Glaucomatous neurodegeneration and the concept of neuroprotection

Effect of Low-Fat Dietary Modification on Incident Open-Angle Glaucoma

PURPOSE

We tested whether dietary modification (DM) altered the risk for incident primary open-angle glaucoma (POAG).

DESIGN

Secondary analysis of a randomized intervention trial.

PARTICIPANTS

We linked Medicare claims data to 45 203 women in the Women's Health Initiative Dietary Modification Trial, of which 23 776 participants were enrolled in fee-for-service Medicare Part B and had physician claims.

METHODS

Women were randomized to follow either DM (a low-fat diet, with increased vegetable, fruit, and grain intake) or their usual diet without modification. Nine thousand three hundred forty women were randomized to the DM intervention, whereas 13 877 women were randomized to the control group. Our analyses were based on an intention-to-treat design, with a follow-up to the end of continuous Medicare coverage, death, or the last clams date (12/31/2018), whichever occurred first. Primary open-angle glaucoma was defined as the first claim with the International Classification of Diseases, Ninth or Tenth Revision, codes. Dietary data were assessed using a food frequency questionnaire.

MAIN OUTCOME MEASURES

We used Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of POAG. Subgroup analyses were performed with P values for interaction.

RESULTS

After exclusion of women with Medicare-derived glaucoma before randomization, the final analysis included 23 217 women (mean age, 64.4 ± 5.8 years). Baseline characteristics were balanced between the intervention and control groups. Primary open-angle glaucoma incidence was 11.1 per 1000 woman-years (mean follow-up, 11.6 ± 7.4 years; mean DM duration, 5.2 ± 3.2 years). We found no overall benefit of DM in reducing incident POAG (HR, 1.04; 95% CI, 0.96-1.12). Race and participant age did not modify this relation (P = 0.08 and P = 0.24 for interaction, respectively). In further analysis of baseline nutrient and food intake stratified by quartile groups, risk of open-angle glaucoma (OAG) in DM participants in the lowest quartile group for percentage calories (kilocalories) from total fat (33.8 or lower) was increased (HR, 1.22; 95% CI, 1.05-1.41; P = 0.007 for interaction).

CONCLUSIONS

Analysis suggests that DM in participants in the lowest quartile group for percentage calories from total fat at baseline increased the risk of incident OAG among women regardless of age or race.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Visual impairment in an optineurin mouse model of primary open-angle glaucoma

Primary open-angle glaucoma (POAG) is characterized by progressive neurodegeneration of retinal ganglion cells (RGCs). Why RGCs degenerate in low-pressure POAG remains poorly understood. To gain mechanistic insights, we developed a novel mouse model based on a mutation in human optineurin associated with hereditary, low-pressure POAG. This mouse improves the design and phenotype of currently available optineurin mice, which showed high global overexpression. Although both 18-month-old optineurin and nontransgenic control mice showed an age-related decrease in healthy axons and RGCs, the expression of mutant optineurin enhanced axonal degeneration and decreased RGC survival. Mouse visual function was determined using visual evoked potentials, which revealed specific visual impairment in contrast sensitivity. The E50K optineurin transgenic mouse described here exhibited clinical features of POAG and may be useful for mechanistic dissection of POAG and therapeutic development.

Expression of RBMX in the light-induced damage of rat retina in vivo

RNA-binding motif protein, X-linked (RBMX) is a 43 kDa nuclear protein in the RBM family and functions on alternative splicing of RNA. The gene encoding RBMX is located on chromosome Xq26. To investigate whether RBMX is involved in retinal neuron apoptosis, we performed a light-induced retinal damage model in adult rats. Western blotting analysis showed RBMX gradually increased, reached a peak at 12 h and then declined during the following days. The association of RBMX in retinal ganglion cells (RGCs) with light exposure was found by immunofluorescence staining. The injury-induced expression of RBMX was detected in active caspase-3 and TUNEL positive cells. We also examined the expression profiles of active caspase-3, bcl-2 and Bax, whose changes were correlated with the expression profiles of RBMX. To summarize, we uncovered the dynamic changes of RBMX in the light-induced retinal damage model for the first time. RBMX might play a significant role in the degenerative process of RGCs after light-induced damage in the retina.

