1
|
Li X, Huang Y, Liang Q, Li G, Feng S, Song Y, Zhang Y, Wang L, Jie Y, Pan Z. Local immunosuppression in WZS-pig to rhesus monkey Descemet's stripping automated endothelial keratoplasty: An innovative method to promote the survival of xeno-grafts. Ophthalmic Res 2021; 65:196-209. [PMID: 34915515 DOI: 10.1159/000521193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 11/20/2021] [Indexed: 11/19/2022]
Abstract
Corneal xenotransplantation is an effective solution for the shortage of human corneas. We investigated the feasibility and efficacy of different postoperative protocols on xeno-Descemet's stripping automated endothelial keratoplasty (DSAEK) grafts. Thirty rhesus monkeys were randomly divided into three groups: control group (C), only Descemet's membrane (DM) stripping; DSAEK 1 (D1) and DSAEK 2 (D2) groups, DM stripping followed by endothelial keratoplasty. Betamethasone 3.5 mg was subconjunctival injected in groups control and D1 postoperatively, while animals in group D2 were treated with topical 0.1% tacrolimus and topical steroids. All groups were evaluated by slit-lamp microscopy, anterior segment OCT and LSCM for at least nine months. A total of 24 monkeys (24 eyes) met the inclusion criteria. Nine months after DSAEK surgery, all xenografts showed good attachment, and most corneas were transparent. Graft rejection occurred in 25% of the cases in group D1 and 28.57% of those in group D2 (P > 0.05). The corneal endothelium density in the DSAEK groups was 2715.83±516.20/mm² (D1) and 2220.00 ± 565.13/mm² (D2) (P > 0.05). Xenogeneic corneal endothelial grafts can survive and function in rhesus monkey eyes for a long time with subconjunctival steroid or topical tacrolimus and steroid treatment.
Collapse
Affiliation(s)
- Xu Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ying Huang
- National Center for Safety Evaluation of Drugs (NCSED), Beijing, China
| | - Qingfeng Liang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Guoping Li
- Beijing Grand Life Science and Technology, Ltd. PRC, Beijing, China
| | - Shutang Feng
- Beijing Grand Life Science and Technology, Ltd. PRC, Beijing, China
| | - Yaowen Song
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Yang Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Li Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ying Jie
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Zhiqiang Pan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| |
Collapse
|
2
|
Sun P, Shen L, Zhang C, Du L, Wu X. Promoting the expansion and function of human corneal endothelial cells with an orbital adipose-derived stem cell-conditioned medium. Stem Cell Res Ther 2017; 8:287. [PMID: 29262856 PMCID: PMC5738836 DOI: 10.1186/s13287-017-0737-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/16/2017] [Accepted: 11/28/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Corneal endothelial dysfunction causes severe impairment of vision. The only solution is corneal transplantation. However, this treatment is hampered by a worldwide shortage of donor corneas. New therapies may replace the conventional donor corneal transplantation alongside the developments in regenerative medicine and tissue engineering, but sufficient functional corneal endothelial cells (CECs) are essential. The aim of this study was to promote the expansion and function of human corneal endothelial cells (HCECs) in vitro and in vivo. METHODS The phenotypes of human orbital adipose-derived stem cells (OASCs) were detected by flow cytometry and immunofluorescence. HCECs were isolated and cultured using a conditioned medium obtained from OASCs (OASC-CM) in vitro. Related cell markers of HCECs were analyzed by quantitative real-time polymerase chain reaction (qRT-PCR), Western blot, and immunofluorescence. The cell counting kit-8 (CCK-8) assay and the wound healing assay were performed to evaluate the proliferation ability of the cells. The cultured HCECs were then transplanted into rabbit and monkey corneal endothelial dysfunction models by cell injection. RESULTS CD29, CD105, CD49e, CD166, and vimentin were highly expressed in cultured human OASCs. The CEC-relative markers zonula occludens-1 (ZO-1), Na+/K+ ATPase, N-cadherin, Col8a2, and SLC4A4 were expressed in HCECs cultured by OASC-CM. The HCECs were able to maintain polygonal cell morphology and good proliferative capacity. In animal experiments, corneal transparency was achieved after the injection of HCECs, which demonstrated the good repair capacity of the cells. CONCLUSIONS The proliferation abilities of the cells were significantly enhanced, and related functional markers were strongly positive, while HCEC morphology was maintained using OASC-CM. HCECs obtained some stem cell-like properties. This preclinical study confirmed the therapeutic ability of the HCECs in vivo. Our findings demonstrated that cultured HCECs with OASC-CM might be a promising source for research and clinical treatment.
