Associations between the red blood cell distribution width and primary angle-closure glaucoma: a potential for disease prediction

The correlation between primary open-angle glaucoma (POAG) and gut microbiota: a pilot study towards predictive, preventive, and personalized medicine

Background

Glaucoma is the leading cause of irreversible blindness worldwide. Emerged evidence has shown that glaucoma is considered an immune system related disorder. The gut is the largest immune organ in the human body and the gut microbiota (GM) plays an irreversible role in maintaining immune homeostasis. But, how the GM influences glaucoma remains unrevealed. This study aimed at investigating the key molecules/pathways mediating the GM and the glaucoma to provide new biomarkers for future predictive, preventive, and personalized medicine.

Methods

Datasets from the primary open-angle glaucoma (POAG) patients (GSE138125) and datasets for target genes of GM/GM metabolites were downloaded from a public database. For GSE138125, the differentially expressed genes (DEGs) between healthy and POAG samples were identified. And the online Venn diagram tool was used to obtain the DEGs from POAG related to GM. After which GM-related DEGs were analyzed by correlation analysis, pathway enrichment analysis, and protein-protein interaction (PPI) network analysis. Human trabecular meshwork cells were used for validation, and the mRNA level of hub genes was verified by quantitative real-time polymerase chain reaction (RT-qPCR) in the in vitro glaucoma model.

Results

A total of 16 GM-related DEGs in POAG were identified from the above 2 datasets (9 upregulated genes and 7 downregulated genes). Pathway enrichment analysis indicated that these genes are mostly enriched in immune regulation especially macrophages-related pathways. Then 6 hub genes were identified by PPI network analysis and construction of key modules. Finally, RT-qPCR confirmed that the expression of the hub genes in the in vitro glaucoma model was consistent with the results of bioinformatics analysis of the mRNA chip.

Conclusion

This bioinformatic study elucidates NFKB1, IL18, KITLG, TLR9, FKBP2, and HDAC4 as hub genes for POAG and GM regulation. Immune response modulated by macrophages plays an important role in POAG and may be potential targets for future predictive, preventive, and personalized diagnosis and treatment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-023-00336-2.

Characteristics of Hematologic Parameters in Young Patients with Retinal Vein Occlusion

INTRODUCTION

The aim of this study was to investigate the characteristics of hematologic parameters in young patients with retinal vein occlusion (RVO).

METHODS

All participants underwent routine ocular examinations and blood sample tests. Hematologic parameters obtained from a complete blood count, as well as the calculation of specific inflammatory indices, were compared between young patients with RVO and the control subjects. Correlations between hematologic inflammatory biomarkers and aqueous humor inflammatory cytokines were also investigated.

RESULTS

A total of 64 patients with RVO and 64 age- and gender-matched control subjects were included in this study. The white blood cell count, neutrophil cell count, mean platelet volume (MPV), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI) in young patients with RVO were significantly higher than in the controls (all p < 0.05). Compared to patients with nonischemic RVO, patients with ischemic RVO had higher NLR, SII, and SIRI values (p = 0.032, p = 0.035, and p = 0.039, respectively). The areas under the receiver operator characteristic curve were 0.725, 0.651, 0.649, and 0.634 for the MPV, NLR, SII, and SIRI, respectively. In addition, a higher NLR was related to higher levels of interleukin 6 (IL-6; p = 0.046, R = 0.463), and a higher SII was related to higher levels of IL-6 (p = 0.034, R = 0.488) and vascular endothelial growth factor (p = 0.020, R = 0.528).

CONCLUSION

The NLR, SII, and SIRI were significantly elevated in young patients with RVO, especially in young patients with ischemic RVO. NLR and SII were positively correlated with IL-6 levels in aqueous humor, which indicated that systemic inflammation plays an important role in the onset of RVO in young patients.

Risk Factors Associated With a Large Vertical Cup-to-Disc Ratio: Korean National Health and Nutritional Examination Survey

PRCIS

Higher intraocular pressure, higher systolic blood pressure, and higher serum aspartate transaminase to alanine aminotransaminase level were risk factors associated with a large vertical cup-to-disk ratio (vCDR).

PURPOSE

To identify risk factors for a large vCDR using data from the Korea National Health and Nutritional Examination Survey (2008-2012).

MATERIALS AND METHODS

Out of the total 29,322 participants aged 20 or older who participated in Korea National Health and Nutrition Survey (KHANES) from the year 2008 to 2012, this study was conducted on 21,780 participants, excluding 1449 of them without fundus photographs and 6093 of them with missing values. To identify the risk factors associated with a large vCDR, the participants were divided into 2 groups: ≥0.6 and <0.6.

RESULTS

Of the 21,780 subjects, 2357 of them had a vCDR ≥0.6 and 19,423 had a vCDR <0.6. There were significant differences in age, sex, and educational levels between the 2 groups. After adjusting age, sex, education level, and survey year by propensity score matching, in the group having vCDR ≥0.6, intraocular pressure (IOP) was high, systolic blood pressure (SBP) was high, and serum aspartate transaminase to alanine aminotransaminase level (AST/ALT ratio) was high ( P <0.001, P <0.001, and P <0.001). The results of multiple logistic regression analyses revealed that high IOP, high SBP, high myopia, and high AST/ALT ratio were risk factors for vCDR ≥0.6 ( P <0.001, P =0.006, P =0.005, P <0.001).

