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Wang L, Wei X. Exosome-based crosstalk in glaucoma pathogenesis: a focus on oxidative stress and neuroinflammation. Front Immunol 2023; 14:1202704. [PMID: 37529047 PMCID: PMC10388248 DOI: 10.3389/fimmu.2023.1202704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Exosomes are membrane-bound tiny particles that are released by all live cells that contain multiple signal molecules and extensively participate in numerous normal physical activities and pathologies. In glaucoma, the crucial role of exosome-based crosstalk has been primarily revealed in animal models and ex vivo cell studies in the recent decade. In the aqueous drainage system, exosomes derived from non-pigment ciliary epithelium act in an endocrine manner and specifically regulate the function of the trabecular meshwork to cope with persistent oxidative stress challenges. In the retina, a more complicated regulatory network among microglia, retinal neurons, retinal ganglial cells, retinal pigment epithelium, and other immune effector cells by exosomes are responsible for the elaborate modulation of tissue homeostasis under physical state and the widespread propagation of neuroinflammation and its consequent neurodegeneration in glaucoma pathogenesis. Accumulating evidence indicates that exosome-based crosstalk depends on numerous factors, including the specific cargos they carried (particularly micro RNA), concentration, size, and ionization potentials, which largely remain elusive. In this narrative review, we summarize the latest research focus of exosome-based crosstalk in glaucoma pathogenesis, the current research progress of exosome-based therapy for glaucoma and provide in-depth perspectives on its current research gap.
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Affiliation(s)
- Lixiang Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Wei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Department of Ophthalmology, ShangjinNanfu Hospital, Chengdu, China
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2
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Shen Y, Sun J, Sun X. Intraocular nano-microscale drug delivery systems for glaucoma treatment: design strategies and recent progress. J Nanobiotechnology 2023; 21:84. [PMID: 36899348 PMCID: PMC9999627 DOI: 10.1186/s12951-023-01838-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/02/2023] [Indexed: 03/12/2023] Open
Abstract
Glaucoma is a leading cause of irreversible visual impairment and blindness, affecting over 76.0 million people worldwide in 2020, with a predicted increase to 111.8 million by 2040. Hypotensive eye drops remain the gold standard for glaucoma treatment, while inadequate patient adherence to medication regimens and poor bioavailability of drugs to target tissues are major obstacles to effective treatment outcomes. Nano/micro-pharmaceuticals, with diverse spectra and abilities, may represent a hope of removing these obstacles. This review describes a set of intraocular nano/micro drug delivery systems involved in glaucoma treatment. Particularly, it investigates the structures, properties, and preclinical evidence supporting the use of these systems in glaucoma, followed by discussing the route of administration, the design of systems, and factors affecting in vivo performance. Finally, it concludes by highlighting the emerging notion as an attractive approach to address the unmet needs for managing glaucoma.
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Affiliation(s)
- Yuening Shen
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, 200031, China
| | - Jianguo Sun
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, 200031, China.,NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China
| | - Xinghuai Sun
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, 200031, China. .,State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China. .,NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China.
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3
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Finite element modeling of effects of tissue property variation on human optic nerve tethering during adduction. Sci Rep 2022; 12:18985. [PMID: 36347907 PMCID: PMC9643519 DOI: 10.1038/s41598-022-22899-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022] Open
Abstract
Tractional tethering by the optic nerve (ON) on the eye as it rotates towards the midline in adduction is a significant ocular mechanical load and has been suggested as a cause of ON damage induced by repetitive eye movements. We designed an ocular finite element model (FEM) simulating 6° incremental adduction beyond the initial configuration of 26° adduction that is the observed threshold for ON tethering. This FEM permitted sensitivity analysis of ON tethering using observed material property variations in measured hyperelasticity of the anterior, equatorial, posterior, and peripapillary sclera; and the ON and its sheath. The FEM predicted that adduction beyond the initiation of ON tethering concentrates stress and strain on the temporal side of the optic disc and peripapillary sclera, the ON sheath junction with the sclera, and retrolaminar ON neural tissue. However, some unfavorable combinations of tissue properties within the published ranges imposed higher stresses in these regions. With the least favorable combinations of tissue properties, adduction tethering was predicted to stress the ON junction and peripapillary sclera more than extreme conditions of intraocular and intracranial pressure. These simulations support the concept that ON tethering in adduction could induce mechanical stresses that might contribute to ON damage.
