Epidemiological and other studies in the assessment of factors contributing to cataractogenesis

Calcium and the physiology of cataract

Calcium has long been known to play a role in cataract formation but techniques have only recently become available for investigating the physiological mechanisms. Previous studies showed that lens membrane permeability alters when the external calcium concentration falls below 1 mM, so it was interesting that values for human aqueous from cataract patients ranged from 0.45 to 2.0 mM. The mean value for the aqueous was one half that for the plasma. The calcium concentration in cataractous lenses ranged from 0.1 to 64 mM and lenses with a high calcium concentration also had a high sodium content. In lenses with near normal sodium content the highest calcium concentrations were associated with highly localized opacities, while nuclear cataracts had a low calcium content. The relationship between calcium and transparency was investigated in a rat lens system using ion-sensitive microelectrodes. The distribution of free calcium in the lens varied with age and was correlated with a change in the sensitivity of the lens to cold cataract and a change in lens birefringence. The highest free calcium levels were obtained from lenses incubated in 10 mM-calcium in the absence of glucose and these lenses showed most light scattering. Ion-sensitive microelectrode techniques applied to human lenses yielded calcium levels of 0.1 microM-2 mM. In lenses with dense, highly localized opacities the calcium distribution was not uniform and was highest in regions that scattered most light. The movement of calcium through individual membrane channels was investigated using patch clamp techniques. Three types of ionic channels have been identified in the lens. The smallest appears to be a calcium channel; the larger current fluctuations are associated with sodium and potassium movements. In organ culture studies of the bovine lens, a marked decrease in protein synthesis and net leakage of proteins was associated more strongly with an increase in calcium than with an increase in sodium. The stability of the lens protein gel thus seems to depend on maintaining a low internal level of calcium ions.

Activation of metallothioneins and alpha-crystallin/sHSPs in human lens epithelial cells by specific metals and the metal content of aging clear human lenses

PURPOSE

To identify those metallothionein and alpha-crystallin/small heat-shock genes induced by toxic metals in human lens cells and to evaluate the levels of these metals between young and aged human lenses.

METHODS

Human SRA01/04 and primary human lens epithelial cells were cultured and exposed to Cd(2+), Cu(2+), and Zn(2+). The levels of lens metallothioneins (Ig, If, Ih, Ie, and IIa) and alpha-crystallin/small heat-shock (alphaA-crystallin, alphaB-crystallin, and HSP27) genes were analyzed by semiquantitative and quantitative competitive RT-PCR. The content of aluminum, cadmium, calcium, chromium, copper, iron, lead, magnesium, manganese, nickel, potassium, sodium, and zinc in young (mean, 32.8 years), middle-aged (mean, 52.3 years), and old (mean, 70.5 years) human lenses was analyzed by inductively coupled plasma-emission spectroscopy.

RESULTS

Lens metallothioneins (Ig, If, Ih, Ie, and IIa) and alpha-crystallin/small heat-shock genes (alphaA-crystallin, alphaB-crystallin, and HSP27) were differentially induced by specific metals in SRA01/04 human lens epithelial cells. Cd(2+) and Zn(2+), but not Cu(2+), induced the metallothioneins, whereas Cd(2+) and Cu(2+), but not Zn(2+), induced alphaB-crystallin and HSP27. alphaA-crystallin was induced by Cu(2+) only. Similar responses of the metallothionein IIa gene were detected in identically treated primary human lens epithelial cells. Cd(2+) and Zn(2+) induced metallothionein IIa to five times higher levels than metallothionein Ig. Of 13 different metals, only iron was altered, exhibiting an 81% decrease in old versus young lenses.

CONCLUSIONS

Induction of metallothioneins and alpha-crystallin/small heat shock proteins by different metals indicates the presence of metal-specific lens regulatory pathways that are likely to be involved in protection against metal-associated stresses.

Effects of modifications of alpha-crystallin on its chaperone and other properties

The role of alpha-crystallin, a small heat-shock protein and chaperone, may explain how the lens stays transparent for so long. alpha-Crystallin prevents the aggregation of other lens crystallins and proteins that have become unfolded by 'trapping' the protein in a high-molecular-mass complex. However, during aging, the chaperone function of alpha-crystallin becomes compromised, allowing the formation of light-scattering aggregates that can proceed to form cataracts. Within the central part of the lens there is no turnover of damaged protein, and therefore post-translational modifications of alpha-crystallin accumulate that can reduce chaperone function; this is compounded in cataract lenses. Extensive in vitro glycation, carbamylation and oxidation all decrease chaperone ability. In the present study, we report the effect of the modifiers malondialdehyde, acetaldehyde and methylglyoxal, all of which are pertinent to cataract. Also modification by aspirin, which is known to delay cataract and other diseases, has been investigated. Recently, two point mutations of arginine residues were shown to cause congenital cataract. 1,2-Cyclohexanedione modifies arginine residues, and the extent of modification needed for a change in chaperone function was investigated. Only methylglyoxal and extensive modification by 1,2-cyclohexanedione caused a decrease in chaperone function. This highlights the robust nature of alpha-crystallin.

