Authors: Tremolada, Gemma¹; Lattanzio, Rosangela¹; Mazzolari, Gabriella²; Zerbini, Gianpaolo²

Source: American Journal of Cardiovascular Drugs, Volume 7, Number 6, 2007 , pp. 393-398(6)

Publisher: Adis International

Abstract:

During the last few years, the incidence of microvascular complications in diabetes mellitus has rapidly increased as a consequence of both an increase in incidence of type 2 and type 1 diabetes mellitus.

The pathogenesis of diabetic microvascular complications is still largely unknown. Among the many hypotheses, a dysfunction in angiogenesis has been suggested as a common origin for retinopathy, nephropathy, and neuropathy. Based on this hypothesis, inhibition of vascular endothelial growth factor (VEGF) has been tested as a potential therapeutic approach to prevent and cure diabetic microvascular complications. Several VEGF inhibitors are currently under evaluation or are approved for the treatment of wet age-related macular degeneration and macular edema. These include inhibitors of intracellular transcription of VEGF (e.g. bevasiranib), inhibitors of extracellular VEGF (e.g. pegaptanib), inhibitors of VEGF receptor expression (e.g. aflibercept [VEGF-TRAP]) and inhibitors of the intracellular signaling cascade activating VEGF (e.g. midostaurin).

According to the existing evidence base, although inhibition of VEGF results in a better outcome in the case of diabetic retinopathy and also, despite some discrepant results, in the case of diabetic nephropathy, there is no final confirmation that VEGF inhibition is a valid approach for diabetic neuropathy. The latter complication actually, in line with other chronic neuropathies, seems to improve with stimulation of angiogenesis through increased expression of VEGF.

Document Type: Leading article

Affiliations: 1: 1 Department of Ophthalmology and Visual Sciences, San Raffaele Scientific Institute, Milan, Italy 2: 2 Renal Pathophysiology Unit, San Raffaele Scientific Institute, Milan, Italy

Publication date: 2007-01-01

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