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Wong CW, Cheung N, Ho C, Barathi V, Storm G, Wong TT. Characterisation of the inflammatory cytokine and growth factor profile in a rabbit model of proliferative vitreoretinopathy. Sci Rep 2019; 9:15419. [PMID: 31659187 PMCID: PMC6817814 DOI: 10.1038/s41598-019-51633-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/27/2019] [Indexed: 12/15/2022] Open
Abstract
To clarify the mechanisms and their temporal relationship in the development of proliferative vitreoretinopathy (PVR), we measured vitreous levels of pro-inflammatory cytokines and growth factors in a rabbit model of PVR. PVR was surgically induced in 11 rabbit eyes by vitrectomy, retinotomy, cryotherapy and injection of platelet-rich plasma at baseline. Severity of PVR was assessed on dilated fundal examination with indirect binocular ophthalmoscopy and graded based on the revised experimental PVR classification. Severe PVR was defined as stage 5 or worse. Vitreous concentrations of interleukin 6 (IL-6), interleukin 8 (IL-8), interleukin 1 beta (IL-1 β), tumor necrosis factor beta (TNF-β), granulocyte macrophage colony stimulating factor (GM-CSF), interferon gamma (IFN-γ), C reactive protein; (CRP), placental growth factor (PlGF), platelet derived growth factor BB (PDGF-BB), vascular endothelial growth factor (VEGF) and angiopoietin 2 (Ang-2) at weeks 2, 3 and 4 were compared to baseline and correlations between the cytokines with PVR severity were assessed. Four weeks after PVR induction, 5 eyes (45.5%) had developed severe PVR. IL-8 was raised at 2 weeks post PVR induction (1.46 ± 0.48 pg/ml vs 0.53 ± 0.25 pg/ml, p = 0.04) and remained significantly elevated at week 4 (2.6 ± 3.1 pg/ml, p = 0.03). CRP was significantly raised at week 4 (34.8 ± 12.0 pg/ml vs 13.0 ± 13.1 pg/ml, p < 0.001). Among the growth factors, PDGF-BB was the earliest to show significantly elevated levels, at 3 weeks (50.4 ± 19.0 pg/ml vs 6.2 ± 10.1 pg/ml) and remained elevated at week 4 (p = 0.002), while PlGF (11.2 ± 7.7 pg/ml vs 5.3 ± 3.8 pg/ml, p = 0.002) and Ang2 (13617.0 ± 8170.2 pg/ml vs 38593.8 ± 8313.4, p = 0.02) were significantly raised at week 4. IFN-γ (p = 0.03), PDGF-BB (p = 0.02) and VEGF (p = 0.02) were significantly associated with PVR severity. We demonstrated that inflammatory cytokines IL-6, -8, elevation post PVR induction is followed by elevated levels of fibroproliferative growth factors, Ang2, PlGF, VEGF and PDGF-BB in the development of PVR. These findings will guide future studies targeting appropriate therapeutic strategies for the treatment of PVR.
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Affiliation(s)
- Chee Wai Wong
- Singapore National Eye Centre (SNEC), 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke NUS Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Ning Cheung
- Singapore National Eye Centre (SNEC), 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke NUS Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Candice Ho
- Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Veluchamy Barathi
- Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke NUS Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Gert Storm
- Department Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands.,Department Biomaterials Science & Technology (BST), Section Targeted Therapeutics, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Tina T Wong
- Singapore National Eye Centre (SNEC), 11 Third Hospital Avenue, Singapore, 168751, Singapore. .,Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore, 168751, Singapore. .,School of Materials Science and Engineering (MSE), Nanyang Technological University, 11 Faculty Avenue, Singapore, 639977, Singapore. .,Ophthalmology and Visual Sciences Academic Clinical Program, Duke NUS Medical School, 8 College Rd, Singapore, 169857, Singapore.
