Long-term culture of human fetal spinal cord neurons: morphological, immunocytochemical and electrophysiological characteristics

Cultures were prepared from ventral spinal cord tissue from 8-11-week gestational human fetuses and grown for a period of up to 6 months. These cultures were studied by morphological, immunocytochemical and intracellular electrophysiological techniques. From 2 weeks in vitro and onward, small bipolar cells were found in outgrowths of spinal cord explants and were identified as neurons by positive immunoreactions with an antibody specific for neurofilament protein. In addition, a large population of glial fibrillary acidic protein-positive astrocytes and a smaller number of galactocerebroside-positive oligodendrocytes were recognized in these cultures. The development of synaptic terminals was also studied by electron microscopy. The first appearance of synaptic terminal was found in a 3-week culture and was an axo-dendritic synapse. During the next 2 months, there was a steady increase in number and structural maturation of synaptic profiles. In addition to axo-dendritic synapses, which were most common, axo-somatic and axo-axonic synapses were demonstrated. After 3 months in culture, the occurrence of large neurons possessing the characteristic features of mature neurons was also noted. Although the occurrence of oligodendrocytes in these cultures was confirmed, no myelination of axons was demonstrated by electron microscopy. Intracellular recordings were obtained from the cultured spinal cord cells, and these cells were identified clearly as neurons by their action potential responses to depolarizing current pulses. The average input resistance of these neurons was 31 M omega with resting membrane potential of -52 +/- 2.3 mV.

Implantation of posterior chamber lens in the absence of capsular and zonular support

We have developed surgical techniques for implanting a posterior chamber lens in the absence of capsular and zonular support by securing both haptics of the posterior chamber lens to the sclera at the ciliary sulcus with 10-0 prolene suture. These techniques have been successfully performed and have produced good visual results in six monocularly aphakic patients who had contact lens intolerance and/or contraindications to anterior chamber lens implantations. In consideration of the high incidence and the great variety of complications associated with anterior chamber lenses, these newly developed surgical techniques will be a useful alternative to anterior chamber lenses, even in patients who do not have definite contraindications to anterior chamber lens implantations.

Growth factors for human glial cells in culture

Using a new double-labeling immunofluorescence technique, we assessed various growth factors on their ability to promote proliferation of cultured human glial cells. Cells studied were fetal astrocytes, fetal Schwann cells, adult astrocytes, and adult oligodendrocytes. Effective agents for fetal astrocytes were glial growth factor from the bovine pituitary, platelet-derived growth factor, fibroblast growth factor, and 4 beta-phorbol 12,13-dibutyrate. For fetal Schwann cells, mitogens were glial growth factor from the bovine pituitary, platelet-derived growth factor, nerve growth factor, and 4 beta-phorbol 12,13-dibutyrate. Adult astrocytes and oligodendrocytes did not normally divide in culture, and none of the agents tested were effective in inducing their proliferation. The report that interleukin-2 was a mitogen for oligodendrocytes could not be replicated in the present study on any of the glial cell types.

Hormonal secretion by adult pituitary cells in culture

Cells isolated from 24 autopsied adult human pituitary glands by enzymatic dissociation and Percoll density gradient methods were maintained in culture for up to 10 months. Using rabbit antisera specific for individual pituitary hormones and immunoperoxidase staining, we found a large number of cultured pituitary cells to react positively to growth hormone, prolactin, adrenocorticotropin, follicle-stimulating hormone, luteinizing hormone, and thyrotropin immunoreactions. Electron microscopic examination of cultured pituitary cells demonstrated the occurrence of secretory granules in cytoplasm characteristic of in vivo human pituitary cells. The hormone secretion in culture by these pituitary cells was confirmed by the detection of prolactin, thyrotropin, and follicle-stimulating hormone in the culture medium by radioimmunoassay.

