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Wynne N, Jiang YY, Aleman TS, Morgan JIW. Retinal Sensitivity in Comparison to Cone Density in Choroideremia. Invest Ophthalmol Vis Sci 2024; 65:6. [PMID: 39625441 PMCID: PMC11620006 DOI: 10.1167/iovs.65.14.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 11/06/2024] [Indexed: 12/08/2024] Open
Abstract
Purpose Choroideremia (CHM) is an X-linked inherited retinal degeneration causing loss of photoreceptors, retinal pigment epithelium, and choriocapillaris. Structural abnormalities of the cone photoreceptor mosaic have been reported even within the retained island of functioning retina. Here, we describe the relationship between cone density and visual sensitivity within the retained central retina in CHM. Methods The cone mosaics of 31 patients aged 10 to 57 years with CHM were imaged using a multi-modal, custom-built adaptive optics scanning light ophthalmoscope (AOSLO). Retinal sensitivity was measured using fundus tracking perimetry, cross-sectional retinal structure with optical coherence tomography. The relationship between sensitivity at each retinal location tested and structural parameters of local disease severity (cone density and distance to border) was explored using unpaired t-tests and linear regressions. Ellipsoid zone area was also investigated. Results Three hundred fourteen individual regions of interest were analyzed. Cone density and retinal sensitivities were significantly decreased compared with healthy controls (P < 0.0002). There was a statistically significant correlation between cone density and visual sensitivity within the fovea and parafovea (P < 0.0005), but not in the perifovea (P > 0.1). There was a significant relationship between the distance to the atrophic border and sensitivity from 400 µm to 1600 µm eccentricity (P < 0.001). Mean sensitivity was significantly related to the ellipsoid extent (P < 0.0001). Conclusions The correlation between cone density and retinal sensitivity within 1 mm of the foveal center in CHM suggests central sensitivity loss is driven by cone loss. Outside of the central fixation point, proximity to the atrophic border is correlated with sensitivity, suggesting the presence of a functional transition zone.
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Affiliation(s)
- Niamh Wynne
- Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Yu You Jiang
- Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Tomas S. Aleman
- Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jessica I. W. Morgan
- Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Cideciyan AV, Roman AJ, Warner RL, Sumaroka A, Wu V, Jiang YY, Swider M, Garafalo AV, Viarbitskaya I, Russell RC, Kohl S, Wissinger B, Ripamonti C, Barbur JL, Bach M, Carroll J, Morgan JIW, Aleman TS. Evaluation of Retinal Structure and Visual Function in Blue Cone Monochromacy to Develop Clinical Endpoints for L-opsin Gene Therapy. Int J Mol Sci 2024; 25:10639. [PMID: 39408969 PMCID: PMC11477341 DOI: 10.3390/ijms251910639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Revised: 09/21/2024] [Accepted: 09/30/2024] [Indexed: 10/20/2024] Open
Abstract
L-cone opsin expression by gene therapy is a promising treatment for blue cone monochromacy (BCM) caused by congenital lack of long- and middle-wavelength-sensitive (L/M) cone function. Eight patients with BCM and confirmed pathogenic variants at the OPN1LW/OPN1MW gene cluster participated. Optical coherence tomography (OCT), chromatic perimetry, chromatic microperimetry, chromatic visual acuity (VA), and chromaticity thresholds were performed with unmodified commercial equipment and/or methods available in the public domain. Adaptive optics scanning laser ophthalmoscope (AOSLO) imaging was performed in a subset of patients. Outer retinal changes were detectable by OCT with an age-related effect on the foveal disease stage. Rod and short-wavelength-sensitive (S) cone functions were relatively retained by perimetry, although likely impacted by age-related increases in the pre-retinal absorption of short-wavelength lights. The central macula showed a large loss of red sensitivity on dark-adapted microperimetry. Chromatic VAs with high-contrast red gratings on a blue background were not detectable. Color vision was severely deficient. AOSLO imaging showed reduced total cone density with majority of the population being non-waveguiding. This study developed and evaluated specialized outcomes that will be needed for the determination of efficacy and safety in human clinical trials. Dark-adapted microperimetry with a red stimulus sampling the central macula would be a key endpoint to evaluate the light sensitivity improvements. VA changes specific to L-opsin can be measured with red gratings on a bright blue background and should also be considered as outcome measures in future interventional trials.
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Affiliation(s)
- Artur V. Cideciyan
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.J.R.); (R.L.W.); (A.S.); (V.W.); (Y.Y.J.); (M.S.); (A.V.G.); (I.V.); (R.C.R.); (J.I.W.M.); (T.S.A.)
| | - Alejandro J. Roman
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.J.R.); (R.L.W.); (A.S.); (V.W.); (Y.Y.J.); (M.S.); (A.V.G.); (I.V.); (R.C.R.); (J.I.W.M.); (T.S.A.)
| | - Raymond L. Warner
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.J.R.); (R.L.W.); (A.S.); (V.W.); (Y.Y.J.); (M.S.); (A.V.G.); (I.V.); (R.C.R.); (J.I.W.M.); (T.S.A.)
| | - Alexander Sumaroka
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.J.R.); (R.L.W.); (A.S.); (V.W.); (Y.Y.J.); (M.S.); (A.V.G.); (I.V.); (R.C.R.); (J.I.W.M.); (T.S.A.)
| | - Vivian Wu
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.J.R.); (R.L.W.); (A.S.); (V.W.); (Y.Y.J.); (M.S.); (A.V.G.); (I.V.); (R.C.R.); (J.I.W.M.); (T.S.A.)
| | - Yu Y. Jiang
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.J.R.); (R.L.W.); (A.S.); (V.W.); (Y.Y.J.); (M.S.); (A.V.G.); (I.V.); (R.C.R.); (J.I.W.M.); (T.S.A.)
| | - Malgorzata Swider
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.J.R.); (R.L.W.); (A.S.); (V.W.); (Y.Y.J.); (M.S.); (A.V.G.); (I.V.); (R.C.R.); (J.I.W.M.); (T.S.A.)
| | - Alexandra V. Garafalo
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.J.R.); (R.L.W.); (A.S.); (V.W.); (Y.Y.J.); (M.S.); (A.V.G.); (I.V.); (R.C.R.); (J.I.W.M.); (T.S.A.)
| | - Iryna Viarbitskaya
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.J.R.); (R.L.W.); (A.S.); (V.W.); (Y.Y.J.); (M.S.); (A.V.G.); (I.V.); (R.C.R.); (J.I.W.M.); (T.S.A.)
| | - Robert C. Russell
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.J.R.); (R.L.W.); (A.S.); (V.W.); (Y.Y.J.); (M.S.); (A.V.G.); (I.V.); (R.C.R.); (J.I.W.M.); (T.S.A.)
| | - Susanne Kohl
- Molecular Genetics Laboratory, Centre for Ophthalmology, University of Tübingen, D-72076 Tübingen, Germany; (S.K.); (B.W.)
| | - Bernd Wissinger
- Molecular Genetics Laboratory, Centre for Ophthalmology, University of Tübingen, D-72076 Tübingen, Germany; (S.K.); (B.W.)
| | | | - John L. Barbur
- Centre for Applied Vision Research, School of Health & Psychological Sciences, City St. George’s, University of London, London EC1V 0HB, UK;
| | - Michael Bach
- Eye Center, Medical Center—Faculty of Medicine, University of Freiburg, D-79106 Freiburg, Germany;
| | - Joseph Carroll
- Departments of Ophthalmology & Visual Science, Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Jessica I. W. Morgan
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.J.R.); (R.L.W.); (A.S.); (V.W.); (Y.Y.J.); (M.S.); (A.V.G.); (I.V.); (R.C.R.); (J.I.W.M.); (T.S.A.)
| | - Tomas S. Aleman
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.J.R.); (R.L.W.); (A.S.); (V.W.); (Y.Y.J.); (M.S.); (A.V.G.); (I.V.); (R.C.R.); (J.I.W.M.); (T.S.A.)
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Paez-Escamilla M, Alabek ML, Beale O, Prensky CJ, Lejoyeux R, Friberg TR, Sahel JA, Rosin B. An Optical Coherence Tomography-Based Measure as an Independent Estimate of Retinal Function in Retinitis Pigmentosa. Diagnostics (Basel) 2023; 13:3521. [PMID: 38066762 PMCID: PMC10706660 DOI: 10.3390/diagnostics13233521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND With the clinical advances in the field of gene therapy, the development of objective measures of visual function of patients with inherited retinal dystrophies (IRDs) is of utmost importance. Here, we propose one such measure. METHODS We retrospectively analyzed data from a cohort of 194 eyes of 97 genetically diagnosed patients with retinitis pigmentosa (RP), the most common IRD, followed at the UPMC Vision Institute. The analyzed data included the reflectivity ratio (RR) of the retinal nerve fiber layer (RNFL) to that of the entire retina, visual acuity (VA) and the thickness of the retinal outer nuclear layer (ONL) and the RNFL. RESULTS There was a strong positive correlation between the RR and VA. Both VA and the RR were negatively correlated with disease duration; VA, but not the RR, was negatively correlated with age. The RR correlated with the ONL but not with the RNFL thickness or the intraocular pressure. Age, RR, disease duration and ONL thickness were found to be independent predictors of VA by multivariate analysis. CONCLUSION The OCT RR could serve as an independent predictor of visual acuity, and by extension of retinal function, in genetically diagnosed RP patients. Such objective measures can be of great value in patient selection for therapeutic trials.
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Affiliation(s)
- Manuel Paez-Escamilla
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
- Department of Ophthalmology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Michelle L. Alabek
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Oliver Beale
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Colin J. Prensky
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Raphael Lejoyeux
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
- Rothschild Foundation Hospital, 75019 Paris, France
- Institut Oeil Paupiere, Viry-Chatillon, 91170 Paris, France
| | - Thomas R. Friberg
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Jose-Alain Sahel
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
| | - Boris Rosin
- Department of Ophthalmology/UPMC Vision Institute, University of Pittsburgh Medical Center (UPMC), 1622 Locust Street, Pittsburgh, PA 15219, USA; (M.P.-E.); (M.L.A.); (O.B.); (C.J.P.); (R.L.); (T.R.F.); (J.-A.S.)
