Kattankulathur, 603 203, Tamilnadu, India; Department of Biotechnology, School of Bioengineering, SRM Institute of Science & Technology, Kattankulathur, 603 203, Tamil Nadu, India
| | - Elango Bhakkiyalakshmi
- Life Science Division, SRM Research Institute, SRM Institute of Science & Technology, Kattankulathur, 603 203, Tamilnadu, India; Department of Biotechnology, School of Bioengineering, SRM Institute of Science & Technology, Kattankulathur, 603 203, Tamil Nadu, India
| | - Ravichandran Jayasuriya
- Life Science Division, SRM Research Institute, SRM Institute of Science & Technology, Kattankulathur, 603 203, Tamilnadu, India; Department of Biotechnology, School of Bioengineering, SRM Institute of Science & Technology, Kattankulathur, 603 203, Tamil Nadu, India
| | - D V L Sarada
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science & Technology, Kattankulathur, 603 203, Tamil Nadu, India
| | - Kunka Mohanram Ramkumar
- Life Science Division, SRM Research Institute, SRM Institute of Science & Technology, Kattankulathur, 603 203, Tamilnadu, India; Department of Biotechnology, School of Bioengineering, SRM Institute of Science & Technology, Kattankulathur, 603 203, Tamil Nadu, India.
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284
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Carroll LS, Uehara H, Fang D, Choi S, Zhang X, Singh M, Sandhu Z, Cummins PM, Curtis TM, Stitt AW, Archer BJ, Ambati BK. Intravitreal AAV2.COMP-Ang1 Attenuates Deep Capillary Plexus Expansion in the Aged Diabetic Mouse Retina. Invest Ophthalmol Vis Sci 2019; 60:2494-2502. [PMID: 31185088 PMCID: PMC6559753 DOI: 10.1167/iovs.18-26182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We determine whether intravitreal angiopoietin-1 combined with the short coiled-coil domain of cartilage oligomeric matrix protein by adeno-associated viral serotype 2 (AAV2.COMP-Ang1) delivery following the onset of vascular damage could rescue or repair damaged vascular beds and attenuate neuronal atrophy and dysfunction in the retinas of aged diabetic mice. Methods AAV2.COMP-Ang1 was bilaterally injected into the vitreous of 6-month-old male Ins2Akita mice. Age-matched controls consisted of uninjected C57BL/6J and Ins2Akita males, and of Ins2Akita males injected with PBS or AAV2.REPORTER (AcGFP or LacZ). Retinal thickness and visual acuity were measured in vivo at baseline and at the 10.5-month endpoint. Ex vivo vascular parameters were measured from retinal flat mounts, and Western blot was used to detect protein expression. Results All three Ins2Akita control groups showed significantly increased deep vascular density at 10.5 months compared to uninjected C57BL/6J retinas (as measured by vessel area, length, lacunarity, and number of junctions). In contrast, deep microvascular density of Ins2Akita retinas treated with AAV2.COMP-Ang1 was more similar to uninjected C57BL/6J retinas for all parameters. However, no significant improvement in retinal thinning or diabetic retinopathy-associated visual loss was found in treated diabetic retinas. Conclusions Deep retinal microvasculature of diabetic Ins2Akita eyes shows late stage changes consistent with disorganized vascular proliferation. We show that intravitreally injected AAV2.COMP-Ang1 blocks this increase in deep microvascularity, even when administered subsequent to development of the first detectable vascular defects. However, improving vascular normalization did not attenuate neuroretinal degeneration or loss of visual acuity. Therefore, additional interventions are required to address neurodegenerative changes that are already underway.