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Noailles A, Kutsyr O, Mayordomo-Febrer A, Lax P, López-Murcia M, Sanz-González SM, Pinazo-Durán MD, Cuenca N. Sodium Hyaluronate-Induced Ocular Hypertension in Rats Damages the Direction-Selective Circuit and Inner/Outer Retinal Plexiform Layers. Invest Ophthalmol Vis Sci 2022; 63:2. [PMID: 35503230 PMCID: PMC9078050 DOI: 10.1167/iovs.63.5.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose To assess the changes in retinal morphology in a rat model of chronic glaucoma induced by ocular hypertension. Methods Intraocular pressure (IOP) was surgically increased through weekly injections of sodium hyaluronate (HYA) in the anterior eye chamber of the left eye of male Wistar rats, whereas the right eyes were sham operated (salt solution). During the 10-week experimental period, IOP was measured weekly with a rebound tonometer. Retinal cryosections were prepared for histological/immunohistochemical analysis and morphometry. Results IOP was higher in HYA-treated eyes than in sham-operated eyes along the 10-week period, which was significant from the fourth to the nineth week. Ocular hypertension in HYA-treated eyes was associated with morphologic and morphometric changes in bipolar cells, ON-OFF direction-selective ganglion cells, ON/OFF starburst amacrine cells, and inner plexiform layer sublamina. Conclusions Serial HYA treatment in the rat anterior eye chamber results in mild-to-moderate elevated and sustained IOP and ganglion cell death, which mimics most human open-angle glaucoma hallmarks. The reduced number of direction-selective ganglion cells and starburst amacrine cells accompanied by a deteriorated ON/OFF plexus in this glaucoma model could lend insight to the abnormalities in motion perception observed in patients with glaucoma.
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Affiliation(s)
- Agustina Noailles
- Physiology, Genetics and Microbiology, University of Alicante, Spain.,OFTARED. Spanish Net of Ophthalmic Research. Institute of health Carlos III, Madrid, Spain
| | - Oksana Kutsyr
- Physiology, Genetics and Microbiology, University of Alicante, Spain.,OFTARED. Spanish Net of Ophthalmic Research. Institute of health Carlos III, Madrid, Spain
| | - Aloma Mayordomo-Febrer
- Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universidad CEU Cardenal Herrera, Valencia, Spain.,OFTARED. Spanish Net of Ophthalmic Research. Institute of health Carlos III, Madrid, Spain.,Mixed Research Unit for Visual Health and Veterinary Ophthalmology CEU/FISABIO, Valencia, Spain
| | - Pedro Lax
- Physiology, Genetics and Microbiology, University of Alicante, Spain.,OFTARED. Spanish Net of Ophthalmic Research. Institute of health Carlos III, Madrid, Spain
| | - María López-Murcia
- Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universidad CEU Cardenal Herrera, Valencia, Spain.,Mixed Research Unit for Visual Health and Veterinary Ophthalmology CEU/FISABIO, Valencia, Spain
| | - Silvia M Sanz-González
- OFTARED. Spanish Net of Ophthalmic Research. Institute of health Carlos III, Madrid, Spain.,Cellular and Molecular Ophthalmo-biology Research Group, Department of Surgery, University of Valencia, Valencia, Spain.,Ophthalmic Research Unit "Santiago Grisolía"/FISABIO, Valencia, Spain
| | - María Dolores Pinazo-Durán
- OFTARED. Spanish Net of Ophthalmic Research. Institute of health Carlos III, Madrid, Spain.,Cellular and Molecular Ophthalmo-biology Research Group, Department of Surgery, University of Valencia, Valencia, Spain.,Ophthalmic Research Unit "Santiago Grisolía"/FISABIO, Valencia, Spain
| | - Nicolás Cuenca
- Physiology, Genetics and Microbiology, University of Alicante, Spain.,OFTARED. Spanish Net of Ophthalmic Research. Institute of health Carlos III, Madrid, Spain
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Cepeda-Ortegon GE, Treviño-Herrera AB, Olvera-Barrios A, Martínez-López-Portillo A, Mohamed-Hamsho J, Mohamed-Noriega J. Simultaneous and Bilateral Non-Arteritic Anterior Ischaemic Optic Neuropathy and Acute Angle-Closure. Neuroophthalmology 2021; 45:407-410. [PMID: 34720273 DOI: 10.1080/01658107.2020.1851263] [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: 10/22/2022] Open
Abstract
Non-arteritic anterior ischaemic optic neuropathy (NAION) is the second most common cause of permanent optic nerve-related visual loss in adults after glaucoma. NAION is caused by complex mechanisms that lead to optic nerve head hypoperfusion and is frequently associated with cardiovascular risk factors like type 2 diabetes mellitus (DM2) and hypertension. An attack of acute angle-closure (AAC) occurs when the trabecular meshwork is blocked with peripheral iris that causes an abrupt rise in intraocular pressure, which can trigger a decrease in optic nerve head perfusion. We present a case with simultaneous and bilateral AAC and NAION in association with uncontrolled DM2.
