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Muc R, Saracen A, Grabska-Liberek I. Associations of Diabetic Retinopathy with Retinal Neurodegeneration on the Background of Diabetes Mellitus. Overview of Recent Medical Studies with an Assessment of the Impact on Healthcare systems. Open Med (Wars) 2018; 13:130-136. [PMID: 29675479 PMCID: PMC5906647 DOI: 10.1515/med-2018-0008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 02/27/2018] [Indexed: 11/24/2022] Open
Abstract
Diabetes Mellitus (DM) is one of the biggest healthcare and financial problems worldwide. The disease is strongly associated with microvascular and macrovascular complications, causing co-existing diseases like Diabetic Retinopathy, Diabetic Neuropathy and Diabetic Nephropathy. Annual healthcare expenditures for diabetes treatment and complications prevention cost 727 billion USD in year 2017. Diabetes Mellitus, Diabetic Retinopathy and Diabetic Retinal Neuropathy are closely related diseases - originating from incorrectly controlled glycemia, blood pressure and lipid levels in the course of increasing resistance of the body tissues to insulin. Irrespectively of thorough programs for Diabetes Mellitus prevention and treatment, Diabetic Retinopathy management requires targeted treatment strategies for both microvasculopathy and retinal neurodegeneration, to delay disease severity course and risk of blindness. The study and conclusions in this article are based on web-available data and officially published articles related to the diabetes mellitus and associated diseases - Diabetic Retinopathy and Diabetic Retinal Neuropathy. The articles have been reviewed and analyzed to assess mutual relations between the discussed diseases.
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Affiliation(s)
- Rafał Muc
- Faculty of Health Sciences and Physical Education, K. Pulaski University of Technology and Humanities in Radom, Radom, Poland
| | - Agnieszka Saracen
- Faculty of Health Sciences and Physical Education, K. Pulaski University of Technology and Humanities in Radom, Radom, Poland
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352
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Essential Roles of Lactate in Müller Cell Survival and Function. Mol Neurobiol 2018; 55:9108-9121. [PMID: 29644598 DOI: 10.1007/s12035-018-1056-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/29/2018] [Indexed: 12/17/2022]
Abstract
Müller cells are pivotal in sustaining retinal ganglion cells, and an intact energy metabolism is essential for upholding Müller cell functions. The present study aimed to investigate the impact of lactate on Müller cell survival and function. Primary mice Müller cells and human Müller cell lines (MIO-M1) were treated with or without lactate (10 or 20 mM) for 2 and 24 hours. Simultaneously, Müller cells were incubated with or without 6 mM of glucose. L-lactate exposure increased Müller cell survival independently of the presence of glucose. This effect was abolished by the addition of the monocarboxylate inhibitor 4-cinnamic acid to the treatment media, whereas survival continued to increase in response to addition of D-lactate during glucose restriction. ATP levels decreased over time in MIO-M1 cells and remained stable over time in primary Müller cells. Lactate was preferably metabolized in MIO-M1 cells compared to glucose, and 10 mM of L-Lactate exposure prevented complete glycogen depletion in MIO-M1 cells. Glutamate uptake increased after 2 hours and decreased after 24 hours in glucose-restricted Müller cells compared to cells with glucose supplement. The addition of 10 mM of lactate to the treatment media increased glutamate uptake in glucose supplemented and restricted cells. In conclusion, lactate is a key component in maintaining Müller cell survival and function. Hence, lactate administration may be of great future interest, ultimately leading to novel therapies to rescue retinal ganglion cells.
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353
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Ward ME, Gelfand JM, Lui LY, Ou Y, Green AJ, Stone K, Pedula KL, Cummings SR, Yaffe K. Reduced contrast sensitivity among older women is associated with increased risk of cognitive impairment. Ann Neurol 2018; 83:730-738. [PMID: 29518257 PMCID: PMC5947874 DOI: 10.1002/ana.25196] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/05/2018] [Accepted: 03/07/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Several cross-sectional studies have reported an association between visual contrast sensitivity (a functional measure of low contrast vision) and poor cognitive performance or dementia, but no studies have investigated this association prospectively in a population-based cohort with final adjudication of mild cognitive impairment (MCI)/dementia. METHODS In a prospective, community-based study of aging women (Study of Osteoporotic Fractures), we analyzed whether visual contrast sensitivity was associated with increased risk of MCI or dementia and/or worse performance on various cognitive tests assessed 10 years later. Contrast sensitivity was assessed at baseline in each eye using a VISTECH VCTS 6500 wall chart. MCI/dementia was adjudicated by an expert panel. Multivariate logistic and linear regression models were analyzed. RESULTS Of 1,352 white (88.2%) and African American (11.8%) women with a mean age of 77.7 years (standard deviation = 3.3), 536 (39.6%) went on to develop MCI/dementia over 10 years. MCI/dementia risk was more than doubled (odds ratio = 2.16, 95% confidence interval = 1.58-2.96) in women with the lowest quartile of contrast sensitivity compared to the highest (p < 0.0001 for the linear trend). Reduced baseline contrast sensitivity was also associated with lower performance on several cognitive measures assessed 10 years later. INTERPRETATION Among older women, reduced contrast sensitivity is associated with a greater risk of MCI/dementia. These findings suggest that visual system neurodegeneration or dysfunction may parallel or precede dementia-related cortical or subcortical degeneration, and that contrast sensitivity testing may be useful in identifying aging adults at high risk for dementia. Ann Neurol 2018;83:730-738.
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Affiliation(s)
- Michael E. Ward
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Jeffrey M. Gelfand
- Division of Neuroinflammation and Glial Biology, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, CA
| | - Li-Yung Lui
- Research Institute, California Pacific Medical Center, San Francisco, CA
| | - Yvonne Ou
- Department of Ophthalmology, University of California San Francisco, CA
| | - Ari J. Green
- Division of Neuroinflammation and Glial Biology, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, CA
- Department of Ophthalmology, University of California San Francisco, CA
| | - Katie Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Kathryn L. Pedula
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Steven R. Cummings
- Department of Medicine, University of California, San Francisco, California and California Pacific Medical Center, San Francisco, CA
| | - Kristine Yaffe
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
- Departments of Psychiatry and Epidemiology, University of California, San Francisco and the San Francisco VA Medical Center, San Francisco, California
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354
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Abstract
In the face of the global epidemic of diabetes, it is critical that we update our knowledge about the pathogenesis of diabetes and the related micro alterations on the vascular network in the body. This may ultimately lead to early diagnosis and novel treatment options for delaying the progression of diabetic complications. Research has recently revealed the pivotal role of endothelin in the pathogenesis of diabetic complications, particularly in the regulation of the capillary flow, which is affected in the course of retinopathy. Although there are several reviews on various approaches to the treatment of diabetes, including normalization of glucose and fat metabolism, no reviews in literature have focused on the endothelin system as a therapeutic target or early indicator of diabetic microangiopathy. In this review, we summarize some of the experimental and clinical evidence suggesting that current therapeutic approaches to diabetes may include the modulation of the blood concentration of compounds of the endothelin system. In addition, we will briefly discuss the beneficial effects produced by the inhibition of the production of high levels of endothelin in vasculopathy, with focus on diabetic retinopathy. The cutting-edge technology currently widely used in opththalmology, such as the OCT angiography, allows us to detect very early retinal morphological changes alongside alterations in choroidal and retinal vascular network. Combination of such changes with highly sensitive measurements of alterations in serum concentrations of endothelin may lead to more efficient early detection and treatment of diabetes and related macro/microvascular complications.
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355
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Lange J, Hadziahmetovic M, Zhang J, Li W. Region-specific ischemia, neovascularization and macular oedema in treatment-naïve proliferative diabetic retinopathy. Clin Exp Ophthalmol 2018; 46:757-766. [PMID: 29412501 DOI: 10.1111/ceo.13168] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 12/08/2017] [Accepted: 01/24/2018] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Region-specific pathology in proliferative diabetic retinopathy enhances our understanding and management of this disease. BACKGROUND To investigate non-perfusion, neovascularization and macular oedema. DESIGN A cross-sectional, observational, non-randomized study. PARTICIPANTS Consecutive 43 eyes of 27 treatment-naïve patients. METHODS Ultra-widefield fluorescein angiography for studying specific zones, that is, far-peripheral zone, mid-peripheral zone and central retina (cr), and spectral-domain optical coherence tomography for analysing thickness of macular layers. MAIN OUTCOME MEASURES Non-perfusion index (NPI) and neovascularization index (NVI) in different zones, thickness of cr, retinal nerve fibre layer, ganglion cell layer (GCL), inner nuclear layer (INL) and outer plexiform layer in parafoveal regions. RESULTS The NPI of far-periphery and NVI of mid-periphery were the highest by one-way analysis of variance testing. Ischemic retina defined as high NPI in far-periphery was significantly related to macular oedema via a binary classification approach (P < 0.05). The ischemic retina was correlated with a decreased thickness of both retinal nerve fibre and GCL (P < 0.05); macular oedema was correlated with increased INL thickness (P < 0.0001). CONCLUSIONS AND RELEVANCE The region-specific correlation of NPI of far-periphery and NVI of mid-periphery, but not with central retinal thickness, suggests different pathogeneses of neovascularization and macular oedema. Retinal nerve fibre layer and GCL, both biomarkers of diabetic retinal neuronopathy, are associated with retinal ischemia, but not with macular oedema, suggesting that diabetic microangiopathy and neuronopathy possess distinct pathogenic pathways. The strong correlation between macular oedema and INL indicates that intracellular oedema is a determining factor of diabetic macular oedema.
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Affiliation(s)
- Jason Lange
- Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.,Department of Ophthalmology, University of South Florida Morsani School of Medicine, Tampa, Florida, USA
| | - Majda Hadziahmetovic
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jingfa Zhang
- Department of Ophthalmology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiye Li
- Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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356
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De Clerck EE, Schouten JS, Berendschot TT, Goezinne F, Dagnelie PC, Schaper NC, Schram MT, Stehouwer CD, Webers CA. Macular thinning in prediabetes or type 2 diabetes without diabetic retinopathy: the Maastricht Study. Acta Ophthalmol 2018; 96:174-182. [PMID: 29090852 DOI: 10.1111/aos.13570] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 07/30/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE To assess macular thinning in individuals with prediabetes or type 2 diabetes without diabetic retinopathy (DM2 w/o DR) compared with individuals with normal glucose metabolism (NGM). METHODS Using spectral domain optical coherence tomography (SD-OCT), we measured macular thickness in six subfields as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS) in 1838 participants from The Maastricht Study, a population-based cohort study (mean age 59 ± 8 years, 49% men, 1087 NGM, 279 prediabetes, 472 DM2 w/o DR). Multivariable linear regression was used to assess the association between macular thickness and glucose metabolism status. RESULTS After adjustment for age, sex and spherical equivalent, individuals with prediabetes showed a significant decrease in pericentral superior macular thickness [β = -2.14 μm (95% confidence interval (CI): -4.24 to -0.03), p < 0.05] compared with individuals with NGM. In individuals with DM2 w/o DR, the fovea [β = -4.05 μm (95% CI: -6.30 to -1.79), p < 0.001] and the four pericentral quadrants (range: β = -4.64 to -5.29 μm, p < 0.001) were significantly thinner compared with individuals with NGM. There was a significant linear trend of macular thinning with severity of glucose metabolism status in five subfields (p < 0.001). CONCLUSION Macular thickness is reduced in prediabetes and a greater reduction occurs in DM2, even before DR is clinically present. About half of the thinning observed in DM2 w/o DR was already found in prediabetes. Generalized thinning of the macula could be related to thinning of the temporal side of the optic nerve head through the connecting papillo-macular bundle.
