Oxidative Stress in the Anterior Ocular Diseases: Diagnostic and Treatment

Microfluidic contact lens for continuous monitoring of ocular oxidative stress

Oxidative stress-induced ocular dysfunctions are a significant global health concern. Glutathione (GSH), an abundant antioxidant in tears, can serve as an index for oxidative stress (OS). A coumarin-based fluorescent probe named CCAE was synthesized for GSH monitoring, functioning through structural changes via Michael's addition with GSH and elimination by H2O2, which restores the conjugation structure to assess the severity of OS-induced ocular diseases. CCAE demonstrated a high sensitivity with a detection limit (LOD) of 0.12 mM and reversibility for 15 cycles. A wearable contact lens sensor was developed featuring a microfluidic lens patterned with a 365 nm pulsed laser, requiring 6 μL of tears. CCAE was encapsulated in citric acid-crosslinked poly(vinyl alcohol) film and embedded in poly((hydroxyethyl)methacrylate-co-ethylene glycol)/polyvinylpyrrolidone (poly(HEMA-co-EG)/PVP) lenses. A customized smartphone readout device enabled quantitative GSH readings for point-of-care applications. Tested on an ex vivo porcine anterior eye model, the sensor achieved an LOD of 0.204 mM, within a detection range of 0.62-1.17 mM and 0.13-0.73 mM under mild and severe OS conditions respectively. The sensors maintained operational stability for 2 days and storage stability for 1 week. This reversible GSH contact lens sensor offers a unique platform for diagnosing and monitoring OS-related ocular conditions at point-of-care settings.

Nano-based drug delivery systems for the treatment of non-infectious uveitis

Background

Uveitis is one of the most prevalent causes of global visual impairment. The current approaches to treating non-infectious uveitis (NIU) involve the utilization of corticosteroids, immunosuppressant and biologics agents. Nevertheless, the intricate ocular anatomy barriers and adverse side effects of the drugs pose significant obstacles to effective treatment outcomes.

Main text

To improve drug bioavailability and therapeutic outcomes for NIU while minimize side effects, researchers are committed to developing novel nano-based drug delivery systems (DDS), which have the capacity to achieve targeted delivery, increase bioavailability, achieve sustained release, reduce side effects and improve therapeutic effects. Thus, DDS based on nanotechnology, including liposome, dendrimer, hydrogels, nanoparticles, nanomicelles, nanosuspensions and nanoemulsions have emerged as promising alternatives to conventional ocular delivery methods for the management of NIU.

Conclusions

In this review, we summarize the current therapeutic challenges faced by NIU and describe various nano-based intraocular DDS involved in the treatment of NIU. It is concluded that nano-based DDS is an appealing approach to addressing the unmet needs for the treatment of NIU.

Decreased inflammatory biomarkers after using artificial tears with Aloe vera and hypromellose for dry eye

CLINICAL RELEVANCE

Research has increasingly highlighted the therapeutic potential of Aloe vera and hypromellose for treating dry eye due to their healing properties and multifaceted benefits including anti-inflammatory, antioxidant, antimicrobial, and wetting capabilities.

BACKGROUND

During the last few years, the use of natural extracts in the form of ophthalmic and oral formulations has been proposed as an alternative to those currently available treatments for dry eye. The purpose of the current study was to demonstrate the anti-inflammatory effect of artificial tears containing an extract of Aloe vera and hypromellose on ocular surface inflammation in dry eye patients, along with evaluating various signs and symptoms of dry eye.

METHODS

A three-month prospective, randomised, double-masked, and placebo-controlled study was performed on twenty dry eye patients (51.9 ± 8.4 years). One eye was treated with saline solution as a placebo control, while the contralateral eye was treated with artificial tears containing Aloe vera and hypromellose, randomly assigned. Concentrations of MMP-9, IL-1β, and IL-6 in tears, tear secretion, tear meniscus height, tear break-up time, and dry eye questionnaire were measured immediately before (baseline) and after (one month and three months) the topical instillation of the treatments.

RESULTS

Compared with the baseline, the saline solution showed no significant changes in any of the studied variables (p ≥ 0.05). Conversely, the artificial tears containing Aloe vera and hypromellose showed beneficial effects on concentrations of MMP-9 and IL-6 in tears, tear break-up time, and ocular symptoms of dryness and irritation after three months (p < 0.05).

CONCLUSIONS

The topical instillation of artificial tears containing Aloe vera and hypromellose is presented as an effective and alternative treatment for dry eye management, especially in cases where the severity of disease is mild.

Omics in Keratoconus: From Molecular to Clinical Practice

Keratoconus (KC) is a progressive ocular disorder marked by structural and functional alterations of the cornea, leading to significant visual impairment. Recent studies indicate that these corneal changes are linked to molecular and cellular mechanisms that disrupt and degrade the extracellular matrix. This degradation is influenced by proteinases that contribute to a loss of homeostasis and an imbalance in the antioxidant/oxidative state within the cornea, fostering oxidative stress, inflammation, and apoptosis. Although these biological processes have been identified primarily through molecular biology research, omics technologies have significantly advanced our understanding of the physiological and pathological phenomena associated with KC. Omics studies encompassing genomics, transcriptomics, proteomics, epigenomics, and metabolomics, have emerged as critical tools in elucidating the complex biological landscape of various diseases, including ocular conditions. The integrative application of these studies has demonstrated their potential in personalizing medicine across diverse fields such as oncology, neurology, and ophthalmology. This review aims to describe findings from omics research applied to keratoconus, highlighting the genomic, transcriptomic, proteomic, epigenomic, and metabolomic aspects derived from ocular and other biological samples. Notably, the molecular insights gained from these studies hold promise for identifying biomarkers of keratoconus, which could enhance diagnostic accuracy and therapeutic strategies. The exploration of these biomarkers may facilitate improved management and treatment options for patients, contributing to personalized care in keratoconus management.

