Effect of prostaglandins A(2), E(1), F(2 alpha)and latanoprost on cultured human iridal melanocytes

Quantitative Study of Human Scleral Melanocytes and Their Topographical Distribution

PURPOSE

While fibroblasts constitute the main cell component of the sclera, the purpose of the present study was to investigate the cell densities of melanocytes at different regions of the sclera, and to compare them with associated scleral fibroblast densities in human donor eye sections.

METHODS

. Paraffin-embedded sections of sclera from 21 human eyes were stained with hematoxylin-eosin (H&E) and immunohistochemical staining (S-100/AEC). Scleral melanocyte and fibroblast numbers were counted in different regions of the sclera. The relationship between the melanocyte density and iris pigmentation was also analyzed.

RESULTS

. Melanocytes were found in the posterior region of the sclera, especially around the vessels and nerves in emmissarial canals, whereas no or rare melanocytes were found in equatorial and anterior regions. In H&E sections, melanocyte densities in eyes with light-colored irides were significantly less than in eyes with medium or dark-colored irides (P < .05). In S-100-stained sections, more melanocytes could be detected than those in the H&E sections in light-colored eyes (P < .05), but not in medium or dark-colored eyes (P > .05). The numbers of scleral fibroblasts were relatively stable in different regions. In the posterior scleral region, the numbers of fibroblasts were slightly higher than the number of melanocytes, however, this differences were not statistically significant (P > .05).

CONCLUSION

. Notable numbers of melanocytes were present in the posterior sclera suggesting that these cells may play a role in ocular physiology and in the pathogenesis of various disorders of the sclera.

Melanogenesis in uveal melanoma cells: Effect of argan oil

The mechanisms underlying cutaneous melanogenesis have been widely studied; however, very little is known about uveal melanogenesis. Melanin is normally produced by uveal melanocytes and gives the color to the iris. A derangement from this normal production may occur, for instance, by iatrogenic events, such as glaucoma therapy with prostaglandins that may enhance cutaneous and iris pigmentation. In this study, we investigated the mechanisms that regulate uveal melanogenesis in human uveal melanoma cells (92.1) and murine cutaneous melanoma cells (B16-F1). In the first part of the study, we compared the effects of known cutaneous pigmenting agents on the B16-F1 and 92.1 cells, showing an opposite response of the two cell lines. Subsequently, using argan oil, a known depigmenting agent for murine cutaneous melanoma cells, on 92.1 cells, we found that in these cells, it also functioned as an inhibitor of melanogenesis and tyrosinase expression. From a molecular perspective, treatment of the 92.1 cells with argan oil decreased melanogenesis-associated transcription factor (MITF) gene expression by inducing MITF phosphorylation at Ser73, thus leading to MITF ubiquitination and disposal. It also led to the downregulation of the extracellular signal-regulated kinase (ERK)1/2 and Akt pathways, also known to be involved in cutaneous melanogenesis, although with an opposing function. Taken together, our data indicate that: ⅰ) some differences exist in the regulation of melanogenesis between cutaneous and uveal melanoma cells; and ⅱ) argan oil exerts a depigmenting effect on 92.1 cells through its action on the ERK1/2 and Akt pathways.

Effects of Four Formulations of Prostaglandin Analogs on Eye Surface Cells. A Comparative Study

We evaluated the cytotoxic effects of four prostaglandin analogs (PGAs) used to treat glaucoma. First we established primary cultures of conjunctival stromal cells from healthy donors. Then cell cultures were incubated with different concentrations (0, 0.1, 1, 5, 25, 50 and 100%) of commercial formulations of bimatoprost, tafluprost, travoprost and latanoprost for increasing periods (5 and 30 min, 1 h, 6 h and 24 h) and cell survival was assessed with three different methods: WST-1, MTT and calcein/AM-ethidium homodimer-1 assays. Our results showed that all PGAs were associated with a certain level of cell damage, which correlated significantly with the concentration of PGA used, and to a lesser extent with culture time. Tafluprost tended to be less toxic than bimatoprost, travoprost and latanoprost after all culture periods. The results for WST-1, MTT and calcein/AM-ethidium homodimer-1 correlated closely. When the average lethal dose 50 was calculated, we found that the most cytotoxic drug was latanoprost, whereas tafluprost was the most sparing of the ocular surface in vitro. These results indicate the need to design novel PGAs with high effectiveness but free from the cytotoxic effects that we found, or at least to obtain drugs that are functional at low dosages. The fact that the commercial formulation of tafluprost used in this work was preservative-free may support the current tendency to eliminate preservatives from eye drops for clinical use.

Pharmacology of topical prostaglandin F2 α analogs and their place in the treatment of glaucoma in small animals

A distinguishing feature of the most common types of glaucoma is an increased intra-ocular pressure (IOP), which has a damaging effect on optic nerve axons, leading to the progressive loss of retinal ganglion cells. Therefore, IOP-lowering medications are the mainstay of glaucoma therapy. Topical prostaglandin F2 α analogs (PGAs) are a relatively new class of ocular hypotensive drugs, which have made a huge impact on the treatment of glaucoma in dogs. This study summarizes the current state of knowledge on the mechanism of action of these agents and their effect on IOP in dogs and cats. It also discusses potential harmful side effects of PGAs and presents contemporary opinions about their role and place in the medical management of glaucoma in small animals.

