Analysis of orthograde fast axonal transport and nonaxonal transport along the optic pathway of albino rabbits during increased and decreased intraocular pressure

Transient Diagnostics and Therapeutic-Related Increase in Intraocular Pressure and Risk to the Glaucoma Patient

This review evaluates the impact of transient intraocular pressure (IOP) elevations during common ophthalmic surgical and diagnostic procedures on glaucoma patients. Elevated IOP is a key risk factor in glaucoma, and while transient IOP spikes are frequently encountered during surgeries like cataract extraction, laser in situ keratomileusis (LASIK), and femtosecond laser-assisted cataract surgery (FLACS), the clinical significance of these short-term elevations remains uncertain, particularly for eyes with compromised optic nerves. There is still a lack of data on which IOP level and duration of IOP insult the glaucoma damage occurs. Still, it is known that the combination of the degree of IOP elevation, duration of the insult and optic nerve susceptibility are important determinants of this event. While transient IOP elevations during these procedures are generally well tolerated, patients with advanced glaucoma and severely compromised optic nerves may be at greater risk for further damage. More research is needed to fully understand the long-term implications of acute IOP spikes, particularly in patients with advanced disease.

The Role of Axonal Transport in Glaucoma

Glaucoma is a neurodegenerative disease that affects the retinal ganglion cells (RGCs) and leads to progressive vision loss. The first pathological signs can be seen at the optic nerve head (ONH), the structure where RGC axons leave the retina to compose the optic nerve. Besides damage of the axonal cytoskeleton, axonal transport deficits at the ONH have been described as an important feature of glaucoma. Axonal transport is essential for proper neuronal function, including transport of organelles, synaptic components, vesicles, and neurotrophic factors. Impairment of axonal transport has been related to several neurodegenerative conditions. Studies on axonal transport in glaucoma include analysis in different animal models and in humans, and indicate that its failure happens mainly in the ONH and early in disease progression, preceding axonal and somal degeneration. Thus, a better understanding of the role of axonal transport in glaucoma is not only pivotal to decipher disease mechanisms but could also enable early therapies that might prevent irreversible neuronal damage at an early time point. In this review we present the current evidence of axonal transport impairment in glaucomatous neurodegeneration and summarize the methods employed to evaluate transport in this disease.

Time-Dependent Effects of Reduced Cerebrospinal Fluid Pressure on Optic Nerve Retrograde Axonal Transport

Purpose

To study the time-dependent effects of reduced cerebrospinal fluid pressure (CSFP) on axonal transport in the rat optic nerve.

Methods

Seventy-two adult Sprague Dawley rats were used for this study. Fluoro-Gold was injected into the superior colliculi to study axonal transport. CSFP was reduced to 1.5 to 2.9 mm Hg by continuous aspiration of cerebrospinal fluid. In the sham control group (n = 18), a trocar was implanted in the cisterna magna, but cerebrospinal fluid was not released. CSFP and intraocular pressure (IOP) were continually monitored. CSFP was reduced for 1 hour (low-CSFP-1h study group; n = 18), 3 hours (low-CSFP-3h study group; n = 18), or 6 hours (low-CSFP-6h study group; n = 18) before the animals were euthanized. Confocal microscopy was used to compare axonal transport in different quadrants of the retina between control and low-CSFP eyes.

Results

Changes in axonal transport were observed only after 3 hours of CSFP reduction and not in the low-CSFP-1h study group. These changes occurred in a time-dependent manner, with 6 hours of CSFP reduction producing the longest lasting and most severe reduction in fluorescence.

Conclusions

The time-dependent changes observed in axonal transport in the optic nerve provide further evidence regarding the pathogenesis of axonal damage caused by reduced CSFP.

Pluripotent Stem Cell-Based Approaches to Explore and Treat Optic Neuropathies

Sight is a major sense for human and visual impairment profoundly affects quality of life, especially retinal degenerative diseases which are the leading cause of irreversible blindness worldwide. As for other neurodegenerative disorders, almost all retinal dystrophies are characterized by the specific loss of one or two cell types, such as retinal ganglion cells, photoreceptor cells, or retinal pigmented epithelial cells. This feature is a critical point when dealing with cell replacement strategies considering that the preservation of other cell types and retinal circuitry is a prerequisite. Retinal ganglion cells are particularly vulnerable to degenerative process and glaucoma, the most common optic neuropathy, is a frequent retinal dystrophy. Cell replacement has been proposed as a potential approach to take on the challenge of visual restoration, but its application to optic neuropathies is particularly challenging. Many obstacles need to be overcome before any clinical application. Beyond their survival and differentiation, engrafted cells have to reconnect with both upstream synaptic retinal cell partners and specific targets in the brain. To date, reconnection of retinal ganglion cells with distal central targets appears unrealistic since central nervous system is refractory to regenerative processes. Significant progress on the understanding of molecular mechanisms that prevent central nervous system regeneration offer hope to overcome this obstacle in the future. At the same time, emergence of reprogramming of human somatic cells into pluripotent stem cells has facilitated both the generation of new source of cells with therapeutic potential and the development of innovative methods for the generation of transplantable cells. In this review, we discuss the feasibility of stem cell-based strategies applied to retinal ganglion cells and optic nerve impairment. We present the different strategies for the generation, characterization and the delivery of transplantable retinal ganglion cells derived from pluripotent stem cells. The relevance of pluripotent stem cell-derived retinal organoid and retinal ganglion cells for disease modeling or drug screening will be also introduced in the context of optic neuropathies.

