American Journal of Cardiovascular Drugs

, Volume 7, Issue 6, pp 393–398

The Therapeutic Potential of VEGF Inhibition in Diabetic Microvascular Complications


  • Gemma Tremolada
    • Department of Ophthalmology and Visual SciencesSan Raffaele Scientific Institute
  • Rosangela Lattanzio
    • Department of Ophthalmology and Visual SciencesSan Raffaele Scientific Institute
  • Gabriella Mazzolari
    • Renal Pathophysiology UnitSan Raffaele Scientific Institute
    • Renal Pathophysiology UnitSan Raffaele Scientific Institute
    • Division of MedicineSan Raffaele Scientific Institute
Leading Article

DOI: 10.2165/00129784-200707060-00002

Cite this article as:
Tremolada, G., Lattanzio, R., Mazzolari, G. et al. Am J Cardiovasc Drugs (2007) 7: 393. doi:10.2165/00129784-200707060-00002


During the last few years, the incidence of microvascular complications in diabetes mellitus has rapidly increased as a consequence of both an increase in incidence of type 2 and type 1 diabetes mellitus.

The pathogenesis of diabetic microvascular complications is still largely unknown. Among the many hypotheses, a dysfunction in angiogenesis has been suggested as a common origin for retinopathy, nephropathy, and neuropathy. Based on this hypothesis, inhibition of vascular endothelial growth factor (VEGF) has been tested as a potential therapeutic approach to prevent and cure diabetic microvascular complications. Several VEGF inhibitors are currently under evaluation or are approved for the treatment of wet age-related macular degeneration and macular edema. These include inhibitors of intracellular transcription of VEGF (e.g. bevasiranib), inhibitors of extracellular VEGF (e.g. pegaptanib), inhibitors of VEGF receptor expression (e.g. aflibercept [VEGF-TRAP]) and inhibitors of the intracellular signaling cascade activating VEGF (e.g. midostaurin).

According to the existing evidence base, although inhibition of VEGF results in a better outcome in the case of diabetic retinopathy and also, despite some discrepant results, in the case of diabetic nephropathy, there is no final confirmation that VEGF inhibition is a valid approach for diabetic neuropathy. The latter complication actually, in line with other chronic neuropathies, seems to improve with stimulation of angiogenesis through increased expression of VEGF.

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