The Role of Concomitant Immunosuppressants in Impeding the Progression of Diabetic Retinopathy: A Pilot Study

Overview

Journal Indian J Ophthalmol

Specialty Ophthalmology

Date 2021 Oct 28

PMID 34708796

Citations 1

Authors

Premnath Raman

Rupal Kathare

Affiliations

Soon will be listed here.

Abstract

Purpose: Hallmark of Diabetic Retinopathy (DR) is blood-retinal barrier alteration. Vascular endothelial growth factor (VEGF) and inflammation are involved in the pathogenesis of DR. Anti-VEGFs and lasers are effective in treating DR but have numerous drawbacks, hence the need to develop alternative therapies that may delay the onset or progression of DR.

Methods: Fifteen patients were recruited in each group; the study group was on immunosuppressants for some other coexisting disease and the control group was not on them. Each subject underwent detailed history, ophthalmic examination, and glycosylated hemoglobin (HbA1c) and renal function tests at the time of recruitment and the end of one year. Primary outcome measure was to compare the progression of DR in diabetics on immunosuppressant versus those not on it.

Results: Median age in the study and control group was 57 years and 60 years, respectively (P = 0.6). Median duration of diabetes was 11 and 12 years in the study and control group, respectively (P = 0.7). HbA1c for the study and control group for first visit was 7.6% and 8.0%, respectively (P = 0.26) and for second visit was 7.5% and 8.1%, respectively (P = 0.11). Hypertensives in the study and control groups were 9 and 4, respectively (P = 0.065); renal disease in the study and control groups was 4 and 2, respectively (P = 0.361). The control group showed 33.3% progression of DR, and no progression was seen in the study group (P = 0.014).

Conclusion: Immunosuppressants seemed to delay the onset and progression of DR in the earlier stages.

Citing Articles

Insights into the systemic risk factors associated with diabetic retinopathy in the Indian population: A comprehensive systematic review and meta-analysis.

Favas K, Niveditha M, Yoosuf B, Bhukya M, Gupta P, Dutta P Indian J Ophthalmol. 2024; 73(Suppl 1):S24-S30.

PMID: 39723866 PMC: 11834928. DOI: 10.4103/IJO.IJO_818_24.

Commentary: Oral management of diabetic retinopathy.

Delhiwala K, Khamar B Indian J Ophthalmol. 2021; 69(11):3327-3328.

PMID: 34708797 PMC: 8725083. DOI: 10.4103/ijo.IJO_2088_21.

References

Tang J, Kern T . Inflammation in diabetic retinopathy. Prog Retin Eye Res. 2011; 30(5):343-58. PMC: 3433044. DOI: 10.1016/j.preteyeres.2011.05.002. View

Limb G, CHIGNELL A, Green W, Leroy F, Dumonde D . Distribution of TNF alpha and its reactive vascular adhesion molecules in fibrovascular membranes of proliferative diabetic retinopathy. Br J Ophthalmol. 1996; 80(2):168-73. PMC: 505411. DOI: 10.1136/bjo.80.2.168. View

Hawrami K, Hitman G, Rema M, Snehalatha C, Viswanathan M, Ramachandran A . An association in non-insulin-dependent diabetes mellitus subjects between susceptibility to retinopathy and tumor necrosis factor polymorphism. Hum Immunol. 1996; 46(1):49-54. DOI: 10.1016/0198-8859(95)00177-8. View

Hussain R, Rajesh B, Giridhar A, Gopalakrishnan M, Sadasivan S, James J . Knowledge and awareness about diabetes mellitus and diabetic retinopathy in suburban population of a South Indian state and its practice among the patients with diabetes mellitus: A population-based study. Indian J Ophthalmol. 2016; 64(4):272-6. PMC: 4901844. DOI: 10.4103/0301-4738.182937. View

Zhang W, Liu H, Rojas M, Caldwell R, Caldwell R . Anti-inflammatory therapy for diabetic retinopathy. Immunotherapy. 2011; 3(5):609-28. PMC: 3671852. DOI: 10.2217/imt.11.24. View

Boyer D, Rippmann J, Ehrlich M, Bakker R, Chong V, Nguyen Q . Amine oxidase copper-containing 3 (AOC3) inhibition: a potential novel target for the management of diabetic retinopathy. Int J Retina Vitreous. 2021; 7(1):30. PMC: 8042903. DOI: 10.1186/s40942-021-00288-7. View

