The Role of HIF1α-PFKFB3 Pathway in Diabetic Retinopathy

Diabetic retinopathy (DR) is the leading cause of blindness for adults in developed countries. Both microvasculopathy and neurodegeneration are implicated in mechanisms of DR development, with neuronal impairment preceding microvascular abnormalities, which is often underappreciated in the clinic. Most current therapeutic strategies, including anti-vascular endothelial growth factor (anti-VEGF)-antibodies, aim at treating the advanced stages (diabetic macular edema and proliferative diabetic retinopathy) and fail to target the neuronal deterioration. Hence, new therapeutic approach(es) intended to address both vascular and neuronal impairment are urgently needed. The hypoxia-inducible factor 1 alpha (HIF1 alpha)-6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase 3 (PFKFB3) pathway is critically implicated in the islet pathology of diabetes. Recent evidence highlighted the pathway relevance for pathologic angiogenesis and neurodegeneration, two key aspects in DR. PFKFB3 is key to the sprouting angiogenesis, along with VEGF, by determining the endothelial tip-cell competition. Also, ISSN PFKFB3-driven glycolysis compromises the antioxidative capacity of neurons leading to neuronal loss and reactive gliosis.Therefore, the HIF1 alpha-PFKFB3 signaling pathway is unique as being a pervasive pathological component across multiple cell types in the retina in the early as well as late stages of DR. A metabolic point-of-intervention based on HIF1 alpha-PFKFB3 targeting thus deserves further consideration in DR.

Automated summary

Diabetic retinopathy is the leading cause of blindness in developed countries, with neuronal impairment often preceding microvascular abnormalities. Current therapeutic strategies fail to target neuronal deterioration, necessitating new approaches to address both vascular and neuronal impairment. The HIF1α-PFKFB3 signaling pathway plays a critical role in neurodegeneration and pathologic angiogenesis in DR, highlighting its potential as a metabolic intervention point.