Destruction of human tear proteins by ozone

The mystery of dry indoor air - An overview

"Dry air" is a major and abundant indoor air quality complaint in office-like environments. The causality of perceived "dry air" and associated respiratory effects continues to be debated, despite no clear definition of the complaint, yet, has been provided. The perception of "dry air" is semantically confusing without an associated receptor but mimics a proto-state of sensory irritation like a cooling sensation. "Dry air" may also be confused with another common indoor air quality complaint "stuffy air", which mimics the sense of no fresh air and of nasal congestion. Low indoor air humidity (IAH) was dismissed more than four decades ago as cause of "dry air" complaints, rather indoor pollutants was proposed as possible exacerbating causative agents during the cold season. Many studies, however, have shown adverse effects of low IAH and beneficial effects of elevated IAH. In this literature overview, we try to answer, "What is perceived "dry air" in indoor environments and its associated causalities. Many studies have shown that the perception is caused not only by extended exposure to low IAH, but also simultaneously with and possibly exacerbated by indoor air pollutants that aggravate the protective mucous layer in the airways and the eye tear film. Immanent diseases in the nose and airways in the general population may also contribute to the overall complaint rate and including other risk factors like age of the population, use of medication, and external factors like the local ambient humidity. Low IAH may be the single cause of perceived "dry air" in the elderly population, while certain indoor air pollutants may come into play among susceptible people, in addition to baseline contribution of nasal diseases. Thus, perceived "dry air" intercorrelates with dry eyes and throat, certain indoor air pollutants, ambient humidity, low IAH, and nasal diseases.

Extracts of different pollen species and their effect on human tear fluid and an epithelial cell line

PURPOSE

Hazelnut and birch pollen are known to destroy tear film components and attack ocular surface cells. We investigated further pollen species from different plant families, whether they show similar effects on human tear fluid and an epithelial cell line in vitro, to provide a broad basis for further research on pollen reactions affecting the tear film and ocular surface.

MATERIALS AND METHODS

Regional pollen species from different plant families (Adoxaceae, Betulaceae, Fagaceae, Juglandaceae, Malvaceae, Oleaceae, Pinaceae, Plantaginaceae, Poaceae, Salicaceae, Sapindaceae) were collected. Their proteolytic activity was evaluated by Zymography. Human tear fluid and cells of an epithelial cell line were incubated with pollen extracts. Tear fluid was analyzed by Polyacrylamide gel electrophoresis (PAGE). Cytomorphology was assessed microscopically and cell viability by proliferation (MTS), water-soluble tetrazolium (WST-1) assay and the impedance-based xCELLigence real-time analysis (RTCA).

RESULTS

Zymography revealed significant protease activity and PAGE showed the degradation of tear proteins by different pollen species. Cells incubated with pollen extracts presented dose- and time-dependent cytomorphological changes. MTS, WST-1, and RTCA revealed cytostatic as well as cytotoxic effects of pollen extracts.

CONCLUSIONS

Pollen species from different plant families exert proteolytic activity and degrade human tear fluid as well as epithelial cells, which may play a crucial role in the pathogenesis of allergic and non-allergic reactions affecting the ocular surface.

A randomized, double-blind, placebo-controlled study of oral antioxidant supplement therapy in patients with dry eye syndrome

Purpose

To evaluate the efficacy of oral antioxidant supplementation in the treatment of patients with dry eye syndrome (DES).

Methods

A prospective, randomized, double-blinded study compared the effects of an antioxidant supplement (containing anthocyanosides, astaxanthin, vitamins A, C, and E, and several herbal extracts, including Cassiae semen and Ophiopogonis japonicus) with placebo on patients with DES. We assessed dry eye symptoms, visual acuity, Schirmer’s test, tear film breakup time, cornea and conjunctiva fluorescein staining, serum anti-SSA/anti-SSB antibodies, and the level of reactive oxygen species (ROS) in tears. The supplementation period was 8 weeks and patients were followed up every 4 weeks for 16 weeks. A linear mixed model was used to compare the groups, while within-group differences were tested by repeated-measures analysis of variance.

