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Alev-Tuzuner B, Oktay S, Cergel E, Elik G, Magaji UF, Sacan O, Yanardag R, Yarat A. Moringa oleifera hydroalcoholic leaf extracts mitigate valproate-induced oxidative status in the extraorbital lacrimal gland in a rat model. Exp Eye Res 2024; 248:110104. [PMID: 39303844 DOI: 10.1016/j.exer.2024.110104] [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: 05/27/2024] [Revised: 09/02/2024] [Accepted: 09/18/2024] [Indexed: 09/22/2024]
Abstract
Dysfunction of the extraorbital lacrimal gland (ELG) can lead to loss of vision due to damage to the epithelium of cornea. The broad-spectrum anti-epileptic drug sodium valproate (SV) has numerous side effects. Moringa oleifera (M.oleifera) is widely used as a food and in folk medicine. The effects of orally administered SV and M. oleifera hydroalcoholic leaf extract on rat ELG were investigated in this study by analysing both antioxidant and oxidant parameters. Additionally, boron level and tissue factor (TF) activity were determined. Protein changes were detected by sodium dodecyl sulfate gel electrophoresis (SDS-PAGE). Significantly lower values of glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) and total antioxidant status (TAS) were observed in the SV group compared to the control group. Treatment with Moringa extract significantly increased SOD, CAT and TAS values in the Moringa given SV group (SVM). While no significant differences were observed between the sialic acid values of the groups, lipid peroxidation (LPO), nitric oxide (NO) and total oxidant status (TOS) values were significantly elevated in the SV group compared to the control group. Due to the effect of Moringa extract, LPO, NO and TOS levels were significantly decreased in the SVM group compared to the SV group. TF activity was not meaningfully altered between groups. Compared to control rats, oxidative stress index (OSI) level significantly increased, whereas the boron level decreased in the SV group. Moringa extract treatment noticeably reduced OSI in the SVM group. According to SDS-PAGE, decreases in the density of protein bands with molecular weights of 51, 83, and 90 kDa were observed in SV given rats compared to the other groups. These decreases were reversed by the administration of Moringa extract. Moringa extract has shown protective properties arising from antioxidant potential, especially with its very low OSI value. Individuals undergoing SV treatment and having ELG complications might consider using Moringa extract to mitigate valproate induced damage.
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Affiliation(s)
- Burcin Alev-Tuzuner
- Istanbul Gelisim University, Faculty of Dentistry, Basic Medical Sciences, Biochemistry, Avcilar, Istanbul, Turkiye; Istanbul Gelisim University, Life Sciences and Biomedical Engineering Application and Research Centre, Istanbul, Turkiye.
| | - Sehkar Oktay
- Marmara University, Faculty of Dentistry, Basic Medical Sciences, Biochemistry, Maltepe, Istanbul, Turkiye.
| | - Eda Cergel
- Haliç University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Eyupsultan, Istanbul, Turkiye.
| | - Gulsum Elik
- Egil District State Hospital, Department of Nutrition and Dietetics, Egil, Diyarbakir, Turkiye.
| | - Umar Faruk Magaji
- Istanbul University-Cerrahpaşa, Faculty of Engineering, Department of Chemistry, Avcilar, Istanbul, Turkiye; Federal University Birnin Kebbi, Department of Biochemistry and Molecular Biology, Birnin Kebbi, Kebbi, Nigeria.
| | - Ozlem Sacan
- Istanbul University-Cerrahpaşa, Faculty of Engineering, Department of Chemistry, Avcilar, Istanbul, Turkiye.
| | - Refiye Yanardag
- Istanbul University-Cerrahpaşa, Faculty of Engineering, Department of Chemistry, Avcilar, Istanbul, Turkiye.
| | - Aysen Yarat
- Marmara University, Faculty of Dentistry, Basic Medical Sciences, Biochemistry, Maltepe, Istanbul, Turkiye.
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Woronkowicz M, Roberts H, Skopiński P. The Role of Insulin-like Growth Factor (IGF) System in the Corneal Epithelium Homeostasis-From Limbal Epithelial Stem Cells to Therapeutic Applications. BIOLOGY 2024; 13:144. [PMID: 38534414 DOI: 10.3390/biology13030144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/28/2024]
Abstract
The corneal epithelium, comprising three layers of cells, represents the outermost portion of the eye and functions as a vital protective barrier while concurrently serving as a critical refractive structure. Maintaining its homeostasis involves a complex regenerative process facilitated by the functions of the lacrimal gland, tear film, and corneal nerves. Crucially, limbal epithelial stem cells located in the limbus (transitional zone between the cornea and the conjunctiva) are instrumental for the corneal epithelium integrity by replenishing and renewing cells. Re-epithelialization failure results in persistent defects, often associated with various ocular conditions including diabetic keratopathy. The insulin-like growth factor (IGF) system is a sophisticated network of insulin and other proteins essential for numerous physiological processes. This review examines its role in maintaining the corneal epithelium homeostasis, with a special focus on the interplay with corneal limbal stem cells and the potential therapeutic applications of the system components.
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Affiliation(s)
- Małgorzata Woronkowicz
- NDDH, Royal Devon University Healthcare NHS Foundation Trust, Barnstaple EX31 4JB, UK
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Harry Roberts
- West of England Eye Unit, Royal Devon University Healthcare NHS Foundation Trust, Exeter EX2 5DW, UK
- University of Exeter Medical School, Exeter EX1 2HZ, UK
| | - Piotr Skopiński
- Department of Ophthalmology, SPKSO Ophthalmic University Hospital, Medical University of Warsaw, 00-576 Warsaw, Poland
- Department of Histology and Embryology, Medical University of Warsaw, 02-004 Warsaw, Poland
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Locatelli EVT, Huang JJ, Mangwani-Mordani S, Tovar Vetencourt AA, Galor A. Individuals with Diabetes Mellitus Have a Dry Eye Phenotype Driven by Low Symptom Burden and Anatomic Abnormalities. J Clin Med 2023; 12:6535. [PMID: 37892672 PMCID: PMC10607897 DOI: 10.3390/jcm12206535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/29/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Dry eye disease is an umbrella term that includes a variety of symptoms and signs. A link between diabetes mellitus and dry eye disease exists, but the associated phenotype needs further examination. Thus, our aim was to determine how diabetes mellitus relates to the dry eye disease phenotype. A prospective, cross-sectional study was conducted at the Miami Veteran Affairs Medical Center ophthalmology clinic between October 2013 and September 2019. Participants included a volunteer sample of 366 South Florida veterans with one or more symptoms or signs of dry eye disease [Dry Eye Questionnaire-5 ≥ 6 OR tear break-up time ≤ 5 OR Schirmer's test score ≤ 5 OR corneal fluorescein staining ≥ 2]. Participants were divided into three groups: (1) individuals without diabetes mellitus (controls); (2) individuals with diabetes mellitus but without end-organ complications; and (3) individuals with diabetes mellitus and end-organ complications. Dry eye metrics were compared across groups. The main outcome measures included ocular symptom questionnaires [e.g., 5-item Dry Eye Questionnaire, Ocular Surface Disease Index, and ocular pain assessment] and clinical parameters obtained from an ocular surface evaluation. A total of 366 individuals were included (mean age 59 ± 6 years; 89% males; 39% White; 11% diabetes mellitus and end-organ complications; 15% diabetes mellitus but without end-organ complications). Individuals with diabetes mellitus and end-organ complications had lower symptom scores on the dry eye disease and pain-specific questionnaires compared to individuals with diabetes mellitus but without end-organ complications and controls (Ocular Surface Disease Index: 42.1 ± 24.5 vs. 38.9 ± 25.1 vs. 23.6 ± 16.2; p < 0.001; numerical rating scale of ocular pain intensity: 4.9 ± 3.2 vs. 4.3 ± 2.7 vs. 3.5 ± 2.7; p = 0.02). Eyelid laxity was also more severe in the group with diabetes mellitus and end-organ complications (0.69 ± 0.64 vs. 0.73 ± 0.72 vs. 1.08 ± 0.77; p = 0.004) compared to the two other groups. The diabetic dry eye disease phenotype is driven by signs more so than by symptoms, with anatomic eyelid abnormalities being more frequent in individuals with diabetes mellitus and end-organ complications. Given this, ocular surface abnormalities in individuals with DM may be missed if screened by symptoms alone. As such, individuals with DM should undergo a slit lamp examination for signs of ocular surface disease, including anatomic abnormalities.
