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Naaman E, Malul N, Safuri S, Bar N, Pollack S, Magen D, Leibu R, Perlman I, Zayit-Soudry S. Reduced Electroretinogram Responses in Morphologically Normal Retina in Patients with Primary Hyperoxaluria Type 1. Ophthalmol Sci 2023; 3:100268. [PMID: 36909147 PMCID: PMC9996110 DOI: 10.1016/j.xops.2022.100268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023]
Abstract
Purpose To describe ocular findings in individuals with primary hyperoxaluria type 1 (PH1), focusing on the correlations between retinal anatomy and retinal function. To characterize the retinal alterations that occur at different disease stages by evaluating individuals with diverse degrees of renal impairment associated with PH1. Design A cross-sectional study. Participants Patients diagnosed with PH1 based on clinical criteria and genetic testing, treated in the Pediatric Nephrology Unit of the Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel between 2013 and 2021. Methods The ophthalmological assessment included a slit-lamp biomicroscopy of the anterior and posterior segment or indirect ophthalmoscopy. Electroretinography was employed for assessment of the retinal function, and retinal imaging included spectral-domain OCT and fundus autofluorescence. A systematic evaluation of the disease stage was based on clinical criteria including physical examination, purposeful imaging (X-ray, echocardiography, and US abdomen), and laboratory tests as needed. Main Outcome Measures Anatomical and functional assessment of the retina in patients with PH1, and the relationship between retinal dysfunction and kidney impairment. Results A total of 16 eyes were examined in the study of 8 children ranging in age from 4 to 19 years. Four eyes (25%) showed normal structural and functional retinal findings, 8 eyes (50%) presented functional impairment in the absence of pathological structural findings, and 4 eyes (25%) had advanced retinal damage that manifested as significant morphological and functional impairment. There was no direct relationship between the severity of the renal disease and the severity of the retinal phenotype. Conclusions Subjects with PH1 present varying severity levels of the retinal phenotype, with possible discrepancy between the clinical retinal morphology and the retinal function noted on electroretinography. These findings raise questions about the molecular basis of the retinal manifestations in PH1. The presence of functional impairment in the absence of evident crystal deposition in the retina suggests that, in addition to oxalate crystal accumulation, other biomolecular processes may play a role in the development of retinopathy.
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Affiliation(s)
- Efrat Naaman
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Netta Malul
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shadi Safuri
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Nitai Bar
- Department of Radiology, Rambam Health Care Campus, Haifa, Israel
| | - Shirley Pollack
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Nephrology Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Daniella Magen
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Nephrology Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Rina Leibu
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Ido Perlman
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shiri Zayit-Soudry
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Owsley C, Swain TA, McGwin G, Clark ME, Kar D, Curcio CA. Biologically Guided Optimization of Test Target Location for Rod-mediated Dark Adaptation in Age-related Macular Degeneration: Alabama Study on Early Age-related Macular Degeneration 2 Baseline. Ophthalmol Sci 2023; 3:100274. [PMID: 36875335 PMCID: PMC9978854 DOI: 10.1016/j.xops.2023.100274] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
Purpose We evaluate the impact of test target location in assessing rod-mediated dark adaptation (RMDA) along the transition from normal aging to intermediate age-related macular degeneration (AMD). We consider whether RMDA slows because the test locations are near mechanisms leading to or resulting from high-risk extracellular deposits. Soft drusen cluster under the fovea and extend to the inner ring of the ETDRS grid where rods are sparse. Subretinal drusenoid deposits (SDDs) appear first in the outer superior subfield of the ETDRS grid where rod photoreceptors are maximal and spread toward the fovea without covering it. Design Cross-sectional. Participants Adults ≥ 60 years with normal older maculas, early AMD, or intermediate AMD as defined by the Age-Related Eye Disease Study (AREDS) 9-step and Beckman grading systems. Methods In 1 eye per participant, RMDA was assessed at 5° and at 12° in the superior retina. Subretinal drusenoid deposit presence was identified with multi-modal imaging. Main Outcome Measures Rod intercept time (RIT) as a measure of RMDA rate at 5° and 12°. Results In 438 eyes of 438 persons, RIT was significantly longer (i.e., RMDA is slower) at 5° than at 12° for each AMD severity group. Differences among groups were bigger at 5° than at 12°. At 5°, SDD presence was associated with longer RIT as compared to SDD absence at early and intermediate AMD but not in normal eyes. At 12°, SDD presence was associated with longer RIT in intermediate AMD only, and not in normal or early AMD eyes. Findings were similar in eyes stratified by AREDS 9-step and Beckman systems. Conclusions We probed RMDA in relation to current models of deposit-driven AMD progression organized around photoreceptor topography. In eyes with SDD, slowed RMDA occurs at 5° where these deposits typically do not appear until later in AMD. Even in eyes lacking detectable SDD, RMDA at 5° is slower than at 12°. The effect at 5° may be attributed to mechanisms associated with the accumulation of soft drusen and precursors under the macula lutea throughout adulthood. These data will facilitate the design of efficient clinical trials for interventions that aim to delay AMD progression.
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Affiliation(s)
- Cynthia Owsley
- Department of Ophthalmology & Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Thomas A. Swain
- Department of Ophthalmology & Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gerald McGwin
- Department of Ophthalmology & Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark E. Clark
- Department of Ophthalmology & Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Deepayan Kar
- Department of Ophthalmology & Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christine A. Curcio
- Department of Ophthalmology & Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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McGwin G, Kar D, Berlin A, Clark ME, Swain TA, Crosson JN, Sloan KR, Owsley C, Curcio CA. Macular and Plasma Xanthophylls Are Higher in Age-related Macular Degeneration than in Normal Aging: Alabama Study on Early Age-related Macular Degeneration 2 Baseline. Ophthalmol Sci 2023; 3:100263. [PMID: 36864830 PMCID: PMC9972499 DOI: 10.1016/j.xops.2022.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/04/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Purpose Quantification of retinal xanthophyll carotenoids in eyes with and without age-related macular degeneration (AMD) via macular pigment optical volume (MPOV), a metric for xanthophyll abundance from dual wavelength autofluorescence, plus correlations to plasma levels, could clarify the role of lutein (L) and zeaxanthin (Z) in health, AMD progression, and supplementation strategies. Design Cross-sectional observational study (NCT04112667). Participants Adults ≥ 60 years from a comprehensive ophthalmology clinic, with healthy maculas or maculas meeting fundus criteria for early or intermediate AMD. Methods Macular health and supplement use was assessed by the Age-related Eye Disease Study (AREDS) 9-step scale and self-report, respectively. Macular pigment optical volume was measured from dual wavelength autofluorescence emissions (Spectralis, Heidelberg Engineering). Non-fasting blood draws were assayed for L and Z using high-performance liquid chromatography. Associations among plasma xanthophylls and MPOV were assessed adjusting for age. Main Outcome Measures Age-related macular degeneration presence and severity, MPOV in fovea-centered regions of radius 2.0° and 9.0°; plasma L and Z (μM/ml). Results Of 809 eyes from 434 persons (89% aged 60-79, 61% female), 53.3% eyes were normal, 28.2% early AMD, and 18.5% intermediate AMD. Macular pigment optical volume 2° and 9° were similar in phakic and pseudophakic eyes, which were combined for analysis. Macular pigment optical volume 2° and 9° and plasma L and Z were higher in early AMD than normal and higher still in intermediate AMD (P < 0.0001). For all participants, higher plasma L was correlated with higher MPOV 2° (Spearman correlation coefficient [Rs] = 0.49; P < 0.0001). These correlations were significant (P < 0.0001) but lower in normal (Rs = 0.37) than early and intermediate AMD (Rs = 0.52 and 0.51, respectively). Results were similar for MPOV 9°. Plasma Z, MPOV 2°, and MPOV 9° followed this same pattern of associations. Associations were not affected by supplement use or smoking status. Conclusions A moderate positive correlation of MPOV with plasma L and Z comports with regulated xanthophyll bioavailability and a hypothesized role for xanthophyll transfer in soft drusen biology. An assumption that xanthophylls are low in AMD retina underlies supplementation strategies to reduce progression risk, which our data do not support. Whether higher xanthophyll levels in AMD are due to supplement use cannot be determined in this study.
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Key Words
- ALSTAR2, Alabama Study on Early Age-related Macular Degeneration 2
- AMD, age-related macular degeneration
- AREDS, age-related eye disease studies
- Age-related macular degeneration
- Autofluorescence
- BrM, Bruch’s membrane
- HDL, high density lipoprotein
- L, Lutein
- Lutein
- MP, macular pigment
- MPOD, macular pigment optical density
- MPOV, macular pigment optical volume
- Macular xanthophyll pigment
- RPE, retinal pigment epithelium
- Z, Zeaxanthin
- Zeaxanthin
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Affiliation(s)
- Gerald McGwin
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Deepayan Kar
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andreas Berlin
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Ophthalmology, University Hospital Wurzburg, Wurzburg, Germany
| | - Mark E. Clark
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Thomas A. Swain
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jason N. Crosson
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Retina Consultants of Alabama, Birmingham, Alabama
| | - Kenneth R. Sloan
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Computer Science, School of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christine A. Curcio
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Mititelu M, Uschner D, Doherty L, Bjornstad P, Domalpally A, Drews KL, Gubitosi-Klug R, Levitsky LL, Pak JW, White NH, Blodi BA. Retinal Thickness and Morphology Changes on OCT in Youth with Type 2 Diabetes: Findings from the TODAY Study. Ophthalmol Sci 2022; 2:100191. [PMID: 36531589 PMCID: PMC9754955 DOI: 10.1016/j.xops.2022.100191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/13/2022] [Accepted: 06/22/2022] [Indexed: 06/17/2023]
Abstract
Objective To evaluate changes in retinal thickness and morphology using OCT in youth with type 2 diabetes (T2D) and to identify systemic biomarkers correlating with these changes. Design Retrospective subgroup analysis of a prospective study. Participants Participants who underwent OCT imaging in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) trial and its follow-up study TODAY2. Methods In 2010-2011 (TODAY) and 2017-2018 (TODAY2), 6 × 6-mm macular volume OCT scans were acquired, segmented, and analyzed to generate total retinal thickness, inner retinal thickness, and outer retinal thickness. The main retinal morphologies graded were intraretinal cystoid spaces, subretinal fluid, and posterior vitreous detachment (PVD). Main Outcome Measures Changes in total and individual retinal layer thickness and development of abnormal vitreomacular morphology between TODAY and TODAY2. Results Participants had a mean age of 17.9 ± 2.4 years and glycated hemoglobin (HbA1c) of 8.2 ± 2.8% in TODAY and a mean age of 25.0 ± 2.4 years and mean HbA1c of 9.5 ± 2.8% in TODAY2. Longitudinally between assessments, there were overall decreases in outer retinal thickness from 167.2 ± 11.5 microns to 158.4 ± 12.8 microns (P < 0.001) and in photoreceptor thickness from 30.3 ± 2.9 microns to 29.8 ± 4.1 microns (P = 0.04) in the central subfield, while in the inner subfield, we noted a decrease in outer retinal thickness from 150.5 ± 10.1 microns to 144.9 ± 10.5 microns (P < 0.001) and an increase in inner retinal thickness from 136.9 ± 11.5 microns to 137.4 ± 12.6 microns (P = 0.01). Multivariate analysis showed that in the center subfield, HbA1c increases were associated with increases in total retinal thickness (r: 0.67, P = 0.001), whereas fasting glucose was positively correlated with inner retinal thickness (r: 0.02, P = 0.02). In the inner subfield, both systolic (r: -0.22, P < 0.001) and diastolic (r: -0.22, P = 0.003) blood pressures were negatively correlated with total retinal thickness. There was an increase in PVD (18.9%) and cystoid spaces (4.2%). Conclusions Youth with T2D develop retinal thickness changes on OCT, including increases in total retinal and inner retinal thickness in the center subfield that correlate with HbA1c and fasting glucose, respectively. Taken together with the increased prevalence of abnormal vitreomacular morphology in this cohort at risk, these findings emphasize the importance of controlling risk factors to prevent the development of sight-threatening retinal complications.
