Integrative Biology of Diabetic Retinal Disease: Lessons from Diabetic Kidney Disease

[Validation and comparison of diabetic retinopathy-based diagnostic models for diabetic nephropathy]

OBJECTIVE

To validate and compare the efficacy of two noninvasive diagnostic models for diabetic nephropathy (DN) based on diabetic retinopathy (DR).

METHODS

A total of 565 patients with type 2 diabetes undergoing kidney biopsy in the Department of Nephrology, PLA General Hospital from January, 1993 to December, 2014 were studied. The patients were divided into DN group and non-diabetic nephropathy (NDRD) group according to renal pathological diagnosis. The data from the 22-year period were divided into 3 stages based on chronological order: early stage (from 1993 to 2003), middle stage (from 2004 to April, 2012), and late stage (from May, 2012 to December, 2014). The changes in clinical features and pathological diagnosis of the patients with renal biopsy over the 22 years were analyzed. The published DNT model and JDB model, both based on DR, were validated and compared for diagnostic effectiveness of DN, and the characteristics of the misdiagnosed cases were analyzed.

RESULTS

The incidences of hypertension and DR and levels of glycosylated hemoglobin (HbA1c), creatinine and 24-h urinary protein were all significantly higher, while hemoglobin and triglyceride levels were lower in DN group than in NDRD group (P<0.05). The proportion of NDRD cases increased gradually over time, with IgA nephropathy and membranous nephropathy as the main pathological types. The AUC of JDB model was 0.946, similar to that of NDT model (0.925; P=0.198). The disease course of diabetes, hematuria and incidence of DR were important clinical features affecting the diagnostic accuracy of the models.

CONCLUSION

The clinical features and pathological diagnosis of DR change over time. The non-invasive diagnostic models based on DR have good diagnostic efficacy for DN.

A comparative qualitative assessment of the severity of diabetic retinopathy in patients with stages III, IV and V, requiring hemodialysis, of chronic renal insufficiency

Purpose. Comparative qualitative assessment of the severity of proliferative diabetic vitreoretinopathy (PDR) in patients with stages III, IV and V of chronic renal failure (CRF). Material and methods. 150 patients (64 % women; 36 % men, aged 38 to 79, mean age 61.3 ± 2.3 years) were examined. The patients were divided into three groups, each consisting of 50 subjects (100 eyes), according to the stages of CRF diagnosed in terms of glomerular filtration rate — CRF-3; CRF-4; and CRF-5, the latter requiring hemodialysis (НD). All groups were approximately equally distributed as to age and gender. A total of 11 qualitative indicators were assessed, including the condition of the fundus, the severity of diabetic macular edema, the degree of fibrovascular tissue neovascularization, the spread of traction retinal detachment to the periphery. All examinations were performed by one ophthalmic surgeon (A.S. Golovin) in order to increase the reliability of the qualitative assessment. The following scoring system was used: 1 point— no changes; 2 points — insignificant (weak) changes; 3 points — moderate severity of changes; 4 points — pronounced changes. Results. For all qualitative indicators, the severity of PDR in patients with HD was significantly higher than in patients with CRF-3 or CRF-4. The average severity of clinical manifestations of PDR for all criteria was 2.10 ± 0.27; 2.35 ± 0.30 and 3.21 ± 0.10 points (p < 0.05) for CRF-3; CRF-4 and CRF-5 (HD), respectively. Conclusion. The severity of retinal violations in patients with HD is 36.5–52.9 % higher compared with patients with CRF-4 and CRF-3. Considering the more severe nature of PDR and somatic status of HD patients, it seems expedient to develop an advanced vitrectomy technology for HD patients, its medical maintenance and anesthetic means.

Status and Trends of the Association Between Diabetic Nephropathy and Diabetic Retinopathy From 2000 to 2021: Bibliometric and Visual Analysis

Background: Diabetic nephropathy (DN) and diabetic retinopathy (DR) are microvascular complications of diabetes that share a similar pathogenesis and clinical relevance. The study aimed to visually analyze the research status and development trend of the relationship between DN and DR by means of bibliometrics and knowledge mapping.

Methods: Publications were collected from the Science Citation Index-Expanded of the Web of Science Core Collection between 2000 and 2021. CiteSpace, Alluvial Generator, and Microsoft Excel were used to analyze and present the data.

Results: A total of 3,348 publications were retrieved and 3,285 were included in the analysis after deduplication. The publications demonstrated an annually increasing trend. The results of the collaborative network analysis showed that the United States, Steno Diabetes Center, and Tien Y. Wong were the most influential country, institution and author, in this field of research, respectively. The analysis of references and keywords showed that the pathogenesis of DN and DR and their relationship with cardiovascular disease are research hotspots. The clinical relevance and drug therapy for DN and DR will become frontiers of future research in this field.

Conclusion: This study is the first to visualize the correlation between DN and DR using a bibliometric approach. This study provides a reference of research trends for scholars.

Regulatory role of miRNA-23a in diabetic retinopathy

The present study aimed to investigate the expression of microRNA (miRNA)-23a in blood and tear samples from diabetic retinopathy (DR) patients. Blood and tear samples were obtained from 33 patients with proliferative DR. Additionally, a rat model of DR was established. Reverse transcription-quantitative PCR was used to determine vascular endothelial growth factor (VEGF) mRNA and miRNA-23a expression levels, while ELISA and western blot analysis were performed to determine protein expression levels. Bioinformatics analysis and dual luciferase reporter assay were used to predict and validate the interaction between miRNA-23a and VEGF and cell proliferative ability was assessed with the MTT assay. In comparison to control patients VEGF mRNA and protein expression levels were significantly elevated in the blood and tear samples from patients with DR, while the expression level of miRNA-23a was significantly reduced. In blood and retinal tissues from a rat model of DR, the mRNA and protein expression levels of VEGF were significantly increased, while the miRNA-23a expression level was significantly decreased relative to controls. Dual luciferase reporter assay showed that miRNA-23a bound to the 3'-untranslated region (UTR) of VEGF. Moreover, over-expression of miRNA-23a significantly reduced the expression level of VEGF and the proliferative activity of human retinal microvascular endothelial cells. The elevated VEGF expression in the blood and tears of patients with DR may be related to the reduced miRNA-23a expression. miRNA-23a may regulate microvascular growth at the retina via VEGF and contribute to DR progression.