Apoptosis And Inflammation Form The Mystery Of Pathogenesis Of Diabetic Retinopathy

Faster anaerobic glycolysis in type 2 diabetes mellitus generates increased lactate and NADH. Uncoupling of NADH produces excessive reactive oxygen species which form the main stream of apoptosis of vascular and neural cells in retina. Increased lipid peroxidation and extracellular glutamate toxicity further augment this process. Vascular endothelial growth factor is up regulated to resist the apoptotic destruction or in response to non-perfusion of acellular capillaries. Deleterious effects of excessive vascular endothelial growth factor under an adverse biochemical circumstances causes microangiopathy in diabetic subjects. Blood levels of lactate, glutamate, malondialdehyde and vascular endothelial growth factor were seen significantly higher in mild non-proliferative diabetic retinopathy in comparison to diabetic subjects with no retinopathy.