Therapeutic uses of prostaglandin F(2α) analogues in ocular disease and novel synthetic strategies

The pharmacological management of glaucoma and ocular hypertension has significantly changed over the last 18 years with the introduction of PGF2α analogues, more specifically latanoprost (6), travoprost (8), bimatoprost (10) and tafluprost (12). Prostanoids are currently the first-line medicines among ocular antihypertensive drugs in terms of efficacy, safety, patient compliance and medical economy. Their ability to effectively reduce intraocular pressure with once-per-day dosing, ocular tolerability comparable to timolol and general lack of systemic adverse effects have made them the mainstay of pharmacological therapy for glaucoma and ocular hypertension all over the world. The present review reports a novel, convergent and highly diastereoselective method for the synthesis of PGF2α analogues from the structurally advanced prostaglandin phenylsulfone (5Z)-(+)-15 and new ω-chain synthons. The biochemistry, clinical efficacy and side effects of four commercially available PGF2α analogues, currently used as first-line agents for reducing intraocular pressure in patients with glaucoma or ocular hypertension, are also discussed.

siRNA-mediated knock-down of COX-2 in melanocytes suppresses melanogenesis

Cyclooxygenase-2 (COX-2) is an enzyme induced in response to multiple mitogenic and inflammatory stimuli, including UV light. UV-induced COX-2 expression induces production of prostaglandin E2 (PGE2) in keratinocytes, which mediates inflammation and cell proliferation. Until recently, studies regarding COX-2 and PGE2 in the skin have focused on keratinocytes and skin cancer and the effect of PGs produced by keratinocytes on melanocytes. However, the effects of COX-2 itself or COX-2 inhibitors on melanogenesis are not well known. Therefore, to establish the role of COX-2 in melanogenesis, we investigated the effects of knock-down of COX-2 in melanocytes on melanin production and the expression of melanogenic molecules through silencing of COX-2 expression with COX-2 short interfering RNA (siRNA). COX-2 knock-down in melanocytes decreased the expressions of tyrosinase, TRP-1, TRP-2, gp100 and MITF and also reduced tyrosinase enzyme activity. Furthermore, COX-2 siRNA-transfected melanocytes showed markedly reduced alpha-melanocyte stimulating hormone (α-MSH)-induced melanin production. In addition, α-MSH-induced COX-2 expression in both scrambled siRNA-transfected and COX-2 siRNA-transfected melanocytes was greater than α-MSH-untreated cells. Our results suggest that COX-2 might be a candidate target for the development of anti-melanogenic agents and α-MSH-induced pigmentation could be closely associated with COX-2 expression. COX-2 inhibitors might therefore be of particular use in whitening cosmetics for hyperpigmentation disorders such as melasma, postinflammatory hyperpigmentation and solar lentigo.

Intracellular signaling in human iridial fibroblasts and iridial melanocytes in response to prostaglandins, endothelin, isoproterenol, and other pharmacological agents

PURPOSE

The receptor-coupled signal transduction systems present in isolated human iridial fibroblasts (HIF) and in human iridial melanocytes (HIM) were investigated. Cell responsiveness to numerous prostaglandins (PGs), and other compounds of interest, was profiled in order to better understand their involvement in the iridial hyper-pigmentation process observed during treatment of elevated intraocular pressure with FP-receptor against PG analogs.

METHODS

[(3)H]-inositol phosphates ([(3)H]-IPs) generated in the cells were measured by ion-exchange chromatography followed by liquid scintillation spectroscopy. cAMP generated in the cells was quantified using an enzyme immunoassay.

RESULTS

HIF cells exhibited a robust phosphoinositide (PI) hydrolysis response to FP-class PG analogs, such as cloprostenol (potency, EC(50) = 2.4 ± 0.5 nM, n = 5), fluprostenol (EC(50) = 5.3 ± 0.6 nM, n = 3), PGF(2α) (EC(50) = 54 ± 18 nM, n = 5), and latanoprost acid (EC(50) = 121 ± 17 nM, n = 4). Other PGs exhibited the following potencies (EC(50)) for stimulating [(3)H]-IPs accumulation in HIF cells: PGD(2) EC(50) = 327 ± 195 nM, n =3; PGE(2) EC(50) = 550 ± 50 nM, n = 3; and two TP-receptor agonists (I-BOP, EC(50) = 23 ± 8 nM, n = 3; U-46619 EC(50) = 1.1 ± 0.4 µM, n = 3). Endothelin-1 (ET-1) and histamine increased [(3)H]-IPs production in HIF and HIM cells. HIM cells exhibited minimal PI turnover response to cloprostenol, latanoprost acid, latanoprost, PGF(2α), PGE(2), and histamine, but there were robust responses to ET-1 (EC(50) = 4.6 nM, n = 2) and an ET(B)-receptor agonist (BQ-3020, EC(50) = 5 nM, n = 2) that were blocked by an ET(B)-antagonist (BQ-788, IC(50) = 21 ± 6 nM, n = 3). In the adenylyl cyclase activation assay, numerous PGs (1 and 10 µM) stimulated cAMP production in HIF cells yielding the following rank order of efficacy: PGI(2) > PGE(2) > misoprostil > isoproterenol = BW245C > PGD(2) = PGF(2α) = fluprostenol. In HIM cells, PGE(2) (EC(50) = 1.3 ± 0.3 nM) and isoproterenol (β-agonist; EC(50) = 89 ± 13 nM) potently and efficaciously stimulated cAMP production and ICI-118851 (β(2)-antagonist) attenuated the effects of isoproterenol. However, latanoprost acid, latanoprost, ET-1, and BW245C (DP-receptor agonist) were relatively less efficacious than isoproterenol and PGE(2) in HIM cells at stimulating cAMP production.

CONCLUSIONS

These studies have shown that while HIF cells express FP prostaglandin and histamine receptors coupled to phospholipase C to produce [(3)H]-IPs, the HIM cells lack such functionally active FP-receptors. In contrast, HIF and HIM cells express functional ET-1 receptors coupled to [(3)H]-IPs production and both cell-types respond to PGE(2), BW245C, and isoproterenol by generating cAMP. It is concluded that human iridial fibroblasts and melanocytes respond differently to PGs and histamine, but in the same manner to ET-1, isoproterenol and BW245C. This may have relevance to the intercellular communication within the iris relative to the melanogenic processes.

Cytotoxicity of prostaglandin analog eye drops preserved with benzalkonium chloride in multiple corneoconjunctival cell lines

Purpose:

This study evaluated the cytotoxicity of five prostaglandin analog ophthalmic solutions on four ocular surface cell lines, ie, Chang (human conjunctiva), SIRC (rabbit cornea), RC-1 (rabbit cornea), and BCE C/D-1b (bovine cornea).

Methods:

Cell viability was measured by neutral red and MTT assays in cells treated for 10, 30, or 60 minutes with various doses of prostaglandins (undiluted, and 2- and 10-fold dilutions). The number of cell lines with viability ≥50% in the presence of selected dilution of the drug (CVS₅₀) was used for comparison. In addition, 24 cell viability comparisons (four cell lines, two assays, and three exposure times) were made between latanoprost (Xalatan^®) and each other solution at each dose. A comparison between the newly introduced tafluprost (Tapros^®) with 0.01% benzalkonium chloride was also made.

