A multi-department research team from Michigan State University and other academic institutions have identified advancements that hold the potential to facilitate earlier diagnosis and treatment of diabetic retinopathy.
Their findings, recently published in the journal Diabetologia, include contributors from the University of Alabama at Birmingham, Case Western Reserve University, and Western University of Health Sciences.
The researchers discovered that conditions like diabetes, age-related health issues, and metabolic disorders can result in the accumulation of cholesterol in the retina, leading to its crystallization and contributing to the onset of diabetic retinopathy.
These crystallized deposits exhibit high reflectivity and are detectable in retinal images. This discovery is particularly significant because most optometrists can perform noninvasive retina evaluations, offering the potential for earlier diagnosis for a wider population.
"Retinopathy is the leading cause of preventable blindness and one of the most feared complications of type 1 and type 2 diabetes," explained Julia Busik, MSU professor emeritus of physiology. "Within 20 years of developing diabetes, every individual with either type 1 or type 2 diabetes will have some degree of retinopathy. Current treatment approaches are very invasive and are only directed at the very late stage of retinopathy."
"We are actively pursuing what can be done to lower cholesterol in the retina," said Tim Dorweiler, a doctoral candidate in the Molecular, Cellular and Integrated Physiology Program at MSU and first author of the paper. "The retina is a very isolated organ, just like the brain, and both have a blood barrier that separates them from the rest of the body. This is what makes the retina hard to study and extremely complex."
George Abela, who serves as the chief of the MSU Division of Cardiology, drew parallels between these cholesterol crystals and the crystals found in atherosclerotic plaque, known to develop in arteries and contribute to heart attacks. His laboratory at MSU was instrumental in making this discovery.
Abela played a key role in assisting the research team in devising methods for retinal scanning using modified tissue preparation techniques for scanning electron microscopy. This innovation aids in the detailed analysis of crystal composition, typically formed when cholesterol accumulates excessively in a specific location.
Furthermore, there is optimism that novel treatments targeting cholesterol-induced crystals might offer less invasive alternatives to current therapies for diabetic retinopathy. Additionally, questions arise about the potential application of such treatments in other areas of the body to prevent various diseases.
Sandra S. Hammer et al, Cholesterol crystal formation is a unifying pathogenic mechanism in the development of diabetic retinopathy, Diabetologia (2023). DOI: 10.1007/s00125-023-05949-w