OBJECTIVE -The purpose of this study was to evaluate erythropoietin (Epo) and Epo receptor (EpoR) expression in the retina and in vitreous fluid from diabetic and nondiabetic donors. To gain insight into the mechanisms responsible for the regulation of Epo production in the retina, we also assessed retinal expression of hypoxia-inducible factors (HIF-1␣ and HIF-2␣).RESEARCH DESIGN AND METHODS -Eighteen postmortem eyes from 9 diabetic patients without clinically detectable retinopathy were compared with 18 eyes from 9 nondiabetic donors. mRNA of Epo, HIF-1␣, and HIF-2␣ (quantitative RT-PCR) were measured separately in neuroretina and retinal pigment epithelium (RPE). Epo and EpoR were assessed in the retina (immunofluorescence by confocal laser microscopy) and in the vitreous fluid (radioimmunoassay and enzyme-linked immunosorbent assay, respectively).RESULTS -Epo and EpoR mRNAs were significantly higher in the RPE than in the neuroretina. Higher expression of Epo was detected in the retinas (both in the RPE and in the neuroretina) from diabetic donors. By contrast, EpoR expression was similar in both groups. We did not find any difference in HIF-1␣ and HIF-2␣ mRNA expression between diabetic and nondiabetic donors (both in RPE and neuroretina). Intravitreal Epo concentration was higher in diabetic donors than in nondiabetic control subjects. However, EpoR concentrations were similar in both groups.CONCLUSIONS -Epo overexpression is an early event in the retina of diabetic patients, and this is not associated with any change in EpoR. At this early stage, other factors apart from hypoxia seem to be more important in accounting for the Epo upregulation that exists in the diabetic retina.
Diabetes Care 31:1189-1194, 2008E rythropoietin (Epo) was first described as a glycoprotein produced exclusively in fetal liver and adult kidney that acts as a major regulator of erythropoiesis (1). However, Epo expression has been found in the human brain (2), and, recently, we have demonstrated that Epo mRNA also exists in the adult human retina (3). Epo has a potent neuroprotective effect in the brain as well as in the retina (4,5).The retina is the most metabolically active tissue in the human body and, therefore, is highly sensitive to reductions in oxygen tension. Hypoxia-inducible factor (HIF) is the primary hypoxic signaling protein in cells for regulating angiogenesis and is able to induce the transcription of more than 70 genes, such as Epo (6). Indeed, HIF was discovered during studies of the regulation of Epo (7). Hypoxia is a major stimulus for both systemic (1) and intraocular Epo production (8), and high intravitreous levels of Epo have been reported in ischemic retinal diseases such as proliferative diabetic retinopathy (9 -11). In addition, it has been reported that Epo has an angiogenic potential equivalent to that of vascular endothelial growth factor (11,12). However, we also found elevated intravitreal levels of Epo in patients with diabetic macular edema, a condition in which neither hypoxia nor angiogenesis i...