Results

Forty-three patients, 20 and 23 in treatment and placebo groups, respectively, completed the study. Liver and renal functions were normal. Diastolic blood pressure decreased in the treatment group. There were no significant differences in systolic blood pressure, dry eye symptoms, serum anti-SSA and anti-SSB, visual acuity, intraocular pressure, or fluorescein corneal staining between the groups. Tear film breakup time scores and Schirmer’s test without topical anesthesia significantly improved in the treatment group. Tear ROS level differed between the groups and decreased after treatment. Overall subjective impression revealed a significant improvement with treatment compared with placebo.

Conclusion

Oral antioxidant supplementations may increase tear production and improve tear film stability by reducing tear ROS. The vegetable-based antioxidant supplement used in this study is safe and can be utilized as an adjuvant therapy to conventional artificial tear therapy for patients with DES.

Effects of ozone exposure on the ocular surface

Changes in the ocular surface induced by ozone have received limited research attention. Here, we investigate the effects of ozone exposure on the integrity of the ocular surface, the production of inflammatory cytokines in tears, and changes in mucin-secreting cells in a mouse model. In addition, ozone-induced nuclear factor-κB (NF-κB)-mediated inflammatory processes were evaluated in cultured human conjunctival epithelial cells. In vivo, ozone induced the breakdown of corneal epithelial integrity, decreased the number of mucin-secreting cells, and induced the production of inflammatory cytokines, without altering tear volume. In vitro, ozone exposure led to increases in NF-κB nuclear translocation, κB-dependent transcriptional activity, NF-κB inhibitor α (IκBα) proteolysis, and expression of phosphorylated IκBα (p-IκBα), but did not cause cytotoxicity or cellular apoptosis. In addition, ozone induced the expression of inflammatory cytokines, Toll-like receptors, and C-C chemokine receptors, but decreased the expression of mucins. Furthermore, inhibition of NF-κB with pyrrolidine dithiocarbamate before exposure of cultured human conjunctival epithelial cells to ozone prevented changes in IκBα and p-IκBα levels in association with a decrease in the levels of inflammatory cytokines. Therefore, we conclude that ozone exposure interferes with ocular surface integrity and induces inflammation involving NF-κB-mediated processes at the level (and/or upstream) of IκBα. Understanding the role of ozone in the initiation of inflammatory processes on the animal ocular surface and in cultured human conjunctival epithelial cells can help elucidate the pathogenesis of ocular surface damage and suggest protective strategies for preserving a healthy ocular surface against ozone exposure.

Fragmentation mechanisms of oxidized peptides elucidated by SID, RRKM modeling, and molecular dynamics

The gas-phase fragmentation reactions of singly charged angiotensin II (AngII, DR(+)VYIHPF) and the ozonolysis products AngII+O (DR(+)VY*IHPF), AngII+3O (DR(+)VYIH*PF), and AngII+4O (DR(+)VY*IH*PF) were studied using SID FT-ICR mass spectrometry, RRKM modeling, and molecular dynamics. Oxidation of Tyr (AngII+O) leads to a low-energy charge-remote selective fragmentation channel resulting in the b(4)+O fragment ion. Modification of His (AngII+3O and AngII+4O) leads to a series of new selective dissociation channels. For AngII+3O and AngII+4O, the formation of [MH+3O](+)-45 and [MH+3O](+)-71 are driven by charge-remote processes while it is suggested that b(5) and [MH+3O](+)-88 fragments are a result of charge-directed reactions. Energy-resolved SID experiments and RRKM modeling provide threshold energies and activation entropies for the lowest energy fragmentation channel for each of the parent ions. Fragmentation of the ozonolysis products was found to be controlled by entropic effects. Mechanisms are proposed for each of the new dissociation pathways based on the energies and entropies of activation and parent ion conformations sampled using molecular dynamics.

Determination of uric acid concentrations in human tear fluid, aqueous humour and serum

PURPOSE

The aim of this investigation was to assess and compare levels of uric acid in human tear fluid, aqueous humour and serum in cataract patients in order to obtain information about uric acid-dependent antioxidative status.

