Diabetic retinopathy (DR) is the most common complication of diabetes and one of the leading causes of preventable blindness. DR has been classically considered to be a microcirculatory disease of the retina. However, before any microcirculatory abnormalities can be detected under ophthalmoscopic examination, retinal neurodegeneration is already present. This is to say that retinal neurodegeneration is an early event in the pathogenesis of diabetic retinopathy. There is a need to have a good animal model where potentially neuroprotective drugs could be tested on and understand their mechanisms of action. _x000D_ In the first chapter of this thesis the main aim was to characterize the sequential events that take place in retinal neurodegeneration in a murine model of spontaneous type 2 diabetes, the db/db mouse. We found progressively increased levels of the histological markers of neurodegeneration (glial activation and apoptosis) at all stages studied worsening with age. Significant electroretinographic abnormalities were present in diabetic mice at weeks 16 and 24 but not at week 8. Moreover it was observed a progressive accumulation of glutamate in diabetic mice associated with an early downregulation of its transporter GLAST. All this abnormalities were abrogated by lowering blood glucose levels. Finally, a dysregulation of several genes related to neurotransmission and oxidative stress such as UCP2 were found at week 8. All these results suggest that db/db mouse reproduce the features of the neurodegenerative process that occurs in the human diabetic eye. Therefore it is an appropriate model for investigating the underlying mechanisms of diabetes induced retinal neurodegeneration and for testing neuroprotective drugs. _x000D_ In the second chapter the potential effects of fenofibric acid (FA) (the active metabolite of fenofibrate) in preventing retinal neurodegeneration in the db/db mouse are evaluated. Oral treatment for one week resulted in a reduction of glial activation and apoptosis in comparison to vehicle-treated mice. Functional abnormalities were ameliorated and FA treatment also prevented GLAST downregulation induced by diabetes. Our results suggest that neuroprotection is one of the underlying mechanisms by which FA exerts its beneficial actions in diabetic retinopathy. _x000D_ The third chapter is focused on GLP-1 and its neuroprotective effects in the retina. GLP-1 has been demonstrated to have neuroprotective effects in the central nervous system. We sought to examine the expression and content of GLP-1R in human and db/db mice retinas, to determine the retinal neuroprotective effects of systemic and topical administration of GLP-1R agonists in db/db mice and, to examine the underlying neuroprotective mechanisms. We found abundant expression of GLP-1R in the human retina and retinas from db/db mice. Moreover, it has been demonstrated that systemic administration of GLP-1R agonists (liraglutide) prevents retinal neurodegeneration (glial activation, neural apoptosis and electroretinographical abnormalities). This effect can be attributed to a significant reduction of extracellular glutamate and to an increase of prosurvival signalling pathways. We have found a similar neuroprotective effect using topical administration of native GLP-1 and several GLP-1R agonists (liraglutide, lixisenatide and exenatide). Notably, this neuroprotective action was observed without any reduction in blood glucose levels. These results suggest that GLP-1R activation itself prevents diabetes induced retinal neurodegeneration.
Neurodegeneration as an early event in the pathogenesis of diabetic retinopathy: therapeutic implications
Lidia Corraliza Márquez (Author). 4 Nov 2016
Student thesis: Doctoral thesis
Student thesis: Doctoral thesis