Coculture of autologous limbal and conjunctival epithelial cells to treat severe ocular surface disorders: long-term survival analysis

BACKGROUND

Cultivated limbal epithelium for reconstruction of corneal surface is a well-established procedure; however, it is not adequate for damage which also extensively involves the conjunctiva. In severe cases of ocular surface damage that warrant additional conjunctival transplantation apart from cultivated limbal stem cell transplantation, we describe the long-term survival of a novel method of cocultivating autologous limbal and conjunctival epithelium on a single substrate.

MATERIALS AND METHODS

Forty eyes of 39 patients with severe limbal stem cell deficiency and conjunctival scarring or symblepharon underwent transplantation of autologous cocultivated epithelium on human amniotic membrane. A ring barrier was used to segregate the central limbal and peripheral conjunctival epithelia in vitro. Patients were followed up at regular intervals to assess stability of the ocular surface, defined by absence of conjunctivalization into the central 4 mm of the cornea and absence of diffuse fluorescein staining. Penetrating keratoplasty (PKP) was subsequently performed, where indicated, in patients with surface stability.

RESULTS

The cumulative survival probability was 60% at 1 year and 45% at 4 years by Kaplan-Meier analysis (mean follow-up duration: 33 ± 29 months, range: 1-87 months). Best-corrected visual acuity improved to greater than 20/200 in 38% eyes at the last follow-up, compared with 5% eyes before surgery. Immunohistochemistry in five of the corneal buttons excised for PKP showed an epithelial phenotype similar to cornea in all five.

CONCLUSIONS

Synchronous use of cultured limbal and conjunctival epithelium offers a feasible alternative and a simpler one-step surgical approach to treat severe ocular surface disorders involving limbus and conjunctiva.

Clinical outcomes of xeno-free autologous cultivated limbal epithelial transplantation: a 10-year study

PURPOSE

Ocular burns can damage the corneal epithelial stem cells located at the limbus. This study evaluated the efficacy of xeno-free autologous cell-based treatment of limbal stem cell deficiency.

METHODS

This retrospective study included 200 patients, above 8 years of age, with clinically diagnosed unilateral total limbal stem cell deficiency due to ocular surface burns treated between 2001 and 2010. A small limbal biopsy was obtained from the unaffected eye. The limbal epithelial cells were expanded ex vivo on human amniotic membrane for 10-14 days using a xeno-free explant culture system. The resulting cultured epithelial monolayer and amniotic membrane substrate were transplanted on to the patient's affected eye. Postoperative corneal surface stability, visual improvement and complications were objectively analysed.

RESULTS

A completely epithelised, avascular and clinically stable corneal surface was seen in 142 of 200 (71%) eyes at a mean follow-up of 3 ± 1.6 (range: 1-7.6) years. A two-line improvement in visual acuity, without further surgical intervention, was seen in 60.5% of eyes. All donor eyes remained healthy.

CONCLUSIONS

Autologous cultivated limbal epithelial transplantation using a xeno-free explant culture technique was effective in long-term restoration of corneal epithelial stability and improvement of vision in eyes with ocular surface burns.

Binocular interaction in post-LASIK subjects with unsatisfactory outcome

PURPOSE

A shift from binocular summation to binocular inhibition has been observed when there is a significant decrease in contrast sensitivity or reduced retinal illuminance in one eye compared to the other as in cases of unilateral cataract and amblyopia. This study aims to determine how binocular function in post-LASIK subjects with unsatisfactory outcomes is influenced by differences between the two eyes in visual acuity and contrast sensitivity.

MATERIALS AND METHODS

A retrospective analysis of monocular and binocular visual acuity (VA) and contrast sensitivity (CS) results was performed for 23 LASIK subjects who previously underwent a Functional Vision Test battery at Vision Sciences Research Corp. (San Ramon, CA). Photopic VA was measured with ETDRS chart and sine-wave grating CS was measured with FACT chart.