METHODS

Reflex tear fluid, aqueous humour and serum were obtained from 103 cataract patients (52 women, 51 men). Uric acid was determined by a reversed phase chromatographic method with electrochemical detection. The Randox test was used to measure the contribution of uric acid to the total antioxidative status (TAS) of these body fluids.

RESULTS

Mean concentrations of uric acid were 20 +/- 8 microg/ml in tear fluid, 18 +/- 6 microg/ml in aqueous humour and 58 +/- 15 microg/ml in serum. Significantly less uric acid was found in tear fluid (p < 0.01) and aqueous humour (p < 0.01) in female cataract patients compared with male cataract patients. There was a significant positive correlation between uric acid content in tear fluid, aqueous humour and serum, respectively (p < 0.01). The contribution of uric acid to TAS (Randox test) amounted to 38% in tear fluid, 10% in aqueous humour and 37% in serum.

CONCLUSIONS

Uric acid was found in comparable amounts in tear fluid and aqueous humour, but these were two- to threefold lower than in serum. Female cataract patients had lower uric acid values in tear fluid and aqueous humour compared with male cataract patients. Uric acid is an important antioxidant, as proven by its contribution to TAS as determined by the Randox test. The precise role of uric acid in the antioxidative reactions in tear fluid and aqueous humour is still under debate.

"Healthy" eye in office-like environments

Eye irritation symptoms, e.g. dry eyes, are common and abundant symptoms reported in office-like environments, e.g. aircraft cabins. To improve the understanding of indoor related eye symptomatology, relevant knowledge from the ophthalmological and indoor environmental science literature has been merged. A number of environmental (relative humidity, temperature, draft), occupational (e.g. visual display unit work), and individual (e.g. gender, use of cosmetics, and medication) risk factors have been identified, which are associated with alteration of the precorneal tear film (PTF); these factors may subsequently exacerbate development of eye irritation symptoms by desiccation. Low relative humidity including reduced atmospheric pressure further increases the water evaporation from an altered PTF; in addition, work with visual display units may destabilize the PTF by lower eye blink frequency and larger ocular surface. Results from epidemiological and clinical studies support that relative humidity >40% is beneficial for the PTF. Only few pollutants reach high enough indoor concentrations to cause sensory irritation of the eyes, while an altered PTF may exacerbate their sensory effect. Sustained low relative humidity causes impairment of the PTF, while its stability, including work performance, is retained by low gaze and intermittent breaks.

Variations in electrophoretic tear protein pattern due to contact lens wear

Electrophoresis of tear proteins was used to compare the patterns from tear proteins in contact lens wearers with non-contact lens wearers. Thirty-five non-contact lens wearers and 35 wearers volunteered to enter our study. Both groups aged 20-25 years with no history of eye diseases. Stimulated tear samples were collected using a capillary tube. Total tear protein was measured for each group individually using standard assay methods. The results showed slightly higher total tear protein in the group wearing contact lenses. Some new bands also appeared in the electrophoresis patterns of this group as compared to the control group.

Peptide ozonolysis: product structures and relative reactivities for oxidation of tyrosine and histidine residues

Angiotensin II (DRVYIHPF) and two analogs, (DRVYIAPA and DRVAIHPA), were used as model systems to study the ozonolysis of peptides containing tyrosine and histidine residues. The ESI mass spectrum of angiotensin II following exposure to ozone showed the formation of adducts containing one, three, and four oxygen atoms. CID and SID spectra of these adducts were consistent with formation of Tyr + O and His + 3O as expected from previous work with amino acids. However, several fragment ions observed in the CID and SID spectra suggested formation of a rather unexpected adduct, Tyr + 3O, and a small amount of the Phe + O adduct. These findings were confirmed by examining two angiotensin analogs. Exposure of DRVYIAPA to ozone resulted in the addition of either one or three oxygen atoms on Tyr, while DRVAIHPA showed only the addition of three oxygen atoms--all on His. Other noteworthy minor oxidation products were observed from these analogs including Tyr + 34 Da, His + 5 Da, His + 34 Da, and His + 82 Da. The reaction rates of the peptides with ozone were found to be similar: second-order rate coefficients are 274 +/- 3, 379 +/- 6, and 439 +/- 34 M(-1) s(-1) for DRVYIAPA, DRVAIHPA, and angiotensin II, respectively. The relative rates indicate (1) an isolated His residue has a slightly greater ozone reactivity than an isolated Tyr residue, and (2) the reaction rates of isolated residues are not additive when both residues are present in the same molecule.

