Correlation between serum cytokine levels and the effect of allogeneic serum-based eye drops

INTRODUCTION

The Institute of Hematology and Transfusion Medicine (IHTM) in Warsaw has produced autologous serum eye drops (ASEDs) for the treatment of Dry Eye Syndrome (DES) since 1991. In 2019, IHTM introduced allogeneic tears (alloSEDs) for patients on long-term treatment.

MATERIALS AND METHODS

114 patients who applied alloSEDs were included in the study.They were asked to complete the OSDI questionnaire before and after using ASEDs and 100 units of alloSEDs drops from each donation. The OSDI index rates DES severity (0 no symptoms; 100 severe). We also compared the content of IL-1β, IL-2, IL- 6, IL-10 and VEGF in ASEDs (38 samples) and alloSEDs (15 serum samples). The study data covered the 2019-2022 period.

RESULTS

114 patients participated in the study. We compared the the effectiveness of ASEDs and alloSEDs. The average, OSDI dropped from 68.42 ± 5,86 (before application) to 51.05 ± 19,06 (after application). Data from the questionnaires (prepared at IHTM) completed and returned (41/114) present the most common indications for the use of serum drops, including DES with no underlying disease, DES secondary to GvHD (Graft versus Host Disease), Sjögren's Syndrome (SS). The study reported higher cytokine levels associated with disease entities such as SS. After application of drops with high cytokine levels, patients reported adverse reactions such as sand under the eyelids, impaired visual acuity, and worse eye lubrication.

CONCLUSIONS

AlloSEDs with acceptably low values of pro-inflammatory cytokines and sufficiently high levels of VEGF growth factor may contribute to alleviation of inflammatory eye symptoms.

[Culinary arts as reinforcement for paediatric end-of-life suffering]

This article presents a support model of paediatric suffering based on a culinary activity guided by the nurse. It is based on a clinical end-of-life situation for a child in a Cameroon hospital. The caring approach helps to strengthen psycho-emotional links between the child and his/her loved ones, and to ease anxieties around the mother/child dyad.

Stenotic Bicuspid and Tricuspid Aortic Valves - Micro-Computed Tomography and Biological Indices of Calcification

BACKGROUND

Valve calcification is well estimated by ex-vivo micro-computed tomography (micro-CT). The objective of this study was to investigate the associations between micro-CT findings and biological indices of calcification in aortic stenosis (AS), as well as differences between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV).Methods and Results:Aortic valves and plasma were obtained from patients undergoing valve surgery. Valves were dissected and underwent micro-CT, genetic analyses, and calcium content assessment. Plasma levels of calcification markers were measured. Forty-two patients with isolated severe AS, including 22 with BAV, were studied. BAV patients had a lower median CT value (140.0 [130.0-152.0] vs. 157.0 [147.0-176.0], P=0.002) and high-density calcification (HDC) fraction (9.3 [5.7-23.3] % vs. 21.3 [14.3-31.2] %, P=0.01), as compared with TAV. Calcification fraction (CF) correlated with AS severity (measured as maximal transvalvular pressure gradient [r=0.34, P=0.03], maximal flow velocity [r=0.38, P=0.02], and indexed aortic valve area [r=-0.37, P=0.02]). For TAV patients only, mRNA expression of integrin-binding sialoprotein correlated with CF (r=0.45, P=0.048), and the receptor activator of the nuclear factor κ-B ligand transcript correlated with HDC corrugation (r=0.54, P=0.01).

CONCLUSIONS

TAV patients with AS present more mineralized calcifications in micro-CT than BAV subjects. The relative volume of calcifications increases with the AS severity. In TAV patients, upregulated expression of genes involved in osteoblastogenesis in AS correlates with leaflet mineralization in micro-CT.

Triple therapy: Phaco-vitrectomy with ILM peeling, retinal endophotocoagulation, and intraoperative use of bevacizumab for diffuse diabetic macular edema

BACKGROUND

The aim of this study was to evaluate the visual acuity and structural outcomes of combined phacovitrectomy with ILM peeling, retinal endophotocoagulation and use of bevacizumab in patients with diffuse diabetic macular edema (DDME).

