How is increased capillary permeability explained in DM

There is a decrease in pericytes in DM, i.e., the supportive cells of the capillary walls, which have myofibrils and regulate the volume of blood that passes through the capillaries. As a result, the capillary wall is locally dilated and microaneurysms form, with resultant fluid or cellular components leak. Furthermore, hyperglycaemia causes loosening of the junctions between endothelial cells, resulting in breakage of the retinal barrier and diffusion of cellular and non-cellular components of the blood. In this way oedema is formed due to the exit of fluid from the retina, hard exudates due to the release of lipoproteins and haemorrhages due to the release of red blood cells and platelets. Other factors that contribute to the increased vascular permeability are the increased production of free radicals from endothelial cells and white blood cells that accumulate in the region, leukotrienes production from white blood cells, LDL oxidation and release of IGF-1 (insulin-like growth factor-1), interleukin 1b, nitrous oxide and VEGF (vascular endothelial growth factor) from endothelial cells.

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