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AAV2-hCHM Subretinal Delivery to the Macula in Choroideremia: Two Year Interim Results of an Ongoing Phase I/II Gene Therapy Trial. Ophthalmology 2022; 129:1177-1191. [PMID: 35714735 DOI: 10.1016/j.ophtha.2022.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To assess the safety of the subretinal delivery of a recombinant adeno-associated virus serotype 2 (AAV2) vector carrying a human CHM-encoding cDNA in choroideremia (CHM). DESIGN Prospective, open-label, non-randomized, dose-escalation, phase 1/2 clinical trial. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS Fifteen CHM patients (ages 20-57 years at dosing). METHODS, INTERVENTION, OR TESTING Patients received uniocular subfoveal injections of low dose (up to 5x1010 vector genome (vg) per eye, n=5) or high dose (up to 1x1011 vg per eye, n=10) AAV2-hCHM. Patients were evaluated pre- and post-operatively for two years with ophthalmic examinations, multimodal retinal imaging and psychophysical testing. MAIN OUTCOME Measures: visual acuity (VA), perimetry (10-2 protocol), spectral-domain optical coherence tomography (SD-OCT) and short-wavelength fundus autofluorescence (SW-FAF). RESULTS We detected no vector-related or systemic toxicities. VA returned to within 15 letters of baseline in all but two patients (one developed acute foveal thinning, another patient, a macular hole); the rest showed no gross changes in foveal structure at two years. There were no significant differences between intervention and control eyes in mean light-adapted sensitivity by perimetry, or in the lateral extent of retinal pigment epithelium (RPE) relative preservation by SD-OCT and SW-FAF. Microperimetry showed non-significant (<3SD of the intervisit variability) gains in sensitivity in some locations and participants in the intervention eye. There were no obvious dose-dependent relationships. CONCLUSIONS VA was within 15 letters of baseline after the subfoveal AAV2-hCHM injections in 13/15 (87%) of the patients. Acute foveal thinning with unchanged perifoveal function in one patient and macular hole in a second suggests foveal vulnerability to the subretinal injections. Longer observation intervals will help establish the significance of the minor differences in sensitivities and rate of disease progression observed between intervention and control eyes.
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Morgan JIW, Jiang YY, Vergilio GK, Serrano LW, Pearson DJ, Bennett J, Maguire AM, Aleman TS. Short-term Assessment of Subfoveal Injection of Adeno-Associated Virus-Mediated hCHM Gene Augmentation in Choroideremia Using Adaptive Optics Ophthalmoscopy. JAMA Ophthalmol 2022; 140:411-420. [PMID: 35266957 PMCID: PMC8914909 DOI: 10.1001/jamaophthalmol.2022.0158] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/17/2022] [Indexed: 11/14/2022]
Abstract
Importance Subretinal injection for gene augmentation in retinal degenerations forcefully detaches the neural retina from the retinal pigment epithelium, potentially damaging photoreceptors and/or retinal pigment epithelium cells. Objective To use adaptive optics scanning light ophthalmoscopy (AOSLO) to assess the short-term integrity of the cone mosaic following subretinal injections of adeno-associated virus vector designed to deliver a functional version of the CHM gene (AAV2-hCHM) in patients with choroideremia. Design, Setting, and Participants This longitudinal case series study enrolled adult patients with choroideremia from February 2015 to January 2016 in the US. To be included in the study, study participants must have received uniocular subfoveal injections of low-dose (5 × 1010 vector genome per eye) or high-dose (1 × 1011 vector genome per eye) AAV2-hCHM. Analysis began February 2015. Main Outcomes and Measures The macular regions of both eyes were imaged before and 1 month after injection using a custom-built multimodal AOSLO. Postinjection cone inner segment mosaics were compared with preinjection mosaics at multiple regions of interest. Colocalized spectral-domain optical coherence tomography and dark-adapted cone sensitivity was also acquired at each time point. Results Nine study participants ranged in age from 26 to 50 years at the time of enrollment, and all were White men. Postinjection AOSLO images showed preservation of the cone mosaic in all 9 AAV2-hCHM-injected eyes. Mosaics appeared intact and contiguous 1 month postinjection, with the exception of foveal disruption in 1 patient. Optical coherence tomography showed foveal cone outer segment shortening postinjection. Cone-mediated sensitivities were unchanged in 8 of 9 injected and 9 of 9 uninjected eyes. One participant showed acute loss of foveal optical coherence tomography cone outer segment-related signals along with cone sensitivity loss that colocalized with disruption of the mosaic on AOSLO. Conclusions and Relevance Integrity of the cone mosaic is maintained following subretinal delivery of AAV2-hCHM, providing strong evidence in support of the safety of the injections. Minor foveal thinning observed following surgery corresponds with short-term cone outer segment shortening rather than cone cell loss. Foveal cone loss in 1 participant raises the possibility of individual vulnerability to the subretinal injection.
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Affiliation(s)
- Jessica I. W. Morgan
- Scheie Eye Institute, University of Pennsylvania, Philadelphia
- Center for Advanced Retinal & Ocular Therapeutics, University of Pennsylvania, Philadelphia
| | - Yu You Jiang
- Scheie Eye Institute, University of Pennsylvania, Philadelphia
- Center for Advanced Retinal & Ocular Therapeutics, University of Pennsylvania, Philadelphia
| | - Grace K. Vergilio
- Scheie Eye Institute, University of Pennsylvania, Philadelphia
- Center for Advanced Retinal & Ocular Therapeutics, University of Pennsylvania, Philadelphia
| | - Leona W. Serrano
- Scheie Eye Institute, University of Pennsylvania, Philadelphia
- Center for Advanced Retinal & Ocular Therapeutics, University of Pennsylvania, Philadelphia
| | - Denise J. Pearson
- Scheie Eye Institute, University of Pennsylvania, Philadelphia
- Center for Advanced Retinal & Ocular Therapeutics, University of Pennsylvania, Philadelphia
| | - Jean Bennett
- Scheie Eye Institute, University of Pennsylvania, Philadelphia
- Center for Advanced Retinal & Ocular Therapeutics, University of Pennsylvania, Philadelphia
| | - Albert M. Maguire
- Scheie Eye Institute, University of Pennsylvania, Philadelphia
- Center for Advanced Retinal & Ocular Therapeutics, University of Pennsylvania, Philadelphia
| | - Tomas S. Aleman
- Scheie Eye Institute, University of Pennsylvania, Philadelphia
- Center for Advanced Retinal & Ocular Therapeutics, University of Pennsylvania, Philadelphia
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Bilateral visual acuity decline in males with choroideremia: a pooled, cross-sectional meta-analysis. BMC Ophthalmol 2022; 22:29. [PMID: 35034620 PMCID: PMC8762852 DOI: 10.1186/s12886-022-02250-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Choroideremia is a rare inherited retinal disease that leads to blindness. Visual acuity (VA) is a key outcome measure in choroideremia treatment studies, but VA decline rates change with age. An accurate understanding of the natural deterioration of VA in choroideremia is important to assess the treatment effect of new therapies in which VA is the primary outcome measure. We conducted a meta-analysis of data on individuals with choroideremia to determine the rate of VA deterioration between the better- and worse-seeing eye (BSE and WSE, respectively). METHODS Data were collected from the prospective Natural History of the Progression of Choroideremia (NIGHT) study (613 eyes, baseline data only), studies included in a recent meta-analysis, and studies identified in a targeted literature search performed on March 25, 2020, including individual best-corrected VA (BCVA) and age data in male individuals with choroideremia. Best-corrected VA decline rates (measured by logMAR units) by age and trends in BCVA decline rates in the BSE and WSE were evaluated. RESULTS: Data from 1037 males (1602 eyes; mean age, 41.8 years) were included. Before and after an age cutoff of 33.8 years, BCVA decline rates for the WSE were 0.0086 and 0.0219 logMAR per year, respectively. Before and after an age cutoff of 39.1 years, BCVA decline rates for the BSE were 0.00001 and 0.0203 logMAR per year, respectively. Differences in absolute BCVA and decline rates increased between the 2 eyes until age ~ 40; thereafter, differences in absolute BCVA and decline rates were similar between eyes. CONCLUSIONS Using the largest choroideremia data set to date, this analysis demonstrates accelerated BCVA decline beginning between 30 and 40 years of age. Disparate interocular progression rates were observed before the transition age, with similar interocular progression rates after the transition age.
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Abstract
PURPOSE To evaluate choroidal features in young patients affected by choroideremia (CHM). METHODS Young CHM patients and control subjects were recruited at the Eye Clinic in Florence. High-resolution choroidal imaging was obtained using swept-source optical coherence tomography with long optical coherence tomography scans (12 × 9 mm optical coherence tomography scans). We considered the subfoveal choroidal area within 9 mm of the optic disk in the horizontal plane and the subfoveal choroidal area within a 3-mm diameter centered over the fovea. The subfoveal choroidal thickness, total choroidal area, luminal area, stromal area, and choroidal vascularity index were assessed using the "ImageJ" software in both groups. RESULTS Eight patients (16 eyes; mean age, 19.3 ± 5.2 years) and seven control subjects (14 eyes; mean age, 19.0 ± 5.0 years) were included in this study. Best-corrected visual acuity was 20/20 in both eyes of seven CHM patients and in all control subjects and 20/25 in both eyes in one CHM patient. Mean subfoveal choroidal thickness did not differ between CHM patients and control subjects. Luminal area9mm, stromal area9mm, and total choroidal area9mm were reduced in patients compared with the control group. Luminal area3mm, stromal area3mm, and total choroidal area3mm did not differ between patients and control subjects. Choroidal vascularity index9mm and choroidal vascularity index3mm were not different between patients and control subjects. CONCLUSION There are no differences in the choroidal vascularity index between young CHM patients and control subjects; this result suggests a simultaneous, proportional impairment of both the stromal and vascular components of the choroid in the early stages of the disease.
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Bartlett H, Howells O, Eperjesi F. The role of macular pigment assessment in clinical practice: a review. Clin Exp Optom 2021; 93:300-8. [DOI: 10.1111/j.1444-0938.2010.00499.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hannah Bartlett
- Ophthalmic Research Group, School of Life & Health Sciences, Aston University, Birmingham, United Kingdom
E‐mail:
| | - Olivia Howells
- Ophthalmic Research Group, School of Life & Health Sciences, Aston University, Birmingham, United Kingdom
E‐mail:
| | - Frank Eperjesi
- Ophthalmic Research Group, School of Life & Health Sciences, Aston University, Birmingham, United Kingdom
E‐mail:
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Polat Gultekin B, Sahli E. Macular pigment optical density in central serous chorioretinopathy. Ther Adv Ophthalmol 2021; 13:2515841421997195. [PMID: 33738428 PMCID: PMC7934065 DOI: 10.1177/2515841421997195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose The aim of our study was to evaluate the macular pigment optical density in patients with acute and chronic central serous chorioretinopathy and to describe the association between central retinal thickness and choroidal thickness with the macular pigment optical density. Materials and Methods Eyes with acute central serous chorioretinopathy and chronic central serous chorioretinopathy (patients, who were diagnosed as having disease activity for 6 months) were included in this study. Macular pigment was measured using the heterochromatic flicker technique of the MPS II device for both eyes in patients with acute and chronic central serous chorioretinopathy and in control subjects. Results Twenty-seven eyes with acute central serous chorioretinopathy, 23 eyes with chronic central serous chorioretinopathy, and 25 control eyes were enrolled. The mean macular pigment optical density in chronic central serous chorioretinopathy (0.480 ± 0.16 density unit (95% confidence interval: 0.390-0.570) was found to be significantly lower than in the control eyes (0.571 ± 0.128 density unit) (95% confidence interval: 0.480-0.670) (p = 0.007). In correlation analysis, no significant association was detected between the central retinal thickness, choroidal thickness, and macular pigment optical density values in central serous chorioretinopathy group (p = 0.31, p = 0.71). Conclusion Macular pigment optical density levels were significantly lower in chronic central serous chorioretinopathy patients than in controls, possibly due to degeneration of the neurosensorial retina, as a result of the long-term persistence of subretinal fluid. There was not a significant correlation between choroidal thickness and macular pigment optical density levels in central serous chorioretinopathy group.