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Affiliation(s)
- Lara S Carroll
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, United States
| | - Hironori Uehara
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, United States
| | - Daniel Fang
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, United States
| | - Susie Choi
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, United States
| | - Xiaohui Zhang
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, United States
| | - Malkit Singh
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, United States
| | - Zoya Sandhu
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, United States
| | - Philip M Cummins
- School of Biotechnology, Dublin City University, Glasnevin, Dublin, Ireland
| | - Tim M Curtis
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Alan W Stitt
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Bonnie J Archer
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, United States
| | - Balamurali K Ambati
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, United States
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285
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Kim K, Kim ES, Kim DG, Yu SY. Progressive retinal neurodegeneration and microvascular change in diabetic retinopathy: longitudinal study using OCT angiography. Acta Diabetol 2019; 56:1275-1282. [PMID: 31401734 DOI: 10.1007/s00592-019-01395-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/29/2019] [Indexed: 01/08/2023]
Abstract
AIMS To investigate the association between progressive macular ganglion cell/inner plexiform layer (mGCIPL) thinning and change of optical coherence tomography angiography (OCTA)-derived microvascular parameters in early-stage diabetic retinopathy (DR). METHODS A retrospective cohort study involved 40 eyes presenting with no DR or mild non-proliferative DR at baseline, and 30 healthy controls were included. All participants underwent spectral-domain OCT and OCTA at baseline and at 6, 12, 18, and 24 months. Change of mGCIPL thickness and OCTA metrics including foveal avascular zone (FAZ) area and FAZ circularity, vessel density (VD), and perfusion index (PI) was measured. Correlations between mGCIPL thickness and OCTA metrics were explored using regression models. RESULTS Average progressive mGCIPL loss was 0.45 µm per year. Three microvascular parameters were significantly impaired at 24 months compared to baseline (FAZ area: 0.34-0.36 mm2, VD: 18.9-18.5/mm, PI: 0.35-0.34). A strong positive correlation was found between loss of mGCIPL and VD from baseline to 24 months (r = 0.817, p < 0.001). Multivariable regression analysis showed that thinner baseline mGCIPL and greater loss of mGCIPL thickness (B = 0.658, p < 0.001) were significantly associated with change of VD. CONCLUSIONS In the early stage of DR, progressive structural retinal neurodegeneration and parafoveal microvascular change seem to be highly linked. Advanced mGCIPL thinning might precede microvascular impairment in early DR.
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Affiliation(s)
- Kiyoung Kim
- Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Republic of Korea
| | - Eung Suk Kim
- Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Republic of Korea
| | - Do Gyun Kim
- Department of Ophthalmology, Hanyang University College of Medicine Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University Medical Center, Kyung Hee University, Seoul, Republic of Korea.
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286
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PRESENCE OF PERIPHERAL LESIONS AND CORRELATION TO MACULAR PERFUSION, OXYGENATION AND NEURODEGENERATION IN EARLY TYPE II DIABETIC RETINAL DISEASE. Retina 2019; 40:1964-1971. [DOI: 10.1097/iae.0000000000002704] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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287
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Budzinskaya MV, Petrachkov DV, Savochkina OA, Arzhukhanov DD. [On classification of diabetic retinopathy]. Vestn Oftalmol 2019; 135:272-277. [PMID: 31691672 DOI: 10.17116/oftalma2019135052272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The article analyses current state of the problem of diabetic retinopathy classifications based on the data from Russian and foreign literature on pathogenesis, clinical manifestations, results of multicenter studies on treatment and prognosis of the disease. Every existing classification was found to be limited in applications; attempts had been made to unify and complement them with the aim of achieving more complete and better-detailed description of the processes of diagnostics and determination of treatment algorithms. In conclusion, none of the existing classifications can be considered consistent in both clinical and practical aspects with respect to diabetic retinopathy.