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Affiliation(s)
- Eline E.B. De Clerck
- University Eye Clinic Maastricht; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Jan S.A.G. Schouten
- University Eye Clinic Maastricht; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Tos T.J.M. Berendschot
- University Eye Clinic Maastricht; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Fleur Goezinne
- University Eye Clinic Maastricht; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Pieter C. Dagnelie
- Cardiovascular Research Institute Maastricht (CARIM); Maastricht University Medical Center+; Maastricht The Netherlands
- Department of Epidemiology; Maastricht University; Maastricht The Netherlands
- Care and Public Health Research Institute (CAPHRI); Maastricht University; Maastricht The Netherlands
| | - Nicolaas C. Schaper
- Department of Epidemiology; Maastricht University; Maastricht The Netherlands
- Care and Public Health Research Institute (CAPHRI); Maastricht University; Maastricht The Netherlands
- Department of Internal Medicine; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Miranda T. Schram
- Department of Epidemiology; Maastricht University; Maastricht The Netherlands
- Department of Internal Medicine; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Coen D.A. Stehouwer
- Department of Epidemiology; Maastricht University; Maastricht The Netherlands
- Care and Public Health Research Institute (CAPHRI); Maastricht University; Maastricht The Netherlands
- Department of Internal Medicine; Maastricht University Medical Center+; Maastricht The Netherlands
| | - Carroll A.B. Webers
- University Eye Clinic Maastricht; Maastricht University Medical Center+; Maastricht The Netherlands
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357
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Ruebsam A, Dulle JE, Myers AM, Sakrikar D, Green KM, Khan NW, Schey K, Fort PE. A specific phosphorylation regulates the protective role of αA-crystallin in diabetes. JCI Insight 2018; 3:97919. [PMID: 29467334 DOI: 10.1172/jci.insight.97919] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/17/2018] [Indexed: 12/19/2022] Open
Abstract
Neurodegeneration is a central aspect of the early stages of diabetic retinopathy, the primary ocular complication associated with diabetes. While progress has been made to improve the vascular perturbations associated with diabetic retinopathy, there are still no treatment options to counteract the neuroretinal degeneration associated with diabetes. Our previous work suggested that the molecular chaperones α-crystallins could be involved in the pathophysiology of diabetic retinopathy; however, the role and regulation of α-crystallins remained unknown. In the present study, we demonstrated the neuroprotective role of αA-crystallin during diabetes and its regulation by its phosphorylation on residue 148. We further characterized the dual role of αA-crystallin in neurons and glia, its essential role for neuronal survival, and its direct dependence on phosphorylation on this residue. These findings support further evaluation of αA-crystallin as a treatment option to promote neuron survival in diabetic retinopathy and neurodegenerative diseases in general.
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Affiliation(s)
- Anne Ruebsam
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer E Dulle
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Angela M Myers
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Katelyn M Green
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Naheed W Khan
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin Schey
- Department of Biochemistry and Ophthalmology and Visual Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Patrice E Fort
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA.,Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
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358
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Ozaki H, Inoue R, Matsushima T, Sasahara M, Hayashi A, Mori H. Serine racemase deletion attenuates neurodegeneration and microvascular damage in diabetic retinopathy. PLoS One 2018; 13:e0190864. [PMID: 29304076 PMCID: PMC5755926 DOI: 10.1371/journal.pone.0190864] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/21/2017] [Indexed: 01/21/2023] Open
Abstract
Diabetic retinopathy (DR) is a leading cause of blindness. DR is recognized as a microvascular disease and inner retinal neurodegeneration. In the course of retinal neurodegeneration, N-methyl-D-aspartate receptor (NMDAR)-mediated excitotoxicity is involved. Full activation of NMDAR requires binding of agonist glutamate and coagonist glycine or D-serine. D-Serine is produced from L-serine by serine racemase (SRR) and contributes to retinal neurodegeneration in rodent models of DR. However, the involvement of SRR in both neurodegeneration and microvascular damage in DR remains unclear. Here, we established diabetic model of SRR knockout (SRR-KO) and control wild-type (WT) mice by streptozotocin injection. Six months after the onset of diabetes, the number of survived retinal ganglion cells was higher in SRR-KO mice than that of WT mice. The reduction of thickness of inner retinal layer (IRL) was attenuated in SRR-KO mice than that of WT mice. Moreover, the number of damaged acellular capillaries was lower in SRR-KO mice than that of WT mice. Our results suggest the suppression of SRR activity may have protective effects in DR.
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Affiliation(s)
- Hironori Ozaki
- Department of Molecular Neuroscience, Graduate School of Innovative Life Science, University of Toyama, Toyama, Japan
- Department of Molecular Neuroscience, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Ran Inoue
- Department of Molecular Neuroscience, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Takako Matsushima
- Department of Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Masakiyo Sasahara
- Department of Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
- Department of Pathology, Graduate School of Innovative Life Science, University of Toyama, Toyama, Japan
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Hisashi Mori
- Department of Molecular Neuroscience, Graduate School of Innovative Life Science, University of Toyama, Toyama, Japan
- Department of Molecular Neuroscience, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
- * E-mail:
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359
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Hammes HP. Diabetic retinopathy: hyperglycaemia, oxidative stress and beyond. Diabetologia 2018; 61:29-38. [PMID: 28942458 DOI: 10.1007/s00125-017-4435-8] [Citation(s) in RCA: 200] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 07/04/2017] [Indexed: 12/15/2022]
Abstract
Diabetic retinopathy remains a relevant clinical problem. In parallel with diagnostic and therapeutic improvements, the role of glycaemia and reactive metabolites causing cell stress and biochemical abnormalities as treatment targets needs continuous re-evaluation. Furthermore, the basic mechanisms of physiological angiogenesis, remodelling and pruning give important clues about the origins of vasoregression during the very early stages of diabetic retinopathy and can be modelled in animals. This review summarises evidence supporting a role for the neurovascular unit-composed of neuronal, glial and vascular cells-as a responder to the biochemical changes imposed by reactive metabolites and high glucose. Normoglycaemic animal models developing retinal degeneration, provide valuable information about common pathways downstream of progressive neuronal damage that induce vasoregression, as in diabetic models. These models can serve to assess novel treatments addressing the entire neurovascular unit for the benefit of early diabetic retinopathy.
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Affiliation(s)
- Hans-Peter Hammes
- 5. Med. Department, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.
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360
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The Role of Microglia in Diabetic Retinopathy: Inflammation, Microvasculature Defects and Neurodegeneration. Int J Mol Sci 2018; 19:ijms19010110. [PMID: 29301251 PMCID: PMC5796059 DOI: 10.3390/ijms19010110] [Citation(s) in RCA: 235] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 12/23/2017] [Accepted: 12/25/2017] [Indexed: 12/15/2022] Open
Abstract
Diabetic retinopathy is a common complication of diabetes mellitus, which appears in one third of all diabetic patients and is a prominent cause of vision loss. First discovered as a microvascular disease, intensive research in the field identified inflammation and neurodegeneration to be part of diabetic retinopathy. Microglia, the resident monocytes of the retina, are activated due to a complex interplay between the different cell types of the retina and diverse pathological pathways. The trigger for developing diabetic retinopathy is diabetes-induced hyperglycemia, accompanied by leukostasis and vascular leakages. Transcriptional changes in activated microglia, mediated via the nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB) and extracellular signal–regulated kinase (ERK) signaling pathways, results in release of various pro-inflammatory mediators, including cytokines, chemokines, caspases and glutamate. Activated microglia additionally increased proliferation and migration. Among other consequences, these changes in microglia severely affected retinal neurons, causing increased apoptosis and subsequent thinning of the nerve fiber layer, resulting in visual loss. New potential therapeutics need to interfere with these diabetic complications even before changes in the retina are diagnosed, to prevent neuronal apoptosis and blindness in patients.
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361
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Amato R, Dal Monte M, Lulli M, Raffa V, Casini G. Nanoparticle-Mediated Delivery of Neuroprotective Substances for the Treatment of Diabetic Retinopathy. Curr Neuropharmacol 2018; 16:993-1003. [PMID: 28714394 PMCID: PMC6120116 DOI: 10.2174/1570159x15666170717115654] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 05/04/2017] [Accepted: 07/14/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is a major complication of diabetes, characterized by extensive vascular pathology leading to vision loss. Neuronal suffering and death are also present in the diabetic retina as a result of different molecular mechanisms that are compromised or modified in response to high glucose. The aim of this paper is to highlight recent data indicating that neurodegeneration is likely to play a primary role in the development of DR and that strategies based on nanomedicine may be exploited to deliver neuroprotection to the retina. METHODS An extensive analysis of the publications dealing with the role of neuroprotection in DR and with nanoparticle-mediated drug delivery to the retina has been conducted using PubMed, with particular attention to the most recent papers. RESULTS There are important limitations related to possible systemic side effects of neuroprotective substances and to drug bioavailability in the retina such as, for instance, the amount of drug reaching the retina, the need of keeping to a minimum the number of administrations (especially, for example, in the case of intraocular injections) and the need of assuring a long-lasting, graded intraocular drug delivery. In recent years, a variety of investigations have been aimed at the exploitation of approaches of nanomedicine to enhance the pharmacokinetics and pharmacodynamic activity of intraocularly delivered drugs. In particular, we provide some preliminary results that we have obtained about the feasibility of delivering magnetic nanoparticles functionalized with a neuroprotectant to mouse eyes through intraocular injections. CONCLUSION We propose that nanoparticles functionalized with neuroprotective substances may be used to protect the diabetic retina, thus causing an impact in the design of future pharmacologic treatments for DR.
