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Wang Y, Liu Y, Wang Y, Wu Y, Chen Z, Wang F, Wan X, Wang F, Sun X. Macrophage Sult2b1 promotes pathological neovascularization in age-related macular degeneration. Life Sci Alliance 2023; 6:e202302020. [PMID: 37550000 PMCID: PMC10427760 DOI: 10.26508/lsa.202302020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023] Open
Abstract
Disordered immune responses and cholesterol metabolism have been implicated in age-related macular degeneration (AMD), the leading cause of blindness in elderly individuals. SULT2B1, the key enzyme of sterol sulfonation, plays important roles in inflammation and cholesterol metabolism. However, the role and underlying mechanism of SULT2B1 in AMD have not been investigated thus far. Here, we report that SULT2B1 is specifically expressed in macrophages in choroidal neovascularization lesions. Sutl2b1 deficiency significantly reduced leakage areas and inhibited pathological angiogenesis by inhibiting M2 macrophage activation in vivo and in vitro. Mechanistically, loss of Sult2b1 activated LXRs and subsequently increased ABCA1 and ABCG1 (ABCA1/G1)-mediated cholesterol efflux from M2 macrophages. LXR inhibition (GSK2033 treatment) in Sult2b1 -/- macrophages reversed M2 polarization and decreased intracellular cholesterol capacity to promote pathological angiogenesis. In contrast to SULT2B1, STS, an enzyme of sterol desulfonation, protected against choroidal neovascularization development by activating LXR-ABCA1/G1 signalling to block M2 polarization. Collectively, these data reveal a cholesterol metabolism axis related to macrophage polarization in neovascular AMD.
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Affiliation(s)
- Yafang Wang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Liu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Wang
- Medical Research Center, Peking University Third Hospital, Beijing, China
| | - Yidong Wu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhixuan Chen
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Wang
- Shanghai Institute of Immunology, Department of Immunology and Microbiology, State Key Laboratory of Oncogenes and Related Genes, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoling Wan
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
| | - Fenghua Wang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
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Garweg JG, Keiper J, Pfister IB, Schild C. Functional Outcomes of Brolucizumab-Induced Intraocular Inflammation Involving the Posterior Segment-A Meta-Analysis and Systematic Review. J Clin Med 2023; 12:4671. [PMID: 37510788 PMCID: PMC10380786 DOI: 10.3390/jcm12144671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Early poor outcomes of intraocular inflammation (IOI) after intravitreal brolucizumab (IVB) have negatively affected the use of brolucizumab in clinical routine. We wished to identify factors related to the treatment details of IOI involving the posterior segment resulting from IVB for neovascular AMD (nAMD), if these were reported in detail. Articles were retrieved from PubMed, Scopus, ClinicalTrials, and CENTRAL using the following search terms: <Brolucizumab> AND <AMD> AND <intraocular inflammation>. The risk of bias was rated using the JBI Critical Appraisal Tool. We included 31 reports (41 patients and 46 eyes). Patients were 75.9 ± 8.5 years, and 58.5% were female. IOI occurred 41.7 ± 37.5 (median 37.0) days after treatment initiation with 2.0 ± 1.3 (1-6) IVB injections. A mean change in visual acuity of -14.6 ± 21.0 (median -6.5) letters was reported. The mean time from first IOI signs to the initiation of any anti-inflammatory treatment was 3.3 ± 6.2 days, with 63% of the patients receiving systemic corticosteroids as standard treatment. Finally, a period effect was observed, with a change in visual acuity of -25.3 ± 27.1 and -2.6 ± 7.3 letters in the chronologically first and last third, respectively, of treated eyes (effect size: r = 0.71; p = 0.006). Functional outcomes markedly improved with increasing experience in managing IOI.
