眼科学报2026，Vol.41Issue(8)：689-697,9.DOI:10.12419/25071901
能量代谢重编程驱动糖尿病视网膜病变的研究进展
Research progress on energy metabolism reprogramming driving diabetic retinopathy
摘要
Abstract
Diabetic retinopathy(DR)is the most common microvascular complication of diabetes and a leading cause of blindness.Its pathogenesis is complex,primarily involving disruptions in the energy metabolism of the retinal neurovascular unit.Recent studies indicate that metabolic reprogramming is a key driver of DR progression,characterized by hyperglycemia-induced glycolytic overload,mitochondrial dysfunction,lactate shuttle system disruption,and dysregulated lipid metabolism.Under hyperglycemic conditions,retinal cells-especially endothelial and Müller cells-exhibit an aberrant increase in glycolytic flux,leading to the accumulation of glycolytic intermediates This accumulation triggers oxidative stress,inflammatory,apoptosis,and vascular damage,ultimately driving blood-retinal barrier breakdown and neovascularization.Furthermore,hyperglycemia impairs the mitochondrial electron transport chain,compromises oxidative phosphorylation,and decreases ATP production while exacerbating reactive oxygen species(ROS).This results in mitochondrial DNA damage and network fragmentation,further compromising retinal blood vessels,neurons,and glial cells.Disruption of the lactate shuttle among Müller cells,retinal pigment epithelial(RPE)cells,and photoreceptors leads to an inadequate energy supply and impaired metabolic waste clearance in photoreceptors,resulting in functional decline.Additionally,lactate accumulation promotes pathological angiogenesis and inflammation via histone lactylation.Notably,endothelial cells in pathological retinal neovessels exhibit a metabolic shift toward fatty acid oxidation(FAO).Conversely,impaired FAO leads to the accumulation of lipid peroxides,triggering ferroptosis,which is particularly detrimental to RPE cells.In conclusion,metabolic reprogramming drives DR progression through a complex interplay of multiple pathways.Elucidating this mechanism provides theoretical basis and identifies potential targets for developing more effective and precise treatment strategies for DR.关键词
糖尿病视网膜病变/线粒体/糖酵解/脂质代谢/能量代谢重编程Key words
diabetic retinopathy/energy metabolism/mitochondria/glycolysis/lipid metabolism分类
医药卫生引用本文复制引用
孙程,朱姗姗,姚进,柏文..能量代谢重编程驱动糖尿病视网膜病变的研究进展[J].眼科学报,2026,41(8):689-697,9.基金项目
江苏省大学生创新训练计划(S202510312095) （S202510312095）
江苏省研究生科研与实践创新计划(JX10414318).This work was supported by the Research and Innovation Program for College Graduates of Jiangsu Province(S202510312095)and the Postgraduate Research&Practice Innovation Program of Jiangsu Province(JX10414318). （JX10414318）