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Affiliation(s)
| | | | | | | | - Giovanni Casini
- Address correspondence to this author at the Department of Biology, University of Pisa, via S. Zeno 31, I-56127 Pisa, Italy; Tel: ++39-050-2211423; E-mail:
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362
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Abramoff MD, Fort PE, Han IC, Jayasundera KT, Sohn EH, Gardner TW. Approach for a Clinically Useful Comprehensive Classification of Vascular and Neural Aspects of Diabetic Retinal Disease. Invest Ophthalmol Vis Sci 2018; 59:519-527. [PMID: 29372250 PMCID: PMC5786342 DOI: 10.1167/iovs.17-21873] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/08/2017] [Indexed: 11/24/2022] Open
Abstract
The Early Treatment Diabetic Retinopathy Study (ETDRS) and other standardized classification schemes have laid a foundation for tremendous advances in the understanding and management of diabetic retinopathy (DR). However, technological advances in optics and image analysis, especially optical coherence tomography (OCT), OCT angiography (OCTa), and ultra-widefield imaging, as well as new discoveries in diabetic retinal neuropathy (DRN), are exposing the limitations of ETDRS and other classification systems to completely characterize retinal changes in diabetes, which we term diabetic retinal disease (DRD). While it may be most straightforward to add axes to existing classification schemes, as diabetic macular edema (DME) was added as an axis to earlier DR classifications, doing so may make these classifications increasingly complicated and thus clinically intractable. Therefore, we propose future research efforts to develop a new, comprehensive, and clinically useful classification system that will identify multimodal biomarkers to reflect the complex pathophysiology of DRD and accelerate the development of therapies to prevent vision-threatening DRD.
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Affiliation(s)
- Michael D. Abramoff
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
- Stephen A. Wynn Institute for Vision Research, University of Iowa, Iowa City, Iowa, United States
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States
- Iowa City VA Health Care System, Iowa City, Iowa, United States
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States
| | - Patrice E. Fort
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, United States
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, United States
| | - Ian C. Han
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
- Stephen A. Wynn Institute for Vision Research, University of Iowa, Iowa City, Iowa, United States
| | - K. Thiran Jayasundera
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, United States
| | - Elliott H. Sohn
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
- Stephen A. Wynn Institute for Vision Research, University of Iowa, Iowa City, Iowa, United States
| | - Thomas W. Gardner
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, United States
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan, United States
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363
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Doustar J, Torbati T, Black KL, Koronyo Y, Koronyo-Hamaoui M. Optical Coherence Tomography in Alzheimer's Disease and Other Neurodegenerative Diseases. Front Neurol 2017; 8:701. [PMID: 29312125 PMCID: PMC5742098 DOI: 10.3389/fneur.2017.00701] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/06/2017] [Indexed: 12/19/2022] Open
Abstract
Over the past decade, a surge of evidence has documented various pathological processes in the retina of patients suffering from mild cognitive impairment, Alzheimer's disease (AD), Parkinson's disease (PD), and other neurodegenerative diseases. Numerous studies have shown that the retina, a central nervous system tissue formed as a developmental outgrowth of the brain, is profoundly affected by AD. Harboring the earliest detectable disease-specific signs, amyloid β-protein (Aβ) plaques, the retina of AD patients undergoes substantial ganglion cell degeneration, thinning of the retinal nerve fiber layer, and loss of axonal projections in the optic nerve, among other abnormalities. More recent investigations described Aβ plaques in the retina located within sites of neuronal degeneration and occurring in clusters in the mid- and far-periphery of the superior and inferior quadrants, regions that had been previously overlooked. Diverse structural and/or disease-specific changes were also identified in the retina of PD, Huntington's disease, and multiple sclerosis patients. The pathological relationship between the retina and brain prompted the development of imaging tools designed to noninvasively detect and monitor these signs in living patients. One such tool is optical coherence tomography (OCT), uniquely providing high-resolution two-dimensional cross-sectional imaging and three-dimensional volumetric measurements. As such, OCT emerged as a prominent approach for assessing retinal abnormalities in vivo, and indeed provided multiple parameters that allowed for the distinction between normal aged individuals and patients with neurodegenerative diseases. Beyond the use of retinal optical fundus imaging, which recently allowed for the detection and quantification of amyloid plaques in living AD patients via a wide-field view of the peripheral retina, a major advantage of OCT has been the ability to measure the volumetric changes in specified retinal layers. OCT has proven to be particularly useful in analyzing retinal structural abnormalities consistent with disease pathogenesis. In this review, we provide a summary of OCT findings in the retina of patients with AD and other neurodegenerative diseases. Future studies should explore the combination of imaging early hallmark signs together with structural-functional biomarkers in the accessible retina as a practical means of assessing risk, disease progression, and therapeutic efficacy in these patients.
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Affiliation(s)
- Jonah Doustar
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Tania Torbati
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, United States
| | - Keith L Black
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Yosef Koronyo
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Maya Koronyo-Hamaoui
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.,Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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364
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Fehér J, Taurone S, Spoletini M, Biró Z, Varsányi B, Scuderi G, Orlando MP, Turchetta R, Micera A, Artico M. Ultrastructure of neurovascular changes in human diabetic retinopathy. Int J Immunopathol Pharmacol 2017; 31:394632017748841. [PMID: 29251013 PMCID: PMC5849217 DOI: 10.1177/0394632017748841] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The previous concept regarding diabetic retinopathy assigned a primary role to
hyperglycemia-induced microvascular alterations, while neuronal and glial
abnormalities were considered to be secondary to either ischemia or exudation.
The aim of this study was to reveal the potential role of neuronal and glial
cells in initial and advanced alterations of the retinopathy in human type 2
diabetes. Electron microscopy and histochemical studies were performed on 38
surgically removed human eyes (28 obtained from diabetic patients and 10 from
non-diabetic patients). Morphometric analysis of basement membrane material and
lipids was performed. An accumulation of metabolic by-products was found in the
capillary wall with aging: this aspect was significantly more pronounced in
diabetics. Müller glial cells were found to contribute to alterations of the
capillary wall and to occlusion, as well as to the development of proliferative
retinopathy and cystoid degeneration of the retina. Our results showed
morphological evidence regarding the role of neuronal and glial cells in the
pathology of diabetic retinopathy, prior and in addition to microangiopathy.
These morphological findings support a neurovascular pathogenesis at the origin
of diabetic retinopathy, thus the current treatment approach should be completed
by neuroprotective measures.
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Affiliation(s)
- János Fehér
- 1 Ophthalmic Neuroscience Program, Nutripharma Hungaria Ltd, Budapest, Hungary
| | | | | | - Zsolt Biró
- 4 Department of Ophthalmology, University of Pécs, Pécs, Hungary
| | - Balázs Varsányi
- 4 Department of Ophthalmology, University of Pécs, Pécs, Hungary
| | - Gianluca Scuderi
- 5 Ophthalmology Unit, NESMOS Department, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Rosaria Turchetta
- 3 Department of Sensory Organs, Sapienza University of Rome, Rome, Italy
| | | | - Marco Artico
- 3 Department of Sensory Organs, Sapienza University of Rome, Rome, Italy
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365
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Dai W, Tham YC, Cheung N, Yasuda M, Tan NYQ, Cheung CY, Wang JJ, Mitchell P, Sabanayagam C, Wong TY, Cheng CY. Macular thickness profile and diabetic retinopathy: the Singapore Epidemiology of Eye Diseases Study. Br J Ophthalmol 2017; 102:1072-1076. [PMID: 29175970 DOI: 10.1136/bjophthalmol-2017-310959] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 09/25/2017] [Accepted: 11/04/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND To evaluate retinal thickness profiles in eyes with and without diabetic retinopathy (DR) using spectral-domain optical coherence tomography (SD-OCT) among individuals with diabetes. METHODS Participants were recruited from the Singapore Epidemiology of Eye Diseases Study, a population-based study among Chinese, Malays and Indians aged 40 years or older residing in Singapore. All participants underwent standardised systemic and ophthalmic examinations. Average thickness of the macula, ganglion cell-inner plexiform layer and outer retina layer (from the outer plexiform layer to the retinal pigment epithelium layer) were measured using SD-OCT. DR status and severity were graded based on fundus photographs using the modified Airlie House classification system. Participants with macular oedema were excluded. RESULTS 2240 eyes from 1280 participants were included. Of these, 1764 (78.7%) eyes had no DR, 351 (15.7%) eyes had minimal or mild DR and 125 (5.6%) eyes had moderate or worse DR. After adjusting for age, gender, ethnicity, axial length, hypertension, glycated haemoglobin, body mass index, total cholesterol and diabetes duration, eyes with DR had thicker macula (245.44 µm vs 243.04 µm, P=0.03) and outer retina (124.26 µm vs 123.08 µm, P=0.01) than eyes without DR. When stratified by DR severity, thicker macula (250.24 µm vs 242.88 µm, P=0.011) and outer retina (126.4 µm vs 123.0 μm, P=0.006) were observed in eyes with moderate or worse, but not minimal or mild DR, compared with eyes without DR. CONCLUSIONS Even in the absence of macular oedema, eyes with DR, particularly those with more severe DR, had thicker macular and outer retinal layers than eyes without DR.
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Affiliation(s)
- Wei Dai
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ning Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore
| | - Masayuki Yasuda
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Nicholas Y Q Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Department of Ophthalmology, National University Hospital, Singapore
| | - Carol Y Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Jie Jin Wang
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Paul Mitchell
- Centre for Vision Research, University of Sydney, Sydney, Australia
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien-Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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366
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Guha Mazumder A, Chatterjee S, Chatterjee S, Gonzalez JJ, Bag S, Ghosh S, Mukherjee A, Chatterjee J. Spectropathology-corroborated multimodal quantitative imaging biomarkers for neuroretinal degeneration in diabetic retinopathy. Clin Ophthalmol 2017; 11:2073-2089. [PMID: 29200821 PMCID: PMC5703157 DOI: 10.2147/opth.s140110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Image-based early detection for diabetic retinopathy (DR) needs value addition due to lack of well-defined disease-specific quantitative imaging biomarkers (QIBs) for neuroretinal degeneration and spectropathological information at the systemic level. Retinal neurodegeneration is an early event in the pathogenesis of DR. Therefore, development of an integrated assessment method for detecting neuroretinal degeneration using spectropathology and QIBs is necessary for the early diagnosis of DR. Methods The present work explored the efficacy of intensity and textural features extracted from optical coherence tomography (OCT) images after selecting a specific subset of features for the precise classification of retinal layers using variants of support vector machine (SVM). Fourier transform infrared (FTIR) spectroscopy and nuclear magnetic resonance (NMR) spectroscopy were also performed to confirm the spectropathological attributes of serum for further value addition to the OCT, fundoscopy, and fluorescein angiography (FA) findings. The serum metabolomic findings were also incorporated for characterizing retinal layer thickness alterations and vascular asymmetries. Results Results suggested that OCT features could differentiate the retinal lesions indicating retinal neurodegeneration with high sensitivity and specificity. OCT, fundoscopy, and FA provided geometrical as well as optical features. NMR revealed elevated levels of ribitol, glycerophosphocholine, and uridine diphosphate N-acetyl glucosamine, while the FTIR of serum samples confirmed the higher expressions of lipids and β-sheet-containing proteins responsible for neoangiogenesis, vascular fragility, vascular asymmetry, and subsequent neuroretinal degeneration in DR. Conclusion Our data indicated that disease-specific spectropathological alterations could be the major phenomena behind the vascular attenuations observed through fundoscopy and FA, as well as the variations in the intensity and textural features observed in OCT images. Finally, we propose a model that uses spectropathology corroborated with specific QIBs for detecting neuroretinal degeneration in early diagnosis of DR.