Doganay S, Evereklioglu C, Er H, Turkoz Y, Sevinc A, Mehmet N . Comparison of serum NO, TNF-alpha, IL-1beta, sIL-2R, IL-6 and IL-8 levels with grades of retinopathy in patients with diabetes mellitus. Eye (Lond). 2002; 16(2):163-70. DOI: 10.1038/sj.eye.6700095. View

Vincent J, Mohr S . Inhibition of caspase-1/interleukin-1beta signaling prevents degeneration of retinal capillaries in diabetes and galactosemia. Diabetes. 2006; 56(1):224-30. DOI: 10.2337/db06-0427. View

Funatsu H, Yamashita H, Ikeda T, Mimura T, Eguchi S, Hori S . Vitreous levels of interleukin-6 and vascular endothelial growth factor are related to diabetic macular edema. Ophthalmology. 2003; 110(9):1690-6. DOI: 10.1016/S0161-6420(03)00568-2. View

10.

Joussen A, Poulaki V, Mitsiades N, Kirchhof B, Koizumi K, Dohmen S . Nonsteroidal anti-inflammatory drugs prevent early diabetic retinopathy via TNF-alpha suppression. FASEB J. 2002; 16(3):438-40. DOI: 10.1096/fj.01-0707fje. View

11.

Roy R, Das M, Pal B, Ganesan S, Raman R, Sharma T . The effects of renal transplantation on diabetic retinopathy: clinical course and visual outcomes. Indian J Ophthalmol. 2013; 61(10):552-6. PMC: 3853450. DOI: 10.4103/0301-4738.121067. View

12.

Joussen A, Poulaki V, Qin W, Kirchhof B, Mitsiades N, Wiegand S . Retinal vascular endothelial growth factor induces intercellular adhesion molecule-1 and endothelial nitric oxide synthase expression and initiates early diabetic retinal leukocyte adhesion in vivo. Am J Pathol. 2002; 160(2):501-9. PMC: 1850650. DOI: 10.1016/S0002-9440(10)64869-9. View

13.

Adamis A, Berman A . Immunological mechanisms in the pathogenesis of diabetic retinopathy. Semin Immunopathol. 2008; 30(2):65-84. DOI: 10.1007/s00281-008-0111-x. View

14.

Celik Buyuktepe T, Demirel S, Batioglu F, Ozmert E . The Correlation of Inflammation and Microvascular Changes with Diabetic Retinal Neurodegeneration. Curr Eye Res. 2021; 46(10):1559-1566. DOI: 10.1080/02713683.2021.1908567. View

15.

Bourne R, Stevens G, White R, Smith J, Flaxman S, Price H . Causes of vision loss worldwide, 1990-2010: a systematic analysis. Lancet Glob Health. 2014; 1(6):e339-49. DOI: 10.1016/S2214-109X(13)70113-X. View

16.

Zhang W, Liu H, Al-Shabrawey M, Caldwell R, Caldwell R . Inflammation and diabetic retinal microvascular complications. J Cardiovasc Dis Res. 2011; 2(2):96-103. PMC: 3144626. DOI: 10.4103/0975-3583.83035. View

17.

Tsalamandris S, Antonopoulos A, Oikonomou E, Papamikroulis G, Vogiatzi G, Papaioannou S . The Role of Inflammation in Diabetes: Current Concepts and Future Perspectives. Eur Cardiol. 2019; 14(1):50-59. PMC: 6523054. DOI: 10.15420/ecr.2018.33.1. View

18.

Limb G, Hollifield R, CHIGNELL A . Vascular adhesion molecules in vitreous from eyes with proliferative diabetic retinopathy. Invest Ophthalmol Vis Sci. 1999; 40(10):2453-7. View

19.

Hernandez C, Burgos R, Canton A, Garcia-Arumi J, Segura R, Simo R . Vitreous levels of vascular cell adhesion molecule and vascular endothelial growth factor in patients with proliferative diabetic retinopathy: a case-control study. Diabetes Care. 2001; 24(3):516-21. DOI: 10.2337/diacare.24.3.516. View

20.

Mittal N, Bajwa G, Sandhu J . Diabetic retinopathy before and after renal transplantation: a longitudinal study. Transplant Proc. 2005; 37(5):2077-9. DOI: 10.1016/j.transproceed.2005.03.027. View