December 24, 2012

Alphabet Soup to Prevent DME

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egfA new therapeutic approach to treat diabetic macular edema (DME) combines insulin and an inhibitor of epidermal growth factor (EGF).

Many people with diabetic retinopathy will also develop DME as a secondary complication. This is a thickening of the center of the retina.. Over 10 years, 20% of patients with Type 1 diabetes (T1D) and 40% with Type 2 diabetes (T2D) will develop DME.

The EGF is called betacellulin (BTC). BTC promotes the regeneration of pancreatic beta cells in the pancreas. The study found that when patients with Type 1 diabetes (T1D) are treated with insulin and BTC, the “cross–talk” between the two compounds preserved the vascular integrity in the eye.

Researchers determined that insulin was disrupting tight junctions between the barrier layer wrapped around retinal nerves. Substituting a BTC-targeted EGF inhibitor, the researchers forced the preventative “cross-talk” between BTC and insulin, preserving the tight junctions in the retina.

The idea of this combination therapy derived from a trend of Type 2 diabetic patients who no longer used oral medications and began using insulin to treat the disease. These patients presented a correlation between starting insulin therapy and developing DME

Another example of why insulin and EGF inhibitor may work is supported by the patients who had pancreatic cancer and had undergone a pancreatectomy. Without a pancreas to produce and regulate insulin, these patients developed diabetes but rarely developed retinopathy, even when they survived for more than 10 to 20 years. In the pancreas of people with diabetes, it’s possible that “cross-talk” occurred between injected insulin and the secretion of a vascular permeability-inducing factor.

In 2012 the FDA approved Lucentis as the first treatment for DME. The drug is an anti-VEGF agent. If the combination of an EGF inhibitor  and insulin preserves the vascular integrity in the eye and an anti-VEGF injection treats the condition – what’s a better approach? Prevention is the best cure.

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