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Stanescu N, Arnon R, Yahalomi T, Nemet A, Cohen I, Pikkel J. The association between elevated blood estradiol level and corneal ectasia in women. Eur J Ophthalmol 2024:11206721241266002. [PMID: 39056134 DOI: 10.1177/11206721241266002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
PURPOSE This study aims to investigate the association between blood estradiol level and two different etiologies of corneal ectasia in premenopausal women. METHODS This is an observational case-control study with three groups of women. Group 1 included women with keratoconus. Group 2 included women with post refractive surgery ectasia (PRSE). Group 3 was the control group. Venous blood for the measurement of estradiol was collected in order to assess the relationship between estradiol levels and ectasia. Participant's age, regular cycle (yes/no) and oral contraceptive pills (OCP) use (yes/no) was also documented. We compared the differences in estradiol levels between the 3 groups. Logistic regression was used to detect variables' effect on participants' chance to ectasia. RESULTS Ninety-six women were enrolled: 36 (37%), 29 (30%), and 31 (32%) in the keratoconus, PRSE, and control group, respectively. The mean age of the participants was 29.8 ± 3.2, 31.9 ± 2.6, and 30.7 ± 3.5 years, respectively (p = 0.04, between groups 1 and 2). Estradiol levels [pg/mL] were 38.0 ± 2.4, 43.4 ± 2.4, and 28.6 ± 3.9, respectively (p < 0.001, between any pair of groups). Two multivariate logistic regression models adjusted to age, regular cycle, and OCP use, indicated that higher blood estradiol levels were associated with an increased risk of ectasia (OR = 2.71 and 2.44, respectively; p < 0.001). CONCLUSION Corneal ectasia may be associated with elevated blood estradiol levels. Estradiol measurements could be useful in women with keratoconus or in women who undergo refractive surgery.
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Affiliation(s)
- Nir Stanescu
- Department of Ophthalmology, Assuta Samson Hospital, Ashdod, Israel
- Faculty of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Roee Arnon
- Department of Ophthalmology, Assuta Samson Hospital, Ashdod, Israel
- Faculty of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Tal Yahalomi
- Department of Ophthalmology, Assuta Samson Hospital, Ashdod, Israel
- Faculty of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Achia Nemet
- Department of Ophthalmology, Assuta Samson Hospital, Ashdod, Israel
- Faculty of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Itzhak Cohen
- Faculty of Engineering, Shenkar College of Engineering and Design, Ramat-Gan, Israel
| | - Joseph Pikkel
- Department of Ophthalmology, Assuta Samson Hospital, Ashdod, Israel
- Faculty of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Meng F, Ren S. Identification of hub genes and molecular pathways in keratoconus by integrating bioinformatics and literature mining at the RNA level. Int Ophthalmol 2024; 44:244. [PMID: 38904678 DOI: 10.1007/s10792-024-03071-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/16/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Keratoconus (KC) is a condition characterized by progressive corneal steepening and thinning. However, its pathophysiological mechanism remains vague. We mainly performed literature mining to extract bioinformatic and related data on KC at the RNA level. The objective of this study was to explore the potential pathological mechanisms of KC by identifying hub genes and key molecular pathways at the RNA level. METHODS We performed an exhaustive search of the PubMed database and identified studies that pertained to gene transcripts derived from diverse corneal layers in patients with KC. The identified differentially expressed genes were intersected, and overlapping genes were extracted for further analyses. Significantly enriched genes were screened using "Gene Ontology" (GO) and "Kyoto Encyclopedia of Genes and Genomes" (KEGG) analysis with the "Database for Annotation, Visualization, and Integrated Discovery" (DAVID) database. A protein-protein interaction (PPI) network was constructed for the significantly enriched genes using the STRING database. The PPI network was visualized using the Cytoscape software, and hub genes were screened via betweenness centrality values. Pathways that play a critical role in the pathophysiology of KC were discovered using the GO and KEGG analyses of the hub genes. RESULTS 68 overlapping genes were obtained. Fifty genes were significantly enriched in 67 biological processes, and 16 genes were identified in 7 KEGG pathways. Moreover, 14 nodes and 32 edges were identified via the PPI network constructed using the STRING database. Multiple analyses identified 4 hub genes, 12 enriched biological processes, and 6 KEGG pathways. GO enrichment analysis showed that the hub genes are mainly involved in the positive regulation of apoptotic process, and KEGG analysis showed that the hub genes are primarily associated with the interleukin-17 (IL-17) and tumor necrosis factor (TNF) pathways. Overall, the matrix metalloproteinase 9, IL-6, estrogen receptor 1, and prostaglandin-endoperoxide synthase 2 were the potential important genes associated with KC. CONCLUSION Four genes, matrix metalloproteinase 9, IL-6, estrogen receptor 1, and prostaglandin endoperoxide synthase 2, as well as IL-17 and TNF pathways, are critical in the development of KC. Inflammation and apoptosis may contribute to the pathogenesis of KC.