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Affiliation(s)
- Burcu Polat Gultekin
- Department of Ophthalmology, Ministry of Health Ankara City Hospital, Ankara 06800, Turkey
| | - Esra Sahli
- Department of Ophthalmology, Ankara University Medical Faculty, Ankara, Turkey
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Abbouda A, Avogaro F, Moosajee M, Vingolo EM. Update on Gene Therapy Clinical Trials for Choroideremia and Potential Experimental Therapies. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:64. [PMID: 33445564 PMCID: PMC7826687 DOI: 10.3390/medicina57010064] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/26/2020] [Accepted: 01/07/2021] [Indexed: 12/27/2022]
Abstract
Background and objectives: Choroideremia (CHM) is an X-linked recessive chorioretinal dystrophy caused by mutations involving the CHM gene. Gene therapy has entered late-phase clinical trials, although there have been variable results. This review gives a summary on the outcomes of phase I/II CHM gene therapy trials and describes other potential experimental therapies. Materials and Methods: A Medline (National Library of Medicine, Bethesda, MD, USA) search was performed to identify all articles describing gene therapy treatments available for CHM. Results: Five phase I/II clinical trials that reported subretinal injection of adeno-associated virus Rab escort protein 1 (AAV2.REP1) vector in CHM patients were included. The Oxford study (NCT01461213) included 14 patients; a median gain of 5.5 ± 6.8 SD (-6 min, 18 max) early treatment diabetic retinopathy study (ETDRS) letters was reported. The Tubingen study (NCT02671539) included six patients; only one patient had an improvement of 17 ETDRS letters. The Alberta study (NCT02077361) enrolled six patients, and it reported a minimal vision change, except for one patient who gained 15 ETDRS letters. Six patients were enrolled in the Miami trial (NCT02553135), which reported a median gain of 2 ± 4 SD (-1 min, 10 max) ETDRS letters. The Philadelphia study (NCT02341807) included 10 patients; best corrected visual acuity (BCVA) returned to baseline in all by one-year follow-up, but one patient had -17 ETDRS letters from baseline. Overall, 40 patients were enrolled in trials, and 34 had 2 years of follow-up, with a median gain of 1.5 ± 7.2 SD (-14 min, 18 max) in ETDRS letters. Conclusions: The primary endpoint, BCVA following gene therapy in CHM, showed a marginal improvement with variability between trials. Optimizing surgical technique and pre-, peri-, and post-operative management with immunosuppressants to minimize any adverse ocular inflammatory events could lead to reduced incidence of complications. The ideal therapeutic window needs to be addressed to ensure that the necessary cell types are adequately transduced, minimizing viral toxicity, to prolong long-term transgenic potential. Long-term efficacy will be addressed by ongoing studies.
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Affiliation(s)
| | - Filippo Avogaro
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, p.le A. Moro 5, 00185 Rome, Italy;
| | - Mariya Moosajee
- UCL Institute of Ophthalmology, London EC1V 9EL, UK;
- Moorfields Eye Hospital NHS Foundation Trust, London EC1V 2PD, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
- The Francis Crick Institute, London NW1 1AT, UK
| | - Enzo Maria Vingolo
- Fiorini Hospital Terracina AUSL, 04019 Terracina, Latina, Italy;
- Department of Sense Organs, Faculty of Medicine and Odontology, Sapienza University of Rome, p.le A. Moro 5, 00185 Rome, Italy;
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11
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Shen LL, Ahluwalia A, Sun M, Young BK, Grossetta Nardini HK, Del Priore LV. Long-term natural history of visual acuity in eyes with choroideremia: a systematic review and meta-analysis of data from 1004 individual eyes. Br J Ophthalmol 2020; 105:271-278. [PMID: 32471821 DOI: 10.1136/bjophthalmol-2020-316028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Best-corrected visual acuity (BCVA) is the most common primary endpoint in treatment trials for choroideremia (CHM) but the long-term natural history of BCVA is unclear. METHODS We searched in seven databases to identify studies that reported BCVA of untreated eyes with CHM. We sought individual-level data and performed segmented regression between BCVA and age. For eyes followed longitudinally, we introduced a horizontal translation factor to each dataset to account for different ages at onset of a rapid BCVA decline. RESULTS We included 1004 eyes from 23 studies. BCVA of the right and left eyes was moderately correlated (r=0.60). BCVA as a function of age followed a 2-phase decline (slow followed by rapid decline), with an estimated transition age of 39.1 years (95% CI 33.5 to 44.7). After the introduction of horizontal translation factors to longitudinal datasets, BCVA followed a 2-phase decline until it reached 0 letters (r2=0.90). The BCVA decline rate was 0.33 letters/year (95% CI -0.38 to 1.05) before 39 years, and 1.23 letters/year (95% CI 0.55 to 1.92) after 39 years (p=0.004). CONCLUSION BCVA in eyes with CHM follows a 2-phase linear decline with a transition age of approximately 39 years. Future trials enrolling young patients may not be able to use BCVA as a primary or sole endpoint, but rather, may need to employ additional disease biomarkers that change before age 39. BCVA may still have utility as a primary endpoint for patients older than 39 years who have measurable BCVA decline rates.
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Affiliation(s)
- Liangbo L Shen
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Aneesha Ahluwalia
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mengyuan Sun
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, Connecticut, USA
| | - Benjamin K Young
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Holly K Grossetta Nardini
- Harvey Cushing/John Hay Whitney Medical Library, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lucian V Del Priore
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
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12
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Nagai N, Asato T, Minami S, Suzuki M, Shinoda H, Kurihara T, Sonobe H, Watanabe K, Uchida A, Ban N, Tsubota K, Ozawa Y. Correlation between Macular Pigment Optical Density and Neural Thickness and Volume of the Retina. Nutrients 2020; 12:nu12040888. [PMID: 32218119 PMCID: PMC7230595 DOI: 10.3390/nu12040888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 01/28/2023] Open
Abstract
Macular pigment (MP), which is composed of lutein/zeaxanthin/mezo-zeaxanthin, is concentrated in the central part of the retina, the macula. It protects the macula by absorbing short-wavelength light and suppressing oxidative stress. To evaluate whether MP levels are related to retinal neural protection and resulting health, we analyzed the association between the MP optical density (MPOD), and the macular thickness and volumes. Forty-three eyes of 43 healthy adult volunteers (21 men and 22 women; age: 22–48 (average 31.4 ± 1.1) years) were analyzed. Highly myopic eyes (<-6 diopters) were excluded. MPOD was measured using MPS2®, and the neural retinal thickness and volume were measured using optical coherence tomography. The mean MPOD was 0.589 ± 0.024, and it positively correlated with the central retinal thickness (P = 0.017, R = 0.360) and retinal volume of the fovea (1-mm diameter around the fovea; P = 0.029, R = 0.332), parafovea (1–3-mm diameter; P = 0.002, R = 0.458), and macula (6-mm diameter; P = 0.003, R = 0.447). In the macular area (diameter: 6 mm), MPOD was correlated with the retinal neural volume of the ganglion cell layer (P = 0.037, R = 0.320), inner plexiform layer (P = 0.029, R = 0.333), and outer nuclear layer (P = 0.020, R = 0.353). Thus, MPOD may help in estimating neural health. Further studies should determine the impact of MP levels on neuroprotection.
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Affiliation(s)
- Norihiro Nagai
- Laboratory of Retinal Cell Biology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (N.N.); (M.S.)
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (T.A.); (S.M.); (H.S.); (T.K.); (H.S.); (K.W.); (A.U.); (N.B.); (K.T.)
| | - Teru Asato
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (T.A.); (S.M.); (H.S.); (T.K.); (H.S.); (K.W.); (A.U.); (N.B.); (K.T.)
| | - Sakiko Minami
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (T.A.); (S.M.); (H.S.); (T.K.); (H.S.); (K.W.); (A.U.); (N.B.); (K.T.)
| | - Misa Suzuki
- Laboratory of Retinal Cell Biology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (N.N.); (M.S.)
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (T.A.); (S.M.); (H.S.); (T.K.); (H.S.); (K.W.); (A.U.); (N.B.); (K.T.)
| | - Hajime Shinoda
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (T.A.); (S.M.); (H.S.); (T.K.); (H.S.); (K.W.); (A.U.); (N.B.); (K.T.)
| | - Toshihide Kurihara
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (T.A.); (S.M.); (H.S.); (T.K.); (H.S.); (K.W.); (A.U.); (N.B.); (K.T.)
| | - Hideki Sonobe
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (T.A.); (S.M.); (H.S.); (T.K.); (H.S.); (K.W.); (A.U.); (N.B.); (K.T.)
| | - Kazuhiro Watanabe
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (T.A.); (S.M.); (H.S.); (T.K.); (H.S.); (K.W.); (A.U.); (N.B.); (K.T.)
| | - Atsuro Uchida
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (T.A.); (S.M.); (H.S.); (T.K.); (H.S.); (K.W.); (A.U.); (N.B.); (K.T.)
| | - Norimitsu Ban
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (T.A.); (S.M.); (H.S.); (T.K.); (H.S.); (K.W.); (A.U.); (N.B.); (K.T.)
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (T.A.); (S.M.); (H.S.); (T.K.); (H.S.); (K.W.); (A.U.); (N.B.); (K.T.)
| | - Yoko Ozawa
- Laboratory of Retinal Cell Biology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (N.N.); (M.S.)
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (T.A.); (S.M.); (H.S.); (T.K.); (H.S.); (K.W.); (A.U.); (N.B.); (K.T.)