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Key Words
- DR, diabetic retinopathy
- EZ, ellipsoid zone
- Glycemic control
- HbA1c, glycated hemoglobin
- ILM, internal limiting membrane
- INL, inner nuclear layer
- Macular morphology
- NPDR, nonproliferative DR
- OPL, outer plexiform layer
- PVD, posterior vitreous detachment
- Posterior vitreous detachment
- RPE, retinal pigment epithelium
- Retinal thickening
- SD-OCT, spectral-domain OCT
- T2D, type 2 diabetes
- TD-OCT, time-domain OCT
- TODAY, Treatment Options for Type 2 Diabetes in Adolescents and Youth
- Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study
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Affiliation(s)
- Mihai Mititelu
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Diane Uschner
- The Biostatistics Center, George Washington University, Rockville, Maryland
| | - Lindsay Doherty
- The Biostatistics Center, George Washington University, Rockville, Maryland
| | - Petter Bjornstad
- University of Colorado, School of Medicine, Department of Pediatrics, Section of Endocrinology, Department of Medicine, Division of Renal Diseases and Hypertension, Denver, Colorado
| | - Amitha Domalpally
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kimberly L. Drews
- The Biostatistics Center, George Washington University, Rockville, Maryland
| | | | - Lynne L. Levitsky
- MassGeneral for Children, Harvard Medical School, Boston, Massachusetts
| | - Jeong W. Pak
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Neil H. White
- School of Medicine, Washington University, St. Louis, Missouri
| | - Barbara A. Blodi
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Sim RZH, Tham YC, Betzler BK, Zhou L, Wang X, Sabanayagam C, Cheung GCM, Wong TY, Cheng CY, Nusinovici S. Relationships between Lipid-Related Metabolites and Age-Related Macular Degeneration Vary with Complement Genotype. Ophthalmol Sci 2022; 2:100211. [PMID: 36531576 PMCID: PMC9755028 DOI: 10.1016/j.xops.2022.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Lipid dysregulation and complement system (CS) activation are 2 important pathophysiology pathways for age-related macular degeneration (AMD). We hypothesized that the relationship between lipids and AMD may also differ according to CS genotype profile. Thus, the objective was to investigate the relationships between lipid-related metabolites and AMD according to CS genotypes. DESIGN Population-based cross-sectional study. PARTICIPANTS A total of 6947 participants from Singapore Epidemiology of Eye Diseases study with complete relevant data were included. METHODS We investigated a total of 32 blood lipid-related metabolites from nuclear magnetic resonance metabolomics data including lipoproteins and their subclasses, cholesterols, glycerides, and phospholipids, as well as 4 CS single nucleotide polymorphisms (SNPs): rs10922109 (complement factor H), rs10033900 (complement factor I), rs116503776 (C2-CFB-SKIV2L), and rs2230199 (C3). We first investigated the associations between AMD and the 32 lipid-related metabolites using multivariable logistic regression models. Then, to investigate whether the effect of lipid-related metabolites on AMD differ according to the CS SNPs, we tested the possible interactions between the CS SNPs and the lipid-related metabolites. MAIN OUTCOME MEASURES Age-related macular degeneration was defined using the Wisconsin grading system. RESULTS Among the 6947 participants, the prevalence of AMD was 6.1%, and the mean age was 58.3 years. First, higher levels of cholesterol in high-density lipoprotein (HDL) and medium and large HDL particles were associated with an increased risk of AMD, and higher levels of serum total triglycerides (TG) and several very-low-density lipoprotein subclass particles were associated with a decreased risk of AMD. Second, these lipids had significant interaction effects on AMD with 2 CS SNPs: rs2230199 and rs116503776 (after correction for multiple testing). For rs2230199, in individuals without risk allele, higher total cholesterol in HDL2 was associated with an increased AMD risk (odds ratio [OR] per standard deviation increase, 1.20; 95% confidence interval (CI), 1.06-1.37; P = 0.005), whereas, in individuals with at least 1 risk allele, higher levels of these particles were associated with a decreased AMD risk (OR, 0.69; 95% CI, 0.45-1.05; P = 0.079). Conversely, for rs116503776, in individuals without risk allele, higher serum total TG were associated with a decreased AMD risk (OR, 0.84; 95% CI, 0.74-0.95; P = 0.005), whereas, in individuals with 2 risk alleles, higher levels of these particles were associated with an increased risk of AMD (OR, 2.3, 95% CI, 0.99-5.39, P = 0.054). CONCLUSIONS Lipid-related metabolites exhibit opposite directions of effects on AMD according to CS genotypes. This indicates that lipid metabolism and CS may have synergistic interplay in the AMD pathogenesis.
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Key Words
- AMD, age-related macular degeneration
- Age-related macular degeneration
- CFH, complement factor H
- CS, complement system
- Complement system
- HDL, high-density lipoprotein
- Lipids
- Metabolites
- NMR, nuclear magnetic resonance
- OR, odds ratio
- RPE, retinal pigment epithelium
- SNP, single nucleotide polymorphism
- TG, triglycerides
- VLDL, very-low–density lipoprotein
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Affiliation(s)
- Ralene Zi Hui Sim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | | | - Lei Zhou
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Xiaomeng Wang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Gemmy Chiu Ming Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Simon Nusinovici
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
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Kihara Y, Shen M, Shi Y, Jiang X, Wang L, Laiginhas R, Lyu C, Yang J, Liu J, Morin R, Lu R, Fujiyoshi H, Feuer WJ, Gregori G, Rosenfeld PJ, Lee AY. Detection of Nonexudative Macular Neovascularization on Structural OCT Images Using Vision Transformers. Ophthalmol Sci 2022; 2:100197. [PMID: 36531577 PMCID: PMC9754966 DOI: 10.1016/j.xops.2022.100197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/09/2022] [Accepted: 07/01/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE A deep learning model was developed to detect nonexudative macular neovascularization (neMNV) using OCT B-scans. DESIGN Retrospective review of a prospective, observational study. PARTICIPANTS Normal control eyes and patients with age-related macular degeneration (AMD) with and without neMNV. METHODS Swept-source OCT angiography (SS-OCTA) imaging (PLEX Elite 9000, Carl Zeiss Meditec, Inc) was performed using the 6 × 6-mm scan pattern. Individual B-scans were annotated to distinguish between drusen and the double-layer sign (DLS) associated with the neMNV. The machine learning model was tested on a dataset graded by humans, and model performance was compared with the human graders. MAIN OUTCOME MEASURES Intersection over Union (IoU) score was measured to evaluate segmentation network performance. Area under the receiver operating characteristic curve values, sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) were measured to assess the performance of the final classification performance. Chance-corrected agreement between the algorithm and the human grader determinations was measured with Cohen's kappa. RESULTS A total of 251 eyes from 210 patients, including 182 eyes with DLS and 115 eyes with drusen, were used for model training. Of 125 500 B-scans, 6879 B-scans were manually annotated. A vision transformer segmentation model was built to extract DLS and drusen from B-scans. The extracted prediction masks from all B-scans in a volume were projected to an en face image, and an eye-level projection map was obtained for each eye. A binary classification algorithm was established to identify eyes with neMNV from the projection map. The algorithm achieved 82%, 90%, 79%, and 91% sensitivity, specificity, PPV, and NPV, respectively, on a separate test set of 100 eyes that were evaluated by human graders in a previous study. The area under the curve value was calculated as 0.91 (95% confidence interval, 0.85-0.98). The results of the algorithm showed excellent agreement with the senior human grader (kappa = 0.83, P < 0.001) and moderate agreement with the junior grader consensus (kappa = 0.54, P < 0.001). CONCLUSIONS Our network (code is available at https://github.com/uw-biomedical-ml/double_layer_vit) was able to detect the presence of neMNV from structural B-scans alone by applying a purely transformer-based model.
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Key Words
- AI, artificial intelligence
- AMD, age-related macular degeneration
- Age-related macular degeneration
- CNN, convolutional neural network
- DLS, double-layer sign
- Deep learning
- GA, geographic atrophy
- IoU, Intersection over Union
- MNV, macular neovascularization
- Macular neovascularization
- NPV, negative predictive value
- OCT
- OCTA, OCT angiography
- PPV, positive predictive value
- ROC, receiver operating characteristic
- RPE, retinal pigment epithelium
- SS-OCT, swept-source OCT
- SS-OCTA, swept-source OCT angiography
- ViT, Vision Transformer
- iAMD, intermediate age-related macular degeneration
- neMNV, nonexudative macular neovascularization
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Affiliation(s)
- Yuka Kihara
- University of Washington, Department of Ophthalmology, Seattle, Washington
| | - Mengxi Shen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Yingying Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Xiaoshuang Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Liang Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Rita Laiginhas
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Cancan Lyu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jin Yang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Jeremy Liu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Rosalyn Morin
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Randy Lu
- University of Washington, Department of Ophthalmology, Seattle, Washington
| | - Hironobu Fujiyoshi
- Department of Robotic Science and Technology, Chubu University, Aichi, Japan
| | - William J. Feuer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Philip J. Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Aaron Y. Lee
- University of Washington, Department of Ophthalmology, Seattle, Washington
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Heriot WJ, Metha AB, He Z, Lim JK, Hoang A, Nishimura T, Okada M, Bui BV. Optimizing Retinal Thermofusion in Retinal Detachment Repair: Achieving Instant Adhesion without Air Tamponade. Ophthalmol Sci 2022; 2:100179. [PMID: 36531586 PMCID: PMC9754973 DOI: 10.1016/j.xops.2022.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Rhegmatogenous retinal detachment repair by intraoperative sealing of the tear without a tamponade agent should enable faster restoration of vision and resumption of normal activities. It avoids the need for further surgery in the case of silicone oil endotamponade. This study evaluated the retinal thermofusion (RTF) retinopexy method of subretinal space dehydration before photocoagulation to create an instantaneous intraoperative retina reattachment in a preclinical model. DESIGN Preclinical study. PARTICIPANTS Twenty Dutch Belt, pigmented rabbits that underwent RTF repair after experimental retinal detachment. METHODS This ex vivo model quantified adhesion force between the retina and underlying retinal pigment epithelium and choroid after treatment of 1 retinal edge using postmortem porcine or human retina (6 × 12 mm). We compared (1) control, (2) laser photocoagulation alone, (3) dehydration alone, and (4) dehydration followed by photocoagulation (RTF). Optimized parameters for RTF were then applied in the in vivo rabbit model of retinal detachment. Animals were followed up for 14 days. MAIN OUTCOME MEASURES For this ex vivo model, we measured adhesion force and related this to tissue temperature. For the in vivo study, we assessed retinal attachment using funduscopy and histologic analysis. RESULTS The ex vivo model showed that RTF repair produced significantly higher adhesion force than photocoagulation alone independent of dehydration method: warm (60° C) high airflow (50-70 ml/minute) or using laser wavelengths targeting water absorption peaks (1470 or 1940 nm) with coaxial low airflow (10-20 ml/minute). The latter approach produced a smaller footprint of dehydration. Application of RTF (1940-nm laser with coaxial airflow) in an in vivo retinal detachment model in rabbit eyes resulted in immediate retinal adhesion, achieving forces similar to those in the ex vivo experiments. Retinal thermofusion repair resulted in stable reattachment of the retina over the 2-week follow-up period. CONCLUSIONS We showed that a short preliminary dehydrating laser treatment of a retinal tear margin before traditional laser photocoagulation creates an immediate intraoperative waterproof retinopexy adhesion independent of tamponade and a wound-healing response. This approach potentially will allow rapid postoperative recovery regardless of the tear location and improved vision.
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Affiliation(s)
- Wilson J. Heriot
- Retinology Institute, Glen Iris, Australia
- Centre for Eye Research Australia, East Melbourne, Australia
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia
| | - Andrew B. Metha
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia
| | - Zheng He
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia
| | - Jeremiah K.H. Lim
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia
- Caring Futures Institute, Flinders University, Bedford Park, Australia
| | - Anh Hoang
- Centre for Eye Research Australia, East Melbourne, Australia
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia
| | - Tomoharu Nishimura
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia
- Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Mali Okada
- Centre for Eye Research Australia, East Melbourne, Australia
| | - Bang V. Bui
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Australia
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Higgins BE, Montesano G, Crabb DP, Naskas TT, Graham KW, Chakravarthy U, Kee F, Wright DM, Hogg RE. Assessment of the Classification of Age-Related Macular Degeneration Severity from the Northern Ireland Sensory Ageing Study Using a Measure of Dark Adaptation. Ophthalmol Sci 2022; 2:100204. [PMID: 36531574 PMCID: PMC9754971 DOI: 10.1016/j.xops.2022.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/27/2022] [Accepted: 07/12/2022] [Indexed: 06/17/2023]
Abstract
Purpose To assess the differences in rod-mediated dark adaptation (RMDA) between different grades of age-related macular degeneration (AMD) severity using an OCT-based criterion compared with those of AMD severity using the Beckman color fundus photography (CFP)-based classification and to assess the association between the presence of subretinal drusenoid deposits (SDDs) and RMDA at different grades of AMD severity using an OCT-based classification. Design Cross-sectional study. Participants Participants from the Northern Ireland Sensory Ageing study (Queen's University Belfast). Methods Complete RMDA (rod-intercept time [RIT]) data, CFP, and spectral-domain OCT images were extracted. Participants were stratified into 4 Beckman groups (omitting late-stage AMD) and 3 OCT-based groups. The presence and stage of SDDs were identified using OCT. Main Outcome Measures Rod-intercept time data (age-corrected). Results Data from 459 participants (median [interquartile range] age, 65 [59-71] years) were stratified by both the classifications. Subretinal drusenoid deposits were detected in 109 eyes. The median (interquartile range) RMDA for the Beckman classification (Beckman 0-3, with 3 being intermediate age-related macular degeneration [iAMD]) groups was 6.0 (4.5-8.7), 6.6 (4.7-10.5), 5.7 (4.4-7.4), and 13.2 (6-21.1) minutes, respectively. OCT classifications OCT0-OCT2 yielded different median (interquartile range) values: 5.8 (4.5-8.5), 8.4 (5.2-13.3), and 11.1 (5.3-20.1) minutes, respectively. After correcting for age, eyes in Beckman 3 (iAMD) had statistically significantly worse RMDA than eyes in the other Beckman groups (P ≤ 0.005 for all), with no statistically significant differences between the other Beckman groups. Similarly, after age correction, eyes in OCT2 had worse RMDA than eyes in OCT0 (P ≤ 0.001) and OCT1 (P < 0.01); however, there was no statistically significant difference between eyes in OCT0 and eyes in OCT1 (P = 0.195). The presence of SDDs was associated with worse RMDA in OCT2 (P < 0.01) but not in OCT1 (P = 0.285). Conclusions Eyes with a structural definition of iAMD have delayed RMDA, regardless of whether a CFP- or OCT-based criterion is used. In this study, after correcting for age, the RMDA did not differ between groups of eyes defined to have early AMD or normal aging, regardless of the classification. The presence of SDDs has some effect on RMDA at different grades of AMD severity.
