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Dănilă AI, Ghenciu LA, Stoicescu ER, Bolintineanu SL, Iacob R, Săndesc MA, Faur AC. Aldose Reductase as a Key Target in the Prevention and Treatment of Diabetic Retinopathy: A Comprehensive Review. Biomedicines 2024; 12:747. [PMID: 38672103 PMCID: PMC11047946 DOI: 10.3390/biomedicines12040747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
The escalating global prevalence of diabetes mellitus (DM) over the past two decades has led to a persistent high incidence of diabetic retinopathy (DR), necessitating screening for early symptoms and proper treatment. Effective management of DR aims to decrease vision impairment by controlling modifiable risk factors including hypertension, obesity, and dyslipidemia. Moreover, systemic medications and plant-based therapy show promise in advancing DR treatment. One of the key mechanisms related to DR pathogenesis is the polyol pathway, through which aldose reductase (AR) catalyzes the conversion of glucose to sorbitol within various tissues, including the retina, lens, ciliary body and iris. Elevated glucose levels activate AR, leading to osmotic stress, advanced glycation end-product formation, and oxidative damage. This further implies chronic inflammation, vascular permeability, and angiogenesis. Our comprehensive narrative review describes the therapeutic potential of aldose reductase inhibitors in treating DR, where both synthetic and natural inhibitors have been studied in recent decades. Our synthesis aims to guide future research and clinical interventions in DR management.
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Affiliation(s)
- Alexandra-Ioana Dănilă
- Department of Anatomy and Embriology, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (A.-I.D.); (S.L.B.); (R.I.); (A.C.F.)
| | - Laura Andreea Ghenciu
- Department of Functional Sciences, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Emil Robert Stoicescu
- Doctoral School, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania;
- Field of Applied Engineering Sciences, Specialization Statistical Methods and Techniques in Health and Clinical Research, Faculty of Mechanics, ‘Politehnica’ University Timisoara, Mihai Viteazul Boulevard No. 1, 300222 Timisoara, Romania
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Research Center for Pharmaco-Toxicological Evaluations, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Sorin Lucian Bolintineanu
- Department of Anatomy and Embriology, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (A.-I.D.); (S.L.B.); (R.I.); (A.C.F.)
| | - Roxana Iacob
- Department of Anatomy and Embriology, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (A.-I.D.); (S.L.B.); (R.I.); (A.C.F.)
- Doctoral School, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania;
- Field of Applied Engineering Sciences, Specialization Statistical Methods and Techniques in Health and Clinical Research, Faculty of Mechanics, ‘Politehnica’ University Timisoara, Mihai Viteazul Boulevard No. 1, 300222 Timisoara, Romania
| | - Mihai-Alexandru Săndesc
- Department of Orthopedics and Traumatology, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania;
| | - Alexandra Corina Faur
- Department of Anatomy and Embriology, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (A.-I.D.); (S.L.B.); (R.I.); (A.C.F.)
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Xiao M, Luo G, Zhang Z, Liu Y, Gong R, Ke J. Correlation Between Thyroid-Related Hormones and Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients with Normal Thyroid Function: A Retrospective Study. Diabetes Metab Syndr Obes 2024; 17:1481-1490. [PMID: 38562279 PMCID: PMC10982540 DOI: 10.2147/dmso.s455428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose To investigate the correlation between thyroid-related hormones and diabetic retinopathy (DR) in euthyroid patients with type 2 diabetes mellitus (T2DM). Patients and Methods Patients with T2DM admitted to our hospital between January 2023 and June 2023 were retrospectively analyzed. The patients were divided into DR and non-diabetic retinopathy (NDR) groups according to whether DR occurred. Thyroid function-related hormones (TSH, FT3, and FT4), blood glucose indices (FBG and HbA1c), and blood lipid indices (HDL-C, LDL-C, TC, and TG) of the two groups were analyzed by univariate and multivariate logistic regression to explore the risk factors for DR. Pearson correlation analysis and multiple stepwise regression analysis were used to investigate the correlation of TSH or FT3 with FBG, HbA1c, and TG in DR patients. Results Of the 286 patients with T2DM included in this study, 101 (35.31%) developed DR and 185 (64.69%) did not. High TG, FBG, HbA1c, and TSH and low FT3 levels were independent risk factors for DR in T2DM patients. TSH positively correlated with TG, whereas FT3 negatively correlated with TG and HbA1c in T2DM patients with DR. Conclusion Higher TSH and lower FT3 in T2DM patients with normal thyroid function may affect glucose and lipid metabolism, thereby increasing the risk of DR.
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Affiliation(s)
- Mei Xiao
- Department of Pharmacy, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, People’s Republic of China
| | - Guangwen Luo
- Department of Pharmacy, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, People’s Republic of China
| | - Zhaowei Zhang
- Department of Pharmacy, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, People’s Republic of China
| | - Yanfen Liu
- Department of Endocrinology and Metabolism, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, People’s Republic of China
| | - Rui Gong
- Department of Clinical Laboratory, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, People’s Republic of China
| | - Jianghuan Ke
- Department of Pharmacy, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, 321000, People’s Republic of China
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Wu JY, Hu JY, Ge QM, Xu SH, Zou J, Kang M, Ying P, Wei H, Ling Q, He LQ, Chen C, Shao Y. Ocular microvascular alteration in patients with myocardial infarction-a new OCTA study. Sci Rep 2024; 14:4552. [PMID: 38402285 PMCID: PMC10894220 DOI: 10.1038/s41598-023-50283-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/18/2023] [Indexed: 02/26/2024] Open
Abstract
Myocardial infarction is defined as a sudden decrease or interruption in blood flow to the coronary arteries, causing ischemic necrosis of the corresponding cardiomyocytes. It is unclear whether systemic macrovascular alterations are associated with retinal microvascular changes. This study utilized optical coherence tomography angiography (OCTA) to compare variations in conjunctival vascular density and fundus retinal vessel density between patients with myocardial infarction (MI) and healthy controls. This study recruited 16 patients (32 eyes) with MI and 16 healthy controls (32 eyes). The superficial retinal layer (SRL), deep retinal layer (DRL) and conjunctival capillary plexus in each eye were evaluated by OCTA. Parameters measured included the density of the temporal conjunctival capillary, retinal microvascular (MIR) and macrovascular (MAR) alterations and total MIR (TMI). The microvascular density of each retinal region was evaluated by the hemisphere segmentation (SR, SL, IL, and IR), annular partition (C1, C2, C3, C4, C5 and C6), and modified early treatment of diabetic retinopathy study (R, S, L, and I) methods. In the macular area, the superficial and deep retinal microvascular densities displayed notable variations. In the superficial layers, the superficial TMI, superficial MIR, and superficial MAR, as well as densities in the SL, IL, S, L, C1, C2, C5 and C6 regions, were significantly lower in MI patients (p < 0.05 each). In the deep layers, the deep MIR and deep TMI), as well as densities in the SL, IL, L, C1, C2 and C6 regions were significantly lower in MI patients (p < 0.05 each). In contrast, the conjunctival microvascular density was significantly higher in MI patients than in healthy controls (p < 0.001). The microvascular densities measured in the deep and superficial retinal layers and in the conjunctiva differ in MI patients and healthy controls. OCTA is effective in detecting changes in the ocular microcirculation.
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Affiliation(s)
- Jun-Yi Wu
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Jin-Yu Hu
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, 200030, China
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Qian-Min Ge
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, 200030, China
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - San-Hua Xu
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, 200030, China
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Jie Zou
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, 200030, China
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Min Kang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, 200030, China
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Ping Ying
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, 200030, China
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Hong Wei
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, 200030, China
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Qian Ling
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, 200030, China
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Liang-Qi He
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, 200030, China
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Cheng Chen
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, 200030, China
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Yi Shao
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, 200030, China.
- Department of Ophthalmology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China.