Down-regulation of the RNA editing enzyme ADAR2 contributes to RGC death in a mouse model of glaucoma

Glaucoma is a progressive neurodegenerative disease of retinal ganglion cells (RGCs) associated with characteristic axon degeneration in the optic nerve. Excitotoxic damage due to increased Ca(2+) influx, possibly through NMDA-type glutamate receptors, has been proposed to be a cause of RGC dysfunction and death in glaucoma. Recent work has found that expression of another potentially critical receptor, the Ca(2+)-permeable AMPA receptor (CP-AMPAR), is elevated during various pathological conditions (including ALS and ischemia), resulting in increased neuronal death. Here we test the hypothesis that CP-AMPARs contribute to RGC death due to elevated Ca(2+) influx in glaucoma. AMPA receptors are impermeable to Ca(2+) if the tetrameric receptor contains a GluA2 subunit that has undergone Q/R RNA editing at a site in the pore region. The activity of ADAR2, the enzyme responsible for this RNA editing, generally ensures that the vast majority of GluA2 proteins are edited. Here, we demonstrate that ADAR2 levels decrease in a mouse model of glaucoma in which IOP is chronically elevated. Furthermore, using an in vitro model of RGCs, we find that knockdown of ADAR2 using siRNA increased the accumulation of Co(2+) in response to glutamate, and decreased the rectification index of AMPA currents detected electrophysiologically, indicating an increased Ca(2+) permeability through AMPARs. The RGCs in primary culture also exhibited increased excitotoxic cell death following knock down of ADAR2. Furthermore, cell death was reversed by NASPM, a specific blocker for CP-AMPARs. Together, our data suggest that chronically elevated IOP in adult mice reduces expression of the ADAR2 enzyme, and the loss of ADAR2 editing and subsequent disruption of GluA2 RNA editing might potentially play a role in promoting RGC neuronal death as observed in glaucoma.

Current Concepts in the Biochemical Mechanisms of Glaucomatous Neurodegeneration

Glaucoma is now regarded as a neurodegenerative disorder. A number of theories including the mechanical and vascular models have been used to explain the pathogenesis of glaucoma. However, there is now increasing evidence of biochemical molecules which may play a part in it's causation. These biochemical mechanisms include the role of excitatory aminoacids, caspases, protein kinases, oxygen free radicals, nitric oxide, TNF-alpha, neurotrophins and metalloproteins. This paper reviews these new developments which form the biochemical basis of glaucomatous neural degeneration. How to cite this article: Ahmad SS, Ghani SA, Rajagopal TH. Current Concepts in the Biochemical Mechanisms of Glaucomatous Neurodegeneration. J Current Glau Prac 2013;7(2):49-53.

Involvement of transcription initiation factor IIB in the light-induced death of rat retinal ganglion cells in vivo

Transcription initiation factor IIB (TFIIB) is a general transcription initiation factor that plays a pivotal role in the response to transcriptional activator proteins. Previous reports have shown that TFIIB have been implicated in the pathogenesis of various experimental central nervous system diseases. However, its distribution and function in the retina remain unclear. In the present study, we investigated the spatiotemporal expression of TFIIB in a light-induced retinal damage model. Western blotting analysis showed TFIIB level significantly improved 3 days after injury, and then declined during the following days. The association of TFIIB and retinal ganglion cells (RGCs) was detected by immunofluorescence double staining. The injury-induced expression of TFIIB was physically co-existed with active caspase-3 and TUNEL (apoptotic markers). Spatiotemporal changes of TFIIB expression suggest that this protein may play a role in the degenerative process of RGCs by light-induced damage in the retina.

Gene transfection to retinal ganglion cells mediated by ultrasound microbubbles in vitro

RATIONALE AND OBJECTIVES

To investigate the expression levels of green fluorescence protein (GFP) into retinal ganglion cells (RGCs) in vitro by ultrasound-mediated microbubble destruction (UMMD) and assess the effect of bcl-xl gene on N-methyl-D-aspartate (NMDA)-induced apoptosis in the cultured RGCs by UMMD.