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Affiliation(s)
- M V Budzinskaya
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - D V Petrachkov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - O A Savochkina
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - D D Arzhukhanov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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288
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Spaide RF. Measurable Aspects of the Retinal Neurovascular Unit in Diabetes, Glaucoma, and Controls. Am J Ophthalmol 2019; 207:395-409. [PMID: 31078537 DOI: 10.1016/j.ajo.2019.04.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To study the structural and angiographic optical coherence tomography (OCT) data of the macula from controls, patients with diabetes, and patients with glaucoma to evaluate neurovascular and structural relationships. METHODS This was a retrospective study of 89 eyes from 49 patients in a community-based retinal referral practice with diabetes, glaucoma, and normal controls. The patients were evaluated with OCT to include retinal nerve fiber layer (RNFL) thickness measurement and ganglion cell layer (GCL) volume determination. The vascular density of the radial peripapillary capillary network and the vascular plexuses in the macula were evaluated with OCT angiography. The main outcome measures were the data obtained per disease state and the interrelationships the data displayed. RESULTS The mean GCL volumes were significantly lower than the control group in both the diabetic (P = .016) and glaucoma (P < .001) groups. The difference between the diabetic and glaucoma groups was not significant (P = .052). The mean global vascular density was greater in the control group than the diabetic group (P = .002) and the glaucoma group (P < .001). The mean RNFL thicknesses were lowest in the glaucoma group. Both the diabetic and glaucoma groups had significantly lower radial peripapillary network and deep vascular plexus density values compared to controls. CONCLUSIONS Although there are important differences in disease pathogenesis between diabetes and glaucoma, they share certain similarities in the structural and angiographic abnormalities eventually produced. This suggests that, in addition to canonical pathways of disease, a component of both could represent neurodegenerative disease, offering the possibility for the development of new treatments. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York, USA.
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289
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Shin YI, Nam KY, Lee SE, Lee MW, Lim HB, Jo YJ, Kim JY. Peripapillary microvasculature in patients with diabetes mellitus: An optical coherence tomography angiography study. Sci Rep 2019; 9:15814. [PMID: 31676848 PMCID: PMC6825207 DOI: 10.1038/s41598-019-52354-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 10/14/2019] [Indexed: 01/01/2023] Open
Abstract
To evaluate changes in peripapillary microvascular parameters in diabetes mellitus (DM) patients using optical coherence tomography angiography (OCTA). Seventy-one diabetic patients (40 in the no diabetic retinopathy [DR] group and 31 in the non-proliferative DR [NPDR] group) and 50 control subjects. OCTA (Zeiss HD-OCT 5000 with AngioPlex) 6 × 6 mm scans centered on the optic disc were analyzed. Peripapillary vessel density (VD), perfusion density (PD) in superficial capillary plexus (SCP) were automatically calculated. The average macular ganglion cell-inner plexiform layer (mGC-IPL) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses of the no DR and NPDR groups were significantly thinner than those of the control group. The no DR and NPDR groups showed lower peripapillary VD and PD in SCP compared with the control group. Using univariate regression analyses, the average mGC-IPL thickness, the pRNFL thickness, the no DR group and NPDR group were significant factors that affected the peripapillary VD and PD in SCP. Multivariate regression analyses showed that the grade of DR was a significant factor affecting the peripapillary VD and PD in SCP. OCTA revealed that peripapillary microvascular parameters in the no DR and NPDR groups were lower than those of normal controls. The peripapillary VD and PD in SCP were correlated with the mGC-IPL thickness, the pRNFL thickness, and the no DR and NPDR groups. Changes in peripapillary OCTA parameters may help with understanding the pathophysiology of DM and evaluating a potentially valuable biomarker for patients with subclinical DR.
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Affiliation(s)
- Yong-Il Shin
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Ki Yup Nam
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Seong Eun Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Min-Woo Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Hyung-Bin Lim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Young-Joon Jo
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jung-Yeul Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea.