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Affiliation(s)
- Gerardo Esteban Cepeda-Ortegon
- Department of Ophthalmology, University Hospital 'Dr. José Eleuterio González' and Faculty of Medicine, Autonomous University of Nuevo Leon (UANL), Monterrey, México
| | - Alan Baltazar Treviño-Herrera
- Department of Ophthalmology, University Hospital 'Dr. José Eleuterio González' and Faculty of Medicine, Autonomous University of Nuevo Leon (UANL), Monterrey, México
| | - Abraham Olvera-Barrios
- Department of Ophthalmology, University Hospital 'Dr. José Eleuterio González' and Faculty of Medicine, Autonomous University of Nuevo Leon (UANL), Monterrey, México
| | - Alejandro Martínez-López-Portillo
- Department of Ophthalmology, University Hospital 'Dr. José Eleuterio González' and Faculty of Medicine, Autonomous University of Nuevo Leon (UANL), Monterrey, México
| | - Jesús Mohamed-Hamsho
- Department of Ophthalmology, University Hospital 'Dr. José Eleuterio González' and Faculty of Medicine, Autonomous University of Nuevo Leon (UANL), Monterrey, México
| | - Jibran Mohamed-Noriega
- Department of Ophthalmology, University Hospital 'Dr. José Eleuterio González' and Faculty of Medicine, Autonomous University of Nuevo Leon (UANL), Monterrey, México
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6
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Kim YC, Hsueh HT, Shin MD, Berlinicke CA, Han H, Anders NM, Hemingway A, Leo KT, Chou RT, Kwon H, Appell MB, Rai U, Kolodziejski P, Eberhart C, Pitha I, Zack DJ, Hanes J, Ensign LM. A hypotonic gel-forming eye drop provides enhanced intraocular delivery of a kinase inhibitor with melanin-binding properties for sustained protection of retinal ganglion cells. Drug Deliv Transl Res 2021; 12:826-837. [PMID: 33900546 DOI: 10.1007/s13346-021-00987-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 12/22/2022]
Abstract
While eye drops are the most common ocular dosage form, eye drops for treating diseases of the posterior segment (retina, choroid, optic nerve) have yet to be developed. In glaucoma, eye drops are used extensively for delivering intraocular pressure (IOP)-lowering medications to the anterior segment. However, degeneration of retinal ganglion cells (RGCs) in the retina may progress despite significant IOP lowering, suggesting that a complementary neuroprotective therapy would improve glaucoma management. Here, we describe a hypotonic, thermosensitive gel-forming eye drop for effective delivery of sunitinib, a protein kinase inhibitor with activity against the neuroprotective targets dual leucine zipper kinase (DLK) and leucine zipper kinase (LZK), to enhance survival of RGCs after optic nerve injury. Further, binding of sunitinib to melanin in the pigmented cells in the choroid and retinal pigment epithelium (RPE) led to prolonged intraocular residence time, including therapeutically relevant concentrations in the non-pigmented retinal tissue where the RGCs reside. The combination of enhanced intraocular absorption provided by the gel-forming eye drop vehicle and the intrinsic melanin binding properties of sunitinib led to significant protection of RGCs with only once weekly eye drop dosing. For a chronic disease such as glaucoma, an effective once weekly eye drop for neuroprotection could result in greater patient adherence, and thus, greater disease management and improved patient quality of life.