RESULTS

The difference between binocular and better monocular VA and CS was calculated for each subject and referred to as binocular difference. The interocular difference was calculated as better eye-worse eye for VA and CS. Significant negative correlations (P < 0.01) were observed between binocular difference and interocular difference for VA (r = -0.84) and CS at each spatial frequency of 1.5 (r = -0.90), 3 (r = -0.85), 6 (r = -0.79), 12 (r = -0.68), and 18c/d (r = -0.72). The greater the difference between the eyes, the lesser the binocular summation. Linear regression predicted a 1-line decrease in binocular summation for a 4-line increase in interocular acuity difference and a 35% decrease in binocular summation for a 50% increase in interocular difference of contrast sensitivity at 3c/d (ANOVA, P < 0.01).

CONCLUSIONS

Binocular inhibition in post-LASIK subjects increases as the visual sensitivity difference between the two eyes increases. Since the peak of human contrast sensitivity function is at the middle spatial frequencies, the decrease in binocular CS at 3c/d due to reduced CS in one eye is functionally significant.

Gas permeable (GP) versus non-GP lens wearers: accuracy of orthokeratology in myopia reduction

PURPOSE

The primary objective of this study is to determine whether there are significant differences in visual and refractive outcomes between gas permeable (GP) and non-GP wearers following a 1-month period of overnight orthokeratology (OK).

METHODS

The study included 14 subjects between the ages of 18 and 42 years. Group 1 consisted of six subjects wearing GP lenses for the correction of myopia for, at minimum, 1 year. Group 2 consisted of eight subjects wearing soft contact lenses or spectacles for the correction of myopia. All subjects were fit into the BE design in Boston XO material and lenses were worn for a period of 1 month. Unaided visual acuity using high (90%) and low (10%) contrast log MAR Bailey-Lovie vision charts, subjective refraction, corneal topography, and slit lamp evaluation were performed. Subjects were evaluated at day 1, 7, 14, 21, and 30.

RESULTS

One eye of each subject was considered for analysis; the eye with the better response was chosen based on post-OK measures. The mean post-OK spherical equivalent was 0.29 +/- 0.55 D in the GP group and 0.37 +/- 0.46 D in the non-GP group; the difference was statistically significant (p = 0.03). Baseline astigmatism decreased in the non-GP group after OK while there was no significant change in the GP group. The mean high contrast acuities were 0.06 +/- 0.12 in the GP group and 0.17 +/- 0.07 in the non-GP group (p = 0.05), whereas the low contrast acuities were 0.18 +/- 0.17 in the GP and 0.02 +/- 0.09 in the non-GP group (p = 0.01).

CONCLUSIONS

Although the non-GP group has higher post-OK visual acuity and spherical equivalent statistically, the GP group has attained an average unaided acuity of >20/20 and residual myopia <0.5 D. Clinically, this shows that OK can be a promising technique in GP wearers.

Evidence for the involvement of JAK/STAT pathway in the signaling mechanism of interleukin-17

Interleukin-17 is a T-cell-derived pro-inflammatory cytokine, exhibiting multiple biological activities in a variety of cells and believed to fine tune all general phases of hematopoietic response. However, the signaling mechanism of this novel cytokine remains unknown. Here, we report for the first time that the early signaling events triggered by interleukin-17 involve tyrosine phosphorylation of several members of the JAK and STAT proteins in human U937 monocytic leukemia cells. Immunoprecipitation with specific antibodies followed by Western blot analysis with antiphosphotyrosine antibody has shown that in U937 cells, interleukin-17 induces time-dependent stimulation of tyrosine phosphorylation of JAK 1, 2 and 3, Tyk 2 and STAT 1, 2, 3 and 4 within 0.5 to 30 min. Interleukin-17-mediated tyrosine phosphorylation of these proteins strongly suggests that the JAK/STAT signaling pathway may play a major role in transducing signals from interleukin-17 receptors to the nucleus.

Interleukin-17 induces rapid tyrosine phosphorylation and activation of raf-1 kinase in human monocytic progenitor cell line U937

Interleukin-17 is a T cell derived pro-inflammatory cytokine exhibiting multiple biological activities in a variety of cells and believed to fine tune all general phases of hematopoietic response. However, the signaling mechanism of this novel cytokine remains unknown. The purpose of this study was to determine whether Interleukin-17 induces tyrosine phosphorylation of proteins and to find out whether the raf-1 kinase signaling pathway is involved in mediating its signaling. Using immunoblotting and immunocomplex kinase assays, we report that the early signaling events triggered by rhIL-17 involves rapid tyrosine phosphorylation of several cellular proteins including raf-1 within 0.5 to 30 min. Optimal stimulation of tyrosine phosphorylation was observed with 0.5 to 1.0 ng/ml of Interleukin-17. Further, Interleukin-17 stimulates rapid activation of raf-1 kinase. These findings provide the first evidence that the mechanism of IL-17 signaling involves rapid tyrosine phosphorylation and activation of raf-1 serine/threonine kinase.