Myopia and diabetes mellitus as modificatory factors of glaucomatous optic neuropathy

Myopic deformation of the eye and metabolic alterations of the nerve tissue of patients with diabetes may modify glaucomatous optic neuropathy (GON). Blockage of axonal transport of neurotrophic factors (NTFs) is the event crucial to understanding the factors that affect GON. The primary, but not sole, blockage site is at the lamina cribrosa (LC). Other than this primary site of damage at the LC, 7 other factors may explain atypical nerve fiber layer (NFL) defects and the vulnerability of the nerve fibers in eyes with high myopia and glaucoma: a second point of blockage at the edge of the posterior scleral foramen; ectatic strain on the NFL; ectasia and distortion of the LC; association of a hypoplastic optic disc; thin and weak collagen fibers; peripapillary chorioretinal atrophy; and myopic neuropathy. Among diabetic patients, diabetic neuropathy in the retinal NFL is present initially, and increased resistance to aqueous outflow leads to ocular hypertension. Superimposition of GON on diabetic neuropathy and ocular hypertension in patients with diabetes may enhance their susceptibility to nerve damage. Results of a meta-analysis study suggested a positive association between diabetes mellitus and glaucoma whereas other reports suggested that leakage of vascular endothelial growth factor, a survival mechanism of ischemic neural tissue, and enhanced stiffness of the LC as a result of diabetic glycation may protect neurons from apoptosis. Thus, modification of GON as a result of diabetes remains controversial.

Inhibition and recovery of retrograde axoplasmic transport in rat optic nerve during and after elevated IOP in vivo

Horseradish peroxidase (HRP) injected into one lateral geniculate nucleus of male inbred PVG/Mol hooded rats is taken up by terminals of the optic nerve and transported retrogradely towards the opposite retina. One hr after injection, the eyes were cannulated and set at an intraocular pressure (IOP) of either 35 mmHg or 15 mmHg. The IOP were set for 4 hr at which time the trial was terminated and retinal HRP content measured. It was found that in eyes set at 35 mmHg (18 eyes) the axoplasmic transport was partially blocked compared with that in eyes set at 15 mmHg (10 eyes), absorbances were 0.034 +/- 0.003 (S.E.) and 0.044 +/- 0.003 (S.E.), respectively, P less than 0.05. In a third group of eyes (nine eyes) set at 50 mmHg for 2 hr (beginning 1 hr after the intrageniculate injection), succeeded by another 2 hr of 15 mmHg IOP, there was no statistically significant difference in retinal HRP content compared to that in eyes set at 15 mmHg throughout, absorbances were 0.040 +/- 0.006 and 0.044 +/- 0.003, respectively. Two hr of 50 mmHg IOP blocks the axonal transport in the rat optic nerve (Johansson, 1986a). The result shows that also moderately increased IOP blocks axonal transport in the rat optic nerve. It also shows the presence of a rapid recovery when the pressure is normalized. A direct mechanical factor underlying axonal transport blockage is proposed.