Results:

The order of cell viability determined by CVS₅₀ was Travatan Z^® (travoprost with the SofZia system) > Tapros ≥ Travatan^® (travoprost) = Xalatan > Rescula^® (unoproston). This was consistent with the results of direct comparisons between Xalatan and the other drugs. There was no clear difference in cell viability between Tapros and benzalkonium chloride.

Conclusions:

Use of two assays, multiple cell lines, and various dilutions and exposure times provided a unique evaluation of cytotoxicity among ophthalmic solutions. CVS₅₀ was useful for comparison of the cell viability of the solutions.

Clinical utility and differential effects of prostaglandin analogs in the management of raised intraocular pressure and ocular hypertension

Prostaglandin analogs (PGA) are powerful topical ocular hypotensive agents available for the treatment of elevated intraocular pressure (IOP). Latanoprost 0.005% and travoprost 0.004% are prodrugs and analogs of prostaglandin F2α. Bimatoprost 0.03% is regarded as a prostamide, and debate continues as to whether it is a prodrug. The free acids of all 3 PGAs reduce IOP by enhancing uveoscleral and trabecular outflow via direct effects on ciliary muscle relaxation and remodeling of extracellular matrix. The vast majority of clinical trials demonstrate IOP-lowering superiority of latanoprost, bimatoprost and travoprost compared with timolol 0.5%, brimonidine 0.2%, or dorzolamide 2% monotherapy. Bimatoprost appears to be more efficacious in IOP-lowering compared with latanoprost, with weighted mean difference in IOP reduction documented in one meta-analysis of 2.59% to 5.60% from 1- to 6-months study duration. PGAs reduce IOP further when used as adjunctive therapy. Fixed combinations of latanoprost, bimatoprost or travoprost formulated with timolol 0.5% and administered once daily are superior to monotherapy of its constituent parts. PGA have near absence of systemic side effects, although do have other commonly encountered ocular adverse effects. The adverse effects of PGA, and also those found more frequently with bimatoprost use include ocular hyperemia, eyelash growth, and peri-ocular pigmentary changes. Iris pigmentary change is unique to PGA treatment. Once daily administration and near absence of systemic side effects enhances tolerance and compliance. PGAs are often prescribed as first-line treatment for ocular hypertension and open-angle glaucoma.

Side effects associated with prostaglandin analog therapy

Topical prostaglandin analogs, which have become first-line therapy in the medical management of glaucoma, have an excellent safety profile with regard to systemic side effects, but are associated with several ocular side effects. Some of these are common, with no apparent serious consequences other than cosmetic, whereas others are much less common but represent potentially sight-threatening side effects. The former group includes conjunctival hyperemia, elongation and darkening of eyelashes, induced iris darkening, and periocular skin pigmentation. The latter group of side effects, which are relatively rare and lack definitive causal relationship to prostaglandin analog therapy, includes iris cysts, cystoid macular edema, anterior uveitis, and reactivation of herpes simplex keratitis. Most of the literature regarding side effects associated with prostaglandin analogs involves the use of latanoprost, probably because it was the first to be studied. There is no evidence, however, aside from less conjunctival hyperemia with latanoprost, that the commercially available prostaglandin analogs differ significantly with regard to side effects.

Methodology for evaluation of melanin content and production of pigment cells in vitro

Melanin has a photo-screening, a biophysical/biochemical and a cosmetic effect. Melanin content of cultured pigmented cells can be measured by spectrophotometry and expressed either as melanin content per cell or melanin content per culture (area). Melanin production can be calculated from melanin content and cell number at the beginning and at the end of a culture using various formulas and expressed as melanin production per cell per day or melanin production per culture per day. Melanin content or production per cell have been used widely to compare melanin content in various cell lines or to compare the melanin content during different stages in the culture (e.g. growing stage and senescent stage). For the evaluation of changes in melanin content and production in a given pigment cell line after treatment with a special chemical, physical or biological stimulator or inhibitor, different parameters used for the evaluation of experimental data can lead to conflicting results. Melanin content per area is determined by melanin content per cell and the number of cells in this area. The biological and cosmetic effects of melanin in vivo are determined mainly by melanin content per area, not melanin content per cell. For example, if melanin content per cell is the same, but the number of cells in a given area is increased after the treatment, then the melanin content per area is also increased. Under this circumstance, the color of skin turns darker and the total antioxidant activity provided by melanin in this area is increased even though the melanin content per cell measured remains the same; therefore, melanin content or production per culture is more important than melanin content or production per cell under this circumstance.

A study of histopathological features of latanoprost-treated irides with or without darkening compared with non-latanoprost-treated irides

OBJECTIVES

To study the histopathological features of latanoprost-treated irides with or without darkening, compared with non-latanoprost-treated irides.

METHODS

Iridectomy specimens and patient history forms were independently examined by 3 ophthalmic pathologists in a masked fashion. Specimens were evaluated for premalignant changes and for differences in level of pigmentation and degrees of cellularity, inflammation, and vascular abnormalities.

RESULTS

The specimens consisted of 22 latanoprost-treated darkened irides, 35 latanoprost-treated irides without darkening, and 35 non-latanoprost-treated irides. There was a statistically significant decrease in the number of nuclear invaginations and prominent nucleoli in latanoprost-treated darkened irides compared with the other 2 groups (P = .004 and P = .005, respectively). The average thickness and pigmentation of the anterior border layer was greater in the latanoprost-treated darkened irides than in the other 2 groups (P = .03 and P = .02, respectively). The latanoprost-treated darkened irides had increased pigmentation of the stroma (P < .001), stromal fibroblasts (P < .001), melanocytes (P = .005), vascular endothelium (P = .02), and adventitia (P < .001) relative to the other 2 groups.

CONCLUSIONS

There is no histopathological evidence of premalignant changes in latanoprost-treated darkened irides. The latanoprost-induced iris color changes are due to a thickening of the anterior border layer and an increased amount of melanin in the anterior border layer and within the stromal melanocytes.