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Affiliation(s)
- Bethany E. Higgins
- Optometry and Visual Sciences, City, University of London, London, United Kingdom
| | - Giovanni Montesano
- Optometry and Visual Sciences, City, University of London, London, United Kingdom
- National Institute for Health and Care Research, Biomedical Research Centre, Moorfields Eye Hospital, National Health Service Foundation Trust and University College London, Institute of Ophthalmology, London, United Kingdom
| | - David P. Crabb
- Optometry and Visual Sciences, City, University of London, London, United Kingdom
| | - Timos T. Naskas
- Centre for Public Health, Queen’s University Belfast, Northern Ireland, United Kingdom
| | - Katie W. Graham
- Centre for Public Health, Queen’s University Belfast, Northern Ireland, United Kingdom
| | - Usha Chakravarthy
- Centre for Public Health, Queen’s University Belfast, Northern Ireland, United Kingdom
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Northern Ireland, United Kingdom
| | - David M. Wright
- Centre for Public Health, Queen’s University Belfast, Northern Ireland, United Kingdom
| | - Ruth E. Hogg
- Centre for Public Health, Queen’s University Belfast, Northern Ireland, United Kingdom
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9
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Kar SS, Cetin H, Lunasco L, Le TK, Zahid R, Meng X, Srivastava SK, Madabhushi A, Ehlers JP. OCT-Derived Radiomic Features Predict Anti-VEGF Response and Durability in Neovascular Age-Related Macular Degeneration. Ophthalmol Sci 2022; 2:100171. [PMID: 36531588 PMCID: PMC9754979 DOI: 10.1016/j.xops.2022.100171] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/15/2022] [Accepted: 05/12/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE No established biomarkers currently exist for therapeutic efficacy and durability of anti-VEGF therapy in neovascular age-related macular degeneration (nAMD). This study evaluated radiomic-based quantitative OCT biomarkers that may be predictive of anti-VEGF treatment response and durability. DESIGN Assessment of baseline biomarkers using machine learning (ML) classifiers to predict tolerance to anti-VEGF therapy. PARTICIPANTS Eighty-one participants with treatment-naïve nAMD from the OSPREY study, including 15 super responders (patients who achieved and maintained retinal fluid resolution) and 66 non-super responders (patients who did not achieve or maintain retinal fluid resolution). METHODS A total of 962 texture-based radiomic features were extracted from fluid, subretinal hyperreflective material (SHRM), and different retinal tissue compartments of OCT scans. The top 8 features, chosen by the minimum redundancy maximum relevance feature selection method, were evaluated using 4 ML classifiers in a cross-validated approach to distinguish between the 2 patient groups. Longitudinal assessment of changes in different texture-based radiomic descriptors (delta-texture features) between baseline and month 3 also was performed to evaluate their association with treatment response. Additionally, 8 baseline clinical parameters and a combination of baseline OCT, delta-texture features, and the clinical parameters were evaluated in a cross-validated approach in terms of association with therapeutic response. MAIN OUTCOME MEASURES The cross-validated area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity were calculated to validate the classifier performance. RESULTS The cross-validated AUC by the quadratic discriminant analysis classifier was 0.75 ± 0.09 using texture-based baseline OCT features. The delta-texture features within different OCT compartments between baseline and month 3 yielded an AUC of 0.78 ± 0.08. The baseline clinical parameters sub-retinal pigment epithelium volume and intraretinal fluid volume yielded an AUC of 0.62 ± 0.07. When all the baseline, delta, and clinical features were combined, a statistically significant improvement in the classifier performance (AUC, 0.81 ± 0.07) was obtained. CONCLUSIONS Radiomic-based quantitative assessment of OCT images was shown to distinguish between super responders and non-super responders to anti-VEGF therapy in nAMD. The baseline fluid and SHRM delta-texture features were found to be most discriminating across groups.
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Key Words
- 3D, 3-dimensional
- AMD, age-related macular degeneration
- AUC, area under the receiver operating characteristic curve
- AUC-PRC, area under the precision recall curve
- IAI, intravitreal aflibercept injection
- ILM, internal limiting membrane
- IRF, intraretinal fluid
- ML, machine learning
- OCT
- QDA, quadratic discriminant analysis
- RFI, retinal fluid index
- RPE, retinal pigment epithelium
- Radiomics
- SHRM, subretinal hyperreflective material
- SRF, subretinal fluid
- SRFI, subretinal fluid index
- TRFI, total retinal fluid index
- Wet age-related macular degeneration
- mRmR, minimum redundancy maximum relevance
- nAMD, neovascular age-related macular degeneration
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Affiliation(s)
- Sudeshna Sil Kar
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Hasan Cetin
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Leina Lunasco
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thuy K. Le
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robert Zahid
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Xiangyi Meng
- Novartis Pharmaceuticals, East Hanover, New Jersey
| | - Sunil K. Srivastava
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
- Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, Ohio
| | - Justis P. Ehlers
- The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
- Vitreoretinal Service, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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10
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Kowalczuk L, Dornier R, Kunzi M, Iskandar A, Misutkova Z, Gryczka A, Navarro A, Jeunet F, Mantel I, Behar-Cohen F, Laforest T, Moser C. In Vivo Retinal Pigment Epithelium Imaging using Transscleral Optical Imaging in Healthy Eyes. Ophthalmol Sci 2022; 3:100234. [PMID: 36545259 PMCID: PMC9762198 DOI: 10.1016/j.xops.2022.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
Objective To image healthy retinal pigment epithelial (RPE) cells in vivo using Transscleral OPtical Imaging (TOPI) and to analyze statistics of RPE cell features as a function of age, axial length (AL), and eccentricity. Design Single-center, exploratory, prospective, and descriptive clinical study. Participants Forty-nine eyes (AL: 24.03 ± 0.93 mm; range: 21.9-26.7 mm) from 29 participants aged 21 to 70 years (37.1 ± 13.3 years; 19 men, 10 women). Methods Retinal images, including fundus photography and spectral-domain OCT, AL, and refractive error measurements were collected at baseline. For each eye, 6 high-resolution RPE images were acquired using TOPI at different locations, one of them being imaged 5 times to evaluate the repeatability of the method. Follow-up ophthalmic examination was repeated 1 to 3 weeks after TOPI to assess safety. Retinal pigment epithelial images were analyzed with a custom automated software to extract cell parameters. Statistical analysis of the selected high-contrast images included calculation of coefficient of variation (CoV) for each feature at each repetition and Spearman and Mann-Whitney tests to investigate the relationship between cell features and eye and subject characteristics. Main Outcome Measures Retinal pigment epithelial cell features: density, area, center-to-center spacing, number of neighbors, circularity, elongation, solidity, and border distance CoV. Results Macular RPE cell features were extracted from TOPI images at an eccentricity of 1.6° to 16.3° from the fovea. For each feature, the mean CoV was < 4%. Spearman test showed correlation within RPE cell features. In the perifovea, the region in which images were selected for all participants, longer AL significantly correlated with decreased RPE cell density (R Spearman, Rs = -0.746; P < 0.0001) and increased cell area (Rs = 0.668; P < 0.0001), without morphologic changes. Aging was also significantly correlated with decreased RPE density (Rs = -0.391; P = 0.036) and increased cell area (Rs = 0.454; P = 0.013). Lower circular, less symmetric, more elongated, and larger cells were observed in those > 50 years. Conclusions The TOPI technology imaged RPE cells in vivo with a repeatability of < 4% for the CoV and was used to analyze the influence of physiologic factors on RPE cell morphometry in the perifovea of healthy volunteers. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Key Words
- AF, autofluorescence
- AL, axial length
- AO, adaptive optics
- Adaptive Optics Transscleral Flood Illumination
- BCVA, best-corrected visual acuity
- CCS, center-to-center spacing
- CoV, coefficient of variation
- D, diopters
- FOV, field of view
- Healthy volunteers
- High resolution retinal imaging
- IOP, intraocular pressure
- NIR, near-infrared
- PRL, preferred retinal locus
- QC, quality criterion
- RE, refractive error
- RPE, retinal pigment epithelium
- Retinal Pigment Epithelium
- SD, standard deviation
- SLO, scanning laser ophthalmoscope
- TOPI, transscleral optical imaging
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Affiliation(s)
- Laura Kowalczuk
- Laboratory of Applied Photonic Devices, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland,Correspondence: Laura Kowalczuk, PhD, École Polytechnique Fédérale de Lausanne, School of Engineering, Institute of Electrical and Micro-engineering, Laboratory of Applied Photonics Devices, BM 4127, Station 17, CH-1015, Lausanne, Switzerland.
| | - Rémy Dornier
- Laboratory of Applied Photonic Devices, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Mathieu Kunzi
- Laboratory of Applied Photonic Devices, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Antonio Iskandar
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Zuzana Misutkova
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Aurélia Gryczka
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Aurélie Navarro
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Fanny Jeunet
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Irmela Mantel
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland,Jules-Gonin Eye Hospital, Fondation Asile des aveugles, Lausanne, Switzerland
| | - Francine Behar-Cohen
- Centre de Recherche des Cordeliers, Université Pierre et Marie Curie, Paris, France,INSERM U1138, USPC, Université de Paris-Cité, Sorbonne Université, Paris, France,Assistance Publique - Hôpitaux de Paris, Ophtalmopôle, Cochin Hospital, Paris, France,Université Paris Cité, Paris, France,Hôpital Foch, Suresnes, France
| | - Timothé Laforest
- Laboratory of Applied Photonic Devices, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Christophe Moser
- Laboratory of Applied Photonic Devices, School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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11
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Lad EM, Fang V, Tessier M, Rautanen A, Gayan J, Stinnett SS, Luhmann UFO. Longitudinal Evaluation of Visual Function Impairments in Early and Intermediate Age-Related Macular Degeneration Patients. Ophthalmol Sci 2022; 2:100173. [PMID: 36245764 DOI: 10.1016/j.xops.2022.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 04/07/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022]
Abstract
Purpose To evaluate visual function (VF) changes in early and intermediate age-related macular degeneration (eAMD and iAMD) over 24 months. Design Prospective, observational natural history study. Participants Participants were enrolled at the Duke Eye Center. Methods A total of 101 subjects (33 with eAMD, 47 with iAMD, and 21 normal controls) were recruited. Visual function (VF) tests included best-corrected visual acuity (BCVA), low- luminance visual acuity (LLVA), microperimetry (MP), cone contrast tests (CCTs), and dark adaptation (DA). Mixed-effect model repeated measures based on absolute values and change from baseline identified VF tests differentiating AMD from controls and revealing longitudinal VF decline when controlling for covariates (baseline value, age, coronary artery disease, dry eye, and phakic status). Nine AMD genetic risk variants, combinations of these (genetic burden score), reticular pseudodrusen (RPD), and hyperreflective foci (HRF) were tested as predictors of diagnosis and VF performance. Main Outcome Measures Longitudinal changes in VF metrics over 24 months. Results A total of 70 subjects completed the 2-year visit (22 with eAMD, 31 with iAMD, and 17 controls). Percent reduced threshold (PRT) on MP and CCT red significantly distinguished iAMD versus controls after 12 and 24 months, respectively. Cone contrast test red, PRT, and absolute threshold (AT) on MP showed significant longitudinal deterioration of VF in iAMD versus baseline at 12 months and onward, however, with a reduced rate of worsening. The DA data confirmed a preexisting functional deficit in iAMD at baseline and revealed an increasing proportion of poorly performing iAMD subjects in DA over the study period. None of the other VF measures showed consistent significant changes among the normal, early, and intermediate groups or over time. The genetic burden score was significantly associated with AMD diagnosis (relative risk for iAMD = 1.64, P < 0.01) and DA (r = 0.42, P = 0.00005). Reticular pseudodrusen and HRF showed moderate associations with DA and weak to moderate associations with MP variables. Conclusions In iAMD, MP variables, CCT red, and DA revealed slow and nonlinear functional decline over 24 months. A structure-function relationship in eAMD and iAMD stages was demonstrated among HRF, RPD, and DA, possibly modified by genetic risk factors. These structural and functional features represent potential end points for clinical trials in iAMD.