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Affiliation(s)
- Justus G Garweg
- Swiss Eye Institute and Clinic for Vitreoretinal Disease, Berner Augenklinik, 3007 Bern, Switzerland
- Department of Ophthalmology, Inselspital (Bern University Hospital), University of Bern, 3010 Bern, Switzerland
| | - Judith Keiper
- Swiss Eye Institute and Clinic for Vitreoretinal Disease, Berner Augenklinik, 3007 Bern, Switzerland
- Department of Ophthalmology, Inselspital (Bern University Hospital), University of Bern, 3010 Bern, Switzerland
| | - Isabel B Pfister
- Swiss Eye Institute and Clinic for Vitreoretinal Disease, Berner Augenklinik, 3007 Bern, Switzerland
| | - Christin Schild
- Swiss Eye Institute and Clinic for Vitreoretinal Disease, Berner Augenklinik, 3007 Bern, Switzerland
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Vogt D, Deiters V, Herold TR, Guenther SR, Kortuem KU, Priglinger SG, Wolf A, Schumann RG. Optimal patient adherence and long-term treatment outcomes of neovascular age-related macular degeneration in real-life. Curr Eye Res 2022; 47:889-896. [PMID: 35179427 DOI: 10.1080/02713683.2022.2044056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To report on long-term real-life outcomes of anti-vascular endothelial growth factor (anti-VEGF) therapy in neovascular age-related macular degeneration (nAMD) with optimal patient adherence. METHODS For this retrospective monocenter study, we identified 3217 eyes of 2793 patients that received a minimum of three intravitreal anti-VEGF injections for nAMD therapy between 2006 and 2014 at the University Eye Hospital Munich. From those, we included eyes with treatment-naïve nAMD, follow-up (FU) of ≥60 months and continuous adherence during FU. Primary measures were corrected visual acuity (VA), number of injections and visits as well as treatment regimen. RESULTS We included 161 eyes of 125 patients with a mean FU of 8.0 ± 2.3 years. Mean VA at baseline was 60.1 letters (Snellen equivalent, 20/63). After the third year, mean VA declined constantly by 2-3 letters per year. After 5 and 8 years, 26.1% and 42.1% had lost at least 3 lines from baseline. Mean cumulative number of injections was 5.3 after the first year, and 23.9, 38.1, 48.5 after 5, 8, and 10 years. 'Treat and extent' regimen with higher injection frequency correlated with better function. At time of last FU, 69.8% of eyes were under active treatment. Eyes with ≥70 letters at baseline correlated with better VA at the end of FU. CONCLUSIONS Despite optimal patient adherence, visual function declined progressively in real-life nAMD therapy over long-term. The highest impact on treatment success is given by an early treatment start with individual but intensive anti-VEGF therapy.
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Affiliation(s)
- Denise Vogt
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Viktoria Deiters
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Tina R Herold
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Stefanie R Guenther
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Karsten U Kortuem
- Department of Ophthalmology, University Hospital Ulm, Priettwitzstr. 43, 89075 Ulm, Germany
| | - Siegfried G Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany
| | - Armin Wolf
- Department of Ophthalmology, University Hospital Ulm, Priettwitzstr. 43, 89075 Ulm, Germany
| | - Ricarda G Schumann
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Mathildenstr. 8, 80336 Munich, Germany.,Munich Eye Center Brienner Hof, Brienner Str. 12, 80333 Munich, Germany
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Garweg JG, Gerhardt C. Disease stability and extended dosing under anti-VEGF treatment of exudative age-related macular degeneration (AMD) - a meta-analysis. Graefes Arch Clin Exp Ophthalmol 2021; 259:2181-2192. [PMID: 33528645 PMCID: PMC8352813 DOI: 10.1007/s00417-020-05048-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To assess disease stability (absence of intra- and/or subretinal fluid) and the portion of eyes being capable to extend their treatment interval to ≥ 12 weeks in exudative age-related macular degeneration (AMD). METHODS A systematic literature search was performed in NCBI, PubMed, CENTRAL, and ClinicalTrials.gov to identify clinical studies reporting treatment outcomes for ranibizumab, aflibercept, and brolucizumab in exudative AMD under a treat-and-extend protocol and a follow-up of ≥ 12 months. Weighted mean differences and subgroup comparisons were used to integrate the different studies. RESULTS This meta-analysis refers to 29 published series, including 27 independent samples and 5629 patients. In the pooled group, disease stability was reported in 62.9% and 56.0%, respectively, after 12 and 24 months of treatment, whereas treatment intervals were extended to ≥ 12 weeks in 37.7% and 42.6%, respectively. Ranibizumab, aflibercept, and brolucizumab differed regarding their potential to achieve disease stability (56.3%, 64.5%, and 71.5% after 12, and 50.0%, 52.7% and 75.7% after 24 months; p = < 0.001) and to allow an interval extension to ≥ 12 weeks (28.6%, 34.2%, and 53.3% after 12, and 34.2%, 47.7%, and 41.7% after 24 months; p = < 0.001). CONCLUSION The portion of eyes achieving disease stability regressed in the second year, whereas the portion of eyes under a ≥ 12-week interval increased. This discrepancy may reflect the challenges in balancing between under-treatment and a reduced treatment burden.
