Li Qin, Onizuka Satoru, Park Kyoungmin, Ma Mingming, Fickweiler Ward, Park Hyunseok, Li Qian, Simao Fabricio, Boisclair Jared, Sharawy Maha, Wu I-Hsien, Yu Marc Gregory, Aiello Lloyd P, Sun Jennifer K, King George L
Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Dianne Nunnally Hoppes Laboratory for Diabetes Complications, Joslin Diabetes Center, Harvard Medical School, Boston, MA.
Diabetes. 2025 May 1;74(5):787-797. doi: 10.2337/db24-0822.
Anti-vascular endothelial growth factor (anti-VEGF) therapies are effective treatment for severe diabetic retinopathy (DR) and macular edema, but a significant subset of people had inadequate response to anti-VEGF intervention. Because elevation or overexpression of retinol binding protein 3 (RBP3) decreases risks for retinal pathologies and progression to severe DR, we compared the therapeutic profiles of RBP3 and anti-VEGF antibody to normalize retinal dysfunctions induced by diabetes. Intravitreous injection of recombinant human RBP3 (rhRBP3) and anti-VEGF antibody (namely, bevacizumab) inhibited retinal vascular permeability in Lewis rats induced by VEGF-A or after 2 months of diabetes induced by streptozotocin, in parallel with reductions of retinal VEGF and VEGF receptor 2 expressions and tyrosine phosphorylation of VEGF receptor. Only rhRBP3 ameliorated diabetes-induced reduction of neural retinal function, measured by electroretinogram. Furthermore, rhRBP3 reduced retinal expressions of inflammatory cytokines (TNF-α and IL-6) in retinal pigmented epithelial and Müller cells exposed to hyperglycemia. Metabolic studies, using a Seahorse flux analyzer, showed only rhRBP3 normalized retinal glycolytic rates in diabetic rats. Thus, both intravitreous anti-VEGF antibody and RBP3 injections normalized retinal vascular dysfunctions caused by diabetes. Only RBP3 targeted both neural and vascular retina to reduce glycolytic rates, reverse neural-retinal dysfunctions, and reduce inflammatory cytokines induced by diabetes, to delay early changes of DR.
抗血管内皮生长因子(抗VEGF)疗法是治疗重度糖尿病视网膜病变(DR)和黄斑水肿的有效方法,但相当一部分人对抗VEGF干预反应不足。由于视黄醇结合蛋白3(RBP3)的升高或过表达可降低视网膜病变风险以及发展为重度DR的风险,我们比较了RBP3和抗VEGF抗体的治疗效果,以恢复糖尿病诱导的视网膜功能障碍。玻璃体内注射重组人RBP3(rhRBP3)和抗VEGF抗体(即贝伐单抗)可抑制VEGF-A诱导的或链脲佐菌素诱导糖尿病2个月后的Lewis大鼠的视网膜血管通透性,同时降低视网膜VEGF和VEGF受体2的表达以及VEGF受体的酪氨酸磷酸化。只有rhRBP3改善了通过视网膜电图测量的糖尿病诱导的神经视网膜功能降低。此外,rhRBP3降低了暴露于高血糖的视网膜色素上皮细胞和Müller细胞中炎性细胞因子(TNF-α和IL-6)的视网膜表达。使用海马通量分析仪进行的代谢研究表明,只有rhRBP3使糖尿病大鼠的视网膜糖酵解速率恢复正常。因此,玻璃体内注射抗VEGF抗体和RBP3均可恢复糖尿病引起的视网膜血管功能障碍。只有RBP3靶向神经视网膜和血管视网膜,以降低糖酵解速率,逆转神经视网膜功能障碍,并减少糖尿病诱导的炎性细胞因子,从而延缓DR的早期变化。