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Diabetes Care 28:963-970, 2005
© 2005 by the American Diabetes Association, Inc.


Reviews/Commentaries/ADA Statements
Perspectives on the News

Diabetic Retinopathy and Neuropathy

Zachary T. Bloomgarden, MD

Diabetes Center, Mount Sinai School of Medicine, New York, New York

Abbreviations: ABI, ankle-brachial index • Akt, protein kinase B • ALA, {alpha}-lipoic acid • Ang, angiopoietin • BPI, bactericidal/permeability-increasing protein • CAN, cardiac autonomic neuropathy • CD, cluster of differentiation • JAM, junctional adhesion molecule • Mac-1, macrophage-1 antigen • MMP, matrix metalloproteinase • PDGF, platelet-derived growth factor • PECAM, platelet endothelial cell adhesion molecule • PKC, protein kinase C • PTA, percutaneous transluminal angioplasty • PVD, peripheral vascular disease • RAGE, receptor for advanced glycation end products • VEGF, vascular endothelial growth factor • VEGF-R, VEGF receptor

The first 300 words of the full text of this article appear below.

This is the seventh in a series of articles on presentations at the American Diabetes Association Annual Meeting, Orlando, Florida, 4–8 June 2004.

Mechanisms of diabetic retinopathy

Holger Gerhardt (Goteborg, Sweden) discussed pericytes and vascular stability in the diabetic retina, noting that these cells cover most of the endothelium and are present during the development of normal new blood vessels, while proliferative retinopathy classically shows "pericyte drop out" as an early pathological marker. It has been hypothesized that endothelial dysfunction leads to capillary occlusion and regression, causing ischemia, to which neovascularization with subsequent proliferative retinopathy is a response. In this schema, pericyte drop out may occur either before or after the stage of endothelial dysfunction. A number of markers can be used for characterizing pericytes. Mice that do not express platelet-derived growth factor (PDGF)-ß have severe diffuse bleeding and die early in the neonatal period. There is diffuse pericyte loss in these mice, suggesting PDGF-ß to be an important growth factor for the cells. An endothelium-specific PDGF-ß knockout displays a variety of phenotypes with variable degrees of pericyte loss, with areas of pericyte-covered vessels and areas lacking pericytes and with severe retinopathy localized to the areas lacking pericytes. Gerhardt suggested that pericyte drop out is therefore sufficient to cause capillary occlusion and regression, leading to retinal ischemia. Why, though, he asked, is there a proliferative response rather than normal development of well-behaved new vessels repairing the region of ischemia, and how does retinal normal vascular development differ from that seen in neovascularization? The normal advancing vascular sprout extends "tip cells," which appear to guide the development of the vasculature, following paths produced by astrocytes, which produce vascular endothelial growth factor (VEGF)-{alpha} in areas of hypoxia, with astrocyte VEGF-{alpha} downregulated after it becomes covered by new vessels. In the developing retina, the VEGF receptor (R)2 . . . [Full Text of this Article]

Clinical retinopathy studies

Autonomic neuropathy

Somatic neuropathy

The diabetic foot


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Copyright © 2005 by the American Diabetes Association.