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290
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Toprak I, Fenkci SM, Fidan Yaylali G, Martin C, Yaylali V. Early retinal neurodegeneration in preclinical diabetic retinopathy: a multifactorial investigation. Eye (Lond) 2019; 34:1100-1107. [PMID: 31654034 DOI: 10.1038/s41433-019-0646-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 07/03/2019] [Accepted: 09/09/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES To investigate effects of microalbuminuria (MA), diabetes duration, glycosylated haemoglobin (HbA1c) level, hypertension (HT) and/or hyperlipidaemia (HL) coexistence on retinal layers in diabetic patients without diabetic retinopathy (DR) using spectral-domain optical coherence tomography (SD-OCT). SUBJECTS/METHODS This cross-sectional study involved 95 (45 had MA and 50 had no MA) patients with type 2 diabetes mellitus (DM) without DR and 91 age- and gender-matched non-diabetic controls. Macular and peripapillary SD-OCT measurements (Heidelberg Engineering GmbH, Heidelberg, Germany), DM duration, HbA1c levels and presence of HT and/or HL were used for statistical analyses. RESULTS The MA (+), MA (-) and control groups had similar age and gender distribution (p > 0.05). The differences in SD-OCT measurements among the MA (+), MA (-) and control groups were insignificant (p > 0.05). However, diabetic patients (n = 95) had significantly thinner inferior-temporal peripapillary retinal nerve fibre layer (RNFL) (p = 0.042) than in the controls (n = 91). Superior peripapillary RNFL was significantly thinner in patients with an HbA1c level > 7% (p = 0.049). However, 3 mm-nasal, temporal and superior perifoveal thicknesses were significantly lower in patients with DM duration over 10 years (p < 0.05). HT and/or HL coexistence did not lead a significant difference in SD-OCT parameters among the groups. CONCLUSIONS In diabetic patients without DR, peripapillary inferior-temporal RNFL thinning might be an early sign of neuroretinal degeneration and it seems to be independent from vascular endothelial damage (MA). Poor metabolic control appears to lead superior peripapillary RNFL thinning, while perifoveal thicknesses tend to decrease with longer DM duration.
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Affiliation(s)
- Ibrahim Toprak
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
| | - Semin Melahat Fenkci
- Department of Endocrinology and Metabolism, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Guzin Fidan Yaylali
- Department of Endocrinology and Metabolism, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Cigdem Martin
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Volkan Yaylali
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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291
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Gholami S, Kamali Y, Reza Rostamzad M. Glycine Supplementation Ameliorates Retinal Neuronal Damage in an Experimental Model of Diabetes in Rats: A Light and Electron Microscopic Study. J Ophthalmic Vis Res 2019; 14:448-456. [PMID: 31875100 PMCID: PMC6825695 DOI: 10.18502/jovr.v14i4.5449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 06/15/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the potential neuroprotective effect of glycine supplementation on the retinal ultrastructure of streptozocin (STZ)-induced diabetic rats. Methods Adult male Wistar rats weighing 200–250 g (n = 40) were randomly divided into four groups of 10 each: normal group (C), glycine + normal group (G), STZ group (D), and glycine + STZ group (DG). The G and DG groups received glycine (130 mM and 1% w/v) freely in their drinking water seven days after the induction of diabetes for up to 16 weeks. Retinal samples for histopathology were examined using light and electron microscopy. Results Diabetes-induced histological changes were attenuated in the retinas of rats in the DG group. The ultrastructural alterations produced by experimental diabetes in the inner nuclear layer, outer nuclear layer, and ganglion cell layer were significantly ameliorated by glycine supplementation. Conclusion Our findings suggest that glycine supplementation effectively attenuates retinal neuronal damage in experimental diabetic rats, and thus may be a potential candidate to protect retinal ultrastructure against diabetes.
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Affiliation(s)
- Soghra Gholami
- Department of Basic Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Younes Kamali
- Department of Basic Sciences, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Mohammad Reza Rostamzad
- Department of Basic Sciences, School of Veterinary Medicine, Shiraz University, International Division, Shiraz, Iran
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292
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Lynch SK, Lee K, Chen Z, Folk JC, Schmidt-Erfurth U, Gerendas BS, Wahle A, Wykoff CC, Abràmoff MD. Intravitreal Fluocinolone Acetonide May Decelerate Diabetic Retinal Neurodegeneration. Invest Ophthalmol Vis Sci 2019; 60:2134-2139. [PMID: 31100106 PMCID: PMC6528841 DOI: 10.1167/iovs.18-24643] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose There is no prevention or treatment for diabetic retinal neurodegeneration (DRN), which is a complication of diabetes that can occur independently of diabetic retinopathy (DR). We hypothesized that an intravitreal fluocinolone acetonide (FAc) implant may affect the rate of DRN when used in patients with diabetic macular edema (DME). Methods In this retrospective analysis, optical coherence tomography with neuroretinal analysis was obtained at 3-month intervals from 130 patients in the USER study both before (mean duration 903 days, range 35-4005 days) and after administration of FAc (mean 408 days, range 7 to 756 days). The rate of DRN was defined as the change over time on inner neuroretinal thickness using logistic regression. A DRN rate was calculated independently for two areas: region 1 located within 1.5 mm of the fovea, and region 2 from 1.5 mm to 3.0 mm from the fovea. Results In regions of the macula more than 1.5 mm from the central fovea, there was a statistically significant decrease in the rate of DRN in the post-FAc period. The pre-FAc neuroretinal loss in this area occurred at 4.0 μm/y, compared with a post-FAc loss rate of 1.1 μm/y (P = 0.001). Conclusions This retrospective study suggests that FAc may decelerate the rate of inner retinal thinning in patients with persistent DME. Further prospective studies are necessary to determine the effects of FAc on the rate of DRN in patients with DME.