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Wang X, Yang S, Yang G, Lin J, Zhao P, Ding J, Sun H, Meng T, Yang MM, Kang L, Liang Z. Novel risk score model for non-proliferative diabetic retinopathy based on untargeted metabolomics of venous blood. Front Endocrinol (Lausanne) 2023; 14:1180415. [PMID: 37670880 PMCID: PMC10476524 DOI: 10.3389/fendo.2023.1180415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/25/2023] [Indexed: 09/07/2023] Open
Abstract
Background and Purpose Nonproliferative diabetic retinopathy (NPDR) occurs in the early stages of Diabetic retinopathy (DR), and the study of its metabolic markers will help to prevent DR. Hence, we aimed to establish a risk score based on multiple metabolites through untargeted metabolomic analysis of venous blood from NPDR patients and diabetic non-DR patients. Experimental Approach Untargeted metabolomics of venous blood samples from patients with NPDR, diabetes melitus without DR were performed using high-performance liquid chromatography-mass spectrometry. Results Detailed metabolomic evaluation showed distinct clusters of metabolites in plasma samples from patients with NPDR and diabetic non-DR patients. NPDR patients had significantly higher levels of phenylacetylglycine, L-aspartic acid, tiglylglycine, and 3-sulfinato-L-alaninate, and lower level of indolelactic acid, threonic acid, L-arginine (Arg), and 4-dodecylbenzenesulfonic acid compared to control. The expression profiles of these eight NPDR risk-related characteristic metabolites were analyzed using Cox regression to establish a risk score model. Subsequently, univariate and multivariate Cox regression analyses were used to determine that this risk score model was a predictor of independent prognosis for NPDR. Conclusions Untargeted metabolome analysis of blood metabolites revealed unreported metabolic alterations in NPDR patients compared with those in diabetic non-DR patients or MH. In the venous blood, we identified depleted metabolites thA and Arg, indicating that they might play a role in NPDR development.
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Affiliation(s)
- Xinyu Wang
- Department of Geriatrics, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
- Department of Nephrology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Shu Yang
- Department of Geriatrics, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
- Guangdong Provincial Clinical Research Center for Geriatrics, Shenzhen Clinical Research Center for Geriatrics, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, Shenzhen, China
- The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Guangyan Yang
- Department of Geriatrics, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
- Guangdong Provincial Clinical Research Center for Geriatrics, Shenzhen Clinical Research Center for Geriatrics, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, Shenzhen, China
- The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Jialong Lin
- Department of Cardiovascular Medicine, The Fourth Affiliated Hospital of Guangzhou Medical University, Zengcheng District People’s Hospital of Guangzhou, Guangzhou, China
| | - Pengfei Zhao
- Department of Geriatrics, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Jingyun Ding
- Department of Geriatric, Shenzhen Second People’s Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Hongyan Sun
- Department of Ophthalmology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Ting Meng
- Department of Ophthalmology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Ming Ming Yang
- Guangdong Provincial Clinical Research Center for Geriatrics, Shenzhen Clinical Research Center for Geriatrics, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, Shenzhen, China
- The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- Department of Ophthalmology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Lin Kang
- Department of Geriatrics, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
- Guangdong Provincial Clinical Research Center for Geriatrics, Shenzhen Clinical Research Center for Geriatrics, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, Shenzhen, China
- The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- The Biobank of National Innovation Center for Advanced Medical Devices, Shenzhen People’s Hospital, Shenzhen, China
| | - Zhen Liang
- Department of Geriatrics, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
- Guangdong Provincial Clinical Research Center for Geriatrics, Shenzhen Clinical Research Center for Geriatrics, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University, Shenzhen, China
- The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
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Ichsan AM, Bukhari A, Lallo S, Miskad UA, Dzuhry AA, Islam IC, Muhiddin HS. Effect of retinol and α-tocopherol supplementation on photoreceptor and retinal ganglion cell apoptosis in diabetic rats model. Int J Retina Vitreous 2022; 8:40. [PMID: 35715832 PMCID: PMC9205037 DOI: 10.1186/s40942-022-00392-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is the most common microvascular complication of diabetes. Retinol and α-tocopherol of diabetic models prevent the damage of photoreceptor and retinal ganglion cells (RGC) caused by hyperglycemia. OBJECTIVE This study aims to examine the effect of retinol and α-tocopherol on photoreceptor and RGC densities and the expression of caspase-3 and -7 on the retinal layers of the diabetic rat model. METHODS Alloxan 150 mg/kg body weight single dose was used to develop animal models, which were separated into eight groups. These consist of one group without intervention (group 1), one positive control with only induced alloxan (group 2), and others receiving retinol (group 3 and 6), α-tocopherol (group 4 and 7), or their combination (group 5 and 8). Furthermore, histopathological examination was performed using Hematoxylin-Eosin staining to evaluate the photoreceptor and RGC densities, while immunohistochemistry staining evaluated the caspase-3 and -7 expressions. RESULTS In the treatment group, the highest and lowest densities were identified in diabetic rats given α-tocopherol (group 7) and retinol (group 3) respectively. The caspase-3 and -7 expression showed that the group given α-tocopherol (group 7) had the lowest value. CONCLUSION In diabetic rats, retinol and α-tocopherol compounds maintained densities and prevented photoreceptor and RGC death. However, α-tocopherol was more promising than retinol or combinations in the prevention of retinal cells apoptosis.
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Affiliation(s)
- Andi Muhammad Ichsan
- Department of Ophthalmology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Agussalim Bukhari
- Department of Clinical Nutrition, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Subehan Lallo
- Department of Pharmaceutical Science, Faculty of Pharmacy, Hasanuddin University, Makassar, Indonesia
| | - Upik Anderiani Miskad
- Department of Pathology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Andi Afdal Dzuhry
- Department of Ophthalmology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Itzar Chaidir Islam
- Department of Ophthalmology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Wang Q, Zeng N, Tang H, Yang X, Yao Q, Zhang L, Zhang H, Zhang Y, Nie X, Liao X, Jiang F. Diabetic retinopathy risk prediction in patients with type 2 diabetes mellitus using a nomogram model. Front Endocrinol (Lausanne) 2022; 13:993423. [PMID: 36465620 PMCID: PMC9710381 DOI: 10.3389/fendo.2022.993423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study aims to develop a diabetic retinopathy (DR) hazard nomogram for a Chinese population of patients with type 2 diabetes mellitus (T2DM). METHODS We constructed a nomogram model by including data from 213 patients with T2DM between January 2019 and May 2021 in the Affiliated Hospital of Zunyi Medical University. We used basic statistics and biochemical indicator tests to assess the risk of DR in patients with T2DM. The patient data were used to evaluate the DR risk using R software and a least absolute shrinkage and selection operator (LASSO) predictive model. Using multivariable Cox regression, we examined the risk factors of DR to reduce the LASSO penalty. The validation model, decision curve analysis, and C-index were tested on the calibration plot. The bootstrapping methodology was used to internally validate the accuracy of the nomogram. RESULTS The LASSO algorithm identified the following eight predictive variables from the 16 independent variables: disease duration, body mass index (BMI), fasting blood glucose (FPG), glycated hemoglobin (HbA1c), homeostatic model assessment-insulin resistance (HOMA-IR), triglyceride (TG), total cholesterol (TC), and vitamin D (VitD)-T3. The C-index was 0.848 (95% CI: 0.798-0.898), indicating the accuracy of the model. In the interval validation, high scores (0.816) are possible from an analysis of a DR nomogram's decision curve to predict DR. CONCLUSION We developed a non-parametric technique to predict the risk of DR based on disease duration, BMI, FPG, HbA1c, HOMA-IR, TG, TC, and VitD.
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Affiliation(s)
- Qian Wang
- Department of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ni Zeng
- Department of Dermatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hongbo Tang
- Department of Critical Care Medicine, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Xiaoxia Yang
- Department of Integrated (Geriatric) Ward, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qu Yao
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Lin Zhang
- Department of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Han Zhang
- Department of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ying Zhang
- Department of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiaomei Nie
- Department of Ophthalmology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xin Liao
- Department of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- *Correspondence: Xin Liao, ; Feng Jiang,
| | - Feng Jiang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- *Correspondence: Xin Liao, ; Feng Jiang,
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Importance of medication adherence in treatment needed diabetic retinopathy. Sci Rep 2021; 11:19100. [PMID: 34580364 PMCID: PMC8476599 DOI: 10.1038/s41598-021-98488-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/09/2021] [Indexed: 11/29/2022] Open
Abstract
We aim to investigate the role of medication adherence history in treatment needed diabetic retinopathy (TNDR). We conducted a retrospective nested case–control study using 3 population-based databases in Taiwan. The major one was the 2-million-sample longitudinal health and welfare population-based database from 1997 to 2017, a nationally representative random sample of National Health Insurance Administration enrolled beneficiaries in 2010 (LHID2010). The national death registry and national cancer registry were also checked to verify the information. The outcome was defined as the TNDR. The Medication possession ratio (MPR) was defined as the ratio of total days of diabetes mellitus (DM) medication supply divided by total observation days. MPR ≥ 80% was proposed as good medication adherence. The association of MPR and the TNDR was analyzed. Other potential confounders and MPR ratio were also evaluated. A total of (n = 44,628) patients were enrolled. Younger aged, male sex and patients with less chronic illness complexity or less diabetes complication severity tend to have poorer medication adherence. Those with severe comorbidity or participating pay-for-performance program (P4P) revealed better adherence. No matter what the characteristics are, patients with good MPR showed a significantly lower likelihood of leading to TNDR after adjustment with other factors. The protection effect was consistent for up to 5 years. Good medication adherence significantly prevents treatment needed diabetic retinopathy. Hence, it is important to promote DM medication adherence to prevent risks of diabetic retinopathy progression, especially those who opt to have low medication adherence.
