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[摘要]
糖尿病视网膜病变(DR)是糖尿病最常见的微血管并发症之一,亦是全球范围内导致视力丧失的重要原因。尽管抗血管内皮生长因子(anti-VEGF)治疗已成为当前DR的主流治疗手段,但少部分患者对该疗法反应不佳,需探索新的治疗靶点。降钙素基因相关肽(CGRP)是一种具有多种生物学功能的神经肽,近年来因其在血管调节、神经保护和免疫炎症调控方面的作用而受到关注。文章综述了CGRP的生物学特性及其受体信号机制,并结合最新研究,探讨CGRP在DR发病机制中的潜在作用,包括其在调节血管舒张、神经退行性病变以及炎症因子释放中的调控效应。同时,文章也评估了CGRP作为DR治疗新靶点的前景,尤其是在对抗VEGF治疗无应答的患者中所体现出的潜在临床价值。尽管目前尚无CGRP靶向药物用于DR治疗,但该类药物在偏头痛等其他疾病中已展现良好的安全性和疗效,为其在DR领域的转化应用提供了理论基础。然而,CGRP在DR不同病理阶段可能扮演双重角色,其治疗策略需精准考量。因此,有必要对CGRP在DR中的具体作用机制进行更深入的研究,从而为新型治疗策略提供思路。
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[Abstract]
Diabetic retinopathy(DR)is a prevalent microvascular complication of diabetes and a leading cause of vision loss globally.Although anti-vascular endothelial growth factor(anti-VEGF)therapies remain the clinical mainstay, a significant proportion of patients exhibit suboptimal responses, highlighting the urgent need for novel therapeutic targets. Calcitonin gene-related peptide(CGRP), a multifunctional neuropeptide, is gaining attention due to its roles in vascular regulation, neuroprotection, and immunomodulation. This review summarizes the biological characteristics of CGRP and its receptor-mediated signaling, and explores emerging evidence of CGRP's involvement in DR through its vasodilatory effects and regulatory effect on neurodegenerative disorders and release of inflammatory cytokines. Furthermore, the therapeutic potential of targeting the CGRP pathway in DR is evaluated, especially in cases unresponsive to VEGF inhibition. Despite currently the lack of CGRP-targeted drugs applied for DR, the peptide demonstrates efficacy and safety in other diseases, such as migraine, suggests promising translational opportunities. However, CGRP may play a dual role in different pathological stages of DR, thus its treatment strategy needs to be considered precisely. Future research elucidating the precise mechanisms of CGRP in DR may pave the way for innovative intervention strategies.
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