Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Maryland.
Invest Ophthalmol Vis Sci. 2013 Dec 13;54(14):ORSF81-7. doi: 10.1167/iovs.13-12979.
Hyperglycemia has toxic effects on almost all cells in the body. Ophthalmic complications of hyperglycemia are most profound in cornea and retina. Seventy percent of diabetics suffer from corneal complications, collectively called diabetic keratopathy, which includes include recurrent erosions, delayed wound healing, ulcers, and edema. Confocal microscopy has permitted in vivo imaging of corneal nerves, which are also affected in diabetic subjects. Gene therapies upregulating MNNG HOS transforming gene (cMet) and/or downregulating MMP10 and cathepsin S are potential future therapies for diabetic keratopathy. Diabetic retinopathy (DR) is the most common cause of blindness in people over the age of 50. There is accumulating evidence that DR is an inflammatory disease. The initial events in animal models of DR are increased vascular permeability and leukostasis. This binding of leukocytes to the endothelium results from an increase in intracellular adhesion molecule-1 (ICAM-1) on the retinal capillary endothelium (EC) and expression of CD11/CD18 on the surface of the activated leukocyte. We have observed polymorphonuclear leukocytes (PMNs) at sites of EC vascular dysfunction in diabetic retinas as well as choroid. Anti-inflammatory drugs like etanercept, aspirin, or meloxicam reduce leukostasis and EC death. Future therapies may include repopulation of the acellular capillaries after EC and pericyte death with vascular progenitors made from the patient's own blood cells.
高血糖对体内几乎所有细胞都有毒性作用。高血糖的眼部并发症在角膜和视网膜最为严重。70%的糖尿病患者患有角膜并发症,统称为糖尿病性角膜病,包括反复性糜烂、延迟伤口愈合、溃疡和水肿。共焦显微镜允许对角膜神经进行体内成像,而糖尿病患者的角膜神经也受到影响。上调 MNNG HOS 转化基因 (cMet) 和/或下调 MMP10 和组织蛋白酶 S 的基因治疗是治疗糖尿病性角膜病的潜在未来疗法。糖尿病性视网膜病变 (DR) 是 50 岁以上人群失明的最常见原因。越来越多的证据表明,DR 是一种炎症性疾病。DR 动物模型中的初始事件是血管通透性增加和白细胞淤滞。白细胞与内皮细胞的这种结合是由于视网膜毛细血管内皮细胞 (EC) 上细胞间黏附分子-1 (ICAM-1) 的增加和活化白细胞表面 CD11/CD18 的表达。我们在糖尿病视网膜和脉络膜的 EC 血管功能障碍部位观察到多形核白细胞 (PMN)。像依那西普、阿司匹林或美洛昔康这样的抗炎药可以减少白细胞淤滞和 EC 死亡。未来的治疗方法可能包括用来自患者自身血细胞的血管祖细胞重新填充 EC 和周细胞死亡后的无细胞毛细血管。