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Padakandla SR, Das T, Sai Prashanthi G, Angadi KK, Reddy SS, Reddy GB, Shivaji S. Dysbiosis in the Gut Microbiome in Streptozotocin-Induced Diabetes Rats and Follow-Up During Retinal Changes. Invest Ophthalmol Vis Sci 2021; 62:31. [PMID: 34431974 PMCID: PMC8399471 DOI: 10.1167/iovs.62.10.31] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose To analyze the gut bacterial microbiome of streptozotocin-induced diabetic rats and rats with retinal changes. Methods Induction of diabetes was confirmed by an increase in blood sugar (>150 mg/dL), and the progression of diabetes with retinal changes was assessed by histology and immunohistochemistry of retinal sections. Microbiomes were generated using fecal DNA, and the V3–V4 amplicons were sequenced and analyzed by QIIME and R. Results Dysbiosis in the gut microbiome of diabetic rats and diabetic rats with retinal changes was observed at the phylum and genus levels compared with the control rats. Heat-map analysis based on the differentially abundant genera indicated that the microbiomes of controls and diabetic rats separated into two distinct clusters. The majority of the microbiomes in diabetic rats with retinal changes also formed a distinct cluster from the control rats. β-diversity analysis separated the microbiome of control rats from the microbiome of diabetic rats and diabetic rats with retinal changes, but the microbiomes of diabetic rats and diabetic rats with retinal changes showed an overlap. Functional analysis indicated that the enhanced inflammation in diabetic rats showing retinal changes could be ascribed to a decrease in anti-inflammatory bacteria and an increase in pathogenic and proinflammatory bacteria. Conclusions This study showed that the gut bacterial microbiome in diabetic rats with retinal changes was different compared with control rats. The results could help develop novel therapeutics for diabetics and diabetic individuals with retinal changes.
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Affiliation(s)
- Shalem Raj Padakandla
- Prof Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Taraprasad Das
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Gumpili Sai Prashanthi
- Prof Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Kiran Kumar Angadi
- Biochemistry Division, ICMR-National Institute of Nutrition, Hyderabad, Telangana, India
| | - S Sreenivasa Reddy
- Biochemistry Division, ICMR-National Institute of Nutrition, Hyderabad, Telangana, India
| | - G Bhanuprakash Reddy
- Biochemistry Division, ICMR-National Institute of Nutrition, Hyderabad, Telangana, India
| | - Sisinthy Shivaji
- Prof Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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Rhee SY, Jung ES, Suh DH, Jeong SJ, Kim K, Chon S, Yu SY, Woo JT, Lee CH. Plasma amino acids and oxylipins as potential multi-biomarkers for predicting diabetic macular edema. Sci Rep 2021; 11:9727. [PMID: 33958610 PMCID: PMC8102569 DOI: 10.1038/s41598-021-88104-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/06/2021] [Indexed: 11/09/2022] Open
Abstract
To investigate the pathophysiologic characteristics of diabetic complications, we identified differences in plasma metabolites in subjects with type 2 diabetes (T2DM) with or without diabetic macular edema (DME) and a disease duration > 15 years. An cohort of older T2DM patients with prolonged disease duration was established, and clinical information and biospecimens were collected following the guidelines of the National Biobank of Korea. DME phenotypes were identified by ophthalmologic specialists. For metabolomics studies, propensity matched case and control samples were selected. To discover multi-biomarkers in plasma, non-targeted metabolite profiling and oxylipin profiling in the discovery cohort were validated in an extended cohort. From metabolomic studies, 5 amino acids (asparagine, aspartic acid, glutamic acid, cysteine, and lysine), 2 organic compounds (citric acid and uric acid) and 4 oxylipins (12-oxoETE, 15-oxoETE, 9-oxoODE, 20-carboxy leukotriene B4) were identified as candidate multi-biomarkers which can guide DME diagnosis among non-DME subjects. Receiver operating characteristic curves revealed high diagnostic value of the combined 5 amino acids and 2 organic compounds (AUC = 0.918), and of the 4 combined oxylipins (AUC = 0.957). Our study suggests that multi-biomarkers may be useful for predicting DME in older T2DM patients.
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Affiliation(s)
- Sang Youl Rhee
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Eun Sung Jung
- Department of Systems Biotechnology, Konkuk University, Seoul, Republic of Korea
| | - Dong Ho Suh
- Department of Bioscience and Biotechnology, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, Republic of Korea
| | - Su Jin Jeong
- Statistics Support Department, Kyung Hee University Medical Center Medical Science Research Institute, Seoul, Republic of Korea
| | - Kiyoung Kim
- Department of Ophthalmology, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Jeong-Taek Woo
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
| | - Choong Hwan Lee
- Department of Systems Biotechnology, Konkuk University, Seoul, Republic of Korea.
- Department of Bioscience and Biotechnology, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, Republic of Korea.
- Research Institute for Bioactive-Metabolome Network, Konkuk University, Seoul, Republic of Korea.
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10
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Dietary glutamic acid and aspartic acid as biomarkers for predicting diabetic retinopathy. Sci Rep 2021; 11:7244. [PMID: 33790305 PMCID: PMC8012375 DOI: 10.1038/s41598-021-83165-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/20/2021] [Indexed: 11/25/2022] Open
Abstract
The screening rate of diabetic retinopathy (DR) is low despite the importance of early diagnosis. We investigated the predictive value of dietary glutamic acid and aspartic acid for diagnosis of DR using the Korea National Diabetes Program cohort study. The 2067 patients with type 2 diabetes without DR were included. The baseline intakes of energy, glutamic acid and aspartic acid were assessed using a 3-day food records. The risk of DR incidence based on intake of glutamic acid and aspartic acid was analyzed. The DR group was older, and had higher HbA1c, longer DM duration, lower education level and income than non-DR group (all p < 0.05). The intake of total energy, glutamic acid and aspartic acid were lower in DR group than non-DR group (p = 0.010, p = 0.025 and p = 0.042, respectively). There was no difference in the risk of developing DR according to the intake of glutamic acid and ascorbic acid. But, aspartic acid intake had a negative correlation with PDR. Hence, the intake of glutamic acid and aspartic acid did not affect in DR incidence. However, lower aspartic acid intake affected the PDR incidence.
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11
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Zewdie KA, Ayza MA, Amare Tesfaye B, Yimer EM. Targeting Netrin-1 and -4 as a Novel Diagnostic Parameter and Treatment Option for Diabetic Retinopathy. Clin Ophthalmol 2020; 14:1741-1747. [PMID: 32612349 PMCID: PMC7323811 DOI: 10.2147/opth.s258044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/16/2020] [Indexed: 12/17/2022] Open
Abstract
Diabetic retinopathy (DR) is a retinal vascular disorder associated with both type 1 and type 2 diabetes mellitus (DM). It is characterized by specific loss of pericytes, which leads to an augmented blood vessel permeability, and development of new blood vessels (retinal neovascularization). Moreover, stiffening of eye membrane, inflammation, and apoptosis of endothelial cells also lead to damage of the blood-retinal barrier and blindness in most cases unless it's detected and managed early. Hence, this review was intended to assess the potential roles of Netrin-1 and -4 as new/alternative biomarkers and therapeutic options for DR. Netrin-1 and -4 have been the most known ligands and are well known for their role in neural guidance. DR has both neural and vascular components; therefore, biomarkers used for both neural and vascular retinal tissues are potentially important. According to different experimental and clinical studies, as compared to the normal groups, there was a significant increment in both retinal Netrin-1 and -4 mRNA and protein levels in the retinopathy groups. In addition, exogenous supplementation of these proteins is also used as a therapeutic agent for DR.