Collapse
Affiliation(s)
- Peng Sun
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China.,The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Lin Shen
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Canwei Zhang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Liqun Du
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Xinyi Wu
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China.
| |
Collapse
|
3
|
Numata R, Okumura N, Nakahara M, Ueno M, Kinoshita S, Kanematsu D, Kanemura Y, Sasai Y, Koizumi N. Cultivation of corneal endothelial cells on a pericellular matrix prepared from human decidua-derived mesenchymal cells. PLoS One 2014; 9:e88169. [PMID: 24505413 PMCID: PMC3914933 DOI: 10.1371/journal.pone.0088169] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 01/03/2014] [Indexed: 12/13/2022] Open
Abstract
The barrier and pump functions of the corneal endothelium are essential for the maintenance of corneal transparency. Although corneal transplantation is the only current therapy for treating corneal endothelial dysfunction, the potential of tissue-engineering techniques to provide highly efficient and less invasive therapy in comparison to corneal transplantation has been highly anticipated. However, culturing human corneal endothelial cells (HCECs) is technically difficult, and there is no established culture protocol. The aim of this study was to investigate the feasibility of using a pericellular matrix prepared from human decidua-derived mesenchymal cells (PCM-DM) as an animal-free substrate for HCEC culture for future clinical applications. PCM-DM enhanced the adhesion of monkey CECs (MCECs) via integrin, promoted cell proliferation, and suppressed apoptosis. The HCECs cultured on the PCM-DM showed a hexagonal morphology and a staining profile characteristic of Na⁺/K⁺-ATPase and ZO-1 at the plasma membrane in vivo, whereas the control HCECs showed a fibroblastic phenotype. The cell density of the cultured HCECs on the PCM-DM was significantly higher than that of the control cells. These results indicate that PCM-DM provides a feasible xeno-free matrix substrate and that it offers a viable in vitro expansion protocol for HCECs while maintaining cellular functions for use as a subsequent clinical intervention for tissue-engineered based therapy of corneal endothelial dysfunction.
Collapse
Affiliation(s)
- Ryohei Numata
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan
| | - Naoki Okumura
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Makiko Nakahara
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan
| | - Morio Ueno
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigeru Kinoshita
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daisuke Kanematsu
- Division of Regenerative Medicine, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Yonehiro Kanemura
- Division of Regenerative Medicine, Institute for Clinical Research, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Yoshiki Sasai
- RIKEN Center for Developmental Biology, Hyogo, Japan
| | - Noriko Koizumi
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan
- * E-mail:
| |
Collapse
|
4
|
Rajan MS. Surgical strategies to improve visual outcomes in corneal transplantation. Eye (Lond) 2014; 28:196-201. [PMID: 24384964 DOI: 10.1038/eye.2013.279] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 11/21/2013] [Indexed: 11/09/2022] Open
Abstract
The recent years have brought about a sea change in the field of corneal transplantation with penetrating keratoplasty being phased to newer lamellar keratoplasty techniques for a variety of corneal pathology. Improved and innovative surgical techniques have allowed selective replacement of diseased host corneal layers with pre-prepared healthy donor corneal lamellae for anterior corneal disorders such as keratoconus and posterior corneal disorders such as Fuch's corneal endothelial dystrophy. The results of lamellar techniques are encouraging, with rapid visual rehabilitation and vastly reduced risk of immune-mediated transplant rejection. The techniques of deep anterior lamellar keratoplasty and Descemet's stripping endothelial keratoplasty (DSAEK) continue to evolve with advent of femtosecond lasers and newer concepts such as pre-conditioned donor corneas for Microthin DSAEK and Descemet's membrane keratoplasty. This review describes the current developments in lamellar keratoplasty, including the futuristic approach using cell therapy to restore vision in corneal blindness.