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Fan W, Zheng X, Yuan S, Xie P, Liu Q. Angiogenic Cytokine Profile of a Patient With Schwartz-Matsuo Syndrome. Ophthalmic Surg Lasers Imaging Retina 2019; 49:721-725. [PMID: 30222809 DOI: 10.3928/23258160-20180831-12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 08/03/2018] [Indexed: 11/20/2022]
Abstract
A 36-year-old man was diagnosed with Schwartz-Matsuo syndrome and received a scleral buckle surgery. Photoreceptor outer segments in aqueous humor were examined under electron microscope to confirm the diagnosis. Afterwards, 17 human angiogenesis and growth factor biomarkers were chosen to make simultaneous quantification in aqueous humor, among which the authors demonstrated the remarkable high expression of angiopoietin-2 in aqueous humor. This is the first reported case of angiogenesis / growth factor biomarkers in aqueous humor of the Schwartz-Matsuo Syndrome patient. Angiopoietin-2 level significantly increased in this patient's aqueous humor, which helped the authors to illuminate the pathogenic mechanisms underlying Schwartz-Matsuo syndrome. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:721-725.].
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Loukovaara S, Haukka J. Repair of primary RRD - comparing pars plana vitrectomy procedure with combined phacovitrectomy with standard foldable intraocular lens implantation. Clin Ophthalmol 2018; 12:1449-1457. [PMID: 30147297 PMCID: PMC6101008 DOI: 10.2147/opth.s171451] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Pars plana vitrectomy (PPV) combined with phacoemulsification and primary intraocular lens implantation can be performed for the repair of primary rhegmatogenous retinal detachment (RRD; PHACOVIT group). The safety and efficacy of this combined ophthalmic procedure on RRD surgery outcomes remain unclear compared with more conventional PPV technique alone (VITRET group). We explored the need for reoperation after primary surgical procedure in these two groups. Methods Retrospective, longitudinal, register-based cohort of RRD patients was operated in University Eye Clinic, Helsinki, Finland, during 2008–2014. The main outcome measure was reoperation rate during a postoperative follow-up period of 1 year due to retinal re-detachment, vitreous rehemorrhage, postoperative endophthalmitis, secondary pucker, macular hole or other reasons. Results We analyzed 1,690 consecutive RRD cases, out of which 1,564 patients were treated in the PPV VITRET group and 126 patients in the PHACOVIT-operated group. Risk for reoperation was 2.67 times higher in the PHACOVIT group compared to the PPV VITRET group (95% CI 1.85–3.85). Conclusion The reoperation rate was higher in RRD eyes operated with combined cataract surgery plus PPV, suggesting that RRD eyes should not primarily undergo combined PHACOVIT surgery.
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Affiliation(s)
- Sirpa Loukovaara
- Unit of Vitreoretinal Surgery, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Identification of proteins associated with clinical and pathological features of proliferative diabetic retinopathy in vitreous and fibrovascular membranes. PLoS One 2017; 12:e0187304. [PMID: 29095861 PMCID: PMC5667868 DOI: 10.1371/journal.pone.0187304] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 10/16/2017] [Indexed: 01/17/2023] Open
Abstract
Purpose To identify the protein profiles in vitreous associated with retinal fibrosis, angiogenesis, and neurite formation in epiretinal fibrovascular membranes (FVMs) in patients with proliferative diabetic retinopathy (PDR). Methods Vitreous samples of 5 non-diabetic control patients with vitreous debris and 7 patients with PDR membranes were screened for 507 preselected proteins using the semi-quantitative RayBio® L-series 507 antibody array. From this array, 60 proteins were selected for a custom quantitative antibody array (Raybiotech, Human Quantibody® array), analyzing 7 control patients, 8 PDR patients with FVMs, and 5 PDR patients without FVMs. Additionally, mRNA levels of proteins of interest were measured in 10 PDR membranes and 11 idiopathic membranes and in retinal tissues and cells to identify possible sources of protein production. Results Of the 507 proteins screened, 21 were found to be significantly elevated in PDR patients, including neurogenic and angiogenic factors such as neuregulin 1 (NRG1), nerve growth factor receptor (NGFR), placental growth factor (PlGF) and platelet derived growth factor (PDGF). Angiopoietin-2 (Ang2) concentrations were strongly correlated to the degree of fibrosis and the presence of FVMs in patients with PDR. Protein correlation analysis showed PDGF to be extensively co-regulated with other proteins, including thrombospondin-1 and Ang2. mRNA levels of glial-derived and brain/derived neurotrophic factor (GDNF and BDNF) were elevated in PDR membranes. These results were validated in a second study of 52 vitreous samples of 32 PDR patients and 20 control patients. Conclusions This exploratory study reveals protein networks that potentially contribute to neurite outgrowth, angiogenesis and fibrosis in the formation of fibrovascular membranes in PDR. We identified a possible role of Ang2 in fibrosis and the formation of FVMs, and of the neurotrophic factors NRG1, PDGF and GDNF in neurite growth that occurs in all FVMs in PDR.