Bilateral effects of long-term monocular timolol therapy

We studied the bilateral intraocular pressure lowering effect of long-term unilateral timolol maleate 0.5% in 30 patients in whom early primary open-angle glaucoma had recently been diagnosed. A significant intraocular pressure reduction was found in the untreated fellow eyes (21.9 mm Hg from 26.4 mm Hg at baseline) (P less than .001), as well as in the treated eyes (21.0 mm Hg from 28.5 mm Hg at baseline) (P less than .001). Fourteen patients (47%) showed a significant bilateral intraocular pressure reduction (P less than .001), with little difference between the treated (8.2 mm Hg) and the untreated eyes (7.7 mm Hg) (P greater than .8).

Removable-suture closure of the lamellar scleral flap in trabeculectomy

Removable-suture closure of the lamellar scleral flap was attempted in trabeculectomy, with the goal of increasing the degree of filtration during the immediate postoperative period by removing the suture so as to undo the closure whenever the need arose. The incorporation of the removable-suture closure of the lamellar scleral flap resulted in an additional mechanism of control over the degree of filtration after trabeculectomy. Furthermore, the availability of such a mechanism allowed the surgeon to close the lamellar scleral flap relatively tightly; this resulted in a decreased incidence of postoperative complications.

Transplantation of cultured human adrenal chromaffin cells into 6-hydroxydopamine-lesioned rat brain

Adult young rats were subjected to a unilateral 6-hydroxydopamine lesion of the nigrostriatal dopamine pathway and then given intrastriatal grafts of human fetal adrenal chromaffin cell cultures. Amphetamine-induced ipsiversive turning behavior in the lesioned rats was largely reversed in four of eight rats given such transplants when tested at 1.5 and 4.5 months post-transplantation. Two rats showed a transient recovery at 1.5 months followed by deterioration at 4.5 months, while two other rats showed continuous deterioration. Six rats given sciatic nerve grafts as controls all showed deterioration from the pretransplantation levels. Catecholamine fluorescent and immunohistochemical examination of chromaffin-cell-transplanted brains demonstrated neurons and neuronal processes positive for catecholamines or tyrosine hydroxylase in the transplanted area. This transplantation of cultured human fetal cells to an animal model may provide the necessary basic experimental system for assessing the possible utility of human neuronal transplants.

Functional recovery in a rat model of Parkinson's disease following transplantation of cultured human sympathetic neurons

Rats subjected to a unilateral 6-hydroxydopamine (6-OHDA)-induced lesion of the nigrostriatal dopamine pathway were given transplants of cultured fetal human sympathetic neurons. Amphetamine-induced turning behavior in these rats was reversed by the transplants after 1.5-4.5 months. The presence of transplanted neurons and their processes was demonstrated by immunohistochemistry for tyrosine hydroxylase.

Prevention and management of delayed suprachoroidal hemorrhage after filtration surgery

We report two new cases of massive delayed nonexpulsive suprachoroidal hemorrhage (DNSH) following a filtering operation in the aphakic eyes of elderly patients with glaucoma. A timely surgical drainage resulted in full recovery of preoperative visual acuity in both of our patients. As we combine our cases with a series of 18 similar cases of others in the literature, the following conclusions emerge. Limited DNSH does not require surgical intervention for a favorable visual outcome. Massive DNSH, however, requires timely and appropriate surgical intervention to achieve a favorable visual outcome and to avoid persistent hypotony. The most effective surgical intervention is drainage of the suprachoroidal hemorrhage and re-formation of the anterior chamber, but without concomitant vitrectomy. In both limited and massive DNSH, the final visual outcome is not determined by the worst vision at the time of DNSH. Some of the known and suspected risk factors of DNSH following filtering surgery are old age, aphakia, postoperative hypotony, a history of vitreous manipulation or complication, general anesthesia, increased venous pressure, use of fluorouracil, and high myopia. In view of these risk factors, we recommend several preventive measures for decreasing the incidence of DNSH following filtering surgery.