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Affiliation(s)
- Arpan Guha Mazumder
- Multimodal Imaging and Computing for Theranostics Laboratory, School of Medical Science and Technology, Indian Institute of Technology-Kharagpur, Kharagpur, West Bengal, India.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Swarnadip Chatterjee
- Advanced Technology Development Centre, Indian Institute of Technology-Kharagpur, Kharagpur, West Bengal, India
| | - Saunak Chatterjee
- Multimodal Imaging and Computing for Theranostics Laboratory, School of Medical Science and Technology, Indian Institute of Technology-Kharagpur, Kharagpur, West Bengal, India
| | - Juan Jose Gonzalez
- Department of Computer and Electrical Engineering, Rice University, Houston, TX, USA
| | - Swarnendu Bag
- Department of Biotechnology, National Institute of Technology Sikkim, Ravangla Sub-Division, South Sikkim
| | - Sambuddha Ghosh
- Department of Ophthalmology, Calcutta National Medical College and Hospital, Kolkata, West Bengal
| | - Anirban Mukherjee
- Department of Electrical Engineering, Indian Institute of Technology-Kharagpur, Kharagpur, West Bengal, India
| | - Jyotirmoy Chatterjee
- Multimodal Imaging and Computing for Theranostics Laboratory, School of Medical Science and Technology, Indian Institute of Technology-Kharagpur, Kharagpur, West Bengal, India
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367
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PANRETINAL PHOTOCOAGULATION VERSUS RANIBIZUMAB FOR PROLIFERATIVE DIABETIC RETINOPATHY: Comparison of Peripapillary Retinal Nerve Fiber Layer Thickness in a Randomized Clinical Trial. Retina 2017; 39:69-78. [PMID: 29135802 DOI: 10.1097/iae.0000000000001909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Compare changes in retinal nerve fiber layer (RNFL) thickness between eyes assigned to intravitreous ranibizumab or panretinal photocoagulation and assess correlations between changes in RNFL and visual field sensitivity and central subfield thickness. METHODS Eyes with proliferative diabetic retinopathy were randomly assigned to ranibizumab or panretinal photocoagulation. Baseline and annual follow-up spectral domain optical coherence tomography RNFL imaging, optical coherence tomography macular imaging, and automated static perimetry (Humphrey visual field 60-4 algorithm) were performed. RESULTS One hundred forty-six eyes from 120 participants were analyzed. At 2 years, for the ranibizumab (N = 74) and panretinal photocoagulation (N = 66) groups, respectively, mean change in average RNFL thickness was -10.9 ± 11.7 μm and -4.3 ± 11.6 μm (difference, -4.9 μm; 95% confidence interval [-7.2 μm to -2.6 μm]; P < 0.001); the correlation between change in RNFL thickness and 60-4 Humphrey visual field mean deviation was -0.27 (P = 0.07) and +0.33 (P = 0.035); the correlation between change in RNFL thickness and central subfield thickness was +0.63 (P < 0.001) and +0.34 (P = 0.005), respectively. CONCLUSION At 2 years, eyes treated with ranibizumab had greater RNFL thinning than eyes treated with panretinal photocoagulation. Correlations between changes in RNFL thickness, visual field, and central subfield thickness suggest that the decrease in RNFL thickness with ranibizumab is likely due to decreased edema rather than loss of axons.
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368
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Liu Y, Xing YX, Gao XY, Kuang HY, Zhang J, Liu R. Obestatin prevents H 2O 2-induced damage through activation of TrkB in RGC-5 cells. Biomed Pharmacother 2017; 97:1061-1065. [PMID: 29136785 DOI: 10.1016/j.biopha.2017.11.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/03/2017] [Accepted: 11/03/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUD In the early stage of diabetic retinopathy, the damage of retinal ganglion cells already exists, promoting the development of the disease. The aim of this study was to investigate the protective role and the mechanisms of obestatin against H2O2-induced damage in RGC-5 cells. METHODS RGC-5 cells were incubated with various concentrations of obestatin for 24h before H2O2 added. The survival rates of RGC-5 were measured by MTT assay. The expression of apoptosis-related proteins and TrkB pathway-related proteins were detected by Western blot analysis. RESULTS Our data showed that H2O2 evidently decreased the survival rate of RGC-5 cells. However, obestatin pretreatment reversed the decreased activity. Moreover, obestatin effectively increased the expression of Bcl-2 and decreased the expression of Bax. In addition, obestatin potentially plays a role in protecting RGC-5 by activating of TrkB. Obestatin notablely increased the phosphorylation of TrkB, AKT and ERK1/2. All these effects of obestatin can be inhibited by GLP-1R antagonist exendin (9-39). CONCLUSIONS Obestatin prevents H2O2-induced damage in RGC-5 cells by activating TrkB pathway. Moreover, GLP-1R is closely related to the function of obestatin in RGC-5 cells.
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Affiliation(s)
- Yang Liu
- Department of Endocrinology, The First Clinical Hospital of Harbin Medical University, Harbin, 150001, China.
| | - Yue-Xian Xing
- Department of Endocrinology, The First Clinical Hospital of Harbin Medical University, Harbin, 150001, China.
| | - Xin-Yuan Gao
- Department of Endocrinology, The First Clinical Hospital of Harbin Medical University, Harbin, 150001, China.
| | - Hong-Yu Kuang
- Department of Endocrinology, The First Clinical Hospital of Harbin Medical University, Harbin, 150001, China.
| | - Jing Zhang
- Department of Endocrinology, The First Clinical Hospital of Harbin Medical University, Harbin, 150001, China.
| | - Rong Liu
- Department of Endocrinology, The First Clinical Hospital of Harbin Medical University, Harbin, 150001, China.
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369
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Shi R, Guo Z, Wang F, Li R, Zhao L, Lin R. Alterations in retinal nerve fiber layer thickness in early stages of diabetic retinopathy and potential risk factors. Curr Eye Res 2017; 43:244-253. [PMID: 29111833 DOI: 10.1080/02713683.2017.1387669] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIMS To investigate the loss of retinal nerve fiber layer (RNFL) in type-2 diabetic patients with early-stage diabetic retinopathy (DR) and to identify potential risk factors accounting for these alterations. METHODS In this cross-sectional study, 158 type-2 diabetic patients were divided into three groups based on their DR status. RNFL thickness and other optic disc parameters were obtained by optical coherence tomography (OCT) and then compared among different groups. We investigated the potential association between RNFL loss and systemic risk factors for DR, including diabetes duration, body mass index (BMI), serum lipids, hemoglobin A1c (HbA1c) and albumin-creatinine ratio (ACR). One-way ANOVA was carried out to compare RNFL thickness among different groups, Pearson correlation and multivariate linear regression analysis were performed to determine potential risk factors related to RNFL thickness in these patients. RESULTS There were significant differences in the average (F = 8.872, P = 0.003), superior (F = 8.769, P = 0.004), and inferior (F = 8.857, P = 0.003) RNFL thickness of both eyes among the groups, but no obvious difference in optic disc parameters was found. Diabetic duration, BMI, TG, High density lipoprotein cholesterol (HDL), HbA1c, and ACR were found negatively related to the RNFL thickness in both or single eye according to Pearson correlation analysis. After controlling for age, gender, and axis length (AL) in multivariate linear regression analysis, the diabetic duration was associated significantly with RNFL thickness of superior in both eye (right eye: p = 0.016, left eye: p = 0.024), BMI was related to the nasal quadrant of the right eye (p = 0.034), and TG was related to the inferior of the right eye (p = 0.037), HbA1c (p = 0.026) was associated significantly with the average RNFL thickness of the right eye. In addition, ACR was found negatively related to average (p = 0.042) and inferior quadrant (p = 0.014) of the left eye, respectively. CONCLUSIONS RNFL loss might be the earliest structural change of retina in diabetic patients, and associated with diabetic duration, BMI, TG, HbA1c, and ACR. The conclusions of this study need to be proved by other well-matched and large-scale prospective clinical trials in the future, because the correlations discovered in our study were weak.
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Affiliation(s)
- Rui Shi
- a Department of Pharmacology , School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center , Xi'an , Shaanxi , P.R. China.,b Department of Ophthalmology , Shaanxi Provincial People's Hospital , Xi'an , China
| | - Zhonglan Guo
- b Department of Ophthalmology , Shaanxi Provincial People's Hospital , Xi'an , China
| | - Feng Wang
- c Department of Ophthalmology , the Second Affiliated Hospital of Xi'an Jiaotong University (Xibei hospital) , Xi'an , China
| | - Rong Li
- d the First Affiliated Hospital , Xi'an Medical University , Xi'an , China
| | - Lei Zhao
- e Department of Molecular Physiology and Biophysics, Holden Comprehensive Cancer Center , University of Iowa Carver College of Medicine , Iowa City , USA
| | - Rong Lin
- f Department of Pharmacology , School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center , Xi'an , P. R. China
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370
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Li S, Wang X, Yang J, Lei H, Wang X, Xiang Y. Metabolic profile of visual cortex in diabetic rats measured with in vivo proton MRS. NMR IN BIOMEDICINE 2017; 30:e3783. [PMID: 28915340 DOI: 10.1002/nbm.3783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 07/09/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
The purpose of the present study was to characterize the metabolic profile of the visual cortex in streptozotocin-induced Type 1 diabetic rats by means of in vivo proton MRS. Several metabolite concentration ratios in the visual cortex were calculated. In addition, postmortem histologic analyses for retinal ganglion cell (RGC) loss, optic nerve injury and visual cortex alterations were monitored. The results showed that diabetes induced several changes in visual cortex metabolites, such as reduced N-acetylaspartate, glutamate, γ-aminobutyric acid, taurine and choline-containing compound levels. Nevertheless, myo-inositol levels increased significantly as compared with controls. Remarkable RGC loss and optic nerve degeneration were observed by morphological analysis. Moreover, the results showed significant neuronal loss and glial activation in the visual cortex. These findings indicated that, besides vascular abnormalities, neuronal loss and degeneration in the visual pathway were induced due to disrupted glucose homeostasis in diabetes. Metabolic or functional abnormalities were induced in cerebral neurons of the visual cortex by diabetes.