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Saharinen P, Eklund L, Alitalo K. Therapeutic targeting of the angiopoietin-TIE pathway. Nat Rev Drug Discov 2017; 16:635-661. [PMID: 28529319 DOI: 10.1038/nrd.2016.278] [Citation(s) in RCA: 311] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The endothelial angiopoietin (ANG)-TIE growth factor receptor pathway regulates vascular permeability and pathological vascular remodelling during inflammation, tumour angiogenesis and metastasis. Drugs that target the ANG-TIE pathway are in clinical development for oncological and ophthalmological applications. The aim is to complement current vascular endothelial growth factor (VEGF)-based anti-angiogenic therapies in cancer, wet age-related macular degeneration and macular oedema. The unique function of the ANG-TIE pathway in vascular stabilization also renders this pathway an attractive target in sepsis, organ transplantation, atherosclerosis and vascular complications of diabetes. This Review covers key aspects of the function of the ANG-TIE pathway in vascular disease and describes the recent development of novel therapeutics that target this pathway.
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Affiliation(s)
- Pipsa Saharinen
- Wihuri Research Institute and Translational Cancer Biology Program, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, P.O. Box 63, FI-00014 Helsinki, Finland
| | - Lauri Eklund
- Oulu Center for Cell-Matrix Research, Faculty of Biochemistry and Molecular Medicine, Biocenter Oulu, Aapistie 5A, University of Oulu, 90220 Oulu, Finland
| | - Kari Alitalo
- Wihuri Research Institute and Translational Cancer Biology Program, Biomedicum Helsinki, University of Helsinki, Haartmaninkatu 8, P.O. Box 63, FI-00014 Helsinki, Finland
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Sahanne S, Tuuminen R, Haukka J, Loukovaara S. A retrospective study comparing outcomes of primary rhegmatogenous retinal detachment repair by scleral buckling and pars plana vitrectomy in Finland. Clin Ophthalmol 2017; 11:503-509. [PMID: 28331284 PMCID: PMC5354527 DOI: 10.2147/opth.s128746] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Rhegmatogenous retinal detachment (RRD) is the most common form of retinal detachment and an ophthalmic emergency. Here, we compared outcomes of primary RRD eyes operated with conventional scleral buckling (SB) with cryoretinopexy to those operated with standard pars plana vitrectomy (PPV). Methods This is an institutional, retrospective, register-based, observational, comparative study. Based on the surgical procedure, 319 eyes of 319 patients were divided into two groups: SB plus cryotherapy (n=50) and PPV (n=269). Changes in intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were recorded at 30 days and reoperation rates within 180 days postoperatively. Results Eyes operated with PPV had less reoperations within the first 180 days as compared with SB eyes (P=0.001, log-rank test); however, changes in IOP were more prominent (mean ± standard deviation: +8.1±8.8 vs. +4.4±7.0 mmHg, respectively; P=0.006). Changes in BCVA did not differ between the surgical procedures. Conclusion PPV was associated with higher primary anatomic success rates and lower risk of reoperation but significant IOP elevation when compared to SB. These factors should be case-specifically considered when choosing treatment modality for primary RRD.
