Changes in the amount of matrix metalloproteinases and kynurenines in individuals with diabetic retinopathy, their role in the development of the disease

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INTRODUCTION: Diabetic retinopathy (DR) is one of most common chronic complications of diabetes mellitus (DM). The pathogenesis of DR is complex and involves interaction of many molecular mechanisms, and far not all of them have been studied.

AIM: To determine the level of matrix metalloproteinases and kynurenines in the blood of patients with type 2 DM (T2DM) with different stages of DR.

MATERIALS AND METHODS: Four groups of patients were formed: Group 1 (control) — 21 healthy individuals; Group 2 — 21 patients with prediabetes, Group 3 — 21 patients with T2DM, Group 4 — 63 patients with T2DM and DR. Then patients with DR were divided into groups (n = 21): Group 5 — non-proliferative stage of DR, Group 6 — preproliferative DR, Group 7 — proliferative DR. In the blood serum, the following parameters were determined: the content of metalloproteinases (MMP) types 2 and 9 (MMP-2, MMP-9) by the enzyme immunoassay; in blood plasma — the concentration of kynurenines by the high-performance liquid chromatography.

RESULTS: Significant differences were recorded in the studied parameters between healthy individuals and patients with diabetes. Subsequently, the results of patients with different stages of DR were compared with the data of patients with diabetes without vascular complications. In the preproliferative stage of DR, an excess of blood MMP-2 by 87.9% (p = 0.030) and MMP-9 by 37% (p = 0.049) was recorded relative to the individuals with diabetes. In the proliferative stage of DR, the levels of MMP-9 and MMP-2 were higher than those of not only the comparison group, but also the groups of non-proliferative and preproliferative stages of DR. In the preproliferative stage of DR, an increased concentration of 3-hydroxykynurenine was also recorded. The maximum increase in kynurenines was noted in the final stage of DR (p < 0.05 relative to the groups of non-proliferative and preproliferative DR).

CONCLUSIONS: In the analyzed groups of individuals, the concentrations of kynurenines increased as the underlying disease progressed. The level of MMP-9 was higher in diabetes mellitus, and in the proliferative stage of DR, the values of MMP-9 and MMP-2 increased.

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作者简介

Olga Saklakova

Chita State Medical Academy

Email: saklakovaoa@mail.ru
ORCID iD: 0009-0007-3163-4953
SPIN 代码: 6375-3450
俄罗斯联邦, Chita

Maria Maksimenya

Chita State Medical Academy

Email: mmv4510@mail.ru
ORCID iD: 0000-0001-6308-3411
SPIN 代码: 1875-5786

Cand. Sci. (Biology)

俄罗斯联邦, Chita

Tatyana Karavaeva

Chita State Medical Academy

编辑信件的主要联系方式.
Email: KaTany1@yandex.ru
ORCID iD: 0000-0002-0487-6275
SPIN 代码: 5483-1547

MD, Cand. Sci. (Medicine), Associate Professor

俄罗斯联邦, Chita

Pavel Tereshkov

Chita State Medical Academy

Email: tpp6915@mail.ru
ORCID iD: 0000-0002-8601-3499
SPIN 代码: 5228-8808

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Chita

Anna Perelomova

Chita State Medical Academy

Email: savani15@mail.ru
ORCID iD: 0009-0004-5205-645X
俄罗斯联邦, Chita

Elena Fefelova

Chita State Medical Academy

Email: fefelova.elena@mail.ru
ORCID iD: 0000-0002-0724-0352
SPIN 代码: 4199-2842

MD, Dr. Sci. (Medicine), Associate Professor

俄罗斯联邦, Chita

参考

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2. Fig. 1. The content of matrix metalloproteinases in the blood of individuals with diabetes mellitus and different stages of diabetic retinopathy Me [Q1; Q3], pg/ml: ММP — matrix metalloproteinase; DR — diabetic retinopathy; DM — diabetes mellitus.

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3. Fig. 2. Blood kynurenine levels in individuals with diabetes and different stages of diabetic retinopathy (Me [Q1; Q3], μmol/l): ММP — matrix metalloproteinase; DR — diabetic retinopathy; DM — diabetes mellitus.

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4. Fig. 3. The role of matrix metalloproteinases and kynurenines in the development of diabetic retinopathy: In diabetes mellitus, the rate of glycation of various biopolymers increases (1), including hemoglobin. Retinal hypoxia is accompanied by overproduction of matrix metalloproteinases MMPs (2), which are involved in neovascularization (3), characteristic of proliferative DR (4). Inflammatory cytokines initiate signaling pathways (5), in particular through mitogen-activated protein kinase (MAPK) and the nuclear transcription factor NF-κB. In addition, chronic hyperinsulinemia stimulates an increase in the level of circulating IGF-1, which triggers the Ras/Raf/MAPK/ERK cascade. This mechanism leads to the activation of MMP-9 in the retina (7) and to cell death (8). MMP induction is regulated by free radical oxidation products (9) with subsequent impairment of mitochondrial function, perpetuating a vicious cycle of mitochondrial damage and MMP activation (10). Kynurenines increase the expression rate of MMPs by activating MAPK (11). Kynurenines induce changes in multiple signaling pathways through activation of the aryl hydrocarbon receptor (AhR) (12), which functions as a transcription factor and also initiates the production of reactive oxygen species (13). Some kynurenine derivatives themselves provoke oxidative stress (13). Oxidative stress accelerates cell death (14), leading to DR (15); DR — diabetic retinopathy, MMP — matrix metalloproteinase, DM — diabetes mellitus, AhR — arylcarbohydrate receptor, IGF-1 — insulin-like growth factor 1, MAPK — mitogen-activated protein kinase.

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