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Affiliation(s)
- Shuang Li
- Department of Ophthalmology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Xinghua Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Junjie Yang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hao Lei
- National Center for Magnetic Resonance in Wuhan, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Xuxia Wang
- National Center for Magnetic Resonance in Wuhan, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Yi Xiang
- Department of Ophthalmology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
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371
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Early changes in retinal structure and BMP2 expression in the retina and crystalline lens of streptozotocin-induced diabetic pigs. Lab Anim Res 2017; 33:216-222. [PMID: 29046696 PMCID: PMC5645599 DOI: 10.5625/lar.2017.33.3.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 01/22/2023] Open
Abstract
Purpose This study aims to evaluate early changes in retinal structure and BMP2 expression in the retina and crystalline lens by comparing streptozotocin-induced diabetic pigs and normal control group pigs. Methods Five eye samples from five diabetic Micro-pigs (Medikinetics, Pyeongtaek, Korea) and five eye samples from five control pigs bred in a specific pathogen-free area were used. Diabetes was developed through intravenous injection of nicotinamide and streptozotocin, and the average fasting glucose level was maintained at 250 mg/dL or higher for 16 weeks. To evaluate BMP2 expression in the retina and crystalline lens, Western blotting was performed. Results In Hematoxylin and Eosin staining, most diabetic pigs showed structural abnormalities in the inner plexiform layer. The number of nuclei in the ganglion cell layer within the range of 104 µm2 was 3.78±0.60 for diabetic pigs and 5.57±1.07 for control group pigs, showing a statistically significant difference. In immunohistochemical staining, diabetic retinas showed an overall increase in BMP2 expression. In Western blotting, the average BMP2/actin level of diabetic retinas was 1.19±0.05, showing a significant increase compared to the 1.06±0.03 of the control group retinas (P=0.016). The BMP2/actin level of diabetic crystalline lenses was similar to the control group crystalline lenses (P=0.730). Conclusions Compared to control group pigs, the number of nuclei in the inner nuclear layer of retinas from streptozotocin-induced diabetic pigs decreased, while an increase in BMP2 expression was observed in the retina of diabetic pigs.
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372
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Masser DR, Otalora L, Clark NW, Kinter MT, Elliott MH, Freeman WM. Functional changes in the neural retina occur in the absence of mitochondrial dysfunction in a rodent model of diabetic retinopathy. J Neurochem 2017; 143:595-608. [PMID: 28902411 DOI: 10.1111/jnc.14216] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/24/2017] [Accepted: 09/06/2017] [Indexed: 12/13/2022]
Abstract
Diabetic retinopathy is a neurovascular diabetes complication resulting in vision loss. A wealth of literature reports retinal molecular changes indicative of neural deficits, inflammation, and vascular leakage with chronic diabetes, but the mechanistic causes of disease initiation and progression are unknown. Microvascular mitochondrial DNA (mtDNA) damage leading to mitochondrial dysfunction has been proposed to drive vascular dysfunction in retinopathy. However, growing evidence suggests that neural retina dysfunction precedes and may cause vascular damage. Therefore, we tested the hypothesis that neural mtDNA damage and mitochondrial dysfunction are an early initiating factor of neural diabetic retinopathy development in a rat streptozotocin-induced, Type I diabetes model. Mitochondrial function (oxygen consumption rates) was quantified in retinal synaptic terminals from diabetic and non-diabetic rats with paired retinal structural and function assessment (optical coherence tomography and electroretinography, respectively). Mitochondrial genome damage was assessed by identifying mutations and deletions across the mtDNA genome by high depth sequencing and absolute mtDNA copy number counting through digital PCR. Mitochondrial protein expression was assessed by targeted mass spectrometry. Retinal functional deficits and neural anatomical changes were present after 3 months of diabetes and prevented/normalized by insulin treatment. No marked dysfunction of mitochondrial activity, maladaptive changes in mitochondrial protein expression, alterations in mtDNA copy number, or increase in mtDNA damage was observed in conjunction with retinal functional and anatomical changes. These results demonstrate that neural retinal dysfunction with diabetes begins prior to mtDNA damage and dysfunction, and therefore retinal neurodegeneration initiation with diabetes occurs through other, non-mitochondrial DNA damage, mechanisms.
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Affiliation(s)
- Dustin R Masser
- Department of Physiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Harold Hamm Diabetes Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Laura Otalora
- Department of Physiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Reynolds Oklahoma Center on Aging, Oklahoma City, Oklahoma, USA.,Oklahoma Nathan Shock Center on Aging, Oklahoma City, Oklahoma, USA
| | - Nicholas W Clark
- Department of Physiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Reynolds Oklahoma Center on Aging, Oklahoma City, Oklahoma, USA
| | - Michael T Kinter
- Oklahoma Nathan Shock Center on Aging, Oklahoma City, Oklahoma, USA.,Aging & Metabolism Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Michael H Elliott
- Department of Ophthalmology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Willard M Freeman
- Department of Physiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Harold Hamm Diabetes Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Reynolds Oklahoma Center on Aging, Oklahoma City, Oklahoma, USA.,Oklahoma Nathan Shock Center on Aging, Oklahoma City, Oklahoma, USA
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Shah AR, Gardner TW. Diabetic retinopathy: research to clinical practice. Clin Diabetes Endocrinol 2017; 3:9. [PMID: 29075511 PMCID: PMC5648499 DOI: 10.1186/s40842-017-0047-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/06/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetic Retinopathy (DR) is a leading cause of visual impairment in the United States. The CDC estimates that the prevalence of DR will triple from 2005 to 2050. MAIN BODY The report summarizes major past advances in diabetes research and their impact on clinical practice. Current paradigms and future directions are also discussed. CONCLUSIONS DR is a leading cause of visual impairment in the US. Significant progress has been made in the understanding and treatment of DR, but rising prevalence demands innovative approaches to management in the future.
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Affiliation(s)
- Anjali R. Shah
- Departments of Ophthalmology and Visual Sciences, University of Michigan Medical Schoo, W.K. Kellogg Eye Center, 1000 Wall St, Ann Arbor, MI 48105 USA
| | - Thomas W. Gardner
- Departments of Ophthalmology and Visual Sciences, University of Michigan Medical Schoo, W.K. Kellogg Eye Center, 1000 Wall St, Ann Arbor, MI 48105 USA
- Molecular and Integrative Physiology, University of Michigan Medical School, W.K. Kellogg Eye Center, 1000 Wall St, Ann Arbor, MI 48105 USA
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374
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Neurodegeneration in diabetic retinopathy: Potential for novel therapies. Vision Res 2017; 139:82-92. [PMID: 28988945 DOI: 10.1016/j.visres.2017.06.014] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 11/20/2022]
Abstract
The complex pathology of diabetic retinopathy (DR) affects both vascular and neural tissue. The characteristics of neurodegeneration are well-described in animal models but have more recently been confirmed in the clinical setting, mostly by using non-invasive imaging approaches such as spectral domain optical coherence tomography (SD-OCT). The most frequent observations report loss of tissue in the nerve fiber layer and inner plexiform layer, confirming earlier findings from animal models. In several cases the reduction in inner retinal layers is reported in patients with little evidence of vascular lesions or macular edema, suggesting that degenerative loss of neural tissue in the inner retina can occur after relatively short durations of diabetes. Animal studies also suggest that neurodegeneration leading to retinal thinning is not limited to cell death and tissue loss but also includes changes in neuronal morphology, reduced synaptic protein expression and alterations in neurotransmission, including changes in expression of neurotransmitter receptors as well as neurotransmitter release, reuptake and metabolism. The concept of neurodegeneration as an early component of DR introduces the possibility to explore alternative therapies to prevent the onset of vision loss, including neuroprotective therapies and drugs targeting individual neurotransmitter systems, as well as more general neuroprotective approaches to preserve the integrity of the neural retina. In this review we consider some of the evidence for progressive retinal neurodegeneration in diabetes, and explore potential neuroprotective therapies.
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375
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ANGPTL-4 induces diabetic retinal inflammation by activating Profilin-1. Exp Eye Res 2017; 166:140-150. [PMID: 29031854 DOI: 10.1016/j.exer.2017.10.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/10/2017] [Accepted: 10/10/2017] [Indexed: 12/30/2022]
Abstract
Diabetic retinopathy (DR), the most common cause of irreversible blindness in working-age adults, results in central vision loss that is caused by microvascular damage to the inner lining of the back of the eye, the retina. The aim of this work was to assess the temporal relationships between angiopoietin-like protein-4 (ANGPTL-4), a novel adipocytokine factor, and diabetic retinal inflammation and microvascular dysfunction. The downstream pathway(s) and upstream mediator(s) of ANGPTL-4 were then determined under high glucose (HG) conditions. Diabetic rats and control animals were randomly assigned to receive hypoxia inducible factor-1 alpha (HIF-1α) blockade (doxorubicin or shRNA) or vehicle for 8 weeks. Human retinal microvascular endothelial cells (HRMECs) were incubated with normal or high glucose, with or without blockade or recombinant proteins, for ANGPTL-4, HIF-1α, and vascular endothelial growth factor (VEGF). The levels of ANGPTL-4, profilin-1, HIF-1α, VEGF, interleukin 1 beta (IL-1β), IL-6, and intercellular adherent molecule 1 (ICAM-1) in the rat retinas and HRMEC extracts were examined by Western blotting and real-time RT-PCR. The levels of ANGPTL-4, profilin-1, HIF-1α, and VEGF protein and mRNA were significantly higher in the diabetic rats and HG-exposed HRMECs. ANGPTL-4 was a potent modulator of increased inflammation, permeability, and angiogenesis via activation of the profilin-1 signaling pathway. Our results showed that ANGPTL-4 upregulation was induced by HG, which was dependent on HIF-1α activation that was also triggered by HG, both in vivo and in vitro. Our results suggest that targeting ANGPTL-4, alone or in combination with profilin-1, may be an effective therapeutic strategy and diagnostic screening biomarker for proliferative diabetic retinopathy and other vitreous-retinal inflammatory diseases.