- Department of Ophthalmology, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
- Correspondence: or ; Tel.: +81-3-3353-1211
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Shen LL, Ahluwalia A, Sun M, Young BK, Grossetta Nardini HK, Del Priore LV. Long-term Natural History of Atrophy in Eyes with Choroideremia-A Systematic Review and Meta-analysis of Individual-Level Data. Ophthalmol Retina 2020; 4:840-852. [PMID: 32362554 DOI: 10.1016/j.oret.2020.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To conduct a systematic review and meta-analysis of the natural history of atrophy secondary to choroideremia (CHM). CLINICAL RELEVANCE A sensitive and reliable anatomic measure to monitor disease progression is needed in treatment trials for CHM. However, the long-term natural history of the residual retinal pigment epithelium (RPE) is unclear, with reported RPE area decline rates varying widely among patients. METHODS We searched in 7 literature databases up through July 17, 2019, to identify studies that assessed the residual RPE area in untreated eyes with CHM using fundus autofluorescence (FAF). We sought individual-eye data and investigated the RPE decline pattern using 3 models: the area linear model (ALM), radius linear model (RLM), and area exponential model (AEM), in which the area, radius, and log-transformed area of RPE change linearly with time, respectively. To account for different eyes' entry times into the studies, we added a horizontal translation factor to each dataset. The RPE decline rate was estimated using a 2-stage random-effects meta-analysis. We assessed the risk of bias using the Quality In Prognosis Studies tool. RESULTS Of 807 articles screened, we included 9 articles containing cross-sectional data (257 eyes) from 6 studies and longitudinal data (229 visits from 68 eyes) from 5 studies. The residual RPE area followed a trend of exponential decay as a function of patient age. After the introduction of horizontal translation factors to longitudinal datasets of individual eyes, the datasets fit along a straight line in the AEM over nearly 60 years (r2 = 0.997). The decline rate of log-transformed RPE area was 0.050 (95% confidence interval, 0.046-0.055) log(mm2)/year and was independent of the baseline RPE area (r = -0.18; P = 0.15) and age (r = 0.06; P = 0.63). In contrast, the decline rates of the area and effective radius of residual RPE strongly correlated with the baseline RPE area (r = 0.90 and 0.61, respectively; P < 0.001). CONCLUSIONS The loss of residual RPE area in untreated eyes with CHM follows the AEM over approximately 60 years. Log-transformed residual RPE area measured by FAF can serve as an anatomic endpoint to monitor CHM.
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Affiliation(s)
- Liangbo L Shen
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Aneesha Ahluwalia
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Mengyuan Sun
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, Connecticut
| | - Benjamin K Young
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | | | - Lucian V Del Priore
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut.
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14
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Murro V, Mucciolo DP, Sodi A, Giorgio D, Passerini I, Pelo E, Virgili G, Rizzo S. En face OCT in choroideremia. Ophthalmic Genet 2020; 40:514-520. [PMID: 31928275 DOI: 10.1080/13816810.2019.1711429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Purpose: To describe the outer retinal tubulation (ORT) morphology using En face OCT elaboration in a large group of patients affected by choroideremia (CHM).Material and Methods: We retrospectively reviewed CHM patients examined at the Regional Reference Center for Hereditary Retinal Degenerations at the Eye Clinic in Florence. We took into consideration genetically confirmed CHM patients with ophthalmological, fundus autofluorescence (FAF) and optical coherence tomography (OCT) examinations.Results: We studied en face OCT features of ORTs in 18 CHM patients, for a total of 36 eyes; (average age 33 years; SD 19,2; range 13-77 years). ORTs were found in 30 eyes of 15 patients (15/18; 83,3% of the patients). We identified 3 en face OCT patterns: round lesions with scalloped boundaries which involved the peripapillary area with more or less evident pseudodendritic ORTs (PD-ORT) (pattern p; 26,7%); central islands with PD-ORTs (pattern i; 53,3%); residual outer retinal areas with no ORTs (pattern r; 20,0%).Conclusions: In CHM, en face OCT imaging allows us to observe various morphological features of the ORTs in different stages of disease, not detectable with other imaging techniques. ORTs were not identified in the mildest phenotypes. En face OCT is a non-invasive useful tool in the characterization and monitoring of the disease.
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Affiliation(s)
- Vittoria Murro
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Dario Pasquale Mucciolo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Andrea Sodi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Dario Giorgio
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Ilaria Passerini
- Department of Genetic Diagnosis, Careggi Teaching Hospital, Florence, Italy
| | - Elisabetta Pelo
- Department of Genetic Diagnosis, Careggi Teaching Hospital, Florence, Italy
| | - Gianni Virgili
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Stanislao Rizzo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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15
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Foote KG, Rinella N, Tang J, Bensaid N, Zhou H, Zhang Q, Wang RK, Porco TC, Roorda A, Duncan JL. Cone Structure Persists Beyond Margins of Short-Wavelength Autofluorescence in Choroideremia. Invest Ophthalmol Vis Sci 2019; 60:4931-4942. [PMID: 31770433 PMCID: PMC6879190 DOI: 10.1167/iovs.19-27979] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/07/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose We studied the relationship between structure and function of the choriocapillaris (CC), retinal pigment epithelium (RPE), and photoreceptors in patients with choroideremia (CHM). Methods Six CHM patients (12 eyes) and four normal subjects (six eyes) were studied with fundus-guided microperimetry, confocal and nonconfocal adaptive optics scanning laser ophthalmoscopy (AOSLO), near-infrared and color fundus photos, short wavelength fundus autofluorescence (SW-AF), and swept-source optical coherence tomography (SS-OCT) and angiography (SS-OCTA) images. Cone spacing was represented using Z-scores (standard deviations from the mean at that eccentricity). CC flow voids were defined using a threshold of 1 SD below the normal mean. Results Cone spacing Z-scores were not significantly correlated with distance from the borders of preserved RPE, determined using either the SS-OCT or SW-AF scans. Cone spacing Z-scores were significantly correlated with CC flow voids and retinal sensitivity. Flow voids were abnormal in regions of preserved RPE and increased progressively from within -2° of the preserved area to +2° beyond the border. Visual sensitivity decreased as CC flow voids increased approaching and beyond the border of preserved structure. Conclusions In CHM, cone spacing Z-scores correlated with CC flow voids, and were negatively correlated with retinal sensitivity, suggesting cone degeneration accompanied reduced CC perfusion. Functional cones were found outside the presumed borders of preserved outer-retina/RPE as defined by SW-AF, but not outside the borders determined by SS-OCT. The use of SW-AF to identify the border of preserved structures may underestimate regions with cells that may be amenable to treatment.
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Affiliation(s)
- Katharina G. Foote
- School of Optometry and Vision Science Graduate Group, University of California, Berkeley, Berkeley, California, United States
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
| | - Nicholas Rinella
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
| | - Janette Tang
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
| | | | - Hao Zhou
- Department of Bioengineering, University of Washington, Seattle, Seattle, Washington, United States
| | - Qinqin Zhang
- Department of Bioengineering, University of Washington, Seattle, Seattle, Washington, United States
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, Seattle, Washington, United States
| | - Travis C. Porco
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
- Francis I. Proctor Foundation, Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
| | - Austin Roorda
- School of Optometry and Vision Science Graduate Group, University of California, Berkeley, Berkeley, California, United States
| | - Jacque L. Duncan
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
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16
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Mucciolo DP, Murro V, Giorgio D, Sodi A, Passerini I, Virgili G, Rizzo S. Near-infrared autofluorescence in young choroideremia patients. Ophthalmic Genet 2019; 40:421-427. [PMID: 31544579 DOI: 10.1080/13816810.2019.1666881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To study near-infrared autofluorescence (NIR-AF) and short- wave autofluorescence (SW-AF) imaging modalities in young patients affected with choroideremia (CHM).Methods: NIR-AF and SW-AF images, Optical coherence tomography (OCT) and color fundus images were acquired from 3 young CHM patients (6 eyes) enrolled at the Regional Reference Center for Hereditary Retinal Degenerations of the Eye Clinic in Florence.Results: We studied 3 young CHM patients (6 eyes). The mean age of the patients was 17,3 years. Using NIR-AF, patient P1 was characterized by speckled hypo-autofluorescent areas at the posterior pole with a preserved central hyper-autofluorescence while patient P2 and P3 were characterized by a preserved NIR-AF signal only at the fovea. Using SW-AF, patient P1 was characterized by a normal macular autofluorescence and by a speckled FAF pattern involved the vascular arcades while patient P2 and P3 showed well-demarcated hypo-autofluorescence areas involving the posterior pole with a preserved macular autofluorescence. The differences between NIR-AF and SW-AF were more pronounced in advanced stages. In correspondence of preserved NIR-AF, the OCT examination showed regular and continuous outer retinal hyperreflective bands. We observed abnormal RPE/Bruch's membrane complex and EZ band externally to the NIR-AF signal area.Conclusions: NIR-AF imaging confirms an early RPE involvement allowing us to identify and to quantify the RPE pigment loss in choroideremia. For this reason, NIR-AF imaging can be useful for monitoring the progression of the disease and to study the effect of future treatments.
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Affiliation(s)
- Dario Pasquale Mucciolo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Vittoria Murro
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Dario Giorgio
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Andrea Sodi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Ilaria Passerini
- Department of Genetic Diagnosis, Careggi Teaching Hospital, Florence, Italy
| | - Gianni Virgili
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Stanislao Rizzo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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17
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Mucciolo D, Murro V, Sodi A, Passerini I, Giorgio D, Virgili G, Rizzo S. Peculiar Clinical Findings in Young Choroideremia Patients: A Retrospective Case Review. Ophthalmologica 2019; 242:195-207. [DOI: 10.1159/000501282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 06/03/2019] [Indexed: 11/19/2022]
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18
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Murro V, Mucciolo DP, Giorgio D, Sodi A, Passerini I, Virgili G, Rizzo S. Optical Coherence Tomography Angiography (OCT-A) in young choroideremia (CHM) patients. Ophthalmic Genet 2019; 40:201-206. [DOI: 10.1080/13816810.2019.1611880] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Vittoria Murro
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Dario Pasquale Mucciolo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Dario Giorgio
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Andrea Sodi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Ilaria Passerini
- Department of Genetic Diagnosis, Careggi Teaching Hospital, Florence, Italy
| | - Gianni Virgili
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Stanislao Rizzo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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19
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Silson EH, Aleman TS, Willett A, Serrano LW, Pearson DJ, Rauschecker AM, Maguire AM, Baker CI, Bennett J, Ashtari M. Comparing Clinical Perimetry and Population Receptive Field Measures in Patients with Choroideremia. Invest Ophthalmol Vis Sci 2019; 59:3249-3258. [PMID: 29971442 PMCID: PMC6110169 DOI: 10.1167/iovs.18-23929] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose Choroideremia (CHM) is an X-linked recessive form of hereditary retinal degeneration, which, at advanced stages, leaves only small central islands of preserved retinal tissue. Unlike many other retinal diseases, the spared tissue in CHM supports excellent central vision and stable fixation. Such spared topography in CHM presents an ideal platform to explore the relationship between preserved central retinal structure and the retinotopic organization of visual cortex by using functional magnetic resonance imaging (fMRI). Methods fMRI was conducted in four participants with CHM and four healthy control participants while they viewed drifting contrast pattern stimuli monocularly. A single ∼3-minute fMRI run was collected for each eye separately. fMRI data were analyzed using the population receptive field (pRF) modeling approach. Participants also underwent ophthalmic evaluations of visual acuity and static automatic perimetry. Results The spatial distribution and strength of pRF estimates correlated positively and significantly with clinical outcome measures in most participants with CHM. Importantly, the positive relationship between clinical and pRF measurements increased with increasing disease progression. A less consistent relationship was observed for control participants. Conclusions Although reflecting only a small sample size, clinical evaluations of visual function in participants with CHM were well characterized by the spatial distribution and strength of pRF estimates by using a single ∼3-minute fMRI experiment. fMRI data analyzed with pRF modeling may be an efficient and objective outcome measure to complement current ophthalmic evaluations. Specifically, pRF modeling may be a feasible approach for evaluating the impact of interventions to restore visual function.
