Is Diabetic Retinopathy (DR) a Lipoxin A4 (LXA4) and Arachidonic Acid (AA) Deficiency Disorder?

Current treatments for DR include photocoagulation, intravitreal injections of anti-VEGF, anti-IL-6 and anti-TNF-α agents and corticosteroids in addition to the control of DM. However, these therapies are ineffective, and vision loss progresses in most patients (2/3). Hence, more effective therapies are needed. Although the retina is rich in unsaturated fatty acids and these fatty acids and their metabolites have profound modulatory effects on vasoactive activity and inflammation, their involvement in DR has been overlooked. We showed that the retinal content and vitreal concentration of LXA4 are lower in DR patients than in nondiabetic and DM patients with no retinopathy. Hence, it is proposed that AA and LXA4 deficiency occurs in DR and are of significant benefit in its treatment. This previously proposed arguments are further elaborated and extended to induce the potential benefit of other anti-inflammatory compounds such as resolvins, protectins and maresins. In this perspective it is argued that AA itself could be of benefit in DR by virtue of its ability to form the immediate precursor of LXA4.