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376
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Joltikov KA, de Castro VM, Davila JR, Anand R, Khan SM, Farbman N, Jackson GR, Johnson CA, Gardner TW. Multidimensional Functional and Structural Evaluation Reveals Neuroretinal Impairment in Early Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2017; 58:BIO277-BIO290. [PMID: 28973314 PMCID: PMC5624741 DOI: 10.1167/iovs.17-21863] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To test whether quantitative functional tests and optical coherence tomography (OCT)-defined structure can serve as effective tools to diagnose and monitor early diabetic neuroretinal disease. Methods Fifty-seven subjects with diabetes (23 without diabetic retinopathy [no DR], 19 with mild nonproliferative diabetic retinopathy [mild NPDR], 15 with moderate to severe [moderate NPDR]), and 18 controls underwent full ophthalmic examination, fundus photography, spectral-domain optical coherence tomography (SD-OCT), e-ETDRS (Early Treatment Diabetic Retinopathy Study) acuity, and the quick contrast sensitivity function (qCSF) method. Perimetry testing included short-wavelength automated perimetry (SWAP), standard automated perimetry (SAP), frequency doubling perimetry (FDP), and rarebit perimetry (RBP). Results ETDRS acuity and RBP were not sensitive for functional differences among subjects with diabetes. AULCSF, a metric of qCSF, was reduced in diabetics with moderate compared to mild NPDR (P = 0.03), and in subjects with no DR compared to controls (P = 0.04). SWAP and SAP mean deviation (MD) and foveal threshold (FT) were reduced in moderate compared to mild NPDR (SWAP, MD P = 0.002, FT P = 0.0006; SAP, MD P = 0.02, FT P = 0.007). FDP 10-2 showed reduced MD in moderate compared to mild NPDR (P = 0.02), and FDP 24-2 revealed reduced pattern standard deviation (PSD) in mild NPDR compared to no DR (P = 0.02). Structural analysis revealed thinning of the ganglion cell layer and inner plexiform layer (GCL+IPL) of moderate NPDR subjects compared to controls. The thinner GCL+IPL correlated with impaired retinal function. Conclusions This multimodal testing analysis reveals insights into disruption of the neuroretina in diabetes and may accelerate the testing of novel therapies.
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Affiliation(s)
- Katherine A Joltikov
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Vinicius M de Castro
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Jose R Davila
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Rohit Anand
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Sami M Khan
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Neil Farbman
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | | | - Chris A Johnson
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Thomas W Gardner
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
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377
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Ren X, Lu H, Wang N, Zhang C, Ji Y, Cui S, Dong Y, Yang K, Du M, Diao F, Kong L. Thioredoxin is implicated in the anti‑apoptotic effects of grape seed proanthocyanidin extract during hyperglycemia. Mol Med Rep 2017; 16:7731-7737. [PMID: 28944891 DOI: 10.3892/mmr.2017.7508] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 07/11/2017] [Indexed: 11/05/2022] Open
Abstract
Diabetic retinopathy has long been recognized as a microvascular disease, however, recent research has indicated that diabetic retinopathy may also be considered a neurodegenerative disease. The elucidation of the molecular mechanisms underlying the development of diabetic retinopathy is imperative for the development of preventive and treatment strategies for patients with diabetes. In the present study, grape seed proanthocyanidin extract (GSPE) was used to upregulate the expression of thioredoxin (Trx), in order to evaluate its potential as a novel agent for the prevention and treatment of neurodegenerative diseases, including diabetic retinopathy. Hematoxylin and eosin staining was performed to observe the morphology of retinal neurons, whereas flow cytometry and terminal deoxynucleotidyl transferase 2'‑deoxyuridine, 5'‑triphosphate nick‑end labeling were employed to investigate cellular apoptosis. Reverse transcription‑quantitative polymerase chain reaction and western blot analysis were performed to assess the mRNA and protein expression of target proteins in order to investigate the underlying molecular mechanisms. In vivo, it was found that the photoreceptor cell was damaged in diabetic mice but following GSPE treatment, the process could be inhibited. In vitro, the results of the current study demonstrated that, under hyperglycemic culture conditions, the expression of 78 kDa glucose‑regulated protein, which is an endoplasmic reticulum stress marker, was upregulated. In addition, the expression of Trx was downregulated and cell apoptosis was enhanced. Notably, treatment with GSPE was revealed to inhibit the neurodegenerative process induced by hyperglycemia. However, treatment with the Trx inhibitor PX12 in combination with GSPE was demonstrated to potentiate apoptosis compared with GSPE treatment alone under hyperglycemic conditions. Furthermore, the protein expression of apoptosis signal‑regulating kinase (ASK) 1 and Trx‑interacting protein (Txnip) was also upregulated by hyperglycemia, whereas GSPE was revealed to counteract this upregulation. In conclusion, the results of the present study indicate that Trx may be implicated in the mechanisms underlying the protective effects of GSPE against hyperglycemia‑induced cell degeneration and apoptosis. The molecular mechanisms may also involve inhibition of the activation of the Trx/ASK1/Txnip signaling pathway.
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Affiliation(s)
- Xiang Ren
- Department of Histology and Embryology, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Heyuan Lu
- Department of Histology and Embryology, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Nina Wang
- Department of Histology and Embryology, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Chenghong Zhang
- Department of Histology and Embryology, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Yunpeng Ji
- Department of Histology and Embryology, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Shiqi Cui
- Department of Histology and Embryology, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Yichen Dong
- Department of Histology and Embryology, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Kaiyuan Yang
- Department of Histology and Embryology, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Mengyi Du
- Department of Histology and Embryology, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Fengsheng Diao
- Department of Traditional Chinese Medicine, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116023, P.R. China
| | - Li Kong
- Department of Histology and Embryology, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
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378
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Kim BJ, Irwin DJ, Song D, Daniel E, Leveque JD, Raquib AR, Pan W, Ying GS, Aleman TS, Dunaief JL, Grossman M. Optical coherence tomography identifies outer retina thinning in frontotemporal degeneration. Neurology 2017; 89:1604-1611. [PMID: 28887373 DOI: 10.1212/wnl.0000000000004500] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/21/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Whereas Alzheimer disease (AD) is associated with inner retina thinning visualized by spectral-domain optical coherence tomography (SD-OCT), we sought to determine if the retina has a distinguishing biomarker for frontotemporal degeneration (FTD). METHODS Using a cross-sectional design, we examined retinal structure in 38 consecutively enrolled patients with FTD and 44 controls using a standard SD-OCT protocol. Retinal layers were segmented with the Iowa Reference Algorithm. Subgroups of highly predictive molecular pathology (tauopathy, TAR DNA-binding protein 43, unknown) were determined by clinical criteria, genetic markers, and a CSF biomarker (total tau: β-amyloid) to exclude presumed AD. We excluded eyes with poor image quality or confounding diseases. SD-OCT measures of patients (n = 46 eyes) and controls (n = 69 eyes) were compared using a generalized linear model accounting for intereye correlation, and correlations between retinal layer thicknesses and Mini-Mental State Examination (MMSE) were evaluated. RESULTS Adjusting for age, sex, and race, patients with FTD had a thinner outer retina than controls (132 vs 142 μm, p = 0.004). Patients with FTD also had a thinner outer nuclear layer (ONL) (88.5 vs 97.9 μm, p = 0.003) and ellipsoid zone (EZ) (14.5 vs 15.1 μm, p = 0.009) than controls, but had similar thicknesses for inner retinal layers. The outer retina thickness of patients correlated with MMSE (Spearman r = 0.44, p = 0.03). The highly predictive tauopathy subgroup (n = 31 eyes) also had a thinner ONL (88.7 vs 97.4 μm, p = 0.01) and EZ (14.4 vs 15.1 μm, p = 0.01) than controls. CONCLUSIONS FTD is associated with outer retina thinning, and this thinning correlates with disease severity.
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Affiliation(s)
- Benjamin J Kim
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
| | - David J Irwin
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Delu Song
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ebenezer Daniel
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jennifer D Leveque
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Aaishah R Raquib
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Wei Pan
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Gui-Shuang Ying
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tomas S Aleman
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Joshua L Dunaief
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Murray Grossman
- From the Scheie Eye Institute, Department of Ophthalmology (B.J.K., D.S., E.D., J.D.L., A.R.R., W.P., G.-S.Y., T.S.A., J.L.D.), and Frontotemporal Lobar Degeneration Center, Department of Neurology (D.J.I., M.G.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
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379
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Hu L, Yang H, Ai M, Jiang S. Inhibition of TLR4 alleviates the inflammation and apoptosis of retinal ganglion cells in high glucose. Graefes Arch Clin Exp Ophthalmol 2017; 255:2199-2210. [DOI: 10.1007/s00417-017-3772-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/03/2017] [Accepted: 08/01/2017] [Indexed: 01/20/2023] Open
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380
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Buccarello L, Sclip A, Sacchi M, Castaldo AM, Bertani I, ReCecconi A, Maestroni S, Zerbini G, Nucci P, Borsello T. The c-jun N-terminal kinase plays a key role in ocular degenerative changes in a mouse model of Alzheimer disease suggesting a correlation between ocular and brain pathologies. Oncotarget 2017; 8:83038-83051. [PMID: 29137322 PMCID: PMC5669948 DOI: 10.18632/oncotarget.19886] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022] Open
Abstract
Recently a range of ocular manifestations such as retinal and lens amyloid-beta accumulation and retinal nerve fiber layer loss have been proposed as potential biomarkers in Alzheimer disease (AD). The TgCRND8 mouse model of AD exhibits age-dependent amyloid β (Aβ) oligomers accumulation and cognitive defects, amyloid plaques and hyperphosphorylated Tau deposition and inflammation. We proved the correlation between ocular pathologies and AD, observing increased levels of p-APP and p-Tau, accumulation of Aβ oligomers in the retina, eye, and optic nerve. The accumulation of amyloid markers was significantly stronger in the retinal ganglion cell (RGC) layer, suggesting that RGC might be more susceptible to degeneration. We detected a thinning of the RGC layer as well as RGC death in the retina of TgCRND8 mice, by using a combination of Optical Coherence Tomography (OCT), immunofluorescence, immunohistochemistry and Western blotting techniques. We proved for the first time the key role of C-Jun N-terminal Kinase (JNK) in the ocular degeneration. In support of this, the administration of the JNK inhibitor, D-JNKI1, was able to counteract the Aβ and p-Tau accumulation in the retina of TgCRND8 mice, and consequently reduce RGCs loss. These results confirm that degenerative changes in the retina/eye of AD mouse model mirrors the events observed in the brain parenchyma. Ocular changes can be detected by non-invasive imaging techniques, such as OCT, to study and test different therapeutic strategies against degenerative events associated to AD.