Association of Per- and Polyfluoroalkyl Substance Exposure With Cataract Prevalence Among U.S. Adults: A NHANES Analysis (2005-2008)

Purpose

Cataract, a major health concern among the elderly, can be influenced by environmental exposures. This study examines the association between per- and polyfluoroalkyl substance (PFAS) exposure and cataract prevalence.

Methods

Six serum PFAS concentrations were detected among 2119 U.S. adults aged 40 years or older based on the National Health and Nutrition Examination Survey. Multivariable models, including weighted logistic regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression, were used to assess the association between individual and overall PFAS exposure and cataract prevalence. A mediation analysis was conducted for inflammation biomarkers.

Results

Single exposure to perfluorohexane sulfonic acid (PFHS) and perfluorononanoic acid (PFNA) was found to be markedly associated with cataract prevalence after adjustment for covariates (PFHS: odds ratio [OR], 1.579; 95% CI, 1.003-2.514; PFNA: OR, 1.629; 95% CI, 1.065-2.506). The WQS index was significantly associated with cataract (OR, 1.441; 95% CI, 1.130-1.837). PFNA and PFHS were the most influential exposures in the PFAS mixture. In the Bayesian kernel machine regression model, PFNA and PFHS exhibited the highest group posterior inclusion probability, aligning with the WQS results. Moreover, serum albumin and neutrophil counts were found to mediate the relationship between PFHS and cataract, accounting for -26.20% and -5.95% of the mediation effect, respectively.

Conclusions

Exposure to PFAS was positively associated with cataract, primarily driven by PFHS and PFNA. Mediation of serum albumin and neutrophil count was observed.

Translational Relevance

This study links PFAS exposure to cataract prevalence, suggesting reducing exposure could help in cataract prevention.

Metabolic Dysfunction-Associated Steatotic Liver Disease Induced by Microplastics: An Endpoint in the Liver-Eye Axis

There is a significant, rather than just anecdotal, connection between the liver and the eyes. This connection is evident in noticeable cases such as jaundice, where the sclera has a yellow tint. But this can be seen through even more subtle indicators, such as molecules known as hepatokines. This relationship is not merely anecdotal; in some studies, it is referred to as the "liver-eye axis". Ubiquitous environmental contaminants, such as microplastics (MPs), can enter the bloodstream and human body through the conjunctival sac, nasolacrimal duct, and upper respiratory tract mucosa. Once absorbed, these substances can accumulate in various organs and cause harm. Toxic substances from the surface of the eye can lead to local oxidative damage by inducing apoptosis in corneal and conjunctival cells, and irregularly shaped microparticles can exacerbate this effect. Even other toxicants from the ocular surface may be absorbed into the bloodstream and distributed throughout the body. Environmental toxicology presents a challenge because many pollutants can enter the body through the same ocular route as that used by certain medications. Previous research has indicated that the accumulation of MPs may play a major role in the development of chronic liver disease in humans. It is crucial to investigate whether the buildup of MPs in the liver is a potential cause of fibrosis, or simply a consequence of conditions such as cirrhosis and portal hypertension.

The Role of the Ubiquitin System in Eye Diseases

The ubiquitin-proteasome system (UPS) is a fundamental process that regulates various biological functions, including immune response, cell cycle, oxidative stress, migration, and cellular proliferation. This system is responsible for the degradation of proteins, while proteasomes play a significant role in mechanisms involved in health and human diseases. The participation of the UPS in immune response is particularly relevant, leading to the involvement of immunoproteasomes. This specialized proteasome is involved in the processing and presentation of antigenic peptides, making it crucial for proper immune function. Moreover, the impact of the UPS is considered essential in understanding several diseases, such as neurodegenerative disorders, infections, and vascular diseases. The dysregulation of the UPS may contribute to the pathogenesis of these conditions, highlighting its importance as a potential therapeutic target. Interestingly, the UPS is also related to ocular structures, playing a role in visual perception and ocular homeostasis. This involvement in the regulation of various ocular processes suggests its potential impact on both anterior and posterior eye pathologies. This review aims to discuss the general considerations of the UPS and provide information about its participation in anterior and posterior eye pathologies. By understanding its role in ocular health and disease, researchers and clinicians may explore novel therapeutic strategies targeting the UPS for the treatment of various eye conditions. In conclusion, the UPS is a crucial player in biological processes, with far-reaching implications in health and disease, including the anterior and posterior segments of the eye. Further research in this field may lead to the development of innovative therapies and a better understanding of the complex mechanisms underlying various eye disorders.

The effect of preoperative total antioxidant capacity on short-term outcomes after kerato-lenticule extraction surgery

To evaluate influence of total antioxidant capacity expression (TAC) on outcome of kerato-lenticule extraction (KLEx). A prospective non-randomized trial was conducted and patients received KLEx were categorized via TAC concentration. A total of 56 and 36 eyes were enrolled into the low TAC and high TAC groups. The main outcomes are the postoperative un-corrected visual acuity (UCVA), refraction and superficial keratitis between groups. The generalized liner model was applied for statistical analysis. One month after the KLEx surgery, the UCVA was significantly higher in the high TAC group (P = 0.028), and low TAC group associated with superficial keratitis risk compared to high TAC group (P = 0.035). The trends of TAC and ascorbic acid (AA) decrements were more significant in the low TAC group (both P < 0.05). Low TAC population and old age correlated to poor UCVA (both P < 0.05) while the thick CCT correlated to better UCVA (P = 0.030). Besides, the low TAC population (P = 0.032) correlated to higher superficial keratitis rate, while old age (P = 0.018) correlated to lower superficial keratitis rate. The presence of low TAC expression correlated to worse UCVA and higher risk of superficial keratitis after KLEx.

Research progress on pharmacological effects against liver and eye diseases of flavonoids present in Chrysanthum indicum L., Chrysanthemum morifolium Ramat., Buddleja officinalis Maxim. and Sophora japonica L

ETHNOPHARMACOLOGICAL RELEVANCE

Chrysanthemum indicum L., Chrysanthemum morifolium Ramat., Buddleja officinalis Maxim., and Sophora japonica L. have the effects of "Clearing the liver" and "Improving vision". Flavonoids are their main active ingredients, but there are few reports on their simultaneous liver and eye protective effects.

