Early cellular and molecular changes induced by diabetes in the retina

For several decades the pathobiology of diabetic retinopathy has been the object of conjecture and hypotheses. Indeed, very little was known about the cellular events triggered by diabetes in the retina and about the processes underlying the microangiopathy. In the last few years there has been a concerted effort to acquire such information, and the work has targeted not just the retinal vessels but more comprehensively the retina. The picture emerging is one of multiplicity: multiple cell types in the retina are affected early by diabetes and multiple processes are operative in the microangiopathy. The main abnormalities captured to date are altered expression of several genes, apoptosis, microthrombosis, and proinflammatory changes. The new information needs to be integrated into temporal and mechanistic sequences and further expanded but it is beginning to provide a framework for the cellular dimension of diabetic retinopathy.

IGF-I mRNA and signaling in the diabetic retina

IGF-I promotes the survival of multiple cell types by activating the IGF-I receptor (IGF-IR), which signals downstream to a serine/threonine kinase termed Akt. Because in diabetes vascular and neural cells of the retina undergo accelerated apoptosis, we examined IGF-I synthesis and signaling in the human and rat diabetic retina. In retinas obtained postmortem from six donors aged 64 +/- 8 years with a diabetes duration of 7 +/- 5 years, IGF-I mRNA levels were threefold lower than in the retinas of six age-matched nondiabetic donors (P = 0.005). In the retinas of rats with 2 months' duration of streptozotocin-induced diabetes, IGF-I mRNA levels were similar to those of control rats, but after 5 months of diabetes they failed to increase to the levels recorded in age-matched controls (P < 0.02). Retinal IGF-I expression was not altered by hypophysectomy, proving to be growth-hormone independent. IGF-IR levels were modestly increased in the human diabetic retinas (P = 0.02 vs. nondiabetic retinas) and were unchanged in the diabetic rats. Phosphorylation of the IGF-IR could be measured only in the rat retina, and was not decreased in the diabetic rats (94 +/- 18% of control values). In the same diabetic rats, phosphorylation of Akt was 123 +/- 21% of control values. There was not yet evidence of increased apoptosis of retinal microvascular cells after 5 months of streptozotocin-induced diabetes. Hence, in the retina of diabetic rats, as in the retina of diabetic human donors, IGF-I mRNA levels are substantially lower than in age-matched nondiabetic controls, whereas IGF-IR activation and signaling are not affected, at least for some time. This finding suggests that in the diabetic retina, the activation of the IGF-IR is modulated by influences that compensate for, or are compensated by, decreased IGF-I synthesis.

Bax is increased in the retina of diabetic subjects and is associated with pericyte apoptosis in vivo and in vitro

Diabetes of even short duration accelerates the death of capillary cells and neurons in the inner retina by a process consistent with apoptosis. We examined whether the process is accompanied by changes in the expression of endogenous regulators of apoptosis. In postmortem retinas of 18 diabetic donors (age 67 +/- 6 years, diabetes duration 9 +/- 4 years) the levels of pro-apoptotic Bax were slightly, but significantly, increased when compared with levels in 20 age-matched nondiabetic donors (P = 0.04). In both groups, Bax localized to vascular and neural cells of the inner retina. Neither pro-apoptotic Bcl-X(S), nor pro-survival Bcl-X(L) appeared affected by diabetes. The levels of these molecules could not be accurately quantitated in lysates of retinal vessels because of variable degrees of glial contamination. However, studies in situ showed in several pericytes, the outer cells of retinal capillaries, intense Bax staining often in conjunction with DNA fragmentation. Bovine retinal pericytes exposed in vitro to high glucose levels for 5 weeks showed elevated levels of Bax (P = 0.03) and increased frequency of annexin V binding, indicative of early apoptosis. Hence, human diabetes selectively alters the expression of Bax in the retina and retinal vascular pericytes at the same time as it causes increased rates of apoptosis. The identical program induced by high glucose in vitro implicates hyperglycemia as a causative factor in vivo, and provides a model for establishing the role of Bax in the accelerated death of retinal cells induced by diabetes.

Expression of vascular endothelial growth factor in the human retina and in nonproliferative diabetic retinopathy

Vascular endothelial growth factor (VEGF)/vascular permeability factor is a likely angiogenic mediator in proliferative diabetic retinopathy, and its role is under scrutiny in the pathogenesis of the capillary leakage characteristic of background diabetic retinopathy. To examine whether the diabetic milieu induces or increases retinal VEGF expression in humans, we examined retinas from nondiabetic eye donors and donors with 9 +/- 5 years of diabetes and documented microangiopathy. To identify possible confounding effects of the postmortem period, we also studied the postmortem stability of the VEGF transcript and the expression of the VEGF protein in rat retinas. In both human and rat retina we detected by Northern analysis a 4.2-kb VEGF mRNA species and by reverse transcriptase polymerase chain reaction the transcripts encoding VEGF165 (the most abundant), VEGF121, and VEGF189. By in situ hybridization and immunohistochemistry VEGF mRNA and protein co-localized at the ganglion cell, inner nuclear, and outer plexiform layers and in the walls of the blood vessels (where mRNA was scarce). The protein was additionally detected in photoreceptors. The abundance and distribution of VEGF mRNA and protein were not altered in the diabetic retinas, indicating that the diabetic environment is not sufficient to increase retinal VEGF expression. The demonstration that VEGF is constitutively expressed in the adult retina and is localized to discrete neural cells and their processes proposes a role for the cytokine in retinal homeostasis and/or function.