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Affiliation(s)
- Yoo Chun Kim
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA
| | - Henry T Hsueh
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Matthew D Shin
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA
| | - Cynthia A Berlinicke
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA
| | - Hyounkoo Han
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA
| | - Nicole M Anders
- The Sidney Kimmel Comprehensive Cancer Center At Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Avelina Hemingway
- The Sidney Kimmel Comprehensive Cancer Center At Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Kirby T Leo
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Renee Ti Chou
- Department of Computational Biology, Bioinformatics, and Genomics, Center for Bioinformatics and Computational Biology, University of Maryland, College Park, MD, 20742, USA
| | - HyeYoung Kwon
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Matthew B Appell
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Usha Rai
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA
| | - Patricia Kolodziejski
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Charles Eberhart
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA
| | - Ian Pitha
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA
| | - Donald J Zack
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA.,Departments of Neuroscience, Molecular Biology and Genetics, and Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Justin Hanes
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA.,Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA.,The Sidney Kimmel Comprehensive Cancer Center At Johns Hopkins University, Baltimore, MD, 21287, USA.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA.,Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Laura M Ensign
- Center for Nanomedicine At the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA. .,Department of Ophthalmology, Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD, 21287, USA. .,Department of Chemical & Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA. .,The Sidney Kimmel Comprehensive Cancer Center At Johns Hopkins University, Baltimore, MD, 21287, USA. .,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA. .,Department of Pharmacology and Molecular Sciences, Johns Hopkins University, Baltimore, MD, 21287, USA. .,Departments Gynecology and Obstetrics and Infectious Diseases, Johns Hopkins University, Baltimore, MD, 21287, USA.
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7
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Tirendi S, Saccà SC, Vernazza S, Traverso C, Bassi AM, Izzotti A. A 3D Model of Human Trabecular Meshwork for the Research Study of Glaucoma. Front Neurol 2020; 11:591776. [PMID: 33335510 PMCID: PMC7736413 DOI: 10.3389/fneur.2020.591776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022] Open
Abstract
Glaucoma is a multifactorial syndrome in which the development of pro-apoptotic signals are the causes for retinal ganglion cell (RGC) loss. Most of the research progress in the glaucoma field have been based on experimentally inducible glaucoma animal models, which provided results about RGC loss after either the crash of the optic nerve or IOP elevation. In addition, there are genetically modified mouse models (DBA/2J), which make the study of hereditary forms of glaucoma possible. However, these approaches have not been able to identify all the molecular mechanisms characterizing glaucoma, possibly due to the disadvantages and limits related to the use of animals. In fact, the results obtained with small animals (i.e., rodents), which are the most commonly used, are often not aligned with human conditions due to their low degree of similarity with the human eye anatomy. Although the results obtained from non-human primates are in line with human conditions, they are little used for the study of glaucoma and its outcomes at cellular level due to their costs and their poor ease of handling. In this regard, according to at least two of the 3Rs principles, there is a need for reliable human-based in vitro models to better clarify the mechanisms involved in disease progression, and possibly to broaden the scope of the results so far obtained with animal models. The proper selection of an in vitro model with a "closer to in vivo" microenvironment and structure, for instance, allows for the identification of the biomarkers involved in the early stages of glaucoma and contributes to the development of new therapeutic approaches. This review summarizes the most recent findings in the glaucoma field through the use of human two- and three-dimensional cultures. In particular, it focuses on the role of the scaffold and the use of bioreactors in preserving the physiological relevance of in vivo conditions of the human trabecular meshwork cells in three-dimensional cultures. Moreover, data from these studies also highlight the pivotal role of oxidative stress in promoting the production of trabecular meshwork-derived pro-apoptotic signals, which are one of the first marks of trabecular meshwork damage. The resulting loss of barrier function, increase of intraocular pressure, as well the promotion of neuroinflammation and neurodegeneration are listed as the main features of glaucoma. Therefore, a better understanding of the first molecular events, which trigger the glaucoma cascade, allows the identification of new targets for an early neuroprotective therapeutic approach.