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Key Words
- AMD, age-related macular degeneration
- AREDS, Age-Related Eye Disease Study
- AT, absolute threshold
- BCVA, best-corrected visual acuity
- CCT, cone contrast test
- CFP, color fundus photography
- DA, dark adaptation
- Early AMD
- HRF, hyperreflective foci
- Intermediate AMD
- LLD, low-luminance deficit
- LLVA
- LLVA, low-luminance visual acuity
- MMRM, mixed-effect repeated measure
- MP, microperimetry
- Microperimetry
- PRT, percent reduced threshold
- RIT, rod intercept time
- RPD, reticular pseudodrusen
- RPE, retinal pigment epithelium
- SD, standard deviation
- SD-OCT, spectral domain OCT
- SNP, single nucleotide polymorphism
- VF, visual function
- Visual function
- dB, decibels
- eAMD, early AMD
- iAMD, intermediate AMD
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Abidi M, Karrer E, Csaky K, Handa JT. A Clinical and Preclinical Assessment of Clinical Trials for Dry Age-Related Macular Degeneration. Ophthalmol Sci 2022; 2:100213. [PMID: 36570624 PMCID: PMC9767821 DOI: 10.1016/j.xops.2022.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 12/27/2022]
Abstract
Age-related macular degeneration (AMD) is the leading cause of blindness for the elderly in high-income countries. Although multivitamin antioxidant nutrients can slow the progression of intermediate "dry" or nonneovascular AMD, no treatment can halt or reverse any stage of dry disease. Multiple biologic pathways have been implicated in AMD pathobiology, including the complement pathway. These pathways have been targeted by various approaches in clinical trials. To date, no treatment has reached their prespecified primary end point in 2 phase III trials, a requirement by the US Food and Drug Administration for a new drug approval. Here, we describe perspectives on the failures and possible successes of various clinical trials that will guide further investigation. These perspectives will also discuss clinical trial design issues to consider in future investigations, and how recent insights into AMD pathobiology might both provide additional explanation for trials not reaching the prespecified primary end points and offer direction for identifying prioritized treatment targets.
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Affiliation(s)
- Muhammad Abidi
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Erik Karrer
- Character Biosciences, Inc., San Carlos, California
| | - Karl Csaky
- Retina Institute of the Southwest, Dallas, Texas
| | - James T. Handa
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland,Correspondence: James T. Handa, MD, Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, 400 N. Broadway, Smith 3015, Baltimore, MD 21287.
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Lin JB, Murakami Y, Miller JW, Vavvas DG. Neuroprotection for Age-Related Macular Degeneration. Ophthalmol Sci 2022; 2:100192. [PMID: 36570623 DOI: 10.1016/j.xops.2022.100192] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 12/27/2022]
Abstract
Age-related macular degeneration (AMD) is a leading cause of blindness worldwide. Early to intermediate AMD is characterized by the accumulation of lipid- and protein-rich drusen. Late stages of the disease are characterized by the development of choroidal neovascularization, termed "exudative" or "neovascular AMD," or retinal pigment epithelium (RPE) cell and photoreceptor death, termed "geographic atrophy" (GA) in advanced nonexudative AMD. Although we have effective treatments for exudative AMD in the form of anti-VEGF agents, they have no role for patients with GA. Neuroprotection strategies have emerged as a possible way to slow photoreceptor degeneration and vision loss in patients with GA. These approaches include reduction of oxidative stress, modulation of the visual cycle, reduction of toxic molecules, inhibition of pathologic protein activity, prevention of cellular apoptosis or programmed necrosis (necroptosis), inhibition of inflammation, direct activation of neurotrophic factors, delivery of umbilical tissue-derived cells, and RPE replacement. Despite active investigation in this area and significant promise based on preclinical studies, many clinical studies have not yielded successful results. We discuss selected past and current neuroprotection trials for AMD, highlight the lessons learned from these past studies, and discuss our perspective regarding remaining questions that must be answered before neuroprotection can be successfully applied in the field of AMD research.
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Key Words
- AD, Alzheimer disease
- ALA, alpha lipoic acid
- AMD, age-related macular degeneration
- AREDS, Age-Related Eye Disease Study
- AREDS2, Age-Related Eye Disease Study 2
- Age-related macular degeneration
- CFH, complement factor H
- CNTF, ciliary neurotrophic factor
- GA, geographic atrophy
- HTRA1, high-temperature requirement A1
- IOP, intraocular pressure
- Neuroprotection
- RBP, retinol-binding protein
- RGC, retinal ganglion cell
- RIPK3, receptor-interacting serine/threonine-protein kinase 3
- ROS, reactive oxygen species
- RPE, retinal pigment epithelium
- Retinal degeneration
- VA, visual acuity
- iPSC, induced pluripotent stem cell
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Moult EM, Shi Y, Wang L, Chen S, Waheed NK, Gregori G, Rosenfeld PJ, Fujimoto JG. Comparing Accuracies of Length-Type Geographic Atrophy Growth Rate Metrics Using Atrophy-Front Growth Modeling. Ophthalmol Sci 2022; 2:100156. [PMID: 36245762 PMCID: PMC9560575 DOI: 10.1016/j.xops.2022.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022]
Abstract
Purpose To compare the accuracies of the previously proposed square-root-transformed and perimeter-adjusted metrics for estimating length-type geographic atrophy (GA) growth rates. Design Cross-sectional and simulation-based study. Participants Thirty-eight eyes with GA from 27 patients. Methods We used a previously developed atrophy-front growth model to provide analytical and numerical evaluations of the square-root-transformed and perimeter-adjusted growth rate metrics on simulated and semisimulated GA growth data. Main Outcome Measures Comparison of the accuracies of the square-root-transformed and perimeter-adjusted metrics on simulated and semisimulated GA growth data. Results Analytical and numerical evaluations showed that the accuracy of the perimeter-adjusted metric is affected minimally by baseline lesion area, focality, and circularity over a wide range of GA growth rates. Average absolute errors of the perimeter-adjusted metric were approximately 20 times lower than those of the square-root-transformed metrics, per evaluation on a semisimulated dataset with growth rate characteristics matching clinically observed data. Conclusions Length-type growth rates have an intuitive, biophysical interpretation that is independent of lesion geometry, which supports their use in clinical trials of GA therapeutics. Taken in the context of prior studies, our analyses suggest that length-type GA growth rates should be measured using the perimeter-adjusted metric, rather than square-root-transformed metrics.
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Affiliation(s)
- Eric M. Moult
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts,Health Sciences and Technology, Harvard & Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Yingying Shi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Liang Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Siyu Chen
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Nadia K. Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts
| | - Giovanni Gregori
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Philip J. Rosenfeld
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - James G. Fujimoto
- Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts,Correspondence: James G. Fujimoto, PhD, Department of Electrical Engineering and Computer Science, Research Laboratory of Electronics, 36-361 Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139.
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15
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Yanagi Y, Yu RM, Ahamed W, Yu M, Teo KYC, Tan AC, Cheng CY, Wong TY, Apte RS, Cheung CMG. Serum Cholesterol Efflux Capacity in Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy. Ophthalmol Sci 2022; 2:100142. [PMID: 36278032 PMCID: PMC9562377 DOI: 10.1016/j.xops.2022.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/03/2022]
Abstract
Purpose To investigate serum cholesterol efflux capacity (the ability of the serum to accept cholesterol) and factors that regulate it using nuclear magnetic resonance-quantified measures of lipoprotein particle composition and size and apolipoproteins metrics in patients with age-related macular degeneration (AMD). Design Case-control study. Participants Four hundred two serum samples from 80 patients with early AMD (eAMD), and 212 patients with neovascular AMD (nAMD), including 80 with typical nAMD (tAMD) and 132 with polypoidal choroidal vasculopathy (PCV), and 110 age- and gender matched control participants. Methods Serum from participants showed cholesterol efflux capacity measured using in vitro cell assays and lipoprotein subfractions measured using nuclear magnetic resonance (Nightingale, Ltd). Associations between cholesterol efflux capacity (measured in percentage) and lipid subfractions were investigated in the patients and control participants. Main Outcome Measures Cholesterol efflux capacity and lipid subfractions in control, eAMD, and nAMD. Associations between HDL subfractions and cholesterol efflux capacity. Results Cholesterol efflux capacity was higher in patients with eAMD (68.0 ± 11.3% [mean ± standard deviation]) and nAMD (75.9 ± 27.7%) than in the control participants (56.9 ± 16.7%) after adjusting for age, gender, and use of lipid-lowering drug (P < 0.0001). Nuclear magnetic resonance lipidomics demonstrated that the mean diameter of HDL was larger both in eAMD (9.96 ± 0.27 mm [mean ± standard deviation]) and PCV (9.97 ± 0.23 mm) compared with that of the control participants (9.84 ± 0.24 mm; P = 0.0001 for both). Among the 28 HDL subfractions, most of the small, medium, and large HDLs, but none of the 7 extra large HDLs fractions, were associated moderately with cholesterol efflux capacity in eAMD and PCV (R = 0.149-0.277). Conclusions Serum cholesterol efflux capacity was increased in eAMD and PCV, but not tAMD, possibly reflecting differential underlying pathophysiologic features of lipid dysregulation in tAMD and PCV. Further studies should be directed toward investigating the diverse biological activities of HDL in AMD, including macular pigment transport, regulation of inflammation, and local cholesterol transport system.
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Key Words
- AMD, age-related macular degeneration
- Age-related macular degeneration
- Cholesterol efflux
- Drusen
- HDL, high-density lipoprotein
- LDL, low-density lipoprotein
- Lipoprotein
- NMR, nuclear magnetic resonance
- PCV, polypoidal choroidal vasculopathy
- Polypoidal choroidal vasculopathy
- RPE, retinal pigment epithelium
- RPMI, Roswell Park Memorial Institute
- SCES, Singapore Chinese Eye Study
- SD, standard deviation
- VLDL, very low-density lipoprotein
- eAMD, early age-related macular degeneration
- nAMD, neovascular age-related macular degeneration
- tAMD, typical neovascular age-related macular degeneration
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Affiliation(s)
- Yasuo Yanagi
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore,Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore,Correspondence: Yasuo Yanagi, Singapore Eye Research Institute, 11 Third Hospital Avenue, 168751, Singapore, Republic of Singapore.
| | - Richard M.C. Yu
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore
| | - Waseem Ahamed
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore
| | - Marco Yu
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore,Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Kelvin Yi Chong Teo
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore,Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Anna C.S. Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore,Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Ching-Yu Cheng
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore,Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore,Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Rajendra S. Apte
- Department of Ophthalmology, Washington University School of Medicine, St. Louis, Missouri,Department of Medicine, Washington University School of Medicine, St. Louis, Missouri,Department of Developmental Biology, Washington University School of Medicine, St. Louis, Missouri
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore,Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
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Mettu PS, Allingham MJ, Cousins SW. Phase 1 Clinical Trial of Elamipretide in Dry Age-Related Macular Degeneration and Noncentral Geographic Atrophy: ReCLAIM NCGA Study. Ophthalmol Sci 2022; 2:100086. [PMID: 36246181 PMCID: PMC9560640 DOI: 10.1016/j.xops.2021.100086] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 11/01/2021] [Accepted: 11/23/2021] [Indexed: 11/04/2022]
Abstract
Purpose Assess the safety, tolerability, and feasibility of subcutaneous administration of the mitochondrial-targeted drug elamipretide in patients with dry age-related macular degeneration (AMD) and noncentral geographic atrophy (NCGA) and to perform exploratory analyses of change in visual function. Design Phase 1, single-center, open-label, 24-week clinical trial with preplanned NCGA cohort. Participants Adults ≥ 55 years of age with dry AMD and NCGA. Methods Participants received subcutaneous elamipretide 40-mg daily; safety and tolerability assessed throughout. Ocular assessments included normal-luminance best-corrected visual acuity (BCVA), low-luminance BCVA (LLBCVA), normal-luminance binocular reading acuity (NLBRA), low-luminance binocular reading acuity (LLBRA), spectral-domain OCT, fundus autofluorescence (FAF), and patient self-reported function by low-luminance questionnaire (LLQ). Main Outcome Measures Primary end point was safety and tolerability. Prespecified exploratory end-points included changes in BCVA, LLBCVA, NLBRA, LLBRA, geographic atrophy (GA) area, and LLQ. Results Subcutaneous elamipretide was highly feasible. All participants (n = 19) experienced 1 or more nonocular adverse events (AEs), but all AEs were either mild (73.7%) or moderate (26.3%); no serious AEs were noted. Two participants exited the study because of AEs (conversion to neovascular AMD, n = 1; intolerable injection site reaction, n = 1), 1 participant discontinued because of self-perceived lack of efficacy, and 1 participant chose not to continue with study visits. Among participants completing the study (n = 15), mean ± standard deviation (SD) change in BCVA from baseline to week 24 was +4.6 (5.1) letters (P = 0.0032), while mean change (SD) in LLBCVA was +5.4 ± 7.9 letters (P = 0.0245). Although minimal change in NLBRA occurred, mean ± SD change in LLBCVA was -0.52 ± 0.75 logarithm of the minimum angle of resolution units (P = 0.005). Mean ± SD change in GA area (square root transformation) from baseline to week 24 was 0.14 ± 0.08 mm by FAF and 0.13 ± 0.14 mm by OCT. Improvement was observed in LLQ for dim light reading and general dim light vision. Conclusions Elamipretide seems to be well tolerated without serious AEs in patients with dry AMD and NCGA. Exploratory analyses demonstrated possible positive effect on visual function, particularly under low luminance. A Phase 2b trial is underway to evaluate elamipretide further in dry AMD and NCGA.