AIM OF THE STUDY

Overview of the role of flavonoids of the four medicinal flowers (FFMF) in the prevention and treatment of liver and eye diseases.

MATERIALS AND METHODS

The Web of Science, PubMed, CNKI, Google Scholar, and WanFang databases were searched for FFMF. Using "hepatitis", "liver fibrosis", "liver cancer", "dry eye syndrome", "cataracts", "glaucoma", "age-related macular degeneration", and "diabetic retinopathy" as the keywords, we summarized the main pathological mechanisms of these diseases and the role of FFMF in their prevention and treatment.

RESULTS

We found that the four medicinal flowers contained a total of 125 flavonoids. They can maintain liver and eye homeostasis by regulating pathological mechanisms such as oxidative stress, inflammation, endoplasmic reticulum stress, mitochondrial dysfunction, glucose and lipid metabolism disorders, and programmed cell death, exerting the effect of "clearing the liver and improving vision".

CONCLUSION

FFMF have a series of beneficial properties such as antioxidant, anti-inflammatory, antiviral, and antifibrotic activity, and the regulation of angiogenesis, glycolipid metabolism and programmed cell death, which may explain the efficacy of the four traditional Chinese medicines for "Clearing the liver" and "Improving vision".

Galactose-Induced Cataracts in Rats: A Machine Learning Analysis

Background: Rat models are widely used to study cataracts due to their cost-effectiveness and prominent physiological and genetic similarities to humans The objective of this study was to identify genes involved in cataractogenesis due to galactose exposure in rats. Methods: We analyzed four datasets from the Gene Expression Omnibus, including both ex vivo and in vivo models of cataracts in different rat strains. Feature selection tools were used to identify genes potentially relevant in cataract-related gene expression. A decision tree algorithm was implemented, and its predictions were interpreted using SHAP and LIME. To validate gene expression levels, PCR was conducted on six rat lenses cultured in M199 medium and galactose to induce cataract and six lenses cultured in M199 alone. Results: Using feature selection tools, four key genes-PLAGL2, CMTM7, PCYT1B, and NR1D2-were identified. Only PCYT1B was significantly differentially expressed between the cataract and control groups across analyzed datasets. The model showed strong predictive performance, particularly in ex vivo datasets. SHAP and LIME analyses revealed that CMTM7 had the largest impact on model predictions. PCR results did not show significant differences in gene expression between the cataract and control groups. Conclusion: The decision tree model trained on an in vivo dataset could predict ex vivo and in vivo cataracts despite no significant gene expression differences found between the cataract and control groups. Given a small number of samples, larger studies are needed to validate our findings.

Tear matrix metalloproteinases-9 and ocular surface parameters in diabetics: a cross-sectional study in Shenyang, China

BACKGROUND

Overexpression of tear matrix metalloproteinases-9 (MMP-9) on the ocular surface tissues has been reported to result in ocular surface damage. MMP-9 levels in tears have been listed as one of many tools for confirming dry eye disease (DED).

OBJECTIVE

This investigation aimed to compare MMP-9 levels and ocular surface parameters in diabetic patients with and without DED.

DESIGN

A cross-sectional study.

SETTING

He Eye Specialist Hospital, Shenyang, China.

PARTICIPANTS

This study recruited 144 right eyes of 144 diabetic patients between November and December of 2023, and 110 patients with similar propensity scores were included in the analyses.

MAIN OUTCOME MEASURES

Non-invasive breakup time (NITBUT), tear film lipid layer (TFLL), conjunctival hyperaemia (redness score (RS)), corneoconjunctival staining (CS), corneal sensitivity and Ocular Surface Disease Index (OSDI) questionnaire were evaluated. MMP-9 was measured using an immunochromatography assay.

RESULTS

In total, 55 patients (55 eyes) were grouped as diabetic dry eye (DDE) and 55 patients (55 eyes) as diabetic non-dry eye (DNDE). The mean MMP-9 concentrations were higher in patients with DDE than DNDE (70.63±52.06 ng/mL vs 33.98±33.93 ng/mL; p<0.001). The optimal cut-off value of MMP-9 to predict DED in diabetic patients was>52.5 ng/mL, with 58.2% sensitivity and 78.2% specificity.

CONCLUSIONS

MMP-9 concentration was higher in patients with DDE than DNDE. The MMP-9 test is a potential diagnostic tool for DDE. It may help follow-up diabetic patients with DED and guide clinicians in deciding on anti-inflammatory treatments for these patients.

Norepinephrine Attenuates Benzalkonium Chloride-Induced Dry Eye Disease by Regulating the PINK1/Parkin Mitophagy Pathway

BACKGROUND

Increased reactive oxygen species (ROS) are involved in the pathological process of dry eye disease. Our previous results suggested that norepinephrine (NE) has a protective effect on dry eye.

PURPOSE

This study explored the potential therapeutic role and underlying mechanisms of NE in benzalkonium chloride (BAC)-induced dry eye disease.

METHODS

BAC-pretreated human corneal epithelial cells (HCEpiC) were cultured with various concentrations of NE. A BAC-induced dry eye mice model was established to explore the role of NE. Alterations in mice corneal tissues, ROS levels, mitochondrial function, and mitophagy levels were analyzed.

RESULTS

In vitro, our results revealed that BAC-exposed HCEpiC led to mitochondrial malfunction, which involved excessive ROS production, decreased mitochondrial membrane potential (MMP), and promoted mitochondrial fragmentation through increased DRP1 and fission protein 1 (Fis1) expression and reduced mitofusin 2 (Mfn2) expression. Moreover, topical BAC application induced excessive mitophagy. These effects were reversed by NE. Additionally, the increased expression of LC3B, SQSTM1/p62, PINK1, and Parkin, which control mitophagy, in BAC-exposed HCEpiC was suppressed by NE. In BAC-induced C57BL/6J mice, NE resulted in lower fluorescein staining scores, decreased TUNEL-positive cells, and decreased mitochondrial fragmentation.

