Detection of mucus glycoconjugates in human conjunctiva by using the lectin-colloidal gold technique in TEM. III. A quantitative study in asymptomatic contact lens wearers

The Epithelial Cell Glycocalyx in Ocular Surface Infection

The glycocalyx is the main component of the transcellular barrier located at the interface between the ocular surface epithelia and the external environment. This barrier extends up to 500 nm from the plasma membrane and projects into the tear fluid bathing the surface of the eye. Under homeostatic conditions, defense molecules in the glycocalyx, such as transmembrane mucins, resist infection. However, many pathogenic microorganisms have evolved to exploit components of the glycocalyx in order to gain access to epithelial cells and consequently exert deleterious effects. This manuscript reviews the implications of the ocular surface epithelial glycocalyx to bacterial, viral, fungal and parasitic infection. Moreover, it presents some ongoing controversies surrounding the functional relevance of the epithelial glycocalyx to ocular infectious disease.

The effect of rebamipide ophthalmic suspension on ocular surface mucins in soft contact lens wearers

PURPOSE

To evaluate the changes in ocular surface mucins with 2%rebamipide ophthalmic suspension treatment in soft contact lens (SCL) wearers. Rebamipide suspension is a mucin secretagogue approved for the treatment of dry eye syndrome in Japan. In this study, the fluorescence intensity of wheat germ agglutinin conjugate of fluorescein (F-WGA) was used as a marker of membrane-associated mucins, and sialic acid concentration in tear fluids as a marker of secreted mucins.

METHODS

Thirty-two eyes of 16 SCL wearers with discomfort were treated with rebamipide suspension at a dose of one drop in each eye four times daily for two weeks. The parameters of clinical efficacy were tear break-up time, fluorescein staining scores for the cornea and conjunctiva, and Schirmer test values. Fluorescence intensities in the central cornea were measured by fluorophotometry after the application of 5% F-WGA solution. Tears collected by Schirmer test strips were analyzed by high-performance liquid chromatography, and the concentrations of sialic acid, total protein, and the four major tear proteins, namely secretory IgA, lactoferrin, lipocalin-1, and lysozyme were measured.

RESULTS

Significant increases in F-WGA fluorescence intensities (p < 0.005) were seen in the corneal surfaces. Sialic acid concentrations increased over time; however, the differences were not statistically significant. Except for a slight increase in kerato-conjunctival staining scores (p < 0.05) and secretory IgA (p < 0.05), no other significant differences were seen among clinical parameters or tear proteins.

CONCLUSIONS

Topical application of rebamipide suspension significantly increased F-WGA intensity, a marker of membrane-associated mucins in SCL wearers.

[Lacrimal film and the ocular surface]

Abnormalities of the ocular surface affect a large proportion of the general population. Symptoms depend on whether the lids, the corneoconjunctival surface, or the lacrimal layer are involved. The latter results from the balance of a fragile mixture of water, lipids, and mucus. Different circumstances can lead to the disruption of the lacrimal layer associated with dry-eye symptoms, eventually leading to inflammation. Alterations observed during dry-eye disease, meibomian dysfunction, allergic conjunctivitis, contact lens wear infectious conjunctivitis, or after refractive surgery are reviewed. Patient relief depends on a reliable analysis of the mechanism involved in the ocular surface disease.

Research in Dry Eye: Report of the Research Subcommittee of the International Dry Eye WorkShop (2007)

Members of the DEWS Research Subcommittee reviewed research into the basic mechanisms underlying dry eye disease. Evidence was evaluated concerning the tear film, lacrimal gland and accessory lacrimal glands, ocular surface epithelia (including cornea and conjunctiva), meibomian glands, lacrimal duct system and the immune system. Consideration was given to both animal and human research data. Results are presented as a series of information matrices, identifying what is known and providing supporting references. An attempt is made to identify areas for further investigation.

Establishment of Pseudomonas aeruginosa infection: lessons from a versatile opportunist

Pseudomonas aeruginosa is an ubiquitous pathogen capable of infecting virtually all tissues. A large variety of virulence factors contribute to its importance in burn wounds, lung infection and eye infection. Prominent factors include pili, flagella, lipopolysaccharide, proteases, quorum sensing, exotoxin A and exoenzymes secreted by the type III secretion system.

CA 19-9 ELISA test: a new method for studying mucus changes in tears

AIMS

This study investigated mucus changes in the tears in various eye conditions using impression cytology. The quantity of mucins was measured by enzyme linked immunosorbent assay (ELISA) using the tumour marker CA 19-9. This assay quantifies the sialylated Lewis(a) structure mainly associated with ocular mucins.

METHODS

Impression cytology was performed using a cellulose nitrate membrane, on 53 healthy patients, 50 glaucoma patients treated with beta blockers, 24 patients suffering from dry eye syndrome, and 45 contact lens wearers. The tear film glycoproteins were eluted and CA 19-9 was measured.