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Key Words
- AE, adverse event
- AMD, age-related macular degeneration
- BCVA, best-corrected visual acuity
- Dry age-related macular degeneration
- ETDRS, Early Treatment Diabetic Retinopathy Study
- Elamipretide
- FAF, fundus autofluorescence
- GA, geographic atrophy
- Geographic atrophy
- LLBCVA, low-luminance best-corrected visual acuity
- LLBRA, low-luminance binocular reading acuity
- LLQ, low-luminance questionnaire
- Mitochondrial dysfunction
- NCGA, noncentral geographic atrophy
- NLBRA, normal-luminance binocular reading acuity
- Phase 1 clinical trial
- RPE, retinal pigment epithelium
- SD, standard deviation
- logMAR, logarithm of the minimum angle of resolution
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Affiliation(s)
- Priyatham S. Mettu
- Duke Center for Macular Diseases, Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Michael J. Allingham
- Duke Center for Macular Diseases, Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
| | - Scott W. Cousins
- Duke Center for Macular Diseases, Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, North Carolina
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17
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Liao M, Yu J, You C, Yan H. Case series: Two cases of severe retinal cicatricial contraction after vitrectomy for open-globe injury in patients with skin keloid. Am J Ophthalmol Case Rep 2022; 25:101248. [PMID: 35036628 PMCID: PMC8743198 DOI: 10.1016/j.ajoc.2021.101248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/19/2021] [Accepted: 12/30/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose To report two cases of severe retinal cicatricial contraction after vitrectomy for open-globe injury in patients with skin keloid. Observations One was a 33-year-old male patient who developed severe retinal cicatricial contraction 6.5 months post-operatively, and his skin wound was observed with keloid simultaneously. The second case was a 36-year-old male patient who developed recurrent retinal detachment 1 week after the two operations, and keloid was also found on his skin. Conclusions and Importance Retinal detachment is a vision-threatening complication of open-globe injury. Besides most of the already known factors, skin keloid should be concerned.
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Key Words
- BCVA, best corrected visual acuity
- HM, hand motion
- LP, light perception
- NLP, no light perception
- OGI, open-globe injury
- OTS, Ocular Trauma Score
- Open-globe injury
- PPV, pars plana vitrectomy
- PVR, proliferative vitreoretinopathy
- Pars plana vitrectomy
- RD, retinal detachment
- RPE, retinal pigment epithelium
- Retinal cicatricial contraction
- Retinal detachment
- Skin keloid
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Affiliation(s)
- Mengyu Liao
- Department of Ophthalmology, Tianjin Medical University General Hospital, No. 154 Anshan Road, Tianjin, China
| | - Jinguo Yu
- Department of Ophthalmology, Tianjin Medical University General Hospital, No. 154 Anshan Road, Tianjin, China
| | - Caiyun You
- Department of Ophthalmology, Tianjin Medical University General Hospital, No. 154 Anshan Road, Tianjin, China
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, No. 154 Anshan Road, Tianjin, China
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18
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Cereda MG, Parrulli S, Douven Y, Faridpooya K, van Romunde S, Hüttmann G, Eixmann T, Schulz-Hildebrandt H, Kronreif G, Beelen M, de Smet MD. Clinical Evaluation of an Instrument-Integrated OCT-Based Distance Sensor for Robotic Vitreoretinal Surgery. Ophthalmol Sci 2021; 1:100085. [PMID: 36246942 PMCID: PMC9560530 DOI: 10.1016/j.xops.2021.100085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/11/2021] [Accepted: 11/08/2021] [Indexed: 04/29/2023]
Abstract
PURPOSE To assess the efficacy of an instrument-integrated OCT (iiOCT)-based distance sensor during robotic vitreoretinal surgery using the Preceyes Surgical System (PSS; Preceyes B.V.). DESIGN Single-center interventional study. PARTICIPANTS Patients requiring vitreoretinal surgery. METHODS Five patients were enrolled. Standard preoperative OCT images were obtained. After vitrectomy, a predefined set of actions was performed using the iiOCT-based sensor. Images then were processed to assess the signal-to-noise ratio (SNR) at various angles to the retina and at different distances between the instrument tip and the retinal surface. Preoperative and intraoperative OCT images were compared qualitatively and quantitatively. MAIN OUTCOMES MEASURES The feasibility in performing surgical tasks using the iiOCT-based sensor during vitreoretinal surgery, the SNR when imaging the retina, differences among intraoperative and preoperative OCT images, and characteristics of intraoperative retinal movements detected with the iiOCT-based probe. RESULTS Surgeons were able to perform all the tasks but one. The PSS was able to maintain a fixed distance. The SNR of the iiOCT-based sensor signal was adequate to determine the distance to the retina and to control the PSS. Analysis of iiOCT-based sensor A-scans identified 3 clearly distinguishable retinal layers, including the inner retinal boundary and the interface at the retinal pigment epithelium-Bruch's membrane. Thickness values differed by less than 5% from that measured by preoperative OCT, indicating its accuracy. The Fourier analysis of iiOCT-based sensor recordings identified anteroposterior retinal movements attributed to heartbeat and respiration. CONCLUSIONS This iiOCT-based sensor was tested successfully and promises reliable use during robot-assisted surgery. An iiOCT-based sensor is a promising step toward OCT-guided robotic retinal surgery.
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Affiliation(s)
- Matteo Giuseppe Cereda
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco,” Sacco Hospital, University of Milan, Milan, Italy
| | - Salvatore Parrulli
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco,” Sacco Hospital, University of Milan, Milan, Italy
- Correspondence: Salvatore Parrulli, MD, Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco,” Sacco Hospital, University of Milan, via G.B. Grassi 74, Milan, 20157, Italy.
| | - Y.G.M. Douven
- Department of Mechanical Engineering, University of Technology, Eindhoven, The Netherlands
| | | | | | - Gereon Hüttmann
- Medical Laser Center Lübeck GmbH, Lübeck, Germany
- Airway Research Center North, Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Tim Eixmann
- Medical Laser Center Lübeck GmbH, Lübeck, Germany
| | | | | | | | - Marc D. de Smet
- Preceyes B.V., Eindhoven, The Netherlands
- MIOS sa, Lausanne, Switzerland
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19
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Pilgrim MG, Marouf S, Fearn S, Csincsik L, Kortvely E, Knowles JC, Malek G, Thompson RB, Lengyel I. Characterization of Calcium Phosphate Spherical Particles in the Subretinal Pigment Epithelium-Basal Lamina Space in Aged Human Eyes. Ophthalmol Sci 2021; 1:100053. [PMID: 36247811 PMCID: PMC9559963 DOI: 10.1016/j.xops.2021.100053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/21/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022]
Abstract
Purpose Micrometer-sized spherules formed of hydroxyapatite or whitlockite were identified within extracellular deposits that accumulate in the space between the basal lamina (BL) of retinal pigment epithelium (RPE) and the inner collagenous layer of Bruch's membrane (sub-RPE-BL space). This investigation aimed to characterize the morphologic features, structure, and distribution of these spherules in aged human eyes with and without clinical indications of age-related macular degeneration (AMD). Design Experimental study. Participants Five human eyes with varying degrees of sub-RPE-BL deposits were obtained from the University College London Institute of Ophthalmology and Moorfield's Eye Hospital Tissue Repository or the Advancing Sight Network. Two eyes were reported as having clinical indications of AMD (age, 76-87 years), whereas 3 were considered healthy (age, 69-91 years). Methods Cadaveric eyes with sub-RPE-BL deposits were embedded in paraffin wax and sectioned to a thickness of 4-10 μm. Spherules were identified and characterized using high-resolution scanning electron microscopy (SEM), energy-dispersive x-ray spectroscopy, and time-of-flight secondary ion mass spectroscopy. Main Outcome Measures High-resolution scanning electron micrographs of spherules, the size-frequency distribution of spherules including average diameter, and the distribution of particles across the central-peripheral axis. Elemental maps and time-of-flight secondary ion mass spectra also were obtained. Results The precipitation of spherules is ubiquitous across the central, mid-peripheral, and far-peripheral axis in aged human eyes. No significant difference was found in the frequency of spherules along this axis. However, statistical analysis indicated that spherules exhibited significantly different sizes in these regions. In-depth analysis revealed that spherules in the sub-RPE-BL space of eyes with clinical signs of AMD were significantly larger (median diameter, 1.64 μm) than those in healthy aged eyes (median diameter, 1.16 μm). Finally, spherules showed great variation in surface topography and internal structure. Conclusions The precipitation of spherules in the sub-RPE-BL space is ubiquitous across the central-peripheral axis in aged human eyes. However, a marked difference exists in the size and frequency of spherules in eyes with clinical signs of AMD compared to those without, suggesting that the size and frequency of spherules may be associated with AMD.
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Key Words
- AMD, age-related macular degeneration
- BL, basal lamina
- BrM, Bruch’s membrane
- C, Calcium
- Choroid
- Drusen
- EDX, Energy dispersive x-ray spectroscopy
- Ectopic calcification
- H, hydrogen
- Mg, Magnesium
- N, Nitrogen
- Na, sodium
- O, oxygen
- P, phosphorus
- RPE, retinal pigment epithelium
- Retina
- SEM, scanning electron microscopy
- Spherical particle
- Sub-retinal pigment epithelium-basal lamina deposit
- Sub-retinal pigment epithelium-basal lamina space
- Sub–retinal pigment epithelium
- ToF-SIMs, time of flight-secondary ion mass spectrometry
- sub-RPE–BL space, sub-retinal pigment epithelium-basal lamina space
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Affiliation(s)
- Matthew G. Pilgrim
- University College London Institute of Ophthalmology, London, United Kingdom
- Division of Biomaterials and Tissue Engineering, University College London Eastman Dental Institute, Royal Free Hospital, London, United Kingdom
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Science, Queen’s University Belfast, Belfast, United Kingdom
| | - Salma Marouf
- Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Sarah Fearn
- Department of Materials, Imperial College London, London, United Kingdom
| | - Lajos Csincsik
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Science, Queen’s University Belfast, Belfast, United Kingdom
| | - Elod Kortvely
- Roche Pharma Research and Early Development, Immunology, Infectious Diseases and Ophthalmology (I20) Discovery and Translational Area, Roche Innovation Centre Basel, F. Hoffmann-La Roche, Ltd., Basel, Switzerland
| | - Jonathan C. Knowles
- Division of Biomaterials and Tissue Engineering, University College London Eastman Dental Institute, Royal Free Hospital, London, United Kingdom
| | - Goldis Malek
- Department of Ophthalmology, Albert Eye Research Institute, and Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Richard B. Thompson
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Imre Lengyel
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Science, Queen’s University Belfast, Belfast, United Kingdom
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20
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Benson MD, Papp KM, Casey GA, Radziwon A, St Laurent CD, Doucette LP, MacDonald IM. PEX6 Mutations in Peroxisomal Biogenesis Disorders: An Usher Syndrome Mimic. Ophthalmol Sci 2021; 1:100028. [PMID: 36249295 PMCID: PMC9559095 DOI: 10.1016/j.xops.2021.100028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/29/2021] [Accepted: 05/14/2021] [Indexed: 06/16/2023]
Abstract
PURPOSE Peroxisomal biogenesis disorders (PBDs) represent a spectrum of conditions that result in vision loss, sensorineural hearing loss, neurologic dysfunction, and other abnormalities resulting from aberrant peroxisomal function caused by mutations in PEX genes. With no treatments currently available, we sought to investigate the disease mechanism in a patient with a PBD caused by defects in PEX6 and to probe whether overexpression of PEX6 could restore peroxisome function and potentially offer therapeutic benefit. DESIGN Laboratory-based study. PARTICIPANTS A 12-year-old boy sought treatment with hearing loss and retinopathy. After negative results in an Usher syndrome panel, targeted genetic testing revealed compound heterozygous mutations in PEX6. These included a 14-nucleotide deletion (c.802_815del: p.(Asp268Cysfs∗8)) and a milder missense variant (c.35T→C:(p.Phe12Ser)). METHODS Patient-derived skin fibroblasts were cultured, and a PEX6 knockout cell line was developed using clustered regularly interspaced short palindromic repeats and Cas9 technology in HEK293T cells to emulate a more severe disease phenotype. Immunoblot analysis of whole cell lysates was performed to assess peroxisome number. Immunofluorescence studies used antibodies against components of the peroxisomal protein import pathway to interrogate the effects of mutations in PEX6 on protein trafficking. MAIN OUTCOME MEASURES Primary outcome measures were peroxisome abundance and matrix protein import. RESULTS Peroxisome number was not significantly different between control fibroblasts and patient fibroblasts; however, fewer peroxisomes were observed in PEX6 knockout cells compared with wild-type cells (P = 0.04). Analysis by immunofluorescent microscopy showed significantly impaired peroxisomal targeting signal 1- and peroxisomal targeting signal 2-mediated matrix protein import in both patient fibroblasts and PEX6 knockout cells. Overexpressing PEX6 resulted in improved matrix protein import in PEX6 knockout cells. CONCLUSIONS Mutations in PEX6 were responsible for combined hearing loss and retinopathy in our patient. The primary peroxisomal defect in our patient's skin fibroblasts was impaired peroxisomal protein import as opposed to reduction in the number of peroxisomes. Genetic strategies that introduce wild-type PEX6 into cells deficient in PEX6 protein show promise in restoring peroxisome function. Future studies of patient-specific induced pluripotent stem cell-derived retinal pigment epithelium cells may clarify the role of PEX6 in the retina and the potential for gene therapy in these patients.