CONCLUSIONS

In this study, risk factors associated with large vCDR were analyzed. Higher IOP, higher SBP, and higher AST/ALT ratio were related to vCDR ≥0.6.

New insight of metabolomics in ocular diseases in the context of 3P medicine

Metabolomics refers to the high-through untargeted or targeted screening of metabolites in biofluids, cells, and tissues. Metabolome reflects the functional states of cells and organs of an individual, influenced by genes, RNA, proteins, and environment. Metabolomic analyses help to understand the interaction between metabolism and phenotype and reveal biomarkers for diseases. Advanced ocular diseases can lead to vision loss and blindness, reducing patients' quality of life and aggravating socio-economic burden. Contextually, the transition from reactive medicine to the predictive, preventive, and personalized (PPPM / 3P) medicine is needed. Clinicians and researchers dedicate a lot of efforts to explore effective ways for disease prevention, biomarkers for disease prediction, and personalized treatments, by taking advantages of metabolomics. In this way, metabolomics has great clinical utility in the primary and secondary care. In this review, we summarized much progress achieved by applying metabolomics to ocular diseases and pointed out potential biomarkers and metabolic pathways involved to promote 3P medicine approach in healthcare.

Blood cell traits and risk of glaucoma: A two-sample mendelian randomization study

Importance: Glaucoma is the second leading cause of blindness in the world. The causal direction and magnitude of the association between blood cell traits and glaucoma is uncertain because of the susceptibility of observational studies to confounding and reverse causation. Objective: To explore whether there is a causal relationship of blood cell traits including white blood cell (WBC) count (WBCC) and its subtypes [basophil cell count (BASO), monocyte cell count (MONO), lymphocyte cell count (LYMPH), eosinophil cell count (EOS), neutrophil cell count (NEUT)], red blood cell (RBC) count (RBCC), red blood distribution width (RDW), platelet count (PLT), and plateletcrit (PCT) on glaucoma risk. Methods: A two-sample Mendelian randomization (MR) analysis was conducted. Genome-wide significant single nucleotide polymorphisms (SNPs) from published genome-wide association studies (GWAS) on human blood cell traits were utilized as exposure instruments and the dataset for outcome was from the GWAS summary data of glaucoma. In the univariable MR analysis, we examined the association between genetic evidence of blood cell traits and glaucoma. To further investigate the potential causal mechanisms underlying the observed association, we performed multivariable MR analysis with three models, taking into account the mediator effect of inflammation and oxidative stress. According to Bonferroni-corrected for the 10 exposures in 3 methods, the MR study yielded a statistically significant p-value of 0.0017. Results: Genetically BASO, PCT, LYMPH, and PLT were potentially positively associated with glaucoma in the European ancestry [BASO: Odds ratio (OR) = 1.00122, 95% confidence interval (CI), 1.00003-1.00242, p = 0.045; PCT: OR = 1.00078, 95% CI, 1.00012-1.00143, p = 0.019; LYMPH: OR = 1.00076, 95% CI, 1.00002-1.00151, p = 0.045; PLT: OR = 1.00065, 95% CI, 1.00006-1.00123, p = 0.030], There was insufficient evidence to support a causal association of MONO, NEUT, EOS, WBCC, RBCC and RDW (MONO: OR = 1.00050, p = 0.098; NEUT: OR = 1.00028, p = 0.524; EOS: OR = 1.00020, p = 0.562; WBCC: OR = 1.00008, p = 0.830; RBCC: OR = 0.99996, p = 0.920; RDW: OR = 0.99987, p = 0.734) with glaucoma. The multivariable MR with model 1, 2, and 3 demonstrated that BASO, PCT, LYMPH, and PLT were still potentially genetically associated with the risk of glaucoma. Conclusion: Our study reveals a genetic predisposition to higher LYMPH, BASO, PLT, and PCT are associated with a higher risk of glaucoma, whereas WBCC, MONO, EOS, NEUT, RBCC, and RDW are not associated with the occurrence of glaucoma. This finding also supports previous observational studies associating immune components with glaucoma, thus provide guidance on the predication and prevention for glaucoma.

Association of systemic inflammation indices with visual field loss progression in patients with primary angle-closure glaucoma: potential biomarkers for 3P medical approaches

RELEVANCE

Accumulating evidence suggests a dysfunction of the para-inflammation in the retinal ganglion cell layer and the optic nerve head in patients with glaucoma. Currently, circulating blood platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR) are regarded as novel indicators of systemic inflammation. Biomarkers allow early identification of patients with visual field (VF) loss progression and timely implementation of replacement therapies.