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Affiliation(s)
- Feiying Meng
- Henan Eye Hospital, Henan Provincial People's Hospital/People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
- Eye Institute, Henan Academy of Innovations in Medical Science, Zhengzhou, China
| | - Shengwei Ren
- Henan Eye Hospital, Henan Provincial People's Hospital/People's Hospital of Zhengzhou University, Zhengzhou, 450003, China.
- Eye Institute, Henan Academy of Innovations in Medical Science, Zhengzhou, China.
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Escandon P, Nicholas SE, Vasini B, Cunningham RL, Murphy DA, Riaz KM, Karamichos D. Selective Modulation of the Keratoconic Stromal Microenvironment by FSH and LH. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:1762-1775. [PMID: 36822267 PMCID: PMC10726429 DOI: 10.1016/j.ajpath.2023.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/19/2023] [Accepted: 02/01/2023] [Indexed: 02/23/2023]
Abstract
Keratoconus (KC) affects the corneal structure, with thinning and bulging outward into a conelike shape. Irregular astigmatism and decreased visual acuity appear during puberty and progress into the mid-30s, with unpredictable disease severity. The cause of KC is recognized as multifactorial, but remains poorly understood. Hormone imbalances are a significant modulator of the onset of KC. This study sought to investigate the role of gonadotropins, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) in KC, using a three-dimensional, self-assembled matrix in vitro model. Healthy corneal fibroblasts and human KC cells in the corneal stroma were isolated, cultured, and stimulated with stable vitamin C to promote extracellular matrix assembly. Cultures were further stimulated with 2.5 or 10 mIU/mL FSH and 5 or 35 mIU/mL LH. Samples were evaluated for cell proliferation and morphology via BrdU assay and imaging; protein expression was assessed via Western blot analysis. Proliferation was significantly greater in human KC cells compared to healthy corneal fibroblasts with LH stimulation, but no changes were found with FSH stimulation. Additionally, in sex hormone receptors, fibrotic markers, proteoglycans, and members of the gonadotropin signaling pathway were significantly changed, largely driven by exogenous LH. The impact of exogenous FSH/LH in the KC stromal microenvironment was demonstrated. These results highlight the need to further examine the role of FSH/LH in KC and in human corneal homeostasis.
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Affiliation(s)
- Paulina Escandon
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, Texas; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas
| | - Sarah E Nicholas
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, Texas; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas
| | - Brenda Vasini
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, Texas; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas
| | - Rebecca L Cunningham
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas
| | - David A Murphy
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kamran M Riaz
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, Texas; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas; Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas.