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Key Words
- CRISPR, clustered regularly interspaced short palindromic repeats
- DTM, docking translocation module
- GFP, green fluorescent protein
- HEK293T, human embryonic kidney 293T
- Hearing loss
- PBD, peroxisomal biogenesis disorder
- PBS, phosphate-buffered saline
- PEX6
- PTS1, peroxisomal targeting signal 1
- PTS2, peroxisomal targeting signal 2
- Peroxisomal biogenesis disorders
- Peroxisome
- RPE, retinal pigment epithelium
- Retinal degeneration
- Usher syndrome
- WT, wild-type
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Affiliation(s)
- Matthew D. Benson
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - Kimberly M. Papp
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - Geoffrey A. Casey
- Department of Medical Genetics, University of Alberta, Edmonton, Canada
| | - Alina Radziwon
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - Chris D. St Laurent
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - Lance P. Doucette
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - Ian M. MacDonald
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, Canada
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21
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Fukushima A, Takahashi E, Saruwatari J, Tanihara H, Inoue T. The angiogenic effects of exosomes secreted from retinal pigment epithelial cells on endothelial cells. Biochem Biophys Rep 2020; 22:100760. [PMID: 32420462 DOI: 10.1016/j.bbrep.2020.100760] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/17/2020] [Accepted: 02/11/2020] [Indexed: 12/14/2022] Open
Abstract
Exosomes are informative microvesicles associated with intercellular communication via the transfer of many molecular constituents such as proteins, lipids, and nucleic acids; environmental changes and the cellular status around cells greatly affect exosome components. Cells of the retinal pigment epithelium (RPE) are key players in retinal homeostasis. Transforming growth factor (TGF)-β and tumour necrosis factor (TNF)-α are increased in the vitreous and retina in several retinal diseases and activate and undergo epithelial-mesenchymal transition (EMT) in RPE cells. EMT is closely associated with mechanisms of wound healing, including fibrosis and related angiogenesis; however, whether exosome components depend on the cell status, epithelium or mesenchyme and whether these exosomes have pro- or anti-angiogenic roles in the retina are unknown. We performed this study to investigate whether these EMT inducers affect the kinds of components in exosomes secreted from RPE cells and to assess their angiogenic effects. Exosomes were collected from culture media supernatants of a human RPE cell line (ARPE-19) stimulated with or without 10 ng/ml TNF-α and/or 5 ng/ml TGF-β2. NanoSight tracking analysis and immunoblot analysis using exosome markers were used to qualify harvested vesicles. Angiogenic factor microarray analysis revealed that exosomes derived from ARPE-19 cells cultured with TNF-α alone (Exo-TNF) and co-stimulated with TNF-α and TGF-β2 (Exo-CO) contained more angiogenic factors than exosomes derived from control cells (Exo-CTL) or ARPE-19 cells cultured with TGF-β2 alone (Exo-TGF). To assess the effect on angiogenesis, we performed chemotaxis, tube formation, and proliferation assays of human umbilical vein endothelial cells (HUVECs) stimulated with or without exosomes. HUVECs migrated to RPE-derived exosomes, and exosomes derived from ARPE-19 cells accelerated HUVEC tube formation. In contrast, Exo-TNF and Exo-CO reduced HUVEC proliferation. Our findings provide insight into the mechanisms underlying the relation between angiogenesis and exosomes derived from RPE cells.
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Williams PJ, Salek S, Prinzi RA, Bergstrom C, Hubbard GB 3rd. Distribution patterns of torpedo maculopathy: Further evidence of a congenital retinal nerve fiber layer-driven etiology. Saudi J Ophthalmol 2019; 33:260-7. [PMID: 31686968 DOI: 10.1016/j.sjopt.2019.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 07/13/2019] [Accepted: 07/25/2019] [Indexed: 11/24/2022] Open
Abstract
With fewer than 100 peer-reviewed cases reported in the world to date, the underlying etiology of torpedo maculopathy has remained elusive. In this literature review, we provide new evidence to better support, reject and unify claims regarding cause, diagnosis, and proper clinical management of this disease. We reviewed 44 case reports and case series, which included 77 patients (after exclusions). We additionally introduced 3 new cases from our clinical practice for a total of 80 cases. Ages at presentation ranged from 6 months old to 73 years old (mean: 24.2 years old). The nasal aspects of torpedo maculopathy lesions pointed toward the optic disc and localized to a kite-shaped region of the temporal macula, correlating with the anatomic junction of the superior arcuate, inferior arcuate, and papillomacular bundles of retinal nerve fiber layer distribution. No patterns were observed among the temporal aspects of the lesions. These findings support a congenital etiology of torpedo maculopathy and a possible influence of the retinal nerve fiber layer in the development of mature retinal pigment epithelium.
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Ramos de Carvalho JE, Verwoert MT, Vogels IM, Reits EA, Van Noorden CJ, Klaassen I, Schlingemann RO. Involvement of the ubiquitin-proteasome system in the expression of extracellular matrix genes in retinal pigment epithelial cells. Biochem Biophys Rep 2018; 13:83-92. [PMID: 29387813 PMCID: PMC5789218 DOI: 10.1016/j.bbrep.2018.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 01/06/2023] Open
Abstract
Emerging evidence suggests that dysfunction of the ubiquitin-proteasome system is involved in the pathogenesis of numerous senile degenerative diseases including retinal disorders. The aim of this study was to assess whether there is a link between proteasome regulation and retinal pigment epithelium (RPE)-mediated expression of extracellular matrix genes. For this purpose, human retinal pigment epithelial cells (ARPE-19) were treated with different concentrations of transforming growth factor-β (TGFβ), connective tissue growth factor (CTGF), interferon-γ (IFNγ) and the irreversible proteasome inhibitor epoxomicin. First, cytotoxicity and proliferation assays were carried out. The expression of proteasome-related genes and proteins was assessed and proteasome activity was determined. Then, expression of fibrosis-associated factors fibronectin (FN), fibronectin EDA domain (FN EDA), metalloproteinase-2 (MMP-2), tissue inhibitor of metalloproteinases-1 (TIMP-1) and peroxisome proliferator-associated receptor-γ (PPARγ) was assessed. The proteasome inhibitor epoxomicin strongly arrested cell cycle progression and down-regulated TGFβ gene expression, which in turn was shown to induce expression of pro-fibrogenic genes in ARPE-19 cells. Furthermore, epoxomicin induced a directional shift in the balance between MMP-2 and TIMP-1 and was associated with down-regulation of transcription of extracellular matrix genes FN and FN-EDA and up-regulation of the anti-fibrogenic factor PPARγ. In addition, both CTGF and TGFβ were shown to affect expression of proteasome-associated mRNA and protein levels. Our results suggest a link between proteasome activity and pro-fibrogenic mechanisms in the RPE, which could imply a role for proteasome-modulating agents in the treatment of retinal disorders characterized by RPE-mediated fibrogenic responses.
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Key Words
- AMD, age-related macular degeneration
- ARPE-19, human retinal pigment epithelial cells
- CNV, choroidal neovascularization
- CTGF
- CTGF, connective tissue growth factor
- ECM, extracellular matrix
- EMT, epithelial-mesenchymal transition
- Epoxomicin
- FN EDA, fibronectin EDA domain
- FN, fibronectin
- Fibrosis
- IFNγ, interferon-γ
- MMP-2, matrix metalloproteinase-2
- PPARγ
- PPARγ, peroxisome proliferator-associated receptor-γ
- Proteasome
- RPE
- RPE, retinal pigment epithelium
- Retina
- TGFβ
- TGFβ, transforming growth factor-β
- TIMP-1, tissue inhibitor of metalloproteinases-1
- UPS, ubiquitin-proteasome system
- nAMD, neovascular age-related macular degeneration
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Affiliation(s)
- J. Emanuel Ramos de Carvalho
- Ocular Angiogenesis Group, Departments of Ophthalmology and Medical Biology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Milan T. Verwoert
- Ocular Angiogenesis Group, Departments of Ophthalmology and Medical Biology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ilse M.C. Vogels
- Ocular Angiogenesis Group, Departments of Ophthalmology and Medical Biology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric A. Reits
- Department of Medical Biology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis J.F. Van Noorden
- Ocular Angiogenesis Group, Departments of Ophthalmology and Medical Biology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Medical Biology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ingeborg Klaassen
- Ocular Angiogenesis Group, Departments of Ophthalmology and Medical Biology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Reinier O. Schlingemann
- Ocular Angiogenesis Group, Departments of Ophthalmology and Medical Biology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Rogers CA, Scott LJ, Reeves BC, Downes S, Lotery AJ, Dick AD, Chakravarthy U. Serum Vascular Endothelial Growth Factor Levels in the IVAN Trial; Relationships with Drug, Dosing, and Systemic Serious Adverse Events. Ophthalmol Retina 2018; 2:118-127. [PMID: 30555977 PMCID: PMC6278944 DOI: 10.1016/j.oret.2017.05.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 01/14/2023]
Abstract
Purpose To describe serum vascular endothelial growth factor (sVEGF) in patients with neovascular age-related macular degeneration (nAMD) receiving anti-VEGF agents and associations between sVEGF and systemic serious adverse events (SSAEs). Design Exploratory analyses of a randomized controlled trial that enrolled 610 participants with nAMD and compared 2 anti-VEGF antibodies, ranibizumab and bevacizumab, and 2 treatment regimens, monthly vs. discontinuous, with 2 years' follow-up. Participants Adults aged 50+ years with treatment-naïve nAMD and a visual acuity of ≥25 letters (Snellen equivalent 20/320) in the affected eye. Methods Intravitreal injection of anti-VEGF antibodies. Main Outcome Measures sVEGF and occurrence of SSAE, with particular interest in arteriothromboembolic events (ATE) and immunologically mediated events (IME). Results On average, sVEGF (measured at months 0, 1, 11, 12, 23, and 24) decreased from a geometric mean of 168 pg/mL at baseline to 64 pg/mL at month 24. The decrease was greater with bevacizumab than with ranibizumab and was dependent on time since last treatment; at month 24 sVEGF was 11% lower with bevacizumab if treated ≥3 months previously, 51% lower if treated 2 months previously, and 76% lower if treated the previous month, compared with ranibizumab. The hazard of experiencing an ATE increased with age (hazard ratio [HR] = 2.01; 95% confidence interval [CI] = 1.32–3.05; P = 0.001) and higher sVEGF (HR = 1.16; 95% CI = 1.03–1.30, per 100 unit rise in sVEGF; P = 0.013). There was no association between sVEGF and the hazard of an IME (HR = 1.01; 95% CI = 0.76–1.33; P = 0.942); however, the hazard of an IME was significantly increased by treatment with bevacizumab compared with ranibizumab (HR = 3.53; 95% CI = 1.35–9.22; P = 0.010). The hazard of an “other SSAE” (not categorized as ATE or IME) increased with age (HR 1.51, 95% CI 1.14–2.01, P = 0.005) and decreased if an injection had been administered within the previous month (HR = 0.68; 95% CI = 0.45–1.03; P = 0.069). Conclusions The decrease in sVEGF is greater with bevacizumab than with ranibizumab, but this difference is eliminated when treatment is withheld for 3 months. Higher sVEGF increased the hazard of an ATE and bevacizumab increases the hazard of an IME compared with ranibizumab.
