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Benfotiamine blocks three major pathways of hyperglycemic damage and prevents experimental diabetic retinopathy


Three of the major biochemical pathways implicated in the pathogenesis of hyperglycemia induced vascular damage (the hexosamine pathway, the advanced glycation end product (AGE) formation pathway and the diacylglycerol (DAG)–protein kinase C (PKC) pathway) are activated by increased availability of the glycolytic metabolites glyceraldehyde-3-phosphate and fructose-6-phosphate. We have discovered that the lipid-soluble thiamine derivative benfotiamine can inhibit these three pathways, as well as hyperglycemia-associated NF-κB activation, by activating the pentose phosphate pathway enzyme transketolase, which converts glyceraldehyde-3-phosphate and fructose-6-phosphate into pentose-5-phosphates and other sugars. In retinas of diabetic animals, benfotiamine treatment inhibited these three pathways and NF-κB activation by activating transketolase, and also prevented experimental diabetic retinopathy. The ability of benfotiamine to inhibit three major pathways simultaneously might be clinically useful in preventing the development and progression of diabetic complications.

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Figure 1: Potential mechanism by which benfotiamine blocks 4 pathways of hyperglycemic damage.
Figure 2: Effect of glucose and benfotiamine concentration on transketolase activity in cultured bovine aortic endothelial cells.
Figure 3: Effect of benfotiamine on pathways of hyperglycemic damage in cultured bovine aortic endothelial cells, in the absence and presence of transketolase inhibition by antisense oligonucleotides.
Figure 4: Effect of chronic benfotiamine administration on transketolase activity in retinas from long-term diabetic rats.
Figure 5: Effect of chronic benfotiamine administration on pathways of hyperglycemic damage in retinas from long-term diabetic rats.
Figure 6: Effect of benfotiamine on experimental diabetic retinopathy.


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We thank S. Hofmann for comments and suggestions and F. Scharpert for technical assistance. This work was supported in part by grants from the US National Institutes of Health, the Juvenile Diabetes Research Foundation, the American Diabetes Association, the Deutsche Forschungsgemeinschaft and Wörwag Pharma, GmbH & Co. KG (Böblingen, Germany).

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Correspondence to Michael Brownlee.

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Hammes, HP., Du, X., Edelstein, D. et al. Benfotiamine blocks three major pathways of hyperglycemic damage and prevents experimental diabetic retinopathy. Nat Med 9, 294–299 (2003).

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