Müller cell changes in human diabetic retinopathy

Vascular cells may not be the only cells affected by diabetes in the retina. In particular, abnormalities of the b-wave of the electroretinogram in diabetic patients with absent or minimal microangiopathy have pointed to possible dysfunction of Müller cells, the principal glia of the retina. In this study, we sought evidence for diabetes-induced Müller cell abnormalities by testing the expression of three proteins (Bcl-2, glutamine synthetase [GS], and glial fibrillar acidic protein [GFAP]) that are solely or predominantly expressed in Müller cells and show a reproducible pattern of changes in the context of retinal injuries or degenerations. Retinas obtained postmortem from a total of 14 donors aged 65 +/- 6 years with 10 +/- 4 years of diabetes and histological evidence of microangiopathy and 18 age-matched nondiabetic donors were examined by immunohistochemistry and immunoblotting. The typical Müller cell pattern of Bcl-2 and GS immunostaining was similar for both intensity and distribution in the nondiabetic and diabetic retinas, as were the levels of the two proteins. In contrast, GFAP staining, largely confined to the most proximal retina in the nondiabetic donors, was in most diabetic retinas present along the entire length of the Müller cell processes, throughout the outer retina. Accordingly, the level of GFAP was increased in the diabetic retinas (161 +/- 106 densitometric units/microg protein vs. 55 +/- 45 in the nondiabetic retinas, P = 0.03). These data provide evidence for selective biosynthetic changes of Müller glial cells in diabetes. Because Müller cells produce factors capable of modulating blood flow, vascular permeability, and cell survival, and their processes surround all blood vessels in the retina, a possible role of these cells in the pathogenesis of retinal microangiopathy deserves to be investigated.

Novel degradation pathway of glycated amino acids into free fructosamine by a Pseudomonas sp. soil strain extract

A Pseudomonas sp. soil strain, selected for its ability to grow on epsilon-(1-deoxyfructosyl) aminocaproic acid, was induced to express a membrane-bound enzymatic activity which oxidatively degrades Amadori products into free fructosamine. Apparent Km values for fructosyl aminocaproate, epsilon-fructosyl lysine, fructosyl glycine, and ribated lysine were 0.21 mM, 2.73 mM, 3.52 mM, and 1.57 mM, respectively. The enzyme was also active against alpha-fructosyl lysine and borohydride-reduced Amadori product, weakly active with ribated and glycated polylysine, and inactive with reducing sugars, amino acids, and glycated proteins. The enzymatic activity was highest at pH 6.5 and 25 degrees C in 0.1 M sodium phosphate, while over 80% of the activity was lost above 65 degrees C. Complete inhibition was observed by HgCl2, NaN3, and NaCN suggesting a role for SH groups and copper in the enzymatic activity. The reaction products were characterized by 1H NMR, 13C NMR, and GC/MS and found to correspond to 1-deoxy-1-aminofructose, i.e. free "fructosamine," and adipic acid. Confirmation of the free fructosamine structure was based on the complete spectroscopic identity of the borohydride reduction product with commercially available glucamine (1-amino-1-deoxyglucitol). The new enzyme is provisorily classified as fructosyl N-alkyl amino acid oxidase (EC 1.5.3) (fructosyl-amino acid:oxygen oxidoreductase) and may thus belong to a novel class of "Amadoriases" which deglycate Amadori products oxidatively. In contrast, however, the new enzyme acts on the alkylamine bond rather than the ketoamine bond of the Amadori product.

Isolation, purification, and characterization of an Amadori product binding protein from a Pseudomonas sp. soil strain

