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Low intravitreal angiopoietin‐2 and VEGF levels in vitrectomized diabetic patients with simvastatin treatment
Author(s) -
Tuuminen Raimo,
Sahanne Sari,
Loukovaara Sirpa
Publication year - 2014
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.12363
Subject(s) - simvastatin , medicine , angiopoietin , vascular endothelial growth factor , statin , diabetic retinopathy , diabetes mellitus , urology , endocrinology , gastroenterology , vegf receptors
Purpose To investigate the intravitreal levels of potent vasoactive, angiogenic and extracellular matrix remodelling factors in the diabetic patients with simvastatin treatment. Methods This is an institutional, prospective, observational case–control study. Type‐1 and type‐2 diabetic patients on lipophilic simvastatin ( N = 14) compared with patients without statin medication ( N = 50). Vitreous samples were subjected to protein measurements of angiopoietin (Ang)‐1 and Ang‐2, erythropoietin ( EPO ), transforming growth factor ( TGF )‐ β 1, vascular endothelial growth factor ( VEGF ) by ELISA and matrix metalloproteinase ( MMP )‐2 and MMP‐9 by gelatin zymography. Results Intravitreal levels of Ang‐2 (p = 0.029), VEGF (p = 0.001) and pro MMP ‐9 (p = 0.015) were lower in simvastatin‐treated than in non‐statin‐treated controls. In diabetics with macular oedema ( DME ), intravitreal Ang‐2 (p = 0.006) and VEGF (p = 0.002) levels were lower in simvastatin‐treated patients compared with non‐statin‐treated controls. In those patients with proliferative diabetic retinopathy ( PDR ), intravitreal Ang‐2 (p = 0.002), TGF ‐ β 1 (p = 0.037), VEGF (p = 0.001) and pro‐ and total MMP ‐9 (p = 0.004 and p = 0.007) levels were lower when receiving simvastatin medication. Conclusions In diabetic patients with DME or PDR , the intravitreal levels of permeability and proangiogenic factors Ang‐2 and VEGF were lower in simvastatin‐treated than in those without statin medication. Moreover, the levels of MMP ‐9 and TGF ‐ β 1, factors involved in the breakdown of basement membrane and fibroproliferation, were lower in patients with PDR having simvastatin medication. When acetylsalicylic acid was combined with simvastatin treatment, the intraocular levels of Ang‐2 and VEGF were significantly lower than in diabetics treated with simvastatin alone. These data provide a novel insight into the potential protective mechanisms underlying simvastatin medication in patients with diabetic retinopathy complications.