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Affiliation(s)
- Edward H Silson
- Section on Learning and Plasticity, Laboratory of Brain and Cognition, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
| | - Tomas S Aleman
- Center for Advanced Retinal and Ocular Therapeutics (CAROT), University of Pennsylvania, Philadelphia, Pennsylvania, United States.,F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Aimee Willett
- Center for Advanced Retinal and Ocular Therapeutics (CAROT), University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Leona W Serrano
- Center for Advanced Retinal and Ocular Therapeutics (CAROT), University of Pennsylvania, Philadelphia, Pennsylvania, United States.,F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Denise J Pearson
- Center for Advanced Retinal and Ocular Therapeutics (CAROT), University of Pennsylvania, Philadelphia, Pennsylvania, United States.,F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Andreas M Rauschecker
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Albert M Maguire
- Center for Advanced Retinal and Ocular Therapeutics (CAROT), University of Pennsylvania, Philadelphia, Pennsylvania, United States.,F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Chris I Baker
- Section on Learning and Plasticity, Laboratory of Brain and Cognition, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
| | - Jean Bennett
- Center for Advanced Retinal and Ocular Therapeutics (CAROT), University of Pennsylvania, Philadelphia, Pennsylvania, United States.,F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Manzar Ashtari
- Center for Advanced Retinal and Ocular Therapeutics (CAROT), University of Pennsylvania, Philadelphia, Pennsylvania, United States.,F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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20
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Foote KG, Roorda A, Duncan JL. Multimodal Imaging in Choroideremia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1185:139-143. [PMID: 31884602 PMCID: PMC9126851 DOI: 10.1007/978-3-030-27378-1_23] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Choroideremia (CHM) is associated with progressive degeneration of the retinal pigment epithelium (RPE), choriocapillaris (CC), and photoreceptors. As animal models of CHM are lacking, most information about cell survival has come from imaging affected patients. This chapter discusses a combination of imaging techniques, including fundus-guided microperimetry, confocal and non-confocal adaptive optics scanning laser ophthalmoscopy (AOSLO), fundus autofluorescence (FAF), and swept-source optical coherence tomography angiography (SS-OCTA) to analyze macular sensitivity, cone photoreceptor outer and inner segment structure, RPE structure, and CC perfusion, respectively. Combined imaging modalities such as those described here can provide sensitive measures of monitoring retinal structure and function in patients with CHM.
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Affiliation(s)
- Katharina G Foote
- School of Optometry and Vision Science Graduate Group, University of California, Berkeley, CA, USA.
- Department of Ophthalmology, University of California, San Francisco, CA, USA.
| | - Austin Roorda
- School of Optometry and Vision Science Graduate Group, University of California, Berkeley, CA, USA
| | - Jacque L Duncan
- Department of Ophthalmology, University of California, San Francisco, CA, USA
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Mitsios A, Dubis AM, Moosajee M. Choroideremia: from genetic and clinical phenotyping to gene therapy and future treatments. Ther Adv Ophthalmol 2018; 10:2515841418817490. [PMID: 30627697 PMCID: PMC6311551 DOI: 10.1177/2515841418817490] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/05/2018] [Indexed: 11/15/2022] Open
Abstract
Choroideremia is an X-linked inherited chorioretinal dystrophy leading to blindness by late adulthood. Choroideremia is caused by mutations in the CHM gene which encodes Rab escort protein 1 (REP1), an ubiquitously expressed protein involved in intracellular trafficking and prenylation activity. The exact site of pathogenesis remains unclear but results in degeneration of the photoreceptors, retinal pigment epithelium and choroid. Animal and stem cell models have been used to study the molecular defects in choroideremia and test effectiveness of treatment interventions. Natural history studies of choroideremia have provided additional insight into the clinical phenotype of the condition and prepared the way for clinical trials aiming to investigate the safety and efficacy of suitable therapies. In this review, we provide a summary of the current knowledge on the genetics, pathophysiology, clinical features and therapeutic strategies that might become available for choroideremia in the future, including gene therapy, stem cell treatment and small-molecule drugs with nonsense suppression action.
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Affiliation(s)
- Andreas Mitsios
- Institute of Ophthalmology, University College London, London, UK
| | - Adam M Dubis
- Institute of Ophthalmology, University College London, London, UK
| | - Mariya Moosajee
- Institute of Ophthalmology, University College London, London, UK
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22
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Xue K, Jolly JK, Barnard AR, Rudenko A, Salvetti AP, Patrício MI, Edwards TL, Groppe M, Orlans HO, Tolmachova T, Black GC, Webster AR, Lotery AJ, Holder GE, Downes SM, Seabra MC, MacLaren RE. Beneficial effects on vision in patients undergoing retinal gene therapy for choroideremia. Nat Med 2018; 24:1507-1512. [PMID: 30297895 PMCID: PMC7032956 DOI: 10.1038/s41591-018-0185-5] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/06/2018] [Indexed: 11/09/2022]
Abstract
Retinal gene therapy is increasingly recognized as a novel molecular intervention that has huge potential in treating common causes of blindness, the majority of which have a genetic aetiology1-5. Choroideremia is a chronic X-linked retinal degeneration that was first described in 18726. It leads to progressive blindness due to deficiency of Rab-escort protein 1 (REP1). We designed an adeno-associated viral vector to express REP1 and assessed it in a gene therapy clinical trial by subretinal injection in 14 patients with choroideremia. The primary endpoint was vision change in treated eyes 2 years after surgery compared to unoperated fellow eyes. Despite complications in two patients, visual acuity improved in the 14 treated eyes over controls (median 4.5 letter gain, versus 1.5 letter loss, P = 0.04), with 6 treated eyes gaining more than one line of vision (>5 letters). The results suggest that retinal gene therapy can sustain and improve visual acuity in a cohort of predominantly late-stage choroideremia patients in whom rapid visual acuity loss would ordinarily be predicted.
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Affiliation(s)
- Kanmin Xue
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jasleen K Jolly
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alun R Barnard
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Anna Rudenko
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Anna P Salvetti
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Maria I Patrício
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Thomas L Edwards
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Markus Groppe
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Harry O Orlans
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tanya Tolmachova
- Molecular Medicine Section, National Heart and Lung Institute, Imperial College, London, UK
| | - Graeme C Black
- Division of Evolution and Genomic Sciences, Neuroscience and Mental Health Domain, Manchester Centre for Genomic Medicine, University Hospitals NHS Foundation Trust and Academic Health Sciences Centre, St Mary's Hospital, Manchester, UK
| | - Andrew R Webster
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- University College London Institute of Ophthalmology, London, UK
| | - Andrew J Lotery
- Clinical Neurosciences Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Graham E Holder
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- University College London Institute of Ophthalmology, London, UK
- Department of Ophthalmology, National University of Singapore, Singapore, Singapore
| | - Susan M Downes
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Miguel C Seabra
- University College London Institute of Ophthalmology, London, UK
- Chronic Diseases Research Centre, Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Robert E MacLaren
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.
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Abstract
PURPOSE To evaluate full-field sensitivity thresholds (FSTs) across a wide range of choroideremia (CHM) disease stages and to determine their applicability as functional endpoints for CHM clinical trials. METHODS Thirty CHM subjects (60 eyes) and 50 healthy controls (50 eyes) underwent FST testing under dark-adapted conditions to determine rod- and cone-mediated FSTs. Central retinal structure and function were assessed using fundus autofluorescence and microperimetry. Correlation and regression analyses were performed to compare FST responses with the residual area of retinal pigment epithelium in the peri- and parafoveal regions, as well as the mean and highest macular microperimetry sensitivity. RESULTS All patients with CHM had a baseline of 18 dB elevation in dark-adapted rod FSTs, including the least affected individuals. Further FST sensitivity loss was exponentially associated with decrease in the area of residual peri- and parafoveal retinal pigment epithelium, with precipitous loss of sensitivity noted for fundus autofluorescence areas less than 5 mm. Cone FSTs were comparable with controls, except for advanced stages of CHM. Full-field sensitivity threshold responses showed high correlation with both mean and highest macular microperimetry thresholds (P < 0.001). In some cases of absent macular fundus autofluorescence, the peripheral retina could contribute to detectable rod FST responses but with severely diminished cone-driven responses. CONCLUSION Full-field sensitivity threshold testing demonstrated a baseline level of rod dysfunction in CHM present in all rod photoreceptors. Further decline in FST responses correlated strongly with the extent of central retina structural and functional loss. Full-field sensitivity threshold allowed quantification of residual rod function in peripheral islands of vision, which cannot be reliably achieved with other conventional tests. As such, the FST can serve as a complimentary tool to guide patient selection and expand the eligibility criteria for current and future CHM clinical trials.
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Effect of Carotenoid Supplemented Formula on Carotenoid Bioaccumulation in Tissues of Infant Rhesus Macaques: A Pilot Study Focused on Lutein. Nutrients 2017; 9:nu9010051. [PMID: 28075370 PMCID: PMC5295095 DOI: 10.3390/nu9010051] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 12/31/2022] Open
Abstract
Lutein is the predominant carotenoid in the developing primate brain and retina, and may have important functional roles. However, its bioaccumulation pattern during early development is not understood. In this pilot study, we investigated whether carotenoid supplementation of infant formula enhanced lutein tissue deposition in infant rhesus macaques. Monkeys were initially breastfed; from 1 to 3 months of age they were fed either a formula supplemented with lutein, zeaxanthin, β-carotene and lycopene, or a control formula with low levels of these carotenoids, for 4 months (n = 2/group). All samples were analyzed by high pressure liquid chromatography (HPLC). Final serum lutein in the supplemented group was 5 times higher than in the unsupplemented group. All brain regions examined showed a selective increase in lutein deposition in the supplemented infants. Lutein differentially accumulated across brain regions, with highest amounts in occipital cortex in both groups. β-carotene accumulated, but zeaxanthin and lycopene were undetectable in any brain region. Supplemented infants had higher lutein concentrations in peripheral retina but not in macular retina. Among adipose sites, abdominal subcutaneous adipose tissue exhibited the highest lutein level and was 3-fold higher in the supplemented infants. The supplemented formula enhanced carotenoid deposition in several other tissues. In rhesus infants, increased intake of carotenoids from formula enhanced their deposition in serum and numerous tissues and selectively increased lutein in multiple brain regions.