Sugars react nonenzymatically with protein amino groups to form a ketoamine adduct (Amadori product), which leads to the formation of advanced glycation end-products. These compounds are involved in the development of tissue modifications such as cross-linking and fluorescence in diabetes and aging. Searching for an enzyme to reverse protein glycation, we isolated a Pseudomonas sp. soil strain growing selectively on the Amadori product epsilon-fructosyl-aminocaproate. An Amadori product binding protein (ABP) was purified from the bacterial extract by single-step affinity chromatography on glycated lysine-Sepharose. The protein, a monomer of 45 kDa, did not bind to unglycated or NaBH4-reduced glycated lysine-Sepharose suggesting specificity for the Amadori compound. The concentration-dependent binding of glycated aminocaproate showed saturation with Kd = 1.49 microM and Bmax = 17.63 nmol/mg of protein corresponding to 0.8 mol/mol of protein. The binding of epsilon-1-[14C]fructosyl-aminocaproate to the protein was inhibited by other glucose-derived Amadori products, but not by free sugars, unglycated amines, or ribated lysine. The sequence of the first 16 NH2-terminal amino acids and a GenBank search revealed that ABP is a novel protein. Its synthesis was inducible by growth of the organism in Amadori product. Immunoblotting studies showed that ABP is not found in cell extracts from other prokaryotes, yeast, or liver homogenate and does not bind Amadori products in glycated proteins. ABP has no enzymatic activity toward glycated substrates and may thus have transport or permease function for glycated amino acids.

A study on in vitro glycation processes by matrix-assisted laser desorption ionization mass spectrometry

The number of glucose molecules condensed on glycated bovine serum albumin have been easily determined by means of matrix-assisted laser desorption/ionization mass spectrometry. Measurements were carried out on samples from incubation of the protein with glucose at different concentrations (0.02 M, 0.2 M, 2 M and 5 M). A clear increase in molecular mass of BSA with respect to incubation time is detected. In contrast to what is observed with fluorescence, the plots of molecular mass increase vs. incubation time show the occurrence of a steady state, corresponding to the complete saturation of all the protein sites reactive against glucose. Comparison of fluorescence and molecular mass data reveals that some further reactions, different from condensation, must take place, which could be in principle either intramolecular or originated by reactivity of modified condensed glucose moieties vs. free glucose.

Identification of furoyl-containing advanced glycation products in collagen samples from diabetic and healthy rats

The compounds resulting from the reaction of glucose with proteins (advanced glycation products) can be important markers of chronic diabetic complications. To test the possible diagnostic value of advanced glycation products containing the furoyl moiety, collagen samples from diabetic and healthy rats were analyzed by parent ion spectroscopy. In our study, we compared normal collagen, diabetic collagen and normal collagen incubated with different glucose concentrations and we employed different hydrolysis procedures (HCl and proteinase). Mass spectroscopic measurements performed on hydrolyzed samples showed that either different samples or different hydrolysis procedures produce a similar set of furoyl-containing compounds. 2-(2-Furoyl)-4(5)-(2-furanyl)-1H-imidazole (FFI) which has been reported to be one of the advanced glycation products, was never found in any of the samples examined. Hence neither FFI nor furoyl-containing molecules can be considered markers of advanced glycation processes.

Absence of brown product FFI in nondiabetic and diabetic rat collagen

Accumulation of brown products in long-lived proteins might be an important factor in determining long-term diabetic complications. Fluorescent chromophore 2-(2-furoyl)-4-(5)-(2-furanyl)-1H-imidazole (FFI), isolated from hydrolyzed brown products synthesized in vitro, was proposed as a specific brown product responsible for functional and structural changes in long-lived proteins. In this study, an attempt was made to demonstrate by means of collision spectroscopy the presence of FFI in collagen samples taken from diabetic rats. Diabetic rat collagen samples showed mean values of absorbance per milligram of 4-hydroxy-L-proline significantly higher than those observed in nondiabetic rats, suggesting higher FFI levels. Surprisingly, all collagen samples from diabetic and nondiabetic rats gave collision spectra in which no peak diagnostic of FFI presence was observed. These data suggest that the absorbance level observed in diabetic rats is not due to the presence of FFI but to structurally related compounds, which are being investigated by means of mass spectrometry.

Red cell sorbitol concentration in relation to short- and medium-term variation of plasma glucose

To evaluate the time course of changes in red cell sorbitol (RCS) concentration in relation to variations of plasma glucose levels, RCS was determined in 7 normal subjects during i.v. glucose infusion (IVGTT); in 6 hyperglycemic insulin-dependent diabetic subjects while glycemia was normalized with Biostator GC 115 and in 4 diabetic patients in previously poor metabolic control, in whom normal glycemia was obtained in 8-10 days by intensive insulin therapy. During IVGTT, plasma glucose levels increased with significant differences from baseline at 5, 10, 16, 25, 60, 100 and 160 min and returned to basal levels after 3h; RCS concentration showed small and insignificant increases. During i.v. insulin infusion, plasma glucose fell to almost normal levels within roughly 3h; RCS levels showed a gradual reduction becoming significant at 180 min. In the third study, decrease in plasma glucose was always associated with a fall in RCS level which became significant between the 2nd and the 3rd day of the study. Thus, RCS levels were not affected by very short-term variations of glycemia but by a previous hyperglycemic crisis that lasted a few hours. There were therefore medium-term variations of RCS level. In conclusion, RCS determination is not useful as an index of metabolic control in diabetes.