REVIEW: Diabetic Retinopathy: From Molecular Mechanisms to Modern Therapy

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Natalia G. Shebardina^1,a*, Kristina A. Kazakova^2,3,b, Timur A. Asaevich^1,4,c, Sofia A. Belolipskaia^1,4,d, Ivan V. Rodionov^5,6,7,e, Sanchay S. Tulush^1,5,f, Mikhail L. Shishkin^1,5,g, Andrey R. Komarov^8,h, Olga A. Krasienko^9,i, Elizaveta S. Gromova^10,j, Andrey A. Zamyatnin, Jr.^1,5,6,k, Anastasia M. Moisenovich^1,2,l, and Evgeni Yu. Zernii^1,m*

¹⁰Faculty of Chemistry, Lomonosov Moscow State University, 119992 Moscow, Russia

¹Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119992 Moscow, Russia

²Faculty of Biology, Lomonosov Moscow State University, 119992 Moscow, Russia

³Faculty of Fundamental Medicine, Lomonosov Moscow State University, 119992 Moscow, Russia

⁴Department of Biotechnology, Nelyubin Institute of Pharmacy, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, 119991 Moscow, Russia

⁵Department of Biochemistry, Institute of Digital Biodesign and Artificial Intelligence in Medicine, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, 119991 Moscow, Russia

⁶Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, 119992 Moscow, Russia

⁷Institute of Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, 119991 Moscow, Russia

⁸Center for Master’s Degree Programs, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, 119991 Moscow, Russia

⁹Faculty of Chemical Technology and Biotechnology, Moscow Polytechnic University, 107023 Moscow, Russia

^* To whom correspondence should be addressed.

Received: April 1, 2026; Revised: April 27, 2026; Accepted: April 27, 2026

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Diabetic retinopathy (DR) remains one of the leading causes of vision loss. Its development is driven by complex interconnected pathophysiological mechanisms triggered by chronic hyperglycemia. Traditional diagnostic approaches, which rely on detecting visible microangiopathies, often identify the disease only after significant and progressive retinal damage had already occurred. Consequently, current therapeutic strategies are largely focused on managing advanced, proliferative stages of DR. A major direction in modern ophthalmology is the shift toward identifying and intervening at stages that precede clinical DR manifestations. This review presents current data on the pathogenesis and molecular mechanisms of DR, discusses associated biochemical alterations revealed through multi-omics approaches, and examines methods for preclinical diagnostics, innovative therapeutic strategies, and novel targets for early pathogenetic intervention. Overall, the evidence suggests that that effective treatment options for DR might include multi-target therapeutic approaches extending beyond the blockade of angiogenesis and aimed at addressing metabolic, inflammatory, and oxidative disorders causing neurodegeneration and vascular dysfunction.

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KEY WORDS: diabetic retinopathy, molecular mechanisms, early diagnosis, biomarkers, pathogenetic treatment, preclinical stage

DOI: 10.1134/S000629792660105X

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