Novel approaches for treating diabetic retinopathy based on recent pathogenic evidence.
Diabetic retinopathy remains as a leading cause of blindness in developed countries. Current treatments target late stages of DR when vision has already been significantly affected. A better understanding of the pathogenesis of DR would permit the development of more efficient preventional/interventional strategies against early stages of DR. In this article a critical review of the state of the art of this issue is provided along with a discussion of problems which have yet to be overcome. Neuroprotection as a new approach for the treatment of the early stages of DR has been particularly emphasized. The development and progression of DR is not homogeneous and, apart from blood glucose levels and blood pressure, it depends on genetic factors which remain to be elucidated. In addition, the role of the pathogenic pathways is not the same in all patients. All these factors should be taken into account in the near future when an individualized oriented treatment for DR could become feasible. The new techniques in retinal imaging acquisition, the identification of useful circulating biomarkers and the individualized analysis of biological samples could facilitate the development of early and personalized therapy in the setting of DR. Finally, it should be noted that only a coordinated action among ophthalmologists, diabetologists, basic researchers, experts in pharmaco-economics and health care providers addressed to the design of rational strategies targeting prevention and the early stages of DR will be effective in reducing the burden and improving the clinical outcome of this devastating complication of diabetes.
CIBERDEM (CIBER de Diabetes y Enfermedades Metabólicas Asociadas) and Diabetes and Metabolism Research Unit, Vall Hebron Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, 08035 Barcelona, Spain. Electronic address: rafael.simo@vhir.org.
Rafael
R
Simó
CIBERDEM (CIBER de Diabetes y Enfermedades Metabólicas Asociadas) and Diabetes and Metabolism Research Unit, Vall Hebron Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, 08035 Barcelona, Spain. Electronic address: cristina.hernandez@vhir.org.
Cristina
C
Hernández
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001766:Blindness / Q000517:prevention & control; D003930:Diabetic Retinopathy / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D015316:Genetic Therapy / Q000379:methods; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D018696:Neuroprotective Agents / Q000627:therapeutic use; D009798:Ocular Hypertension / Q000517:prevention & control; D018384:Oxidative Stress / Q000502:physiology; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000379:methods
D000305:Adrenal Cortex Hormones; D020533:Angiogenesis Inhibitors; D000893:Anti-Inflammatory Agents; D000959:Antihypertensive Agents; D018696:Neuroprotective Agents
Biomarkers; Diabetic retinopathy; Neurodegeneration; New treatments; Pathogenesis; Personalized approach