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Affiliation(s)
- Elyana V. T. Locatelli
- Surgical and Research Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA; (E.V.T.L.); (J.J.H.); (S.M.-M.)
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA;
| | - Jaxon J. Huang
- Surgical and Research Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA; (E.V.T.L.); (J.J.H.); (S.M.-M.)
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA;
| | - Simran Mangwani-Mordani
- Surgical and Research Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA; (E.V.T.L.); (J.J.H.); (S.M.-M.)
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA;
| | | | - Anat Galor
- Surgical and Research Services, Miami Veterans Affairs Medical Center, Miami, FL 33125, USA; (E.V.T.L.); (J.J.H.); (S.M.-M.)
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA;
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Faustino-Barros JF, Saranzo Sant'Ana AM, Dias LC, de Andrade Batista Murashima A, Costa Mendes da Silva LE, Fantucci MZ, Garcia DM, Rocha EM. Distinct Inflammatory and Oxidative Effects of Diabetes Mellitus and Hypothyroidism in the Lacrimal Functional Unit. Int J Mol Sci 2023; 24:ijms24086974. [PMID: 37108138 PMCID: PMC10138510 DOI: 10.3390/ijms24086974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 04/29/2023] Open
Abstract
Diabetes mellitus (DM) and hypothyroidism (HT) are prevalent diseases associated with dry eye (DE). Their impact on the lacrimal functional unit (LFU) is poorly known. This work evaluates the changes in the LFU in DM and HT. Adult male Wistar rats had the disease induced as follows: (a) DM: streptozotocin and (b) HT: methimazole. The tear film (TF) and blood osmolarity were measured. Cytokine mRNA was compared in the lacrimal gland (LG), trigeminal ganglion (TG), and cornea (CO). Oxidative enzymes were evaluated in the LG. The DM group showed lower tear secretion (p = 0.02) and higher blood osmolarity (p < 0.001). The DM group presented lower mRNA expression of TRPV1 in the cornea (p = 0.03), higher Il1b mRNA expression (p = 0.03), and higher catalase activity in the LG (p < 0.001). The DM group presented higher Il6 mRNA expression in the TG (p = 0.02). The HT group showed higher TF osmolarity (p < 0.001), lower expression of Mmp9 mRNA in the CO (p < 0.001), higher catalase activity in the LG (p = 0.002), and higher expression of Il1b mRNA in the TG (p = 0.004). The findings revealed that DM and HT induce distinct compromises to the LG and the entire LFU.
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Affiliation(s)
- Jacqueline Ferreira Faustino-Barros
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, Brazil
| | - Ariane Mirela Saranzo Sant'Ana
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, Brazil
| | - Lara Cristina Dias
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, Brazil
| | - Adriana de Andrade Batista Murashima
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, Brazil
| | - Lilian Eslaine Costa Mendes da Silva
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, Brazil
| | - Marina Zílio Fantucci
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, Brazil
| | - Denny Marcos Garcia
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, Brazil
| | - Eduardo Melani Rocha
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto 14049-900, Brazil
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Peterson C, Chandler HL. Insulin facilitates corneal wound healing in the diabetic environment through the RTK-PI3K/Akt/mTOR axis in vitro. Mol Cell Endocrinol 2022; 548:111611. [PMID: 35231580 PMCID: PMC9053186 DOI: 10.1016/j.mce.2022.111611] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 12/13/2022]
Abstract
Diabetic patients can develop degenerative corneal changes, termed diabetic keratopathy, during the course of their disease. Topical insulin has been shown to reduce corneal wound area and restore sensitivity in diabetic rats, and both the insulin receptor (IR) and insulin-like growth factor 1 receptor (IGF-1R) stimulate cell signaling of the PI3K-Akt pathway. The purpose of this study was to assess a mechanism by which improved wound healing occurs by characterizing expression within the PI3K-Akt pathway in corneal epithelial and stromal cells. In vitro scratch tests were used to evaluate wound healing outcomes under variable glucose conditions in the presence or absence of insulin. Protein expression of intracellular kinases in the PI3K pathway, stromal cell markers, and GLUT-1 was evaluated by immunoblotting.TGF-β1 expression was evaluated by ELISA. Insulin promoted in vitro wound healing in all cell types. In human corneal epithelial cells, insulin did not induce PI3K-Akt signaling; however, in all other cell types evaluated, insulin increased expression of PI3K-Akt signaling proteins compared to vehicle control. Fibroblasts variably expressed α-SMA under all treatment conditions, with significant increases in α-SMA and TGF-β1 occurring in a dose-dependent manner with glucose concentration. These results indicate that insulin can promote corneal cellular migration and proliferation by inducing Akt signaling. Exogenous insulin therapy may serve as a novel target of therapeutic intervention for diabetic keratopathy.
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Affiliation(s)
- C Peterson
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA; Department of Vision Science, The Ohio State University College of Optometry, Columbus, OH, 43210, USA.
| | - H L Chandler
- Department of Vision Science, The Ohio State University College of Optometry, Columbus, OH, 43210, USA
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6
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Lemos CN, da Silva LECM, Faustino JF, Fantucci MZ, Murashima ADAB, Adriano L, Alves M, Rocha EM. Oxidative Stress in the Protection and Injury of the Lacrimal Gland and the Ocular Surface: are There Perspectives for Therapeutics? Front Cell Dev Biol 2022; 10:824726. [PMID: 35359431 PMCID: PMC8963457 DOI: 10.3389/fcell.2022.824726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/16/2022] [Indexed: 12/24/2022] Open
Abstract
Oxidative stress (OS) is a major disruption in the physiology of the lacrimal functional unit (LFU). Antioxidant enzymes have dual protective activities: antioxidant and antimicrobial activities. Peroxidases have been indistinctly used as markers of the secretory activity of the LFU and implicated in the pathophysiology, diagnosis and treatment of dry eye disease (DED), even though they comprise a large family of enzymes that includes lactoperoxidase (LPO) and glutathione peroxidase (GPO), among others. Assays to measure and correlate OS with other local LFU phenomena have methodological limitations. Studies implicate molecules and reactions involved in OS as markers of homeostasis, and other studies identify them as part of the physiopathology of diseases. Despite these conflicting concepts and observations, it is clear that OS is influential in the development of DED. Moreover, many antioxidant strategies have been proposed for its treatment, including calorie restriction to nutritional supplementation. This review offers a critical analysis of the biological mechanisms, diagnostic outcomes, drug use, dietary supplements, and life habits that implicate the influence of OS on DED.
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Affiliation(s)
- Camila Nunes Lemos
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
- *Correspondence: Camila Nunes Lemos,
| | - Lilian Eslaine Costa Mendes da Silva
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Jacqueline Ferreira Faustino
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Marina Zilio Fantucci
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Adriana de Andrade Batista Murashima
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Leidiane Adriano
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Monica Alves
- Department of Ophthalmology and Otorhinolaryngology, Faculty of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
| | - Eduardo Melani Rocha
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
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Galley AP, Beltran E, Tetas Pont R. Neurogenic keratoconjunctivitis sicca in 34 dogs: A case series. Vet Ophthalmol 2021; 25:140-152. [PMID: 34870366 DOI: 10.1111/vop.12949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 10/03/2021] [Accepted: 10/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the clinical findings, imaging features, underlying conditions, treatment, and progression of dogs presented between 2010 and 2019 with neurogenic keratoconjunctivitis sicca (NKCS). METHODS Dogs diagnosed with NKCS were searched in the clinical database. Inclusion criteria were STT-1 readings <15 mm/min, clinical signs of KCS with concurrent ipsilateral xeromycteria. RESULTS Thirty-four cases were identified. Mean age at presentation was 8.2 years, median 8.9 years (0.3-14.7). Twenty dogs were male, and 14 dogs were female. Concurrent neurological deficits included facial neuropathy (n = 13, 38%), peripheral vestibular syndrome (n = 10, 29%), and Horner's syndrome (n = 5, 15%). Advanced imaging was acquired in 53% of cases (n = 18). Etiologies included idiopathic (n = 18, 53%), endocrinopathy (n = 6, 18%), otitis interna (n = 4, 12%), head trauma (n = 3, 9%), iatrogenic (post-TECA-LBO, n = 1, 3%), brainstem mass (n = 1, 3%), and an area of inflammation in the pterygopalatine fossa (n = 1, 3%). Treatment for NKCS was initiated in most cases (n = 30, 88%) including: oral pilocarpine 2% and lacrimostimulant (n = 19), oral pilocarpine 2% only (n = 3), or lacrimostimulant only (n = 8). A mean time follow-up of 3.7 months, median 3 months (1-14) was available in 23 cases (68%). Eleven cases with follow-up were responsive (48%) with resolution of the clinical signs in a median time 4 months (1-10), and all of them were treated with oral pilocarpine (±lacrimostimulant). CONCLUSIONS Most cases presented as idiopathic NKCS; in others, an underlying cause of facial neuropathy was identified. All responsive cases were treated with oral pilocarpine 2%.