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Affiliation(s)
- Kaleab Alemayehu Zewdie
- Department of Pharmacology and Toxicology, School of Pharmacy, Mekelle University, Mekelle, Ethiopia
| | - Muluken Altaye Ayza
- Department of Pharmacology and Toxicology, School of Pharmacy, Mekelle University, Mekelle, Ethiopia
| | - Bekalu Amare Tesfaye
- Department of Pharmacology and Toxicology, School of Pharmacy, Mekelle University, Mekelle, Ethiopia
| | - Ebrahim M Yimer
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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12
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Moosaie F, Davatgari RM, Firouzabadi FD, Esteghamati S, Deravi N, Meysamie A, Khaloo P, Nakhjavani M, Esteghamati A. Lipoprotein(a) and Apolipoproteins as Predictors for Diabetic Retinopathy and Its Severity in Adults With Type 2 Diabetes: A Case-Cohort Study. Can J Diabetes 2020; 44:414-421. [PMID: 32205075 DOI: 10.1016/j.jcjd.2020.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/15/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Our aim in this study was to assess the relationship between serum lipoprotein(a) [Lp(a)] and apolipoproteins and the risk of developing diabetic retinopathy (DR). METHODS One thousand fifty-seven patients with type 2 diabetes were divided into 2 main groups and followed for 5 years: 637 patients without DR and 420 patients with DR. A group of patients with DR were then divided into 2 subgroups: 162 patients with nonproliferative DR (NPDR) and 163 patients with proliferative DR (PDR). The association between serum Lp(a) and apolipoproteins with NPDR and PDR was assessed using univariate and multivariate regression analyses. Receiver-operating characteristic curve analysis was performed based on the new cutoff values. RESULTS There was a positive relationship between Lp(a) and the presence of DR as well as a negative correlation between ApoA and DR (p<0.001 and p=0.03, respectively). We also found a positive association between ApoB and the severity of DR (p=0.008). ApoA1 had an area under the curve of 55.0% for the prediction of DR. The calculated cutoff values of ApoB/ApoA1 ratio (0.58 g/L) and ApoB (77.5 g/L) in detection of DR were lower than their standard cutoff values of 0.8 and 90 g/L, respectively. Also, the sensitivity of new cutoff values for ApoB and ApoB/ApoA1 ratio was higher than the standard value, but the specificity of the standard cutoff values for both was higher than our new cutoff value. CONCLUSIONS Serum Lp(a) and ApoA1 levels were independently associated with DR, and serum ApoB correlated with severity of DR. These measurements can be used for assessment and early treatment of this vision-threatening complication of diabetes.
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Affiliation(s)
- Fatemeh Moosaie
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Mohamadhosseinzadeh Davatgari
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Dehghani Firouzabadi
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf Esteghamati
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloofar Deravi
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alipasha Meysamie
- Department of Community Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Khaloo
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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13
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Wang JR, Chen Z, Yang K, Yang HJ, Tao WY, Li YP, Jiang ZJ, Bai CF, Yin YC, Duan JM, Zhou YY, Geng XQ, Yang Y. Association between neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and diabetic retinopathy among diabetic patients without a related family history. Diabetol Metab Syndr 2020; 12:55. [PMID: 32636938 PMCID: PMC7331251 DOI: 10.1186/s13098-020-00562-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/24/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is a specific neurovascular complication of diabetes mellitus (DM). Clinically, family history is a widely recognized risk factor for DR, assisting diagnosis and risk strata. However, among a great amount of DR patients without hereditary history like hypertension and diabetes, direct and simple risk factors to assist clinical decisions are still required. Herein, we intend to investigate the associated risk factors for these DR patients based on systemic inflammatory response indexes, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). METHODS We consecutively enrolled 1030 patients with a definite diagnosis of type 2 diabetes mellitus (T2DM) from the endocrinology department of the Second hospital of People in Yun Nan. Based on funduscopy and family history checking, we excluded patients with a family history of hypertension and diabetes and finally enrolled 264 patients with DR and 206 patients with non-diabetic retinopathy (NDR). Through correlation analysis, univariate and multivariate regression, we further explore the association between NLR, PLR, and DR. On top of that, we investigate the effect of NLR and PLR on risk reclassification of DR. RESULTS Compared with NDR patients, NLR and PLR levels are significantly higher among DR patients (NLR: 2.36 ± 1.16 in DR group versus 1.97 ± 1.06 in NDR group, p < 0.001; PLR: 11.62 ± 4.55 in DR group versus10.56 ± 4.45 in NDR group, p = 0.012). According to univariate analysis, NLR and PLR add risks to DR. After fully adjusting co-founders, NLR, as both continuous and categorical variate, remains an independent risk factor for DR (OR (95%CI): 1.37 (1.06, 1.78) P = 0.018). And though PLR was not independently associated with DR as a continuous variable (OR (95%CI) 1.05 (0.99, 1.11) p = 0.135), the highest quantile of PLR add two-fold increased risk (OR (95%CI) 2.20 (1.05, 4.59) p = 0.037) in the fully adjusted model for DR. In addition, addition of PLR and NLR to the established factor hemoglobin (Hb) improved the discriminability of the model and assisted the reclassification of DR. After combining PLR and NLR the Area under curve (AUC) of Hb based model raised from 0.76 to 0.78, with a category-free net reclassification improvement (NRI) of 0.532 (p < 0.001) and integrated discrimination improvement (IDI) of 0.029 (p < 0.001). CONCLUSIONS Systemic inflammatory response indexes NLR and PLR were associated with the presence of DR among patients without associated family history and contributed to improvements in reclassification of DR in addition to Hb.
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Affiliation(s)
- Jin-Rui Wang
- Department of Endocrinology and Metabolism, The Second People’s Hospital of Yunnan Province, Fourth Affiliated Hospital of Kunming Medical University, Kunming, 650021 China
| | - Zhongli Chen
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 200001 Shanghai, China
| | - Ke Yang
- Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 200001 Shanghai, China
| | - Hui-Jun Yang
- Department of Endocrinology and Metabolism, The Second People’s Hospital of Yunnan Province, Fourth Affiliated Hospital of Kunming Medical University, Kunming, 650021 China
| | - Wen-Yu Tao
- Department of Endocrinology and Metabolism, The Second People’s Hospital of Yunnan Province, Fourth Affiliated Hospital of Kunming Medical University, Kunming, 650021 China
| | - Yi-Ping Li
- Department of Endocrinology and Metabolism, The Second People’s Hospital of Yunnan Province, Fourth Affiliated Hospital of Kunming Medical University, Kunming, 650021 China
| | - Ze-Jia Jiang
- The Second People’s Hospital of Qujing City, Yunnan Qujing, 655000 China
| | - Chao-Fang Bai
- Department of Endocrinology and Metabolism, The Second People’s Hospital of Yunnan Province, Fourth Affiliated Hospital of Kunming Medical University, Kunming, 650021 China
| | - Yue-Chuan Yin
- Department of Endocrinology and Metabolism, The Second People’s Hospital of Yunnan Province, Fourth Affiliated Hospital of Kunming Medical University, Kunming, 650021 China
| | - Jian-Mei Duan
- Department of Endocrinology and Metabolism, The Second People’s Hospital of Yunnan Province, Fourth Affiliated Hospital of Kunming Medical University, Kunming, 650021 China
| | - Yuan-Yuan Zhou
- Department of Endocrinology and Metabolism, The Second People’s Hospital of Yunnan Province, Fourth Affiliated Hospital of Kunming Medical University, Kunming, 650021 China
| | - Xin-Qian Geng
- Department of Endocrinology and Metabolism, The Second People’s Hospital of Yunnan Province, Fourth Affiliated Hospital of Kunming Medical University, Kunming, 650021 China
| | - Ying Yang
- Department of Endocrinology and Metabolism, The Second People’s Hospital of Yunnan Province, Fourth Affiliated Hospital of Kunming Medical University, Kunming, 650021 China
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14
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Zarranz-Ventura J, Barraso M, Alé-Chilet A, Hernandez T, Oliva C, Gascón J, Sala-Puigdollers A, Figueras-Roca M, Vinagre I, Ortega E, Esmatjes E, Adan A. Evaluation of microvascular changes in the perifoveal vascular network using optical coherence tomography angiography (OCTA) in type I diabetes mellitus: a large scale prospective trial. BMC Med Imaging 2019; 19:91. [PMID: 31752726 PMCID: PMC6873669 DOI: 10.1186/s12880-019-0391-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/25/2019] [Indexed: 02/01/2023] Open
Abstract
Background Diabetic retinopathy (DR) is the leading cause of blindness in type 1 Diabetes Mellitus (DM) patients, as a consequence of impaired blood flow in the retina. Optical coherence tomography angiography (OCTA) is a newly developed, non-invasive, retinal imaging technique that permits adequate delineation of the perifoveal vascular network. It allows the detection of paramacular areas of capillary non perfusion and/or enlargement of the foveal avascular zone (FAZ), representing an excellent tool for assessment of DR. The relationship of these microvascular changes with systemic factors such as metabolic control or duration of the disease still needs to be elucidated. Methods Prospective, consecutive, large-scale OCTA study. A complete ocular examination including a comprehensive series of OCTA images of different scan sizes captured with 2 OCT devices (Cirrus HD-OCT, Carl Zeiss Meditec, Dublin, CA, USA, and Triton Deep Range Imaging OCT, Topcon Corp, Topcon, Japan) will be obtained as part of the yearly routine follow up visits in type 1 DM patients seen in the Diabetes Unit of the Endocrinology department which give written informed consent to participate in the project. The aim of this study is to investigate the relationship between OCTA-derived parameters and systemic factors, as metabolic control (Hb1Ac, lipid profile, cholesterol, etc), and other relevant clinical factors as demographics or duration of the disease. Discussion This study is directed to investigate the relationship between the status of the perifoveal vascular network and systemic markers of the disease, and in particular to study whether these changes reflect those occurring elsewhere in the body affected by diabetic microvascular disease, as the kidneys or the brain. If these relationships were demonstrated, early detection of these microvascular changes by OCTA could lead to modifications in the pharmacological management of type 1 diabetic patients, as a way to reduce the risk of future complications in both the eye and other organs. Trial registration ClinicalTrials.gov, trial number NCT03422965.