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Natural History of the Central Structural Abnormalities in Choroideremia: A Prospective Cross-Sectional Study. Ophthalmology 2016; 124:359-373. [PMID: 27986385 DOI: 10.1016/j.ophtha.2016.10.022] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/17/2016] [Accepted: 10/24/2016] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To describe in detail the central retinal structure of a large group of patients with choroideremia (CHM). DESIGN A prospective, cross-sectional, descriptive study. PARTICIPANTS Patients (n = 97, age 6-71 years) with CHM and subjects with normal vision (n = 44; ages 10-50 years) were included. METHODS Subjects were examined with spectral-domain optical coherence tomography (SD OCT) and near-infrared reflectance imaging. Visual acuity (VA) was measured during their encounter or obtained from recent ophthalmic examinations. Visual thresholds were measured in a subset of patients (n = 24) with automated static perimetry within the central regions (±15°) examined with SD OCT. MAIN OUTCOME MEASURES Visual acuity and visual thresholds; total nuclear layer, inner nuclear layer (INL), and outer nuclear layer (ONL) thicknesses; and horizontal extent of the ONL and the photoreceptor outer segment (POS) interdigitation zone (IZ). RESULTS Earliest abnormalities in regions with normally appearing retinal pigment epithelium (RPE) were the loss of the POS and ellipsoid zone associated with rod dysfunction. Transition zones (TZs) from relatively preserved retina to severe ONL thinning and inner retinal thickening moved centripetally with age. Most patients (88%) retained VAs better than 20/40 until their fifth decade of life. The VA decline coincided with migration of the TZ near the foveal center. There were outer retinal tubulations in degenerated, nonatrophic retina in the majority (69%) of patients. In general, RPE abnormalities paralleled photoreceptor degeneration, although there were regions with detectable but abnormally thin ONL co-localizing with severe RPE depigmentation and choroidal thinning. CONCLUSIONS Abnormalities of the POS and rod dysfunction are the earliest central abnormalities observed in CHM. Foveal function is relatively preserved until the fifth decade of life. Migration of the TZs to the foveal center with foveal thinning and structural disorganization heralded central VA loss. The relationships established may help outline the eligibility criteria and outcome measures for clinical trials for CHM.
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Macular Pigment Optical Density and Measures of Macular Function: Test-Retest Variability, Cross-Sectional Correlations, and Findings from the Zeaxanthin Pilot Study of Response to Supplementation (ZEASTRESS-Pilot). Foods 2016; 5:foods5020032. [PMID: 28231126 PMCID: PMC5302333 DOI: 10.3390/foods5020032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/24/2016] [Accepted: 04/26/2016] [Indexed: 12/24/2022] Open
Abstract
We report on the short-term test-retest baseline variability in macular function tests in ZEASTRESS-Pilot participants (n = 18), on their cross-sectional correlation with macular pigment optical density (MPOD), and on the effects of four months (FUV4) of 20 mg/day zeaxanthin (ZX), followed by a four-month washout (FUV8; n = 24, age 50–81 years old). Outcomes included: MPOD at 0.5 and 2.0 deg eccentricity (MPOD-0.5 and -2.0); contrast sensitivity (CS); pattern-reversal electroretinogram (PERG) amplitude; dark-adapted 650 nm foveal cone sensitivity (DA650-FCS); and 500 mn parafoveal rod sensitivity (DA500-PFRS). All measures of macular function showed close test-retest correlation (Pearson’s r range: 0.744–0.946) and low coefficients of variation (CV range: 1.13%–4.00%). MPOD correlated in a complex fashion with macular function. Following supplementation, MPOD-0.5 and MPOD-2.0 increased at both FUV4 and FUV8 (p ≤ 0.0001 for all measures). Continued, delayed MPOD increase and a small, but significant (p = 0.012), CS increase was seen at FUV8 only in females. PERGs increased significantly at FUV4 (p = 0.0006), followed by a partial decline at FUV8. In conclusion, following ZX supplementation, MPOD increased significantly. There was no effect on DA-650 FCS or DA-500 PFRS. Both CS and PERG amplitudes increased following supplementation, but the effect varied between males and females. Additional studies appear warranted to confirm and characterize further these inter-gender differences.
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27
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Freund PR, Sergeev YV, MacDonald IM. Analysis of a large choroideremia dataset does not suggest a preference for inclusion of certain genotypes in future trials of gene therapy. Mol Genet Genomic Med 2016; 4:344-58. [PMID: 27247961 PMCID: PMC4867567 DOI: 10.1002/mgg3.208] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/16/2016] [Accepted: 01/20/2016] [Indexed: 11/17/2022] Open
Abstract
Background Choroideremia (CHM) is an X‐linked degeneration of the retinal pigment epithelium, photoreceptors, and choroid, which causes nyctalopia and progressive constriction of visual fields leading to blindness. The CHM gene encodes Rab escort protein 1 (REP‐1). In this work, we reviewed the phenotypes and genotypes of affected males with the purpose of understanding the functional effects of CHM mutations and their relationship with the phenotypes. Methods A retrospective review of 128 affected males was performed analyzing the onset of symptoms, visual acuity, and visual fields with respect to their mutations in the CHM gene. Results In rank order, reflecting data from this report, the most common mutations found in the CHM gene were nonsense mutations (41%), exon deletions (37%), and splice sites (14%) associated with a loss of functional protein. In the pool of 106 CHM mutations, we discovered four novel missense mutations (c.238C>T; p.L80F, c.819G>T; p.Q273H, c.1327A>G; p.M443V, and c.1370C>T; p.L457P) predicted to be severe changes affecting protein stability and folding with the effect similar to that of other types of mutations. No significant genotype–phenotype correlation was found with respect to the onset of nyctalopia, the onset of other visual symptoms, visual acuity, or width of visual fields. Conclusion There is no evidence to support exclusion of CHM patients from clinical trials based on their genotypes or any potential genotype–phenotype correlations.
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Affiliation(s)
- Paul R Freund
- Department of Ophthalmology and Visual Sciences University of Alberta Edmonton Alberta Canada
| | - Yuri V Sergeev
- Ophthalmic Genetics and Visual Function Branch National Eye Institute National Institutes of Health Bethesda Maryland
| | - Ian M MacDonald
- Department of Ophthalmology and Visual Sciences University of Alberta Edmonton Alberta Canada
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Chan SC, Bubela T, Dimopoulos IS, Freund PR, Varkouhi AK, MacDonald IM. Choroideremia research: Report and perspectives on the second international scientific symposium for choroideremia. Ophthalmic Genet 2016; 37:267-75. [PMID: 26855058 DOI: 10.3109/13816810.2015.1088958] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To discuss progress in research on choroideremia (CHM) and related retinopathies with special emphasis on gene therapy approaches. METHODS Biomedical and clinical researchers from across the world as well as representatives of the social science research community were convened to the 2nd International Scientific Symposium for Choroideremia in Denver, Colorado in June 2014 to enhance our understanding of CHM and accelerate the translation of research to clinical application for the benefit of those affected by CHM. RESULTS Pre-clinical research using cell and animal models continues to further our understanding in the pathogenesis of CHM as well as to demonstrate proof-of-concept for gene transfer strategies. With the advent of modern imaging technology, better outcome measures are being defined for upcoming clinical trials. Results from the first gene therapy trial in CHM show promise, with sustained visual improvement over 6 months post-treatment. Current and next-generation gene transfer approaches may make targeted vector delivery possible in the future for CHM and other inherited retinal diseases. CONCLUSIONS While no accepted therapies exist for CHM, promising approaches using viral-vectored gene therapy and cell therapies are entering clinical trials for eye diseases, with gene therapy trials underway for CHM.
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Affiliation(s)
- Stephanie C Chan
- a Department of Ophthalmology and Visual Sciences , University of Alberta , Edmonton , Alberta , Canada
| | - Tania Bubela
- b School of Public Health , University of Alberta , Edmonton , Alberta , Canada
| | - Ioannis S Dimopoulos
- a Department of Ophthalmology and Visual Sciences , University of Alberta , Edmonton , Alberta , Canada
| | - Paul R Freund
- a Department of Ophthalmology and Visual Sciences , University of Alberta , Edmonton , Alberta , Canada
| | - Amir K Varkouhi
- a Department of Ophthalmology and Visual Sciences , University of Alberta , Edmonton , Alberta , Canada
| | - Ian M MacDonald
- a Department of Ophthalmology and Visual Sciences , University of Alberta , Edmonton , Alberta , Canada
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29
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Roldán-Fidalgo A, Martín Saldaña S, Trinidad A, Olmedilla-Alonso B, Rodríguez-Valiente A, García-Berrocal JR, Ramírez-Camacho R. In vitro and in vivo effects of lutein against cisplatin-induced ototoxicity. ACTA ACUST UNITED AC 2016; 68:197-204. [PMID: 26850526 DOI: 10.1016/j.etp.2016.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/05/2016] [Accepted: 01/14/2016] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Cisplatin is a commonly prescribed drug that produces ototoxicity as a side effect. Lutein is a carotenoid with antioxidant and anti-inflammatory properties previously tested for eye, heart and skin diseases but not evaluated to date in ear diseases. AIM To evaluate the protective effects of lutein on HEI-OC1 auditory cell line and in a Wistar rat model of cisplatin ototoxicity. MATERIALS AND METHODS In vitro study: Culture HEI-OC1 cells were exposed to lutein (2.5-100 μM) and to 25 μM cisplatin for 24h. In vivo study: Twenty eight female Wistar rats were randomized into three groups. Group A (n=8) received intratympanic lutein (0.03 mL) (1mg/mL) in the right ear and saline solution in the left one to determine the toxicity of lutein. Group B (n=8) received also intraperitoneal cisplatin (10mg/kg) to test the efficacy of lutein against cisplatin ototoxicity. Group C (n=12) received intratympanic lutein (0.03 mL) (1mg/mL) to quantify lutein in cochlear fluids (30 min, 1h and 5 days after treatment). Hearing function was evaluated by means of Auditory Steady-State Responses before the procedure and 5 days after (groups A and B). Morphological changes were studied by confocal laser scanning microscopy. RESULTS In vitro study: Lutein significantly reduced the cisplatin-induced cytotoxicity in the HEI-OC1 cells when they were pre-treated with lutein concentrations of 60 and 80 μM. In vivo study: Intratympanic lutein (1mg/mL) application showed no ototoxic effects. However it did not achieve protective effect against cisplatin-induced ototoxicity in Wistar rats. CONCLUSIONS Although lutein has shown beneficial effects in other pathologies, the present study only obtained protection against cisplatin ototoxicity in culture cells, but not in the in vivo model. The large molecule size, the low dose administered, and restriction to diffusion in the inner ear could account for this negative result.
