title: Vitreous levels of vascular endothelial growth factor and stromal-derived factor 1 in patients with diabetic retinopathy and cystoid macular edema before and after intraocular injection of triamcinolone.
abstract: BACKGROUND
  Diffuse macular edema (DME) and/or aberrant neovascularization (NV) can cause vision loss in diabetic retinopathy (DR) and may be modulated by growth factors and chemokines. The chemokine stromal-derived factor 1 (SDF-1) is a potent stimulator of vascular endothelial growth factor (VEGF) expression, the main effector of NV, and the key inducer of vascular permeability associated with DME. Circulating endothelial cell precursors migrating in response to SDF-1 participate in NV.
  
  
  OBJECTIVE
  To investigate the relationship between SDF-1 and (VEGF) in vitreous of patients with varying degrees of DR and DME before and after intraocular injection of triamcinolone acetonide, used to treat refractory DME.
  
  
  METHODS
  In this prospective study, 36 patients were included and observed for 6 months. Vitreous VEGF and SDF-1 levels were measured by enzyme-linked immunosorbent assay in samples obtained immediately before and 1 month after injection of triamcinolone.
  
  
  RESULTS
  Both VEGF and SDF-1 were significantly higher (P<.01) in patients with proliferative DR than in patients with nonproliferative DR. Levels of SDF-1 were markedly increased in patients with DME compared with those without DME. Vascular endothelial growth factor correlated with SDF-1 levels and disease severity (r(2) = 0.88).
  
  
  CONCLUSIONS
  Triamcinolone administration resulted in dramatic reductions of VEGF and SDF-1 to nearly undetectable levels, eliminated DME, and caused regression of active NV. Our results support a role for SDF-1 and VEGF in the pathogenesis of the adverse visual consequences of DR and suggest that the elimination of DME with regression and/or initiation of fibrosis of NV after triamcinolone injection may be due to the suppression of VEGF and SDF-1.
authors.affiliation: Southern Vitreoretinal Association, Tallahassee, Fla, USA.
authors.forename: H Logan
authors.initials: HL
authors.lastname: Brooks
authors.forename: Sergio
authors.initials: S
authors.lastname: Caballero
authors.forename: Charles K
authors.initials: CK
authors.lastname: Newell
authors.forename: Robert L
authors.initials: RL
authors.lastname: Steinmetz
authors.forename: Debbie
authors.initials: D
authors.lastname: Watson
authors.forename: Mark S
authors.initials: MS
authors.lastname: Segal
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Harrison
authors.forename: Edward W
authors.initials: EW
authors.lastname: Scott
authors.forename: Maria B
authors.initials: MB
authors.lastname: Grant
mesh_terms: D000368:Aged; D001813:Blood-Retinal Barrier; D002199:Capillary Permeability; D002478:Cells, Cultured; D054377:Chemokine CXCL12; D019743:Chemokines, CXC / Q000378:metabolism*; D002633:Chemotaxis / Q000502:physiology; D003930:Diabetic Retinopathy / Q000188:drug therapy / Q000378:metabolism*; D004730:Endothelium, Vascular / Q000502:physiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008269:Macular Edema / Q000188:drug therapy / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D041623:Tomography, Optical Coherence; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism*; D014822:Vitreous Body / Q000378:metabolism*
chemical_list: C515255:CXCL12 protein, human; D054377:Chemokine CXCL12; D019743:Chemokines, CXC; D005938:Glucocorticoids; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D014222:Triamcinolone Acetonide