OBJECTIVE

This study aimed to investigate whether higher inflammatory indices (PLR, NLR, and LMR) were associated with VF loss progression in patients with primary angle-closure glaucoma (PACG) for the predictive diagnostics, targeted prevention, and personalization of medical services.

METHODS

This prospective cohort study followed up 277 patients with PACG for at least 24 months, with clinical examination and VF testing every 6 months. Inflammatory cell quantification, including platelets, neutrophils, lymphocytes, and monocytes, was measured using the Sysmex XN-A1 automated inflammatory cells quantification system. Three systemic inflammatory indices, PLR, NLR, and LMR, were determined on the basis of baseline neutrophil, lymphocyte, monocyte, and platelet counts in patients with PACG. The risk factors for PACG were analyzed using logistic regression, Cox proportional hazards regression, and the Kaplan-Meier curve.

RESULTS

Our results revealed that 111 (40.07%) patients showed VF loss progression. The PLR was significantly higher (P = 0.046) in the progression group than in the non-progression group. A higher PLR (OR 1.05, 95% CI 1.01-1.08, P = 0.004) was a risk factor for PACG progression. In multivariate analyses, PLR independently predicted VF loss progression (HR 1.01, 95% CI 1.00-1.01, P = 0.04). Kaplan-Meier curve analysis showed that higher PLR indicated significantly higher rates of VF loss progression (66.91% vs. 52.90%, P = 0.03). Comparable results were observed in the male and female subgroups.

CONCLUSION

Our findings revealed the significant association between a high PLR and a greater risk of VF loss progression in patients with PACG. PLR may be highly recommended as a novel predictive/diagnostic tool for the assessment of VF loss progression from the perspectives of predictive, preventive, and personalized medicine in vulnerable populations and for individual screening.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13167-021-00260-3.

Systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio levels are associated with keratoconus

Purpose:

The aim of this study was to assess the systemic immune-inflammation index (SII) levels, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in patients with keratoconus (KC).

Methods:

A total of 42 patients with KC (KC group) and 42 age- and sex-matched healthy subjects (control group) were included into this cross sectional study. Complete blood count parameters were assayed. SII, NLR, red cell distribution width (RDW), and PLR values were calculated. The SII value was calculated as follows: platelet count × (neutrophil/lymphocyte).

Results:

SII, NLR, RDW, and PLR values were significantly higher in KC group compared to control group [709 ± 236 vs. 418 ± 117 (P < 0.001), 2.5 ± 0.8 vs. 1.76 ± 0.3 (P < 0.001), 14.3 ± 1.6% vs. 12.9 ± 0.54% (P < 0.001), and 143 ± 36 vs. 106 ± 23 (P < 0.001), respectively]. Using the receiver operating characteristics (ROC) curve analysis to predict KC, the highest area under the curve (AUC) was determined SII (0.846 for SII, 0.778 for NLR, and 0.796 for PLR).

Conclusion:

SII, NLR, RDW, and PLR levels were significantly increased in patients with KC. This study supports the idea that several inflammatory pathways may play important role in the pathogenesis of this disorder. SII may be much better marker than NLR and PLR for predicting the inflammatory status of the disease.

Health screening program revealed risk factors associated with development and progression of papillomacular bundle defect

BACKGROUND/AIMS

The papillomacular bundle (PMB) area is an important anatomical site associated with central vision. As preventive medicine and health screening examinations are now becoming commonplace, the incidental detection of papillomacular bundle defect (PMBD) on fundus photography has been increasing. However, clinical significance of incidental PMBD has not been well documented to date. Thus, through long-term and longitudinal observation, we aimed to investigate the risk factors for the development and progression of PMBD and its predictive role associated with systemic diseases and glaucoma.

METHODS

This longitudinal study included subjects who had undergone standardized health screening. We retrospectively reviewed patients for whom PMBD had been detected in fundus photography and followed up for more than 5 years. For a comparative analysis, non-PMBD groups of age- and gender-matched healthy controls were selected.

RESULTS

A total of about 67,000 fundus photographs were analyzed for 8.0 years, and 587 PMBD eyes were found. Among them, 234 eyes of 234 patients who had had fundus photographs taken for more than 5 years were finally included. A total of 216 eyes (92.3%) did not progress during the 8.1 ± 2.7 years, whereas 18 eyes (7.7%) showed progression at 7.6 ± 2.9 years after initial detection. A multivariate logistic regression analysis using 224 non-PMBD healthy controls revealed low body mass index (BMI < 20 kg/m2), systemic hypertension, and sclerotic changes of retinal artery as the significant risk factors for the development of PMBD. Regarding PMBD progression, low BMI, concomitant retinal nerve fiber layer defect (RNFLD) at non-PMB sites, optic disc hemorrhage, and higher vertical cup/disc ratio were individual significant risk factors.

CONCLUSION

PMBD is associated with ischemic effects. Although the majority of PMBD do not progress, some of cases are associated with glaucomatous damage in a long-term way. PMBD might be a personalized indicator representing ischemia-associated diseases and a predictive factor for diagnosis and preventive management of glaucoma.