Inhibition of human chorionic gonadotropin production by prolactin from term human trophoblast

In vivo suppression of prolactin concentrations by bromocriptine near term, in a pregnant woman with a prolactinoma, was followed by augmentation of human chorionic gonadotropin levels. Suspension of drug therapy at 38 weeks of gestation was followed by a reversal of this sequence of events. In vitro, both ovine prolactin and human prolactin added to explants of term placental trophoblast significantly inhibited human chorionic gonadotropin production from this tissue. Although, with ovine prolactin, this inhibitory effect was demonstrable up to 5 micrograms/ml of ovine prolactin in the culture medium, only doses of 0.1 to 0.2 micrograms/ml of human prolactin significantly suppressed human chorionic gonadotropin production. Overall, 0.1 and 0.2 micrograms/ml of ovine prolactin and human prolactin most consistently suppressed human chorionic gonadotropin production to a statistically significant extent. In general, the concentrations in the culture medium of both ovine prolactin and human prolactin that inhibited human chorionic gonadotropin production in vitro were comparable to the concentrations of prolactin present in the mother and fetus. These in vivo and in vitro observations suggest that prolactin inhibits human chorionic gonadotropin production from term human trophoblast.

Expression of Ia antigens on the surface of human oligodendrocytes and astrocytes in culture

Oligodendrocytes and astrocytes were isolated from normal adult human brains 3-15 h postmortem using a Percoll density gradient centrifugation and were cultured for 10-135 days. The presence of HLA-DR(Ia) antigens on the surface of these human oligodendrocytes and astrocytes was studied using double immunofluorescence procedures. Only half of separate culture series (6/12 donors) contained HLA-DR-positive oligodendrocytes, while all of the culture series (12/12 donors) revealed HLA-DR-positive astrocytes. Among the HLA-DR-positive cultures, 4-16% of galactocerebroside-positive oligodendrocytes and 9-24% of GFAP-positive astrocytes were found to immunoreact with HLA-DR antibody. The presence of Ia antigens on the surface of certain populations of oligodendrocytes and astrocytes may be important in the induction of an immune response to these cells.

Transplantation of cultured fetal human adrenal chromaffin cells to rat brain

Adrenal chromaffin cells, obtained from a therapeutically aborted human fetus of about 11 weeks gestation, were cultured for 3 weeks in vitro and then transplanted to the striatum of rats. Transplanted cells became established through strands of tissue growing into the host striatum. No signs of inflammation or rejection were observed up to the time of sacrifice one month post-transplantation. Histofluorescence examination of the implanted areas showed many clusters of cells having an intensely positive catecholamine fluorescence with some of the cells developing conspicuous processes. This study, showing survival of cultured human adrenal chromaffin cells transplanted into rat brain tissue, might indicate the feasibility of using cultured human material for future human neuronal transplantation studies as a therapeutic measure.

Modulation of antigenic expression in cultured adult human oligodendrocytes by derivatives of adenosine 3',5'-cyclic monophosphate

Oligodendrocytes were isolated from adult human brains obtained at autopsy by enzyme treatment - Percoll density gradient centrifugation, and grown in culture. During the first week in vitro, these cultures consisted of an enriched population (93-98%) of galactocerebroside-immunoreactive oligodendrocytes. After 2 weeks and onward, a large number of GFAP-positive astrocytes and glial cells doubly positive for galactocerebroside and GFAP markers was found among the oligodendrocytes. When these cultures were exposed to dibutyryl cyclic AMP, 8-bromocyclic AMP and RO-1724, an inhibitor of cyclic nucleotide phosphodiesterase, for 4-14 days, the majority of cells returned to express oligodendrocytic phenotype. These findings suggest the presence of heretofore unidentified "transitional" or "bipotential" glial cells in human brains that express both oligodendrocytic and astrocytic phenotypes, and the regulatory role of cyclic AMP derivatives which may induce a stable antigen expression in oligodendrocytes.

Isolation, culture and cell-type identification of adult human pituitary cells

Pituitary cells were isolated from adult human pituitary glands obtained at autopsy 4-12 h postmortem by enzyme treatment (collagenase and dispase) and by Percoll density gradients. Cells thus isolated were maintained in culture for more than 6 months. By immunoperoxidase staining methods using rabbit sera monospecific against various pituitary hormones, a large number of cultured cells reacted positively. The hormones identified in these cells were growth hormone, prolactin, adrenocorticotropin, follicle-stimulating hormone, luteinizing hormone and thyrotropin. Electron-microscopic examination of cultured cells revealed the presence of secretory granules in cytoplasm characteristic of in vivo human pituitary cells.

