Neurodegeneration in diabetic retinopathy : does it really matter?
Simó Canonge, Rafael (Universitat Autònoma de Barcelona. Departament de Medicina)
Stitt, Alan W. (Queen's University. Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences)
Gardner, Thomas W. (Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Medical School)
Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol

Date:	2018
Abstract:	The concept of diabetic retinopathy as a microvascular disease has evolved, in that it is now considered a more complex diabetic complication in which neurodegeneration plays a significant role. In this article we provide a critical overview of the role of microvascular abnormalities and neurodegeneration in the pathogenesis of diabetic retinopathy. A special emphasis is placed on the pathophysiology of the neurovascular unit (NVU), including the contributions of microvascular and neural elements. The potential mechanisms linking retinal neurodegeneration and early microvascular impairment, and the effects of neuroprotective drugs are summarised. Additionally, we discuss how the assessment of retinal neurodegeneration could be an important index of cognitive status, thus helping to identify individuals at risk of dementia, which will impact on current procedures for diabetes management. We conclude that glial, neural and microvascular dysfunction are interdependent and essential for the development of diabetic retinopathy. Despite this intricate relationship, retinal neurodegeneration is a critical endpoint and neuroprotection, itself, can be considered a therapeutic target, independently of its potential impact on microvascular disease. In addition, interventional studies targeting pathogenic pathways that impact the NVU are needed. Findings from these studies will be crucial, not only for increasing our understanding of diabetic retinopathy, but also to help to implement a timely and efficient personalised medicine approach for treating this diabetic complication.
Grants:	Ministerio de Economía y Competitividad SAF2016-77784
Note:	Altres ajuts: RS is supported by the following grants: Ministerio de Economía y Competitividad and the Fundació Marató TV3 (201629-10). AWS is supported by the following grants: Fight for Sight, The Belfast Association for the Blind and The Jules Thorn Trust. TWG is supported by the following grants: R01EY20582, R24DK082841, Research to Prevent Blindness and The Taubman Medical Research Institute.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Diabetic retinopathy ; Microvascular impairment ; Neurodegeneration ; Neuroprotection ; Neurovascular unit ; Personalised medicine ; Review
Published in:	Diabetologia, Vol. 61 (july 2018) , p. 1902-1912, ISSN 1432-0428

DOI: 10.1007/s00125-018-4692-1
PMID: 30030554

11 p, 1.9 MB

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