Collapse
Affiliation(s)
- M S Rajan
- 1] Cornea Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK [2] Vision and Eye Research Unit (VERU), Anglia Ruskin University, Cambridge, UK
| |
Collapse
|
5
|
Corneal endothelial expansion promoted by human bone marrow mesenchymal stem cell-derived conditioned medium. PLoS One 2013; 8:e69009. [PMID: 23894393 PMCID: PMC3720876 DOI: 10.1371/journal.pone.0069009] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/11/2013] [Indexed: 12/13/2022] Open
Abstract
Healthy corneal endothelium is essential for maintaining corneal clarity, as the damage of corneal endothelial cells and loss of cell count causes severe visual impairment. Corneal transplantation is currently the only therapy for severe corneal disorders. The greatly limited proliferative ability of human corneal endothelial cells (HCECs), even in vitro, has challenged researchers to establish efficient techniques for the cultivating HCECs, a pivotal issue for clinical applications. The aim of this study was to evaluate conditioned medium (CM) obtained from human bone marrow-derived mesenchymal stem cells (MSCs) (MSC-CM) for use as a consistent expansion protocol of HCECs. When HCECs were maintained in the presence of MSC-CM, cell morphology assumed a hexagonal shape similar to corneal endothelial cells in vivo, as opposed to the irregular cell shape observed in control cultures in the absence of MSC-CM. They also maintained the functional protein phenotypes; ZO-1 and Na(+)/K(+)-ATPase were localized at the intercellular adherent junctions and pump proteins of corneal endothelium were accordingly expressed. In comparison to the proliferative potential observed in the control cultures, HCECs maintained in MSC-CM were found to have more than twice as many Ki67-positive cells and a greatly increased incorporation of BrdU into DNA. MSC-CM further facilitated the cell migration of HCECs. Lastly, the mechanism of cell proliferation mediated by MSC-CM was investigated, and phosphorylation of Akt and ERK1/2 was observed in HCECs after exposure to MSC-CM. The inhibitor to PI 3-kinase maintained the level of p27(Kip1) for up to 24 hours and greatly blocked the expression of cyclin D1 and D3 during the early G1 phase, leading to the reduction of cell density. These findings indicate that MSC-CM not only stimulates the proliferation of HCECs by regulating the G1 proteins of the cell cycle but also maintains the characteristic differentiated phenotypes necessary for the endothelial functions.
Collapse
|
6
|
Krabcova I, Studeny P, Jirsova K. Endothelial quality of pre-cut posterior corneal lamellae for Descemet membrane endothelial keratoplasty with a stromal rim (DMEK-S): two-year outcome of manual preparation in an ocular tissue bank. Cell Tissue Bank 2012; 14:325-31. [PMID: 22790559 DOI: 10.1007/s10561-012-9327-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 07/03/2012] [Indexed: 12/21/2022]
Abstract
To assess the quantitative and qualitative parameters of pre-cut posterior corneal lamellae for Descemet membrane endothelial keratoplasty with a stromal rim (DMEK-S) prepared manually in the Ocular Tissue Bank Prague. All 65 successfully prepared pre-cut posterior corneal lamellae provided for grafting during a 2-year period were analyzed retrospectively. The lamellae, consisting of a central zone of endothelium-Descemet membrane surrounded by a supporting peripheral stromal rim, were prepared manually from corneoscleral buttons having an endothelial cell density higher than 2,500 cells/mm(2). The live endothelial cell density, the percentage of dead cells, the hexagonality and the coefficient of variation were assessed before and immediately after preparation as well as after 2 days of organ culture storage at 31 °C. Altogether, the endothelium of 57 lamellae was assessed. Immediately after preparation, the mean live endothelial cell density was 2,835 cells/mm(2) and, on average, 1.8 % of dead cells were found. After 2 days of storage, the cell density decreased significantly to 2,757 cells/mm(2) and the percentage of dead cells to 1.0 %. There was a significant change in the mean hexagonality and the coefficient of variation after lamellar preparation and subsequent storage. The amount of tissue wasted during the preparation was 23 %. The endothelial cell density of posterior corneal lamellae sent for DMEK-S was higher than 2,700 cells/mm(2) in average with a low percentage of dead cells; 65 pre-cut tissues were used for grafting during a 2-year period.