Morphometric Effects of Long-term Exposure to Latanoprost

PURPOSE

To investigate the morphological and melanin granule changes in irides after variable-term exposure to latanoprost, where the latanoprost-induced iris darkening (LIID) side effect has been identified and photographically recorded.

DESIGN

Experimental study.

PARTICIPANTS

Fifteen LIID cases and 15 untreated controls.

METHODS

Iridectomy specimens from LIID cases were collected from patients undergoing trabeculectomy, whereas before surgery they had been on topical latanoprost and there was clear evidence of iris color change from the treating ophthalmologist, which was recorded photographically. A control series of peripheral iridectomies were obtained from blue, heterogeneous, and brown irides. All the specimens were visualized by light and electron microscopy. Masked assessment was made of stromal cell number, cell atypia, anterior border thickness, presence of free stromal melanin, melanin proximity to blood vessels, and change in stromal melanocyte melanin granule numbers and size. For the melanin granule analysis, electron micrographs were subjected to detailed image analysis to quantify the number of melanin granules, size of the granules, and overall percentage filling of the iris stromal melanocytes with melanin.

MAIN OUTCOME MEASURES

Iris morphology and melanin granule changes.

RESULTS

There was no evident difference in stromal cellularity or anterior border thickness. Atypia, free stromal melanin, and melanin adjacent to blood vessel lumina were identified, but there was no difference between LIIDs and controls. Within stromal melanocytes, we found no change in the total number of melanin granules of the LIID cases, as compared with the brown and heterogeneously colored normals. However, melanin granules in the anterior border melanocytes of the LIID eyes were significantly larger than those in the controls. A trend towards bigger melanin granules was apparent in the deep stroma, but this difference did not reach significance.

CONCLUSIONS

In the LIID cases that we examined, the darkening side effect does not seem to be associated with either proliferative or generative iris changes, nor with increases in number of granules. Instead, it appears to be due to small increases in the size of mature melanin granules, particularly in the anterior border region.

Biochemistry of prostaglandins A

This review considers modern concepts on the structural-functional properties and antiproliferative, antitumor, and antiviral effects of cyclopentenone prostaglandins A and mechanisms underlying their actions. Possible directions of pharmacological application of these compounds and their analogs are discussed.

Extracellular signal-regulated kinase-dependent proliferation is mediated through the protein kinase A/B-Raf pathway in human uveal melanoma cells

Mutated B-Raf-mediated constitutive activation of ERK1/2 is involved in about 66% of cutaneous melanoma. By contrast, activating mutations in B-RAF are rare in ocular melanoma. This study aimed to determine the role of wild-type B-Raf ((WT)B-Raf) in uveal melanoma cell growth. We used cell lines derived from primary tumors of uveal melanoma to assess the role of (WT)B-Raf in cell proliferation and to characterize its upstream regulators and downstream effectors. Melanoma cell lines expressing (WT)B-Raf and (WT)Ras grew with similar proliferation rates, showed constitutive activation of ERK1/2, and had similar levels of B-Raf expression and B-Raf kinase activity as melanoma cell lines expressing the activating V600E mutation ((V600E)B-Raf). They were equally as sensitive to pharmacological inhibition of MEK1/2 for cell proliferation and transformation as (V600E)B-Raf cells. siRNA-mediated depletion of Raf-1 did not affect either ERK1/2 activation, whereas siRNA-mediated depletion of B-Raf reduced cell proliferation by up to 65% through the inhibition of ERK1/2 activation, irrespective of the mutational status of B-Raf. Pharmacological inhibition of cAMP-dependent protein kinase (PKA) and siRNA-mediated depletion of PKA greatly reduced B-Raf activity, ERK1/2 activation, and cell proliferation in (WT)B-Raf cells, whereas it did not affect (V600E)B-Raf cells, demonstrating a key role of PKA in mediating (WT)B-Raf/ERK signaling for uveal melanoma cell growth. Moreover, inactivation or depletion of PKA did not affect Rap-1 activity, and Rap-1 depletion did not affect either B-Raf activity or ERK1/2 activation. This ruled out a role for Rap1 in the PKA-mediated B-Raf/ERK activation in (WT)B-Raf cells. Finally, we demonstrated the importance of cyclin D1 in mediating PKA/(WT)B-Raf signaling for cell proliferation. Altogether, our results suggest that the PKA/B-Raf pathway is a potential target for therapeutic strategies against (WT)B-Raf-expressing uveal melanoma.

Uveal Melanocytes Produce Matrix Metalloproteinases-2 and -9 In Vitro

The purpose of the present study was to investigate the expression of matrix metalloproteinase (MMP)-2 and MMP-9 by cultured human uveal melanocytes, and to test the effects of 12-O-tetradecanoyl-phorbol-13-acetate on the expression of these MMPs. Gelatin zymography of conditioned culture medium from four cultures of human uveal melanocytes (two cultures of iridal melanocytes and two cultures of choroidal melanocytes) detected MMP-2 (72 kDa) and a relatively small amount of MMP-9 (92 kDa), both in the latent form. RT-PCR analysis revealed the MMP-2 mRNA and MMP-9 mRNA in cultured uveal melanocytes. Addition of 12-O-tetradecanoyl-phorbol-13-acetate (10 ng/ml) to the culture medium caused an increase of production of MMP-2 and MMP-9 by cultured uveal melanocytes, and also stimulated the transcription of MMP-2 and MMP-9 of these cells.

Low incidence of iris pigmentation and eyelash changes in 2 randomized clinical trials with unoprostone isopropyl 0.15%

OBJECTIVE

To assess whether iris color and eyelash changes occur with the use of unoprostone for 2 years.

DESIGN

The 2 clinical trials described herein were prospective, randomized, double-masked, active-controlled, parallel group, multicenter studies.

PARTICIPANTS

A total of 1131 patients with primary open-angle glaucoma or ocular hypertension participated in 2 clinical trials and received either unoprostone isopropyl 0.15% (659), timolol maleate 0.5% (331), or betaxolol hydrochloride 0.5% (141), 1 drop per eye twice daily for up to 24 months.