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Affiliation(s)
- Lucia Buccarello
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Alessandra Sclip
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Matteo Sacchi
- University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
| | | | - Ilaria Bertani
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Andrea ReCecconi
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - Silvia Maestroni
- Unità Complicanze del Diabete, Istituto Scientifico San Raffaele, Milan, Italy
| | - Gianpaolo Zerbini
- Unità Complicanze del Diabete, Istituto Scientifico San Raffaele, Milan, Italy
| | - Paolo Nucci
- University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
| | - Tiziana Borsello
- IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.,Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
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381
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Fondi K, Wozniak PA, Howorka K, Bata AM, Aschinger GC, Popa-Cherecheanu A, Witkowska KJ, Hommer A, Schmidl D, Werkmeister RM, Garhöfer G, Schmetterer L. Retinal oxygen extraction in individuals with type 1 diabetes with no or mild diabetic retinopathy. Diabetologia 2017; 60:1534-1540. [PMID: 28547132 PMCID: PMC5491565 DOI: 10.1007/s00125-017-4309-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/20/2017] [Indexed: 12/25/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to compare retinal oxygen extraction in individuals with diabetes with no or mild non-proliferative diabetic retinopathy and healthy age- and sex-matched volunteers. METHODS A total of 24 participants with type 1 diabetes and 24 healthy age- and sex-matched volunteers were included in this cross-sectional study. Retinal oxygen extraction was measured by combining total retinal blood flow measurements using a custom-built bi-directional Doppler optical coherence tomography system with measurements of oxygen saturation using spectroscopic reflectometry. Based on previously published mathematical modelling, the oxygen content in retinal vessels and total retinal oxygen extraction were calculated. RESULTS Total retinal blood flow was higher in diabetic participants (46.4 ± 7.4 μl/min) than in healthy volunteers (40.4 ± 5.3 μl/min, p = 0.002 between groups). Oxygen content in retinal arteries was comparable between the two groups, but oxygen content in retinal veins was higher in participants with diabetes (0.15 ± 0.02 ml O2/ml) compared with healthy control participants (0.13 ± 0.02 ml O2/ml, p < 0.001). As such, the arteriovenous oxygen difference and total retinal oxygen extraction were reduced in participants with diabetes compared with healthy volunteers (total retinal oxygen extraction 1.40 ± 0.44 vs 1.70 ± 0.47 μl O2/min, respectively, p = 0.03). CONCLUSIONS/INTERPRETATION Our data indicate early retinal hypoxia in individuals with type 1 diabetes with no or mild diabetic retinopathy as compared with healthy control individuals. Further studies are required to fully understand the potential of the technique in risk stratification and treatment monitoring. TRIAL REGISTRATION ClinicalTrials.gov NCT01843114.
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Affiliation(s)
- Klemens Fondi
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Piotr A Wozniak
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - Kinga Howorka
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Ahmed M Bata
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerold C Aschinger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Alina Popa-Cherecheanu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Ophthalmology, Emergency University Hospital, Bucharest, Romania
| | - Katarzyna J Witkowska
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Anton Hommer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Ophthalmology, Sanatorium Hera, Vienna, Austria
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - René M Werkmeister
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
- Singapore Eye Research Institute, Singapore, Republic of Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Republic of Singapore.
- Imperial College, London, UK.
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382
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Abstract
The Edwin Bierman Award Lecture is presented in honor of the memory of Edwin L. Bierman, MD, an exemplary scientist, mentor, and leader in the field of diabetes, obesity, hyperlipidemia, and atherosclerosis. The award and lecture recognizes a leading scientist in the field of macrovascular complications and contributing risk factors in diabetes. Clay F. Semenkovich, MD, the Irene E. and Michael M. Karl Professor and Chief of the Division of Endocrinology, Metabolism and Lipid Research at Washington University School of Medicine in St. Louis, St. Louis, MO, received the prestigious award at the American Diabetes Association's 76th Scientific Sessions, 10-14 June 2016, in New Orleans, LA. He presented the Edwin Bierman Award Lecture, "We Know More Than We Can Tell About Diabetes and Vascular Disease," on Sunday, 12 June 2016.Diabetes is a disorder of abnormal lipid metabolism, a notion strongly supported by the work of Edwin Bierman, for whom this eponymous lecture is named. This abnormal lipid environment continues to be associated with devastating vascular complications in diabetes despite current therapies, suggesting that our understanding of the pathophysiology of blood vessel disease in diabetes is limited. In this review, potential new insights into the nature of diabetic vasculopathy will be discussed. Recent observations suggest that while the concept of distinct macrovascular and microvascular complications of diabetes has been useful, vascular diseases in diabetes may be more interrelated than previously appreciated. Moreover, the intermediary metabolic pathway of de novo lipogenesis, which synthesizes lipids from simple precursors, is robustly sensitive to insulin and may contribute to these complications. De novo lipogenesis requires fatty acid synthase, and recent studies of this enzyme suggest that endogenously produced lipids are channeled to specific intracellular sites to affect physiology. These findings raise the possibility that novel approaches to treating diabetes and its complications could be based on altering the intracellular lipid milieu.
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Affiliation(s)
- Clay F Semenkovich
- Division of Endocrinology, Metabolism and Lipid Research, Department of Cell Biology and Physiology, Washington University School of Medicine in St. Louis, St. Louis, MO
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383
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Zhang J, Liu R, Kuang HY, Gao XY, Liu HL. Protective treatments and their target retinal ganglion cells in diabetic retinopathy. Brain Res Bull 2017; 132:53-60. [DOI: 10.1016/j.brainresbull.2017.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 05/10/2017] [Indexed: 12/19/2022]
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384
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Determinants of Quantitative Optical Coherence Tomography Angiography Metrics in Patients with Diabetes. Sci Rep 2017; 7:2575. [PMID: 28566760 PMCID: PMC5451475 DOI: 10.1038/s41598-017-02767-0] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/18/2017] [Indexed: 11/08/2022] Open
Abstract
Early microvascular damage in diabetes (e.g. capillary nonperfusion and ischemia) can now be assessed and quantified with optical coherence tomography-angiography (OCT-A). The morphology of vascular tissue is indeed affected by different factors; however, there is a paucity of data examining whether OCT-A metrics are influenced by ocular, systemic and demographic variables in subjects with diabetes. We conducted an observational cross-sectional study and included 434 eyes from 286 patients with diabetes. Foveal avascular zone (FAZ) area, FAZ circularity, total and parafoveal vessel density (VD), fractal dimension (FD), and vessel diameter index (VDI) from the superficial capillary plexus OCT-angiogram were measured by a customized automated image analysis program. We found that diabetic retinopathy (DR) severity was associated with increased FAZ area, decreased FAZ circularity, lower VD, lower FD, and increased VDI. Enlarged FAZ area was correlated with shorter axial length and thinner central subfield macular thickness. Decreased FAZ circularity was correlated with a reduction in visual function. Decreased VD was correlated with thinner macular ganglion-cell inner plexiform layer. Increased VDI was correlated with higher fasting glucose level. We concluded that the effects of ocular and systemic factors in diabetics should be taken into consideration when assessing microvascular alterations via OCT-A.
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385
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Mishra M, Kowluru RA. The Role of DNA Methylation in the Metabolic Memory Phenomenon Associated With the Continued Progression of Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2017; 57:5748-5757. [PMID: 27787562 PMCID: PMC5089211 DOI: 10.1167/iovs.16-19759] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose Clinical and experimental studies have shown that diabetic retinopathy progression does not halt after termination of hyperglycemia, suggesting a “metabolic memory” phenomenon. DNA is highly dynamic, and cytosine methylation changes can last for several years. In diabetes, DNA methylation regulates expression of many genes associated with retinal mitochondrial homeostasis. Our aim was to investigate the role of DNA methylation in the metabolic memory. Methods Reversal of 4 days of 20 mM glucose by 4 to 8 days of 5 mM glucose, in the presence/absence of Dnmt inhibitor (5-aza-2′-deoxycytidine), was investigated on DNA methylation and its machinery in human retinal endothelial cells. The key parameters were confirmed in the retina from diabetic rats maintained in good glycemic control (glycated hemoglobin ∼6%) for 3 months after 3 months of poor control (glycated hemoglobin >10%). Results DNA methyltransferase 1 (Dnmt 1) remained active after 4 days of normal glucose that followed 4 days of high glucose, and mtDNA stayed hypermethylated with impaired transcription. Hydroxymethylating enzyme Tet2, and matrix metalloproteinase-9 (regulated by hydroxymethylation) also remained upregulated. But, 8 days of normal glucose after 4 days of high glucose ameliorated mtDNA methylation and MMP-9 hydroxymethylation. Direct Dnmt targeting by Aza during the reversal period benefited methylation status of mtDNA and MMP-9 DNA. Similarly, reinstitution of good control after 3 months of poor control in rats did not reverse diabetes-induced increase in retinal Dnmt1 and Tet2, and alter the methylation status of mtDNA and MMP-9. Conclusions Retinal DNA methylation-hydroxymethylation machinery does not benefit immediately from reversal of hyperglycemia. Maintenance of good glycemic control for longer duration, and/or direct targeting DNA methylation ameliorates continuous mitochondrial damage, and could retard/halt diabetic retinopathy progression.
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Affiliation(s)
- Manish Mishra
- Kresge Eye Institute, Wayne State University, Detroit, Michigan, United States
| | - Renu A Kowluru
- Kresge Eye Institute, Wayne State University, Detroit, Michigan, United States
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386
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Mendiola AS, Cardona AE. The IL-1β phenomena in neuroinflammatory diseases. J Neural Transm (Vienna) 2017; 125:781-795. [PMID: 28534174 DOI: 10.1007/s00702-017-1732-9] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/04/2017] [Indexed: 02/06/2023]
Abstract
It is becoming increasingly clear that neuroinflammation has a causal role in the pathogenesis of central nervous system (CNS)-related diseases, and therefore therapeutic strategies targeting the regulation or availability of inflammatory mediators can be used to prevent or mitigate pathology. Interestingly, the proinflammatory cytokine, interleukin-1 beta (IL-1β), has been implicated in perpetuating immune responses and contributing to disease severity in a variety of CNS diseases ranging from multiple sclerosis, neurodegenerative diseases, traumatic brain injury, and diabetic retinopathy. Moreover, pharmacological blockade of IL-1 signaling has shown to be beneficial in some autoimmune and autoinflammatory diseases, making IL-1β a promising therapeutic target in neuroinflammatory conditions. This review highlights recent advances of our understanding on the multifaceted roles of IL-1β in neuroinflammatory diseases.
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Affiliation(s)
- Andrew S Mendiola
- Department of Biology, University of Texas at San Antonio, San Antonio, TX, 78249, USA
| | - Astrid E Cardona
- Department of Biology, University of Texas at San Antonio, San Antonio, TX, 78249, USA.
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387
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Lynch SK, Abràmoff MD. Diabetic retinopathy is a neurodegenerative disorder. Vision Res 2017; 139:101-107. [PMID: 28408138 DOI: 10.1016/j.visres.2017.03.003] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 01/20/2023]
Abstract
Since 1875, controversy has ensued over whether ocular diabetic complications are primarily vasculopathic or neuropathic in nature. Here, we discuss the historical context by which diabetic retinopathy (DR) came to be considered a primary vasculopathy, in contrast to more recent data suggesting the importance of diabetic retinal neurodegeneration (DRN) as the primary manifestation of ocular diabetic damage. Unsurprisingly, DRN parallels other diabetic complications related to neuropathy. In general, there are three possible relationships between microvascular DR and DRN: i) microvasculopathy causes neurodegeneration; ii) neurodegeneration causes microvasculopathy or iii) they are mutually independent. The authors' group has recently produced experimental data showing that DRN precedes even the earliest manifestations of DR microvasculopathy. In combination with earlier studies showing that focal implicit time delays predicted future development of DR microvasculopathy in the same location, relationships i) and iii) are unlikely. As such, ii) is the most likely relationship: DRN is a cause of DR. Granted, additional studies are needed to confirm this hypothesis and elucidate the mechanism of diabetes-induced neurodegeneration. We conclude this review by proposing experimental approaches to test the hypothesis that DRN causes DR. If confirmed, this new paradigm may lead to earlier detection of ocular diabetic damage and earlier treatment of early DR, thereby preventing visual loss in people with diabetes.