Glycosylation of lens proteins in senile cataract and diabetes mellitus

We have investigated glycosylation of lens proteins in diabetic and non-diabetic senile cataract patients. Our study reveals that glycosylation of lens cortical proteins, but not of nuclear proteins, is significantly higher in diabetic patients with senile cataract. This finding serves to clarify the confusion over glycosylation of lens proteins as it relates to diabetes mellitus and further contributes to an understanding of glycosylation of lens tissues as a distinct posttranslational modification.

Culture and cryopreservation of adult human oligodendrocytes and astrocytes

Human adult oligodendrocytes were bulk-isolated from the brains obtained at autopsy by the Percoll density gradient method and cultured in vitro for 2-28 days. Cultured human oligodendrocytes were then scraped from the dishes or coverslips, frozen at -70 degrees C in the presence of 10% dimethyl sulfoxide as a cryoprotectorant, and then stored in liquid nitrogen tank. After the fast thawing, 55%-70% of human oligodendrocytes plus astrocytes were found to survive in the culture. Identification of cell types was established by using antibodies directed against galactocerebroside (oligodendrocyte) and glial fibrillary acidic protein (astrocyte).

Long-term cultures of human adult Schwann cells isolated from autopsy materials

Enriched populations of adult human Schwann cells were obtained from trigeminal ganglia and roots of autopsy material. The cells, isolated by enzymatic procedure, were seeded on rat tail collagen-coated coverslips. Subcultures were established several weeks later, and secondary cells were grown on polylysine-coated coverslips and maintained in vitro for as long as 5 months. The Schwann cells in culture displayed the same light- and electron-microscopic features and arrangement as those cells observed in vivo. The addition of bovine pituitary glial growth factor in the medium induced a 3-5-fold increase in Schwann cell division.

Glycosylation in vivo of human lens capsule (basement membrane) and diabetes mellitus

Glycosylation represents a nonenzymatic posttranslational modification of some proteins in vivo. We have investigated possible glycosylation, in vivo, of human lens capsule (basement membrane of lens epithelium) using a colorimetric method. Our study reveals, for the first time, in vivo glycosylation of human lens capsule. Furthermore, the glycosylation of the lens capsule in the diabetics (57.30 +/- 11.26 n moles/mg. protein) is found to be significantly greater than that in their nondiabetic counterparts (29.11 +/- 4.90 n moles/mg. protein) (p less than 0.0005). The present observation represents the first example of increased glycosylation of a basement membrane in the diabetic patients as compared to the nondiabetic controls.

The murine ependymoblastoma: growth pattern and survival in C57Bl/6J mice

The murine ependymoblastoma is a transplantable tumor of cerebral origin. The growth pattern and survival times of the murine ependymoblastoma implanted peripherally and intracranially in non nude C57Bl/6J mice have been found to be predictable and consistent when examined by means of Tumor Cell Dose Assessment (end point solution), Tumor Growth and Survival Assessment. The results suggest that a greater tumor cell dose is required to generate peripheral tumor take than brain tumor take. This difference may result from a greater immunologic response to tumor implanted peripherally than into the immunologically privileged brain.

HLA in pigment dispersion and glaucoma

Histocompatibility antigen typing was performed on 12 Caucasian patients with the pigment dispersion syndrome. Increased prevalence of HLA-B13 and Bw17 that had been observed in a previous study (Becker et al. 1977) could not be confirmed in the present study. There were no significant increases of HLA-B7 and B12 in glaucoma patients with or without the pigment dispersion syndrome. HLA-Bw35 was increased in white patients with primary open-angle glaucoma in the Greater Detroit area.

Argon laser iris photocoagulation to relieve acute angle-closure glaucoma

Two patients, a 67-year-old woman and a 24-year-old man, suffered acute attacks of angle-closure glaucoma. After standard treatment methods had failed, argon laser iris photocoagulation was used to relieve the attacks. In one case the argon laser photocoagulation relieved the pupillary block, decreasing the intraocular pressure and permitting successful argon laser peripheral iridotomy. In the second case, argon laser photocoagulation broke up the posterior synechiae, decreasing the intraocular pressure.