METHODS

Color photographs (1:1 magnification) were taken of the iris and eyelid of each patient at baseline and at regular intervals thereafter through month 24 using a standardized camera system. Photography included 7 views of each eye plus a calibration photograph and a patient identification photograph, for a total of 16 photographs per patient per visit. Two independent (masked) readers subjectively compared baseline iris colors to subsequent visits. Side view photographs of the upper and lower eyelashes were used for the eyelash length analysis, with each having sufficient depth of field and a sufficient number of eyelashes in focus. Similarly, frontal eyelash views were used for the eyelash density analysis.

MAIN OUTCOME MEASURES

Changes from baseline in iris color and eyelash length and density within and between treatment groups.

RESULTS

Seven cases of iris color change (1.06%) were confirmed in patients treated with unoprostone for up to 24 months; no confirmed cases were reported in the timolol or betaxolol groups. In the unoprostone group, cases of iris color change were confirmed at months 12 (1 case), 18 (2 cases), and 24 (4 cases). No clinically relevant differences were observed among treatment groups for changes from baseline in eyelash length or density.

CONCLUSION

Although iris hyperpigmentation and abnormal eyelash changes may occur after treatment with unoprostone, the incidence of these events appears to be low in the 2-year clinical study.

Proteinase-activated receptor-2 stimulates prostaglandin production in keratinocytes: analysis of prostaglandin receptors on human melanocytes and effects of PGE2 and PGF2alpha on melanocyte dendricity

Prostaglandins (PG) are key mediators of diverse functions in the skin and several reports suggest that PG mediate post-inflammatory pigmentary changes through modulation of melanocyte dendricity and melanin synthesis. The proteinase-activated receptor 2 (PAR-2) is important for skin pigmentation because activation of keratinocyte PAR-2 stimulates uptake of melanosomes through phagocytosis in a Rho-dependent manner. In this report, we show that activation of keratinocyte PAR-2 stimulates release of PGE(2) and PGF(2alpha) and that PGE(2) and PGF(2alpha) act as paracrine factors that stimulate melanocyte dendricity. We characterized the expression of the EP and FP receptors in human melanocytes and show that human melanocytes express EP1 and EP3, and the FP receptor, but not EP2 and EP4. Treatment of melanocytes with EP1 and EP3 receptor agonists resulted in increased melanocyte dendricity, indicating that both EP1 and EP3 receptor signaling contribute to PGE(2)-mediated melanocyte dendricity. Certain EP3 receptor subtypes have been shown to increase adenosine 3',5'-cyclic monophosphate (cAMP) through coupling to Gs, whereas EP1 is known to couple to Gq to activate phospholipase C with elevation in Ca(2+). The cAMP/protein kinase A system is known to modulate melanocyte dendrite formation through modulation of Rac and Rho activity. Neither PGF(2alpha) or PGE(2) elevated cAMP in human melanocytes showing that dendricity observed in response to PGE(2) and PGF(2alpha) is cAMP-independent. Our data suggest that PAR-2 mediates cutaneous pigmentation both through increased uptake of melanosomes by keratinocytes, as well as by release of PGE(2) and PGF(2alpha) that stimulate melanocyte dendricity through EP1, EP3, and FP receptors.

Latanoprost : an update of its use in glaucoma and ocular hypertension

Latanoprost (Xalatan) is an ester analogue of prostaglandin F2alpha that reduces intraocular pressure (IOP) by increasing uveoscleral outflow. The IOP-lowering efficacy of latanoprost 0.005% lasts for up to 24 hours after a single topical dose, which allows for a once-daily dosage regimen. In patients with ocular hypertension or open-angle glaucoma, a single drop of latanoprost 0.005% solution (about 1.5 microg) administered topically once daily reduced diurnal IOP by 22 to 39% over 1 to 12 months' treatment in well-controlled trials; efficacy was maintained during treatment periods of up to 2 years. At this dosage, latanoprost was significantly more effective than timolol 0.5% twice daily in 3 of 4 large, double-blind, randomised studies, was generally as effective as bimatoprost or travoprost, and was significantly more effective than dorzolamide, brimonidine or unoprostone. Furthermore, in patients whose IOP was poorly controlled with timolol, switching to latanoprost monotherapy was at least as effective at lowering IOP as adding dorzolamide or pilocarpine to the regimen. Latanoprost has also shown significant additive effects when used in combination with one or more other glaucoma medications. The fixed combination of latanoprost plus timolol was significantly more effective than either of its individual components in two double-blind randomised studies and more effective than the fixed combination of dorzolamide and timolol in a 3-month, evaluator-masked study. Data in patients with angle-closure glaucoma are limited, but in patients with elevated IOP after undergoing iridotomy, latanoprost 0.005% once daily was significantly more effective than timolol 0.5% twice daily at reducing IOP over 12 weeks of treatment in a large double-blind, randomised study. Latanoprost is generally well tolerated and, unlike timolol, induces minimal systemic adverse events. In well-controlled, 6-month trials, the most commonly occurring drug-related ocular events in latanoprost recipients were mild to moderate conjunctival hyperaemia (3 to 15%) and iris colour change (2 to 9%); these seldom required patient withdrawal although the latter may be permanent. Latanoprost 0.005% as a single daily drop has shown good IOP-lowering efficacy in patients with open-angle glaucoma or ocular hypertension and does not produce the cardiopulmonary adverse effects associated with beta-blockers. Thus, latanoprost is a valuable addition to the first-line treatment options for patients with open-angle glaucoma or ocular hypertension. In addition, adjunctive treatment with latanoprost in patients who are refractory to beta-blocker therapy is a viable, second-line treatment option. Although preliminary findings are promising, wider clinical experience is required to define the place of latanoprost in the treatment of angle-closure glaucoma.