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Affiliation(s)
- Stephanie K Lynch
- Department of Ophthalmology and Visual Sciences, University of Iowa, Carver College of Medicine, Iowa City, Iowa, United States
| | - Kyungmoo Lee
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States
| | - Zhi Chen
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States
| | - James C Folk
- Department of Ophthalmology and Visual Sciences, University of Iowa, Carver College of Medicine, Iowa City, Iowa, United States.,IDx, Coralville, Iowa, United States
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Vienna Reading Center, Medical University of Vienna, Vienna, Austria
| | - Bianca S Gerendas
- Department of Ophthalmology and Optometry, Vienna Reading Center, Medical University of Vienna, Vienna, Austria
| | - Andreas Wahle
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States
| | - Charles C Wykoff
- Retina Consultants of Houston, Blanton Eye Institute, Houston, Texas, United States
| | - Michael D Abràmoff
- Department of Ophthalmology and Visual Sciences, University of Iowa, Carver College of Medicine, Iowa City, Iowa, United States.,Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States.,IDx, Coralville, Iowa, United States.,Iowa Institute for Vision Research, Iowa City, Iowa, United States.,Veterans Affairs Medical Center, Iowa City, Iowa, United States
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293
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Luo Q, Xiao Y, Alex A, Cummins TR, Bhatwadekar AD. The Diurnal Rhythm of Insulin Receptor Substrate-1 (IRS-1) and Kir4.1 in Diabetes: Implications for a Clock Gene Bmal1. Invest Ophthalmol Vis Sci 2019; 60:1928-1936. [PMID: 31042800 PMCID: PMC6735779 DOI: 10.1167/iovs.18-26045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Purpose Diabetes leads to the downregulation of the retinal Kir4.1 channels and Müller cell dysfunction. The insulin receptor substrate-1 (IRS-1) is a critical regulator of insulin signaling in Müller cells. Circadian rhythms play an integral role in normal physiology; however, diabetes leads to a circadian dysrhythmia. We hypothesize that diabetes will result in a circadian dysrhythmia of IRS-1 and Kir4.1 and disturbed clock gene function will have a critical role in regulating Kir4.1 channels. Methods We assessed a diurnal rhythm of retinal IRS-1 and Kir4.1 in db/db mice. The Kir4.1 function was evaluated using a whole-cell recording of Müller cells. The rat Müller cells (rMC-1) were used to undertake in vitro studies using a siRNA. Results The IRS-1 exhibited a diurnal rhythm in control mice; however, with diabetes, this natural rhythm was lost. The Kir4.1 levels peaked and troughed at times similar to the IRS-1 rhythm. The IRS-1 silencing in the rMC-1 led to a decrease in Kir4.1 and BMAL1. The insulin treatment of retinal explants upregulated Kir4.1 possibly via upregulation of BMAL1 and phosphorylation of IRS-1 and Akt-1. Conclusions Our studies highlight that IRS-1, by regulating BMAL1, is an important regulator of Kir4.1 in Müller cells and the dysfunctional signaling mediated by IRS-1 may be detrimental to Kir4.1.
