Diabetic Retinopathy–An Underdiagnosed and Undertreated Inflammatory, Neuro-Vascular Complication of Diabetes

Abstract

Diabetes mellitus is a world-wide epidemic and diabetic retinopathy, a devastating, vision-threatening condition, is one of the most common diabetes-specific complications. Diabetic retinopathy is now recognized to be an inflammatory, neuro-vascular complication with neuronal injury/dysfunction preceding clinical microvascular damage. Importantly, the same pathophysiologic mechanisms that damage the pancreatic β-cell (e.g., inflammation, epigenetic changes, insulin resistance, fuel excess, and abnormal metabolic environment), also lead to cell and tissue damage causing organ dysfunction, elevating the risk of all complications, including diabetic retinopathy. Viewing diabetic retinopathy within the context whereby diabetes and all its complications arise from common pathophysiologic factors allows for the consideration of a wider array of potential ocular as well as systemic treatments for this common and devastating complication. Moreover, it also raises the importance of the need for methods that will provide more timely detection and prediction of the course in order to address early damage to the neurovascular unit prior to the clinical observation of microangiopathy. Currently, treatment success is limited as it is often initiated far too late and after significant neurodegeneration has occurred. This forward-thinking approach of earlier detection and treatment with a wider array of possible therapies broadens the physician's armamentarium and increases the opportunity for prevention and early treatment of diabetic retinopathy with preservation of good vision, as well the prevention of similar destructive processes occurring among other organs.

C1q/TNF-Related Protein-3 (CTRP-3) and Pigment Epithelium-Derived Factor (PEDF) Concentrations in Patients with Gestational Diabetes Mellitus: A Case-Control Study

“…Some authors postulate that dysregulation of the PEDF-ATGL interaction may be associated with the elevation of PEDF level in serum. ATGL is crucial for lipid homeostasis lipase and putative PEDF receptor at the same time [56,57]. Our study did not reveal any statistically significant difference between the concentration of PEDF in the control and GDM groups as well as between subgroups with GDM1 and GDM2.…”

Ocular Microbiota and Intraocular Inflammation

“…For example, one of the early pathological features of DR, a common diabetes complication in the eye, is retinal vascular leakage ( 13 ). Coincidently, DR has been demonstrated to be affected by microbiome ( 14 , 15 ). Furthermore, some microbes (mainly viruses) could spread along the nerves.…”

Importance of the Use of Oxidative Stress Biomarkers and Inflammatory Profile in Aqueous and Vitreous Humor in Diabetic Retinopathy

“…Several therapeutic approaches have been assessed targeting mitochondrial dysfunction despite the low specificity of DNMT, synthetic DNA methylation inhibitors such as hydralazine and procainamide are being evaluated in clinical trials, or polyphenols like resveratrol have shown to directly inhibit DNMTs as well as being a powerful antioxidant which ultimately lead to epigenetic changes with altered gene expression [251][252][253][254].…”