CONCLUSIONS

In conclusion, our findings showed that NE therapy prevented HCEpiC following BAC application by regulating mitochondrial quality control, which is controlled by PINK1/Parkin-dependent mitophagy. Our research suggests a potential targeted treatment for dry eye disease.

The Role of Antioxidant Plant Extracts' Composition and Encapsulation in Dietary Supplements and Gemmo-Derivatives, as Safe Adjuvants in Metabolic and Age-Related Conditions: A Review

Given the current global circumstances, marked by severe environmental pollution-including the contamination of food-along with daily stress and a sedentary lifestyle, many consumers choose to improve their quality of life by using, among others, minimally processed food, food supplements, and gemmo-derivatives. Recent lab and clinical studies have shown the positive impact of specific nutrients with antioxidant capacities in the treatment of several conditions generated by oxidative stress. This paper reviews antioxidant plant extracts utilized as components in various dietary supplements and gemmoderivatives, highlighting their chemical composition and biological properties in preventing diseases caused by oxidative stress. A modern approach to food science brings to the fore the concept of dietary supplements vs. functional food, nutraceuticals, and gemmo-derivatives. The definitions of these terms are not being unanimously regulated in this respect and describe each category of compound and product, also emphasizing the need to implement adequate nutrivigilance. In order to enhance the absorption and bioavailability of dietary supplements and gemmo-derivatives based on antioxidant plant extracts, some encapsulation techniques are outlined.

Increased susceptibility of human limbal aniridia fibroblasts to oxidative stress

Aniridia-associated keratopathy originates from a haploinsufficiency of the transcription factor PAX6 (PAX6+/-). In the corneal epithelium of PAX6+/- mice, a significant increase in oxidized proteins was observed, accompanied by impaired compensation for elevated oxidative stress (OS). The extent to which limbal fibroblast cells (LFCs) are affected by an increased susceptibility to OS in cases of congenital aniridia (AN) has not been determined, yet. Our aim was to examine the impact of OS on antioxidant enzyme expression in normal and AN-LFCs. Following isolation and culture of primary LFCs (n = 8) and AN-LFCs (n = 8), cells were treated with cobalt chloride for 48 h to chemically induce hypoxic conditions and OS. Subsequently, HIF-1α/-2α, PHD1/2, Nrf2, CAT, SOD1, PRDX6, and GPX1 gene expression was examined by qPCR. SOD1, PRDX6, and GPX1 protein levels were assessed from the cell lysate by Western blot. The induction of hypoxia led to reduced HIF-1α gene expression in both fibroblast groups (p≤0.008), while the decrease in PHD1 was limited to AN-LFCs (p = 0.0007). On the other hand, under hypoxic conditions, PHD2 showed higher mRNA expression in AN-LFCs compared to normal LFCs (p = 0.013). As a result of OS, the mRNA levels of Nrf2 (p<0.0001) and the antioxidant enzymes CAT (p = 0.005), SOD1 (p = 0.005), GPX1 (p = 0.002) decreased in AN-LFCs. This was accompanied by an increased protein expression of SOD1 (p = 0.019) and PRDX6 (p=0.0009). In the normal LFC group, the induced extent of OS had no impact on the gene (p≥0.151) and protein expression (p ≥ 0.629) of antioxidant enzymes, except for the GPX1 mRNA level (p = 0.027). AN-LFCs exhibit higher susceptibility to OS than normal LFCs. Therefore, in AN-LFCs, there are sustained alterations in gene and protein expression of antioxidative enzymes even after 48 h of CoCl2 treatment.

Selected Trace Elements and Their Impact on Redox Homeostasis in Eye Health

Oxidative stress plays a crucial role in the pathogenesis of various ocular degenerative diseases, leading to structural and functional changes in eye tissues. This imbalance between reactive oxygen species (ROS) and antioxidants significantly contributes to conditions such as age-related macular degeneration, diabetic retinopathy, cataracts, and glaucoma. Both enzymatic and nonenzymatic antioxidants are vital for maintaining ocular health by neutralizing ROS and restoring cellular redox balance. Essential trace elements, including iron, zinc, copper, and selenium, are fundamental for the proper functioning of these antioxidant systems. Iron is indispensable for enzymatic activity and cellular energy production, zinc supports numerous proteins involved in visual functions and antioxidant defense, copper is essential for various enzymatic reactions preventing oxidative stress, and selenium is critical for the activity of antioxidant enzymes such as glutathione peroxidase (GPX) and thioredoxin reductase (TrxR). This review summarizes current research on the complex interactions between oxidative stress and trace elements in ocular diseases, highlighting the therapeutic potential of antioxidant supplementation to mitigate oxidative damage and improve eye health. By integrating insights from studies on oxidative stress, trace elements, and eye physiology, this article underscores new diagnostic and therapeutic strategies that could lead to more effective prevention and treatment of ocular diseases, aiming to enhance clinical outcomes and guide future research in optimizing therapeutic strategies for eye health.

Oxidative Stress in Cataract Formation: Is There a Treatment Approach on the Horizon?

Cataracts, a leading cause of blindness worldwide, are closely linked to oxidative stress-induced damage to lens epithelial cells (LECs). Key factors contributing to cataract formation include aging, arterial hypertension, and diabetes mellitus. Given the high global prevalence of cataracts, the burden of cataract-related visual impairment is substantial, highlighting the need for pharmacological strategies to supplement surgical interventions. Understanding the molecular pathways involved in oxidative stress during cataract development may offer valuable insights for designing novel therapeutic approaches. This review explores the role of oxidative stress in cataract formation, focusing on critical mechanisms, such as mitochondrial dysfunction, endoplasmic reticulum stress, loss of gap junctions, and various cell death pathways in LECs. Additionally, we discuss emerging therapeutic strategies and potential targeting options, including antioxidant-based treatments.

