Modification of Biochemical Derangements and VEGF Secretion May Prevent Diabetic Retinopathy (DR): An Advance Study

Unused, massive intracellular glucose in insulin-independent tissues, such as the retina, has many consequences: I increased formation of advanced glycation end products, (ii) polyol pathway activation, (iii) anaerobic glycolysis, (iv) glutamate toxicity, (v) lipid peroxidation and oxidative stress, and (vi) convergence to up regulation of antigenic peptides. The aim of this pilot study is to evaluate the effects of one type of intervention on the development of DR: B-vitamin supplementation (B1, B2, B3, B5, and B6), vitamin C, and vitamin E supplementation on amelioration of biochemical derangements related to DR development. In this unblended randomised trial, 400 diagnosed type 2 diabetic patients were randomly assigned to receive oral antidiabetic medication along with B-vitamins, vitamin C, and vitamin E or only antidiabetic medication to offer the study and monitored population from December 2004 to December 2017. Preliminary tasks were completed as follows: To begin, thorough fundoscopic examinations at baseline were sufficient to rule out the existence of retinopathy. Second, were baseline biochemical parameters such as NAD+, NADH, advanced glycation end products (AGEs), malondialdehyde (MDA), VEGF, and VEGFR2 measured in the blood? Finally, yearly fundoscopic exams were recorded in order to identify DR symptoms. The following conclusions were reached as a result of these efforts: 32 of the 187 (17.11%) patients who obtained B-vitamins, vitamin C, and vitamin E supplementation experienced very mild microangiopathy. 92 patients out of 200 (46%) with diabetic retinopathy experienced mild to moderate nonproliferative diabetic retinopathy (NPDR). Thirteen patients from the research group were counted as missing from the study’s observation. The results lead to the following conclusion: To avoid biochemical derangements that lead to increased expression of VEGF, precursors of oxidised cofactors and antioxidants should be supplemented to the glycolysis and citric acid cycle.

Author (s) Details

Lakshmi Kanta Mondal
Regional Institute of Ophthalmology, Kolkata, India.

Subhasish Pramanik
Institute of Post-Graduate Medical Education & Research, Kolkata, India.

Sriparna De
Department of Polymer Science and Technology, University of Calcutta, Kolkata, India.

Suman K. Paine
Regional Medical Research Centre ICMR, Dibrugarh, India.

Gautam Bhaduri
MGM Medical College, Kissangang, Bihar, India.

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