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Affiliation(s)
- Sari Sahanne
- Department of Anesthesiology, Helsinki University Central Hospital, Helsinki
| | - Raimo Tuuminen
- Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka
| | - Jari Haukka
- Hjelt Institute, Faculty of Medicine, University of Helsinki
| | - Sirpa Loukovaara
- Unit of Vitreoretinal Surgery, Department of Ophthalmology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
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Decreased hyaluronan concentration during primary rhegmatogenous retinal detachment. Eur J Ophthalmol 2016; 26:633-638. [PMID: 27198637 DOI: 10.5301/ejo.5000802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the concentration and molecular weight of hyaluronan (HA) polysaccharides as well as hyaluronidase activity in patients with rhegmatogenous retinal detachment (RRD). METHODS Twenty vitreous samples from 20 patients with RRD and 19 samples from 19 patients with idiopathic epiretinal membrane, macular hole, or vitreomacular traction syndrome were collected during surgical management with pars plana vitrectomy. The molecular weight of various HA fragments was assessed using agarose gel electrophoresis. Enzyme-linked immunosorbent assay was employed for the measurement of HA (in μg/mL). Hyaluronidase activity was evaluated using substrate (HA) sodium dodecyl sulfate polyacrylamide gel electrophoresis. RESULTS Agarose gel electrophoresis showed that the vitreous of the control group contained HA of high molecular mass, in contrast with the patient group. Mean HA concentration in the patient group was 50.96 μg/mL and differed significantly from that of the control group, which was 271.81 μg/mL (p<0.0005). Hyaluronidase activity was significantly higher in the vitreous of patients with RRD (p = 0.037). CONCLUSIONS The vitreous of patients with RRD is characterized by decreased HA concentration compared to controls of the same age and sex and shows higher hyaluronidase catalytic activity. Hyaluronan degradation could be associated with specific vitreous alterations that potentially contribute to retinal break formation and consequently detachment.
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Loukovaara S, Sahanne S, Jalkanen S, Yegutkin GG. Increased intravitreal adenosine 5'-triphosphate, adenosine 5'-diphosphate and adenosine 5'-monophosphate levels in patients with proliferative diabetic retinopathy. Acta Ophthalmol 2015; 93:67-73. [PMID: 25079888 DOI: 10.1111/aos.12507] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/04/2014] [Indexed: 12/28/2022]
Abstract
PURPOSE Extracellular purines play important role in ocular physiology, diabetes, vascular remodelling and adaptation to inflammation. This study was aimed to evaluate intravitreal purine levels in patients with diabetic retinopathy (DR) and other non-vascular vitreoretinal eye diseases. METHODS Vitreous samples were collected at the start of the three-port pars plana vitrectomy. Study group comprised 55 eyes operated due to sight-threatening forms of DR, including eyes of 24 patients with proliferative DR. Of the 143 non-diabetic controls, 112 had rhegmatogenous retinal detachment and 31 macular hole or pucker. Intravitreal purine concentrations were determined using a combination of bioluminescent [adenosine 5'-triphosphate (ATP), adenosine 5'-diphosphate (ADP)] and fluorometric [adenosine 5'-monophosphate (AMP), adenosine, inosine] enzyme-coupled sensing assays. RESULTS Compared with non-diabetic controls, DR eyes contained significantly higher (p < 0.01) concentrations of ATP (4.2 ± 0.6 versus 34.5 ± 13.7 nm; mean ± SEM), ADP (19.5 ± 2.7 versus 43.7 ± 14.5 nm) and AMP (1290 ± 115 versus 1876 ± 190 nm). Intravitreal adenosine and inosine levels varied within submicromolar to low micromolar range, and their concentrations did not differ between the groups studied. CONCLUSIONS High concentrations of intravitreal nucleotides ATP, ADP and AMP may be related to the pathogenesis of sight-threatening forms of DR.