RESULTS

CA 19-9 content expressed as kilo units (kU) per microgram of tears was significantly decreased in dry eye syndrome (25.8 kU (SD 17.3)/microgram) (p < 0.05), glaucoma patients over 60 years (28.9 (19.5) kU/microgram) (p < 0.05), and contact lens wearers (28.4 kU (18)/microgram) (p < 0.05), when compared with healthy individuals (39.4 kU (22.2)/microgram).

CONCLUSION

Impression cytology can be regarded as a valuable method for obtaining samples of glycoconjugates of mucin. The decrease of sialylated chains observed with this method confirms the hypothesis that some quantitative changes in the tear film may be encountered in ocular surface disorders.

Modulation of Pseudomonas aeruginosa adherence to the corneal surface by mucus

To gain access to the corneal epithelium and cause infections keratitis, bacterial pathogens must first interact with ocular surface factors that could affect bacterial adherence. In this study, we demonstrated that the mucus layer, and, in particular, the mucin fraction of mucus, modulated adherence to intact corneal epithelium of Pseudomonas aeruginosa but not that of Staphylococcus aureus or Streptococcus pyogenes. Removal of endogenous mucus from rat or rabbit eyes increased the adherence of P. aeruginosa by 3- to 10-fold. Ocular mucus obtained from rat eyes, porcine stomach mucin, or bovine submaxillary gland mucin inhibited adherence of P. aeruginosa to uninjured corneal epithelium. The mucin fraction of ocular mucus, purified by ultracentrifugation, was found to contain the inhibitory activity, and inhibition was demonstrated at concentrations of mucin as low as 35 micrograms/ml. Ocular mucin was the only material tested that inhibited adherence of P. aeruginosa to an injured cornea. However, the binding of P. aeruginosa to immobilized substrates in vitro did not predict which fraction would possess antiadherence activity: bacteria bound well to whole ocular mucus, mucin, the nonmucin fraction of ocular mucus, and dilute human tears as well as to porcine stomach mucin and bovine submaxillary gland mucin. The effectiveness of the mucin fraction of ocular mucus at inhibiting the binding of P. aeruginosa to the cornea implies that this material is a barrier that protects the surface of the eye from P. aeruginosa adherence.

The relation between contact lens oxygen transmissibility and binding of Pseudomonas aeruginosa to the cornea after overnight wear

PURPOSE

To assess adverse effects of contact lens-induced hypoxia on the rabbit cornea in vivo and determine the relation between binding of Pseudomonas aeruginosa and oxygen transmissibility for rigid and hydrogel lenses.

METHODS

Six rigid lenses with Dk/Ltotal values between 0 and 97 x 10(-9) (cm/second) (ml O2/ml mmHg) and four hydrogel lenses (Dk/Ltotal 9, 20, 39, 51) were tested. All lenses had 14.0-mm diameters and a thickness (parallel) of 0.12 or 0.15 mm. Tear lactate dehydrogenase activity and tandem scanning confocal microscopy determinations were performed after the lens was worn for 24 hours. Binding of P. aeruginosa then was separately determined by the colony-forming unit method. Scanning electron microscopy was used to confirm in vivo tandem scanning confocal microscopy findings.

RESULTS

Lens oxygen transmissibility determines binding of P. aeruginosa to the cornea after the lens is worn for 24 hours; epithelial damage produced by lenses of lower Dk/Ltotal appears to be the dominant biologic factor for P. aeruginosa binding and not lens rigidity.

CONCLUSIONS

These results suggest that the risk of P. aeruginosa keratitis developing with overnight wear will be enhanced significantly for contact lenses with Dk/Ltotal values less than 50 x 10(-9) (cm/second) (ml O2/ml mmHg) (human equivalent oxygen percentage < or = 15%), and this risk will increase with further decreases in oxygen transmissibility. Because no hydrogel lenses approved by the Food and Drug Administration are available with oxygen transmission at this level, patients should be made aware of the increased risk of infectious keratitis associated with the overnight wear of current extended wear hydrogel lenses. Results of this study also demonstrate that quantitative clinical tandem scanning confocal microscopy imaging and tear lactate dehydrogenase activity measurements can provide prospective, noninvasive methods for assessing the ongoing interaction between contact lens and cornea in vivo.

Mucus alteration and eye dryness. A possible relationship

From a very early phase we studied 15 patients suffering from a dry-eye condition ant associated to systemic diseases. Conjunctival biopsies were studied in Transmission (TEM) and Scanning (SEM) electron microscopy. Moreover, the lectin-gold cytochemistry at ultrastructural level was applied to investigate the distribution of some glycosidic receptors produced by both the goblet cells and the vesicles belonging to the Second Mucus System (SMS). No evidence of epithelial stratification and only a decrease in the goblet cell population was observed. The SMS vesicles and the superficial cell microvilli did not appear greatly reduced in number. A difference in the mucus composition in terms of content of glycosidic residues was detected in dry-eye patients compared to the normal subjects. The role of the mucus produced by both the goblet cells and the SMS vesicles in debated. A possible correlation between the alteration of the mucus content and the failure of the tear film stability is proposed. On the basis of these data, a new therapeutic approach for eye dryness is suggested.