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Key Words
- ATE, arteriothromboembolic event
- CI, confidence interval
- DVT, deep vein thrombosis
- GMR, geometric mean ratio
- HR, hazard ratio
- IME, immunologically mediated event
- RPE, retinal pigment epithelium
- SSAE, systemic serious adverse event
- VEGF, vascular endothelial growth factor
- nAMD, neovascular age-related macular degeneration
- pVEGF, plasma vascular endothelial growth factor
- sVEGF, serum vascular endothelial growth factor
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Affiliation(s)
- Chris A. Rogers
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Lauren J. Scott
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Barnaby C. Reeves
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Susan Downes
- Oxford Eye Hospital, Oxford University Hospitals Foundation Trust, Oxford, United Kingdom
| | - Andrew J. Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Andrew D. Dick
- School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
- UCL Institute of Ophthalmology and National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| | - Usha Chakravarthy
- Centre for Experimental Medicine, Queen's University, Belfast, United Kingdom
- Correspondence: Usha Chakravarthy, MBBS, FRCOphth, Centre for Experimental Medicine, Queen's University of Belfast, Institute for Clinical Science A, Grosvenor Road, Belfast, BT12 6BA, UK.
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McLenachan S, Hao E, Zhang D, Zhang L, Edel M, Chen F. Bioengineered Bruch's-like extracellular matrix promotes retinal pigment epithelial differentiation. Biochem Biophys Rep 2017; 10:178-85. [PMID: 28955745 DOI: 10.1016/j.bbrep.2017.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/21/2017] [Accepted: 03/26/2017] [Indexed: 11/21/2022] Open
Abstract
In the eye, the retinal pigment epithelium (RPE) adheres to a complex protein matrix known as Bruch's membrane (BrM). The aim of this study was to provide enriched conditions for RPE cell culture through the production of a BrM-like matrix. Our hypothesis was that a human RPE cell line would deposit an extracellular matrix (ECM) resembling BrM. The composition and structure of ECM deposited by ARPE19 cells (ARPE19-ECM) was characterized. To produce ARPE19-ECM, ARPE19 cells were cultured in the presence dextran sulphate. ARPE19-ECM was decellularized using deoxycholate and characterized by immunostaining and western blot analysis. Primary human RPE and induced pluripotent stem cells were seeded onto ARPE19-ECM or geltrex coated surfaces and examined by microscopy or RT-PCR. Culture of ARPE19 cells with dextran sulphate promoted nuclear localization of SOX2, formation of tight junctions and deposition of ECM. ARPE19 cells deposited ECM proteins found in the inner layers of BrM, including fibronectin, vitronectin, collagens IV and V as well as laminin-alpha-5, but not those found in the middle elastic layer (elastin) or the outer layers (collagen VI). ARPE19-ECM promoted pigmentation in human RPE and pluripotent stem cell cultures. Expression of RPE65 was significantly increased on ARPE19-ECM compared with geltrex in differentiating pluripotent stem cell cultures. ARPE19 cells deposit ECM with a composition and structure similar to BrM in the retina. Molecular cues present in ARPE19-ECM promote the acquisition and maintenance of the RPE phenotype. Together, these results demonstrate a simple method for generating a BrM-like surface for enriched RPE cell cultures. Macromolecular crowding promoted deposition of extracellular matrix by ARPE19 cells. ARPE19 cells deposited matrix proteins found in the inner layers of Bruch's membrane. ARPE19-ECM displayed similar microstructure to Bruch's membrane. ARPE19-ECM promoted pigmentation in human retinal pigment epithelial cell cultures. ARPE19-ECM promoted RPE differentiation from pluripotent stem cells.
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Oliver VF, Jaffe AE, Song J, Wang G, Zhang P, Branham KE, Swaroop A, Eberhart CG, Zack DJ, Qian J, Merbs SL. Differential DNA methylation identified in the blood and retina of AMD patients. Epigenetics 2016; 10:698-707. [PMID: 26067391 DOI: 10.1080/15592294.2015.1060388] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Age-related macular degeneration (AMD) is a major cause of blindness in the western world. While genetic studies have linked both common and rare variants in genes involved in regulation of the complement system to increased risk of development of AMD, environmental factors, such as smoking and nutrition, can also significantly affect the risk of developing the disease and the rate of disease progression. Since epigenetics has been implicated in mediating, in part, the disease risk associated with some environmental factors, we investigated a possible epigenetic contribution to AMD. We performed genome-wide DNA methylation profiling of blood from AMD patients and controls. No differential methylation site reached genome-wide significance; however, when epigenetic changes in and around known GWAS-defined AMD risk loci were explored, we found small but significant DNA methylation differences in the blood of neovascular AMD patients near age-related maculopathy susceptibility 2 (ARMS2), a top-ranked GWAS locus preferentially associated with neovascular AMD. The methylation level of one of the CpG sites significantly correlated with the genotype of the risk SNP rs10490924, suggesting a possible epigenetic mechanism of risk. Integrating genome-wide DNA methylation analysis of retina samples with and without AMD together with blood samples, we further identified a consistent, replicable change in DNA methylation in the promoter region of protease serine 50 (PRSS50). These methylation changes may identify sites in novel genes that are susceptible to non-genetic factors known to contribute to AMD development and progression.
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Key Words
- AMD, Age-related macular degeneration
- AMD-MMAP, Michigan, Mayo
- AREDS, Age-Related Eye Disease Study
- AREDS, and Pennsylvania
- DNA methylation
- DNAm, DNA methylation
- GA, geographic atrophy
- GWAS, genome-wide association study
- KEC, Kellogg Eye Center
- LCLs, lymphoblastoid cell lines
- NV, choroidal neovascularization
- RPE, retinal pigment epithelium
- age-related macular degeneration
- genome-wide methylation
- meQTL, methylation quantitative trait loci
- methyl-QTL
- peripheral blood leukocytes
- retina
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Affiliation(s)
- Verity F Oliver
- a Department of Ophthalmology; Johns Hopkins University; School of Medicine ; Baltimore , MD USA
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Yao J, Jia L, Khan N, Lin C, Mitter SK, Boulton ME, Dunaief JL, Klionsky DJ, Guan JL, Thompson DA, Zacks DN. Deletion of autophagy inducer RB1CC1 results in degeneration of the retinal pigment epithelium. Autophagy 2016; 11:939-53. [PMID: 26075877 DOI: 10.1080/15548627.2015.1041699] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Autophagy regulates cellular homeostasis and response to environmental stress. Within the retinal pigment epithelium (RPE) of the eye, the level of autophagy can change with both age and disease. The purpose of this study is to determine the relationship between reduced autophagy and age-related degeneration of the RPE. The gene encoding RB1CC1/FIP200 (RB1-inducible coiled-coil 1), a protein essential for induction of autophagy, was selectively knocked out in the RPE by crossing Best1-Cre mice with mice in which the Rb1cc1 gene was flanked with Lox-P sites (Rb1cc1(flox/flox)). Ex vivo and in vivo analyses, including western blot, immunohistochemistry, transmission electron microscopy, fundus photography, optical coherence tomography, fluorescein angiography, and electroretinography were performed to assess the structure and function of the retina as a function of age. Deletion of Rb1cc1 resulted in multiple autophagy defects within the RPE including decreased conversion of LC3-I to LC3-II, accumulation of autophagy-targeted precursors, and increased numbers of mitochondria. Age-dependent degeneration of the RPE occurred, with formation of atrophic patches, subretinal migration of activated microglial cells, subRPE deposition of inflammatory and oxidatively damaged proteins, subretinal drusenoid deposits, and occasional foci of choroidal neovascularization. There was secondary loss of photoreceptors overlying the degenerated RPE and reduction in the electroretinogram. These observations are consistent with a critical role of autophagy in the maintenance of normal homeostasis in the aging RPE, and indicate that disruption of autophagy leads to retinal phenotypes associated with age-related degeneration.
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Key Words
- AMD, age-related macular degeneration
- ANOVA, analysis of variance
- Bru, Bruch's membrane
- CKO, conditional knockout
- CTSD, cathepsin D
- ERG, electroretinogram
- FIP200
- GCL, ganglion cell layer
- INL, inner nuclear layer
- IS, inner segment
- LAP, LC3-associated phagocytosis
- MTOR, mechanistic target of rapamycin
- OCT, optical coherence tomography
- ONL, outer nuclear layer
- OS, outer segment
- PBS, phosphate-buffered saline
- POS, photoreceptor outer segments
- RB1CC1, RB1-inducible coiled-coil 1
- RPE, retinal pigment epithelium
- age-related macular degeneration
- photoreceptor
- retina
- retinal pigment epithelium
- siRNA, small interfering ribonucleic acid.
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Affiliation(s)
- Jingyu Yao
- a Department of Ophthalmology and Visual Sciences ; University of Michigan ; Ann Arbor , MI USA
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28
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Mateos MV, Kamerbeek CB, Giusto NM, Salvador GA. Early LPS-induced ERK activation in retinal pigment epithelium cells is dependent on PIP 2 -PLC. Data Brief 2016; 7:423-7. [PMID: 27006973 PMCID: PMC4786752 DOI: 10.1016/j.dib.2016.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/02/2016] [Accepted: 02/20/2016] [Indexed: 11/25/2022] Open
Abstract
This article presents additional data regarding the study “The phospholipase D pathway mediates the inflammatory response of the retinal pigment epithelium” [1]. The new data presented here show that short exposure of RPE cells to lipopolysaccharide (LPS) induces an early and transient activation of the extracellular signal-regulated kinase (ERK1/2). This early ERK1/2 activation is dependent on phosphatidylinositol bisphosphate-phospholipase C (PIP2-PLC). On the contrary, neither the phospholipase D 1 (PLD1) nor the PLD2 inhibition is able to modulate the early ERK1/2 activation induced by LPS in RPE cells.
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Affiliation(s)
- Melina V Mateos
- Instituto de Investigaciones Bioquímicas de Bahía Blanca (INIBIBB), Universidad Nacional del Sur (UNS) and Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Camino La Carrindanga km 7, 8000 Bahía Blanca, Argentina
| | - Constanza B Kamerbeek
- Instituto de Investigaciones Bioquímicas de Bahía Blanca (INIBIBB), Universidad Nacional del Sur (UNS) and Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Camino La Carrindanga km 7, 8000 Bahía Blanca, Argentina
| | - Norma M Giusto
- Instituto de Investigaciones Bioquímicas de Bahía Blanca (INIBIBB), Universidad Nacional del Sur (UNS) and Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Camino La Carrindanga km 7, 8000 Bahía Blanca, Argentina
| | - Gabriela A Salvador
- Instituto de Investigaciones Bioquímicas de Bahía Blanca (INIBIBB), Universidad Nacional del Sur (UNS) and Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Camino La Carrindanga km 7, 8000 Bahía Blanca, Argentina
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29
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Shen Z, Shao J, Dai J, Lin Y, Yang X, Ma J, He Q, Yang B, Yao K, Luo P. Diosmetin protects against retinal injury via reduction of DNA damage and oxidative stress. Toxicol Rep 2015; 3:78-86. [PMID: 28959525 PMCID: PMC5615423 DOI: 10.1016/j.toxrep.2015.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/02/2015] [Accepted: 12/12/2015] [Indexed: 11/15/2022] Open
Abstract
Visual impairment is a global public health problem that needs new candidate drugs. Chrysanthemum is a traditional Chinese drug, famous for its eye-protective function, with an unclear mechanism of action. To determine how chrysanthemum contributes to vision, we identified, for the first time, the component of chrysanthemum, diosmetin (DIO), which acts in protecting the injured retina in an adriamycin (ADR) improving model. We observed that DIO could attenuate the apoptosis of retinal cells in Sprague–Dawley rats and verified this effect in cultured human retinal pigment epithelium (RPE) cells, ARPE-19. Our further study on the mechanism revealed the counteractive effect of DIO on the attenuation of DNA damage and oxidative stress, which occurs in a wide range of retinal disorders. These results collectively promise the potential value of DIO as a retinal-protective agent for disorders that lead to blindness. In addition, we identified, for the first time, the component of chrysanthemum, DIO, which acts in protecting the injured retina.