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Affiliation(s)
- Sara Tirendi
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
- Inter-University Center for the Promotion of the 3Rs Principles in Teaching & Research (Centro 3R), Pisa, Italy
| | - Sergio Claudio Saccà
- Ophthalmology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefania Vernazza
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Bietti, Rome, Italy
| | - Carlo Traverso
- Clinica Oculistica, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili, University of Genoa and Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Maria Bassi
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
- Inter-University Center for the Promotion of the 3Rs Principles in Teaching & Research (Centro 3R), Pisa, Italy
| | - Alberto Izzotti
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
- Mutagenesis Unit, IST National Institute for Cancer Research, Istituto di Ricovero e Cura a Carattere Scientifico San Martino University Hospital, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
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A Tenon's capsule/bulbar conjunctiva interface biomimetic to model fibrosis and local drug delivery. PLoS One 2020; 15:e0241569. [PMID: 33141875 PMCID: PMC7608904 DOI: 10.1371/journal.pone.0241569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/18/2020] [Indexed: 12/13/2022] Open
Abstract
Glaucoma filtration surgery is one of the most effective methods for lowering intraocular pressure in glaucoma. The surgery efficiently reduces intra-ocular pressure but the most common cause of failure is scarring at the incision site. This occurs in the conjunctiva/Tenon’s capsule layer overlying the scleral coat of the eye. Currently used antimetabolite treatments to prevent post-surgical scarring are non-selective and are associated with potentially blinding side effects. Developing new treatments to target scarring requires both a better understanding of wound healing and scarring in the conjunctiva, and new means of delivering anti-scarring drugs locally and sustainably. By combining plastic compression of collagen gels with a soft collagen-based layer, we have developed a physiologically relevant model of the sub-epithelial bulbar conjunctiva/Tenon’s capsule interface, which allows a more holistic approach to the understanding of subconjunctival tissue behaviour and local drug delivery. The biomimetic tissue hosts both primary human conjunctival fibroblasts and an immune component in the form of macrophages, morphologically and structurally mimicking the mechanical proprieties and contraction kinetics of ex vivo porcine conjunctiva. We show that our model is suitable for the screening of drugs targeting scarring and/or inflammation, and amenable to the study of local drug delivery devices that can be inserted in between the two layers of the biomimetic. We propose that this multicellular-bilayer engineered tissue will be useful to study complex biological aspects of scarring and fibrosis, including the role of inflammation, with potentially significant implications for the management of scarring following glaucoma filtration surgery and other anterior ocular segment scarring conditions. Crucially, it uniquely allows the evaluation of new means of local drug delivery within a physiologically relevant tissue mimetic, mimicking intraoperative drug delivery in vivo.
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Wilson KI, Godara P, Jasien JV, Zohner E, Morris JS, Girkin CA, Samuels BC, Downs JC. Intra-Subject Variability and Diurnal Cycle of Ocular Perfusion Pressure as Characterized by Continuous Telemetry in Nonhuman Primates. Invest Ophthalmol Vis Sci 2020; 61:7. [PMID: 32492113 PMCID: PMC7415896 DOI: 10.1167/iovs.61.6.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To characterize ocular perfusion pressure (OPP) fluctuations with continuous telemetry over 24-hour periods across multiple days in nonhuman primates (NHPs) to test the hypotheses that OPP differs among NHPs and that the diurnal cycle of OPP is characterized by low OPP during sleep. Methods We have developed and validated two implantable radiotelemetry systems that allow continuous measurement of intraocular pressure (IOP), arterial blood pressure (BP), and OPP up to 500 Hz. OPP was measured unilaterally in 12 male NHPs for periods of 38 to 412 days. IOP transducers were calibrated directly via anterior chamber manometry, and OPP was calculated continuously as central retinal artery BP minus IOP. OPP data were corrected for signal drift between calibrations and averaged hourly. Results OPP varied widely among animals, with daily averages ranging from ∼47 to 65 mm Hg. In eight of 12 NHPs, OPP was significantly lower during sleep compared to waking hours. In three animals, the diurnal cycle was reversed and OPP was significantly higher during sleep (P < 0.05), and one NHP showed no diurnal cycle. Day-to-day OPP variability within NHPs was the largest source of overall OPP variability, even larger than the differences between NHPs. Average daily OPP showed an unexplained ∼32-day cyclic pattern in most NHPs. Conclusions Average OPP varied widely and exhibited differing diurnal cycles in NHPs, a finding that matches those of prior patient studies and indicates that OPP studies in the NHP model are appropriate. Infrequent snapshot measurements of either IOP or BP are insufficient to capture true IOP, BP, and OPP and their fluctuations.
