Información del artículo
La angiopatía es una complicación muy frecuente en los diabéticos. El daño endotelial multicausal origina tanto la micro como la macroangiopatía. La disfunción del endotelio sería la primera fase de la secuencia patogénica. Existe una serie de marcadores bioquímicos, morfológicos y funcionales que permiten su detección en estadios iniciales. Aunque en la retinopatía diabética ha sido ampliamente analizado el papel del factor de crecimiento del endotelio vascular (VEGF), parece que también puede tener una intervención en otras complicaciones vasculares, como son la nefropatía, la neuropatía y la macroangiopatía. Recientemente se han comenzado a ensayar tratamientos que modulan la acción de ese factor; sin embargo, las consecuencias que podrían derivarse sobre algunos territorios, como el coronario y el retiniano, pueden ser contrapuestas.
Palabras clave:
Disfunción endotelial
Macroangiopatía
Microangiopatía
Diabetes mellitus
Factor de crecimiento del endotelio vascular
Vascular complications are the main causes of morbidity and mortality in patients with diabetes. Several lines of evidence suggest that endothelial damage and angiogenic factors, could play a key role in the development of both micro-and macroangiopathy. Great progress has been achieved in elucidating the fundamental processes underlying the pathogenesis of these complications. Several markers are used to estimate the risl of endothelial dysfunction. The angiogenic response accounts for much of the diabetic retinopathy and may, in addition, serve a significant role in nephropathy and neuropathy. In contrast, recent data suggest that vascular collateralization resulting from ischemia-induced growth factor release in tissues compromised by macrovascular disease may be important in reducing clinical symptoms and tissue damage. Thus, two apparently diametrically opposed pathogenetic paradigms are arising, which complicate the actual understanding of these phenomena, generating a perplexing paradox, which necessitates careful consideration of the potential risks, benefits, and interactions arising from the probable future used of therapeutic approaches with growth factor agonists and antagonists.
Key words:
Endothelial dysfunction
Macroangiopathy
Microangiopaty
Diabetes mellitus
Vascular endothelial growth factor
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