Collapse
Affiliation(s)
- Ivana Krabcova
- Laboratory of the Biology and Pathology of the Eye, Institute of Inherited Metabolic Disorders, First Faculty of Medicine, General Teaching Hospital, Charles University in Prague, Ke Karlovu 2, 128 08, Prague 2, Czech Republic
| | | | | |
Collapse
|
7
|
Ang M, Htoon HM, Cajucom-Uy HY, Tan D, Mehta JS. Donor and surgical risk factors for primary graft failure following Descemet's stripping automated endothelial keratoplasty in Asian eyes. Clin Ophthalmol 2011; 5:1503-8. [PMID: 22069353 PMCID: PMC3206122 DOI: 10.2147/opth.s25973] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Descemet’s stripping automated endothelial keratoplasty (DSAEK) has been shown to have superior refractive and visual results compared with penetrating keratoplasty, but higher rates of primary graft failure (PGF). This paper presents donor and surgical risk factors for PGF in DSAEK cases in Asian eyes. Design Retrospective case-control study. Participants All consecutive patients who underwent DSAEK at a tertiary referral teaching hospital from March 2006–December 2008. Methods Donor details analyzed were: age of donor, cause of donor death, death to harvesting time, donor storage time, distribution distance of tissue, preoperative endothelial cell count. Surgical factors analyzed were: donor diameter, donor thickness, and method of donor insertion. These risk factors in cases of PGF were compared with patients with successful DSAEK as the control group. Main outcome measure PGF. Results A total of 124 DSAEK procedures were performed. Six DSAEK procedures (five eyes of five patients; one eye with two failures) resulted in PGF (4.8%). Significant risk factors were found for PGF to include graft insertion using a folding technique (odds ratio [OR], 34.03; 95% confidence interval [CI], 3.75–314.32; P = 0.0017) and a small donor diameter (OR, 39.94; 95% CI, 2.18–732.17; P = 0.013). Conclusion The results of this study suggest that in Asian eyes with shallow anterior chambers, surgical trauma relating to the technique of donor insertion, and the use of a small donor are major risk factors for PGF following DSAEK.
Collapse
Affiliation(s)
- Marcus Ang
- Singapore National Eye Centre, Bukit Merah
| | | | | | | | | |
Collapse
|
8
|
Alkatan H, Al-Rajhi A, Al-Shehri A, Khairi A. Histopathological findings of failed grafts following Descemet's stripping automated endothelial keratoplasty (DSAEK). Saudi J Ophthalmol 2011; 26:79-85. [PMID: 23960973 DOI: 10.1016/j.sjopt.2011.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 04/23/2011] [Accepted: 05/25/2011] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To study the histopathological findings of the early cases of failed DSAEK grafts and to analyze the causes of graft failure. METHODS Retrospective study of 13 failed DSAEK grafts (four grafts submitted alone with no host cornea) of 12 patients. The histopathologic features are correlated with the clinical and operative findings. RESULTS Significant attenuation of the endothelial cells found in 10/13 cases (77%), retained recipient Descemet's membrane in 7/13 (54%), variability of graft thickness in 5/13 (38%) and two of these had stromal irregularity. Retrocorneal fibrous membrane along the donor's Descemet's membrane was found in 4/13 (31%) resulting in endothelial detachment in one case. Eight of the nine host cornea-graft specimens were found to have: total graft-cornea detachment (in one), subtotal in four and partial (⩽50% of graft length) in three. The detached flaps showed infection at the interface of the graft-host cornea in two, epithelial ingrowth and fibrous proliferation along the anterior stromal surface of the graft (one case each). An additional histopathological finding was secondary amyloid deposition within the host stroma (in one). CONCLUSION Irregular or thick graft, graft-host interface fibrous/epithelial ingrowth, and infection all predispose to DSAEK failures related to graft detachment. Endothelial cells attenuation and retrocorneal fibrous membrane are major causes for primary graft failure.