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Affiliation(s)
- Javier Zarranz-Ventura
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain. .,Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Marina Barraso
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Anibal Alé-Chilet
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Teresa Hernandez
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Cristian Oliva
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Jesus Gascón
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Anna Sala-Puigdollers
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marc Figueras-Roca
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Irene Vinagre
- Diabetes Unit, Institut Clínic de Malalties Digestives i Metaboliques (ICMDM), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Emilio Ortega
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Diabetes Unit, Institut Clínic de Malalties Digestives i Metaboliques (ICMDM), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Enric Esmatjes
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Diabetes Unit, Institut Clínic de Malalties Digestives i Metaboliques (ICMDM), Hospital Clinic de Barcelona, Barcelona, Spain
| | - Alfredo Adan
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic de Barcelona, C/ Sabino Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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15
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Liang J, Lei W, Cheng J. Correlations of blood lipids with early changes in macular thickness in patients with diabetes. J Fr Ophtalmol 2019; 42:276-280. [PMID: 30736987 DOI: 10.1016/j.jfo.2018.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE This study aimed to investigate the correlations of blood lipids with changes in macular volume and thickness in patients with diabetes. METHODS Central subfield macular thickness (CSMT) and central subfield macular volume (CSMV) were measured in 85 patients with type 2 diabetes (DM2) using spectral-domain optical coherence tomography (SD-OCT). In addition, serum creatinine (Cr), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), glycated hemoglobin (HbA1c), and proteinuria were measured in all patients. RESULTS The mean CSMT of the 85 patients was 272.8±16.9μm, and CSMV was 215.1±14.6×10-3mm3. TC, LDLC, HbA1c, and proteinuria were closely correlated to CSMT, and HDLC, HbA1c, and proteinuria were correlated to CSMV. After adjustment for sex, age, DM2 course, proteinuria, and HbA1c, LDLC was significantly correlated to CSMT (95% confidence interval (CI), 1.93-11.05, P=0.008) and CSMV (95% CI, 0.92-8.41, P=0.021); however, HDLC, TC, and TG showed no significant correlation with CSMT or CSMV. CONCLUSIONS Increased LDLC was closely correlated to changes in CSMT and CSMV in early diabetic patients, and increased CSMT was also accompanied by increased LDLC; therefore, this type of patient would be more likely to develop macular edema.
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Affiliation(s)
- J Liang
- Department of Ophthalmology, Central Hospital of Linyi, Linyi 276400, Shandong, China
| | - W Lei
- Department of Ophthalmology, Central Hospital of Linyi, Linyi 276400, Shandong, China
| | - J Cheng
- Department of Ophthalmology, Central Hospital of Linyi, Linyi 276400, Shandong, China.
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16
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Wang L, Zhou X, Yin Y, Mai Y, Wang D, Zhang X. Hyperglycemia Induces Neutrophil Extracellular Traps Formation Through an NADPH Oxidase-Dependent Pathway in Diabetic Retinopathy. Front Immunol 2019; 9:3076. [PMID: 30671057 PMCID: PMC6331470 DOI: 10.3389/fimmu.2018.03076] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 12/12/2018] [Indexed: 02/05/2023] Open
Abstract
Neutrophil extracellular traps (NETs), the product of NETosis, is found to localize pathogens and crystals in immune response. Recent studies have found that excessive NETs lead to disease conditions such as diabetes and its complications like diabetic retinopathy (DR). However, the correlation between NETs and high glucose or DR remains unclear. Here, we found NETs level was significantly increased in the serum of diabetic patients, especially in proliferation diabetic retinopathy (PDR) patients. High glucose dramatically increased NETs production in diabetic individuals with time prolonging. The activation of NADPH oxidase was involved in the NETs process which is triggered by high glucose. Moreover, we verified the infiltration of neutrophils in the eyes and adhesion to vascular endothelial cells in diabetic rat models. NETs formation was observed in the vitreous bodies and retinas of diabetic individuals, which indicates NETs may play a role in the pathogenesis of diabetic retinopathy. Furthermore, anti-VEGF therapy downregulates NETs production indicating that NADPH oxidase-derived ROS may be another signaling pathway involved in anti-VEGF therapy.
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Affiliation(s)
- Luoziyi Wang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Xin Zhou
- Laboratory of Stem Cell Biology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yizhou Yin
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Yuxin Mai
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Desai Wang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Xuedong Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, China
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17
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Mugisho OO, Rupenthal ID, Squirrell DM, Bould SJ, Danesh-Meyer HV, Zhang J, Green CR, Acosta ML. Intravitreal pro-inflammatory cytokines in non-obese diabetic mice: Modelling signs of diabetic retinopathy. PLoS One 2018; 13:e0202156. [PMID: 30133488 PMCID: PMC6105000 DOI: 10.1371/journal.pone.0202156] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/27/2018] [Indexed: 12/22/2022] Open
Abstract
Diabetic retinopathy is a vascular disease of the retina characterised by hyperglycaemic and inflammatory processes. Most animal models of diabetic retinopathy are hyperglycaemia-only models that do not account for the significant role that inflammation plays in the development of the disease. In the present study, we present data on the establishment of a new animal model of diabetic retinopathy that incorporates both hyperglycaemia and inflammation. We hypothesized that inflammation may trigger and worsen the development of diabetic retinopathy in a hyperglycaemic environment. Pro-inflammatory cytokines, IL-1β and TNF-α, were therefore injected into the vitreous of non-obese diabetic (NOD) mice. CD1 mice were used as same genetic background controls. Fundus and optical coherence tomography images were obtained before (day 0) as well as on days 2 and 7 after intravitreal cytokine injection to assess vessel dilation and beading, retinal and vitreous hyper-reflective foci and retinal thickness. Astrogliosis and microgliosis were assessed using immunohistochemistry. Results showed that intravitreal cytokines induced vessel dilation, beading, severe vitreous hyper-reflective foci, retinal oedema, increased astrogliosis and microglia upregulation in diabetic NOD mice. Intravitreal injection of inflammatory cytokines into the eyes of diabetic mice therefore appears to provide a new model of diabetic retinopathy that could be used for the study of disease progression and treatment strategies.