Is month of birth associated with cataract in later life?

BACKGROUND

It has been suggested that season of birth might influence the susceptibility to cataract in later life.

METHODS

This hypothesis was investigated using data pooled from two case-control studies carried out in Oxfordshire.

RESULTS/CONCLUSION

The results showed no relation between month or season of birth and cataract in later life in an English population.

Some blood plasma constituents correlate with human cataract

AIMS

To look for differences between matched pairs of patients and controls in concentrations of various plasma constituents which might indicate dysfunctions associated with cataract.

METHOD

One thousand patients were taken from the cataract waiting list of a specialist eye hospital. For each patient a matched control of the same sex and half-decade of age but without cataract was taken from the patient list of the family doctor of the patient; the control was the next alphabetically after the patient on the doctor's list. The patients and controls were visited in their homes by a team of nurses who performed venepunctures and collected information for a questionnaire. Eye examinations were performed by a team of ophthalmologists.

RESULTS

Significant differences were found between the cataract and control groups in 10 of the 18 examined plasma constituents. A constellation of three--bilirubin, alkaline phosphatase, and gamma glutamyl transpeptidase--was significantly higher in the cataract group, suggesting subclinical liver dysfunction as a risk factor. Steroid treatment and diabetes increased cataract risk. Endogenous basal plasma cortisol levels were raised in the cataract group, irrespective of steroid use and diabetic status. Alkaline phosphatase, calcium, glucose, and sodium were all raised in the cataract group. Given the raised total protein and albumin also found in the cataract group, the lower albumin/(total protein-albumin) ratio (an approximation for albumin/globulin ratio) may imply an increase in globulin, suggestive of possible (chronic) infection. Total cholesterol was lower in the cataract group.

CONCLUSION

Human cataract in older age groups seems to be due to an accumulation of risk factors, even if individual mean concentrations are well within normal limits but, of course, differing significantly from the corresponding means in the control population.

Smoking of beedies and cataract: cadmium and vitamin C in the lens and blood

Estimation of cadmium and vitamin C was performed in the blood and lens of smokers in three age groups up to a maximum age of 58, habituated to smoking a minimum of 10 beedies a day for many years, as well as those of non-smokers in the same age groups. Only nuclear cataracts with or without posterior or anterior subcapsular cataract were chosen. It was found that there was a significant accumulation of cadmium in both the blood and the lens of the smokers. Such an accumulation of cadmium might have a role in cataractogenesis in chronic smokers. In a similar experiment, with smokers and non-smokers of two age groups up to a maximum age of 40, both without cataract, increased levels of cadmium were found in the blood of smokers only, though the extent of accumulation was not as high as in chronic smokers of higher age groups. Vitamin C content of lens was on the lower side of normal in both chronic smokers of beedies in the two age groups and non-smokers with nuclear cataract with or without posterior and anterior subcapsular cataract, and there was no significant change brought about by smoking. Vitamin C levels in blood were towards the lower side of the normal in smokers and non-smokers with and without cataract.

Diabetes, glaucoma, sex, and cataract: analysis of combined data from two case control studies

Data from two case control studies in Oxfordshire were combined and analysed. The combined study covered 1940 subjects, 723 cases, and 1217 controls, between the ages of 50 and 79 with a response rate of 97% for cases and 94% for controls. Diabetes was shown to be a powerful and highly significant risk factor for cataract with a relative risk of 5.04. More than 11% of cataracts in Oxfordshire are attributable to diabetes. The relative risk did not increase significantly with age within the range 50 to 79 years but was higher in females than in males. For females with diabetes the relative risk was 7.85 with 95% confidence interval from 4.30 to 14.3 compared with 3.42 with confidence interval from 2.05 to 5.71 for males with diabetes. Diabetes remained a powerful risk factor when other identified risk factors had been controlled for. No known mechanism for the development of diabetic complications provides an explanation for the excess risk in females. Combination of the two studies led to better estimates of the relative risk of glaucoma as a risk factor for cataract (3.96 with 95% confidence interval from 2.35 to 6.68). The relative risk appeared to be greater in women than in men but this difference was not statistically significant. There was no significant change in risk with age. Glaucoma is a powerful and independent risk factor for cataract in both sexes and may be responsible for 5% of all cataracts in our area.