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Affiliation(s)
- A Roldán-Fidalgo
- Department of Otorhinolaryngology, Hospital Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
| | - S Martín Saldaña
- Foundation for Biomedical Research, Puerta de Hierro Hospital, Madrid, Spain
| | - A Trinidad
- Department of Otorhinolaryngology, Hospital Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - B Olmedilla-Alonso
- Institute of Food Science, Technology and Nutrition, CSIC, Madrid, Spain
| | - A Rodríguez-Valiente
- Department of Otorhinolaryngology, Hospital Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - J R García-Berrocal
- Department of Otorhinolaryngology, Hospital Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - R Ramírez-Camacho
- Department of Otorhinolaryngology, Hospital Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
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Dimopoulos IS, Chan S, MacLaren RE, MacDonald IM. Pathogenic mechanisms and the prospect of gene therapy for choroideremia. Expert Opin Orphan Drugs 2015; 3:787-798. [PMID: 26251765 PMCID: PMC4522943 DOI: 10.1517/21678707.2015.1046434] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Choroideremia is a rare, X-linked disorder recognized by its specific ocular phenotype as a progressive degenerative retinopathy resulting in blindness. New therapeutic approaches, primarily based on genetic mechanisms, have emerged that aim to prevent the progressive vision loss. AREAS COVERED This article will review the research that has progressed incrementally over the past two decades from mapping to gene discovery, uncovering the presumed mechanisms triggering the retinopathy to preclinical testing of potential therapies. EXPERT OPINION While still in an evaluative phase, the introduction of gene replacement as a potential therapy has been greeted with great enthusiasm by patients, advocacy groups and the medical community.
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Affiliation(s)
- Ioannis S Dimopoulos
- University of Alberta, Department of Ophthalmology and Visual Sciences, Edmonton, Alberta, Canada
| | - Stephanie Chan
- University of Alberta, Department of Ophthalmology and Visual Sciences, Edmonton, Alberta, Canada
| | - Robert E MacLaren
- Oxford Eye Hospital and Nuffield Laboratory of Ophthalmology, John Radcliffe Hospital, Oxford, UK
- Moorfields Eye Hospital Foundation Trust, NIHR Ophthalmology Biomedical Research Centre, London, UK
| | - Ian M MacDonald
- University of Alberta, Department of Ophthalmology and Visual Sciences, Edmonton, Alberta, Canada
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31
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Manayi A, Abdollahi M, Raman T, Nabavi SF, Habtemariam S, Daglia M, Nabavi SM. Lutein and cataract: from bench to bedside. Crit Rev Biotechnol 2015; 36:829-39. [DOI: 10.3109/07388551.2015.1049510] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Azadeh Manayi
- Medicinal Plants Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran,
| | - Mohammad Abdollahi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran,
| | - Thiagarajan Raman
- Department of Bioengineering, School of Chemical & Biotechnology, SASTRA University, Thanjavur, India,
| | - Seyed Fazel Nabavi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran,
| | - Solomon Habtemariam
- Pharmacognosy Research Laboratories, Medway School of Science, University of Greenwich, Chatham-Maritime, Kent, UK, and
| | - Maria Daglia
- Department of Drug Sciences, Medicinal Chemistry and Pharmaceutical Technology Section, University of Pavia, Pavia, Italy
| | - Seyed Mohammad Nabavi
- Applied Biotechnology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran,
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Ulbricht C. An Evidence-Based Systematic Review of Lutein by the Natural Standard Research Collaboration. J Diet Suppl 2015; 12:383-480. [PMID: 25616151 DOI: 10.3109/19390211.2014.988577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
An evidence-based systematic review of lutein by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated, reproducible grading rationale. This article includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.
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Raman R, Lahane S, Gupta A, Sandeep D, Sharma T. Foveal slope measurements in subjects with high-risk of age-related macular degeneration. Indian J Ophthalmol 2013; 61:507-10. [PMID: 24104710 PMCID: PMC3831767 DOI: 10.4103/0301-4738.119437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Recent reports indicated that the slope of the foveal depression influences the macular pigment (MP) spatial profile. MP has been shown to confer possible protection against age-related macular degeneration (ARMD) because of its antioxidant properties. Aims: To study the configuration of foveal slope and the foveal thickness in fellow eyes of subjects with unilateral neovascular ARMD. Settings and design: Case-control series. Materials and Methods: The study population consisted of 30 cases aged >50, who had unilateral choroidal neovascular membrane (CNVM) or disciform scar in the fellow eye and 29 controls aged >50, who had no sign of ARMD in the either eye. Using spectral-domain optical coherence tomography, foveal thickness at different locations including the central subfield foveal thickness (CSFT) was noted. The foveal slopes were calculated in the six radial scans (between 0.25° and 1° retinal eccentricity) as well as the 3D scan. Results: Cases had a significantly higher CSFT when compared to controls (215.1 ± 36.19 μ vs. 193.0 ± 17.38 μ, P = 0.004). On the 3D scan, the cases had shallower superior (cases 1.32 ± 0.32 vs. controls 1.45 ± 0.13, P = 0.04) and temporal slopes (cases 1.27 ± 0.21 vs. controls 1.39 ± 0.12, P = 0.01) in comparison to the controls. Conclusions: We noted a shallower superior and temporal foveal slope and a higher CSFT in the fellow eyes of subjects with a unilateral neovascular ARMD. Prospective studies observing the development of CNVM in subjects with altered foveal slope might provide more information on this optical coherence tomography finding.
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Affiliation(s)
- Rajiv Raman
- Shri Bhagwan Mahavir Department of Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Syed R, Sundquist SM, Ratnam K, Zayit-Soudry S, Zhang Y, Crawford JB, MacDonald IM, Godara P, Rha J, Carroll J, Roorda A, Stepien KE, Duncan JL. High-resolution images of retinal structure in patients with choroideremia. Invest Ophthalmol Vis Sci 2013; 54:950-61. [PMID: 23299470 DOI: 10.1167/iovs.12-10707] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To study retinal structure in choroideremia patients and carriers using high-resolution imaging techniques. METHODS Subjects from four families (six female carriers and five affected males) with choroideremia (CHM) were characterized with best-corrected visual acuity (BCVA), kinetic and static perimetry, full-field electroretinography, and fundus autofluorescence (FAF). High-resolution macular images were obtained with adaptive optics scanning laser ophthalmoscopy (AOSLO) and spectral domain optical coherence tomography (SD-OCT). Coding regions of the CHM gene were sequenced. RESULTS Molecular analysis of the CHM gene identified a deletion of exons 9 to 15 in family A, a splice site mutation at position 79+1 of exon 1 in family B, deletion of exons 6 to 8 in family C, and a substitution at position 106 causing a premature stop in family D. BCVA ranged from 20/16 to 20/63 in carriers and from 20/25 to 5/63 in affected males. FAF showed abnormalities in all subjects. SD-OCT showed outer retinal layer loss, outer retinal tubulations at the margin of outer retinal loss, and inner retinal microcysts. Patchy cone loss was present in two symptomatic carriers. In two affected males, cone mosaics were disrupted with increased cone spacing near the fovea but more normal cone spacing near the edge of atrophy. CONCLUSIONS High-resolution retinal images in CHM carriers and affected males demonstrated RPE and photoreceptor cell degeneration. As both RPE and photoreceptor cells were affected, these cell types may degenerate simultaneously in CHM. These findings provide insight into the effect of CHM mutations on macular retinal structure, with implications for the development of treatments for CHM. (ClinicalTrials.gov number, NCT00254605.).
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Affiliation(s)
- Reema Syed
- Department of Ophthalmology, University of California, San Francisco, USA
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Zheng W, Zhang Z, Jiang K, Zhu J, He G, Ke B. Macular pigment optical density and its relationship with refractive status and foveal thickness in Chinese school-aged children. Curr Eye Res 2012; 38:168-73. [PMID: 22906053 DOI: 10.3109/02713683.2012.713150] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate macular pigment optical density (MPOD) and its relationship with refractive status and foveal thickness in Chinese school-aged children. METHODS Ninety-four healthy Chinese children, 6 to 12 years old, were recruited to the study. MPOD was measured with a heterochromatic flicker photometer (HFP), and foveal thickness, including both minimum and central foveal thicknesses (MFT and CFT, respectively), were measured by optical coherence tomography (OCT) with fast macular map scan. A noncontact tonometer was used to measure intraocular pressure (IOP) followed by determination of the refraction using an autorefractor after cycloplegia. Information on body mass index (BMI) was obtained. The correlation between MPOD values and foveal thickness, spherical equivalent (SE) refraction, IOP, BMI, sex, and age was statistically analyzed using SAS 8.2 statistical software. RESULTS The MPOD in examined school-aged children was 0.56 ± 0.25, without any significant difference between boys and girls (p = 0.12). MPOD showed no significant association with age, BMI, IOP, SE, MFT, or CFT. In the myopia group, however, there was an inverse relationship between MPOD and MFT (R =-0.66, p = 0.028) and a positive relationship between MPOD and CFT (R = 0.67, p = 0.025). CONCLUSIONS MPOD was inversely related to MFT and positively related to CFT in Chinese school-age children with low-to-moderate myopia. MPOD showed no significant association with age, BMI, IOP, SE or foveal thickness.
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Affiliation(s)
- Wenjing Zheng
- Department of Ophthalmology, First People's Hospital of Shanghai Affiliated to Shanghai Jiaotong University, Shanghai, China
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Abstract
Choroideremia (CHM) is an X-linked retinal dystrophy belonging to the family of blinding disorders. It is characterized by progressive degeneration of the choriocapillaris, retinal pigment epithelium and photoreceptors. CHM is caused by mutations in the Rab Escort Protein 1 (REP-1) gene, which encodes a protein involved in vesicular trafficking. This paper gives an overview of the clinical features, visual function, biochemistry, histology, molecular genetics, pathogenesis, diagnosis and treatment of CHM.
