Insights into diabetic retinopathy

The 2018 Kreissig Lecture looked at the role of inflammation in the disease

Leigh Spielberg

Posted: Friday, December 7, 2018

Antonia M. Joussen delivered the 2018 Kreissig Award Lecture

Does inflammation cause diabetic retinopathy, or is it an epiphenomenon of the disease? This mystery was addressed by Professor Antonia M. Joussen, Charité University of Medicine and Berlin Institute of Health, Germany, during her 2018 Kreissig Award Lecture at the 18th EURETINA Congress in Vienna.

Dr Joussen’s lecture, entitled “Diabetic Retinopathy: A Neuroinflammatory Disorder?”, covered the breadth of her research, which investigates ocular angiogenesis with a particular focus on diabetic retinopathy.

Dr Joussen reminded delegates that despite advances in the medical treatment of diabetic macular oedema and surgical treatment of proliferative diabetic retinopathy, visual function often does not improve.

“Pericytes loss is an early event in diabetic retinopathy,” Dr Joussen reminded delegates. “And pericyte depletion directly induces inflammatory responses in endothelial cells and infiltration of macrophages.”

Microglial cells, the resident macrophage cells in the retina, are the first and main form of active immune defence in the central nervous system. It is known that microglia are activated in neuro-inflammation. Thus, Dr Joussen’s interest in inflammation as an early target in diabetic retinopathy.

Dr Joussen explained that there is an inhibition of retinal pathology in long-term diabetic mice in which genes encoding for crucial inflammatory proteins had been knocked out.

“In knock-out mice with no inflammation, the retinal capillary net remains intact,” she said, suggesting that these capillaries are indeed destroyed by an inflammatory process.

But is inflammation purely an enemy, or does it have some positive effects in diabetic retinopathy? Initially, there is a certain degree of beneficial inflammation in the retina, but when it becomes excessive, it becomes destructive, she explained.

In order to treat diabetic retinas before they lose structure and function, new compounds are being both investigated and developed to target inflammation. Therapy of type 2 diabetes with salicylates (such as the compound contained in aspirin) indicates the relevance of cytokines in glucotoxicity. Others include IL-1β receptor blockers, IL-1β -specific antibodies and TNFα-inhibitors.

The Kreissig Award, which has been presented yearly since 2004, is given for outstanding contributions to the understanding and treatment of retinal diseases.

Professor Ingrid Kreissig, for whom the award is named, joined Dr Joussen on stage at the end of the latter’s presentation.

“I would like to thank you so much for this stimulating lecture in which you present the complex disease mechanisms in such a manner that we all understand it and remain enchanted,” said Dr Kreissig.

Antonia M. Joussen: