Diyabetik Retinopati ve Nitrik Oksit

Öz

One of the most important cause of blindness in developed or developing countries is diabetic retinopathy, of which pathogenesis has not been yet clarified exactly. Understanding of pathogenesis of DRP can cause better management of this disease. Vascular damage is leading pathology in diabetic retinopathy. There is some proof that endothelin has important role in maintenance of vascular tonus and structure. Nitric oxide (NO) is one of the most important vasoactive mediators derived from endothelium. Nitric oxide is multifunctional molecule having key role on the anti-proliferative regulation of vascular smooth muscle cells. It has also been suggested that nitric oxide can play a role in the pathogenesis of diabetic retinopathy.There are three nitric oxide synthase (NOS) isoenzymes producing NO. Out of them, the isoenzyme present essentially in vascular endothelium is called as endothelialNOS (eNOS) and needed to protect endothelial functions. It has been reported that NO can control cellular growth and play role in the retinal pathologies due to proliferative retinal diseases. From this respect, eNOS appears to be an interesting molecule in the identification of microvascular complications of diabetes. Various polymorphisms have also been identified in the eNOS gene. The T-786C polymorphism located in promoter region of eNOS gene, 27-bp duplication in intron 4 region and Glu298Asp in exon 7 have been attracting attention. Defective retinal eNOS expression related to its polymorphisms may contribute to the development of macular edema. Differences among the studies may demonstrate that a relationship between diabetic retinopathy and eNOS gene polymorphism can vary due to geographic and ethnic differences. Importance of NO and relevant gene polymorphisms in the pathogenesis of diabetic retinopathy has been reviewed in this article

Anahtar Kelimeler

• Diabetic retinopathy, pathogenesis, Nitric Oxide, eNOS, gene polymorphisms

Diyabetik Retinopati ve Nitrik Oksit

Öz

Erişkin körlüğünün en önemli nedenlerinden birisi patogenezi tam olarak açıklanamamış diyabetik retinopatidir. Diyabetik retinopati patogenezinin anlaşılması daha iyi tedavisine ön ayak olabilir. Diyabetik retinopatide vasküler hasar ön plandadır. Endotelin vasküler tonus ve yapının korunmasında önemli rolü olduğuna ilişkin kanıtlar vardır. Endotel türevi vazoaktif mediatörlerden en önemlilerinden biri nitrik oksittir. Nitrik oksit vasküler düz kas hücrelerinin antiproliferatif düzenlenmesinde anahtar role sahip çok fonksiyonlu bir moleküldür. Diabetik retinopati patogenezinde nitrik oksitin de rolü olabileceği savunulmaktadır. Nitrik oksit sentezi yapan üç tür NOS izoenzimi vardır. Bunların içinden temel olarak vasküler endotelde bulunmakta olan izoenzim, endotelial-NOS (eNOS) olarak adlandırılır. eNOS endotel fonksiyonunun korunmasında gereklidir . Retinanın proliferatif hastalıklarında nitrik oksidin rolü olabileceği, nitrik oksidin hücre büyümesini kontrol edebileceği bildirilmiştir. Bu açıdan diyabetin mikrovasküler komplikasyonlarının belirlenmesinde eNOS ilgi çekici görünmektedir. eNOS geninde çeşitli polimorfizmler tanımlanmıştır. Özellikle promotor bölgesindeki T-786C, 4. intron bölgesinde 27-bp tekrarı ve 7. eksondaki Glu298Asp dikkat çekmiştir. Endoteliyal NOS gen polimorfizm ile ilgili olarak retinadaki defektif eNOS ekspresyonu özellikle diabetik makula ödemi gelişimine katkıda bulunabilmektedir. Çalışmalardaki farklılıklar diyabetik retinopati ile eNOS gen polimorfizmi arasındaki ilişkinin coğrafik ve etnik farklılıklara göre değişebildiğini göstermektedir. Bu makalede NO ve ilgili gen polimorfizmlerinin diabetik retinopati patogenezindeki önemi gözden geçirilmeye çalışılmıştır

Anahtar Kelimeler

• Diyabetik Retinopati, Patogenez, Nitrik Oksit, eNOS, Gen Polimorfizmi

Kaynakça

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