Autofluorescence of the crystalline lens in early and late onset diabetes

Blue/green autofluorescence (excitation around 420 to 430 nm, emission around 520 nm) of the crystalline lens has been studied by an in vivo photographic method in two populations of diabetics and controls. The populations consisted of a geographically based survivor group of 161 mixed early and late onset diabetics (and 133 non-diabetic controls) and a second group of 104 early onset insulin dependent diabetics (and 138 non-diabetic controls), the latter all with non-cataractous lenses. Powerful associations (p less than 10(-6) were found between the presence of diabetes and increased lenticular autofluorescence in both populations. Among the mixed diabetics diabetic type was a significant factor after accounting for the effects of age and diabetic duration. In the early onset group (clear lenses) a powerful association existed between autofluorescence and diabetic duration (p = 0.000011) after allowing for the effect of age, while in a subgroup of late onset diabetics with clear lenses this effect was modest (p = 0.015). In the early onset diabetic group diabetic retinopathy (p = 0.0064) was associated with increased lenticular autofluorescence after allowing for the effects of age and diabetic duration. In addition a powerful interaction between diabetic duration and the presence of diabetic retinopathy (p less than 10(-6) was found in this subgroup. Among the geographically based population of diabetics, increased nuclear brunescence was powerfully associated (p less than 10(-6) with increased autofluorescence after allowing for the effects of age, diabetic duration, and type of diabetes. This association was not found in the non-diabetic population. Non-enzymatic glycosylation of lens proteins should be considered as a possible mechanism of production of the fluorogen with emission around 520 nm.

Intracellular pH regulation in the embryonic chicken lens epithelium

1. The intracellular pH (pHi) of embryonic lens epithelia was measured by the emission ratio technique using the fluorescent pH probe carboxy-seminaphthorhodafluor-1 (Snarf-1). 2. In artificial aqueous humour solutions (AAH) containing HCO3-, pHi was 7.45, a value more alkaline than that of the bathing medium (pH = 7.3). In HCO3- -free AAH, pHi was 7.29. 3. Acetazolamide, an inhibitor of carbonic anhydrase, had no effect on resting pHi. 4. The pHi could be manipulated experimentally by changing the external pH (pHo) of HEPES-buffered AAH, the addition or withdrawal of CO2-HCO3-, or by perfusion with the weak bases NH4Cl and procaine. 5. The pHi change induced by withdrawal of 5 mM-procaine was used to calculate a value for the intrinsic cytoplasmic buffering capacity (beta i) of 16.5 mM. 6. The addition of amiloride (1 mM) or treatment with low-Na+ AAH solutions led to a decrease in pHi of 0.23 over the 10 min exposure. In addition, these treatments inhibited pHi recovery from NH4(+)-induced acidosis. These observations are consistent with the presence of amiloride-sensitive N(+)-H+ antiport. 7. Addition of exogenous antiport activity in the form of 50 microM-monensin caused an increase in pHi of 0.24. 8. In HCO3(-)-containing media, replacing Cl- by gluconate or isothionate led to an immediate, reversible increase in pHi which could be completely inhibited by 2 mM-4-acetamido-4'-isothiocyanato-stillbene-2,2'-disulphonic acid (SITS). This indicates the presence of Cl(-)-HCO3- exchange in this tissue. 9. Under HCO3(-)-free conditions, replacement of Cl- by gluconate or isothionate caused a small transient acidification followed, 5 min later, by a large sustained alkalinization. The delayed increase in pHi could be completely blocked by 1 mM-amiloride and may reflect volume-sensitive stimulation of the Na(+)-H+ antiporter as cell volume (estimated by cell height measurements) was shown to decrease significantly during this period.

Oxidation and cataract

Previous work has established that oxidation of the constituents of the human lens is an early event in the development of cataract. In old pre-cataractous lenses, oxidation of the fibre membrane polypeptides is observed. Non-disulphide-linked aggregates possibly generated by photo-oxidation are also found. With the development of cataract the oxidation becomes more extensive, affecting many of the proteins of the tissue. High molecular weight, disulphide-linked aggregates are formed, involving cytosol and membrane components. Membrane rupture accompanies the process. Hydrogen peroxide has been found in elevated levels in the aqueous fluid of some cataract patients. H2O2 will cause cataract and has been shown to affect Na+,K+-ATPase. Analyses of available data suggest that (1) oxidation of membrane components may be an initiating event in cataract, and (2) the oxidizing agent may come from the exterior environment of the tissue. The problems involved in proving this hypothesis are discussed and an approach to testing the hypothesis is suggested.