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Wang T, Zhang T, Dong N, Tan Y, Li X, Xie Y, Li L, Zhou Y, Zhang P, Li M, Li Q, Wang R, Wu R, Gao L. The association of islet autoantibodies with the neural retinal thickness and microcirculation in type 1 diabetes mellitus with no clinical evidence of diabetic retinopathy. Acta Diabetol 2024; 61:897-907. [PMID: 38530415 DOI: 10.1007/s00592-024-02255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/06/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To examine the association between islet autoantibodies (IAbs) and the retinal neurovascular changes in type 1 diabetes mellitus (T1DM) with no diabetic retinopathy (NDR). METHODS This cross-sectional study measured the neural retinal structure and microvascular density of 118 NDR eyes using spectral-domain optical coherence tomography angiography. Retinal structure parameters included retinal thickness (RT), inner retinal thickness (iRT), retina never fibral layer thickness (RNFL thickness), ganglion cell complex thickness (GCC thickness), and loss volume of GCC. Microvascular parameters included vessel density of superficial capillary plexus (sVD), vessel density of deep capillary plexus, and vessel density of choroid capillary plexus. Comparison and correlation analyses of these OCTA parameters were made with various IAbs, including glutamic acid decarboxylase antibody (GADA), tyrosine phosphatase-related islet antigen 2 antibody (IA2A), and zinc transporter 8 antibody (ZnT8A). A general linear model was used to understand the association of IAbs with the retina parameters. RESULTS The IAb positive (IAbs +) group, which included 85 patients, had thinner RT (235.20 ± 18.10 mm vs. 244.40 ± 19.90 mm at fovea, P = 0.021) and thinner iRT (120.10 ± 9.00 mm vs. 124.70 ± 6.90 mm at parafovea, P = 0.015), compared with the IAb negative (IAbs-) group comprising 33 patients. Furthermore, a more severe reduction of RT was demonstrated in the presence of multiple IAbs. Among the three IAbs, GADA was the most significant independent risk factor of all-round RT decrease (β = -0.20 vs. -0.27 at fovea and parafovea, respectively, P < 0.05), while titers of IA2A negatively affect sVD in the parafovea (β = -0.316, P = 0.003). CONCLUSIONS IAbs are associated with neural retinal thinning and microcirculation reduction in T1DM patients before the clinical onset of diabetic retinopathy.
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Affiliation(s)
- Tong Wang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Tong Zhang
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325027, China
| | - Ning Dong
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Yao Tan
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Xia Li
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuting Xie
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Liang Li
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
- Department of Ophthalmology, Mary M. and Sash A. Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Stanford, CA, 94304, USA
| | - Yandan Zhou
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Pu Zhang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Ming Li
- Department of Immunology, College of Basic Medical Immunology, Central South University, Changsha, 410011, China
| | - Qianxin Li
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325027, China
| | - Ruixuan Wang
- Bourns Engineering, The University of California, Riverside, Riverside, CA, 92521, USA
| | - Ronghan Wu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325027, China.
| | - Ling Gao
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
- National Clinical Research Center for Ocular Diseases, Wenzhou, 325027, China.
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Violetta L, Kartasasmita AS, Supriyadi R, Rita C. Circulating Biomarkers to Predict Diabetic Retinopathy in Patients with Diabetic Kidney Disease. Vision (Basel) 2023; 7:vision7020034. [PMID: 37092467 PMCID: PMC10123608 DOI: 10.3390/vision7020034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/05/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
The purpose of this review is to outline the currently available circulating biomarkers to predict diabetic retinopathy (DR) in patients with diabetic kidney disease (DKD). Studies have extensively reported the association between DR and DKD, suggesting the presence of common pathways of microangiopathy. The presence of other ocular complications including diabetic cataracts may hinder the detection of retinopathy, which may affect the visual outcome after surgery. Unlike DKD screening, the detection of DR requires complex, costly machines and trained technicians. Recognizing potential biological markers related to glycation and oxidative stress, inflammation and endothelial dysfunction, basement membrane thickening, angiogenesis, and thrombosis as well as novel molecular markers involved in the microangiopathy process may be useful as predictors of retinopathy and identify those at risk of DR progression, especially in cases where retinal visualization becomes a clinical challenge. Further investigations could assist in deciding which biomarkers possess the highest predictive power to predict retinopathy in clinical settings.
