He Xuemin, Wen Siying, Tang Xixiang, Wen Zheyao, Zhang Rui, Li Shasha, Gao Rong, Wang Jin, Zhu Yanhua, Fang Dong, Li Ting, Peng Ruiping, Zhang Zhaotian, Wen Shiyi, Zhou Li, Ai Heying, Lu Yan, Zhang Shaochong, Shi Guojun, Chen Yanming
Department of Endocrinology and Metabolic Diseases, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
Guangdong Provincial Key Laboratory of Diabetology & Guangzhou Municipal Key Laboratory of Mechanistic and Translational Obesity Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
Acta Pharm Sin B. 2024 Jun;14(6):2613-2630. doi: 10.1016/j.apsb.2024.03.011. Epub 2024 Mar 10.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) protect against diabetic cardiovascular diseases and nephropathy. However, their activity in diabetic retinopathy (DR) remains unclear. Our retrospective cohort study involving 1626 T2DM patients revealed superior efficacy of GLP-1 RAs in controlling DR compared to other glucose-lowering medications, suggesting their advantage in DR treatment. By single-cell RNA-sequencing analysis and immunostaining, we observed a high expression of GLP-1R in retinal endothelial cells, which was down-regulated under diabetic conditions. Treatment of GLP-1 RAs significantly restored the receptor expression, resulting in an improvement in retinal degeneration, vascular tortuosity, avascular vessels, and vascular integrity in diabetic mice. GO and GSEA analyses further implicated enhanced mitochondrial gene translation and mitochondrial functions by GLP-1 RAs. Additionally, the treatment attenuated STING signaling activation in retinal endothelial cells, which is typically activated by leaked mitochondrial DNA. Expression of mRNA was positively correlated to the levels of angiogenic and inflammatory factors in the endothelial cells of human fibrovascular membranes. Further investigation revealed that the cAMP-responsive element binding protein played a role in the GLP-1R signaling pathway on suppression of STING signaling. This study demonstrates a novel role of GLP-1 RAs in the protection of diabetic retinal vasculature by inhibiting STING-elicited inflammatory signals.
胰高血糖素样肽-1受体激动剂(GLP-1 RAs)可预防糖尿病心血管疾病和肾病。然而,它们在糖尿病视网膜病变(DR)中的活性仍不清楚。我们对1626例2型糖尿病患者进行的回顾性队列研究显示,与其他降糖药物相比,GLP-1 RAs在控制DR方面具有更高的疗效,表明其在DR治疗中的优势。通过单细胞RNA测序分析和免疫染色,我们观察到视网膜内皮细胞中GLP-1R的高表达,在糖尿病条件下该表达下调。GLP-1 RAs治疗可显著恢复受体表达,从而改善糖尿病小鼠的视网膜变性、血管迂曲、无血管区和血管完整性。基因本体(GO)和基因集富集分析(GSEA)进一步表明,GLP-1 RAs可增强线粒体基因翻译和线粒体功能。此外,该治疗减弱了视网膜内皮细胞中干扰素基因刺激蛋白(STING)信号的激活,而STING信号通常由泄漏的线粒体DNA激活。mRNA的表达与人类纤维血管膜内皮细胞中血管生成和炎症因子的水平呈正相关。进一步研究表明,环磷酸腺苷反应元件结合蛋白在GLP-1R信号通路抑制STING信号中发挥作用。本研究证明了GLP-1 RAs通过抑制STING引发的炎症信号在保护糖尿病视网膜血管系统中的新作用。