| Abstract: | Blood-retinal barrier (BRB) breakdown is a key event in diabetic retinopathy and other ocular disorders that leads to increased retinal vascular permeability. This causes edema and tissue damage resulting in visual impairment. Insulin-like growth factor-I (IGF-I) is involved in these processes, although the relative contribution of increased systemic versus intraocular IGF-I remains controversial. Here, to elucidate the role of this factor in BRB breakdown, transgenic mice with either local or systemic elevations of IGF-I have been examined. High intraocular IGF-I, resulting from overexpression of IGF-I in the retina, increased IGF-I receptor content and signaling and led to accumulation of vascular endothelial growth factor. This was parallel to up-regulation of vascular Intercellular adhesion molecule I and retinal infiltration by bone marrow-derived microglial cells. These alterations resulted in increased vessel paracellular permeability to both low and high molecular weight compounds in IGF-I-overexpressing retinas and agreed with the loss of vascular tight junction integrity observed by electron microscopy and the altered junctional protein content. In contrast, mice with chronically elevated serum IGF-I did not show alterations in the retinal vasculature structure and permeability, indicating that circulating IGF-I cannot initiate BRB breakdown. Consistent with a key role of IGF-I signaling in retinal diseases, a strong up-regulation of the IGF-I receptor in human retinas with marked gliosis was also observed. Thus, this study demonstrates that intraocular IGF-I, but not systemic IGF-I, is sufficient to trigger processes leading to BRB breakdown and increased retinal vascular permeability. Therefore, therapeutic interventions designed to counteract local IGF-I effects may prove successful to prevent BRB disruption.The BRB5 is a selective diffusion barrier that isolates the retina from the blood, maintaining the appropriate milieu for optimal retinal function and excluding potentially harmful stimuli, therefore acting as a critical protective barrier. The BRB consists of outer and inner components. The outer BRB is formed by the retinal pigmentary epithelium, which separates photoreceptors from choroidal permeable vessels. The inner BRB is determined by the presence of tight junctions (TJs) between the endothelial cells of retinal vessels, which limits paracellular flux. In addition, retinal vessels are partially sheathed by glial end-foot processes. Although not considered direct components of the inner BRB, glial cells could play a key role in its formation, maintenance, and breakdown (1). The disruption of the BRB is an important feature not only of non-proliferative and proliferative diabetic retinopathy but also of other diverse ocular disorders (2, 3). Increased vascular permeability results in extravasation of plasma components leading to edema. If the accumulation of fluids threatens the macula it poses a serious risk to visual function. Indeed, macular edema is a leading cause of visual loss among diabetic patients (3).IGF-I has been associated with the pathogenesis of BRB breakdown. Although most studies report an increase of intraocular IGF-I levels in diabetic patients (4, 5), the source of IGF-I is not clear (6, 7), and the relative contribution of local versus serum IGF-I in initiating ocular pathology is unknown. IGF-I is a potent inducer of vascular endothelial growth factor (VEGF) (8), a pro-angiogenic factor that increases vessel permeability (1). We and others have shown in animal models that IGF-I participates in the pathophysiology of diabetic retinopathy by inducing retinal VEGF expression (9, 10). In diabetic retinopathy there is a correlation between VEGF vitreous levels and macular edema (11). Aqueous humor levels of VEGF are also higher in diabetic patients with macular edema, and levels correlate with disease severity (12, 13). Moreover, the early BRB breakdown observed in experimental diabetes coincides with an increase in VEGF (14).To discern the contribution of intraocular versus circulating IGF-I in triggering VEGF production and BRB disruption, in this study we have examined the retinas of two transgenic animal models with elevated IGF-I levels either locally or in the serum. We have found that only IGF-I generated within the eye may trigger the breakdown of the BRB in mice, whereas increased circulating IGF-I did not alter retinal vascular permeability. Therefore, therapeutic interventions designed to counteract local IGF-I effects may prove successful to prevent BRB disruption. |
