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<p>The objective of this paper is to analyze research on the polyol pathway-triggered vascular dysfunction through different interlinked pathways, and to investigate multi-targets of diabetic retinopathy (DR), including advanced glycation end product (RAGE) binding, vascular endothelial growth factor (VEGF) activation, nuclear factor kappa B (NF-κB) expression, and reduction of expression of protein kinase C (PKC). The manuscript elaborates on multi-target drugs and pathways of DR, of the past decade, to demonstrate the role of the polyol pathway as an effective target in the suppression of PDR. Designing selective ALR2 inhibitors is challenging due to its 65% homology with aldehyde reductase (ALR1), whose inhibition can lead to toxicity. While Epalrestat is the only approved ALR2 inhibitor for DR, plant-based combinations show promise by suppressing angiogenesis. Anti-VEGF agents and ALR2 inhibitors targeting NF-κB and growth factor pathways could revolutionize DR treatment. Poor glycemic control in proliferative DR activates the polyol pathway, triggering NF-κB, VEGF, RAAS, AGEs, and PKC, leading to angiogenesis and vascular dysfunction. ALR2 inhibitors can serve as multi-target drugs to mitigate inflammation and angiogenesis in PDR.</p>

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Multi-Target Drug Strategies in the Treatment of Diabetic Retinopathy

  • 期刊论文

  • 发表日期：

    2025年6月17日

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  • Angeline Julius,
  • Suresh Malakondaiah,
  • Ramalakshmi Subbarayalu,
  • Remya Rajan Renuka,
  • Raghu Babu Pothireddy

摘要

The objective of this paper is to analyze research on the polyol pathway-triggered vascular dysfunction through different interlinked pathways, and to investigate multi-targets of diabetic retinopathy (DR), including advanced glycation end product (RAGE) binding, vascular endothelial growth factor (VEGF) activation, nuclear factor kappa B (NF-κB) expression, and reduction of expression of protein kinase C (PKC). The manuscript elaborates on multi-target drugs and pathways of DR, of the past decade, to demonstrate the role of the polyol pathway as an effective target in the suppression of PDR. Designing selective ALR2 inhibitors is challenging due to its 65% homology with aldehyde reductase (ALR1), whose inhibition can lead to toxicity. While Epalrestat is the only approved ALR2 inhibitor for DR, plant-based combinations show promise by suppressing angiogenesis. Anti-VEGF agents and ALR2 inhibitors targeting NF-κB and growth factor pathways could revolutionize DR treatment. Poor glycemic control in proliferative DR activates the polyol pathway, triggering NF-κB, VEGF, RAAS, AGEs, and PKC, leading to angiogenesis and vascular dysfunction. ALR2 inhibitors can serve as multi-target drugs to mitigate inflammation and angiogenesis in PDR.