Tear-Based Ocular Wearable Biosensors for Human Health Monitoring

Wearable tear-based biosensors have garnered substantial interest for real time monitoring with an emphasis on personalized health care. These biosensors utilize major tear biomarkers such as proteins, lipids, metabolites, and electrolytes for the detection and recording of stable biological signals in a non-invasive manner. The present comprehensive review delves deep into the tear composition along with potential biomarkers that can identify, monitor, and predict certain ocular diseases such as dry eye disease, conjunctivitis, eye-related infections, as well as diabetes mellitus. Recent technologies in tear-based wearable point-of-care medical devices, specifically the state-of-the-art and prospects of glucose, pH, lactate, protein, lipid, and electrolyte sensing from tear are discussed. Finally, the review addresses the existing challenges associated with the widespread application of tear-based sensors, which will pave the way for advanced scientific research and development of such non-invasive health monitoring devices.

Complete Blood Cell Count-Derived Inflammation Biomarkers and the Need for Laser Capsulotomy Due to Posterior Capsule Opacification Following Cataract Surgery

Background

Inflammation plays a significant role in the proliferation, migration, and differentiation of lens epithelial cells after cataract surgery, clinically manifested as posterior capsule opacification (PCO). This condition is typically treated with neodymium: yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy. Our objective is to evaluate the association between blood-derived inflammatory markers and the development of clinically significant PCO necessitating treatment with laser capsulotomy.

Materials and Methods

We conducted a retrospective review of charts for all patients who underwent Nd:YAG laser capsulotomy in our department between January 2021 and December 2022. The study included 70 patients who diagnosed with clinically significant PCO requiring treatment with Nd:YAG laser capsulotomy following cataract surgery, as well as 70 pseudophakic controls with no signs of PCO. Complete blood cell count parameters were obtained from medical records and the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were calculated.

Results

The mean age of the Nd:YAG laser capsulotomy and control group was 71.83±8.46 and 72.27±9.98 years, respectively. The preoperative NLR scores for the Nd:YAG laser capsulotomy group (mean rank = 34.43) were statistically significantly higher than those of the control group (mean rank = 25.41) (p = 0.044). However, after adjusting for preoperative measurements, no statistically significant differences were observed between the groups for the other parameters.

Conclusion

Preoperative NLR scores were higher in patients who developed clinically significant PCO requiring treatment with Nd:YAG laser capsulotomy. This finding suggests that patients with elevated systemic inflammation may be at an increased risk of developing PCO following cataract surgery. Further research is needed to evaluate the role of systemic inflammation in the pathogenesis of PCO.

Mechanistic elucidation of QiJu-DiHuang Wan in management of age-related dry eye through metabolomics and network pharmacology

BACKGROUND

QiJu-DiHuang Wan (QJDHW), a frequently employed Chinese herbal formula, is used to treat blurred vision. Even so, it is unclear how it works in treating age-related dry eyes.

OBJECTIVE

The aim of this research is to explore the potential mechanisms of QJDHW in treating dry eye using UHPLC-QE-MS, metabolomics, and network pharmacology.

METHODS

Six male SD rats were segregated into control and QJDHW groups. Following intervention, The primary active ingredients in QJDHW-containing serum were identified using UHPLC-QE-MS. Metabolomics and network pharmacology were utilized to investigate potential targets and pathways involved following QJDHW use. Primary lacrimal epithelial cells were used for validation.

RESULTS

A total of 425 active ingredients of QJDHW were identified, along with 210 active ingredients in QJDHW-containing serum. A comparison of QJDHW-containing serum and control serum samples revealed 40 metabolic differentiators. A total of 24 metabolites were found in QJDHW and QJDHW-containing serum. Network pharmacology identified 3,144 targets for dry eye disease, and 102 metabolite action targets were found for QJDHW-entering components. KEGG Enrichment Analysis revealed significance of HIF-1, apoptosis, cell cycle and PI3K-Akt, among others. HIF-1 and PI3K-Akt were chosen for verification in the oxidative damage model of lacrimal epithelial cells.

CONCLUSION

The main active ingredients of QJDHW and its containing serum were elucidated by UHPLC-QE-MS demonstrating that QJDHW treats age-associated dry eye by inhibiting HIF1α/NF-κB through ROS inhibition and PI3K/p-AKT activation.

Nanomedicines for Dry Eye Syndrome: Targeting Oxidative Stress with Modern Nanomaterial Strategies

Dry eye syndrome (DES) is a dynamic, chronic disease of the ocular surface and ocular appendages caused by inflammation. The most common symptoms include redness, itching, and blurred vision, resulting from dysfunction of the meibomian glands and impaired tear-film production. Factors contributing to the development of DES include environmental elements, such as UV radiation, and internal elements, such as hormonal imbalances. These factors increase oxidative stress, which exacerbates inflammation on the surface of the eye and accelerates the development of DES. In recent years, the incidence of DES has risen, leading to a greater need to develop effective treatments. Current treatments for dry eye are limited and primarily focus on alleviating individual symptoms, such as reducing inflammation of the ocular surface. However, it is crucial to understand the pathomechanism of the disease and tailor treatment to address the underlying causes to achieve the best possible therapeutic outcomes. Therefore, in this review, we analyzed the impact of oxidative stress on the development of DES to gain a better understanding of its pathomechanism and examined recently developed nanosystems that allow drugs to be delivered directly to the disease site.

Advances in research on immunocyte iron metabolism, ferroptosis, and their regulatory roles in autoimmune and autoinflammatory diseases

Autoimmune diseases commonly affect various systems, but their etiology and pathogenesis remain unclear. Currently, increasing research has highlighted the role of ferroptosis in immune regulation, with immune cells being a crucial component of the body's immune system. This review provides an overview and discusses the relationship between ferroptosis, programmed cell death in immune cells, and autoimmune diseases. Additionally, it summarizes the role of various key targets of ferroptosis, such as GPX4 and TFR, in immune cell immune responses. Furthermore, the release of multiple molecules, including damage-associated molecular patterns (DAMPs), following cell death by ferroptosis, is examined, as these molecules further influence the differentiation and function of immune cells, thereby affecting the occurrence and progression of autoimmune diseases. Moreover, immune cells secrete immune factors or their metabolites, which also impact the occurrence of ferroptosis in target organs and tissues involved in autoimmune diseases. Iron chelators, chloroquine and its derivatives, antioxidants, chloroquine derivatives, and calreticulin have been demonstrated to be effective in animal studies for certain autoimmune diseases, exerting anti-inflammatory and immunomodulatory effects. Finally, a brief summary and future perspectives on the research of autoimmune diseases are provided, aiming to guide disease treatment strategies.

