糖尿病视网膜神经变性的靶向治疗

Targeted therapy for diabetic retinal neurodegeneration

糖尿病视网膜病变主要病理改变为视网膜微血管病变及视网膜神经变性,且视网膜神经变性发生在微血管病变之前。糖尿病视网膜神经变性(diabetic retinal neurodegeneration,DRN)的发病机制涉及到炎症、氧化应激、谷氨酸积累、自噬、神经营养因子下调及凋亡等。目前,针对DRN的治疗尚不够明确,近年来DRN靶向药物醛糖还原酶抑制剂、普瑞巴林、毛兰素、白藜芦醇、槲皮素、叶黄素、烟酰胺、胍丁胺、哺乳动物雷帕霉素靶蛋白激活剂、乙酰化酶、脑源性神经营养因子、β-神经生长因子、生长抑素、Raf-1激酶抑制蛋白等均能够在一定程度上延缓或减轻DRN进展,有望为将来糖尿病视网膜病变提供新的诊疗方案和预防策略。

The main pathological changes in diabetic retinopathy are retinal microvascular lesions and retinal neurodegeneration,with neurodegeneration occurring before microvascular lesions.The pathogenesis of diabetic retinal neurodegeneration(DRN)involves inflammation,oxidative stress,glutamate accumulation,autophagy,downregulation of neurotrophic factors,and apoptosis.At present,the treatment for DRN is not well established.In recent years,targeted drugs for DRN including aldose reductase inhibitors,pregabalin,maolin,resveratrol,quercetin,lutein,niacinamide,guanidine,mammalian target of rapamycin activators,acetylase,brain-derived neurotrophic factor,β-nerve growth factor,somatostatin,Raf-1 kinase inhibitory protein,have been shown to delay or alleviate the progression of DRN to a certain extent.It is expected to provide new diagnostic and therapeutic strategies as well as prevention strategies for diabetic retinopathy in the future.