MATERIAL/METHODS

In this prospective, nonrandomized, interventional study we included 29 eyes of 26 patients with DDME. The best-corrected visual acuity (BCVA) and central retinal thickness and volume (CRT and CRV) were recorded at 4, 8, 12, and 16 months after surgery.

RESULTS

The mean preoperative BCVA was 0.74±0.36 logMAR (0.3-1.5) and improved finally to 0.4±0.24 logMAR (-0.1-1.0) p=0.000006. The mean preoperative CRT in the 1mm zone was 516±184 microm (256-950) and decreased postoperatively at the last control to 237±75 microm (117-489) p=0.000003. The mean preoperative CRV in the 1mm zone was 0.39±0.14 microL (0.19-0.74) and decreased postoperatively at the last control to 0.17±0.06 microL (0.09-0.36) p=0.000003. The mean preoperative CRT in the 6 mm zone was 407±105 microm (279-640) and decreased postoperatively at the last control to 282±40 µm (212-380) p=0.000004. The mean preoperative CRV in the 6 mm zone was 11.4±2.9 microL (7.85-17.93) and decreased postoperatively at the last control to 7.92±1.0 microL (5.62-10.97) p=0.000003. The 23 (79.3%) eyes showed improvement in BCVA ≥0.2 logMAR, 5 (17.2%) eyes improvement or stabilization of BCVA and 1(3.5%) eye deterioration. Preoperative BCVA was a positive factor for prognosis of BCVA at 12th month follow-up (b=0.42; p=0.006), while the negative factors were: previous panretinal photocoagulation (b=-0.24; p=0.04), presence of vitreomacular traction (b=-0.29; p=0.02) and preoperative CRT in the 1000 microm zone (b=-0.24; p=0.07). A greater visual acuity improvement occurred in eyes with worse baseline visual acuity (b=-1.01; p=0.00001). The presentation of vitreomacular traction (b=-0.38; p=0.02), previous panretinal photocoagulation (b=-0.31, p=0.04) and greater preoperative CRT in the 1000 µm zone (b=-0.31; p=0.07) were negative factors for visual improvement.

CONCLUSIONS

This combined treatment resulted in improvement or stabilization of BCVA and decrease of CRT and CRV. Larger comparative studies are necessary to establish the real impact of this therapeutic approach.

[Combined surgical and pharmacological treatment of diabetic maculopathy]

There are at least three avenues of investigation that support the theoretical value of vitrectomy for the treatment of DME, based on (1) vitrectomy with ILM peeling for the relief of traction on the macula, (2) vitrectomy to improve oxygenation of the macula leading to decreased vascular permeability with subsequent resolution or decrease in DME, and (3) ILM peeling to remove a part of the Müller cell endfeet and the horizontal gliosis. Visual improvement could be due to the induction of a higher overexpression of GFAP at the Müller cells level. It is likely that the proliferation of GFAP-stained gliofibrils, observed in these cells, preserves the blood-retinal barrier, reinforces architectural cohesion, and opposes the installation of the edema. In addition, the search for a specific pharmacological treatment is ongoing on the basis of new findings regarding the involvement of cytokines and growth factors in the formation of macular edema. Vascular endothelial growth factor (VEGF), inhibitors are currently being investigated in clinical studies. However, endogenous VEGF is required for visual function. Growing body evidence indicates that VEGF acts also on nonvascular cells, it plays survival role on Müller cells and photoreceptors. Therefore anti-VEGF therapies should be administered with caution.

Müller glial cells--the mediators of vascular disorders with vitreomacular interface pathology in diabetic maculopathy

The key to identifying the type of diabetic maculopathy is determining the status of posterior vitreous adhesion. In the pathological state, the breakdown of the internal and external blood-retina barrier is evident, however the mechanism is usually complex. The common denominator for these disorders are Müller glial cells, which mediate in maintaining the blood-retina barrier by linking the vessels, neurons and the vitreous in anatomical network and into functional dependence. The breakdown of the blood-retina barrier results in proliferation of Müller cells. Molecular changes in these cells increase endothelial barrier properties, but also induce pathological processes on the vitreo-retinal junction, resulting in increased adhesiveness of the collagen fibers of vitreous to retinal internal limiting membrane. The ability of Müller cells to reactive gliosis is influenced by the healthy functioning of the retinal pigment epithelium, which is a source of trophic factors necessary for appropriate Müller cells morphogenesis. Vitrectomy with the removal of ILM eliminates the vitreofoveal interface pathology, additionally provoking reactive gliosis within the macula. Intraoperative use of anti-VEGF supports short-term tightness of the blood-retina barrier in the perioperative neuralgic period. In the future, supplying astrocytes may be a strategy that will allow not only the inhibition of pathological neovascularization but also the restoration of the physiological network of capillaries in avascular retina areas. The delivery of recombinant PEDF allows for the recovery of Müller cells, and thus creates the conditions favourable for the survival of nerve cells in loss of retinal homeostasis.

