Glucose transport into the retina is a central component of the
hypothesis of glucose toxicity in the pathogenesis of diabetic
retinopathy.
8 Glucose enters the retina through two
principal pathways: the inner blood–retinal barrier, formed by the
retinal vascular endothelium and the outer blood–retinal barrier,
formed by the retinal pigment epithelium (RPE).
9 The
relative contributions of glucose transport into the retina from the
inner and the outer blood–retinal barriers have not been precisely
determined, but the majority (approximately 60%) of blood glucose
entering the retina appears to be supplied by the outer blood–retinal
barrier.
9 RPE cells are easily isolated from human eyes
obtained after death, and retain well-defined phenotypic
characteristics for up to 30 to 40 passages in
culture.
10 The RPE represents a homogeneous
monolayer of cells that has a nutritive and supportive role for the
neuroretina in vivo.
11 Although there is mounting evidence
suggesting that functional and structural changes in the RPE occur in
experimental and clinical diabetes,
12 13 localization of
blood–retinal barrier breakdown in diabetes has been controversial,
with much of the focus being on changes of the inner blood–retinal
barrier. Extracellular fluid within the retina, distorting the retinal
architecture, has been assumed to result from changes in the
architecture and function of the retinal vasculature.
13 Localization of the sites of blood–retinal barrier breakdown and
leakage in diabetes has been reported in the RPE.
13 14 15 16 17 18 Changes in the RPE outer rod-segment phagocytosis
function,
19 plasma membrane transport and
uptake,
20 21 cell
biochemistry,
16 20 22 protein synthesis,
23 and the c-wave of the electroretinogram
24 have been
reported. In clinical and experimental models of diabetes, the RPE is
also the site of advanced glycosylation end product
formation,
25 growth factor expression,
26 and
accelerated apoptosis.
27 The RPE layer of the human eye
has been shown immunohistochemically to contain large amounts of AR
that are increased in diabetic retinopathy.
15 AR
inhibitors have been reported to decrease retinal vascular endothelial
growth factor production and ultrastructural change,
28 RPE
vacuolization, and degenerative foci in the galactosemic
rat.
29 Therefore, the physiology of glucose metabolism in
the RPE cell may play a central role in glucose-mediated cytotoxicity
and the pathogenesis of diabetic retinopathy. Human RPE cells are an
appropriate biologic system in which to assess glucose-specific effects
on AR2 expression with possible relevance to the pathogenesis of
diabetic retinopathy.