Vasculogenesis and angiogenesis in diabetes mellitus: novel pathogenetic concepts for treatment of vascular complications

Abstract

Hyperglycemia along with other metabolic disorders may disrupt the balance of pro- and antiangiogenic regulators, thus leading to a maladaptive formation of new blood vessels in the state of diabetes mellitus (DM). In their turn, aberrant angiogenesis and vasculogenesis are important mechanisms of vascular complications in DM. Activation of retinal angiogenesis is a cornerstone of proliferative diabetic retinopathy, though in diabetic nephropathy excessive angiogenesis is only seen at early stages. Quite on the contrary, macrovascular complications are characterized by certain inhibition of both angiogenesis and vasculogenesis. Novel therapeutic approaches, based on correction of angiogenesis, have emerged recently. Clinical trials have shown efficacy of angiogenesis inhibitors (the ?anti-VEGF? agents) for management of diabetic macular edema and proliferative retinopathy. Experimental evidence also indicates that this treatment may hinder the progress of diabetic nephropathy. In addition, stimulation of angiogenesis and vasculogenesis with stem cells or growth factors promise an option for treatment of large vessels in DM.

Keywords

• angiogenesis
• diabetic microangiopathy
• macroangiopathy
• angiogenesis inhibitors