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Affiliation(s)
- Amy P Galley
- Royal Veterinary College (RVC), Queen Mother Hospital for Animals (QMHA), London, UK
| | - Elsa Beltran
- Royal Veterinary College (RVC), Queen Mother Hospital for Animals (QMHA), London, UK
| | - Roser Tetas Pont
- Royal Veterinary College (RVC), Queen Mother Hospital for Animals (QMHA), London, UK
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Purushothaman I, Zagon IS, Sassani JW, McLaughlin PJ. Ocular surface complications in diabetes: The interrelationship between insulin and enkephalin. Biochem Pharmacol 2021; 192:114712. [PMID: 34324868 PMCID: PMC8478878 DOI: 10.1016/j.bcp.2021.114712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 12/17/2022]
Abstract
Diabetes is a multi-faceted disorder with increasing prevalence and rising healthcare costs. The burden of diabetes is increased because of associated complications affecting nearly all organs including the eye. The underlying pathophysiology for the onset of these ocular surface disorders is not well known. Enkephalins are endogenous opioids that originate in the brain and have numerous actions in the human body. Opioid growth factor (OGF), chemically termed [Met5]-enkephalin, binds to a novel, nuclear-associated receptor and mediates cellular homeostasis. Serum OGF levels are elevated in diabetic individuals and rodent models of diabetes. Sustained blockade of the OGF receptor (OGFr) with opioid receptor antagonists, such as naltrexone (NTX), reverses many complications of diabetes in the animal model, including delayed cutaneous wound healing, dry eye, altered corneal surface sensitivity, and keratopathy. The increased enkephalin levels observed in diabetes suggest a relationship between endogenous opioid peptides and the pathophysiology of diabetes. It is common for diabetic patients to undergo insulin therapy to restore normal blood glucose levels. However, this restoration does not alter OGF serum levels nor ameliorate ocular surface complications in the animal model of diabetes. Moreover, sex differences in the prevalence of diabetes, response to insulin therapy, and abnormalities in the OGF-OGFr axis have been reported. This review highlights current knowledge on the dysregulation of the OGF-OGFr pathway and possible relationships of insulin and enkephalins to the development of ocular surface defects in diabetes. It proposes that this dysregulation is a fundamental mechanism for the pathobiology of diabetic complications.
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Affiliation(s)
- Indira Purushothaman
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA
| | - Ian S Zagon
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA
| | - Joseph W Sassani
- Department of Ophthalmology, Penn State University College of Medicine, Hershey, PA 17033, USA
| | - Patricia J McLaughlin
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA.
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Kattar A, Concheiro A, Alvarez-Lorenzo C. Diabetic eye: associated diseases, drugs in clinic, and role of self-assembled carriers in topical treatment. Expert Opin Drug Deliv 2021; 18:1589-1607. [PMID: 34253138 DOI: 10.1080/17425247.2021.1953466] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Diabetes is a pandemic disease that causes relevant ocular pathologies. Diabetic retinopathy, macular edema, cataracts, glaucoma, or keratopathy strongly impact the quality of life of the patients. In addition to glycemic control, intense research is devoted to finding more efficient ocular drugs and improved delivery systems that can overcome eye barriers. Areas covered: The aim of this review is to revisit first the role of diabetes in the development of chronic eye diseases. Then, commercially available drugs and new candidates in clinical trials are tackled together with the pros and cons of their administration routes. Subsequent sections deal with self-assembled drug carriers suitable for eye instillation combining patient-friendly administration with high ocular bioavailability. Performance of topically administered polymeric micelles, liposomes, and niosomes for the management of diabetic eye diseases is analyzed in the light of ex vivo and in vivo results and outcomes of clinical trials. Expert opinion: Self-assembled carriers are being shown useful for efficient delivery of not only a variety of small drugs but also macromolecules (e.g. antibodies) and genes. Successful design of drug carriers may offer alternatives to intraocular injections and improve the treatment of both anterior and posterior segments diabetic eye diseases.
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Affiliation(s)
- Axel Kattar
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Angel Concheiro
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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10
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de Campos TDP, da Cruz Rodrigues KC, Pereira RM, Anaruma CP, Dos Santos Canciglieri R, de Melo DG, da Silva ASR, Cintra DE, Ropelle ER, Pauli JR, de Moura LP. The protective roles of clusterin in ocular diseases caused by obesity and diabetes mellitus type 2. Mol Biol Rep 2021; 48:4637-4645. [PMID: 34036481 DOI: 10.1007/s11033-021-06419-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Abstract
Obesity is a chronic, non-transmissible and multifactorial disease commonly associated with systemic inflammation and damage to health. This disorder has been pointed out as leading to the development of a diversity of eye diseases and, consequently, damage to visual acuity. More specifically, cardiometabolic risk is associated with lacrimal gland dysfunctions, since it changes the inflammatory profile favoring the development and worsening of dry eye disease. In more severe and extreme cases, obesity, inflammation, and diabetes mellitus type 2 can trigger the total loss of vision. In this scenario, besides its numerous metabolic functions, clusterin, an apolipoprotein, has been described as protective to the ocular surface through the seal mechanism. Thus, the current review aimed to explain the role of clusterin in dry eye disease that can be triggered by obesity and diabetes.
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Affiliation(s)
- Thaís Dantis Pereira de Campos
- Laboratory of Molecular Biology of Exercise (LaBMEx), School of Applied Sciences, University of Campinas, 1300 Pedro Zaccaria Street, Limeira, SP, Brazil
| | - Kellen Cristina da Cruz Rodrigues
- Laboratory of Molecular Biology of Exercise (LaBMEx), School of Applied Sciences, University of Campinas, 1300 Pedro Zaccaria Street, Limeira, SP, Brazil
| | - Rodrigo Martins Pereira
- Laboratory of Molecular Biology of Exercise (LaBMEx), School of Applied Sciences, University of Campinas, 1300 Pedro Zaccaria Street, Limeira, SP, Brazil
| | - Chadi Pellegrini Anaruma
- Laboratory of Molecular Biology of Exercise (LaBMEx), School of Applied Sciences, University of Campinas, 1300 Pedro Zaccaria Street, Limeira, SP, Brazil
| | - Raphael Dos Santos Canciglieri
- Laboratory of Molecular Biology of Exercise (LaBMEx), School of Applied Sciences, University of Campinas, 1300 Pedro Zaccaria Street, Limeira, SP, Brazil
| | - Diego Gomes de Melo
- Laboratory of Molecular Biology of Exercise (LaBMEx), School of Applied Sciences, University of Campinas, 1300 Pedro Zaccaria Street, Limeira, SP, Brazil
| | | | - Dennys Esper Cintra
- Laboratory of Nutritional Genomics (LABGeN), School of Applied Sciences, University of Campinas, Limeira, SP, Brazil
- CEPECE - Center of Research in Sport Sciences. School of Applied Sciences, University of Campinas (UNICAMP), Limeira, SP, Brazil
| | - Eduardo Rochete Ropelle
- Laboratory of Molecular Biology of Exercise (LaBMEx), School of Applied Sciences, University of Campinas, 1300 Pedro Zaccaria Street, Limeira, SP, Brazil
- CEPECE - Center of Research in Sport Sciences. School of Applied Sciences, University of Campinas (UNICAMP), Limeira, SP, Brazil
| | - José Rodrigo Pauli
- Laboratory of Molecular Biology of Exercise (LaBMEx), School of Applied Sciences, University of Campinas, 1300 Pedro Zaccaria Street, Limeira, SP, Brazil
- CEPECE - Center of Research in Sport Sciences. School of Applied Sciences, University of Campinas (UNICAMP), Limeira, SP, Brazil
| | - Leandro Pereira de Moura
- Laboratory of Molecular Biology of Exercise (LaBMEx), School of Applied Sciences, University of Campinas, 1300 Pedro Zaccaria Street, Limeira, SP, Brazil.