Eye complaints in the office environment: precorneal tear film integrity influenced by eye blinking efficiency

To achieve a common base for understanding work related eye complaints in the office environment, it is necessary to merge approaches from indoor air science, occupational health, and ophthalmology. Based on database searches, it is concluded that precorneal tear film (PTF) alteration leads to eye complaints that may be caused by: (1) thermal factors (low relative humidity; high room temperature); (2) demanding task content (attention decreases blinking and widens the exposed ocular surface area); and (3) individual characteristics (for example, tear film alterations, blinking anomalies, gland dysfunctions, and use of contact lenses). These factors and conditions are able to progressively increase water evaporation and faster thinning of the PTF, which causes dryness and dry spot formation on the cornea, possibly followed by corneal and conjunctiva epithelial alterations and eye complaints. Another possible cause of eye complaints is certain irritating chemical compounds, in addition to oxidation mixtures that are formed in reactions between ozone and unsaturated organic compounds (alkenes). The effect may be exacerbated by low relative humidity.

Iodide iontophoresis as a treatment for dry eye syndrome

BACKGROUND/AIMS

Among the causes related to the development or perpetuation and aggravation of dry eye disease, oxidative reactions may have a role in the pathogenesis of this disorder. Antioxidants, such as iodide, have shown a strong effect in preventing the oxidative damage to constituents of the anterior part of the eye. In this clinical trial the effectiveness of iodide iontophoresis and iodide application without current in moderate to severe dry eye patients was compared.

METHODS

16 patients were treated with iodide iontophoresis and 12 patients with iodide application without current for 10 days. Subjective improvement, frequency of artificial tear application, tear function parameters (break up time, Schirmer test without local anaesthesia), vital staining (fluorescein and rose bengal staining) as well as impression cytology of the bulbar conjunctiva were evaluated before treatment, 1 week, 1 month, and 3 months after treatment.

RESULTS

A reduction in subjective symptoms, frequency of artificial tear substitute application, and an improvement in certain tear film and ocular surface factors could be observed in both groups. A stronger positive influence was seen after application of iodide with current (iontophoresis), as observed in a distinct improvement in break up time, fluorescein and rose bengal staining, and in a longer duration of this effect compared with the non-current group. No significant change in Schirmer test results and impression cytology were observed in both groups.

CONCLUSIONS

Iodide iontophoresis has been demonstrated to be a safe and well tolerated method of improving subjective and objective dry eye factors in patients with ocular surface disease.

Oral antioxidant therapy for marginal dry eye

OBJECTIVE

To assess the efficacy of an orally administered antioxidant dietary supplement for managing marginal dry eye.

DESIGN

A prospective, randomised, placebo controlled trial with cross-over.

SETTING

Eye Clinic, Department of Vision Sciences, Glasgow Caledonian University.

SUBJECTS

Forty marginal dry eye sufferers composed of 30 females and 10 males (median age 53 y; range 38-69 y).

INTERVENTIONS

Baseline assessments were made of tear volume sufficiency (thread test), tear quality (stability), ocular surface status (conjunctival impression cytology) and dry eye symptoms (questionnaire). Each subject was administered courses of active treatment, placebo and no treatment, in random order for 1 month each and results compared to baseline.

RESULTS

Tear stability and ocular surface status were significantly improved following active treatment (P<0.05). No changes from baseline were detected following administration of placebo and no treatment (P>0.05). Absolute increase in tear stability correlated with absolute change in goblet cell population density. Tear volume was not improved following any treatment period and dry eye symptom responses were subject to placebo effect.

CONCLUSIONS

Oral antioxidants improved both tear stability and conjunctival health, although it is not yet understood whether increased ocular surface health mediates increased tear stability or vice versa.

SPONSORS

This study was supported by a PhD scholarship funded by the Department of Vision Sciences, Glasgow Caledonian University, Scotland. Antioxidant supplements and placebos were kindly donated by Vitabiotics.