Lycopene: A Potent Antioxidant with Multiple Health Benefits

Lycopene is a naturally occurring carotenoid predominantly found in tomatoes and tomato-based products. Like other phytochemicals, it exhibits health beneficial biological activities that can be exploited when it is used as a dietary supplement. In vitro and in vivo, lycopene has been demonstrated to mitigate oxidative stress-induced metabolic dysfunctions and diseases including inflammation, obesity, and diabetes mellitus. Lycopene has been shown to alleviate metabolic diseases that affect the bone, eye, kidney, liver, lungs, heart, and nervous system. This review presents the state of the art regarding lycopene's health benefits and its potential applications in health system delivery. Furthermore, lycopene's protective effects against toxins, safety in its use, and possible toxicity are explored.

Bioinformatics analysis of signature genes related to cell death in keratoconus

Keratoconus is corneal disease in which the progression of conical dilation of cornea leads to reduced visual acuity and even corneal perforation. However, the etiology mechanism of keratoconus is still unclear. This study aims to identify the signature genes related to cell death in keratoconus and examine the function of these genes. A dataset of keratoconus from the GEO database was analysed to identify the differentially expressed genes (DEGs). A total of 3558 DEGs were screened from GSE151631. The results of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis showed that they mainly involved in response to hypoxia, cell-cell adhesion, and IL-17 signaling pathway. Then, the cell death-related genes datasets were intersected with the above 3558 DEGs to obtain 70 ferroptosis-related DEGs (FDEGs), 32 autophagy-related DEGs (ADEGs), six pyroptosis-related DEGs (PDEGs), four disulfidptosis-related DEGs (DDEGs), and one cuproptosis-related DEGs (CDEGs). After using Least absolute shrinkage and selection operator (LASSO), Random Forest analysis, and receiver operating characteristic (ROC) curve analysis, one ferroptosis-related gene (TNFAIP3) and five autophagy-related genes (CDKN1A, HSPA5, MAPK8IP1, PPP1R15A, and VEGFA) were screened out. The expressions of the above six genes were significantly decreased in keratoconus and the area under the curve (AUC) values of these genes was 0.944, 0.893, 0.797, 0.726, 0.882 and 0.779 respectively. GSEA analysis showed that the above six genes mainly play an important role in allograft rejection, asthma, and circadian rhythm etc. In conclusion, the results of this study suggested that focusing on these genes and autoimmune diseases will be a beneficial perspective for the keratoconus etiology research.

Myclobutanil induces cardiotoxicity in developing zebrafish larvae by initiating oxidative stress and apoptosis: The protective role of curcumin

Myclobutanil (MYC) is a common triazole fungicide widely applied in agriculture. MYC extensively exists in the natural environment and can be detected in organisms. However, little is known about MYC-induced embryonic developmental damage. This study aimed to unravel the cardiotoxicity of MYC and the underlying mechanisms, as well as the cardioprotective effect of curcumin (CUR, an antioxidant polyphenol) using the zebrafish model. Here, zebrafish embryos were exposed to MYC at concentrations of 0, 0.5, 1 and 2 mg/L from 4 to 96 h post fertilization (hpf) and cardiac development was assessed. As results, MYC reduced the survival and hatching rate, body length and heart rate, but increased the malformation rate and spontaneous movement. MYC caused abnormal cardiac morphology and function in myl7:egfp transgenic zebrafish, and downregulated cardiac developmental genes. MYC promoted oxidative stress through excessive reactive oxygen species (ROS) accumulation and suppressed the activities of antioxidant enzymes, triggering cardiomyocytic apoptosis via upregulated expression of apoptosis-related genes. These adverse toxicities could be significantly ameliorated by the antioxidant properties of CUR, indicating that CUR rescued MYC-induced cardiotoxicity by inhibiting oxidative stress and apoptosis. Overall, our study revealed the potential mechanisms of oxidative stress and apoptosis in MYC-induced cardiotoxicity in zebrafish and identified the cardioprotection of CUR in this pathological process.

Recommendations for nutritional supplements for dry eye disease: current advances

Dry eye disease (DED) represents a prevalent ocular surface disease. The development of effective nutritional management strategies for DED is crucial due to its association with various factors such as inflammation, oxidative stress, deficiencies in polyunsaturated fatty acids (PUFAs), imbalanced PUFA ratios, and vitamin insufficiencies. Extensive research has explored the impact of oral nutritional supplements, varying in composition and dosage, on the symptoms of DED. The main components of these supplements include fish oils (Omega-3 fatty acids), vitamins, trace elements, and phytochemical extracts. Beyond these well-known nutrients, it is necessary to explore whether novel nutrients might contribute to more effective DED management. This review provides a comprehensive update on the therapeutic potential of nutrients and presents new perspectives for combination supplements in DED treatment.

Nicotinamide Supplementation Mitigates Oxidative Injury of Bovine Intestinal Epithelial Cells through Autophagy Modulation

The small intestine is important to the digestion and absorption of rumen undegradable nutrients, as well as the barrier functionality and immunological responses in ruminants. Oxidative stress induces a spectrum of pathophysiological symptoms and nutritional deficits, causing various gastrointestinal ailments. Previous studies have shown that nicotinamide (NAM) has antioxidant properties, but the potential mechanism has not been elucidated. The aim of this study was to explore the effects of NAM on hydrogen peroxide (H2O2)-induced oxidative injury in bovine intestinal epithelial cells (BIECs) and its potential mechanism. The results showed that NAM increased the cell viability and total antioxidant capacity (T-AOC) and decreased the release of lactate dehydrogenase (LDH) in BIECs challenged by H2O2. The NAM exhibited increased expression of catalase, superoxide dismutase 2, and tight junction proteins. The expression of autophagy-related proteins was increased in BIECs challenged by H2O2, and NAM significantly decreased the expression of autophagy-related proteins. When an autophagy-specific inhibitor was used, the oxidative injury in BIECs was not alleviated by NAM, and the T-AOC and the release of LDH were not affected. Collectively, these results indicated that NAM could alleviate oxidative injury in BIECs by enhancing antioxidant capacity and increasing the expression of tight junction proteins, and autophagy played a crucial role in the alleviation.

