Emerging drugs for diabetic retinopathy

Abstract

Diabetic retinopathy (DR) is prevalent even among “well controlled” diabetics, and remains the commonest cause of visual loss in working age adults. Current evidence based treatments, including intensive glycemic and hypertensive control and laser photocoagulation, rarely improves visual outcomes in those with established DR. There has been an increasing focus on the underlying molecular mechanisms involved in DR, and targeted therapeutic interventions to temper their damaging effects. Methods: We review potential targets and emerging therapies for DR, including treatments currently in clinical trials. Results: Emerging therapies including inhibition of aldose reductase/polyol pathway, non-enzymatic glycation/advanced glycated end products inhibitors, protein kinase C inhibitors, and reduction of oxidative stress/superoxide induced damage. Newer drugs modulating growth factor and cytokine production (including VEGF, TNF and cytokines such as NF-kB) and newer targeted therapeutics utilising antisense oligonucleotides, and small interfering RNAs are also currently in clinical trials. Conclusions: Emerging treatments, possibly used in combination with standard therapy, offer the hope of effective and safe treatment that may allow us to improve visual outcomes and prevent the damaging consequences of DR.

Keywords::

• 3-hydroxy-3methyl-glutaryl coenzyme A reductase inhibitor
• advanced glycation end products
• aldose reductase inhibitor
• aminoguanadine
• angiotensin II receptor blocker
• angiotensin-converting enzyme inhibitor
• antioxidants
• corticosteroids
• cyclooxygenase inhibitors
• diabetes
• diabetic retinopathy
• intravitreal therapy
• macular oedema
• protein kinase C
• small interfering ribonucleic acids
• vascular endothelial growth factor