Intraocular pressure reduction and regulation system

The IOP reduction and regulation system performs certain specific functions: it can be used to lower (or raise) IOP in a controlled way; it responds rapidly to maintain a selectable, set, minimum IOP under variable flow demands; and it reduces the rapid dynamic increases in IOP resulting from loads applied to the eye. The system has been tested and evaluated in the laboratory with a small test chamber and excised animal eyes and subsequently with anesthetized live animals. The system has also had limited clinical use in selected patients. An expanded program of laboratory and clinical investigations is planned.

Application of intraocular pressure reduction and regulation system

In some patients undergoing intraocular procedures, the intraocular pressure may remain dangerously high immediately before surgical penetration of the anterior chamber despite all available measures. A mechanical device, called an "Intraocular Pressure Reduction and Regulation System," has been devised as a means of reducing and regulating intraocular pressure immediately before and during intraocular procedures. The system has been used in selected glaucoma patients with satisfactory results.

Intraocular pressure response to topical epinephrine and HLA-B12

Twenty high responders to topical corticosteroids (intraocular pressure greater than 31 mm Hg after six weeks of topical 0.1% dexamethasone, four times daily) and 20 low responders (IOP less than 20 mm Hg) of similar age, sex, race, initial IOP, and facility of outflow were selected. After 24 hours of treatment (two doses) of topical 1% epinephrine hydrochloride, the high corticosteroid responders showed a mean (+/-SD) corrected decrease in IOP of 3.6 +/- 2.0 mm Hg as opposed to 1.8 +/- 2.1 mm Hg in the low corticosteroid responders. Within both corticosteroid groups, individuals with the antigen HLA-B12 showed significantly greater decreases in IOP. This suggested that the presence of HLA-B12 was not only associated with increased responses to corticosteroids but also to epinephrine.

Dipivefrin use in patients with intolerance to topically applied epinephrine

Twelve patients who had previously demonstrated an intolerance to topically applied epinephrine received dipivefrin 0.1% in one eye and epinephrine 2% in the other eye. An adverse reaction occurred in only one eye (8%) receiving dipivefrin, but in ten (83%) on epinephrine. Topical dipivefrin 0.1% proved useful for lowering intraocular pressure in patients intolerant to topically applied epinephrine.

Histocompatibility antigens and diabetic retinopathy

Of 160 patients with onset of diabetes at or after 30 years of age, the 84 with no evidence prevalences of HLA-A1 and B8 when compared with the 76 with retinal complications or with the 282 healthy blood donors. In addition, in 90 patients with onset of diabetes before age 30 years, we could confirm the reported significant increase of HLA-B8 and decrease of B7, but no differences were noted between those juvenile-onset diabetics with and those without retinopathy.

Topical corticosteroid response and retinopathy in juvenile-onset diabetes mellitus

In a prospective study, 64 patients with insulin-dependent juvenile-onset diabetes mellitus were followed for eight to 12 years to determine if those with higher spontaneous intraocular pressures (IOPs) would be protected from the development of retinopathy. The patients were also classified initially as high (GG), intermediate (NG), or low (NN), responders on the basis of their IOP response to corticosteroid eyedrops. High responders were found to be considerably in excess (25 per cent) of the proportion found in the general population (6 per cent). Retinopathy developed significantly less often and was less severe in the high (GG) corticosteroid responders. Although the GG diabetics had significantly higher mean baseline IOPs than the less responsive NN and NG groups in each corticosteroid response category, the mean IOP of the group with retinopathy was not significantly different from that without retinopathy. This suggested that factors associated with the GG response other than increased IOP might be important in the relative resistance to diabetic retinopathy.

The ocular hypotensive effect of epinephrine in high and low corticosteroid responders

Nonglaucomatous individuals were classified by their intraocular pressure response to 6 weeks of topical dexamethasone, 0.1%, four times daily. Twenty GG responders (over 31 mm. Hg after dexamethasone) and 20 NN responders (below 20 mm. Hg after dexamethasone) of similar age, sex, race, initial intraocular pressure, and facility of outflow were selected. After 24 hr. of treatment (two doses) with 1% epinephrine HCl, the GG subjects demonstrated a mean (+/-sigma) corrected decrease in intraocular pressure of 4.2 mm. Hg (+/- 2.5) as opposed to 1.8 mm. Hg (+/- 2.1) in the NN subjects (p less than 0.005). The relationship between increased responsiveness to corticosteroids, to epinephrine, and to theophylline suggested cyclic nucleotides as a possible common pathway.