- CEPECE - Center of Research in Sport Sciences. School of Applied Sciences, University of Campinas (UNICAMP), Limeira, SP, Brazil.
- Postgraduate Program in Motricity Sciences, São Paulo State University (UNESP), São Paulo, Brazil.
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11
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Zhang K, Zhang S, Yu J, Lu Y, Zhu X. Changes of the tear film lipid layer thickness after cataract surgery in patients with diabetes mellitus. Acta Ophthalmol 2021; 99:e202-e208. [PMID: 32749786 DOI: 10.1111/aos.14565] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/16/2020] [Accepted: 07/02/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate changes in the tear film lipid layer thickness (LLT) in cataract patients with diabetes mellitus (DM) after cataract surgery. METHODS We recruited consecutive cataract patients and recorded data regarding DM condition. Lipid layer thickness (LLT) and partial blinks rates measured with the LipiView interferometer, tear break-up time (TBUT) and Schirmer's tests, and dry eye symptoms evaluated with the Ocular Surface Disease Index (OSDI) questionnaire were conducted before and one month after cataract surgery. RESULTS Finally, 38 age-related cataract (ARC) and 31 diabetic cataract (DC) patients were available for analysis. No significant difference in preoperative LLT and partial blink rates was found between ARC and DC group. However, preoperative TBUT and Schirmer's test results were significantly lower in DC group compared to ARC group (both p < 0.001). DC group showed higher preoperative OSDI score with no significant difference than ARC group (p = 0.279). In DC group, LLT was significantly thinner in cases with longer duration of DM (over 10 years) than in those with shorter duration (p < 0.001). One month after surgery, LLT of DC group was significantly thinner than at baseline (pre: 65.7 ± 23.3, post: 51.3 ± 17.1, p = 0.002). While in ARC group, LLT had no significant difference before and after cataract surgery (pre: 67.1 ± 23.4, post: 60.2 ± 21.1, p = 0.078). Compared to baseline data, there was no statistically significant difference between two groups in the partial blink rates, TBUT and Schirmer's test results after cataract surgery (p > 0.05). Ocular Surface Disease Index (OSDI) scores were significantly higher after surgery than at baseline in both ARC (pre: 8.9 ± 8.4, post: 12.4 ± 8.5, p = 0.003) and DC group (pre: 11.4 ± 10.3, post: 18.5 ± 8.5, p = 0.001). Multivariate linear regression analysis showed OSDI scores were associated with LLT either before or after cataract surgery (β = -0.862, p < 0.001 and β = -0.592, p < 0.001, respectively). CONCLUSION The tear film LLT is correlated with duration of DM and becomes significantly thinner one month after cataract surgery, leading to the aggravation of dry eye symptoms.
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Affiliation(s)
- Keke Zhang
- Eye Institute, Eye & ENT Hospital Shanghai Medical College Fudan University Shanghai China
- Department of Ophthalmology, Eye & ENT Hospital Shanghai Medical College Fudan University Shanghai China
- NHC Key Laboratory of Myopia (Fudan University) Key Laboratory of Myopia Chinese Academy of Medical Sciences Shanghai China
- Shanghai Key Laboratory of Visual Impairment and Restoration Fudan University Shanghai China
| | - Shaohua Zhang
- Eye Institute, Eye & ENT Hospital Shanghai Medical College Fudan University Shanghai China
- Department of Ophthalmology, Eye & ENT Hospital Shanghai Medical College Fudan University Shanghai China
- NHC Key Laboratory of Myopia (Fudan University) Key Laboratory of Myopia Chinese Academy of Medical Sciences Shanghai China
- Shanghai Key Laboratory of Visual Impairment and Restoration Fudan University Shanghai China
| | - Jifeng Yu
- Department of Ophthalmology Beijing Children's Hospital National Center for Children's Health Capital Medical University Beijing China
| | - Yi Lu
- Eye Institute, Eye & ENT Hospital Shanghai Medical College Fudan University Shanghai China
- Department of Ophthalmology, Eye & ENT Hospital Shanghai Medical College Fudan University Shanghai China
- NHC Key Laboratory of Myopia (Fudan University) Key Laboratory of Myopia Chinese Academy of Medical Sciences Shanghai China
- Shanghai Key Laboratory of Visual Impairment and Restoration Fudan University Shanghai China
| | - Xiangjia Zhu
- Eye Institute, Eye & ENT Hospital Shanghai Medical College Fudan University Shanghai China
- Department of Ophthalmology, Eye & ENT Hospital Shanghai Medical College Fudan University Shanghai China
- NHC Key Laboratory of Myopia (Fudan University) Key Laboratory of Myopia Chinese Academy of Medical Sciences Shanghai China
- Shanghai Key Laboratory of Visual Impairment and Restoration Fudan University Shanghai China
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12
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Chu EPF, Cho CHH, Lee WJ, Lee IT, Cheng IF, Kuo TC, Chen RY, Sheu WHH, Shen CN. Generation of three induced pluripotent stem cell lines from type 2 diabetic patients with ocular complications. Stem Cell Res 2020; 49:102109. [PMID: 33370876 DOI: 10.1016/j.scr.2020.102109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/28/2020] [Indexed: 12/01/2022] Open
Abstract
Retinopathy is a well-known ocular complication that occurs in patients with type 2 diabetes (T2D). Recent evidence also indicates that diabetic patients have an increased prevalence of dry eye syndrome. However, the etiologies of both diabetic retinopathy (DR) and dry eye disease are complex, and their associations with T2D remains to be fully understood. Patient-derived human induced pluripotent stem cells (hiPSCs) enable the generation of disease-specific retinal tissues such as retinal pigment epithelium and lacrimal gland to model disease pathogenesis. Here, we describe the establishment of three hiPSC lines from T2D patients with PDR or dry eye disease.
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Affiliation(s)
| | | | - Wen-Jane Lee
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Fen Cheng
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Tzu-Chien Kuo
- Genomics Research Center, Academia Sinica, Taipei, Taiwan; Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ruei-Ying Chen
- Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Ning Shen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan; Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan.
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Mu PY, Chu CC, Yu D, Shao Y, Zhao SZ. PPARγ: the dominant regulator among PPARs in dry eye lacrimal gland and diabetic lacrimal gland. Int J Ophthalmol 2020; 13:860-869. [PMID: 32566495 PMCID: PMC7270247 DOI: 10.18240/ijo.2020.06.02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/10/2020] [Indexed: 12/12/2022] Open
Abstract
AIM To investigate the regulatory roles of the members of the peroxisome proliferator-activated receptor (PPAR) family in lacrimal gland dysfunction under conditions of desiccating stress or diabetes. METHODS Quantitative polymerase chain reaction (qPCR) was used to examine the expression of PPARs in the cornea, conjunctiva, meibomian gland, and lacrimal gland in adult rats. The rats were divided into 3 groups: a control group, dry eye group, and diabetic group. The phenol red threads test, tear film break-up time (BUT) test and fluorescein staining were carried out to evaluate the development of dry eye. Based on bioinformatics research, qPCR was used to examine the expression level of PPARγ, tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), sirtuin 1 (Sirt1), myeloid differentiation factor 88 (MyD88) and transforming growth factor-β (TGF-β) in the lacrimal glands. RESULTS PPARα and PPARβ/δ were mainly expressed in the conjunctiva and the lacrimal gland, respectively. However, PPARγ was expressed in both the conjunctiva and lacrimal gland, at much higher levels than those measured for PPARα and PPARβ/δ. Dry eye rats and diabetic rats both showed decreased tear secretion, shortened BUT, and increased corneal staining. Significant changes in gene expression were observed compared with the control group. In the lacrimal glands of dry eye rats and diabetic rats, expression of PPARγ decreased (P<0.05), expression of Sirt1 also decreased (P<0.01), whereas expression of TNF-α, IL-1β, IL-6, MyD88, and TGF-β increased (P<0.05). CONCLUSION Among PPARs, PPARγ might play a dominant role in the regulation of metabolic- and inflammatory-signaling pathways on the ocular surfaces and in lacrimal glands. Down-regulation of PPARγ is highly relevant to lacrimal gland dysfunction under desiccating-stress and diabetic conditions. PPARγ, thus, is a potential therapeutic target in the treatment of environment- or diabetes-induced dry eye diseases.