MATERIALS AND METHODS

pEGFP-N1 was transfected to RGCs in vitro by UMMD and liposome was used as the control. The transfection effect was detected using microscope and flow cytometry qualitatively and quantitatively. Monotetrazolium was adopted to measure the cell vitality. NMDA was used to induce apoptosis in the cultured RGCs, and the bcl-xl gene was transfected into RGCs by UMMD before NMDA-induced apoptosis. The expression of bcl-xl protein in RGCs was assessed by immunohistochemistry assay. The amorphous character of RGCs was revealed by acridine orange and ethidium bromide staining. DNA fragment was detected by agarose gel electrophoresis.

RESULTS

Ultrasound combined with microbubbles enhanced gene transfection to the cultured cells in some condition. The average transfection rate of pEGFP-N1 with UMMD was 25%. Both ultrasound and microbubble had no effect on cell viability. The expression of bcl-xl protein in transfected and non-transfected RGCs was significantly different. Less apoptotic bodies and no representative DNA fragment were detected in the treatment group.

CONCLUSIONS

Microbubble destruction can enhance the reporter gene transfection and expression and have a good target. Transfection of bcl-xl gene has an anti-apoptosis effect on the cultured RGCs induced by NMDA with UMMD.

Retinal ganglion cell protection by 17-beta-estradiol in a mouse model of inherited glaucoma

Glaucoma is the second leading cause of blindness in the world. The ultimate cause of vision loss due to glaucoma is thought to be retinal ganglion cell (RGC) apoptosis. Neuroprotection of RGC is becoming an important approach of glaucoma therapy. Several lines of evidence suggest that estrogen has neurotrophic and neuroprotective properties. In this study, we examine the role of estrogen in preventing RGC loss in DBA/2J mouse, an in vivo model of an inherited (pigmentary) glaucoma. Two-month-old female DBA/2J mice were anesthetized and ovariectomized with or without subcutaneous 17beta-estradiol (betaE2) pellet implantation. RGC survival was evaluated from flat-mounted whole retinas by counting retrograde-labeled cells. The loss of nerve fibers and RGC were also evaluated in paraffin-fixed retinal cross sections. Biochemical alterations in the retinas of DBA/2J mice in response to systemic injection of betaE2 were also examined. We have made several important observations showing that: (1) betaE2 treatment reduced the loss of RGC and neurofibers through inhibition of ganglion cell apoptosis, (2) betaE2 activated Akt and cAMP-responsive-element-binding-protein (CREB), (3) betaE2 up-regulated thioredoxin-1 (Trx-1) expression, (4) betaE2 reduced the increased activations of mitogen-activated protein kinases (MAPK) and NF-kappaB, (5) betaE2 inhibited the increased interleukin-18 (IL-18) expression, and (6) treatment with tamoxifen, an estrogen receptor antagonist, blocked betaE2-mediated activation of Akt and inhibition of MAPK phosphorylation in the retinas of DBA/2J mice. These findings suggest the possible involvement of multiple biochemical events, including estrogen receptor/Akt/CREB/thioredoxin-1, and estrogen receptor/MAPK/NF-kappaB, in estrogen-mediated retinal ganglion cell protection.

Estrogen has a neuroprotective effect on axotomized RGCs through ERK signal transduction pathway

The neuroprotective effects of estrogen on neuronal cells in central nervous system have been described previously, however, the mechanisms of neuroprotective effect of estrogen against retinal ganglion cell (RGC) death has not been well identified. To examine the role of endogenous sex steroids produced in ovary, retina samples were prepared from female rats with or without ovariectomy and the density of RGC was calculated. Ovariectomy alone had no effect on the density of fluorogold (FG)-labeled RGC without injury, while the density of surviving RGC after optic nerve axotomy with ovariectomy was significantly decreased compared to that without ovariectomy. To examine the role of exogenous sex steroids, 17beta-estradiol was injected into the vitreous cavity in ovariectomized rats and showed neuroprotective effect on axotomy-induced RGC death while exogenous progesterone showed no effect. Immunoblot and immunohistochemical analysis demonstrated that ERK-c-Fos signal transduction pathway was activated by exogenous 17beta-estradiol in ganglion cell layer. U0126, an ERK inhibitor, inhibited the neuroprotective effect of estrogen on axotomized RGC death. These data suggest that estrogen has neuroprotective effect through activation of ERK-c-Fos signaling pathway on axotomy-induced RGC death. The neuroprotective effect of estrogen may have therapeutic benefits in retinal diseases associated with RGC death such as glaucoma.