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Affiliation(s)
- Justus G Garweg
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland. .,Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland.
| | - Christin Gerhardt
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
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Kaya C, Zandi S, Pfister IB, Gerhardt C, Garweg JG. Adding a Corticosteroid or Switching to Another Anti-VEGF in Insufficiently Responsive Wet Age-Related Macular Degeneration. Clin Ophthalmol 2019; 13:2403-2409. [PMID: 31824134 PMCID: PMC6901048 DOI: 10.2147/opth.s224456] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/15/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose To compare the effect of adding a corticosteroid or switching to another anti-VEGF treatment in patients with exudative age-related macular degeneration (eAMD) with persisting intraretinal fluid on anti-VEGF monotherapy. Methods This retrospective, interventional case series involved 43 pseudophakic eyes with eAMD and persistent intraretinal fluid on anti-VEGF treatment that switched treatment to a combination of Ozurdex® or Triamcinolone and anti-VEGF therapy (group 1) or to another anti-VEGF agent (group 2). The number of injections, time to re-injection, change in central retinal thickness (CRT), and best-corrected visual acuity (BCVA) from 12 months prior to 12 months after switch to third-line therapy were defined as primary outcomes. Results Whereas the treatment demand was reduced (from 8.8±2.2 to 4.6±2.9 injections; p=0.001) and the re-injection interval extended in group 1 (from 1.5±0.4 months to 4.4±3.8 months; p=0.001), these parameters did not change in group 2 (7.4±1.6 to 7.3±2.2; p=0.90 and 1.7±0.3 months to 1.9±0.8 months; p=0.75). Mean CRT decreased from 455.7±30.1 and 427.6±36.0µm (groups 1 and 2, respectively) to 359.1±38.2 and 303.1±44.4µm (intergroup p=0.03). The mean baseline BCVA of 62.6±3.8 letters (group 1) and 63.0±1.9 letters (group 2) remained stable under therapy in both groups (intergroup p=0.67). Conclusion In eyes with eAMD with persistent intraretinal fluid on anti-VEGF monotherapy despite frequent re-injections, corticosteroids achieved a similar functional and morphological outcome over 12 months as switching to another anti-VEGF therapy, but with a reduced injection burden. In selected cases, corticosteroid treatment may thus be an option for third-line therapy in refractory exudative AMD.