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Affiliation(s)
- Sirpa Loukovaara
- Unit of Vitreoretinal Surgery; Department of Ophthalmology; Helsinki University Central Hospital; Helsinki Finland
| | - Sari Sahanne
- Unit of Anesthesiology and Intensive Care Medicine; Eye-ENT Hospital; Helsinki University Central Hospital; Helsinki Finland
| | - Sirpa Jalkanen
- MediCity Research Laboratory; University of Turku and Turku University Hospital; Turku Finland
- National Institute for Health and Welfare; Turku Finland
| | - Gennady G. Yegutkin
- MediCity Research Laboratory; University of Turku and Turku University Hospital; Turku Finland
- National Institute for Health and Welfare; Turku Finland
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Tuuminen R, Haukka J, Loukovaara S. Statins in rhegmatogenous retinal detachment are associated with low intravitreal angiopoietin-2, VEGF and MMP-2 levels, and improved visual acuity gain in vitrectomized patients. Graefes Arch Clin Exp Ophthalmol 2014; 253:1685-93. [PMID: 25432094 DOI: 10.1007/s00417-014-2873-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/22/2014] [Accepted: 11/19/2014] [Indexed: 01/08/2023] Open
Abstract
PURPOSE In rhegmatogenous retinal detachment (RRD), intravitreal growth factors and cytokines may compromise post-vitrectomy outcomes. Here, we analysed perioperative intravitreal protein levels of potent vasoactive, pro-inflammatory, and extracellular matrix-remodelling factors in RRD eyes of patients treated with statins and evaluated post-vitrectomy outcome in the same study eyes. METHODS Institutional, retrospective, observational study of 14 patients operated on for RRD while on statins compared to patients without statin medication (n = 82). Vitreous samples were subjected to protein measurements of angiopoietin (ANGPT)-1 and -2, transforming growth factor-β1, and vascular endothelial growth factor (VEGF) by ELISA, and of matrix metalloproteinase (MMP)-2 and -9 by gelatin zymography. A 1-month best-corrected visual acuity (BCVA) gain was modelled by Student's T-test and multivariate linear regression with concomitant perioperative medication. Cumulative 12-month revitrectomy frequency was modelled by Kaplan-Meier log-rank test. RESULTS Intravitreal levels of ANGPT-2 (49.2 ± 33.1 vs. 112.8 ± 134.1 pg/ml, mean ± SD, p < 0.001), VEGF (2.3 ± 2.4 vs. 17.7 ± 57.8 pg/ml, p = 0.021), and MMP-2 (1107.1 ± 884.6 vs 1976.4 ± 970.1 AU/ml, p = 0.005) in RRD eyes of patients treated with statins were lower than in non-statin-treated controls. Patients on statins had better 1-month BCVA improvement than did those not on statins (p = 0.022), with no difference in 1-year re-vitrectomy rates. CONCLUSIONS Intravitreal levels of ANGPT-2, VEGF, factors involved in vascular permeability and inflammation, and activity of MMP-2, the factor connected with breakdown of basement membrane and fibroproliferation, were lower in RRD eyes of patients with statin treatment. At 1-month, postoperative BCVA gain was improved in statin-treated RRD eyes, suggesting that statin administration may be effective in preventing inflammation-related PVR formation.
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Affiliation(s)
- Raimo Tuuminen
- Department of Ophthalmology, Helsinki University Central Hospital, Haartmaninkatu 4 C, FI-00290, Helsinki, Finland
| | - Jari Haukka
- Hjelt Institute, Faculty of Medicine, University of Helsinki, Haartmaninkatu 4 C, FI-00290, Helsinki, Finland
| | - Sirpa Loukovaara
- Unit of Vitreoretinal Surgery, Department of Ophthalmology, Helsinki University Central Hospital, Haartmaninkatu 4 C, FI-00290, Helsinki, Finland.
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