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Howells O, Eperjesi F, Bartlett H. Measuring macular pigment optical density in vivo: a review of techniques. Graefes Arch Clin Exp Ophthalmol 2011; 249:315-47. [PMID: 21221629 DOI: 10.1007/s00417-010-1577-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 11/04/2010] [Accepted: 11/15/2010] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Macular pigment has been the focus of much attention in recent years, as a potential modifiable risk factor for age-related macular degeneration. This interest has been heightened by the ability to measure macular pigment optical density (MPOD) in vivo. METHOD A systematic literature search was undertaken to identify all available papers that have used in vivo MPOD techniques. The papers were reviewed, and all relevant information was incorporated into this article. RESULTS Measurement of MPOD is achievable with a wide range of techniques, which are typically categorized into one of two groups: psychophysical (requiring a response from the subject) or objective (requiring minimal input from the subject). The psychophysical methods include heterochromatic flicker photometry and minimum motion photometry. The objective methods include fundus reflectometry, fundus autofluorescence, resonance Raman spectroscopy and visual evoked potentials. Even within the individual techniques, there is often much variation in how data is obtained and processed. CONCLUSION This review comprehensively details the procedure, instrumentation, assumptions, validity and reliability of each MPOD measurement technique currently available, along with their respective advantages and disadvantages. This leads us to conclude that development of a commercial instrument, based on fundus reflectometry or fundus autofluorescence, would be beneficial to macular pigment research and would support MPOD screening in a clinical setting.
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Affiliation(s)
- Olivia Howells
- Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK.
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Dose-dependent response of serum lutein and macular pigment optical density to supplementation with lutein esters. Arch Biochem Biophys 2010; 504:50-5. [PMID: 20599660 DOI: 10.1016/j.abb.2010.06.019] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 06/15/2010] [Accepted: 06/16/2010] [Indexed: 11/21/2022]
Abstract
We conducted a study to determine the effect of different doses of a lutein supplement on serum lutein concentration and macular pigment optical density (MPOD). Lutein is one of the major components of human macular pigment. Eighty-seven subjects received daily doses of 5, 10, or 20 mg of lutein, or a placebo, over a 140 day period. Serum lutein concentration was determined by HPLC and MPOD by heterochromatic flicker photometry (HFP). Serum lutein responded positively, except in the placebo group, reaching a plateau that, averaged for each dosage group, was linearly dependent on dose. Likewise MPOD, on average, increased at a rate that varied linearly with dose. For subjects deemed more proficient at HFP, approximately 29% of the variability in MPOD response could be attributed to a linear dependence on the fractional change in serum lutein concentration. We did not detect any significant influence of age on serum lutein uptake or MPOD response.
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Loughman J, Davison PA, Nolan JM, Akkali MC, Beatty S. Macular pigment and its contribution to visual performance and experience. JOURNAL OF OPTOMETRY 2010; 3:74-90. [PMCID: PMC3974304 DOI: 10.1016/s1888-4296(10)70011-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Accepted: 03/29/2010] [Indexed: 06/07/2023]
Abstract
There is now a consensus, based on histological, biochemical and spectral absorption data, that the yellow colour observed at the macula lutea is a consequence of the selective accumulation of dietary xanthophylls in the central retina of the living eye. Scientific research continues to explore the function(s) of MP in the human retina, with two main hypotheses premised on its putative capacity to (1) protect the retina from (photo)-oxidative damage by means of its optical filtration and/or antioxidant properties, the so-called protective hypothesis and (2) influence the quality of visual performance by means of selective short wavelength light absorption prior to photoreceptor light capture, thereby attenuating the effects of chromatic aberration and light scatter, the so-called acuity and visibility hypotheses. The current epidemic of age-related macular degeneration has directed researchers to investigate the protective hypothesis of MP, while there has been a conspicuous lack of work designed to investigate the role of MP in visual performance. The aim of this review is to present and critically appraise the current literature germane to the contribution of MP, if any, to visual performance and experience.
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Affiliation(s)
- James Loughman
- Optometry Department, Dublin Institute of Technology, Dublin, Ireland
| | - Peter A. Davison
- Optometry Department, Dublin Institute of Technology, Dublin, Ireland
| | - John M. Nolan
- Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland
| | - Mukunda C. Akkali
- Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland
| | - Stephen Beatty
- Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland
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Scientific Opinion on the substantiation of health claims related to lutein and maintenance of vision (ID 1603, 1604, 1931) pursuant to Article 13(1) of Regulation (EC) No 1924/2006. EFSA J 2010. [DOI: 10.2903/j.efsa.2010.1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Bernstein PS, Delori FC, Richer S, van Kuijk FJM, Wenzel AJ. The value of measurement of macular carotenoid pigment optical densities and distributions in age-related macular degeneration and other retinal disorders. Vision Res 2009; 50:716-28. [PMID: 19854211 DOI: 10.1016/j.visres.2009.10.014] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 10/08/2009] [Accepted: 10/17/2009] [Indexed: 11/24/2022]
Abstract
There is increasing recognition that the optical and antioxidant properties of the xanthophyll carotenoids lutein and zeaxanthin play an important role in maintaining the health and function of the human macula. In this review article, we assess the value of non-invasive quantification of macular pigment levels and distributions to identify individuals potentially at risk for visual disability or catastrophic vision loss from age-related macular degeneration, and we consider the strengths and weaknesses of the diverse measurement methods currently available.
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Affiliation(s)
- Paul S Bernstein
- Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Moeller SM, Voland R, Sarto GE, Gobel VL, Streicher SL, Mares JA. Women's Health Initiative diet intervention did not increase macular pigment optical density in an ancillary study of a subsample of the Women's Health Initiative. J Nutr 2009; 139:1692-9. [PMID: 19587126 PMCID: PMC2728692 DOI: 10.3945/jn.109.107748] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 04/14/2009] [Accepted: 05/30/2009] [Indexed: 11/14/2022] Open
Abstract
In this study, we examined the impact of long-term (>8 y), low-fat, high-fruit and -vegetable diets on levels of lutein and zeaxanthin in the macula of the retina, as indicated by the OD of macular pigment. Macular pigment OD, measured by heterochromatic flicker photometry, was compared in women aged 60-87 y, who, 7-18 mo earlier (median 12 mo), had been in the dietary modification intervention (n = 158) or comparison (n = 236) groups of the Women's Health Initiative (WHI) at the Madison, WI site for a mean of 8.5 y. Women in the intervention group ate more fruits and vegetables (mean +/- SEM) (6.1 +/- 0.2 vs. 4.6 +/- 0.2 servings/d; P < 0.0001) and had higher intakes of lutein and zeaxanthin from foods and supplements (2.7 +/- 0.2 vs. 2.1 +/- 0.1 mg/d; P = 0.0003) than the comparison group. However, macular pigment density did not differ between the intervention (0.36 +/- 0.02 OD units) and comparison (0.35 +/- 0.01 OD units) groups. It tended to be higher (11%; P = 0.11) in women consuming lutein and zeaxanthin in the highest compared with the lowest quintile (median 6.4 vs. 1.1 mg/d). The increase in fruit and vegetable intake among dietary modification participants of this WHI subsample was not of sufficient magnitude to alter the mean density of retinal carotenoids, given other existing dietary conditions in this sample.
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Affiliation(s)
- Suzen M Moeller
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI 53705, USA
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Preising M, Ayuso C. Rab escort protein 1 (REP1) in intracellular traffic: a functional and pathophysiological overview. Ophthalmic Genet 2009; 25:101-10. [PMID: 15370541 DOI: 10.1080/13816810490514333] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The intracellular distribution of proteins, compartments, substrates, and products is an active process called intracellular traffic. Control of intracellular traffic is established by small GTP-binding proteins (Rab proteins). Rab proteins are modified by geranyl-geranyl moieties necessary for membrane association and target-protein recognition. Geranyl-geranyl groups are transferred to Rab proteins by geranyl-geranyl transferase 2 (GGTase2). GGTase2 requires Rab escort protein 1 (REP1) to bind Rab proteins. REP1 null mutations underlie an X-linked retinal degeneration called choroideremia (CHM). This review summarizes the current biochemical and clinical knowledge on REP1 and CHM.
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Affiliation(s)
- Markus Preising
- Department of Pediatric Ophthalmology, Strabismology and Ophthalmogenetics, Klinikum, University of Regensburg, Germany.
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Neelam K, Hogg RE, Stevenson MR, Johnston E, Anderson R, Beatty S, Chakravarthy U. Carotenoids and Co-Antioxidants in Age-Related Maculopathy: Design and Methods. Ophthalmic Epidemiol 2009; 15:389-401. [DOI: 10.1080/09286580802154275] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bonilha VL, Trzupek KM, Li Y, Francis PJ, Hollyfield JG, Rayborn ME, Smaoui N, Weleber RG. Choroideremia: analysis of the retina from a female symptomatic carrier. Ophthalmic Genet 2008; 29:99-110. [PMID: 18766988 DOI: 10.1080/13816810802206499] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To define the retinal pathology in a 91 year-old affected matriarch of a three-generation choroideremia family with multiple manifesting carriers. METHODS Tissue from three different retinal areas was processed for immunohistochemistry. The macular area was processed for transmission electron microscopy. Cryosections were studied by indirect immunofluorescence, using well-characterized antibodies to cone cytoplasm, rhodopsin and cone opsins. The affected donor eyes were compared to a postmortem matched normal eye. RESULTS The retina displayed areas of severe degeneration, with no photoreceptor outer segments, photoreceptor nuclear atrophy, and atrophy of the inner retina. Other retinal areas were near to normal. The RPE was severely degenerated, with thinning, pigment clumping and sub-epithelial debris deposition in all the areas examined. The choroid displayed depigmentation. Labeling with cone opsin antibodies revealed that cones were drastically affected: blue opsin was almost completely absent, while red/green opsins were distributed along the entire plasma membrane of the cell. Rhodopsin was also distributed along the entire rod plasma membrane. Ultrastructural analysis of the affected macula revealed the absence of RPE apical microvilli and basal infoldings. Instead, RPE's basal surface and choroid displayed the presence of banded fibers composed of clumps of wide-spacing collagen. Bruch's membrane was filled with vesicular structures, some smooth and others with bristle-like projections. CONCLUSIONS The histological data suggests that the clinical manifestation in this donor is related to degenerative changes in the retina, RPE, and choroid.
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Affiliation(s)
- Vera L Bonilha
- The Cleveland Clinic Foundation, The Cole Eye Institute, Cleveland, Ohio 44195, USA.
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Bartlett HE, Eperjesi F. A randomised controlled trial investigating the effect of lutein and antioxidant dietary supplementation on visual function in healthy eyes. Clin Nutr 2008; 27:218-27. [DOI: 10.1016/j.clnu.2008.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Revised: 12/19/2007] [Accepted: 01/08/2008] [Indexed: 11/30/2022]
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