Low-dose methazolamide and intraocular pressure

Sixteen patients with increased intraocular pressure (over 20 mm Hg) received 25 and 50 mg of oral methazolamide, twice daily, during consecutive weeks and then 500 mg (Sequels) of acetazolamide. The two methazolamide regimens produced significant decreases in intraocular pressure. Acetazolamide treatment resulted in a greater decrease in intraocular pressure but more systemic acidosis and side effects.

Increased ocular and systemic responsiveness to epinephrine in primary open-angle glaucoma

Sixteen patients with primary open-angle gaucoma (POAG) were matched as to age, sex, and race with an equal number of patients with secondary glaucoma. Although initial intraocular pressures were comparable, treatment with topical epinephrine hydrochloride, decreased intraocular pressure more than 5 mm Hg in 14 (88%) of the 16 patients with POAG but in only five (31%) of the 16 patients with secondary glaucoma (p less than .005). Eleven (69%) of the 16 patients with POAG demonstrated premature ventricular contractions during tonography as opposed to three (19%) of the 16 patients with secondary glaucoma (p less than .025). These findings suggested greater ocular as well as cardiac responsiveness to epinephrine in patients with POAG.

Family history in primary open-angle glaucoma

A family history of glaucoma was found in 50% of patients with primary open-angle glaucoma (POAG) and 43% of patients with ocular hypertension (OH). Positive family history was twice as prevalent in those with OH and either HLA-B7 or B12 antigens than in OH with neither antigen (P less than .01). Although POAG occurred equally in men and women, the prevalence of a positive family history of glaucoma on the maternal side of the family in POAG patients was six to seven times greater than on the paternal side (P less than .0005). However, in patients with OH, but no glaucomatous field loss, there was no difference in prevalence of maternal and paternal family history. Even in OH with HLA-B7 or B12 antigens, there was no predominance of maternal family history. The implication that offspring were more likely to develop POAG when their mother's side of the family rather than their father's side had the disease has provided an additional potentially useful risk factor in patients with OH. In addition, it has raised interesting questions as to possible maternal cytoplasmic factors in the transmission and pathogenesis of POAG.

The association of HLA-B7 and HLA-B12 antigens with cup/disk ratio, family history of glaucoma, and intraocular pressure

The presence of either HLA-B7 or HLA-B12 antigens was associated with a higher prevalence of cup/disk ratios greater than 0.3 in the GG responders (intraocular pressure greater than 31 mm Hg after six weeks of topical dexamethasone 0.1%, four times daily) and in the combined NN-NG (intraocular pressure less than or equal to 31 mm Hg) groups. The presence of either antigen was associated with a higher prevalence of a family history of glaucoma in the GG group. N association was noted between the antigens and age, sex, race, or mean intraocular pressure in either of the groups studied.

The pigment dispersion syndrome

The pigment dispersion syndrome was noted in 10% of white and black subjects with and without glaucoma. This suggested pigment dispersion was not a high risk factor in the development of glaucoma. The HLA-B7 antigen was less prevalent and HLA-B13 and Bw17 antigens were significantly more prevalent in individuals with the pigment dispersion syndrome than in subjects without the syndrome. Either HLA-B13 or Bw17 antigen was found in 23 (77%) of 30 patients with the pigment dispersion syndrome and in only 13 (6%) of the 203 subjects without pigment dispersion. Pigmentary glaucoma was characterized by a significantly higher prevalence of combinations of HLA-B12 and B13 or HLA-B12 and Bw17 antigens as compared to the pigment dispersion syndrome without glaucoma, primary open-angle glaucoma, or the general population. This suggested that pigmentary glaucoma differed genetically from primary open-angle glaucoma and was a separate entity.

