Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal (S.T.-C., F.F.-R., M.F.); Faculty of Medicine, University of Porto, Porto, Portugal (M.C.A.V.); and Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal (F.F.-R., M.F.)
Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal (S.T.-C., F.F.-R., M.F.); Faculty of Medicine, University of Porto, Porto, Portugal (M.C.A.V.); and Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal (F.F.-R., M.F.).
J Pharmacol Exp Ther. 2020 Jun;373(3):445-452. doi: 10.1124/jpet.119.262956. Epub 2020 Apr 3.
Diabetic macular edema (DME) is the most common cause of visual loss in patients with diabetes. Antivascular endothelial growth factors (anti-VEGF) agents are first-line therapy for DME. Nevertheless, up to 60% of patients (depending on the anti-VEGF drug used) have an inadequate response to anti-VEGF treatment. Several cytokines are increased in aqueous humor of patients with DME. Differences in response to treatment may be related to baseline cytokine levels. Intravitreal corticosteroids may be used as an alternative to anti-VEGF agents. Steroids have a different pharmacological profile and act on different pathophysiologic mechanisms. Their effect on aqueous humor cytokines is different from the effect of anti-VEGF therapy. This review highlights the major cytokines involved in DME and evaluates whether baseline cytokine levels could be predictors of response to treatment in DME. SIGNIFICANCE STATEMENT: Antivascular endothelial growth factor (anti-VEGF) agents are efficient as diabetic macular edema (DME) treatment. However, in some cases, DME fails to respond to anti-VEGF intravitreal injections. Changes in cytokine levels after treatment supported the idea that other cytokines than VEGF are implicated in DME pathogenesis and could be predictors of response to anti-VEGF treatment or corticosteroids allowing targeted and individualized therapy guided by cytokine levels.
糖尿病性黄斑水肿（DME）是糖尿病患者视力丧失的最常见原因。抗血管内皮生长因子（anti-VEGF）药物是 DME 的一线治疗药物。然而，高达 60%的患者（取决于所用的 anti-VEGF 药物）对 anti-VEGF 治疗反应不足。几种细胞因子在 DME 患者的房水中增加。对治疗的反应差异可能与基线细胞因子水平有关。玻璃体内皮质类固醇可作为抗 VEGF 药物的替代物。类固醇具有不同的药理学特性，作用于不同的病理生理机制。它们对房水细胞因子的作用与抗 VEGF 治疗的作用不同。本综述重点介绍了与 DME 相关的主要细胞因子，并评估了基线细胞因子水平是否可以预测 DME 治疗的反应。意义：抗血管内皮生长因子（anti-VEGF）药物是治疗糖尿病性黄斑水肿（DME）的有效药物。然而，在某些情况下，DME 对 anti-VEGF 玻璃体内注射没有反应。治疗后细胞因子水平的变化支持了这样一种观点，即除了 VEGF 之外的其他细胞因子也与 DME 的发病机制有关，并且可以预测对 anti-VEGF 治疗或皮质类固醇的反应，从而允许根据细胞因子水平进行靶向和个体化治疗。
