Oxidative Stress Markers and the Retinopathy of Prematurity

Abstract

Retinopathy of prematurity (ROP) is a leading cause of potentially preventable blindness in low birth weight preterm infants. Several perinatal and postnatal factors contribute to the incomplete maturation of retinal vascularization, leading to oxidative stress damage. Literature data suggest that the lack of equilibrium between pro-oxidants and anti-oxidants plays a key role. In the last decade, there has been an increasing interest in identifying the antecedents of ROP and the relevant pathogenic mechanisms involved. In this context, a panel of biomarkers was investigated in order to achieve early detection of oxidative stress occurrence and to prevent retinal damage. Several nutritional elements have been found to play a relevant role in ROP prevention. At this stage, no conclusive data have been shown to support the usefulness of one biomarker over another. Recently, the Food and Drugs Administration, the European Medicine Agency, and the National Institute of Health proposed a series of criteria in order to promote the inclusion of new biomarkers in perinatal clinical guidelines and daily practice. The aim of the present review is to offer an update on a panel of biomarkers, currently investigated as potential predictors of ROP, highlighting their strengths and weaknesses.

Keywords: ROP; antioxidants; biomarkers; lutein; oxidative stress.

Figure 1

Description of the main known biochemical cascade of events leading to retinopathy of prematurity (ROP). Abbreviations: eNOS, endothelial NO synthase; HIFs, hypoxia-inducible factors; NADPH, dihydronicotinamide-adenine dinucleotide phosphate; NO, nitric oxide; pSTAT3, phosphorylated signal transducer and activator of transcription 3; PGs, prostaglandins; ROP, retinopathy of prematurity; TXA2, thromboxane A2; VEGFR, vascular endothelial growth factor receptor.

Figure 2

Description of the main known pathophysiological cascade of events leading to retinopathy of prematurity (ROP). Abbreviations: EPO, erythropoietin; HIFs, hypoxia-inducible factors; IGF-1, insulin-like growth factor 1; O2, oxygen; ROS, reactive oxygen species; VEGF, vascular endothelial growth factor.