Collapse
Affiliation(s)
- Hind Alkatan
- Pathology and Laboratory Medicine Department, King Khaled Eye Specialist Hospital, Riyadh 11462, Saudi Arabia
| | | | | | | |
Collapse
|
9
|
Khor WB, Mehta JS, Tan DTH. Descemet stripping automated endothelial keratoplasty with a graft insertion device: surgical technique and early clinical results. Am J Ophthalmol 2011; 151:223-32.e2. [PMID: 21168813 DOI: 10.1016/j.ajo.2010.08.027] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 08/19/2010] [Accepted: 08/19/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To present the surgical technique and the early clinical results of the EndoGlide, a graft insertion device for use during Descemet stripping automated endothelial keratoplasty (DSAEK). DESIGN Prospective interventional case series. METHODS PATIENTS Graft insertion with the EndoGlide was performed in 25 eyes of Asian patients with endothelial dysfunction suitable for DSAEK. Demographic and clinical details, best-corrected visual acuity, postoperative complications, and endothelial cell density (ECD) loss were documented. SURGICAL TECHNIQUE The prepared graft is transferred onto a preparation base and pulled into the glide capsule with forceps. Drawing the graft into the capsule curls it into a "double-coil" configuration. The assembled EndoGlide is inserted into the eye, and the graft is pulled into the anterior chamber with forceps, where it uncoils in the correct orientation with minimal manipulation. RESULTS Average age was 70 years (range 28-91) and the commonest diagnosis was pseudophakic bullous keratopathy (12 eyes). Preoperative donor ECD was 2957 ± 242 cells/mm(2), median graft diameter was 8.75 mm, and all surgeries were completed successfully by 2 surgeons. There was a short learning curve in loading of the graft into the EndoGlide and in uncoiling the graft in the recipient eye. No patient had graft dislocation or primary iatrogenic graft failure. At 6 months, the mean ECD was 2586 ± 338 cells/mm(2) and mean cell loss was 13.1% in 20 eyes. At 12 months, the mean ECD was 2575 ± 289 cells/mm(2) and mean cell loss was 15.6% in 10 eyes. CONCLUSIONS Graft insertion with the EndoGlide is safe in DSAEK, with a short learning curve and a low endothelial cell loss at 6 and 12 months.
Collapse
|
10
|
Albarracin D, Tannenbaum MB, Glasman LR, Rothman AJ. Modeling structural, dyadic, and individual factors: the inclusion and exclusion model of HIV related behavior. AIDS Behav 2010; 14:239-49. [PMID: 20848306 DOI: 10.1007/s10461-010-9801-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Changing HIV-related behaviors requires addressing the individual, dyadic, and structural influences that shape them. This supplement of AIDS & Behavior presents frameworks that integrate these three influences on behavior. Concepts from these frameworks were selected to model the processes by which structural factors affect individual HIV-related behavior. In the Inclusion/Exclusion Model, material and symbolic inclusions and exclusions (sharing versus denying resources) regulate individuals' ability and motivation to detect, prevent, and treat HIV. Structural interventions create inclusions that increase one's ability or motivation to perform these behaviors or exclusions that hinder one's ability or motivation to execute counterproductive behaviors. The need to expand research regarding multilevel influences on HIV-related behavior is also discussed, particularly concerning further understanding of sustained behavior change and effective dissemination of evidence-based intervention strategies.
