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Oxidative Medicine and Cellular Longevity
Volume 3 (2010), Issue 6, Pages 392-403
http://dx.doi.org/10.4161/oxim.3.6.14786

Retinal Redox Stress and Remodeling in Cardiometabolic Syndrome and Diabetes

1Yunnan Province 2nd Hospital, Kunming, China
2University of Missouri School of Medicine, Department of Internal Medicine, MO, USA
3University of Missouri School of Medicine, Physiology and Pharmacology, MO, USA
4University of Missouri School of Medicine, 4Division of Endocrinology, Diabetes, Metabolism and Cardiovascular Disease, MO, USA
5University of Missouri School of Medicine, Harry S. Truman VA Medical Center, MO, USA

Received 13 December 2010; Revised 4 January 2011; Accepted 7 January 2011

Copyright © 2010 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Diabetic retinopathy (DR) is a significant cause of global blindness; a major cause of blindness in the United States in people aged between 20–74. There is emerging evidence that retinopathy is initiated and propagated by multiple metabolic toxicities associated with excess production of reactive oxygen species (ROS). The four traditional metabolic pathways involved in the development of DR include: increased polyol pathway flux, advanced glycation end-product formation, activation of protein kinase Cisoforms and hexosamine pathway flux. These pathways individually and synergisticallycontribute to redox stress with excess ROS resulting in retinal tissue injury resulting in significant microvascular blood retinal barrier remodeling. The toxicity of hyperinsulinemia, hyperglycemia, hypertension, dyslipidemia, increased cytokines and growth factors, in conjunction with redox stress, contribute to the development and progression of DR. Redox stress contributes to the development and progression of abnormalities of endothelial cells and pericytes in DR. This review focuses on the ultrastructural observations of the blood retinal barrier including the relationship between the endothelial cell and pericyte remodeling in young nine week old Zucker obese (fa/ fa) rat model of obesity; cardiometabolic syndrome, and the 20 week old alloxan induced diabetic porcine model. Preventing or delaying the blindness associated with these intersecting abnormal metabolic pathways may be approached through strategies targeted to reduction of tissue inflammation and oxidative—redox stress. Understanding these abnormal metabolic pathways and the accompanying redox stress and remodeling mayprovide both the clinician and researcher a new concept of approaching this complicated disease process