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Affiliation(s)
- Laurencia Violetta
- Nephrology Division, Department of Internal Medicine, Gatot Soebroto Indonesia Army Central Hospital, Jakarta 10410, Indonesia
| | | | - Rudi Supriyadi
- Faculty of Medicine, Universitas Padjajaran, Bandung 40132, Indonesia
| | - Coriejati Rita
- Faculty of Medicine, Universitas Padjajaran, Bandung 40132, Indonesia
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Saxena S, Singh M, Chaubey A, Mohan A, De S, Kaur A, Gilhotra JS, Meyer CH, Akduman L. Anti-Vegf therapy leads to an improvement in grade of retinal pigment epithelium alterations on single layer retinal pigment epithelium map in diabetic macular edema. Eur J Ophthalmol 2022; 33:1412-1417. [PMID: 36575598 DOI: 10.1177/11206721221146581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE In bovine retinal pigment epithelium (RPE) cells, increased secretion of vascular endothelial growth factor (VEGF) has a positive linear association with proliferation of RPE. Spectral domain optical coherence tomography (SD-OCT) based improvement in grades of topographic retinal pigment epithelium alterations (RPE-A), were evaluated after intravitreal anti-VEGF therapy, in diabetic macular edema (DME), for the first time. METHODS A tertiary care center-based, prospective study. Forty-four consecutive patients, 40-65 years of age with type 2 diabetes mellitus (DM) with DME, were administered three doses of anti-VEGF therapy at monthly intervals. Pre- and post-intervention SD-OCT was done and central sub field thickness (CST), cube average thickness (CAT) and topographic grades of RPE-A were assessed using single layer RPE map (SL-RPE) as; Grade 0: No alterations, Grade 1: Alteration in two quadrants, Grade 2: Alteration in more than two quadrants. RESULTS CST decreased from 354.2 ± 16.0 µm pre-intervention to 233.2 ± 7.9 µm post-intervention. CAT reduced from 340.6 ± 6.5 µm pre-intervention to 274.1 ± 5.1 µm post-intervention. Significant improvement in grades of RPE-A pre- v/s post-intervention were observed. (Grade 0: 0 v/s 39; Grade 1: 17 v/s 3; Grade 2: 27 v/s 2) (p < 0.001). CONCLUSION Anti-VEGF therapy is associated with an improvement in grades of RPE-A in DME.The study was registered with the Clinical Trial Registry of India (CTRI/2019/03/018135).
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Affiliation(s)
- Sandeep Saxena
- Department of Ophthalmology, 76140King George's Medical University, Lucknow, India
| | - Malvika Singh
- Department of Ophthalmology, 76140King George's Medical University, Lucknow, India
| | - Anupriya Chaubey
- Department of Ophthalmology, 76140King George's Medical University, Lucknow, India
| | - Akshay Mohan
- Department of Ophthalmology, 76140King George's Medical University, Lucknow, India
| | - Somnath De
- Department of Ophthalmology, 76140King George's Medical University, Lucknow, India
| | - Apjit Kaur
- Department of Ophthalmology, 76140King George's Medical University, Lucknow, India
| | | | | | - Levent Akduman
- Vitreoretinal and Uveitis Service, Department of Ophthalmology, 12274St. Louis University School of Medicine, St. Louis, MO, USA
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Treeful AE, Coffey EL, Friedenberg SG. A scoping review of autoantibodies as biomarkers for canine autoimmune disease. J Vet Intern Med 2022; 36:363-378. [PMID: 35192227 PMCID: PMC8965235 DOI: 10.1111/jvim.16392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/06/2022] [Accepted: 02/09/2022] [Indexed: 11/27/2022] Open
Abstract
Background Autoantibody biomarkers are valuable tools used to diagnose and manage autoimmune diseases in dogs. However, prior publications have raised concerns over a lack of standardization and sufficient validation for the use of biomarkers in veterinary medicine. Objectives Systematically compile primary research on autoantibody biomarkers for autoimmune disease in dogs, summarize their methodological features, and evaluate their quality; synthesize data supporting their use into a resource for veterinarians and researchers. Animals Not used. Methods Five indices were searched to identify studies for evaluation: PubMed, CAB Abstracts, Web of Science, Agricola, and SCOPUS. Two independent reviewers (AET and ELC) screened titles and abstracts for exclusion criteria followed by full‐text review of remaining articles. Relevant studies were classified based on study objectives (biomarker, epitope, technique). Data on study characteristics and outcomes were synthesized in independent data tables for each classification. Results Ninety‐two studies qualified for final analysis (n = 49 biomarker, n = 9 epitope, and n = 34 technique studies). A high degree of heterogeneity in study characteristics and outcomes reporting was observed. Opportunities to strengthen future studies could include: (1) routine use of negative controls, (2) power analyses to inform sample sizes, (3) statistical analyses when appropriate, and (4) multiple detection techniques to confirm results. Conclusions These findings provide a resource that will allow veterinary clinicians to efficiently evaluate the evidence supporting the use of autoantibody biomarkers, along with the varied methodological approaches used in their development.