[Role of the retinal pigment epithelium (RPE) in the pathogenesis and treatment of diabetic macular edema (DME)]

Pigment epithelium-derived factor (PEDF) has recently been shown to be the most potent inhibitor of angiogenesis in the mammalian eye, suggesting that loss of PEDF is involved in the pathogenesis of proliferative diabetic retinopathy. However, a protective role for PEDF in pericyte loss requires elucidation. Present studies suggest that PEDF proteins could protect against advanced glycation end product (AGE), which induce injury in retinal pericytes. Substitution of PEDF proteins may be a promising strategy in the treatment of patients with early diabetic retinopathy. Therefore, injury of RPE is the basic condition, not only of the progress of neovascularization, but initiation of early diabetic microangiopathy and macular edema as well. Recently new intravitreal drugs being used in the treatment of eye diseases with increased level of VEGE. Intravitreally administered a human, monoclonal anti-VEGF agent acts only as symptomatic treatment. It does not eliminate hypoxia and requires repeated administration. It is worth emphasizing, that VEGF functions are not limited to active angiogenesis, but also seems to require the maintenance and differentiation of mature blood vessels, such as the choriocapillaris. Therefore, delivery of these anti-VEGF treatments needs to be specific to sites of neovascularization or limited to a short duration, to prevent disruption of the normal vasculature. The effective method, which preserves RPE, improves oxygenation and release traction on the macula, leading to decreased permeability with subsequent resolution in DME, is pars plana vitrectomy with ILM peeling. There are several investigations that support the theoretical value of vitrectomy for the treatment of DME. Intraoperative administration of anti-VEGF agent and corticosteroids may additionally improve results of operative treatment.

[Current concepts in the pathogenesis of glaucomatous optic neuropathy]

On the basis of review of available literature, the concept of vascular dysregulation, excitotoxicity in the pathogenesis of glaucoma, and influence of intraocular pressure and immunology system on mechanism of glaucomatous optic neuropathy was described.

[Health status of individuals dependent on opiates before and after a year of treatment in a methadone maintenance program]

The aim of this study was to compare physical status of opiate dependent patients before and after one year of participation in the methadone maintenance program (MMP). There were investigated all 113 patients (82 male, 31 female) participating in MMP no shortly then one year. There was been used an especially constructed list of physical disorders and illnesses, where severity of them was scored from 0 to 3 points. We found a great influence of a participation in MMP on an use of forbidden substances, what caused that nobody of our patients overdosed drugs. Reducing of intravenous use of drugs and a change of lifestyle caused that nobody from our 67 HIV-negative patients infected with HIV. Thanks MMP was able the systematic and successful treatment of the most common physical illnesses: superficial venous system and skin infections, internal organs mycoses, lowered body mass index, lack of menstruation, and relatively rarer ones: hypertonia, sexually transmitted diseases, tuberculosis etc. The serious problem was liver impairments of different origin, in majority cases.

IN CONCLUSION

MMPs should develop in Poland more quickly and more commonly.

[Use of urinary beta-hexosaminidase for diagnosing alcoholism in persons with opiate dependency in a methadone substitution program]

Usefulness of urinary beta-hexosaminidase determinations in patients on methadone substitution to pinpoint cases of alcohol abuse was studied. It was found that methadone, illegal drugs and HIV seropositivity had no effect upon the activity of this enzyme. The enzyme activity was significantly higher in patients who admitted to occasional heavy drinking than in those who declared abstinence (p = 0.014), and in healthy controls (p = 5*10(-8)), but still lower than in alcohol dependent persons undergoing detoxification (p = 0.024). In the group of opiate dependent persons in methadone substitution program the sensitivity of the test was 87% and the specificity--80%.