Optic nerve head axonal transport in rabbits with hereditary glaucoma

Rabbits with hereditary glaucoma develop ocular changes that resemble human congenital glaucoma and buphthalmia. The inheritance is autosomal recessive (bu). Previous research was performed primarily on albino bu/bu rabbits that were unhealthy and bred poorly. We have bred pigmented bu/bu rabbits to determine if this would improve hardiness and provide a better model for the disease in humans. First-generation offspring from matings of bu/bu albino with bu/bu pigmented rabbits were all affected, indicating that the bu gene is found at the same locus in both strains. The pigmented bu/bu offspring had a high degree of mortality, as reported previously for albino bu/bu rabbits. Newborn bu/bu rabbits initially had normal intraocular pressure (IOP; 15-23 mmHg); after 1- to 3 months, the IOP increased to 26-48 mmHg. The eyes became buphthalmic and the IOP returned to normal or sub-normal levels after 6-10 months. Since the lamina cribrosa is absent or poorly formed in the rabbit optic nerve head (ONH), this model was used to test the role of mechanical factors in the etiology of ONH pathology caused by increased IOP. Orthograde axonal transport was evaluated in both eyes from eight normal and 24 bu/bu rabbits of different ages, using intravitreal injections of [3H]leucine to mark orthograde axonal transport, followed by light- and electron-microscopic radioautography of the ONHs and superior colliculi. Normal rabbits of all ages showed no blockage of axonal transport in the ONH. All optic axons from young bu/bu rabbits with normal IOP and most axons from older buphthalmic rabbits that previously had elevated IOP were normal morphologically. Small zones of transport blockage occurred in bu/bu eyes while IOP was elevated; most affected axons lay immediately adjacent to ONH connective tissue beams that radiate outward from the central retinal vessels to the optic-nerve sheath. Thus, the rabbit, which lacks a true lamina cribrosa, does not show marked blockage of axonal transport as occurs in the LS of the monkey and cat ONH when IOP is elevated acutely. This anatomic difference appears to be protective against axonal damage, since bu/bu rabbits with chronic IOP elevation did not show significant loss of optic axons. These results are consistent with the proposed 'mechanical' theory of ONH damage resulting from increased IOP. Electron-microscopic radioautography revealed that chronically elevated IOP in bu/bu rabbits, which caused small foci of blocked ONH axonal transport against ONH beams, also caused degeneration of a few optic nerve terminals in the superior colliculi as the disease progressed.(ABSTRACT TRUNCATED AT 400 WORDS)

Retrograde axoplasmic transport in rat optic nerve in vivo. What causes blockage at increased intraocular pressure?

The effect of intraocular pressure (IOP) on retrograde axonal transport of horseradish peroxidase (HRP), from the geniculate body to the retina, was studied in the rat in vivo. In 2-hr experiments (17 eyes at 50 mmHg; 13 eyes at 15 mmHg), the pressures were set just prior to the expected HRP arrival into the eyes. In 4.5-hr experiments (24 eyes at 50 mmHg; 21 eyes at 15 mmHg), the pressures were set 2.5 hr before expected HRP arrival. HRP was measured in the retinas 5 hr after the intrageniculate injection. Transport blockage occurred at an IOP of 50 mmHg in both series of experiments. In an earlier study of axonal transport in vitro, an IOP of 50 mmHg also blocked retrograde HRP transport. In a third series of experiments, 15 eyes were set at an IOP of 180 mmHg for 10 min, 10-20 min before expected arrival of HRP into the eye, while 17 control eyes were set at 15 mmHg. After the 10 min, both groups of eyes were set at 15 mmHg for another 2 hr and the HRP content in the retinas measured, 5 hr after HRP injection. There was no significant difference between these two groups of eyes, suggesting either no rapidly occurring block or a rapid recovery of transport after the high-pressure period. It is proposed that optic nerve fibers are stretched and narrowed near or at their exit, by the high IOP, but recover their shape soon after IOP is normalized.(ABSTRACT TRUNCATED AT 250 WORDS)

Blockage at two points of axonal transport in glaucomatous eyes

Blockage of axonal protein transport in intraocular hypertensive primates (Macaca irus) was studied autoradiographically and quantitatively and the findings compared with our previous work on rabbits. Fast axonal transport was blocked at two points, at the lamina scleralis and at the edge of posterior scleral foramen, and reduced by 25% when intraocular pressure of 50 mmHg continued for 6 h. The importance of the blockage at the lamina scleralis and at the edge of scleral foramen for the explanation of paracentral scotomas and the peripheral nasal step (Rønne) is discussed.

Some experimental data concerning the safety of vitrectomy

Several reasons why vitrectomy does not compromise retinal functions are shown, based on closed and open-sky vitrectomy on the rabbit eye. We observed that ERG b- and c-waves were stable during and after open-sky vitrectomy. The c-wave disappeared when the retina was detached. Function of the retinal ganglion cells after vitrectomy was shown to be almost normal by electrophysiological studies and by measured amounts of axonally transported radioactive proteins.

Impairment of protein synthesis in the retinal tissue in diabetic rabbits: secondary reduction of fast axonal transport

Protein biosynthesis in the retina and fast axonal transport along the optic pathway were studied in rabbits in which diabetes had been experimentally induced. Retinal protein biosynthesis and axonal transport were significantly reduced in the diabetic rabbits, and the reduction was correlated to the severity of the diabetes. The "somal delay time' was only slightly elongated and the O/R ratio was fairly constant in the various levels of blood glucose; thus intrasomal protein movement seems to be less affected in diabetic rabbits. Velocity and the distribution pattern of axonally transported protein remained unaffected in the diabetic rabbits. These findings suggest that a disturbance in the metabolism in the cell body is the most important factor related to quantitative reduction of fast axonal transport in diabetic rabbits.