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Affiliation(s)
- Amy E Treeful
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA.,Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Emily L Coffey
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Steven G Friedenberg
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
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Rola autoimmunizacji w rozwoju powikłań cukrzycowych – przegląd badań. POSTEP HIG MED DOSW 2021. [DOI: 10.2478/ahem-2021-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstrakt
Przewlekłe powikłania cukrzycy są główną przyczyną obniżenia jakości życia, niepełnosprawności, a nawet przedwczesnej śmierci pacjentów cierpiących na tę chorobę. Mimo istotnego postępu w dziedzinie farmakoterapii, ich leczenie pozostaje nadal wyzwaniem w codziennej praktyce klinicznej. Brak terapii przyczynowej wynika z niewystarczającego zrozumienia molekularnych mechanizmów uszkadzających poszczególne narządy w cukrzycy. Uważa się, że etiopatogeneza tych powikłań jest złożona i zależy od czynników genetycznych i środowiskowych. W ich rozwoju, oprócz zaburzeń metabolicznych związanych z hiperglikemią, nasilenia stresu oksydacyjnego, dysfunkcji śródbłonka, indukcji stanu zapalnego, coraz częściej wskazuje się też na znaczącą rolę zaburzeń immunologicznych.
Wyniki badań doświadczalnych przeprowadzonych na zwierzętach, jak również na hodowlach tkankowych, oraz obserwacje kliniczne potwierdzają udział układu odpornościowego obejmujący aktywność autoreaktywnych limfocytów oraz cytotoksyczne działanie autoprzeciwciał w rozwoju poszczególnych powikłań w obu typach cukrzycy. Wydaje się zatem, że zachwianie równowagi immunologicznej wyzwalające autoagresję jest ważnym czynnikiem przyczyniającym się do dysfunkcji poszczególnych organów w typach cukrzycy 1 i 2.
Dokładne zrozumienie immunopatogenezy tych zaburzeń może zmienić dotychczasowe podejście w leczeniu powikłań cukrzycy oraz umożliwić opracowanie skutecznej terapii przyczynowej ukierunkowanej na układ odpornościowy. Identyfikacja swoistych autoprzeciwciał mogłaby usprawnić ich wczesną diagnostykę i prewencję. W artykule podjęto próbę analizy czynników ryzyka najczęstszych schorzeń o podłożu autoimmunizacyjnym, ich związku z typem 1 i 2 cukrzycy oraz podsumowano potencjalne znaczenie autoagresji w rozwoju jej powikłań w oparciu o wyniki dotychczasowych badań doświadczalnych i klinicznych.
