Updates on the Current Treatments for Diabetic Retinopathy and Possibility of Future Oral Therapy
Diabetic retinopathy (DR) is a complication of diabetes and one of the leading causes of vision loss worldwide. Despite extensive efforts to reduce visual impairment, the prevalence of DR is still increasing. The initial pathophysiology of DR includes damage to vascular endothelial cells and loss of...
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MDPI AG
2021-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/20/4666 |
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| author | Yohei Tomita Deokho Lee Kazuo Tsubota Kazuno Negishi Toshihide Kurihara |
| author_facet | Yohei Tomita Deokho Lee Kazuo Tsubota Kazuno Negishi Toshihide Kurihara |
| author_sort | Yohei Tomita |
| collection | DOAJ |
| description | Diabetic retinopathy (DR) is a complication of diabetes and one of the leading causes of vision loss worldwide. Despite extensive efforts to reduce visual impairment, the prevalence of DR is still increasing. The initial pathophysiology of DR includes damage to vascular endothelial cells and loss of pericytes. Ensuing hypoxic responses trigger the expression of vascular endothelial growth factor (VEGF) and other pro-angiogenic factors. At present, the most effective treatment for DR and diabetic macular edema (DME) is the control of blood glucose levels. More advanced cases require laser, anti-VEGF therapy, steroid, and vitrectomy. Pan-retinal photocoagulation for non-proliferative diabetic retinopathy (NPDR) is well established and has demonstrated promising outcomes for preventing the progressive stage of DR. Furthermore, the efficacy of laser therapies such as grid and subthreshold diode laser micropulse photocoagulation (SDM) for DME has been reported. Vitrectomy has been performed for vitreous hemorrhage and tractional retinal detachment for patients with PDR. In addition, anti-VEGF treatment has been widely used for DME, and recently its potential to prevent the progression of PDR has been remarked. Even with these treatments, many patients with DR lose their vision and suffer from potential side effects. Thus, we need alternative treatments to address these limitations. In recent years, the relationship between DR, lipid metabolism, and inflammation has been featured. Research in diabetic animal models points to peroxisome proliferator-activated receptor alpha (PPARα) activation in cellular metabolism and inflammation by oral fenofibrate and/or pemafibrate as a promising target for DR. In this paper, we review the status of existing therapies, summarize PPARα activation therapies for DR, and discuss their potentials as promising DR treatments. |
| first_indexed | 2024-03-10T06:28:41Z |
| format | Article |
| id | doaj.art-378455c88a6c4a7ba4f6f36bc3e044f3 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T06:28:41Z |
| publishDate | 2021-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-378455c88a6c4a7ba4f6f36bc3e044f32023-11-22T18:41:13ZengMDPI AGJournal of Clinical Medicine2077-03832021-10-011020466610.3390/jcm10204666Updates on the Current Treatments for Diabetic Retinopathy and Possibility of Future Oral TherapyYohei Tomita0Deokho Lee1Kazuo Tsubota2Kazuno Negishi3Toshihide Kurihara4Laboratory of Photobiology, Keio University School of Medicine, Tokyo 160-8582, JapanLaboratory of Photobiology, Keio University School of Medicine, Tokyo 160-8582, JapanTsubota Laboratory, Inc., Tokyo 160-0016, JapanDepartment of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, JapanLaboratory of Photobiology, Keio University School of Medicine, Tokyo 160-8582, JapanDiabetic retinopathy (DR) is a complication of diabetes and one of the leading causes of vision loss worldwide. Despite extensive efforts to reduce visual impairment, the prevalence of DR is still increasing. The initial pathophysiology of DR includes damage to vascular endothelial cells and loss of pericytes. Ensuing hypoxic responses trigger the expression of vascular endothelial growth factor (VEGF) and other pro-angiogenic factors. At present, the most effective treatment for DR and diabetic macular edema (DME) is the control of blood glucose levels. More advanced cases require laser, anti-VEGF therapy, steroid, and vitrectomy. Pan-retinal photocoagulation for non-proliferative diabetic retinopathy (NPDR) is well established and has demonstrated promising outcomes for preventing the progressive stage of DR. Furthermore, the efficacy of laser therapies such as grid and subthreshold diode laser micropulse photocoagulation (SDM) for DME has been reported. Vitrectomy has been performed for vitreous hemorrhage and tractional retinal detachment for patients with PDR. In addition, anti-VEGF treatment has been widely used for DME, and recently its potential to prevent the progression of PDR has been remarked. Even with these treatments, many patients with DR lose their vision and suffer from potential side effects. Thus, we need alternative treatments to address these limitations. In recent years, the relationship between DR, lipid metabolism, and inflammation has been featured. Research in diabetic animal models points to peroxisome proliferator-activated receptor alpha (PPARα) activation in cellular metabolism and inflammation by oral fenofibrate and/or pemafibrate as a promising target for DR. In this paper, we review the status of existing therapies, summarize PPARα activation therapies for DR, and discuss their potentials as promising DR treatments.https://www.mdpi.com/2077-0383/10/20/4666diabetic retinopathydiabetic macula edemaanti-VEGF therapyvitrectomylaser photocoagulationfenofibrate |
| spellingShingle | Yohei Tomita Deokho Lee Kazuo Tsubota Kazuno Negishi Toshihide Kurihara Updates on the Current Treatments for Diabetic Retinopathy and Possibility of Future Oral Therapy Journal of Clinical Medicine diabetic retinopathy diabetic macula edema anti-VEGF therapy vitrectomy laser photocoagulation fenofibrate |
| title | Updates on the Current Treatments for Diabetic Retinopathy and Possibility of Future Oral Therapy |
| title_full | Updates on the Current Treatments for Diabetic Retinopathy and Possibility of Future Oral Therapy |
| title_fullStr | Updates on the Current Treatments for Diabetic Retinopathy and Possibility of Future Oral Therapy |
| title_full_unstemmed | Updates on the Current Treatments for Diabetic Retinopathy and Possibility of Future Oral Therapy |
| title_short | Updates on the Current Treatments for Diabetic Retinopathy and Possibility of Future Oral Therapy |
| title_sort | updates on the current treatments for diabetic retinopathy and possibility of future oral therapy |
| topic | diabetic retinopathy diabetic macula edema anti-VEGF therapy vitrectomy laser photocoagulation fenofibrate |
| url | https://www.mdpi.com/2077-0383/10/20/4666 |
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