Latanoprost-induced pigmentation in human iridial melanocytes is fibroblast dependent

The prostaglandin F2alpha derivative, latanoprost (LT), used in glaucoma treatment, can induce pigmentation in irises of patients with hazel or heterochromatic eye colour. The mechanism by which LT induces pigmentation in the iris is not yet established, although it does not appear to induce proliferation of iridial melanocytes. The purpose of this study was to develop an in vitro model in which to investigate this mechanism. The pigmentary responses to LT and prostaglandin F(2alpha) (PGF(2alpha)) were examined in human iridial melanocytes alone or in co-culture with epithelial cells (non-ocular human epidermal keratinocytes and iris pigment epithelial cells) or mesenchymal cells (non-ocular dermal fibroblasts or iridial fibroblasts). Melanogenesis was assessed after 4 days culture with prostanoids, using dopa oxidase activity. Prostaglandin FP expression on human iridial fibroblasts and melanocytes was investigated using an immunofluorescent technique employing antibody to PGF(2alpha) receptor and RT-PCR. Iridial melanocytes did not show a convincing increase in dopa oxidase when cultured alone but in the presence of fibroblasts (ocular or non-ocular) there was a significant increase (25-30%) in dopa oxidase activity in response to 10(-7)-10(-5)m LT and PGF(2alpha). Co-culture of melanocytes with epithelial cells, while leading to increased dopa oxidase activity, did not lead to any melanogenic response to LT or PGF(2alpha). FP receptor expression was detected on fibroblasts but not iridial melanocytes by immunocytochemistry and RT-PCR. The melanocyte/fibroblast co-culture model developed in this study also showed that LT and PGF(2alpha) increased dopa oxidase activity in melanocytes from donors with brown but not blue eyes. These results suggest that LT may be inducing pigmentation in the human iris indirectly through the FP receptor on adjacent fibroblasts.

Increase of melanogenesis by retinoic acid: an ultrastructural and morphometric study

Melanin is a dark pigment protecting the skin against UV radiation in some organisms. Studies on invasion and metastasis using retinoic acid as inhibitor agent are well known, but its role in melanin production (melanogenesis), especially at ultrastructural level and using morphometry were not well studied. In the present study, we analyzed the effects of retinoic acid on the melanosomes in B16F10 melanoma cells. These organelles were identified and quantified using routine electron microscopy and the specific HMB45 antibody. Other approaches such as immunofluorescence, and flow cytometry were also used. Our results indicated that retinoic acid increased the melanogenesis process in B16F10 melanoma cells. Furthermore, this work also provided evidence that this substance interferes at the subcellular level altering the numerical density of melanosomes, as well as the relative volume of the nucleus and nucleolus. In addition, the cells displayed altered morphology and an increase in the percentage of the relative volume of melanosomes, mainly the stages II-III and IV, leading to melanin formation. Furthermore, a decrease in the cells number after retinoic acid treatment was also observed.

Studies on ocular inflammation and development of a prostaglandin analogue for glaucoma treatment

This review summarizes the Ernst H. Bárány Prize Lecture given at the meeting of the International Society of Eye Research in Geneva 2002. In the paper the path from the author's early studies on neurogenic inflammation in the eye to the search for a suitable prostaglandin analogue for glaucoma treatment, and the development of latanoprost are described. In particular the solution to the nociceptive and hyperemic side-effects of naturally occurring prostaglandins in the eye, the mechanism of action of FP prostanoid receptor agonists as well as the selection of dose for glaucoma treatment are discussed. In addition, pharmacokinetical aspects of latanoprost, and the melanogenic side-effect of prostaglandins in the iris are addressed. The paper is primarily focused on studies performed by the author and complete reference to other previous, or contemporary studies is therefore not always given as the purpose is not to present a comprehensive review article.

Latanoprost-induced iris darkening: a morphometric study of human peripheral iridectomies

PURPOSE

This microscopic study was undertaken to compare the melanocytes of peripheral iridectomy specimens from two eyes that had latanoprost-induced iris darkening (LIID) with iridectomies taken from the fellow untreated eyes.

METHODS

The two patients in this study were the ones who underwent LIID in the latanoprost treated eye from a series of 17 patients requiring bilateral trabeculectomy. The first trabeculectomy procedure provided a control peripheral iridectomy for each patient, whereas the second eye was treated with once daily 50 microg ml(-1) latanoprost drops for 6 months. The four peripheral iridectomy specimens from the two LIID patients were subjected to quantitative morphometric analysis by light microscopy of iris cellularity, and electron microscopy of iris melanocyte immature melanosomes and mature melanin granules.

RESULTS

There was no significant difference in stromal cellularity between the LIIDs and their respective controls nor were there significant differences in the numbers of immature melanosomes or melanin granules in the melanocytes. However, there was a significant increase in the diameter of melanin granules that was more pronounced in the anterior border layer than the deeper stroma. With the anterior border melanocytes, the increase in melanin granule size was associated with significant increases in granule area and the percentage of cell cytoplasm occupied by melanin (granularity).

CONCLUSIONS

The only morphological change identified in two peripheral iridectomies that had LIID when compared to untreated fellow eye specimens was a modest increase in the size of stromal melanocyte melanin granules that was more pronounced in the cells of the anterior border region.

Unoprostone isopropyl ester darkens iris color in pigmented rabbits with sympathetic denervation

PURPOSE

Unoprostone isopropyl ester (unoprostone) -induced iris color darkening was evaluated in a rabbit model using a cyclooxygenase inhibitor, an alpha(1)-adrenergic antagonist, and sympathetic denervation.

MATERIALS AND METHODS

Dutch-belted rabbits were divided into five groups based on type of surgery and eyedrop treatment to both eyes: (1) sham surgery (n = 7); (2) bilateral superior cervical ganglionectomy (SCGx, n = 7); (3) SCGx plus flurbiprofen 0.03% (n = 7); (4) SCGx plus thymoxamine 0.5% (n = 6); and (5) SCGx plus flurbiprofen and thymoxamine (n = 6). All rabbits were treated with unoprostone 0.12% to one eye and its vehicle to the contralateral eye twice daily for 43 weeks after SCGx. Periodic color photographs of paired eyes were scored for difference in eye color. Iris melanin and aqueous humor protein were measured at week 43.

RESULTS

Twenty-three of the 26 rabbits with bilateral SCGx and unilateral unoprostone treatment demonstrated a darker iris color on the unoprostone-treated side. The average scores (demonstrating difference in iris color) comparing photographs of treated versus control eyes in the four SCGx groups were higher than those in the sham surgery group (P < 0.03), and higher than at week 0 (P < 0.001). The group pretreated with flurbiprofen and thymoxamine had the highest score of all groups. The aqueous humor protein in unoprostone-treated eyes was higher (P < or = 0.0001) than in vehicle-treated eyes. The melanin content of irides of the denervated groups was higher (P < or = 0.01) in unoprostone-treated than in vehicle-treated eyes.