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Forrester JV, Kuffova L, Delibegovic M. The Role of Inflammation in Diabetic Retinopathy. Front Immunol 2020; 11:583687. [PMID: 33240272 PMCID: PMC7677305 DOI: 10.3389/fimmu.2020.583687] [Citation(s) in RCA: 190] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/21/2020] [Indexed: 12/14/2022] Open
Abstract
Inflammation is central to pathogenic processes in diabetes mellitus and the metabolic syndrome and particularly implicates innate immunity in the development of complications. Inflammation is a primary event in Type 1 diabetes where infectious (viral) and/or autoimmune processes initiate disease; in contrast, chronic inflammation is typical in Type 2 diabetes and is considered a sequel to increasing insulin resistance and disturbed glucose metabolism. Diabetic retinopathy (DR) is perceived as a vascular and neurodegenerative disease which occurs after some years of poorly controlled diabetes. However, many of the clinical features of DR are late events and reflect the nature of the retinal architecture and its cellular composition. Retinal microvascular disease is, in fact, an early event pathogenetically, induced by low grade, persistent leukocyte activation which causes repeated episodes of capillary occlusion and, progressive, attritional retinal ischemia. The later, overt clinical signs of DR are a consequence of the retinal ischemia. Metabolic dysregulation involving both lipid and glucose metabolism may lead to leukocyte activation. On a molecular level, we have shown that macrophage-restricted protein tyrosine phosphatase 1B (PTP1B) is a key regulator of inflammation in the metabolic syndrome involving insulin resistance and it is possible that PTP1B dysregulation may underlie retinal microvascular disease. We have also shown that adherent CCR5+CD11b+ monocyte macrophages appear to be selectively involved in retinal microvascular occlusion. In this review, we discuss the relationship between early leukocyte activation and the later features of DR, common pathogenetic processes between diabetic microvascular disease and other vascular retinopathies, the mechanisms whereby leukocyte activation is induced in hyperglycemia and dyslipidemia, the signaling mechanisms involved in diabetic microvascular disease, and possible interventions which may prevent these retinopathies. We also address a possible role for adaptive immunity in DR. Although significant improvements in treatment of DR have been made with intravitreal anti-VEGF therapy, a sizeable proportion of patients, particularly with sight-threatening macular edema, fail to respond. Alternative therapies targeting inflammatory processes may offer an advantage.
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Affiliation(s)
- John V Forrester
- Institute of Medical Sciences, University of Aberdeen, Scotland, United Kingdom
| | - Lucia Kuffova
- Institute of Medical Sciences, University of Aberdeen, Scotland, United Kingdom.,Eye Clinic, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Mirela Delibegovic
- Institute of Medical Sciences, University of Aberdeen, Scotland, United Kingdom
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Ahuja S, Saxena S, Meyer CH, Gilhotra JS, Akduman L. Central subfield thickness and cube average thickness as bioimaging biomarkers for ellipsoid zone disruption in diabetic retinopathy. Int J Retina Vitreous 2018; 4:41. [PMID: 30410791 PMCID: PMC6214155 DOI: 10.1186/s40942-018-0144-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To evaluate the association of central subfield thickness (CST) and cube average thickness (CAT) with ellipsoid zone (EZ) disruption on spectral domain optical coherence tomography (SD-OCT) in patients of diabetic retinopathy (DR). METHODS Cross sectional study including consecutive patients of type 2 diabetes mellitus [without DR (No DR, n = 97); non-proliferative DR (NPDR, n = 91); proliferative DR (PDR, n = 83)] and healthy controls (n = 82) was undertaken. CST and CAT values were measured using SD-OCT. Data was analyzed using Chi square test, ANOVA and multivariate analysis. Discriminant values of CST and CAT for EZ disruption were evaluated using receiver operator characteristic curve. Area under curve (AUC) was computed. RESULTS Mean CAT and CST values in the study subjects showed an incremental trend. Multivariate ordinal logistic regression analysis showed increase in CST (OR = 1.022, p < 0.001) and CAT (OR = 1.029, p < 0.001) as significant independent predictors of EZ disruption. Area under curve showed excellent predictive results of CST (AUC = 0. 943 ± 0.021, 95% CI, 0.902-0.984, p < 0.05) and CAT (AUC = 0.959 ± 0.012, 95% CI 0.936-0.982, p < 0.05), as bioimaging biomarkers, for EZ disruption. CONCLUSION Increase in CST and CAT is associated with increased odds of EZ disruption and these macular parameters serve as bioimaging biomarkers for EZ disruption in DR.