Nonhomologous RNA-RNA recombination events at the 3' nontranslated region of the Sindbis virus genome: hot spots and utilization of nonviral sequences

The mechanism of RNA-RNA recombination at the 3' nontranslated region (3'NTR) of the Sindbis virus (SIN) genome was studied by using nonreplicative RNA precursors. The 11.7-kb SIN genome was transcribed in vitro as two nonoverlapping RNA fragments. RNA-1 contained the entire 11.4-kb protein coding sequence of SIN and also carried an additional 1.8-kb nonviral sequence at its 3' end. RNA-2 carried the remaining 0.26 or 0.3 kb of the SIN genome containing the 3'NTR. Transfection of these two fragments into BHK cells resulted in vivo RNA-RNA recombination and release of infectious SIN recombinants. Eighteen plaque-purified recombinant viruses were sequenced to precisely map the RNA-RNA crossover sites at the 3'NTR. Sixteen of the 18 recombinants were found to be genetically heterogeneous at the 3'NTR. Two major clustered sites within the 3'NTR of RNA-2 were found to be fused to multiple locations on the nonviral sequence of RNA-1, resulting in insertions of 10 to 1,085 nucleotides at the 3'NTR. Sequence analysis of crossover sites suggested only limited homology and heteroduplex-forming capability between substrate RNAs. Analysis of additional 23 recombinant viruses generated by mutagenized donor and acceptor templates supports the occurrence of recombination hot spots on donor templates. Introduction of a 17-nucleotide rudimentary replicase recognition signal in the acceptor template alone did not induce the polymerase to reinitiate at the 17-nucleotide signal. Interestingly, deletion of a 24-nucleotide hot spot locus on the donor template abolished crossover events at one of the two sites and allowed the polymerase to reinitiate at the 17-nucleotide replicase recognition signal inserted at the acceptor template. The possible roles of RNA-protein and RNA-RNA interactions in the differential regulation of apparent pausing, template selection, and reinitiation are discussed.

Genesis of Sindbis virus by in vivo recombination of nonreplicative RNA precursors

Genetically engineered RNA transcripts coding for various Sindbis virus (SIN) genes were used to study structure and sequence requirements of RNA recombination in BHK cells. Three different groups of RNA transcripts were made: (i) RNAs which retain the ability to replicate and which carry sequences coding for either viral polymerase or viral structural proteins; (ii) RNAs which lack the complete 3' end of the SIN genome and thus are incapable of replicating; and (iii) RNAs which lack the complete 5' end of the SIN genome and also are incapable of replicating. BHK cells were transfected with specific combinations of these precursor RNAs, and virus production and RNA synthetic abilities of the released virus were determined. We demonstrate in vivo generation of infectious SIN by fusion of (i) replicative RNAs to nonreplicative RNAs and (ii) two nonreplicative RNA precursors. Both homologous and nonhomologous types of recombinations were observed. In the homologous type of recombination, a 694-nucleotide overlap at the crossover region of the first pair of precursors resulted in the addition of an A residue converting the UAG stop codon of nonstructural protein P4 to a UAA stop codon. In the nonhomologous type of recombination, the crossover sites contained deletion of up to 76 nucleotides from one of the precursors and complete preservation of junction sequence from the other precursor. This is also the first report that a cytoplasmic RNA virus can be generated from biologically nonreplicative RNA precursors. These results have implications for initiation of viral RNA synthesis and recombination between RNA viral genomes in general. We favor template switching as a mechanism for the fusion events described here and suggest inclusion of polymerase scanning of diverse nonreplicative RNAs as an inherent feature of the copy choice model of RNA recombination. Very importantly, the facile nature of RNA recombination occurring between nonreplicative RNA precursors should speed up the production and analysis of targeted mutants of SIN and possibly other RNA viruses.

Multivalent RNA probes and their use in the quantitation of multiple and non-homologous RNA species immobilized onto nylon membranes

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