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    Keeping up with the latest diabetic eye disease research

    ARVO’s Diabetic Retinopathy meeting brought a wealth of new information

    I was fortunate to attend the Association for Research in Vision and Ophthalmology (ARVO) Diabetic Retinopathy this past August.

    Esteemed researchers and clinicians from all over the world presented myriad talks on subjects ranging from the epidemiology of diabetic eye disease to novel biochemical and epigenetic pathways underlying retinopathy to emerging preventive strategies and treatments. The two-day program also featured a number of interesting scientific posters including a summary of the work several colleagues and I have been doing for the last five years.

    All in all, it was jam packed with information that may significantly impact the way we manage patients in coming years, and I’ll share with you here some of the topics that especially piqued my interest.

    Related: Improve and protect the next patient with diabetes

    Research of note

    Renu Kowluru, PhD, from Wayne State University presented new work on the epigenetics of diabetic retinopathy (DR)—that is, environmental factors independent of gene DNA sequence that determine the activation or suppression of genes resulting in disease. In particular, damage to mitochondrial DNA (mtDNA) is characteristic of DR and results from over-methylation of that DNA, causing apoptosis of retinal capillary endothelial cells.1 As such, blocking enzymes responsible for excess methylation of mtDNA may offer great therapeutic promise. Research in this area is ongoing.

    Alexander Lbujmov, PhD, from UCLA presented work on the use of adult stem cell therapy to prevent vascular hyperpermeability and retinal capillary closure in early DR,2 as well as efforts to use gene therapy to treat corneal complications of diabetes like recurrent erosion, loss of corneal sensitivity, edema, and ulceration, abnormalities which are reported to affect 50 to 75 percent of patients having diabetes.3

    More from Dr. Chous: The importance of multidisciplinary care for diabetes

    Gregg Semenza, MD, PhD, from Johns Hopkins presented evidence showing that hypoxia inducible factor (HIF) is the master regulator of normal and pathologic vascularization and is necessary for activation of multiple genes producing multiple angiogenic factors like vascular endothelial growth factor (VEGF), angiopoetin-like 4 (ANGPTL4), and others.4 Further, he and other speakers showed evidence that half of all eyes with diabetic macular edema (DME) do not have elevated VEGF and that existing HIF inhibitors—such as digoxin—may better block all angiogenic molecules. This may be especially useful for patients who have a poor response to Avastin (bevacizumab, Genentech), Lucentis (ranibizumab, Genentech), and/or Eylea (aflibercept, Regeneron).

    Next: More research

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