Association of Novel Loci With Keratoconus Susceptibility in a Chinese Genome-Wide Association Study

Purpose

Keratoconus (KC) is a progressive corneal disease that can lead to corneal blindness if not properly managed. The purpose of this study was to identify genetic associations with KC in China and to investigate whether these genetic variants are associated with corneal thickness and corneal curvature in KC cases.

Methods

A genome-wide association study was conducted on 853 patients with KC and 6248 controls. The KC cases were genotyped with the Illumina Infinium Human Asian Screening Array BeadChip, and the controls were genotyped with the Illumina Infinium Human Global Screening Array BeadChip. Genetic associations with KC, as well as correlations between the positive variants and corneal parameters including central corneal thickness (CCT) and mean keratometry (Km), were compared using PLINK version 1.90.

Results

Our present study identified four single-nucleotide polymorphisms (SNPs) within four risk loci (PTGER3: rs2300163, EYA1: rs1077435, ASS1: rs141365191, and CHTF8: rs3743680) associated with KC in Chinese patients that reached genome-wide significance. Among the identified SNPs with P < 1.00 × 10-4, seven SNPs (FOSL2-PLB1: rs12622211, RXRA-COL5A1: rs3118515, rs3132306, rs1536482, rs3118520, KAT6B: rs192187772, RAP2A-IPO5: rs41361245) were observed to be associated with CCT, and one SNP (USP13: rs6767552) was found to be associated with Km.

Conclusions

In the first genome-wide association study of KC with a relatively large study population in China, we identified four SNPs in four risk loci associated with the disease. The findings enriched the understanding of genetic susceptibility to KC and provided new insights into the genetic etiology of the disease.

The Association between Ovarian Cancer and the Incidence of Newly Developed Dry Eye Disease: A Nationwide Population-Based Study

We aim to investigate the potential correlation between the presence of ovarian cancer and the development of dry eye disease (DED) via the usage of the Longitudinal Health Insurance Database (LHID) of Taiwan. A retrospective cohort study was executed, and patients with ovarian cancer were selected according to the diagnostic and procedure codes. One ovarian cancer patient was matched to four non-ovarian cancer participants which served as control group, and a total of 4992 and 19,968 patients constructed the ovarian cancer and control groups, respectively. The primary outcome in the current study is the development of DED according to the diagnostic and procedure codes. Cox proportional hazard regression was utilized to produce the adjusted hazard ratio (aHR) and related 95% confidence interval (CI) of DED between the two groups. There were 542 and 2502 DED events observed in the ovarian cancer group and the control group, respectively. The ovarian cancer group illustrated a significantly higher incidence of DED development than the control group after the adjustment of several confounders (aHR: 1.10, 95% CI: 1.01-1.21, p = 0.040). In the subgroup analysis stratified by age, ovarian cancer patients aged older than 60 years showed a higher incidence of DED compared to the non-ovarian cancer population (aHR: 1.19, 95% CI: 1.08-1.28, p = 0.011). In addition, ovarian cancer patients with a disease duration longer than five years also showed higher incidence of DED formation than the non-ovarian cancer population (aHR: 1.13, 95% CI: 1.04-1.22, p = 0.027). In conclusion, the presence of ovarian cancer is associated with higher incidence of subsequent DED, especially in those older than 60 years and with a disease interval of more than five years.

Novel treatments for dry eye syndrome

Dry eye syndrome (DES) is a prevalent and multifactorial disease that leads to a self-perpetuating cycle of inflammation and damage to the ocular surface. This results in symptoms such as redness, burning, and blurred vision, which can negatively affect a patient's quality of life. While treatments are available to manage DES, they only temporarily relieve symptoms. Furthermore, long-term use of certain medications can cause harm to the ocular surface. Therefore, there is a need for safer and effective treatments for DES. This review highlights the latest advancements in DES therapy, providing valuable insights into ongoing efforts to improve patient outcomes.

Potential New Target for Dry Eye Disease-Oxidative Stress

Dry eye disease (DED) is a multifactorial condition affecting the ocular surface. It is characterized by loss of tear film homeostasis and accompanied by ocular symptoms that may potentially result in damage to the ocular surface and even vision loss. Unmodifiable risk factors for DED mainly include aging, hormonal changes, and lifestyle issues such as reduced sleep duration, increased screen exposure, smoking, and ethanol consumption. As its prevalence continues to rise, DED has garnered considerable attention, prompting the exploration of potential new therapeutic targets. Recent studies have found that when the production of ROS exceeds the capacity of the antioxidant defense system on the ocular surface, oxidative stress ensues, leading to cellular apoptosis and further oxidative damage. These events can exacerbate inflammation and cellular stress responses, further increasing ROS levels and promoting a vicious cycle of oxidative stress in DED. Therefore, given the central role of reactive oxygen species in the vicious cycle of inflammation in DED, strategies involving antioxidants have emerged as a novel approach for its treatment. This review aims to enhance our understanding of the intricate relationship between oxidative stress and DED, thereby providing directions to explore innovative therapeutic approaches for this complex ocular disorder.

Targeting the NRF2 pathway: A promising approach for corneal endothelial dysfunction

Maintaining corneal endothelial function is required for vision, and corneal endothelial dysfunction is a major cause of visual deficits and blindness worldwide. To date there has been a dearth of innovation for therapeutics targeting the corneal endothelium. However, recent advances in understanding the role of oxidative stress and mitochondrial dysfunction have revealed potential avenues for the development of new therapies. This review summarizes recent developments in elucidating the role of the NRF2 pathway in corneal endothelial health and disease, focusing specifically on Fuchs' endothelial corneal dystrophy and the loss of corneal endothelial cells associated with cataract surgery. The pro-mitochondrial and antioxidant phenotype elicited by NRF2 activation offers a promising opportunity for new therapeutics for the diseased corneal endothelium.