CONCLUSION

Unoprostone produced iris color darkening in pigmented rabbit eyes with sympathetic denervation. Pretreatment with flurbiprofen and thymoxamine appeared to enhance this effect but this was not statistically demonstrated by the study.

Transporters/receptors in the anterior chamber: pathways to explore ocular drug delivery strategies

Membrane transporters/receptors are involved in drug transport processes and play a key role in intestinal absorption, tissue distribution and elimination. Drug targeting to specific transporters and receptors using carrier-mediated absorption has immense clinical significance. Ocular drug delivery is a challenging task since it involves drug transport across various barriers in the eye. Specialised transport processes exist at these barriers, which control the entry of drugs and xenobiotics. Ocular drug therapy involving topical or systemic administration of drugs has various limitations. Transport processes in the eye have been targeted in an effort to increase ocular bioavailability of drugs following topical instillation. This review discusses various transport processes in the eye and drug delivery strategies utilising these transporters/receptors.

Transcription of prostanoid receptor genes and cyclooxygenase enzyme genes in cultivated human iridial melanocytes from eyes of different colours

Several prostaglandin analogues used for glaucoma treatment have been shown to cause increased iridial pigmentation as side-effect. In the present study we identified the types of prostanoid receptors and cyclooxygenase (COX) enzymes that are expressed in human iridial melanocytes isolated from eyes of different colours. Iris specimens were obtained during trabeculectomy surgery, or from enucleated eyes, and the iridial melanocytes were isolated and cultivated. The transcription of the DP, EP1, EP2, EP3, EP4, FP, IP and TP prostanoid receptor genes as well as the COX-1 and COX-2 enzyme genes was investigated using reverse transcriptase-polymerase chain reaction (RT-PCR). Of the prostanoid receptors the FP receptor gene was found to be most consistently transcribed in the melanocytes isolated from both blue- and hazel-coloured eyes. No RNA of the DP, EP2 and TP receptor genes could be detected, whereas the EP1, EP3, EP4 and IP receptor genes were found to be transcribed in melanocytes from some eyes. The COX-2 gene was found to be transcribed, but the COX-1 gene less consistently. There was no difference in gene transcription pattern between melanocytes originating from eyes treated with latanoprost, and eyes not previously treated with the prostaglandin. These results indicate that the FP prostanoid receptor gene is transcribed in cultivated human iridial melanocytes of both blue and hazel eyes, whereas the other prostanoid receptor genes seem to be transcribed much less frequently, or not at all. Surprisingly, the COX-2 rather than the COX-1 gene, was found to be transcribed in the melanocytes.

Production of prostaglandin e(2) by iridial melanocytes exposed to latanoprost acid, a prostaglandin F(2 alpha) analogue

Several prostaglandin analogues used for glaucoma treatment cause increased pigmentation of the iris. The purpose of the present study was investigate whether latanoprost, a PGF(2 alpha) analogue, has any effect on the production of endogenous prostaglandins in iridial melanocytes, which could be important in the mechanism leading to increased pigmentation. Bovine and human iridial melanocytes in culture were used for the experiments. Production of endogenous prostaglandins was measured by enzyme immunoassay, and the melanin content was measured spectrophotometrically. In bovine iridial melanocytes, latanoprost acid caused a significant increase of the PGE(2) production, which could be blocked by indomethacin and NS398, indicating an involvement of cyclo-oxygenase 2. In order to study the selectivity of the phenomenon other endogenous substances/drugs were tested, e.g., acetylcholine, carbachol, noradrenaline, neuropeptide Y, substance P and alpha-MSH, but none was found to have any significant effect. Human iridial melanocytes also responded to latanoprost acid with increased production of PGE(2) and in 1 out of 5 individuals increased melanogenesis coincided with increased PGE(2) production. In bovine iridial melanocytes, latanoprost acid did not stimulate melanogenesis. These results indicate that latanoprost acid cause enhanced formation of endogenous prostaglandins that may have auto- and/or paracrine effects in the melanocytes, possibly associated with melanogenesis.

Mechanism and clinical significance of prostaglandin-induced iris pigmentation

The new glaucoma drugs latanoprost, isopropyl unoprostone, travoprost, and bimatoprost cause increased pigmentation of the iris in some patients. The purpose of the present article is to survey the available preclinical and clinical data on prostaglandin-induced iris pigmentation and to assess the phenomenon from a clinical perspective. Most of the data have been obtained with latanoprost, and it appears that there is a predisposition to latanoprost-induced iris pigmentation in individuals with hazel or heterochromic eye color. As latanoprost and travoprost are selective agonists for the prostaglandin F(2alpha) receptor, it is likely that the phenomenon is mediated by this receptor. Several studies indicate that latanoprost stimulates melanogenesis in iridial melanocytes, and transcription of the tyrosinase gene is upregulated. The safety aspects of latanoprost-induced iris pigmentation have been addressed in histopathologic studies, and no evidence of harmful consequences of the side effect has been found. Although a final assessment of the clinical significance of prostaglandin-induced iris pigmentation currently is impossible to make, it appears that the only clear-cut disadvantage is a potential heterochromia between the eyes in unilaterally treated patients because the heterochromia is likely to be permanent, or very slowly reversible.

Histology and fine structure of the iris and outflow system following latanoprost therapy

Latanoprost therapy can lead to iris darkening in susceptible individuals, particularly those with hazel eyes. Concerns have been raised about whether latanoprost, and for that matter other prostanoids, may have a harmful effect on the iris. In addition, it is unknown whether latanoprost causes increased pigmentation of the outflow pathways that might eventually lead to blockage and a type of pigmentary glaucoma. The present study summarizes findings from the authors' own laboratories on the effects of latanoprost as seen by light and electron microscopy of the iris and outflow tissues and reviews the as yet limited, relevant literature. The findings support the proposal that latanoprost-induced eye color change is likely to be due to an increased amount of melanin within iris stromal melanocytes rather than any increase in melanocyte numbers, although many aspects of the darkening process remain obscure. No marked pathological changes were found in the latanoprost-treated iris; however, the numbers of specimens examined by us to date are still small (40 specimens in all) and those with latanoprost-induced darkening are even fewer (18). In the authors' experience, pigmentation of the outflow system in latanoprost-treated eyes was no greater than in eyes with primary open-angle glaucoma without prostanoid treatment, but there have been only limited numbers of trabeculectomy specimens examined. Concerns about latanoprost producing meshwork hyperpigmentation and pigmentary glaucoma are discussed.