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Affiliation(s)
- Qianyi Luo
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Yucheng Xiao
- Department of Biology, Indiana University-Purdue University, Indianapolis, Indiana, United States
| | - Alpha Alex
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Theodore R Cummins
- Department of Biology, Indiana University-Purdue University, Indianapolis, Indiana, United States
| | - Ashay D Bhatwadekar
- Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, United States
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294
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Chun LY, Silas MR, Dimitroyannis RC, Ho K, Skondra D. Differences in macular capillary parameters between healthy black and white subjects with Optical Coherence Tomography Angiography (OCTA). PLoS One 2019; 14:e0223142. [PMID: 31596848 PMCID: PMC6785112 DOI: 10.1371/journal.pone.0223142] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/13/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose To investigate if there are differences in macular capillaries between black and white subjects using optical coherence tomography angiography (OCTA) and identify potential factors underlying the epidemiologically-based higher vulnerability of black populations to diabetic retinopathy (DR). Methods This prospective, observational cross-sectional study included 93 eyes of 47 healthy subjects with no medical history and ocular history who self-identified as black or white and were matched for age, sex, refractive error, and image quality. Subjects underwent OCTA imaging (RTVue-XR Avanti) of the superficial (SCP) and deep (DCP) capillary plexuses and choriocapillaris. AngioAnalytics was used to analyze vessel density (VD) and choriocapillaris % blood flow area (BFA) in the 1mm-diameter fovea, parafovea, and 3mm-diameter circular area including the fovea and parafovea (3x3mm image). Foveal avascular zone (FAZ) was also analyzed. Linear mixed models were used to evaluate for differences between the study groups. Results Compared to the white subjects in this study, black subjects were found to have: lower foveal VD in the SCP (p<0.05); lower VD in the parafovea and in the 3x3mm image in the DCP (p<0.05); larger FAZ in SCP and DCP (p<0.05); and decreased choriocapillary BFA in the area underlying the fovea, parafovea, and 3x3mm image (p<0.05). Conclusion In our study, our black subjects had decreased macular capillary vasculature compared to matched white subjects, even in early adulthood and the absence of any systemic or ocular conditions. To our knowledge, this is the first report showing that retinal and choriocapillary vascular differences may contribute to racial disparities in vulnerability to DR.
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Affiliation(s)
- Lindsay Y. Chun
- University of Chicago Pritzker School of Medicine, Chicago, IL, United States of America
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL, United States of America
| | - Megan R. Silas
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL, United States of America
| | - Rose C. Dimitroyannis
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL, United States of America
- University of Chicago, Chicago, IL, United States of America
| | - Kimberly Ho
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL, United States of America
- University of Chicago, Chicago, IL, United States of America
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, IL, United States of America
- J. Terry Ernest Ocular Imaging Center, University of Chicago Medical Center, Chicago, IL, United States of America
- * E-mail:
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295
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Sohn EH, Han IC, Abramoff MD. Diabetic Retinal Neurodegeneration—Should We Redefine Retinopathy From Diabetes? JAMA Ophthalmol 2019; 137:1132-1133. [DOI: 10.1001/jamaophthalmol.2019.2536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Elliott H. Sohn
- Institute for Vision Research, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
| | - Ian C. Han
- Institute for Vision Research, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
| | - Michael D. Abramoff
- Institute for Vision Research, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
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296
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Lim HB, Shin YI, Lee MW, Park GS, Kim JY. Longitudinal Changes in the Peripapillary Retinal Nerve Fiber Layer Thickness of Patients With Type 2 Diabetes. JAMA Ophthalmol 2019; 137:1125-1132. [PMID: 31343674 DOI: 10.1001/jamaophthalmol.2019.2537] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Type 2 diabetes is expected to accelerate age-related peripapillary retinal nerve fiber layer (pRNFL) loss, but limited information on the rate of reduction in pRNFL thicknesses in patients with type 2 diabetes is available. Objective To investigate longitudinal changes in pRNFL thickness in patients with type 2 diabetes, with or without diabetic retinopathy (DR). Design, Setting, and Participants A total of 164 eyes of 63 healthy individuals and 101 patients with type 2 diabetes (49 patients without DR [non-DR group] and 52 patients with mild to moderate nonproliferative DR [NPDR group]) were