Neuroprotection as a Therapeutic Target for Diabetic Retinopathy.
Neuroprotection as a Therapeutic Target for Diabetic Retinopathy.
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DOI：
10.1155/2016/9508541
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发表时间：
2016
影响因子：
4.3
通讯作者：
Casini G
中科院分区：
文献类型：
--
作者：
Hernández C;Dal Monte M;Simó R;Casini G
糖尿病视网膜病变（DR）是一种多因素进行性视网膜疾病，也是视力丧失的主要原因。长期以来，DR 一直被认为是一种血管疾病，尽管神经元死亡和视力障碍出现在血管病变之前，这表明神经变性在 DR 中发挥着重要作用，并且神经保护策略的适当性。血管内皮生长因子 (VEGF) 的上调是当前治疗的主要目标，可能是对视网膜高血糖应激的首要反应之一，并且 VEGF 可能代表 DR 早期的重要生存因素。对于临床试验来说，最重要的是在临床环境中检测视网膜神经变性，而谱域光学相干断层扫描似乎是最有针对性的技术。许多物质已经在动物研究中测试了其神经保护特性并可能用于人类。也许，最有趣的观点是使用内源性神经保护物质或营养保健品。总之，这些数据表明神经退行性变在 DR 发病机制中的核心作用，并表明神经保护是治疗这种疾病的有效策略。然而，需要进行临床试验来确定非侵入性给药途径的有效性和安全性以及依从性。
Diabetic retinopathy (DR) is a multifactorial progressive disease of the retina and a leading cause of vision loss. DR has long been regarded as a vascular disorder, although neuronal death and visual impairment appear before vascular lesions, suggesting an important role played by neurodegeneration in DR and the appropriateness of neuroprotective strategies. Upregulation of vascular endothelial growth factor (VEGF), the main target of current therapies, is likely to be one of the first responses to retinal hyperglycemic stress and VEGF may represent an important survival factor in early phases of DR. Of central importance for clinical trials is the detection of retinal neurodegeneration in the clinical setting, and spectral domain optical coherence tomography seems the most indicated technique. Many substances have been tested in animal studies for their neuroprotective properties and for possible use in humans. Perhaps, the most intriguing perspective is the use of endogenous neuroprotective substances or nutraceuticals. Together, the data point to the central role of neurodegeneration in the pathogenesis of DR and indicate neuroprotection as an effective strategy for treating this disease. However, clinical trials to determine not only the effectiveness and safety but also the compliance of a noninvasive route of drug administration are needed.