Collapse
|
11
|
Zhang Q, Randleman JB, Stulting RD, Lee WB, Stone DU, Kozarsky AM, Grossniklaus HE. Clinicopathologic findings in failed descemet stripping automated endothelial keratoplasty. ARCHIVES OF OPHTHALMOLOGY (CHICAGO, ILL. : 1960) 2010; 128:973-80. [PMID: 20696996 PMCID: PMC3405987 DOI: 10.1001/archophthalmol.2010.140] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate the clinical features of and histologic findings from failed Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS This retrospective observational case series evaluated 47 consecutive corneal specimens from 42 patients who underwent either penetrating keratoplasty or repeated DSAEK for failed DSAEK. Clinical information was obtained for the cases. Sections of the specimens were examined using light microscopy. Immunohistochemical staining was performed for cytokeratins AE1/AE3 and for the myogenic marker smooth-muscle actin when indicated. Transmission electron microscopic examination was performed in some cases. RESULTS Graft survival ranged from 0.5 to 34 months. Histologic examination showed that 94% of the specimens (44 of 47) had endothelial cell loss. Residual host Descemet membrane (19%; 9 of 47), fibrocellular tissue (19%; 9 of 47), epithelial implantation (15%; 7 of 47), and fungal infection (4%; 2 of 47) were also identified. Immunohistochemical stains were positive for AE1/AE3 in the epithelial implantations and for smooth-muscle actin in cells in the fibrocellular proliferations. CONCLUSIONS The principal cause of failed DSAEK is endothelial cell loss. Residual host Descemet membrane, fibrocellular tissue at the edge of the lenticule, and epithelial implantation are common histologic findings. Fungal infection may occur in the setting of DSAEK.
Collapse
Affiliation(s)
- Qing Zhang
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | | | | | | | | |
Collapse
|
12
|
Seet LF, Su R, Barathi VA, Lee WS, Poh R, Heng YM, Manser E, Vithana EN, Aung T, Weaver M, Sage EH, Wong TT. SPARC deficiency results in improved surgical survival in a novel mouse model of glaucoma filtration surgery. PLoS One 2010; 5:e9415. [PMID: 20195533 PMCID: PMC2828474 DOI: 10.1371/journal.pone.0009415] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 02/05/2010] [Indexed: 01/06/2023] Open
Abstract
Glaucoma is a disease frequently associated with elevated intraocular pressure that can be alleviated by filtration surgery. However, the post-operative subconjunctival scarring response which blocks filtration efficiency is a major hurdle to the achievement of long-term surgical success. Current application of anti-proliferatives to modulate the scarring response is not ideal as these often give rise to sight-threatening complications. SPARC (secreted protein, acidic and rich in cysteine) is a matricellular protein involved in extracellular matrix (ECM) production and organization. In this study, we investigated post-operative surgical wound survival in an experimental glaucoma filtration model in SPARC-null mice. Loss of SPARC resulted in a marked (87.5%) surgical wound survival rate compared to 0% in wild-type (WT) counterparts. The larger SPARC-null wounds implied that aqueous filtration through the subconjunctival space was more efficient in comparison to WT wounds. The pronounced increase in both surgical survival and filtration efficiency was associated with a less collagenous ECM, smaller collagen fibril diameter, and a loosely-organized subconjunctival matrix in the SPARC-null wounds. In contrast, WT wounds exhibited a densely packed collagenous ECM with no evidence of filtration capacity. Immunolocalization assays confirmed the accumulation of ECM proteins in the WT but not in the SPARC-null wounds. The observations in vivo were corroborated by complementary data performed on WT and SPARC-null conjunctival fibroblasts in vitro. These findings indicate that depletion of SPARC bestows an inherent change in post-operative ECM remodeling to favor wound maintenance. The evidence presented in this report is strongly supportive for the targeting of SPARC to increase the success of glaucoma filtration surgery.
Collapse
Affiliation(s)
- Li-Fong Seet
- Ocular Wound Healing and Therapeutics Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Roseline Su
- Ocular Wound Healing and Therapeutics Group, Singapore Eye Research Institute, Singapore, Singapore
| | - V. A. Barathi
- Ocular Wound Healing and Therapeutics Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Wing Sum Lee
- Ocular Wound Healing and Therapeutics Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Rebekah Poh
- Ocular Wound Healing and Therapeutics Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Yee Meng Heng
- Institute of Medical Biology, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Ed Manser
- Institute of Medical Biology, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Eranga N. Vithana
- Ocular Genetics Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Tin Aung
- Department of Glaucoma, Singapore National Eye Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Ocular Genetics Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Matt Weaver
- The Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - E. Helene Sage
- The Benaroya Research Institute at Virginia Mason, Seattle, Washington, United States of America
| | - Tina T. Wong
- Ocular Wound Healing and Therapeutics Group, Singapore Eye Research Institute, Singapore, Singapore
- Department of Glaucoma, Singapore National Eye Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- * E-mail:
| |
Collapse
|