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Key Words
- ADR, adriamycin
- AMD, age-related macular degeneration
- ATP, adenosine triphosphate
- Apoptosis
- CNV, choroidal neovascularisation
- Chrysanthemum
- DIO, diosmetin
- DNA damage
- Diosmetin
- Diosmetin (PubChem CID5281612)
- Doxorubicin (PubChem CID31703)
- H&E, hematoxylin and eosin
- IC50, inhibition for 50% of the cells
- IVI, intravitreal injection
- Oxidative stress
- PVR, proliferative vitreoretinopathy
- ROS, reactive oxygen species
- RPE, retinal pigment epithelium
- Retinal injury
- Retinal pigment epithelium
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Affiliation(s)
- Zeren Shen
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, P.R. China.,Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Jinjin Shao
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, P.R. China
| | - Jiabin Dai
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, P.R. China
| | - Yuchen Lin
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, P.R. China.,Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Xiaochun Yang
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, P.R. China
| | - Jian Ma
- Center for Drug Safety Evaluation and Research of Zhejiang University, Hangzhou, P.R. China
| | - Qiaojun He
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, P.R. China
| | - Bo Yang
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, P.R. China
| | - Ke Yao
- Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Peihua Luo
- Institute of Pharmacology & Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, P.R. China
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Brandstaetter H, Kishi-Itakura C, Tumbarello DA, Manstein DJ, Buss F. Loss of functional MYO1C/myosin 1c, a motor protein involved in lipid raft trafficking, disrupts autophagosome-lysosome fusion. Autophagy 2015; 10:2310-23. [PMID: 25551774 PMCID: PMC4502697 DOI: 10.4161/15548627.2014.984272] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
MYO1C, a single-headed class I myosin, associates with cholesterol-enriched lipid rafts and facilitates their recycling from intracellular compartments to the cell surface. Absence of functional MYO1C disturbs the cellular distribution of lipid rafts, causes the accumulation of cholesterol-enriched membranes in the perinuclear recycling compartment, and leads to enlargement of endolysosomal membranes. Several feeder pathways, including classical endocytosis but also the autophagy pathway, maintain the health of the cell by selective degradation of cargo through fusion with the lysosome. Here we show that loss of functional MYO1C leads to an increase in total cellular cholesterol and its disrupted subcellular distribution. We observe an accumulation of autophagic structures caused by a block in fusion with the lysosome and a defect in autophagic cargo degradation. Interestingly, the loss of MYO1C has no effect on degradation of endocytic cargo such as EGFR, illustrating that although the endolysosomal compartment is enlarged in size, it is functional, contains active hydrolases, and the correct pH. Our results highlight the importance of correct lipid composition in autophagosomes and lysosomes to enable them to fuse. Ablating MYO1C function causes abnormal cholesterol distribution, which has a major selective impact on the autophagy pathway.
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Key Words
- BafA1, bafilomycin A1
- EGF, epidermal growth factor
- EGFR, epidermal growth factor receptor
- EM, electron microscopy
- GFP, green fluorescent protein
- KD, knockdown
- LAMP1, lysosomal-associated membrane protein 1
- LC3, microtubule-associated protein 1 light chain 3
- MVB, multivesicular body
- MYO1C, myosin IC
- PB, phosphate buffer
- PCIP, pentachloropseudilin
- PtdIns(4, 5)P2, phosphatidylinositol 4, 5-bisphosphate
- RFP, red fluorescent protein
- RPE, retinal pigment epithelium
- autophagy
- cholesterol
- electron microscopy
- lipid raft
- lysosome, MYO1C
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Affiliation(s)
- Hemma Brandstaetter
- a Cambridge Institute for Medical Research ; University of Cambridge ; Cambridge , UK
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Muraleva NA, Kozhevnikova OS, Zhdankina AA, Stefanova NA, Karamysheva TV, Fursova AZ, Kolosova NG. The mitochondria-targeted antioxidant SkQ1 restores αB-crystallin expression and protects against AMD-like retinopathy in OXYS rats. Cell Cycle 2015; 13:3499-505. [PMID: 25483086 DOI: 10.4161/15384101.2014.958393] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Age-related macular degeneration (AMD), a neurodegenerative and vascular retinal disease, is the leading cause of blindness in the developed world. Accumulating evidence suggests that alterations in the expression of a small heat shock protein (αB-crystallin) are involved in the pathogeneses of AMD. Here we demonstrate that senescence-accelerated OXYS rats-an animal model of the dry form of AMD-develop spontaneous retinopathy against the background of reduced expression of αB-crystallin in the retina at the early preclinical stages of retinopathy (age 20 days) as well as at 4 and 24 months of age, during the progressive stage of the disease. The level of αA-crystallin expression in the retina of OXYS rats at all the ages examined was no different from that in disease-free Wistar rats. Treatment with the mitochondria-targeted antioxidant SkQ1 (plastoquinonyl-decyltriphenylphosphonium) from 1.5 to 4 months of age, 250 nmol/kg, increased the level of αB-crystallin expression in the retina of OXYS rats. SkQ1 slowed the development of retinopathy and reduced histological aberrations in retinal pigment epithelium cells. SkQ1 also attenuated neurodegenerative changes in the photoreceptors and facilitated circulation in choroid blood vessels in the retina of OXYS rats; this improvement was probably linked with the restoration of αB-crystallin expression.
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Li Y, Liu X, Zhou T, Kelley MR, Edwards P, Gao H, Qiao X. Inhibition of APE1/Ref-1 redox activity rescues human retinal pigment epithelial cells from oxidative stress and reduces choroidal neovascularization. Redox Biol 2014; 2:485-94. [PMID: 24624338 PMCID: PMC3949093 DOI: 10.1016/j.redox.2014.01.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/29/2014] [Accepted: 01/31/2014] [Indexed: 02/06/2023] Open
Abstract
The effectiveness of current treatment for age related macular degeneration (AMD) by targeting one molecule is limited due to its multifactorial nature and heterogeneous pathologies. Treatment strategy to target multiple signaling pathways or pathological components in AMD pathogenesis is under investigation for better clinical outcome. Inhibition of the redox function of apurinic endonuclease 1/redox factor-1 (APE1) was found to suppress endothelial angiogenesis and promote neuronal cell recovery, thereby may serve as a potential treatment for AMD. In the current study, we for the first time have found that a specific inhibitor of APE1 redox function by a small molecule compound E3330 regulates retinal pigment epithelium (RPEs) cell response to oxidative stress. E3330 significantly blocked sub-lethal doses of oxidized low density lipoprotein (oxLDL) induced proliferation decline and senescence advancement of RPEs. At the same time, E3330 remarkably decreased the accumulation of intracellular reactive oxygen species (ROS) and down-regulated the productions of monocyte chemoattractant protein-1 (MCP-1) and vascular endothelial growth factor (VEGF), as well as attenuated the level of nuclear factor-κB (NF-κB) p65 in RPEs. A panel of stress and toxicity responsive transcription factors that were significantly upregulated by oxLDL was restored by E3330, including Nrf2/Nrf1, p53, NF-κB, HIF1, CBF/NF-Y/YY1, and MTF-1. Further, a single intravitreal injection of E3330 effectively reduced the progression of laser-induced choroidal neovascularization (CNV) in mouse eyes. These data revealed that E3330 effectively rescued RPEs from oxidative stress induced senescence and dysfunctions in multiple aspects in vitro, and attenuated laser-induced damages to RPE–Bruch׳s membrane complex in vivo. Together with its previously established anti-angiogenic and neuroprotection benefits, E3330 is implicated for potential use for AMD treatment. Specific inhibition of APE1/Ref-1 redox function with E3330 blocked RPE proliferation decline and senescence-like phenotype advancement induced by oxLDL. E3330 suppressed intracellular ROS, down-regulated the MCP-1 and VEGF production, and reduced nuclear NF-κB p65 in RPEs. E3330 repressed the redox sensitive transcription factors Nrf2/Nrf1, p53, NF-κB, HIF1, CBF/NF-Y/YY1, and MTF-1 that stimulated by oxLDL in RPEs. Intravitreal injection of E3330 markedly reduced the laser-induced CNV in mouse eyes. E3330 holds great potential for the management of AMD.
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Key Words
- AMD, age related macular degeneration
- AP-1, activator protein 1
- APE1, apurinic endonuclease 1/redox factor-1
- APE1/Ref-1redox function
- Age-related macular degeneration.
- AhR, aryl hydrocarbon receptor
- ApoE, apolipoprotein E
- CBF/NF-Y/YY1, CCAAT binding factor/nuclear factor-Y/Yin Yang 1
- CECs, choroidal endothelial cells
- CNV, choroidal neovascularization
- DCFH-DA, dichlorodihydrofluorescin diacetate
- DMSO, dimethylsulphoxide
- E3330
- Fluc, firefly luciferase
- HIF-1α, hypoxia inducible factor-1α
- HSF1, heat-shock factor 1
- IκB-α, inhibitory NF-κB-α
- MCP-1, monocyte chemoattractant protein-1
- MTF1, metal regulatory transcription factor 1
- NF-κB, nuclear factor-κB
- Nox, NADPH oxidase
- Nrf, nuclear factor erythroid-2-related factor
- Oxidative stress
- RNV, retinal neovascularization
- ROS, reactive oxygen species
- RPE, retinal pigment epithelium
- RVECs, retinal vascular endothelial cells
- Retinal pigment epithelial cell
- Rluc, renilla luciferase
- SA-β-gal, senescence associated β-gal
- SDS-PAGE, sodium dodecyl sulfate-polyacrylamide gel electrophoresis
- TUNEL, TdT mediated dUTP-fluorescein nick end-labeling
- Transcription factor
- VEGF, vascular endothelial growth factor
- oxLDL, oxidized low density lipoprotein
- redox, reduction/oxidation
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Affiliation(s)
- Y Li
- Department of Ophthalmology, Henry Ford Health System, 1 Ford Place 5D, Detroit, MI, United States ; Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi׳an, Shanxi, People׳s Republic of China
| | - X Liu
- Department of Ophthalmology, Henry Ford Health System, 1 Ford Place 5D, Detroit, MI, United States
| | - T Zhou
- Department of Ophthalmology, Henry Ford Health System, 1 Ford Place 5D, Detroit, MI, United States
| | - M R Kelley
- Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, United States
| | - P Edwards
- Department of Ophthalmology, Henry Ford Health System, 1 Ford Place 5D, Detroit, MI, United States
| | - H Gao
- Department of Ophthalmology, Henry Ford Health System, 1 Ford Place 5D, Detroit, MI, United States
| | - X Qiao
- Department of Ophthalmology, Henry Ford Health System, 1 Ford Place 5D, Detroit, MI, United States
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Keane PA, Sadda SR. Predicting visual outcomes for macular disease using optical coherence tomography. Saudi J Ophthalmol 2011; 25:145-58. [PMID: 23960916 DOI: 10.1016/j.sjopt.2011.01.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 01/21/2011] [Indexed: 12/31/2022] Open
Abstract
In recent years, the management of macular disease has undergone radical changes, in part because of new therapeutic approaches, but also due to the introduction of a new imaging modality - optical coherence tomography (OCT). The application of OCT imaging has clarified many aspects of chorioretinal disease pathophysiology and elucidated many hitherto unrecognized disease characteristics. From an early stage in its development, OCT has also been revolutionary in attempting to extract clinically useful measurements from image data in an automated fashion. As a result, OCT-derived measurements of retinal thickness have been rapidly embraced in clinical and research settings. However, as knowledge of OCT image analysis has developed, it has become increasingly clear that even accurate measurements of retinal thickness may fail to predict visual outcomes for many diseases. As a result, the focus of much current clinical imaging research is on the identification of other OCT-derived anatomic biomarkers predictive of visual outcomes - such biomarkers could serve as surrogate endpoints in clinical trials and provide prognostic information in clinical practice. In this review, we begin by highlighting the importance of accurate visual function assessment and describing the fundamentals of OCT image evaluation, before describing the current state-of-the-art with regard to predicting visual outcomes, for a variety of macular diseases, using OCT.
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Key Words
- AMD, age-related macular degeneration
- Age-related macular degeneration
- BRVO, branch retinal vein occlusion
- CME, cystoid macular edema
- CNV, choroidal neovascularization
- CRVO, central retinal vein occlusion
- CSC, central serous chorioretinopathy
- Central serous chorioretinopathy
- Contrast sensitivity
- DME, diabetic macular edema
- Diabetic macular edema
- ELM, external limiting membrane
- ERM, epiretinal membrane
- ETDRS, Early Treatment Diabetic Retinopathy Study
- GA, geographic atrophy
- Geographic atrophy
- IS–OS, inner segment–outer segment
- MPS, Macular Photocoagulation Study
- Microperimetry
- OCT, optical coherence tomography
- Optical coherence tomography
- PED, pigment epithelium detachment
- RPE, retinal pigment epithelium
- Surrogate endpoints
- Visual acuity
- logMAR, logarithm of the minimum angle of resolution
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Affiliation(s)
- Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, United Kingdom
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