Effects of O2 transmissibility on corneal epithelium after daily and extended contact lens wear in rabbit and man

Hypoxia-induced downregulation of ΔNp63α in the corneal epithelium

PURPOSE

The aim of this study was to establish a relationship between hypoxic stress and the expression of ΔNp63α in an established rabbit contact lens model and in cultured corneal epithelial cells.

METHODS

New Zealand white rabbits were fit in one eye with either a non-oxygen transmissible or hyper-oxygen-permeable rigid contact lens for 24 hrs of wear; the contralateral eye was used as a control. All the rabbits underwent a bilateral nictitating membranectomy to facilitate lens retention. ΔNp63α expression was analyzed by immunofluorescence and western blot. Telomerase-immortalized human corneal epithelial cells (hTCEpi) were grown in serum-free media and treated with the hypoxia-mimetic cobalt chloride to simulate hypoxia for 6 hrs (short term) or 24 hrs (prolonged). Transcriptional activity and protein levels were assessed using luciferase reporter assays, reverse transcription polymerase chain reaction, and western blot. Cell viability was assessed by live/dead assay.

RESULTS

Compared with the non-lens wearing eye, 24 hrs of non-oxygen transmissible lens wear in vivo decreased ΔNp63α protein levels in both the limbal and central corneal epithelium; this decrease was not found in the hyper-oxygen transmissible lens group. In hTCEpi cells in vitro, hypoxia increased the activity of the ΔN promoter but reduced the levels of ΔNp63α mRNA after 24 hrs of prolonged culture. Similarly, ΔNp63α expression levels were unaffected from short-term exposure but decreased after 24 hrs. Live/dead assay confirmed the presence of viable cells after CoCl2 treatment at 6- and 24-hr time points. Cells treated for 24 hrs were viable but were smaller and rounded with signs of membrane blebbing, consistent with early stages of apoptosis.

CONCLUSIONS

Hypoxic stress induced by either prolonged wear of a nonoxygen transmissible lens in vivo or hypoxic-mimic conditions by cobalt chloride in vitro downregulates ΔNp63α in the corneal epithelium. The loss of ΔNp63α in response to hypoxic stress may contribute to the disruption of normal renewal mechanisms reported with low oxygen transmissible contact lens wear and prolonged eyelid closure.

Thickness mapping of the cornea and epithelium using optical coherence tomography

PURPOSE

To measure corneal and epithelial thickness across four meridians using Optical Coherence Tomography (OCT) and to compare these measurements between normal non-lens wearers (NLW), rigid gas permeable (RGP) lens wearers, and RGP-wearing keratoconics (KC).

METHODS

Both eyes of 60 subjects were measured (20 NLW, nine female:11 male, 27.6 +/- 5.9 years; 20 RGP, 20 female, 23.9 +/- 7.6 years; and 20 KC, seven female:13 male, 32.4 +/- 8.1 years). A customized fixation target employing LEDs in eight directions of gaze was attached to the OCT and corneal images obtained. Raw OCT scans were analyzed to yield values for corneal and epithelial thickness and color-coded maps were compiled.

RESULTS

Central corneal thickness (CCT) was thinnest in KC (447 +/- 68 microm) and similar between RGP (518 +/- 32 microm; pKC < 0.001) and NLW (517 +/- 21 microm) (p(KC) < 0.001 NLW pRGP > 0.05). Peripheral corneal thickness in NLW was thickest in the superior temporal and thinnest in the inferior (I) regions (superior temporal(thickest) vs. I(thinnest) p < 0.001). Central epithelial thickness was thinnest in KC (44 +/- 7 microm), followed by RGP (50 +/- 4 microm), then NLW (54 +/- 2 microm) (pKC < 0.001 NLW p(RGP) < 0.05). Central epithelial thickness in the KC group was significantly thinner than in the RGP group (p < 0.001). In the NLW group, peripheral epithelial thickness was thicker (63 +/- 5 microm) than central (p < 0.001) and was thickest in the superior (S) region and thinnest in the inferior (I) region (S(thickest) vs. I(thinnest) p < 0.001). KC epithelium was thinnest in the inferior temporal meridian (42 +/- 5 microm).

CONCLUSIONS

Thickness of the normal cornea and epithelium was greatest in the superior region. In all groups, the inferior cornea and epithelium was thinnest, and to a greater extent in the KC group.

Corneal Oxygen Uptake Associated With Piggyback Contact Lens Systems

PURPOSE

The purpose of this study was to determine the effects of static (without blinking) and dynamic (with blinking once every 5 seconds) wear of piggyback contact lens systems on corneal oxygen uptake.

METHODS

Corneal oxygen uptake rates were measured on the right eyes of 11 human subjects by using a polarographic electrode. Measurements were made for the normal open eye and after 5 minutes of wear of 4 rigid lens materials (Dk/t 0-82.5), 4 soft lens materials (Dk/t 13-122), and 16 combinations of rigid and soft lens materials. The piggyback systems were worn under both static and dynamic conditions. Repeated-measures analysis of variance was used to compare oxygen uptake rates associated with the wear of the rigid lens components, soft lens components, piggyback systems, and static versus dynamic wearing conditions. Spearman correlation coefficients and regression analyses were used to examine relationships between corneal oxygen uptake rates.

RESULTS

Measurable differences were found among oxygen uptake rates associated with the rigid lens components, soft lens components, and piggyback systems. Blinking resulted in no reduction in corneal oxygen uptake with the piggyback systems. Corneal oxygen uptake associated with the wear of the piggyback systems could not be predicted from those associated with the rigid and soft lens components of the systems.

CONCLUSIONS

Piggyback combinations of rigid and soft lens components with the highest transmissibilities resulted in the least increase in corneal oxygen uptake beyond that of the normal open eye.

Hypoxia increases corneal cell expression of CFTR leading to increased Pseudomonas aeruginosa binding, internalization, and initiation of inflammation

PURPOSE

To investigate the effect of hypoxia-induced molecular responses of corneal epithelial cells on the surface of rabbit and human corneas and corneal cells in culture on interactions with Pseudomonas aeruginosa that may underlie increased susceptibility to keratitis.

METHODS

Organ cultures of rabbit and human corneal tissue, primary rabbit and human corneal cells, and transformed human corneal cells from a patient with cystic fibrosis and the same cell line corrected for expression of wild-type cystic fibrosis transmembrane conductance regulator (CFTR), the cellular receptor for P. aeruginosa, were exposed to hypoxic conditions for 24 to 72 hours. Changes in binding and internalization of P. aeruginosa were measured using cellular association and gentamicin-exclusion assays, and expression of CFTR and activation of NF-kappaB in response to hypoxia were determined by confocal laser microscopy and quantitative measurements of NF-kappaB activation.

RESULTS

Hypoxia induced in a time- and oxygen-concentration-dependent manner increased association and internalization of clinical isolates of P. aeruginosa in all cells tested. Hypoxia increased CFTR expression and NF-kappaB nuclear translocation in rabbit and human cells with wild-type CFTR. Corneal cells lacking CFTR had reduced NF-kappaB activation in response to hypoxia. Hypoxia did not affect the increase in corneal cell CFTR levels or NF-kappaB activation after P. aeruginosa infection.

CONCLUSIONS

Hypoxic conditions on the cornea exacerbate the binding and internalization of P. aeruginosa due to increased levels of CFTR expression and also induce basal NF-kappaB activation. Both of these responses probably exacerbate the effects of P. aeruginosa infection by allowing lower infectious doses of bacteria to induce disease and promote destructive inflammatory responses.