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Affiliation(s)
- Odunayo O. Mugisho
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology and the New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology and the New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Ilva D. Rupenthal
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology and the New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology and the New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - David M. Squirrell
- Department of Ophthalmology and the New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Sarah J. Bould
- Department of Ophthalmology and the New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Helen V. Danesh-Meyer
- Department of Ophthalmology and the New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Jie Zhang
- Department of Ophthalmology and the New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Colin R. Green
- Department of Ophthalmology and the New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Monica L. Acosta
- School of Optometry and Vision Science and the New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
- * E-mail:
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18
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Chua J, Chia AR, Chee ML, Man REK, Tan GSW, Lamoureux EL, Wong TY, Chong MFF, Schmetterer L. The relationship of dietary fish intake to diabetic retinopathy and retinal vascular caliber in patients with type 2 diabetes. Sci Rep 2018; 8:730. [PMID: 29335432 PMCID: PMC5768794 DOI: 10.1038/s41598-017-18930-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/18/2017] [Indexed: 12/29/2022] Open
Abstract
In this cross-sectional study, we evaluated the association of dietary fish intake with varying severity of diabetic retinopathy (DR) and retinal vascular caliber in Asians with type 2 diabetes mellitus. 357 Asians (median age: 58 years; 31% women; 78% Chinese) were recruited from a tertiary eye care institution in Singapore. Fish consumption was evaluated using a validated food frequency questionnaire. Digital retinal photographs assessed for DR severity and retinal vascular caliber. Ordered logistic and linear regression models were used to investigate the association of fish intake with DR severity and vascular caliber. Increasing frequency of fish consumption was significantly associated with lower odds of having severe DR (odds ratio [OR] = 0.91, 95% CI: 0.84–0.99 per 1-unit increase of fish intake; P = 0.038). Among those with no retinopathy, persons in quartile 4 fish intake had a wider retinal vascular caliber for arteriolar (β = 22.27 µm, 95% CI: 12.64–31.90; P-trend < 0.001) and venular (β = 32.00 µm, 95% CI: 17.56–46.43; P-trend < 0.001), than those in quartile 1 fish intake. Persons with higher fish intake had a decreased likelihood of having severe DR. In diabetics without retinopathy, higher fish intake was associated with wider retinal vascular caliber. Future research is needed to reinforce the direction of the casualty.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ai-Ru Chia
- Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Miao Li Chee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Ryan Eyn Kidd Man
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.,Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore. .,Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria. .,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Wien, Austria.
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19
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Rabiolo A, Cicinelli MV, Corbelli E, Baldin G, Carnevali A, Lattanzio R, Querques L, Bandello F, Querques G. Correlation Analysis between Foveal Avascular Zone and Peripheral Ischemic Index in Diabetic Retinopathy: A Pilot Study. ACTA ACUST UNITED AC 2018; 2:46-52. [DOI: 10.1016/j.oret.2017.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 05/10/2017] [Accepted: 05/17/2017] [Indexed: 12/27/2022]
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20
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Rhee SY, Jung ES, Park HM, Jeong SJ, Kim K, Chon S, Yu SY, Woo JT, Lee CH. Plasma glutamine and glutamic acid are potential biomarkers for predicting diabetic retinopathy. Metabolomics 2018; 14:89. [PMID: 29950956 PMCID: PMC6013531 DOI: 10.1007/s11306-018-1383-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/06/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Diabetic patients with a long disease duration usually accompanied complication such as diabetic retinopathy, but in some patients had no complication. OBJECTIVES We analyzed differences in plasma metabolites according to the presence or absence of diabetic retinopathy (DR) in type 2 diabetic (T2D) patients with disease duration ≥ 15 years. METHODS A cohort of 183 T2D patients was established. Their biospecimens and clinical information were collected in accordance with the guidelines of the National Biobank of Korea, and the Korean Diabetes Association. DR phenotypes of the subjects were verified by ophthalmologic specialists. Plasma metabolites were analyzed using gas chromatography time-of-flight mass spectrometry and ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry. And these results were analyzed using multivariate statistics. RESULTS For metabolomic study, propensity score matched case and control subjects were chosen. Mean age of the subjects was 66.4 years and mean T2D duration was 22.2 years. Metabolomic identification revealed various carbohydrates, amino acids, and organic compounds that distinguished between age- and sex-matched non-diabetic controls and T2D subjects. Among these, glutamine and glutamic acid were suggested as the most distinctive metabolites for the presence of DR. Receiver operating characteristics curves showed an excellent diagnostic value of combined (AUC = 0.739) and the ratio (AUC = 0.742) of glutamine and glutamic acid for DR. And these results were consistent in validation analyses. CONCLUSION Our results imply that plasma glutamine, glutamic acid, and their ratio may be valuable as novel biomarkers for anticipating DR in T2D subjects.
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Affiliation(s)
- Sang Youl Rhee
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Eun Sung Jung
- Department of Systems Biotechnology, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, Republic of Korea
| | - Hye Min Park
- Department of Systems Biotechnology, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, Republic of Korea
| | - Su Jin Jeong
- Statistics Support Department, Kyung Hee University Medical Center Medical Science Research Institute, Seoul, Republic of Korea
| | - Kiyoung Kim
- Department of Ophthalmology, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Suk Chon
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Jeong-Taek Woo
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
| | - Choong Hwan Lee
- Department of Systems Biotechnology, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, Republic of Korea.
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21
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Yun JS. Letter: Features of Long-Standing Korean Type 2 Diabetes Mellitus Patients with Diabetic Retinopathy: A Study Based on Standardized Clinical Data (Diabetes Metab J 2017;41:393-404). Diabetes Metab J 2017; 41:492-493. [PMID: 29272084 PMCID: PMC5741559 DOI: 10.4093/dmj.2017.41.6.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jae Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
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22
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Mastropasqua R, Toto L, Mastropasqua A, Aloia R, De Nicola C, Mattei PA, Di Marzio G, Di Nicola M, Di Antonio L. Foveal avascular zone area and parafoveal vessel density measurements in different stages of diabetic retinopathy by optical coherence tomography angiography. Int J Ophthalmol 2017; 10:1545-1551. [PMID: 29062774 DOI: 10.18240/ijo.2017.10.11] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/28/2017] [Indexed: 02/07/2023] Open
Abstract
AIM To investigate foveal avascular zone (FAZ) and parafoveal vessel densities (PRVD) by means of optical coherence tomography angiography (OCTA) in diabetic patients with or without diabetic retinopathy (DR) and to assess the reproducibility of FAZ and PRVD measurements. METHODS Sixty diabetic patients (60 eyes) with different stage of DR (graded according to the International Clinical Severity Scale for DR) and 20 healthy subjects underwent FAZ area and PRVD measurements using OCTA by two experienced examiners. FAZ area in all patients was also assessed using fluorescein angiography (FA). RESULTS In subject with proliferative DR and with moderate-severe non proliferative DR, FAZ area was significantly increased compared to healthy controls (P=0.025 and P=0.050 respectively measured with OCTA and P=0.025 and P=0.048 respectively measured with FA). OCTA showed significantly less inter-observer variability compared to FA. Concordance correlation coefficient (CCC) for FAZ area measurements was 0.829 (95%CI: 0.736-0.891) P<0.001 with FA and 1.000 (95%CI: 0.999-1.000) P<0.001 with OCTA. CCC was 0.834 (95%CI: 0.746-0.893) P<0.001 and 0.890 (95%CI: 0.828-0.930) P<0.001 for parafoveal superficial and deep vessel density measurements, respectively. CONCLUSION OCTA shows progressive increase of FAZ area and reduction of PRVD in both superficial and deep plexus at increasing DR severity. FAZ area and PRVD measurements using OCTA are highly reproducible.
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Affiliation(s)
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara, Chieti 66100, Italy
| | - Alessandra Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara, Chieti 66100, Italy
| | - Raffaella Aloia
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara, Chieti 66100, Italy
| | - Chiara De Nicola
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara, Chieti 66100, Italy
| | - Peter A Mattei
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara, Chieti 66100, Italy
| | - Guido Di Marzio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara, Chieti 66100, Italy
| | - Marta Di Nicola
- Department of Experimental and Clinical Sciences, Laboratory of Biostatistics, University G. d'Annunzio Chieti-Pescara, Chieti 66100, Italy
| | - Luca Di Antonio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara, Chieti 66100, Italy
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Clinical Characteristics of Patients with Newly Diagnosed Diabetic Macular Edema in Turkey: A Real-Life Registry Study-TURK-DEM. J Ophthalmol 2017; 2017:3596817. [PMID: 28316835 PMCID: PMC5337790 DOI: 10.1155/2017/3596817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 01/19/2017] [Indexed: 12/18/2022] Open
Abstract
Purpose. To evaluate the clinical and diagnostic characteristics of patients with newly diagnosed diabetic macular edema (DME) in Turkey in a real-life setting. Methods. A total of 945 consecutive patients (mean (SD) age: 61.3 (9.9) years, 55.2% male) with newly diagnosed DME were included. Data on patient demographics, comorbidities, ocular history, ophthalmic examination findings including type of DME, central macular thickness (CMT) via time domain (TD) and spectral domain (SD) optical coherence tomography (OCT), and planned treatments were recorded. Results. OCT (98.8%) and fundoscopy (92.9%) were the two most common diagnostic methods. Diffuse and focal DMEs were detected in 39.2% and 36.9% of cases, respectively. Laser photocoagulation (32.1%) and antivascular endothelial growth factors (anti-VEGF; 31.8%) were the most commonly planned treatments. The median CMT in the right eye was significantly greater in untreated than in treated patients [376.5 μm (range: 160–840) versus 342 μm (range: 146–999) (p = 0.002)] and in the left eye [370 μm (range: 201–780) versus 329 μm (range: 148–999) (p < 0.001)]. Conclusions. This study is the first large-scale real-life registry of DME patients in Turkey. SD-OCT and fundoscopy were the most common diagnostic methods. Laser photocoagulation and anti-VEGF therapy were the most common treatments.