Effects of isopropyl unoprostone and latanoprost on melanogenesis in mouse epidermal melanocytes

PURPOSE

The authors sought to investigate the cellular mechanism of melanogenesis by prostaglandin antiglaucomatous compounds, isopropyl unoprostone (referred to as unoprostone) and latanoprost, and to quantitatively compare their effect on melanogenesis using cultured mouse epidermal melanocytes.

METHODS

M1, M2, and the acid of latanoprost, all of which are possible intraocular metabolites of unoprostone or latanoprost, were used. Tested prostaglandin-related compounds (final concentration range, 1 micromol/L-10 nmol/L) were administrated to the culture medium of purely cultured mouse melanoblasts, melan-A, once daily for 2 weeks. One micromole per liter prostaglandin F(2 alpha) solution was administered in parallel. Radioisotope assays were used to measure the total melanin synthesis and the activity of tyrosinase in converting tyrosine to L-3,4-dihydroxyphenylalanine, which is a rate-limiting reaction in melanogenesis. The effects of prostaglandin F(2 alpha), M1, or M2 on proliferation of melan-A were examined.

RESULTS

M1, M2, and acid of latanoprost but not prostaglandin F(2 alpha), significantly enhanced tyrosinase activity. M2 and acid of latanoprost more greatly enhanced tyrosinase activity than did M1. None of the tested compounds significantly altered the proliferation and total melanin synthesis of melan-A.

CONCLUSIONS

Both unoprostone and latanoprost enhanced tyrosinase activity. These prostaglandin-related compounds may influence the nature of melanin and result in pigmentation.

Ocular phototoxicity

The human eye is constantly exposed to sunlight and artificial lighting. Therefore the eye is exposed to UV-B (295-320 nm), UV-A (320-400 nm), and visible light (400-700 nm). Light is transmitted through the eye and then signals the brain directing both sight and circadian rhythm. Therefore light absorbed by the eye must be benign. Damage to the young and adult eye by intense ambient light is avoided because the eye is protected by a very efficient antioxidant system. In addition, there are protective pigments such as the kynurenines, located in the human lens, and melanin, in the uvea and retina, which absorb ambient radiation and dissipate its energy without causing damage. After middle age there is a decrease in the production of antioxidants and antioxidant enzymes. At the same time, the protective pigments are chemically modified (lenticular 3-hydroxy kynurenine pigment is enzymatically converted into the phototoxic chromophore xanthurenic acid; melanin is altered from an antioxidant to pro-oxidant) and fluorescent chromophores (lipofuscin) accumulate to concentrations high enough to produce reactive oxygen species. We have known for some time that exposure to intense artificial light and sunlight either causes or exacerbates age-related ocular diseases. We now know many of the reasons for these effects, and with this knowledge methods are being developed to interfere with these damaging processes.

A functional study on prostanoid receptors involved in cultured human iridal melanocyte stimulation

The effects of various prostanoids on the growth, melanogenesis and dendrification of cultured iridal melanocytes were studied. Iridal melanocytes were isolated and cultured with medium supplemented with cAMP elevating agents and basic fibroblast growth factor (bFGF) (complete medium). The iridal melanocytes were plated into multiple well plates and cultured with complete medium or various deleted media with or without various prostanoids at different concentrations. After 6 days, the numbers of cells and dendrites were counted and melanin content was measured and compared with controls. Prostaglandin E(2), an EP(2)receptor agonist (AH 13205) and AGN 192093 (thromboxane mimetic) stimulated growth, melanogenesis and dendrification of cultured iridal melanocytes in cAMP-deleted medium. A mixed EP(1)and EP(3)receptor agonist (sulprostone), a EP(4)receptor agonist (ONO-AE1-329), IP receptor agonists (cicaprost or iloprost) and a TP receptor agonist (U-46619) showed no effect. Prostaglandin D(2)showed stimulating effects. However, these stimulating effects could not be blocked by the addition of a DP receptor antagonist (BW A868C). Furthermore, a DP receptor agonist (BW 245C) showed no effects, indicating that the effect of prostaglandin D(2)may involve receptors other than the DP receptor subtype. The present study indicates that: (1) among various EP receptor agonists, only an EP(2)receptor agonist has stimulating effects on iridal melanocytes; (2) DP, IP and TP receptor agonists do not have stimulating effects; and (3) the mechanisms of action of prostaglandin D(2)and AGN 192093 need further study.

The pros and cons of different prostanoids in the medical management of glaucoma

The prostaglandin analogs are new exciting drugs added to the therapeutic armamentarium for patients with glaucoma. Several studies have evaluated the ocular hypotensive properties and side effects of latanoprost in different forms of glaucoma. This drug, seems to be the most effective intraocular pressure (IOP)-reducing agent currently available, and has a low incidence of ocular and systemic side effects. Fewer data are available regarding unoprostone, but the IOP-reducing effect of this drug seems to be comparable or slightly inferior to that of timolol and it produces fewer side effects. When compared with unoprostone, latanoprost has been shown to effect a greater reduction in IOP. A major drawback to the use of prostaglandin analogues is the lack of long-term experience such as that currently available for other classes of agents.

The iris after prostanoid treatment

Morphologic studies to date show that prostanoid-induced iris color change is not associated with any major pathologic process in the tissue. There is no evidence of melanocyte proliferation. The most likely mechanism for iris color darkening is increased melanogenesis, but this is not so marked as to cause any extensive release of melanin granules that might cause iris inflammation or even a pigmentary-type of glaucoma. Some patients, but not all, with color darkening have an apparent thickening of the anterior border zone; it remains to be established whether this is true thickening or merely if the anterior border is emphasized because of increased pigmentation.