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Affiliation(s)
- Stephanie K Lynch
- Department of Ophthalmology and Visual Sciences, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Michael D Abràmoff
- Department of Ophthalmology and Visual Sciences, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; Iowa Institute for Biomedical Imaging, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA 52242, USA; Department of Veterans Affairs, 601 US-6, Iowa City, IA 52246, USA.
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388
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Tavares Ferreira J, Proença R, Alves M, Dias-Santos A, Santos BO, Cunha JP, Papoila AL, Abegão Pinto L. Retina and Choroid of Diabetic Patients Without Observed Retinal Vascular Changes: A Longitudinal Study. Am J Ophthalmol 2017; 176:15-25. [PMID: 28057456 DOI: 10.1016/j.ajo.2016.12.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/22/2016] [Accepted: 12/23/2016] [Indexed: 01/29/2023]
Abstract
PURPOSE To identify changes in choroidal thickness (CT) and all retinal layers of diabetic patients without diabetic retinopathy (DR) after 1 year of follow-up. DESIGN Prospective observational cohort study. METHODS Overall, 125 diabetic patients without DR were included. Two visits were scheduled: the first visit (V1) and a second visit after 12 months (V2). At both visits, patients received a complete ophthalmologic evaluation that included OCT. Each retinal layer thickness was calculated for 9 ETDRS sectors, and CT was measured at 13 locations. Generalized linear mixed-effects models were used. RESULTS Of the 125 patients, 103 completed the study, and 9 of the 103 developed DR (8.7%). CT was significantly higher at V2 than at V1, with an average value of 10-17 μm at almost half the locations (500, 1000, and 1500 μm temporal; 500 and 1000 μm nasal; and 1000 μm superior to the fovea) (P < .001-.003). The thicknesses of the ganglion cell layer (I3 and N6 sectors), inner plexiform layer (S6 and N6 sectors), inner nuclear layer (T6 and N6 sectors), and outer plexiform layer (S6 sector), as well as the overall retinal thickness (RT) (S3, N3, I3, S6, and T6 sectors), were decreased at V2 (P < .001). Visible retinopathy was negatively associated with overall RT (central, S3, T3, I3, and N3 sectors, P = .004-.024) and the thickness of the ONL (T6 and I6 sectors, P = .007 and P = .009) and photoreceptor layer (N6 sector, P = .038). The presence of DR decreased the overall RT by 13.04-16.63 μm. CONCLUSIONS Diabetic patients without DR showed a thicker choroid and a thinner retina, particularly in inner layers, after 1 year of follow-up. These structural changes may correspond to the early neurodegenerative phase of DR.
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389
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Kim SY, Jeong IW, Yang YS, Choi CW. Changes of the Individual Retinal Layer Thickness in Non-proliferative Diabetic Retinopathy in Type 2 Diabetes. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.12.1376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Yeop Kim
- Department of Ophthalmology, Wonkwang University School of Medicine, Iksan, Korea
- Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea
| | - Il Won Jeong
- Department of Ophthalmology, Wonkwang University School of Medicine, Iksan, Korea
- Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea
| | - Yun Sik Yang
- Department of Ophthalmology, Wonkwang University School of Medicine, Iksan, Korea
- Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea
| | - Chang Wook Choi
- Department of Ophthalmology, Wonkwang University School of Medicine, Iksan, Korea
- Institute of Wonkwang Medical Science, Wonkwang University, Iksan, Korea
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390
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Bremer D, Pache F, Günther R, Hornow J, Andresen V, Leben R, Mothes R, Zimmermann H, Brandt AU, Paul F, Hauser AE, Radbruch H, Niesner R. Longitudinal Intravital Imaging of the Retina Reveals Long-term Dynamics of Immune Infiltration and Its Effects on the Glial Network in Experimental Autoimmune Uveoretinitis, without Evident Signs of Neuronal Dysfunction in the Ganglion Cell Layer. Front Immunol 2016; 7:642. [PMID: 28066446 PMCID: PMC5179567 DOI: 10.3389/fimmu.2016.00642] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/13/2016] [Indexed: 12/12/2022] Open
Abstract
A hallmark of autoimmune retinal inflammation is the infiltration of the retina with cells of the innate and adaptive immune system, leading to detachment of the retinal layers and even to complete loss of the retinal photoreceptor layer. As the only optical system in the organism, the eye enables non-invasive longitudinal imaging studies of these local autoimmune processes and of their effects on the target tissue. Moreover, as a window to the central nervous system (CNS), the eye also reflects general neuroinflammatory processes taking place at various sites within the CNS. Histological studies in murine neuroinflammatory models, such as experimental autoimmune uveoretinitis (EAU) and experimental autoimmune encephalomyelitis, indicate that immune infiltration is initialized by effector CD4+ T cells, with the innate compartment (neutrophils, macrophages, and monocytes) contributing crucially to tissue degeneration that occurs at later phases of the disease. However, how the immune attack is orchestrated by various immune cell subsets in the retina and how the latter interact with the target tissue under in vivo conditions is still poorly understood. Our study addresses this gap with a novel approach for intravital two-photon microscopy, which enabled us to repeatedly track CD4+ T cells and LysM phagocytes during the entire course of EAU and to identify a specific radial infiltration pattern of these cells within the inflamed retina, starting from the optic nerve head. In contrast, highly motile CX3CR1+ cells display an opposite radial motility pattern, toward the optic nerve head. These inflammatory processes induce modifications of the microglial network toward an activated morphology, especially around the optic nerve head and main retinal blood vessels, but do not affect the neurons within the ganglion cell layer. Thanks to the new technology, non-invasive correlation of clinical scores of CNS-related pathologies with immune infiltrate behavior and subsequent tissue dysfunction is now possible. Hence, the new approach paves the way for deeper insights into the pathology of neuroinflammatory processes on a cellular basis, over the entire disease course.
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Affiliation(s)
- Daniel Bremer
- German Rheumatism Research Center , Berlin , Germany
| | - Florence Pache
- German Rheumatism Research Center, Berlin, Germany; NeuroCure Clinical Research Center, Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Ruth Leben
- German Rheumatism Research Center , Berlin , Germany
| | - Ronja Mothes
- German Rheumatism Research Center, Berlin, Germany; Department of Neuropathology, Charité - Universitätsmedizin, Berlin, Germany
| | - Hanna Zimmermann
- NeuroCure Clinical Research Center, Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Anja E Hauser
- German Rheumatism Research Center, Berlin, Germany; Immundynamics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Helena Radbruch
- Department of Neuropathology, Charité - Universitätsmedizin , Berlin , Germany
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391
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Abstract
Diabetes mellitus represents a growing international public health issue with a near quadrupling in its worldwide prevalence since 1980. Though it has many known microvascular complications, vision loss from diabetic retinopathy is one of the most devastating for affected individuals. In addition, there is increasing evidence to suggest that diabetic patients have a greater risk for glaucoma as well. Though the pathophysiology of glaucoma is not completely understood, both diabetes and glaucoma appear to share some common risk factors and pathophysiologic similarities with studies also reporting that the presence of diabetes and elevated fasting glucose levels are associated with elevated intraocular pressure-the primary risk factor for glaucomatous optic neuropathy. While no study has completely addressed the possibility of detection bias, most recent epidemiologic evidence suggests that diabetic populations are likely enriched with glaucoma patients. As the association between diabetes and glaucoma becomes better defined, routine evaluation for glaucoma in diabetic patients, particularly in the telemedicine setting, may become a reasonable consideration to reduce the risk of vision loss in these patients.
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Affiliation(s)
- Brian J Song
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA.
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Harvard Medical School, 1 Joslin Place, Boston, MA, 02115, USA
| | - Louis R Pasquale
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA, 02215, USA
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392
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Gardner TW, Davila JR. The neurovascular unit and the pathophysiologic basis of diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2016; 255:1-6. [PMID: 27832340 DOI: 10.1007/s00417-016-3548-y] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To relate the concept of the retinal neurovascular unit and its alterations in diabetes to the pathophysiology of diabetic retinopathy. METHODS Case illustrations and conceptual frameworks are presented that illustrate adaptive and maladaptive "dis-integration" of the retinal neurovascular unit with the progression of diabetes. RESULTS Retinopathy treatment should address pathophysiologic processes rather than pathologic lesions as is current practice. CONCLUSIONS Future improvements in the treatment of diabetic retinopathy requires deeper understanding of the cellular and molecular changes induced by diabetes, coupled with the use of quantitative phenotyping methods that assess the pathophysiologic processes.
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Affiliation(s)
- Thomas W Gardner
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, 1000 Wall St, Ann Arbor, MI, 48105, USA.
| | - Jose R Davila
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, 1000 Wall St, Ann Arbor, MI, 48105, USA
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393
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Macular sub-layer thinning and association with pulmonary function tests in Amyotrophic Lateral Sclerosis. Sci Rep 2016; 6:29187. [PMID: 27383525 PMCID: PMC4935870 DOI: 10.1038/srep29187] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 06/16/2016] [Indexed: 01/24/2023] Open
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a complex neurodegenerative disorder that may have anterior visual pathway involvement. In this study, we compare the macular structure of patients with ALS to healthy controls, and examine correlations between macular sub-layer thickness measurements and pulmonary function tests and disease duration. ALS patients underwent optical coherence tomography (OCT) imaging to obtain macular cube scans of the right eye. Macular cube OCT data from age-matched healthy subjects were provided by the OCT reading center. Semi-automated retinal segmentation software was used to quantify macular sub-layers. Pulmonary function tests and time since symptom onset were collected retrospectively from the electronic medical records of ALS patients. Macular retinal nerve fiber layer was significantly thinner in ALS patients compared to healthy controls (P < 0.05). Total macular and other sub-layer thicknesses were not reduced in the ALS cohort. Macular retinal nerve fiber layer thickness positively correlated with forced vital capacity % predicted and forced expiratory volume in 1 second % predicted (P < 0.05). In conclusion, analysis of OCT measurements supports the involvement of the anterior visual pathway in ALS. Subtle structural thinning in the macular retinal nerve fiber layer correlates with pulmonary function tests.
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