enrolled in this prospective, longitudinal, observational study from January 2, 2013, through February 27, 2015. Participants were followed up for 3 years, and the peripapillary mean and sector RNFL thicknesses were measured at 1-year intervals. The mean rate of pRNFL loss was estimated using a linear mixed model and compared among the 3 groups. Follow-up was completed on March 16, 2018, and data were analyzed from April 2 through July 27, 2018. Exposure Type 2 diabetes. Main Outcomes and Measures The rate of reduction in pRNFL thickness in patients with type 2 diabetes. Results A total of 164 participants (88 women [53.7%]; mean [SD] age, 58.2 [8.7] years) were included in the study analysis. The mean (SD) age of the control group was 56.5 (9.3) years (39 women [61.9%]); the non-DR group, 59.1 (9.4) years (26 women [53.1%]); and the NPDR group, 59.4 (11.0) years (23 women [44.2%]). Mean (SD) duration of type 2 diabetes was 7.1 (4.4) years in the non-DR group and 13.2 (8.4) years in the NPDR group. The baseline mean (SD) pRNFL thickness was 96.2 (11.0) μm in the control group, 93.5 (6.4) μm in the non-DR group, and 90.4 (7.9) μm in the NPDR group. During 3 years of follow-up, these values decreased to 95.0 (9.2) μm in the control group, 90.3 (6.4) in the non-DR group, and 86.6 (7.9) μm in the NPDR group. In a linear mixed model, the estimated mean pRNFL loss was -0.92 μm/y in the non-DR group (P < .001) and -1.16 μm/y in the NPDR group (P < .001), which was 2.9-fold (95% CI, 1.1-14.8; P = .003) and 3.3-fold (95% CI, 1.4-18.0; P < .001) greater, respectively, than that of the control group (-0.35 μm/y; P = .01). Conclusions and Relevance Progressive reduction of pRNFL thickness was observed in healthy controls and patients with type 2 diabetes without and with DR; however, type 2 diabetes was associated with a greater loss of pRNFL regardless of whether DR was present. These findings suggest that pRNFL loss may occur in people with type 2 diabetes even in the absence of DR progression.
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Affiliation(s)
- Hyung Bin Lim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea.,Department of Ophthalmology, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Yong Il Shin
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Min Woo Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea.,Department of Ophthalmology, Konyang University Hospital, Daejeon, Republic of Korea
| | - Gi Seok Park
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jung Yeul Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
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297
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Abstract
Inflammation of the blood vessels that serve the central nervous system has been increasingly identified as an early and possibly initiating event among neurodegenerative conditions such as Alzheimer's disease and related dementias. However, the causal relevance of vascular inflammation to major retinal degenerative diseases is unresolved. Here, we describe how genetics, aging-associated changes, and environmental factors contribute to vascular inflammation in age-related macular degeneration, diabetic retinopathy, and glaucoma. We highlight the importance of mouse models in studying the underlying mechanisms and possible treatments for these diseases. We conclude that data support vascular inflammation playing a central if not primary role in retinal degenerative diseases, and this association should be a focus of future research.
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Affiliation(s)
- Ileana Soto
- Department of Molecular and Cellular Biosciences, Rowan University, Glassboro, New Jersey 08028, USA;
| | - Mark P Krebs
- The Jackson Laboratory, Bar Harbor, Maine 04609, USA;
| | | | - Gareth R Howell
- The Jackson Laboratory, Bar Harbor, Maine 04609, USA; .,Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.,Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, Maine 04469, USA
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298
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Abstract
PURPOSE OF REVIEW To introduce recent advances in the understanding of diabetic retinopathy and to summarize current and emerging strategies to treat this common and complex cause of vision loss. RECENT FINDINGS Advances in retinal imaging and functional analysis indicate that retinal vascular and neural pathologies exist long before the development of clinically visible retinopathy. Such diagnostics could facilitate risk stratification and selective early intervention in high-risk patients. Antagonists of the vascular endothelial growth factor pathway effectively reduce vision loss in diabetes and promote regression of disease severity. Promising new strategies to treat diabetic retinopathy involve novel systemic diabetes therapy and ocular therapies that antagonize angiogenic growth factor signaling, improve blood-retina barrier function and neurovascular coupling, modulate neuroretinal metabolism, or provide neuroprotection. Long considered a pure microvasculopathy, diabetic retinopathy in fact affects the neural and vascular retina as well as neurovascular communication. Emerging therapies include those that target neuroretinal dysfunction in addition to those modulating vascular biology.