Oxidative stress and antioxidants in cataract development

PURPOSE OF REVIEW

Oxidative stress plays a central role in cataract pathogenesis, a leading cause of global blindness. This review delves into the role of oxidative stress in cataract development and key biomarkers - glutathione (GSH), superoxide dismutase (SOD), malondialdehyde (MDA), and 4-hydroxynonenal (4-HNE) - to clarify their functions and potential applications in predictive diagnostics and therapies.

RECENT FINDINGS

Antioxidants serve as pivotal markers in cataract pathogenesis. GSH affects the central lens due to factors such as enzyme depletion and altered connexin expression, impairing GSH diffusion. Age-related oxidative stress may hinder GSH transport via connexin channels or an internal microcirculation system. N-acetylcysteine, a GSH precursor, shows promise in mitigating lens opacity when applied topically. Additionally, SOD, particularly SOD1, correlates with increased cataract development and gel formulations have exhibited protective effects against posterior subscapular cataracts. Lastly, markers of lipid peroxidation, MDA and 4-HNE, have been shown to reflect disease severity. Studies suggest a potential link between 4-HNE and connexin channel modification, possibly contributing to reduced GSH levels.

SUMMARY

Oxidative stress is a significant contributor to cataract development, underscoring the importance of antioxidants in diagnosis and treatment. Notably, GSH depletion, SOD decline, and lipid peroxidation markers are pivotal factors in cataract pathogenesis, offering promising avenues for both diagnosis and therapeutic intervention.

Oxidative stress in the eye and its role in the pathophysiology of ocular diseases

Oxidative stress occurs through an imbalance between the generation of reactive oxygen species (ROS) and the antioxidant defense mechanisms of cells. The eye is particularly exposed to oxidative stress because of its permanent exposure to light and due to several structures having high metabolic activities. The anterior part of the eye is highly exposed to ultraviolet (UV) radiation and possesses a complex antioxidant defense system to protect the retina from UV radiation. The posterior part of the eye exhibits high metabolic rates and oxygen consumption leading subsequently to a high production rate of ROS. Furthermore, inflammation, aging, genetic factors, and environmental pollution, are all elements promoting ROS generation and impairing antioxidant defense mechanisms and thereby representing risk factors leading to oxidative stress. An abnormal redox status was shown to be involved in the pathophysiology of various ocular diseases in the anterior and posterior segment of the eye. In this review, we aim to summarize the mechanisms of oxidative stress in ocular diseases to provide an updated understanding on the pathogenesis of common diseases affecting the ocular surface, the lens, the retina, and the optic nerve. Moreover, we discuss potential therapeutic approaches aimed at reducing oxidative stress in this context.

Oxidative Stress Status and Its Relationship to Skin Aging

Skin and cellular aging are impacted by various toxins in our environment such as air pollution, water contamination, an increased prevalence of light-emitting diodes, electromagnetic frequencies, various yeast and other fungi, parasitic infections, and mold and heavy metal toxicity. Basic topical skin care is insufficient to adequately protect an individual's integumentary system and other organs from these types of daily cellular stressors. These stressors impact the level of oxidative stressstatus (OSS). OSS is measurable through biomarker analysis of various body fluids including blood, saliva, urine, and breath. This poses a unique assessment challenge for aesthetic practitioners as the OSS of a patient impacts their overall aging process. Aesthetic practitioners observe the aging process through visual assessment of a patient's skin quality, skin barrier function, and the presence of solar lentigines, erythema, edema, telangiectasia, loss of collagen and elastin, bone density, and redistribution of subcutaneous tissue. Mitigating a patient's daily exposure to OS and its impacts on the skin, other organ tissues, and metabolism poses a unique challenge in medical aesthetic treatment planning. For this reason, the use of stem cells and exosomes is gaining popularity in aesthetic medicine. The purpose of this literature review is to highlight currently available research, applications, limitations, and mitigation strategies in reducing OSS on the integumentary system and aging processes.

Lactobacillus fermentum HY7302 Improves Dry Eye Symptoms in a Mouse Model of Benzalkonium Chloride-Induced Eye Dysfunction and Human Conjunctiva Epithelial Cells

(1) We investigated the effects of the Lactobacillus fermentum HY7302 (HY7302) in a mouse model of benzalkonium chloride (BAC)-induced dry eye, and the possibility of using HY7302 as a food supplement for preventing dry eye. (2) The ocular surface of Balb/c mice was exposed to 0.2% BAC for 14 days to induce dry eye (n = 8), and the control group was treated with the same amount of saline (n = 8). HY7302 (1 × 10⁹ CFU/kg/day, 14 days, n = 8) was orally administered daily to the mice, and omega-3 (200 mg/kg/day) was used as a positive control. To understand the mechanisms by which HY7302 inhibits BAC-induced dry eye, we performed an in vitro study using a human conjunctival cell line (clone-1-5c-4). (3) The probiotic HY7302 improved the BAC-induced decreases in the corneal fluorescein score and tear break-up time. In addition, the lactic acid bacteria increased tear production and improved the detached epithelium. Moreover, HY7302 lowered the BAC-induced increases in reactive oxygen species production in a conjunctival cell line and regulated the expression of several apoptosis-related factors, including phosphorylated protein kinase B (AKT), B-cell lymphoma protein 2 (Bcl-2), and activated caspase 3. Also, HY7302 alleviated the expression of pro-inflammatory cytokines, such as interleukin-1β (IL-1β), IL-6, and IL-8, and also regulated the matrix metallopeptidase-9 production in the conjunctival cell line. (4) In this study, we showed that L. fermentum HY7302 helps prevent dry eye disease by regulating the expression of pro-inflammatory and apoptotic factors, and could be used as a new functional food composition to prevent dry eye disease.