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Diabetic retinopathy: current understanding, mechanisms, and treatment strategies
Elia J. Duh, Jennifer K. Sun, Alan W. Stitt
Elia J. Duh, Jennifer K. Sun, Alan W. Stitt
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Diabetic retinopathy: current understanding, mechanisms, and treatment strategies

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Abstract

Diabetic retinopathy (DR) causes significant visual loss on a global scale. Treatments for the vision-threatening complications of diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) have greatly improved over the past decade. However, additional therapeutic options are needed that take into account pathology associated with vascular, glial, and neuronal components of the diabetic retina. Recent work indicates that diabetes markedly impacts the retinal neurovascular unit and its interdependent vascular, neuronal, glial, and immune cells. This knowledge is leading to identification of new targets and therapeutic strategies for preventing or reversing retinal neuronal dysfunction, vascular leakage, ischemia, and pathologic angiogenesis. These advances, together with approaches embracing the potential of preventative or regenerative medicine, could provide the means to better manage DR, including treatment at earlier stages and more precise tailoring of treatments based on individual patient variations.

Authors

Elia J. Duh, Jennifer K. Sun, Alan W. Stitt

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Figure 2

The neurovascular unit and its disruption by diabetes.

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The neurovascular unit and its disruption by diabetes.
In normal, health...
In normal, healthy retina (shown in the center), there is functional coupling and interdependency of neurons, glial elements including Müller cells, and vascular cells, with associated immune cells such as microglia. The insets show pathological changes associated with diabetic retinopathy in multiple components of the neurovascular unit and interacting immune cells, including compromise of endothelial-mural cell interactions, vascular basement membrane damage, Müller cell gliosis, and immune cell activation. Together, these changes result in impairment of neurovascular coupling, with consequences including blood-retinal barrier breakdown and dysregulation of retinal blood flow. Illustrated by Rachel Davidowitz.

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