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Affiliation(s)
- Sukriti Ahuja
- Department of Ophthalmology, King George’s Medical University, Lucknow, U.P 226003 India
| | - Sandeep Saxena
- Department of Ophthalmology, King George’s Medical University, Lucknow, U.P 226003 India
| | | | - Jagjit S. Gilhotra
- Department of Ophthalmology, University of Adelaide, Adelaide, Australia
| | - Levent Akduman
- Department of Ophthalmology, Saint Louis University, St. Louis, USA
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Sinha S, Saxena S, Prasad S, Mahdi AA, Bhasker SK, Das S, Krasnik V, Caprnda M, Opatrilova R, Kruzliak P. Association of serum levels of anti-myeloperoxidase antibody with retinal photoreceptor ellipsoid zone disruption in diabetic retinopathy. J Diabetes Complications 2017; 31:864-868. [PMID: 28279572 DOI: 10.1016/j.jdiacomp.2017.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/01/2016] [Accepted: 02/16/2017] [Indexed: 12/31/2022]
Abstract
AIM To study the association of serum levels of anti-myeloperoxidase (MPO) antibody with retinal photoreceptor ellipsoid zone (EZ) disruption in diabetic retinopathy. METHODS Consecutive patients with type 2 DM [diabetes mellitus with no retinopathy (NODR; n=20); non-proliferative diabetic retinopathy (NPDR; n=18); proliferative diabetic retinopathy (PDR; n=16)] and healthy controls (n=20) between the ages of 40 and 65years were included. Disruption of EZ was graded by spectral domain optical coherence tomography as no disruption of EZ and disrupted EZ. The serum levels of anti-MPO antibody was analyzed using standard protocol. Association between the variables was evaluated using multiple regression analysis. RESULTS A significant difference was found between the serum levels of anti-MPO antibody in various study groups (p<0.001). A positive association was found between EZ disruption and levels of anti-MPO antibody [adjusted odd's ratio (AOR)=1.079, CI 1.010-1.124, p=0.04]. A significant positive correlation was found between logMAR visual acuity and grade of disruption (AOR=1.008, CI 1.006-5.688, p=0.04). CONCLUSIONS An increased serum anti-MPO antibody levels is associated with retinal photoreceptor EZ disruption and decreased visual acuity in diabetic retinopathy.
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Affiliation(s)
- Shivani Sinha
- Retina service, Department of Ophthalmology, King George's Medical University, Lucknow, India
| | - Sandeep Saxena
- Retina service, Department of Ophthalmology, King George's Medical University, Lucknow, India.
| | - Senthamizh Prasad
- Department of Preventive and Social Medicine, King George's Medical University, Lucknow, India
| | - Abbas Ali Mahdi
- Department of Biochemistry, King George's Medical University, Lucknow, India
| | - Shashi Kumar Bhasker
- Retina service, Department of Ophthalmology, King George's Medical University, Lucknow, India
| | - Siddharth Das
- Department of Rheumatology, King George's Medical University, Lucknow, India
| | - Vladimir Krasnik
- Department of Ophthalmology, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovakia
| | - Martin Caprnda
- 2nd Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Radka Opatrilova
- Department of Chemical Drugs, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Peter Kruzliak
- Department of Chemical Drugs, Faculty of Pharmacy, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic.
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Abstract
Diabetic retinopathy (DR), a leading cause of acquired vision loss, is a microvascular complication of diabetes. While traditional risk factors for diabetic retinopathy including longer duration of diabetes, poor blood glucose control, and dyslipidemia are helpful in stratifying patient's risk for developing retinopathy, many patients without these traditional risk factors develop DR; furthermore, there are persons with long diabetes duration who do not develop DR. Thus, identifying biomarkers to predict DR or to determine therapeutic response is important. A biomarker can be defined as a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. Incorporation of biomarkers into risk stratification of persons with diabetes would likely aid in early diagnosis and guide treatment methods for those with DR or with worsening DR. Systemic biomarkers of DR include serum measures including genomic, proteomic, and metabolomics biomarkers. Ocular biomarkers including tears and vitreous and retinal vascular structural changes have also been studied extensively to prognosticate the risk of DR development. The current studies on biomarkers are limited by the need for larger sample sizes, cross-validation in different populations and ethnic groups, and time-efficient and cost-effective analytical techniques. Future research is important to explore novel DR biomarkers that are non-invasive, rapid, economical, and accurate to help reduce the incidence and progression of DR in people with diabetes.
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Affiliation(s)
- Daniel Shu Wei Ting
- Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Kara-Anne Tan
- Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Val Phua
- Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Gavin Siew Wei Tan
- Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Chee Wai Wong
- Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
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