TY - JOUR
T1 - Diabetic Retinopathy
T2 - Important Biochemical Alterations and the Main Treatment Strategies
AU - ValdezGuerrero, Amaranta Sarai
AU - Quintana-Pérez, Julio César
AU - Arellano-Mendoza, Mónica Griselda
AU - Castañeda-Ibarra, Francisco Javier
AU - Tamay-Cach, Feliciano
AU - Alemán-González-Duhart, Diana
N1 - Publisher Copyright:
© 2020 Canadian Diabetes Association
PY - 2021/8
Y1 - 2021/8
N2 - Diabetes mellitus (DM) is a chronic metabolic disorder characterized by impaired glucose homeostasis, insulin resistance and hyperglycemia. Among its serious multisystemic complications is diabetic retinopathy (DR), which develops slowly and often insidiously. This disorder—the most common cause of vision loss in working-age adults—is characterized by functional and morphological changes in the retina. It results from the exacerbation of ischemic and inflammatory conditions prompted by alterations in the blood vessels, such as the development of leukostasis, thickening of the basement membrane, retinal neovascularization and fibrovascular tissue formation at the vitreoretinal interface. The pathogenic alterations are usually triggered at the biochemical level, involving a greater activity in 4 pathways: the polyol pathway, the hexosamine pathway, the formation of advanced glycation end-products and the activation of protein kinase C isoforms. When acting together, these pathways give rise to increased levels of reactive oxygen species and decreased levels of endogenous antioxidant agents, thus generating oxidative stress. All current therapies are aimed at the later stages of DR, and their application implies side effects. One possible strategy for preventing the complications of DM is to counteract the elevated superoxide production stemming from a high level of blood glucose. Accordingly, some treatments are under study for their capacity to reduce vascular leakage and avoid retinal ischemia, retinal neovascularization and macular edema. The present review summarizes the biochemical aspects of DR and the main approaches for treating it.
AB - Diabetes mellitus (DM) is a chronic metabolic disorder characterized by impaired glucose homeostasis, insulin resistance and hyperglycemia. Among its serious multisystemic complications is diabetic retinopathy (DR), which develops slowly and often insidiously. This disorder—the most common cause of vision loss in working-age adults—is characterized by functional and morphological changes in the retina. It results from the exacerbation of ischemic and inflammatory conditions prompted by alterations in the blood vessels, such as the development of leukostasis, thickening of the basement membrane, retinal neovascularization and fibrovascular tissue formation at the vitreoretinal interface. The pathogenic alterations are usually triggered at the biochemical level, involving a greater activity in 4 pathways: the polyol pathway, the hexosamine pathway, the formation of advanced glycation end-products and the activation of protein kinase C isoforms. When acting together, these pathways give rise to increased levels of reactive oxygen species and decreased levels of endogenous antioxidant agents, thus generating oxidative stress. All current therapies are aimed at the later stages of DR, and their application implies side effects. One possible strategy for preventing the complications of DM is to counteract the elevated superoxide production stemming from a high level of blood glucose. Accordingly, some treatments are under study for their capacity to reduce vascular leakage and avoid retinal ischemia, retinal neovascularization and macular edema. The present review summarizes the biochemical aspects of DR and the main approaches for treating it.
KW - apoptosis
KW - biochemical alterations
KW - diabetes mellitus
KW - diabetic retinopathy
KW - inflammation
KW - oxidative stress
KW - treatments
UR - http://www.scopus.com/inward/record.url?scp=85097905044&partnerID=8YFLogxK
U2 - 10.1016/j.jcjd.2020.10.009
DO - 10.1016/j.jcjd.2020.10.009
M3 - Artículo de revisión
C2 - 33341391
AN - SCOPUS:85097905044
SN - 1499-2671
VL - 45
SP - 504
EP - 511
JO - Canadian Journal of Diabetes
JF - Canadian Journal of Diabetes
IS - 6
ER -