Curcumol targets the FTO/MAFG-AS1 axis to alleviate diabetic retinopathy via epigenetic remodeling and nanodelivery-based microenvironment modulation

Table 3 Epigenetic regulation-based prevention strategies for diabetic retinopathy

Prevention level	Target population	Intervention strategies	Epigenetic targets	Expected outcomes	Implementation challenges
Primary prevention (prevent onset)	All diabetic patients	Glycemic control, lifestyle optimization (diet, exercise), early screening	Blocking formation of metabolic memory, preventing epigenetic dysregulation	Significant reduction (30%-40%) in DR incidence	Patient compliance, difficulty in long-term adherence
Secondary prevention (high-risk groups)	Patients with diabetes > 5 years or with epigenetic risk markers	Early curcumol intervention, targeted nutritional supplementation, intensive glycemic control	FTO/MAFG-AS1 axis regulation to inhibit epigenetic abnormalities	Delayed DR onset, alleviation of initial symptoms	Accurate identification of high-risk groups, long-term safety of preventive drugs
Tertiary prevention (early-stage DR)	Patients with mild-to-moderate non-proliferative DR	Curcumol combined with anti-VEGF therapy, microenvironmental regulation	Coordinated intervention in multidimensional epigenetic networks	Halting DR progression, prevention of vision loss	Drug interactions in multi-target combination therapies
Early biomarker detection	Regular screening of diabetic patients	Early diagnostic models based on lncRNA-miRNA-mRNA networks	Epigenetic markers such as FTO/MAFG-AS1, miR-125b-5p/SphK1	Early DR risk detection (2-3 years in advance)	Technical complexity of assays, standardization issues
AI-assisted risk assessment	Newly diagnosed diabetic patients	AI prediction systems integrating clinical data and epigenetic biomarkers	Multi-layered epigenetic modification pattern analysis	Personalized risk evaluation, prediction accuracy > 85%	Data privacy, algorithm interpretability, physician-patient acceptance
Metabolic memory intervention	Patients with significant glycemic fluctuations	Specific epigenetic-modifying drugs to reset metabolic memory	DNA methylation, histone lactylation, m6A modification	Disruption of metabolic memory, prevention of ongoing complications	Defining optimal intervention window, individualized treatment planning

AI: Artificial intelligence; DR: Diabetic retinopathy; lncRNA: Long non-coding RNA; m6A: N6-methyladenosine; mRNA: Messenger RNA; VEGF: Vascular endothelial growth factor.