Department of Ophthalmology and Visual Sciences, Department of Molecular and Integrative Physiology, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA.
Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
Nat Rev Endocrinol. 2021 Apr;17(4):195-206. doi: 10.1038/s41574-020-00451-4. Epub 2021 Jan 19.
Diabetes mellitus has profound effects on multiple organ systems; however, the loss of vision caused by diabetic retinopathy might be one of the most impactful in a patient's life. The retina is a highly metabolically active tissue that requires a complex interaction of cells, spanning light sensing photoreceptors to neurons that transfer the electrochemical signal to the brain with support by glia and vascular tissue. Neuronal function depends on a complex inter-dependency of retinal cells that includes the formation of a blood-retinal barrier. This dynamic system is negatively affected by diabetes mellitus, which alters normal cell-cell interactions and leads to profound vascular abnormalities, loss of the blood-retinal barrier and impaired neuronal function. Understanding the normal cell signalling interactions and how they are altered by diabetes mellitus has already led to novel therapies that have improved visual outcomes in many patients. Research highlighted in this Review has led to a new understanding of retinal pathophysiology during diabetes mellitus and has uncovered potential new therapeutic avenues to treat this debilitating disease.
糖尿病会对多个器官系统产生深远影响；然而，糖尿病视网膜病变导致的视力丧失可能是对患者生活影响最大的因素之一。视网膜是一种代谢非常活跃的组织，需要细胞之间的复杂相互作用，从感光的光感受器到将电化学信号传递到大脑的神经元，再到神经胶质细胞和血管组织的支持。神经元功能取决于视网膜细胞之间的复杂相互依存关系，包括形成血视网膜屏障。这一动态系统受到糖尿病的负面影响，改变了正常的细胞间相互作用，导致严重的血管异常、血视网膜屏障丧失和神经元功能受损。了解正常的细胞信号相互作用以及糖尿病如何改变这些相互作用，已经催生了许多改善许多患者视力预后的新疗法。本综述中强调的研究导致了对糖尿病期间视网膜病理生理学的新认识，并揭示了治疗这种使人衰弱的疾病的潜在新治疗途径。