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Lin X, Wang J, Yun L, Jiang S, Li L, Chen X, Li Z, Lu Q, Zhang Y, Ma X. Association betweenLEKR1-CCNL1andIGSF21-KLHDC7Agene polymorphisms and diabetic retinopathy of type 2 diabetes mellitus in the Chinese Han population. J Gene Med 2016; 18:282-287. [PMID: 27607899 DOI: 10.1002/jgm.2926] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/21/2016] [Accepted: 09/06/2016] [Indexed: 12/16/2022] Open
Affiliation(s)
- Xiaohui Lin
- Department of Ophthalmology; The Inner Mongolia Autonomous Region People's Hospital; Hohhot China
| | - Jihong Wang
- Department of Hand and Microsurgery II; the Second Affiliated Hospital of Inner Mongolia Medical University; Hohhot China
| | - Lixia Yun
- Department of Ophthalmology; The Inner Mongolia Autonomous Region People's Hospital; Hohhot China
| | - Shuhong Jiang
- Department of Ophthalmology; The Inner Mongolia Autonomous Region People's Hospital; Hohhot China
| | - Langen Li
- Department of Ophthalmology; The Inner Mongolia Autonomous Region People's Hospital; Hohhot China
| | - Xiaohai Chen
- Department of Ophthalmology; The Inner Mongolia Autonomous Region People's Hospital; Hohhot China
| | - Zhen Li
- Department of Ophthalmology; The Inner Mongolia Autonomous Region People's Hospital; Hohhot China
| | - Qiang Lu
- Department of Ophthalmology; The Inner Mongolia Autonomous Region People's Hospital; Hohhot China
| | - Yihui Zhang
- Department of Ophthalmology; The Inner Mongolia Autonomous Region People's Hospital; Hohhot China
| | - Xiaocheng Ma
- Department of Ophthalmology; The Inner Mongolia Autonomous Region People's Hospital; Hohhot China
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25
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Amadio M, Pascale A, Cupri S, Pignatello R, Osera C, D Agata V, D Amico AG, Leggio GM, Ruozi B, Govoni S, Drago F, Bucolo C. Nanosystems based on siRNA silencing HuR expression counteract diabetic retinopathy in rat. Pharmacol Res 2016; 111:713-720. [PMID: 27475885 DOI: 10.1016/j.phrs.2016.07.042] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/20/2016] [Accepted: 07/26/2016] [Indexed: 12/14/2022]
Abstract
We evaluated whether specifically and directly targeting human antigen R (HuR), a member of embryonic lethal abnormal vision (ELAV) proteins family, may represent a new potential therapeutic strategy to manage diabetic retinopathy. Nanosystems loaded with siRNA silencing HuR expression (lipoplexes), consisting of solid lipid nanoparticles (SLN) and liposomes (SUV) were prepared. Photon correlation spectroscopy analysis, Zeta potential measurement and atomic force microscopy (AFM) studies were carried out to characterize the complexation of siRNA with the lipid nanocarriers. Nanosystems were evaluated by using AFM and scanning electron microscopy. The lipoplexes were injected into the eye of streptozotocin (STZ)-induced diabetic rats. Retinal HuR and VEGF levels were detected by Western blot and ELISA, respectively. Retinal histology was also carried out. The results demonstrated that retinal HuR and VEGF are significantly increased in STZ-rats and are blunted by HuR siRNA treatment. Lipoplexes with a weak positive surface charge and with a 4:1 N/P (cationic lipid nitrogen to siRNA phosphate) ratio exert a better transfection efficiency, significantly dumping retinal HuR and VEGF levels. In conclusion, we demonstrated that siRNA can be efficiently delivered into the rat retina using lipid-based nanocarriers, and some of the lipoplexes loaded with siRNA silencing HuR expression are potential candidates to manage retinal diseases.
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Affiliation(s)
- Marialaura Amadio
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
| | - Alessia Pascale
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
| | - Sarha Cupri
- NANO-iResearch Center on Ocular Nanotechnology, Department of Drug Sciences, University of Catania, Catania, Italy
| | - Rosario Pignatello
- NANO-iResearch Center on Ocular Nanotechnology, Department of Drug Sciences, University of Catania, Catania, Italy
| | - Cecilia Osera
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
| | - Velia D Agata
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Agata Grazia D Amico
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Gian Marco Leggio
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Barbara Ruozi
- Nanomedicine Group, Te.Far.T.I. Center, Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Govoni
- Department of Drug Sciences, Section of Pharmacology, University of Pavia, Pavia, Italy
| | - Filippo Drago
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy
| | - Claudio Bucolo
- Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, Catania, Italy.
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Lee JH, Song SJ. Current Challenges in Diabetic Retinopathy: Are We Really Doing Better? Endocrinol Metab (Seoul) 2016; 31:254-7. [PMID: 27302714 PMCID: PMC4923409 DOI: 10.3803/enm.2016.31.2.254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 05/13/2016] [Accepted: 05/20/2016] [Indexed: 11/04/2022] Open
Abstract
Management of diabetic complications has been a worldwide major global health issue for decades. Recent studies from many parts of the world indicate improvement in this area. However, it is unknown if such an improvement is being realized in Koreans. Although there is limited information regarding diabetic retinopathy management among Koreans, recent epidemiologic studies have indicated improved screening rates and less frequent visual impairment among type 2 diabetics. Moreover, results achieved with new diagnostic and treatment modalities aimed to improve diabetic retinopathy management are encouraging for both physicians and patients.
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Affiliation(s)
- Jae Hyuck Lee
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Jeong Song
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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27
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Abstract
The cornea focuses external light onto the retina, a function for which it must be transparent and possess a smooth surface. Homeostasis of the corneal epithelium is regulated by various humoral factors present in the tear fluid and by neural factors derived from the trigeminal nerve. Neurotrophic keratopathy (NK) is characterized by corneal epithelial disorders that result from impairment of trigeminal nerve function and a consequent deficiency of neural factors. The ideal mode of treatment for this condition is the regeneration of damaged trigeminal nerve fibers, but such therapy is not currently available. In this review, we describe established and potential new treatments of NK. Our research demonstrated that a combination of the neurotransmitter substance P and insulin-like growth factor 1 (IGF-1) has a synergistic stimulatory effect on corneal epithelial migration in vitro and on corneal wound closure in vivo. Furthermore, we identified the minimal amino acid sequences of substance P and IGF-1 required for this synergistic action based on the assumption that the clinical application of peptides corresponding to these sequences would have fewer side effects compared with the full-length molecules. Combination of the substance P-derived peptide FGLM-amide and the IGF-1-derived peptide SSSR promoted corneal epithelial wound healing in patients with NK.Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01756456.
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Jotheeswaran AT, Lovakanth N, Nadiga S, Anchala R, Murthy GVS, Gilbert CE. Estimating the proportion of persons with diabetes developing diabetic retinopathy in India: A systematic review and meta-analysis. Indian J Endocrinol Metab 2016; 20:S51-S58. [PMID: 27144137 PMCID: PMC4847450 DOI: 10.4103/2230-8210.179774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Available evidence from India shows that the control of diabetes is poor in majority of the population. This escalates the risk of complications. There is no systematic review to estimate the magnitude of diabetic retinopathy (DR) in India. MATERIALS AND METHODS A systematic literature search was carried out in Ovid Medline and EMBASE databases using Mesh and key search terms. Studies which reported the proportion of people with diabetes with DR in a representative community population were included. Two independent reviewers reviewed all the retrieved publications. Data were extracted using a predefined form. Review Manager software was used to perform meta-analysis to provide a pooled estimate. Studies included were assessed for methodological quality using selected items from the STROBE checklist. RESULTS Seven studies (1999-2014; n = 8315 persons with diabetes) were included in the review. In the meta-analysis, 14.9% (95% confidence interval [CI] 10.7-19.0%) of known diabetics aged ≥30 years and 18.1% (95% CI 14.8-21.4) among those aged ≥50 years had DR. Heterogeneity around this estimate ranged from I(2)= 79-87%. No linear trend was observed between age and the proportion with DR. The overall methodological quality of included studies was moderate. CONCLUSIONS Early detection of DR is currently not prioritized in public health policies for noncommunicable diseases and blindness programs. Methodological issues in studies suggest that the proportion of diabetics with DR is underestimated in the Indian population. Future research should emphasize more robust methodology for assessing diabetes and DR status.