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Abstract
PURPOSE/AIM We aimed to characterize the connective tissue microanatomy, elastin abundance, and fiber orientation in the human optic nerve sheath, also known as the optic nerve dura mater, for correlation with its biomechanical properties. MATERIALS AND METHODS Seven whole human orbits aged 4-93 years, and five isolated human optic nerve sheaths aged 26-75 years were formalin fixed, paraffin embedded, coronally sectioned, stained by Masson trichrome and van Gieson's elastin methods, and analyzed quantitatively for elastin fiber abundance and orientation. Elastin area fraction was defined as area stained for elastin divided by total area. RESULTS While unilaminar in children, the adult ON sheath exhibited distinct inner and outer layers. Collagen was denser and more compact in the inner layer. Elastin area fraction was significantly greater at 6.0 ± 0.4% (standard error of mean) in the inner than outer layer at 3.6 ± 0.4% (P < 10-5). Elastin fibers had three predominant orientations: longitudinal, diagonal, and circumferential. Of circumferential fibers, 63 ± 4.7% were in the inner and 37 ± 4.7% in the outer layer (P < 10-4). Longitudinal and diagonal fibers were uniformly distributed in both layers. Elastin density and sheath thickness increased significantly with age (P < .01). CONCLUSIONS The adult human optic nerve sheath is bilaminar, with each layer containing elastin fibers oriented in multiple directions consistent with isotropic properties. Differences in laminar elastin density and orientation may reflect greater tensile loading in the inner than in the outer layer.
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Affiliation(s)
- Alan Le
- Department of Bioengineering, University of California , Los Angeles, California, USA.,Department of Ophthalmology and Stein Eye Institute, University of California , Los Angeles, California, USA
| | - Andrew Shin
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital , Boston, Massachusetts, USA
| | - Joseph Park
- Department of Bioengineering, University of California , Los Angeles, California, USA.,Department of Ophthalmology and Stein Eye Institute, University of California , Los Angeles, California, USA
| | - Vadims Poukens
- Department of Ophthalmology and Stein Eye Institute, University of California , Los Angeles, California, USA
| | - Joseph L Demer
- Department of Ophthalmology and Stein Eye Institute, University of California , Los Angeles, California, USA.,Department of Neurology, University of California , Los Angeles, California, USA.,Neuroscience, University of California , Los Angeles, California, USA.,Bioengineering Interdepartmental Programs, University of California , Los Angeles, California, USA.,David Geffen Medical School, University of California , Los Angeles, California, USA
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Demer JL, Clark RA, Suh SY, Giaconi JA, Nouri-Mahdavi K, Law SK, Bonelli L, Coleman AL, Caprioli J. Optic Nerve Traction During Adduction in Open Angle Glaucoma with Normal versus Elevated Intraocular Pressure. Curr Eye Res 2020; 45:199-210. [PMID: 31453714 PMCID: PMC7398593 DOI: 10.1080/02713683.2019.1660371] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/05/2019] [Accepted: 08/21/2019] [Indexed: 12/15/2022]
Abstract
Purpose/Aim: We used magnetic resonance imaging (MRI) to investigate effects of intraocular pressure (IOP), race, and other factors on optic nerve (ON) traction in adduction, a phenomenon proposed as neuropathic in open angle glaucoma (OAG).Materials and Methods: Thirty-five patients with OAG (26 with maximal untreated IOP ≤21 mmHg, 9 with IOP >21mmHg) and 48 controls underwent axial and quasi-coronal MRI in central gaze and large (27-33°) abduction and adduction. Some underwent MRI at smaller ductions (21-28°). Effects of presence vs. absence of OAG; within OAG whether maximum IOP level was ≤21 mmHg vs. >21 mmHg; adduction angle; race; age; and gender on ON path length and globe translation were analyzed using generalized estimating equations to account for possible intereye correlations of individual subjects.Results: Average visual field mean deviation (±standard error of mean, SEM) was -8.2 ± 1.2 dB in OAG with normal IOP, and -6.1 ± 1.4 in high IOP. In central gaze, ON path in OAG was significantly more redundant than in controls but in both groups the ON became significantly and almost equally straighter in small (~21°) or large (~27°) adduction than in central gaze. With progressive adduction only, globes retracted in OAG (P < 0.005) but not in controls; this was only weakly related to globe size and not to IOP elevation. Globe retraction in adduction was significant only in OAG, and in that group was significantly greater in Asian than white patients (P < 0.02).Conclusions: Although ON tethering in adduction is normal, progressive adduction is associated with abnormal globe retraction in OAG regardless of IOP level. This phenomenon is more prominent in Asians who have OAG. Traction in adduction may cause repetitive strain injury to the ON and peripapillary sclera, thus contributing to the optic neuropathy of glaucoma independent of IOP.