HLA antigens and primary open-angle glaucoma in black Americans

Black patients with primary open-angle glaucoma, when compared to nonglaucomatous individuals, demonstrate significantly increased prevalences of the HLA antigens B7 and B12 and significantly decreased frequencies of A1 and A11. White patients with primary open-angle glaucoma have in common with blacks the increases in B7 and B12 and the decrease in A11, but present no deficit of A1. In addition, white patients with primary open-angle glaucoma demonstrate a significant increase of A3 and a decrease of Bw35, both of which are not found in blacks.

The prevalence of HLA-B12 and HLA-B7 antigens in primary open-angle glaucoma

HLA-B12 antigen was found in 50% and HLA-B7 was present in 49% of patients with primary open-angle glaucoma. Either one of the antigens B12 or B7 was noted in 88% of such glaucoma patients. The prevalences of B12, B7, or of either antigen were much greater in patients with primary open-angle glaucoma than in the general population or in patients with normal intraocular pressure. The prevalences in patients with ocular hypertension (IOP greater than 20 mm Hg) were intermediate between the ocular normotensives and the patients with primary open-angle glaucoma. The close association between HLA-B12 and HLA-B7 and primary open-angle glaucoma suggested immunologic components of the disease and possible convenient genetic markers.

Glucocorticoid responsiveness associated with HLA-B12

Primary open-angle galucoma (POAG) patients are more responsive to glucocorticoids, and have increased prevalences of the histocompatibility antigens HLA-B7 and HLA-B12. We report herein a comparison of in vitro cellular responsiveness to glucocorticoids and HLA classification for 25 POAG patients, and 25 individuals who respond to topical dexamethasone with intraocular pressure is greater than 31 mm. HG. (GG responders). Within both the POAG and GG groups, significantly greater responsiveness to prednisolone occurs in patients with HLA-B12 antigen. No such association occurs for patients with HLA-B7.

HLA in primary open-angle glaucoma

Histocompatibility antigen typing was carried out in 50 Caucasian patients with primary open-angle glaucoma (POAG) and 50 Caucasian ocular-normotensive subjects. HLA-A 3 was present in 46%, B7 in 52%, B12 in 50%, and either B7 or B12 in 88% of p,tients with POAG. These prevalences in POAG patients were significantly greater than in ocular-normotensive subjects (p less than 0.01, p less than 0.0005, p less than 0.001, and p less than less than 0.0005, respectively). The prevalences of A 3-B 7, A 3-B 12 and either combination were also significantly greater in POAG patients than in the ocular normotensives (p less than 0.005, p less than 0.005, and p less than 0.0005, respectively). HLA-BW 35 was noted to be in deficit in Caucasian POAG patients (8%) as compared to Caucasian ocular normotensives (32%; p less than 0.01).

Prognostic value of HLA-A 3, BW 35, B 7, and B 12 in ocular hypertension

The prevalences of HLA-A 3, BW 35, B 7 and B 12 in 80 Caucasian patients with ocular hypertension were intermediate between values found in ocular normotensives and in patients with primary open-angle glaucoma. The presence of HLA-B 7 or B 12 had significant predictive value for the development of glaucomatous damage to the optic nerve in patients with ocular hypertension. The HLA-A 3 antigen by itself, or in combination with B 7 and B 12 did not improve the prognostic value of the B 7 and B 12 antigens. Only one of the 20 white ocular hypertensives in this series with HLA BW 35 antigen developed glaucomatous visual field loss.

HLA antigens and corticosteroid response

Compared with normal individuals, patients with primary open-angle glaucoma have increased prevalences of HLA-B12 and B7 antigens and are more responsive to glucocorticoids. Lymphocytes from both ocular normotensive and glaucomatous individuals with the HLA-B12 antigen require significantly (P less than .02) lower concentrations of prednisolone to inhibit phytohemagglutinin-induced transformation.

Pilocarpine ocular inserts

Pilocarpine was administered to a selected group of ocular hypertensive subjects in the form of a synthetic biosoluble matrix inserted into the conjunctival cul-de-sac. Satisfactory lowering of the intraocular pressure resulted, with a minimum of subject intolerance. The decreased pressure response was significant in some cases for greater than 24 hours. Drug delivery by soluble inserts offers promise as a convenient and effective mode of therapy.