Diabetic Macular Edema: Current Understanding, Molecular Mechanisms and Therapeutic Implications
Diabetic retinopathy (DR), with increasing incidence, is the major cause of vision loss and blindness worldwide in working-age adults. Diabetic macular edema (DME) remains the main cause of vision impairment in diabetic patients, with its pathogenesis still not completely elucidated. Vascular endoth...
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MDPI AG
2022-10-01
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| Online Access: | https://www.mdpi.com/2073-4409/11/21/3362 |
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| author | Jingfa Zhang Jingxiang Zhang Chaoyang Zhang Jingting Zhang Limin Gu Dawei Luo Qinghua Qiu |
| author_facet | Jingfa Zhang Jingxiang Zhang Chaoyang Zhang Jingting Zhang Limin Gu Dawei Luo Qinghua Qiu |
| author_sort | Jingfa Zhang |
| collection | DOAJ |
| description | Diabetic retinopathy (DR), with increasing incidence, is the major cause of vision loss and blindness worldwide in working-age adults. Diabetic macular edema (DME) remains the main cause of vision impairment in diabetic patients, with its pathogenesis still not completely elucidated. Vascular endothelial growth factor (VEGF) plays a pivotal role in the pathogenesis of DR and DME. Currently, intravitreal injection of anti-VEGF agents remains as the first-line therapy in DME treatment due to the superior anatomic and functional outcomes. However, some patients do not respond satisfactorily to anti-VEGF injections. More than 30% patients still exist with persistent DME even after regular intravitreal injection for at least 4 injections within 24 weeks, suggesting other pathogenic factors, beyond VEGF, might contribute to the pathogenesis of DME. Recent advances showed nearly all the retinal cells are involved in DR and DME, including breakdown of blood-retinal barrier (BRB), drainage dysfunction of Müller glia and retinal pigment epithelium (RPE), involvement of inflammation, oxidative stress, and neurodegeneration, all complicating the pathogenesis of DME. The profound understanding of the changes in proteomics and metabolomics helps improve the elucidation of the pathogenesis of DR and DME and leads to the identification of novel targets, biomarkers and potential therapeutic strategies for DME treatment. The present review aimed to summarize the current understanding of DME, the involved molecular mechanisms, and the changes in proteomics and metabolomics, thus to propose the potential therapeutic recommendations for personalized treatment of DME. |
| first_indexed | 2024-03-09T19:11:19Z |
| format | Article |
| id | doaj.art-5eeea3ce5355469ea79472514e326f81 |
| institution | Directory Open Access Journal |
| issn | 2073-4409 |
| language | English |
| last_indexed | 2024-03-09T19:11:19Z |
| publishDate | 2022-10-01 |
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| series | Cells |
| spelling | doaj.art-5eeea3ce5355469ea79472514e326f812023-11-24T04:07:31ZengMDPI AGCells2073-44092022-10-011121336210.3390/cells11213362Diabetic Macular Edema: Current Understanding, Molecular Mechanisms and Therapeutic ImplicationsJingfa Zhang0Jingxiang Zhang1Chaoyang Zhang2Jingting Zhang3Limin Gu4Dawei Luo5Qinghua Qiu6Department of Ophthalmology, Shanghai General Hospital (Shanghai First People’s Hospital), School of Medicine, Shanghai Jiao Tong University, 100 Haining Road, Hongkou District, Shanghai 200080, ChinaNursing Department, People’s Hospital of Huangdao District, Qingdao 266400, ChinaDepartment of Ophthalmology, Shanghai General Hospital (Shanghai First People’s Hospital), School of Medicine, Shanghai Jiao Tong University, 100 Haining Road, Hongkou District, Shanghai 200080, ChinaDepartment of Ophthalmology, Shanghai General Hospital (Shanghai First People’s Hospital), School of Medicine, Shanghai Jiao Tong University, 100 Haining Road, Hongkou District, Shanghai 200080, ChinaDepartment of Ophthalmology, Shanghai Aier Eye Hospital, Shanghai 200336, ChinaDepartment of Ophthalmology, Shanghai General Hospital (Shanghai First People’s Hospital), School of Medicine, Shanghai Jiao Tong University, 100 Haining Road, Hongkou District, Shanghai 200080, ChinaDepartment of Ophthalmology, Shanghai General Hospital (Shanghai First People’s Hospital), School of Medicine, Shanghai Jiao Tong University, 100 Haining Road, Hongkou District, Shanghai 200080, ChinaDiabetic retinopathy (DR), with increasing incidence, is the major cause of vision loss and blindness worldwide in working-age adults. Diabetic macular edema (DME) remains the main cause of vision impairment in diabetic patients, with its pathogenesis still not completely elucidated. Vascular endothelial growth factor (VEGF) plays a pivotal role in the pathogenesis of DR and DME. Currently, intravitreal injection of anti-VEGF agents remains as the first-line therapy in DME treatment due to the superior anatomic and functional outcomes. However, some patients do not respond satisfactorily to anti-VEGF injections. More than 30% patients still exist with persistent DME even after regular intravitreal injection for at least 4 injections within 24 weeks, suggesting other pathogenic factors, beyond VEGF, might contribute to the pathogenesis of DME. Recent advances showed nearly all the retinal cells are involved in DR and DME, including breakdown of blood-retinal barrier (BRB), drainage dysfunction of Müller glia and retinal pigment epithelium (RPE), involvement of inflammation, oxidative stress, and neurodegeneration, all complicating the pathogenesis of DME. The profound understanding of the changes in proteomics and metabolomics helps improve the elucidation of the pathogenesis of DR and DME and leads to the identification of novel targets, biomarkers and potential therapeutic strategies for DME treatment. The present review aimed to summarize the current understanding of DME, the involved molecular mechanisms, and the changes in proteomics and metabolomics, thus to propose the potential therapeutic recommendations for personalized treatment of DME.https://www.mdpi.com/2073-4409/11/21/3362diabetic retinopathydiabetic macular edemablood-retinal barrier breakdowndrainage dysfunctioninflammationanti-VEGF |
| spellingShingle | Jingfa Zhang Jingxiang Zhang Chaoyang Zhang Jingting Zhang Limin Gu Dawei Luo Qinghua Qiu Diabetic Macular Edema: Current Understanding, Molecular Mechanisms and Therapeutic Implications Cells diabetic retinopathy diabetic macular edema blood-retinal barrier breakdown drainage dysfunction inflammation anti-VEGF |
| title | Diabetic Macular Edema: Current Understanding, Molecular Mechanisms and Therapeutic Implications |
| title_full | Diabetic Macular Edema: Current Understanding, Molecular Mechanisms and Therapeutic Implications |
| title_fullStr | Diabetic Macular Edema: Current Understanding, Molecular Mechanisms and Therapeutic Implications |
| title_full_unstemmed | Diabetic Macular Edema: Current Understanding, Molecular Mechanisms and Therapeutic Implications |
| title_short | Diabetic Macular Edema: Current Understanding, Molecular Mechanisms and Therapeutic Implications |
| title_sort | diabetic macular edema current understanding molecular mechanisms and therapeutic implications |
| topic | diabetic retinopathy diabetic macular edema blood-retinal barrier breakdown drainage dysfunction inflammation anti-VEGF |
| url | https://www.mdpi.com/2073-4409/11/21/3362 |
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