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Affiliation(s)
- Peng-Yue Mu
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Chen-Chen Chu
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Di Yu
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Yan Shao
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Shao-Zhen Zhao
- Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
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Yıldız E, Zibandeh N, Özer B, Şahin A. Effects of Type 2 Diabetes Mellitus on Gene Expressions of Mouse Meibomian Glands. Curr Eye Res 2019; 45:72-80. [PMID: 31424965 DOI: 10.1080/02713683.2019.1656750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Type 2 Diabetes mellitus (DM) is a major health problem and its ocular complications like orbital infections, cataract and diabetic retinopathy cause blindness. Meibomian gland (MG) dysfunction and dry eye disease are also important ocular complications of type 2 DM but not enough research has been conducted on these complications. Our hypothesis suggests type 2 DM can alter significant gene expressions of MG. In our study, MGs of leptin-deficient spontaneous diabetic and non-diabetic mice were extracted, and gene expression profiles were analyzed with microarray technology.Methods: Mice were divided into two groups; nine Lep b/ob spontaneous diabetic mice as type 2 DM group and nine non-diabetic Balb/c mice as controls. Blood glucose levels, tearfilm break-up time and fluorescein scores were measured in both two groups for 12 weeks. MGs were dissected and RNAs were isolated for microarray gene expression analysis. We filtered probes with standard deviation of more than 0.1 and we used 40452 of 45281 probes for processing. We performed fold change analysis and identified which genes are affected, and we analyzed the impact of genes on proteins, pathways and gene ontologies by using various databases.Results: We observed 172 up-regulated and 118 down-regulated genes in type 2 diabetic mice when compared to non-diabetic mice. Interestingly, expression of collagen type I, integrin beta-I binding protein-I, pyruvate dehydrogenase kinase, TNF receptor genes up-regulated with DM; on the other hand, IL-33, cholecystokinin, plasminogen activator, IL-1 and serine peptidase inhibitor genes down-regulated significantly. Also, we have seen a significant decrease in WNT signaling and pentose phosphate pathways-related genes.Conclusion: Our data show these changes in gene expression caused by endocrine and immune mechanisms of type 2 DM which result disrupted homeostasis of epithelial cells of MG. Increased expressions of apoptosis and inflammation-related genes and their effects on related pathways have proven that MGs were negatively affected by type-2 DM.
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Affiliation(s)
- Erdost Yıldız
- Koc University Center for Translational Medicine Research, Istanbul, Turkey
| | - Noushin Zibandeh
- Koc University Center for Translational Medicine Research, Istanbul, Turkey
| | - Berna Özer
- Koc University Center for Translational Medicine Research, Istanbul, Turkey
| | - Afsun Şahin
- Koc University Center for Translational Medicine Research, Istanbul, Turkey.,Department of Ophthalmology, Koç University Medical School, Istanbul, Turkey
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Derakhshan A, Abrishami M, Khajedaluee M, Omidtabrizi A, Moghaddam SG. Comparison between Tear Film Osmolar Cocentration and Other Tear Film Function Parameters in Patients with Diabetes Mellitus. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:326-332. [PMID: 31389208 PMCID: PMC6685821 DOI: 10.3341/kjo.2013.0146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 05/19/2014] [Accepted: 05/21/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate tear film function in patients with diabetes mellitus (DM) using tear film osmolarity (TFO) measurements compared to other tear film function tests. Methods DM patients without any history of ocular surface disorder but with potential effects on the tear film were enrolled in this cross-sectional study. Data including dry eye symptoms, duration of DM, stage of diabetic retinopathy and blood hemoglobin A1c levels were recorded. Tear film break-up time (TBUT) and basic tear secretion (Schirmer test) were assessed. TFO was determined using the Tearlab Osmolarity System. The outcome measures were the difference between the mean values of TBUT, basic tear secretion and TFO in both the study and control groups. Results We recruited 51 DM patients and 20 control subjects with a mean age of 51.2 (range, 21 to 70) and 48.5 (range, 24 to 70) years, respectively. A total of 27 patients (53%) and 11 controls (55%) reported dry eye symptoms (p = 0.668). The mean TBUT was 10.2 ± 4.8 seconds in the study group versus 10.5 ± 2.8 seconds in controls, which was not significantly different (p = 0.747). The mean Schirmer test score was 8.1 ± 4.3 mm in the patients versus 10.1 ± 3.0 mm in the controls (p = 0.069). The mean TFO was 294.1 ± 12.9 mosmol/L in the patients versus 291.4 ± 14.5 mosmol/L in the controls (p = 0.456). It was significantly higher in patients with poor glycemic control determined by hemoglobin A1c > 8% (p = 0.003). TFO had a positive correlation with the duration of DM (p = 0.030) but not with the stage of diabetic retinopathy (p = 0.944). However, TFO showed a significant relationship with dry eye symptoms (p = 0.001). Conclusions TFO is impaired in patients with uncontrolled DM and is better correlated with glycemic control and dry eye symptoms than the TBUT and Schirmer tests.
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Affiliation(s)
- Akbar Derakhshan
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Abrishami
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Arash Omidtabrizi
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Cruz-Cazarim ELC, Cazarim MS, Ogunjimi AT, Petrilli R, Rocha EM, Lopez RFV. Prospective insulin-based ophthalmic delivery systems for the treatment of dry eye syndrome and corneal injuries. Eur J Pharm Biopharm 2019; 140:1-10. [PMID: 31015020 DOI: 10.1016/j.ejpb.2019.04.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/10/2019] [Accepted: 04/19/2019] [Indexed: 12/18/2022]
Abstract
The presence of insulin (INS) receptors on the ocular surface (OS) and lacrimal gland (LG), and the high prevalence of dry eye syndrome (DES) and corneal lesions in diabetic patients suggest that INS is relevant for OS homeostasis and wound healing. The study aims at developing delivery systems for the topical administration of INS to the OS in order to improve INS local bioavailability and evaluate the influence of the delivery systems on DES in diabetic rats (DM) (n = 05/group). Chitosan microparticles (MP), chitosan/poloxamer gel (GEL) and MP-loaded GEL (GELMP), with or without INS were developed. Formulations were instilled into the eyes of diabetic rats (DM) for 15 days and the tear fluid volume, corneal cells morphology and cornea thickness were assessed and compared with an aqueous dispersion of INS (DISP-INS). All delivery systems had pH of about 6, osmolality suitable for topical application and positive zeta potential. The MPs with or without INS had sizes close to 4 μm, spherical morphology and INS encapsulation efficiency of 77 ± 6%. DISP-INS and GELMP-INS formulations produced tear secretion amounts significantly higher than those receiving formulations containing no INS and similar to healthy animals. Cornea surface impression cytology showed that treatment with INS-delivery systems and not DISP-INS almost normalized cells morphology. Treatment with GELMP-INS increased INS by 2.5 in the LG and eyeball as compared to the groups treated with GEL-INS and MP-INS, while treatment with DISP-INS left no traces of drug in the eye after treatment termination. GEL and GELMP containing INS were also able to normalize the thickness of the corneal epithelia. In conclusion, GELMP-INS normalized tear fluid volume, corneal thickness, protected corneal cells morphology and increased ocular bioavailability of INS, making it a promising treatment strategy for DES and corneal lesions.
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Affiliation(s)
- Estael L C Cruz-Cazarim
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Av. Cafe s/n, 14040-903 Ribeirao Preto, SP, Brazil
| | - Maurílio S Cazarim
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Av. Cafe s/n, 14040-903 Ribeirao Preto, SP, Brazil
| | - Abayomi T Ogunjimi
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Av. Cafe s/n, 14040-903 Ribeirao Preto, SP, Brazil
| | - Raquel Petrilli
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Av. Cafe s/n, 14040-903 Ribeirao Preto, SP, Brazil
| | - Eduardo M Rocha
- School of Medicine of Ribeirao Preto, University of Sao Paulo, Av. Bandeirantes, 3900, 14049-900 Ribeirao Preto, SP, Brazil
| | - Renata F V Lopez
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Av. Cafe s/n, 14040-903 Ribeirao Preto, SP, Brazil.
