Diabetic Retinopathy and VEGF

Abstract

Diabetic retinopathy remains the leading vascular-associated cause of blindness throughout the world. Its treatment requires a multidisciplinary interventional approach at both systemic and local levels. Current management includes laser photocoagulation, intravitreal steroids, and anti-vascular endothelial growth factor (VEGF) treatment along with systemic blood sugar control. Anti-VEGF therapies, which are less destructive and safer than laser treatments, are being explored as primary therapy for the management of vision-threatening complications of diabetic retinopathy such as diabetic macular edema (DME). This review provides comprehensive information related to VEGF and describes its role in the pathogenesis of diabetic retinopathy, and in addition, examines the mechanisms of action for different antiangiogenic agents in relation to the management of this disease. Medline (Pubmed) searches were carried out with keywords “VEGF”, “diabetic retinopathy”, and “diabetes” without any year limitation to review relevant manuscripts used for this article.

Elevated cell proliferation and VEGF production by high-glucose conditions in Müller cells involve XIAP

“…2 The vascular endothelial growth factor (VEGF) family and its receptor system, by endogenously producing vascular cytokines, contribute to angiogenesis, vasodilatation, and increased microvascular permeability. 3,4 In recent years, the development and commercialization of anti-VEGF drugs have revolutionized the therapy of patients with intraocular neovascularization. 5 Nevertheless, the precise mechanism underlying the regulation of VEGF protein expression in intraocular angiogenesis of diabetic retinopathy remains unclear.…”

Epigallocatechin-3-gallate protects retinal vascular endothelial cells from high glucose stress in vitro via the MAPK/ERK-VEGF pathway

“…Previous reports have suggested that blocking of the VEGF receptor signaling pathway can completely prevent the formation of retinal neovascularization, which indicated that VEGF plays a vital role in the formation of new blood vessels (Wang et al, 2010a). DR can be induced by the injection of VEGF in normal animals, suggesting the significant role played by VEGF during the early stages of DR (Gupta et al, 2013). Chronic inflammation is known to play a major role in the development of DR from DM.…”

Diabetic Retinopathy—Update on Prevention Techniques, Present Therapies, and New Leads

“…37,38 Intravitreal injections of anti-VEGF agents are thus novel therapies for the reduction of neovascularization and vessel leakage, and its efficacy has been well demonstrated in both clinical trials and practice. 37,39,40 Combination treatment supplementing pan-retinal photocoagulation with anti-VEGF injections has consistently demonstrated greater vascularization regression and leakage reduction than laser treatment alone. 41,42 In fact, comparative studies even suggest that the efficacy of injection-only treatment surpasses that of the more damaging laser option in patients with DME.…”

“…43,44 There are a number of molecular agents under investigation that act to inhibit VEGF in different ways, including full and fragmented antibodies, small interfering RNAs (siRNAs), and recombinant fusion proteins, although most remain in developmental or trial phases. 37 While agents acting on VEGF by alternative mechanisms may prove more robust once implemented in practice, the efficacy of the anti-VEGF therapies available to patients is limited, primarily restricted to the treatment of DME and even then with a variable success rate of 30-50 %. 45,46 In addition to molecular target agents, the second class of medical treatment involves injection of synthetic corticosteroids, namely intravitreal triamcinolone acetonide (IVTA).…”