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Affiliation(s)
- Avinash Honasoge
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, 660 S. Euclid Ave. 8096, St. Louis, MO, 63108, USA
| | - Eric Nudleman
- Shiley Eye Institute, University of California, San Diego, La Jolla, CA, USA
| | - Morton Smith
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, 660 S. Euclid Ave. 8096, St. Louis, MO, 63108, USA
| | - Rithwick Rajagopal
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, 660 S. Euclid Ave. 8096, St. Louis, MO, 63108, USA.
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299
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Tsang JKW, Liu J, Lo ACY. Vascular and Neuronal Protection in the Developing Retina: Potential Therapeutic Targets for Retinopathy of Prematurity. Int J Mol Sci 2019; 20:E4321. [PMID: 31484463 PMCID: PMC6747312 DOI: 10.3390/ijms20174321] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/21/2019] [Accepted: 08/29/2019] [Indexed: 12/13/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a common retinal disease in preterm babies. To prolong the lives of preterm babies, high oxygen is provided to mimic the oxygen level in the intrauterine environment for postnatal organ development. However, hyperoxia-hypoxia induced pathological events occur when babies return to room air, leading to ROP with neuronal degeneration and vascular abnormality that affects retinal functions. With advances in neonatal intensive care, it is no longer uncommon for increased survival of very-low-birth-weight preterm infants, which, therefore, increased the incidence of ROP. ROP is now a major cause of preventable childhood blindness worldwide. Current proven treatment for ROP is limited to invasive retinal ablation, inherently destructive to the retina. The lack of pharmacological treatment for ROP creates a great need for effective and safe therapies in these developing infants. Therefore, it is essential to identify potential therapeutic agents that may have positive ROP outcomes, especially in preserving retinal functions. This review gives an overview of various agents in their efficacy in reducing retinal damages in cell culture tests, animal experiments and clinical studies. New perspectives along the neuroprotective pathways in the developing retina are also reviewed.
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Affiliation(s)
- Jessica K W Tsang
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jin Liu
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Amy C Y Lo
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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300
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Neurodegeneration in Patients with Type 2 Diabetes Mellitus without Diabetic Retinopathy. J Ophthalmol 2019; 2019:1825819. [PMID: 31485340 PMCID: PMC6702840 DOI: 10.1155/2019/1825819] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/22/2019] [Accepted: 07/01/2019] [Indexed: 01/26/2023] Open
Abstract
Purpose To evaluate neurodegeneration in patients with type 2 diabetes mellitus (DM2) without diabetic retinopathy and to assess the possible role of systemic vascular complications in retinal changes. Methods Sixty eyes of 60 patients with DM2 and without any signs of diabetic retinopathy and 60 eyes of 60 healthy controls underwent retinal evaluation using Spectralis optical coherence tomography. Macular ganglion cell layer (GCL) and retinal nerve fiber layer (RNFL) were evaluated. Peripapillary RNFL thickness was assessed using Glaucoma and Axonal Analytics applications. Comparison between patients with the presence/absence of systemic vascular complications and different disease duration was made. Results Macular GCL was reduced in patients compared to controls (p < 0.001). Differences in the macular RNFL thickness were only observed in the outer inferior sector (p=0.033). A reduction in the peripapillary RNFL (average, inferior, and inferotemporal thickness, p < 0.05 for all three) was observed in patients using both applications. Patients with chronic systemic vascular complications presented a reduction in the temporal RNFL (p=0.019) compared to patients without complications. The superotemporal RNFL thickness was thinner in patients with longer disease duration. Conclusions Patients with type 2 DM without diabetic retinopathy and good metabolic control present neurodegeneration affecting neurons in the macular area and axons in different sectors of the optic disc. Systemic vascular complications contributed to further axonal damage in these patients, suggesting a possible role of subclinical ischaemia to retinal neurodegeneration in type 2 DM.
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