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Garcia DM, Reis de Oliveira F, Módulo CM, Faustino J, Barbosa AP, Alves M, Rocha EM. Is Sjögren's syndrome dry eye similar to dry eye caused by other etiologies? Discriminating different diseases by dry eye tests. PLoS One 2018; 13:e0208420. [PMID: 30507949 PMCID: PMC6277094 DOI: 10.1371/journal.pone.0208420] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/17/2018] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Dry Eye Disease (DED) is part of several conditions, including Sjögren's syndrome (SS) and no single test to diagnosis DED. The present study intends to evaluate whether a set of signs and symptoms of DED can distinguish: a) SS from other non-overlapping systemic diseases related to DED; b) primary and secondary SS. METHODS 182 consecutive patients with DED were evaluated under five groups: SS, graft-versus-host disease (GVHD), Graves' orbitopathy (GO), diabetes mellitus (DM), glaucoma under treatment with benzalkonium chloride medications (BAK). Twenty-four healthy subjects were included as control group (CG). The evaluation consisted of Ocular Surface Disease Index (OSDI), Schirmer test (ST), corneal fluorescein staining (CFS) and tear film break up time (TFBUT). Indeed, a subset of DED patients (n = 130), classified as SS1, SS2 and nonSS (NSS) by the American-European Criteria were compared. Quadratic discriminant analysis (QDA) classified the individuals based on variables collected. The area under Receiver Operating Characteristics (ROC) curve evaluated the classification performance in both comparisons. RESULTS Comparing SS with other diseases, QDA showed that the most important variable for classification was OSDI, followed by TFBUT and CFS. Combined, these variables were able to correctly classify 62.6% of subjects in their actual group. At the discretion of the area under the ROC curve, the group with better classification was the control (97.2%), followed by DM (95.5%) and SS (92.5%). DED tests were different among the NSS, SS1 and SS2 groups. The analysis revealed that the combined tests correctly classified 54.6% of the patients in their groups. The area under the ROC curve better classified NSS (79.5%), followed by SS2 (74.4%) and SS1 (69.4%). CONCLUSIONS Diseases that causes DED, and also SS1, SS2 and NSS are distinguishable conditions, however a single ocular tools was not able to detect the differences among the respective groups.
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Affiliation(s)
- Denny Marcos Garcia
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Craniofacial Research Support Center, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fabiola Reis de Oliveira
- Division of Rheumatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carolina Maria Módulo
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jacqueline Faustino
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Amanda Pires Barbosa
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Monica Alves
- Department of Ophthalmology and Otorhinolaryngology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Eduardo Melani Rocha
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- * E-mail:
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18
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Pontelli RCN, Souza MCO, Fantucci MZ, de Andrade M, Rocha EM. The role of endocrine disruptors in ocular surface diseases. Med Hypotheses 2018; 122:157-164. [PMID: 30593402 DOI: 10.1016/j.mehy.2018.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/05/2018] [Accepted: 11/20/2018] [Indexed: 11/28/2022]
Abstract
Endocrine disruptors are a group of compounds that occur in increasing amounts in the environment. These compounds change the hormone homeostasis of the target organs regulated by those hormones, mostly by binding to their receptors and affecting their signaling pathways. Among the hormones altered by endocrine disruptors are sex hormones, thyroid hormones, and insulin. Studies have documented abnormalities in the reproductive and metabolic systems of various animal species exposed to endocrine disruptors. Endocrine disruptors can play a significant role in ocular diseases once hormone deficiency or excess are involved in the mechanism of that disease. Cataracts, dry eye disease and retinal diseases, such as macular hole and diabetic retinopathy, are some of the frequent problems where hormones have been implicated. We found that some compounds function as endocrine disruptors in the metabolism of body organs and systems. The increasing frequency of dry eye and other ocular diseases indicates the need to better investigate the potential relationships beyond the isolated associations mentioned by patients and documented as rare case reports. The evidence from case-control studies and experimental assays can provide the information necessary to confirm the endocrine effects of these chemicals in the pathophysiology of dry eye disease. We hypothesize that endocrine disruptors may contribute to the increase of ocular diseases, such as dry eye disease, in recent years.
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Affiliation(s)
- Regina C N Pontelli
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Marília C O Souza
- Department of Clinical, Toxicological and Bromatological Analyzes, ASTox - Laboratory of Analytical and Systems Toxicology, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Brazil
| | - Marina Z Fantucci
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Mônica de Andrade
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
| | - Eduardo M Rocha
- Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil.
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Reduction in Histone H3 Acetylation and Chromatin Remodeling in Corneas of Alloxan-Induced Diabetic Rats. Cornea 2018; 37:624-632. [PMID: 29384804 DOI: 10.1097/ico.0000000000001533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate acetylation of histone H3, chromatin remodeling, nuclear size and shape, DNA ploidy, and distribution of nucleolus organizing regions (NORs) in corneal epithelial and stromal cells of diabetic and nondiabetic rats. METHODS Diabetes was induced by a single intraperitoneal injection of alloxan. All diabetic rats (n = 20) included in the study had 4 weeks of moderate-to-severe hyperglycemia (plasma glucose levels >400 mg/dL). Acetylated histone H3 levels were quantified in corneal tissue using a colorimetric assay. Chromatin remodeling, nuclear sizes (area/perimeter) and shapes (circularity), and DNA ploidies were evaluated from Feulgen-stained tissue sections using video image analysis. Distributions of NORs were studied in tissue sections impregnated with silver ions. Ophthalmic clinical parameters, including corneal sensitivity, were investigated. Twenty nondiabetic rats were used as controls. RESULTS Acetylation of histone H3 was reduced in the corneas of the diabetic rats. Nuclei in corneal epithelial cells of diabetic rats compacted chromatin, increased in size, modified their shapes, and elevated DNA ploidy. The only nuclear change observed in the corneal stromal cells of diabetic rats was chromatin decompaction. The size of the silver-stained NOR did not differ between the study samples. The corneal sensitivity in diabetic rats was 51.8% lower than that in nondiabetic rats. CONCLUSIONS The results of this study show that alloxan-induced diabetes altered the histone H3 acetylation pattern and compromised the chromatin supraorganization in corneal tissue/cells. Continued research is needed to understand the clinical and morphofunctional significance of changes in corneal cell nuclei of diabetic individuals.
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Zou X, Lu L, Xu Y, Zhu J, He J, Zhang B, Zou H. Prevalence and clinical characteristics of dry eye disease in community-based type 2 diabetic patients: the Beixinjing eye study. BMC Ophthalmol 2018; 18:117. [PMID: 29747621 PMCID: PMC5946388 DOI: 10.1186/s12886-018-0781-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 04/30/2018] [Indexed: 02/07/2023] Open
Abstract
Background This study was performed to evaluate the prevalence and clinical characteristics of dry eye disease (DED) in community-based type 2 diabetic patients and to identify the associated factors related with DED. Methods A total of 1360 type 2 diabetic patients in the Beixinjing community were randomly selected. All participants were given a questionnaire that assessed basic information and subjective symptoms.DED was diagnosed using the revised Japanese DED diagnostic criteria. All subjects underwent a routine ophthalmic examination, corneal sensitivity test, tear film break-up time(BUT) test, Schirmer I test, fluorescein and lissamine green staining(FL) and fundus photography. Diabetic retinopathy (DR) was graded according to the International severity scale of diabetic retinopathy and diabetic macular edema. Results Of the 1360 subjects, 238 (17.5%) were diagnosed with DED. There was a significant association between the presence of DED and higher blood glucose (P < 0.001, OR1.240) as well as higher levels of glycosylated hemoglobin HbA1c (P < 0.001, OR1.108). Corneal sensitivity was negatively correlated with the prevalence of DED (P = 0.02, OR0.973). Conclusions The prevalence of DED in this community-based study was 17.5%, which was lower than that observed in hospital-based studies. Diabetic patients with poor metabolic control were more likely to present with DED. A dry eye examination should be added to the routine screening of diabetes.
