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Microvascular Modifications in Diabetic Retinopathy

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Abstract

Patients struggling with diabetes are at elevated risks for several sight-threatening diseases, including proliferative diabetic retinopathy (DR). DR manifests in two stages: first, the retinal microvasculature is compromised and capillary degeneration occurs; subsequently, an over-compensatory angiogenic response is initiated. Early changes in the retinal microcirculation include disruptions in blood flow, thickening of basement membrane, eventual loss of mural cells, and the genesis of acellular capillaries. Endothelial apoptosis and capillary dropout lead to a hypoxic inner retina, alterations in growth factors, and upregulation of inflammatory mediators. With disease progression, pathologic angiogenesis generates abnormal preretinal microvessels. Current therapies, which include panretinal photocoagulation and vitrectomy, have remained unaltered for several decades. With several exciting preclinical advances, emergent technologies and innovative cellular targets may offer newfound hope for developing “next-generation” interventional or preventive clinical approaches that will significantly advance current standards of care and clinical outcomes.

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Acknowledgments

We are grateful to Dr. Tatiana Demidova-Rice for her critical reading of this manuscript. This work was supported by the following grants: NIH T32DK07542 (JTD), NIH EY 15125, 19533 (IMH).

Disclosure

Conflicts of interest: J.T. Durham: none; I.M. Herman: has been a consultant for Healthpoint Biopharmaceuticals, has received grant support from Wound Care Partners, and has received payment from NACCME for continuing medical education.

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  1. Sackler School of Graduate Biomedical Sciences Program in Cellular and Molecular Physiology, Department of Molecular Physiology and Pharmacology and the Center for Innovation in Wound Healing Research, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA

    Jennifer T. Durham & Ira M. Herman

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Correspondence to Ira M. Herman.

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Durham, J.T., Herman, I.M. Microvascular Modifications in Diabetic Retinopathy. Curr Diab Rep 11, 253–264 (2011). https://doi.org/10.1007/s11892-011-0204-0

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