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Affiliation(s)
- A. T. Jotheeswaran
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Madhapur, Hyderabad, Telangana, India
- Department of Health Services and Population Research, Center for Global Mental Health, Institute of Psychiatry, King's College, London, UK
| | - Nukala Lovakanth
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Madhapur, Hyderabad, Telangana, India
| | - Shruthi Nadiga
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Madhapur, Hyderabad, Telangana, India
| | - Raghupathy Anchala
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Madhapur, Hyderabad, Telangana, India
| | - G. V. S. Murthy
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Madhapur, Hyderabad, Telangana, India
- Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare E. Gilbert
- Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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29
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Actualización de la retinopatía diabética para médicos de atención primaria: hacia una mejora de la medicina telemática. Semergen 2016; 42:172-6. [DOI: 10.1016/j.semerg.2015.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/12/2015] [Accepted: 06/17/2015] [Indexed: 11/24/2022]
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30
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Yun JS, Lim TS, Cha SA, Ahn YB, Song KH, Choi JA, Kwon J, Jee D, Cho YK, Park YM, Ko SH. Lipoprotein(a) predicts the development of diabetic retinopathy in people with type 2 diabetes mellitus. J Clin Lipidol 2016; 10:426-33. [PMID: 27055974 DOI: 10.1016/j.jacl.2015.12.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 12/27/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Lipoprotein(a) [Lp(a)] has mainly been considered to be a predictor of the incidence of cardiovascular disease. In addition, previous studies have shown potential linkage between Lp(a) and diabetic microvascular complications. OBJECTIVES We investigated the incidence and risk factors for the development of diabetic retinopathy (DR) in patients with type 2 diabetes. METHODS A total of 787 patients with type 2 diabetes without DR were consecutively enrolled and followed up prospectively. Retinopathy evaluation was annually performed by ophthalmologists. The main outcome was new onset of DR. RESULTS The median follow-up time was 11.1 years. Patients in the DR group had a longer duration of diabetes (P < .001), higher baseline HbA1c (P < .001), higher albuminuria level (P = .033), and higher level of Lp(a) (P = .005). After adjusting for sex, age, diabetes duration, presence of hypertension, renal function, LDL cholesterol, mean HbA1c, and medications, the development of DR was significantly associated with the serum Lp(a) level (HR 1.57, 95% confidence interval [1.11-2.24]; P = .012, comparing the 4th vs 1st quartile of Lp(a)). The patient group with the highest quartile range of Lp(a) and mean HbA1c levels ≥7.0% had an HR of 5.09 (95% confidence interval [2.63-9.84]; P < .001) for developing DR compared with patients with lower levels of both factors. CONCLUSIONS In this prospective cohort study, we demonstrated that the DR was independently associated with the serum Lp(a) level in patients with type 2 diabetes.
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Affiliation(s)
- Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Seok Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seon-Ah Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu-Bae Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin A Choi
- Department of Ophthalmology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jinwoo Kwon
- Department of Ophthalmology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Donghyun Jee
- Department of Ophthalmology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yang Kyung Cho
- Department of Ophthalmology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Moon Park
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Amadio M, Govoni S, Pascale A. Targeting VEGF in eye neovascularization: What's new? Pharmacol Res 2016; 103:253-69. [DOI: 10.1016/j.phrs.2015.11.027] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 11/19/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
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Danis RP, Sadda S, Li XY, Cui H, Hashad Y, Whitcup SM. Anatomical effects of dexamethasone intravitreal implant in diabetic macular oedema: a pooled analysis of 3-year phase III trials. Br J Ophthalmol 2015; 100:796-801. [PMID: 26581718 PMCID: PMC4893085 DOI: 10.1136/bjophthalmol-2015-306823] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 09/03/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM To assess long-term effects of dexamethasone intravitreal implant (DEX implant) monotherapy on retinal morphology in diabetic macular oedema (DME). METHODS Two multicentre, masked, phase III studies with identical protocols randomised patients with DME, best-corrected visual acuity of 34-68 Early Treatment Diabetic Retinopathy Study letters and central subfield retinal thickness (CSRT) ≥300 µm to DEX implant 0.7, 0.35 mg or sham procedure. Patients were followed up for 3 years (39 months if treated at month 36), with retreatment allowed at ≥6-month intervals. Patients needing other macular oedema (ME) therapy exited the study. Changes from baseline in CSRT, macular volume and ME grade, area of retinal thickening, macular leakage, macular capillary loss and diabetic retinopathy severity were assessed. RESULTS After 3 years, more eyes treated with DEX implant 0.7 and 0.35 mg than sham showed improvement (although small) in ME grade (p<0.05 vs sham). DEX implant 0.7 mg delayed time to onset of two-step progression in diabetic retinopathy severity by ∼12 months. DEX implant 0.7 and 0.35 mg produced small, non-sustained reductions in macular leakage but had no significant effect on macular capillary loss. CONCLUSIONS DEX implant 0.7 or 0.35 mg, administered at ≥6-month intervals over 3 years, produced sustained retinal structural improvement in DME. TRIAL REGISTRATION NUMBER NCT00168337 and NCT00168389.
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Affiliation(s)
- Ronald P Danis
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Srinivas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
| | | | - Harry Cui
- Allergan, Inc., Irvine, California, USA
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Functional outcome of macular edema in different retinal disorders. Prog Retin Eye Res 2015; 48:119-36. [DOI: 10.1016/j.preteyeres.2015.05.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/11/2015] [Accepted: 05/14/2015] [Indexed: 12/11/2022]
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What have we learnt about the management of diabetic macular edema in the antivascular endothelial growth factor and corticosteroid era? Curr Opin Ophthalmol 2015; 26:177-83. [PMID: 25784111 DOI: 10.1097/icu.0000000000000152] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW To summarize the outcomes of the use of antivascular endothelial growth factor (anti-VEGF) agents and corticosteroids on the treatment paradigm for diabetic macular edema (DME). RECENT FINDINGS Favorable efficacy data along with acceptable long-term safety results of anti-VEGF agents have made them the standard first-line therapy in the management of DME. Level I evidence from large, multicenter clinical trials has established the beneficial role of anti-VEGF agents and intravitreal steroids. In addition, the role of anti-VEGF agents in the treatment of diabetic retinopathy has also been recently recognized. However, concerns such as suboptimal response, VEGF resistance, and long-term effects on retinal layers and vasculature have also been highlighted recently. SUMMARY The use of anti-VEGF agents and corticosteroids has revolutionized the management of DME. Despite the advantages including ease of administration, low incidence of adverse events, and concomitant improvement in retinopathy status, limitations of this therapeutic approach have been recognized. The current review will focus on the lessons learnt in the management of DME in the anti-VEGF and steroid era.
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Nanoengineering of therapeutics for retinal vascular disease. Eur J Pharm Biopharm 2015; 95:323-30. [PMID: 26022642 DOI: 10.1016/j.ejpb.2015.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 04/29/2015] [Accepted: 05/05/2015] [Indexed: 01/07/2023]
Abstract
Retinal vascular diseases, including diabetic retinopathy, neovascular age related macular degeneration, and retinal vein occlusion, are leading causes of blindness in the Western world. These diseases share several common disease mechanisms, including vascular endothelial growth factor (VEGF) signaling, hypoxia, and inflammation, which provide opportunities for common therapeutic strategies. Treatment of these diseases using laser therapy, anti-VEGF injections, and/or steroids has significantly improved clinical outcomes. However, these strategies do not address the underlying root causes of pathology, and may have deleterious side effects. Furthermore, many patients continue to progress toward legal blindness despite receiving regular therapy. Nanomedicine, the engineering of therapeutics at the 1-100 nm scale, is a promising approach for improving clinical management of retinal vascular diseases. Nanomedicine-based technologies have the potential to revolutionize the treatment of ophthalmology, through enabling sustained release of drugs over several months, reducing side effects due to specific targeting of dysfunctional cells, and interfacing with currently "undruggable" targets. We will discuss emerging nanomedicine-based applications for the treatment of complications associated with retinal vascular diseases, including angiogenesis and inflammation.
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