Decrease in reducing power of aqueous humor originating from glaucomatous rabbits

AIM

To evaluate changes in the reducing power of aqueous humor (AH) with cyclic voltammetry (CV) and HPLC-EC.

METHODS

NZW Rabbits exhibiting a sporadic mutation causing bilaterally buphthalmus eyes were set for intra ocular pressure (IOP) and eye size measurements. AH was obtained under anesthesia, from congenital glaucomatic rabbits (CGR, n=6) and age-matched controls (CON; n=6). The AH samples were analysed by CV and HPLC-EC.

RESULTS

CGR IOP was found to be significantly higher than in CON (33.5+/-1.1 and 14.2+/-1.0 mmHg, respectively), eye size was 18.25 and 13.9 cm, respectively. CV analysis revealed two anodic currents representing two groups of low molecular weight antioxidant (LMWA). The two anodic potentials were equal for the two tested groups, indicating the same components of LMWA. The first anodic current of CGR was only 30% of the CON rabbits (2.11 vs7.17 microA/mg protein, t-test: P<0.05). As the main hydrophilic components of the first anodic current are known to be uric acid (UA) and ascorbic acid (AA), they were analysed for exact content by HPLC-EC. UA and AA levels were significantly lower in the CGR group (UA: 17.1+/-3.2 and 189.1+/-75.70 microM/mg, AA: 1.1+/-0.3 and 4.8+/-2.0 microM/mg protein respectively).

CONCLUSIONS

Changes in the reducing power, as indicated by CV analysis, of CGR AH, is probably a result of chronic oxidative stress caused by the pathology. The differences in the first anodic wave are mainly due to a fall in the concentration of UA and AA.

Neuroprotective effect of latanoprost on rat retinal ganglion cells

BACKGROUND

To investigate the neuroprotective effect of intravitreal administration of latanoprost on retinal ganglion cell (RGC) damage induced by N-methyl-D-aspartic acid (NMDA) or optic nerve axotomy.

METHODS

Using Sprague-Dawley rats, retinal ganglion cell damage was induced by either intravitreal administration of NMDA or optic nerve axotomy. Latanoprost at doses of 0.03, 0.3, 3, 30 and 300 pmol was administered intravitreally before NMDA injection or optic nerve axotomy. Retinal damage was evaluated by counting the number of surviving RGCs retrogradely labeled with fluorogold under the microscope.

RESULTS

Seven days after the NMDA injury, the number of surviving RGCs was significantly increased at doses of more than 30 pmol atanoprost (846+/-178 cells/mm(2 ) P=0.0166) compared with vehicle control (556+/-122 cells/mm(2)). Ten days after the optic nerve axotomy, the number of surviving RGC was significantly increased even at a dose of 0.3 pmol (815+/-239 cells/mm(2), P=0.0359) compared with control (462+/-75 cells/mm(2)).

CONCLUSIONS

Intravitreal administration of latanoprost has a neuroprotective effect on rat RGC damage induced by either NMDA or optic nerve axotomy, while its pharmacological features are different.

Possible involvement of a fibroblast growth factor 9 (FGF9)-FGF receptor-3-mediated pathway in adult pig retinal ganglion cell survival in vitro

The expression and potential roles of fibroblast growth factors (FGF) and their cognate FGF receptors (FGFR) in adult mammalian retinal ganglion cells (RGC) are poorly known. We show that FGFR-3 and FGFR-4 are especially pronounced on RGC and amacrine cell bodies in adult pig inner retinae both in vivo and in vitro. Western blotting revealed distinct profiles for each receptor. Expression of each FGFR and effects of the preferred ligand for FGFR-3, FGF9, upon RGC survival and neurite outgrowth were examined in primary retinal cell cultures: whereas there was no stimulation of neuritogenesis, RGC survival was promoted in a dose-dependent manner (ED(50) approximately 500 pg/ml, mean maximal increase of 60%) and could be completely blocked by addition of FGF9 neutralising antibody. Experiments with three additional FGF (FGF1, FGF2, and FGF4) showed no stimulation of RGC survival above control levels. Taken together, these data suggest that the ligand-receptor couple FGF9-FGFR-3 may function to promote survival of adult mammalian RGC, and their application might be beneficial in retinal degenerative diseases such as glaucoma.