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Affiliation(s)
- Joseph L. Demer
- Department of Ophthalmology, University of California, Los Angeles
- Stein Eye Institute; University of California, Los Angeles
- Biomedical Engineering Interdepartmental Program; University of California, Los Angeles
- Neuroscience Interdepartmental Program; University of California, Los Angeles
- Department of Neurology, University of California, Los Angeles
| | - Robert A. Clark
- Department of Ophthalmology, University of California, Los Angeles
- Stein Eye Institute; University of California, Los Angeles
| | - Soh Youn Suh
- Department of Ophthalmology, University of California, Los Angeles
| | - JoAnn A. Giaconi
- Department of Ophthalmology, University of California, Los Angeles
- Stein Eye Institute; University of California, Los Angeles
| | - Kouros Nouri-Mahdavi
- Department of Ophthalmology, University of California, Los Angeles
- Stein Eye Institute; University of California, Los Angeles
| | - Simon K. Law
- Department of Ophthalmology, University of California, Los Angeles
- Stein Eye Institute; University of California, Los Angeles
| | - Laura Bonelli
- Department of Ophthalmology, University of California, Los Angeles
- Stein Eye Institute; University of California, Los Angeles
| | - Anne L. Coleman
- Department of Ophthalmology, University of California, Los Angeles
- Stein Eye Institute; University of California, Los Angeles
| | - Joseph Caprioli
- Department of Ophthalmology, University of California, Los Angeles
- Stein Eye Institute; University of California, Los Angeles
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Moiseev RV, Morrison PWJ, Steele F, Khutoryanskiy VV. Penetration Enhancers in Ocular Drug Delivery. Pharmaceutics 2019; 11:E321. [PMID: 31324063 PMCID: PMC6681039 DOI: 10.3390/pharmaceutics11070321] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 12/12/2022] Open
Abstract
There are more than 100 recognized disorders of the eye. This makes the development of advanced ocular formulations an important topic in pharmaceutical science. One of the ways to improve drug delivery to the eye is the use of penetration enhancers. These are defined as compounds capable of enhancing drug permeability across ocular membranes. This review paper provides an overview of anatomical and physiological features of the eye and discusses some common ophthalmological conditions and permeability of ocular membranes. The review also presents the analysis of literature on the use of penetration-enhancing compounds (cyclodextrins, chelating agents, crown ethers, bile acids and bile salts, cell-penetrating peptides, and other amphiphilic compounds) in ocular drug delivery, describing their properties and modes of action.
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Affiliation(s)
- Roman V Moiseev
- Reading School of Pharmacy, University of Reading, Whiteknights, P.O. Box 224, Reading RG66AD, UK
| | - Peter W J Morrison
- Reading School of Pharmacy, University of Reading, Whiteknights, P.O. Box 224, Reading RG66AD, UK
| | - Fraser Steele
- MC2 Therapeutics, James House, Emlyn Lane, Leatherhead KT22 7EP, UK
| | - Vitaliy V Khutoryanskiy
- Reading School of Pharmacy, University of Reading, Whiteknights, P.O. Box 224, Reading RG66AD, UK.
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13
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Nakagawa A, Sakai O, Tokushige H, Fujishiro T, Aihara M. Development and characterization of a new rat ocular hypertension model induced by intracameral injection of conjunctival fibroblasts. Sci Rep 2019; 9:6593. [PMID: 31036934 PMCID: PMC6488598 DOI: 10.1038/s41598-019-43048-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 04/08/2019] [Indexed: 12/05/2022] Open
Abstract
Glaucoma is a chronic optic neuropathy that leads to visual field loss. Elucidating the mechanisms underlying glaucoma is essential for developing new treatments, such as neuroprotective drugs. Various glaucoma models based on the induction of intraocular pressure (IOP) elevation have been established for use in glaucoma studies. However, the time-dependent pathological changes accompanying IOP elevation have not been fully elucidated. In this study, rat conjunctival fibroblasts were injected into the anterior chamber of rat eyes, and IOP elevation was induced for 28 days. Glaucomatous signs such as optic nerve head cupping, retinal thinning, glial activation and apoptotic signaling in the retina were obvious in the cell-injected eyes on the 14th day after injection. The pattern of retinal ganglion cell (RGC) loss differed by the magnitude of IOP elevation. The number of RGCs decreased by 37.5% in eyes with IOP lower than 50 mmHg (Under-50) and by 88.0% in those with IOP higher than 50 mmHg (Over-50) 28 days after cell injection. The RGC counts were correlated with IOP in the Under-50 group but not in the Over-50 group. Our model may contribute to the investigation of pathogenic mechanisms of glaucoma and the development of new glaucoma treatments.