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Affiliation(s)
- Xinrong Zou
- Shanghai General Hospital, Nanjing Medical University, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China.,Department of Ophthalmology, Fengcheng Hospital, No.9983, Chuannanfeng Road, Fengxian District, Shanghai, 201411, China
| | - Lina Lu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, No. 380, Kangding Road, Jingan, Shanghai, 200040, China
| | - Yi Xu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, No. 380, Kangding Road, Jingan, Shanghai, 200040, China
| | - Jianfeng Zhu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, No. 380, Kangding Road, Jingan, Shanghai, 200040, China
| | - Jiangnan He
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, No. 380, Kangding Road, Jingan, Shanghai, 200040, China
| | - Bo Zhang
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, No. 380, Kangding Road, Jingan, Shanghai, 200040, China
| | - Haidong Zou
- Shanghai General Hospital, Nanjing Medical University, No. 100, Haining Road, Hongkou District, Shanghai, 200080, China. .,Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, No. 380, Kangding Road, Jingan, Shanghai, 200040, China. .,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China. .,Shanghai Key Laboratory of Fundus Disease, Shanghai, China.
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Miller EJ, Brines CM. Canine Diabetes Mellitus Associated Ocular Disease. Top Companion Anim Med 2018; 33:29-34. [PMID: 29793726 DOI: 10.1053/j.tcam.2018.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/11/2018] [Accepted: 03/11/2018] [Indexed: 12/16/2022]
Abstract
Diabetes mellitus (DM) is a commonly encountered disease in companion animal veterinary practice. Ocular complications in dogs with DM are thought to be common but there are no reports of the overall incidence of DM-associated ocular disease. Some complications, such as cataracts and ocular surface disease, can lead to vision loss and significant morbidity among DM patients, therefore early recognition and intervention are essential for successful outcomes. The purpose of this article is to provide a review of several currently known or suspected ocular diseases associated with DM.
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Affiliation(s)
- Eric J Miller
- Department of Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.
| | - Courtenay M Brines
- Department of Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
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Sullivan DA, Rocha EM, Aragona P, Clayton JA, Ding J, Golebiowski B, Hampel U, McDermott AM, Schaumberg DA, Srinivasan S, Versura P, Willcox MDP. TFOS DEWS II Sex, Gender, and Hormones Report. Ocul Surf 2017; 15:284-333. [PMID: 28736336 DOI: 10.1016/j.jtos.2017.04.001] [Citation(s) in RCA: 236] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/16/2017] [Indexed: 12/21/2022]
Abstract
One of the most compelling features of dry eye disease (DED) is that it occurs more frequently in women than men. In fact, the female sex is a significant risk factor for the development of DED. This sex-related difference in DED prevalence is attributed in large part to the effects of sex steroids (e.g. androgens, estrogens), hypothalamic-pituitary hormones, glucocorticoids, insulin, insulin-like growth factor 1 and thyroid hormones, as well as to the sex chromosome complement, sex-specific autosomal factors and epigenetics (e.g. microRNAs). In addition to sex, gender also appears to be a risk factor for DED. "Gender" and "sex" are words that are often used interchangeably, but they have distinct meanings. "Gender" refers to a person's self-representation as a man or woman, whereas "sex" distinguishes males and females based on their biological characteristics. Both gender and sex affect DED risk, presentation of the disease, immune responses, pain, care-seeking behaviors, service utilization, and myriad other facets of eye health. Overall, sex, gender and hormones play a major role in the regulation of ocular surface and adnexal tissues, and in the difference in DED prevalence between women and men. The purpose of this Subcommittee report is to review and critique the nature of this role, as well as to recommend areas for future research to advance our understanding of the interrelationships between sex, gender, hormones and DED.
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Affiliation(s)
- David A Sullivan
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
| | - Eduardo M Rocha
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Pasquale Aragona
- Department of Biomedical Sciences, Ocular Surface Diseases Unit, University of Messina, Messina, Sicily, Italy
| | - Janine A Clayton
- National Institutes of Health Office of Research on Women's Health, Bethesda, MD, USA
| | - Juan Ding
- Schepens Eye Research Institute, Massachusetts Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Blanka Golebiowski
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Ulrike Hampel
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alison M McDermott
- The Ocular Surface Institute, College of Optometry, University of Houston, Houston, TX, USA
| | - Debra A Schaumberg
- Harvard School of Public Health, Boston, MA, USA; University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sruthi Srinivasan
- Centre for Contact Lens Research, School of Optometry, University of Waterloo, Ontario, Canada
| | - Piera Versura
- Department of Specialized, Experimental, and Diagnostic Medicine, University of Bologna, Bologna, Italy
| | - Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Diabetic complications in the cornea. Vision Res 2017; 139:138-152. [PMID: 28404521 DOI: 10.1016/j.visres.2017.03.002] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 12/15/2022]
Abstract
Diabetic corneal alterations, such as delayed epithelial wound healing, edema, recurrent erosions, neuropathy/loss of sensitivity, and tear film changes are frequent but underdiagnosed complications of both type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus. The disease affects corneal epithelium, corneal nerves, tear film, and to a lesser extent, endothelium, and also conjunctiva. These abnormalities may appear or become exacerbated following trauma, as well as various surgeries including retinal, cataract or refractive. The focus of the review is on mechanisms of diabetic corneal abnormalities, available animal, tissue and organ culture models, and emerging treatments. Changes of basement membrane structure and wound healing rates, the role of various proteinases, advanced glycation end products (AGEs), abnormal growth and motility factors (including opioid, epidermal, and hepatocyte growth factors) are analyzed. Experimental therapeutics under development, including topical naltrexone, insulin, inhibitors of aldose reductase, and AGEs, as well as emerging gene and cell therapies are discussed in detail.
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A systematic review on the impact of diabetes mellitus on the ocular surface. Nutr Diabetes 2017; 7:e251. [PMID: 28319106 PMCID: PMC5380897 DOI: 10.1038/nutd.2017.4] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/10/2016] [Accepted: 11/14/2016] [Indexed: 12/27/2022] Open
Abstract
Diabetes mellitus is associated with extensive morbidity and mortality in any human community. It is well understood that the burden of diabetes is attributed to chronic progressive damage in major end-organs, but it is underappreciated that the most superficial and transparent organ affected by diabetes is the cornea. Different corneal components (epithelium, nerves, immune cells and endothelium) underpin specific systemic complications of diabetes. Just as diabetic retinopathy is a marker of more generalized microvascular disease, corneal nerve changes can predict peripheral and autonomic neuropathy, providing a window of opportunity for early treatment. In addition, alterations of immune cells in corneas suggest an inflammatory component in diabetic complications. Furthermore, impaired corneal epithelial wound healing may also imply more widespread disease. The non-invasiveness and improvement in imaging technology facilitates the emergence of new screening tools. Systemic control of diabetes can improve ocular surface health, possibly aided by anti-inflammatory and vasoprotective agents.
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Dry Eye Syndrome in Patients with Diabetes Mellitus: Prevalence, Etiology, and Clinical Characteristics. J Ophthalmol 2016; 2016:8201053. [PMID: 27213053 PMCID: PMC4861815 DOI: 10.1155/2016/8201053] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/20/2016] [Indexed: 01/13/2023] Open
Abstract
There has been substantial progress in our understanding of the ocular surface system/lacrimal function unit in the past 15 years. Keratoconjunctivitis sicca, more commonly referred to as dry eye syndrome (DES), is the most frequently encountered condition and diabetes mellitus (DM) has been identified as one of the leading causes of DES. Poor glycemic control affects both the anterior and the posterior segments of the eye and increasing prevalence of diabetes-associated DES (DMDES) has been reported in recent years. The pathogenesis and specific features of DMDES remain uncertain and interventions are limited to those used in DES. This review outlines the pathogenesis, clinical manifestations, and the current preventive and treatment strategies for diabetes-related DES.