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Affiliation(s)
- Cagdas Kaya
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Souska Zandi
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland.,Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Isabel B Pfister
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland.,Department Ophthalmology, University Hospital Bern, Bern, Switzerland
| | - Christin Gerhardt
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland.,Department Ophthalmology, University Hospital Bern, Bern, Switzerland
| | - Justus G Garweg
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland.,Department Ophthalmology, University Hospital Bern, Bern, Switzerland
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Garweg JG. Twelve-week dosing with Aflibercept in the treatment of neovascular age-related macular degeneration. Clin Ophthalmol 2019; 13:1289-1295. [PMID: 31409968 PMCID: PMC6650619 DOI: 10.2147/opth.s185756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/11/2019] [Indexed: 12/16/2022] Open
Abstract
Purpose To review published evidence for a treatment interval extension to ≥12-weeks in neovascular macular degeneration treated with intravitreal Aflibercept. Methods A systematic search was performed in the NCBI/PubMed database to identify pro- and retrospective studies retrieved by the key terms <exudative> or <neovascular> and <AMD> or <age-related macular degeneration> AND <intravitreal therapy> AND <Aflibercept> and included all papers that used a treat-and-extend (T&E) protocol including a loading phase of 3 intravitreal anti-VEGF injections and a minimal follow-up of 2 years. Disease stability was defined as the absence of any intraocular and absence or stability of subretinal fluid and pigment-epithelial detachment. Results Four studies were identified that reported information pertaining to disease stability or treatment extension beyond 12 weeks under intravitreal Aflibercept therapy including 1,102 eyes in total. Following a T&E protocol, a mean of 62.9% achieved disease stability and a 6.9 letter gain based on 11.9 injections over 24 months of Aflibercept treatment. As much as 43.0% of all eyes or 64.1% of the eyes with stable disease were maintained on ≥12-weekly injection intervals. Conclusions A consequent treatment with a null tolerance for intraretinal fluid is prerequisite to induce stability and maintain visual gain after the loading phase. Using Aflibercept in a T&E protocol, disease stability and interval extension to ≥12 weeks were reported in 43% of the eyes by end of the second year with less injections, but similar results as under fix dosing. A lower treatment burden strongly argues for an individualized proactive treatment regimen.
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Affiliation(s)
- Justus G Garweg
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik Am Lindenhofspital, Bern, Switzerland.,Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland
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Ocular gene therapies in clinical practice: viral vectors and nonviral alternatives. Drug Discov Today 2019; 24:1685-1693. [PMID: 31173914 DOI: 10.1016/j.drudis.2019.05.038] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/17/2019] [Accepted: 05/31/2019] [Indexed: 12/15/2022]
Abstract
Ocular gene therapy has entered into clinical practice. Although viral vectors are currently the best option to replace and/or correct genes, the optimal method to deliver these treatments to the retinal pigment epithelial (RPE) cells and/or photoreceptor cells remains to be improved to increase transduction efficacy and reduce iatrogenic risks. Beyond viral-mediated gene replacement therapies, nonviral gene delivery approaches offer the promise of sustained fine-tuned expression of secreted therapeutic proteins that can be adapted to the evolving stage of the disease course and can address more common nongenetic retinal diseases, such as age-related macular degeneration (AMD). Here, we review current gene therapy strategies for ocular diseases, with a focus on clinical stage products.
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Past and prognosis of anti-VEGF therapy for wet age-related macular degeneration—the future has begun. Graefes Arch Clin Exp Ophthalmol 2018; 256:1553-1555. [DOI: 10.1007/s00417-018-4005-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 05/02/2018] [Indexed: 01/24/2023] Open
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Garweg JG, Zirpel JJ, Gerhardt C, Pfister IB. The fate of eyes with wet AMD beyond four years of anti-VEGF therapy. Graefes Arch Clin Exp Ophthalmol 2018; 256:823-831. [DOI: 10.1007/s00417-018-3907-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/27/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022] Open
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Garweg JG, Niderprim SA, Russ HM, Pfister IB. Comparison of Strategies of Treatment with Ranibizumab in Newly-Diagnosed Cases of Neovascular Age-Related Macular Degeneration. J Ocul Pharmacol Ther 2017; 33:773-778. [DOI: 10.1089/jop.2017.0006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Justus G. Garweg
- Swiss Eye Institute, Rotkreuz, Switzerland
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
- University of Bern, Bern, Switzerland
| | - Sophie A. Niderprim
- Swiss Eye Institute, Rotkreuz, Switzerland
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
- University of Bern, Bern, Switzerland
| | - Hanna Maria Russ
- University of Bern, Bern, Switzerland
- Clinic for Radiology and Nuclear Medicine, University Hospital Lübeck, Lübeck, Germany
- Department of Interventional Radiology, Lübeck, Germany
| | - Isabel B. Pfister
- Swiss Eye Institute, Rotkreuz, Switzerland
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
- University of Bern, Bern, Switzerland
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