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Affiliation(s)
- Ayumi Nakagawa
- Central Research Laboratories, Senju Pharmaceutical Co., Ltd., 6-4-3, Minatojima-Minamimachi, Chuoku, Kobe, Hyogo, 650-0047, Japan
| | - Osamu Sakai
- Central Research Laboratories, Senju Pharmaceutical Co., Ltd., 6-4-3, Minatojima-Minamimachi, Chuoku, Kobe, Hyogo, 650-0047, Japan
| | - Hideki Tokushige
- Central Research Laboratories, Senju Pharmaceutical Co., Ltd., 6-4-3, Minatojima-Minamimachi, Chuoku, Kobe, Hyogo, 650-0047, Japan
| | - Takashi Fujishiro
- Department of Ophthalmology, University of Tokyo, 7-3-1, Hongo, Bunkyoku, Tokyo, 113-8655, Japan
| | - Makoto Aihara
- Department of Ophthalmology, University of Tokyo, 7-3-1, Hongo, Bunkyoku, Tokyo, 113-8655, Japan.
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14
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Mahalingam K, Chaurasia AK, Gowtham L, Gupta S, Somarajan BI, Velpandian T, Sihota R, Gupta V. Therapeutic potential of valproic acid in advanced glaucoma: A pilot study. Indian J Ophthalmol 2018; 66:1104-1108. [PMID: 30038151 PMCID: PMC6080453 DOI: 10.4103/ijo.ijo_108_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/23/2018] [Indexed: 11/12/2022] Open
Abstract
Purpose Oral valproic acid (VPA) used as an anticonvulsant has been shown to improve contrast threshold sensitivities in patients receiving it on long-term. This study aimed to evaluate the efficacy of oral VPA in improving visual function in eyes with advanced stage glaucoma. Methods In this prospective randomized study, 31 patients (n = 31 eyes) with advanced stage glaucoma (with an intraocular pressure <16 mmHg) in at least one eye received oral VPA 500 mg once a day for 3 months and 33 patients (n = 33 eyes) continued on glaucoma therapy. Patients were followed up at 3 and 12 months (to evaluate the legacy effect of the drug). Blood VPA concentrations were measured at 3 months. Following parameters were assessed at baseline, 3 months and 12 months: log of the minimum angle of resolution (LogMAR) visual acuity, mean deviation on visual fields, and multifocal electroretinogram (ERG). Results Median LogMar visual acuity in the VPA group improved from 0.3 at baseline to 0.18 and 0.18 at 3 and 12 months, respectively (P < 0.01). In comparison, the median visual acuity in control group at baseline was 0.18 and showed neither worsening nor improvement over 3 and 12 months (P = 0.56). The improvement in VPA group was significant compared to the control group (P < 0.01; Wilcoxon Signed-rank test). An improvement in one line was experienced in 11 out of 31 eyes in the VPA group compared to 1 out of 33 eyes among controls (P = 0.003). No significant improvement was noted in the mean deviation, and the multifocal ERG (Latency and amplitudes) in the VPA-treated patients. The average blood VPA concentration measured at 3 months of therapy was 26 ± 8.9 μg/ml (range 8-55 μg/ml) which is much lower than that achieved during anticonvulsant therapy. None of the patients complained of any adverse effects that required stopping VPA therapy. Conclusion A 3 months oral VPA therapy results in some improvement in visual acuity in a subgroup of eyes with advanced glaucoma and the effect was seen to persist 9 months after the drug was stopped.
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Affiliation(s)
- Karthikeyan Mahalingam
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Abadh Kumar Chaurasia
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shikha Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Bindu I Somarajan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Thirumurthy Velpandian
- Department of Ocular Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Ramanjit Sihota
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Viney Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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