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Ocular surface changes in patients treated with oral antidiabetic drugs or insulin. Eur J Ophthalmol 2015; 26:303-6. [PMID: 26659019 DOI: 10.5301/ejo.5000710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe and compare ocular surface changes in patients with type 2 diabetes treated with either oral antidiabetic drugs (OAD) or insulin. METHODS Forty eyes of 20 patients treated with OAD, 40 eyes of 20 patients treated with insulin, and 10 nondiabetic controls seen at Ministry of Health Ankara Educational and Research Hospital, 1st Eye Clinic, were studied. All subjects underwent routine ophthalmic examinations, Schirmer test, tear film break-up time analysis, and conjunctival impression cytologic analysis. Patients treated with OAD or insulin and a control group were compared for tear function parameters, goblet cell density, and squamous metaplasia grade. The relation between status of retinopathy and ocular surface disorder and serum HbA1c levels of diabetic patients were also noted. RESULTS The tear film break-up time values were significantly lower in patients treated with OAD (p<0.05). There was no statistically significant difference in Schirmer test results of the 3 groups. Goblet cell density and squamous metaplasia grade were similar in all groups. The median grade was grade 1, in which epithelial cells are slightly larger, more polygonal, have eosinophilic staining cytoplasm, and goblet cells are decreased in number. Status of retinopathy did not seem to relate to ocular surface disorder. The serum HbA1c level of diabetic patients treated with insulin or OAD was similar (p>0.05). CONCLUSIONS Precorneal tear film stability was worse in patients treated with OAD; however, impression cytology analysis and Schirmer test results were similar in all groups.
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The impact of type 1 diabetes mellitus on corneal epithelial nerve morphology and the corneal epithelium. THE AMERICAN JOURNAL OF PATHOLOGY 2014; 184:2662-70. [PMID: 25102563 DOI: 10.1016/j.ajpath.2014.06.016] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/14/2014] [Accepted: 06/17/2014] [Indexed: 12/23/2022]
Abstract
Diabetic corneal neuropathy can result in chronic, sight-threatening corneal pathology. Although the exact etiology is unknown, it is believed that a reduction in corneal sensitivity and loss of neurotrophic support contributes to corneal disease. Information regarding the relationship between nerve loss and effects on the corneal epithelium is limited. We investigated changes in the corneal epithelium and nerve morphology using three-dimensional imaging in vivo and in situ in a streptozotocin-induced diabetic mouse model. Streptozotocin-treated mice showed increased levels of serum glucose and growth retardation consistent with a severe diabetic state. A reduction in the length of the subbasal nerve plexus was evident after 6 weeks of disease. Loss of the subbasal nerve plexus was associated with corneal epithelial thinning and a reduction in basal epithelial cell density. In contrast, loss of the terminal epithelial nerves was associated with animal age. Importantly, this is the first rodent model of type 1 diabetes that shows characteristics of corneal epithelial thinning and a reduction in basal epithelial cell density, both previously have been documented in humans with diabetic corneal neuropathy. These findings indicate that in type 1 diabetes, nerve fiber damage is evident in the subbasal nerve plexus before terminal epithelial nerve loss and that neurotrophic support from both the subbasal nerve plexus and terminal epithelial nerves is essential for the maintenance of corneal epithelial homeostasis.
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Alves M, Reinach PS, Paula JS, Vellasco e Cruz AA, Bachette L, Faustino J, Aranha FP, Vigorito A, de Souza CA, Rocha EM. Comparison of diagnostic tests in distinct well-defined conditions related to dry eye disease. PLoS One 2014; 9:e97921. [PMID: 24848115 PMCID: PMC4029783 DOI: 10.1371/journal.pone.0097921] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 04/27/2014] [Indexed: 01/19/2023] Open
Abstract
PURPOSE This study compares signs, symptoms and predictive tools used to diagnose dry eye disease (DED) and ocular surface disorders in six systemic well-defined and non-overlapping diseases. It is well known that these tests are problematic because of a lack of agreement between them in identifying these conditions. Accordingly, we provide here a comparative clinical profile analysis of these different diseases. METHODS A spontaneous and continuous sample of patients with Sjögren's syndrome (SS) (n=27), graft-versus-host-disease (GVHD) (n=28), Graves orbitopathy (n=28), facial palsy (n=8), diabetes mellitus without proliferative retinopathy (n=14) and glaucoma who chronically received topical drugs preserved with benzalkonium chloride (n=20) were enrolled. Evaluation consisted of a comprehensive protocol encompassing: (1) structured questionnaire - Ocular Surface Disease Index (OSDI); (2) tear osmolarity (TearLab Osmolarity System - Ocusense); (3) tear film break-up time (TBUT); (4) fluorescein and lissamine green staining; (5) Schirmer test and (6) severity grading. RESULTS One hundred and twenty five patients (aged 48.8 years-old ± 14.1, male:female ratio=0.4) were enrolled in the study, along with 24 age and gender matched controls. Higher scores on DED tests were obtained in Sjögren Syndrome (P<0.05), except for tear film osmolarity that was higher in diabetics (P<0.001) and fluorescein staining, that was higher in facial palsy (P<0.001). TFBUT and OSDI correlated better with other tests. The best combination of diagnostic tests for DED was OSDI, TBUT and Schirmer test (sensitivity 100%, specificity 95% and accuracy 99.3%). CONCLUSIONS DED diagnostic test results present a broad range of variability among different conditions. Vital stainings and TBUT correlated best with one another whereas the best test combination to detect DED was: OSDI/TBUT/Schirmer.
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Affiliation(s)
- Monica Alves
- Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil
- Pontific Catholic University of Campinas, Campinas, SP, Brazil
| | - Peter Sol Reinach
- Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil
| | - Jayter Silva Paula
- Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil
| | | | - Leticia Bachette
- Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil
| | - Jacqueline Faustino
- Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil
| | | | - Afonso Vigorito
- Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | | | - Eduardo Melani Rocha
- Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil
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Abstract
: Clinician-scientists bridge the gap between basic research and patient care. At the 2012 Annual Meeting, a symposium highlighting the application of cutting-edge optometric research within the anterior segment was held to present and discuss some of the recent basic scientific advances that will both shape and guide the development of future clinical care practices. This article summarizes this work, bringing together four experts, all clinician-scientists in the field of cornea and ocular surface. Collectively, this work provides new insights to clinicians and researchers alike, as well as brings forth a greater appreciation of the impact of ongoing optometric bench research in advancing clinical care.
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Módulo CM, Machado Filho EB, Malki LT, Dias AC, de Souza JC, Oliveira HCF, Jorge IC, Santos Gomes IB, Meyrelles SS, Rocha EM. The role of dyslipidemia on ocular surface, lacrimal and meibomian gland structure and function. Curr Eye Res 2012; 37:300-8. [PMID: 22440161 DOI: 10.3109/02713683.2011.631720] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Dyslipidemia is characterized by high lipid blood levels that are risk factors for cardiovascular diseases, which are leading causes of death. However, it is unclear whether dyslipidemia is a cause of the dry eye syndrome (DES). Therefore we determined in transgenic mice models of dyslipidemia, whether there is an association with DES development. METHODS Dyslipidemic models included male and female adult mice overexpressing apolipoprotein CIII (Apo CIII), LDL receptor knockout (LDLR-KO) and ApoE knockout (ApoE-KO). They were compared with age- and gender-matched C57BL/6 mice. Ocular health was evaluated based on corneal slit lamp assessment, phenol red thread test (PRT) and impression cytology. Blood lipid profiles and histology of meibomian and lacrimal glands were also evaluated. Effects of high-fat diet and aging were observed in LDLR-KO and ApoCIII strains, respectively. RESULTS Body weight and lacrimal gland weight were significantly higher in male mice compared to females of the same strain (P < 0.05). Body weight was significantly lower in LDLRKO mice receiving high lipid diet compared to their controls (P = 0.0043). ApoE-KO were hypercholesterolemic and ApoCIII hypertriglyceridemic while LDLR-KO showed increases in both parameters. The PRT test was lower in male LDLR-KO mice with high-fat diet than control mice with standard diet (P = 0.0273). Aging did not affect lacrimal structural or functional parameters of ApoCIII strain. CONCLUSIONS DES development is not solely dependent on dyslipidemia in relevant mice models promoting this condition. On the other hand, lacrimal gland structure and function are differentially impacted by lipid profile changes in male and female mice. This dissociation suggests that other factors beside dyslipidemia impact on tear film dysfunction and DES development.
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Affiliation(s)
- Carolina Maria Módulo
- Department of Ophthalmology, Faculty of Medicine of Ribeirão Preto, USP, Ribeirão Preto, São Paulo, Brazil
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