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Interactions Between Hyperglycemia and Hypoxia

Implications for Diabetic Retinopathy

¹ Stereological Research and Electron Microscopical Laboratory, University of Aarhus, Aarhus C, Denmark
² Departments of Medicine and Physiology, Diabetes & Metabolism Unit, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
³ Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
⁴ Department of Pathology, Washington University School of Medicine, St. Louis, Missouri

The primary aim of these experiments was to assess in vitro effects of hyperglycemia (30 mmol/l glucose) and hypoxia (PO₂ = 36 torr) of 2-h duration, separately and in combination, on cytosolic and mitochondrial free NADH (NADHc and NADHm, respectively) in retinas from normal rats. NADH is the major carrier of electrons and protons that fuel ATP synthesis and several metabolic pathways linked to diabetic complications. Hyperglycemia and hypoxia increase free NADHc by different mechanisms that are additive. Hyperglycemia increases transfer of electrons and protons from sorbitol to NAD⁺c, reducing it to NADHc, but does not increase NADHm. Hypoxia increases NADHm by inhibiting its oxidation. Electrons and protons accumulating in NADHm restrain transfer of electrons and protons from NADHc to NAD⁺m via the malate-aspartate electron shuttle. Hyperglycemia and hypoxia also increase glycolysis by different mechanisms that are additive, and hyperglycemia increases ATP levels in hypoxic and in aerobic retinas. The additive effects of hyperglycemia and hypoxia on accumulation of electrons and protons in a common pool of free NADHc confirm the test hypothesis and the potential of a combination of these two risk factors to accelerate the onset and progression of diabetic retinopathy (and other complications of diabetes) by augmenting metabolic pathways fueled by free NADHc.

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