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Cousins HC, Cousins CC, Valluru G, Altman RB, Liu Y, Pasquale LR, Ahmad S. Genetic Correlations Among Corneal Biophysical Parameters and Anthropometric Traits. Transl Vis Sci Technol 2023; 12:8. [PMID: 37561511 PMCID: PMC10424803 DOI: 10.1167/tvst.12.8.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/10/2023] [Indexed: 08/11/2023] Open
Abstract
Purpose The genetic architecture of corneal dysfunction remains poorly understood. Epidemiological and clinical evidence suggests a relationship between corneal structural features and anthropometric measures. We used global and local genetic similarity analysis to identify genomic features that may underlie structural corneal dysfunction. Methods We assembled genome-wide association study summary statistics for corneal features (central corneal thickness, corneal hysteresis [CH], corneal resistance factor [CRF], and the 3 mm index of keratometry) and anthropometric traits (body mass index, weight, and height) in Europeans. We calculated global genetic correlations (rg) between traits using linkage disequilibrium (LD) score regression and local genetic covariance using ρ-HESS, which partitions the genome and performs regression with LD regions. Finally, we identified genes located within regions of significant genetic covariance and analyzed patterns of tissue expression and pathway enrichment. Results Global LD score regression revealed significant negative correlations between height and both CH (rg = -0.12; P = 2.0 × 10-7) and CRF (rg = -0.11; P = 6.9 × 10-7). Local analysis revealed 68 genomic regions exhibiting significant local genetic covariance between CRF and height, containing 2874 unique genes. Pathway analysis of genes in regions with significant local rg revealed enrichment among signaling pathways with known keratoconus associations, including cadherin and Wnt signaling, as well as enrichment of genes modulated by copper and zinc ions. Conclusions Corneal biophysical parameters and height share a common genomic architecture, which may facilitate identification of disease-associated genes and therapies for corneal ectasias. Translational Relevance Local genetic covariance analysis enables the identification of associated genes and therapeutic targets for corneal ectatic disease.
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Affiliation(s)
- Henry C. Cousins
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Clara C. Cousins
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Girish Valluru
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Russ B. Altman
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Yutao Liu
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA
| | - Louis R. Pasquale
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sumayya Ahmad
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Deitel CM, Chen KH, Uber IC. Possible association of keratoconus progression with gender-affirming hormone therapy: A case report. Am J Ophthalmol Case Rep 2023; 30:101850. [PMID: 37131527 PMCID: PMC10149176 DOI: 10.1016/j.ajoc.2023.101850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/22/2023] [Accepted: 04/04/2023] [Indexed: 05/04/2023] Open
Abstract
Purpose To present a case of keratoconus progression following gender-affirming hormone therapy. Observations A 28-year-old male-to-female transgender patient with potential past ocular history of subclinical keratoconus presented with subacute worsening myopia of both eyes (OU), 4 months after initiation of gender-affirming hormone therapy. A diagnosis of keratoconus was established based on slit-lamp exam and computerized corneal tomography. Notable indices were central corneal thinning and inferior steepening OU with maximum corneal curvatures of 58.3 D of the right eye (OD) and 77.7 D of the left eye (OS) and thinnest corneal thickness of 440 μm OD and 397 μm OS. After 8 months of continued hormone therapy, the patient's keratoconus continued to progress and thus corneal crosslinking was recommended and performed. Conclusions Keratoconus progression and relapse has been suggested to have an association with sex hormone changes. We report a case of keratoconus progression following gender-affirming hormone therapy in a transgender patient. Our findings continue to support a correlative relationship between sex hormones and corneal ectasia pathophysiology. Further studies are needed to determine causality and to investigate the utility of screening corneal structure prior to the initiation of gender-affirming hormone therapies.
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Affiliation(s)
| | - Kevin H. Chen
- Corresponding author. Kevin Chen Mailing address: Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA, 23708, USA.
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Shu DY, Chaudhary S, Cho KS, Lennikov A, Miller WP, Thorn DC, Yang M, McKay TB. Role of Oxidative Stress in Ocular Diseases: A Balancing Act. Metabolites 2023; 13:187. [PMID: 36837806 PMCID: PMC9960073 DOI: 10.3390/metabo13020187] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
Redox homeostasis is a delicate balancing act of maintaining appropriate levels of antioxidant defense mechanisms and reactive oxidizing oxygen and nitrogen species. Any disruption of this balance leads to oxidative stress, which is a key pathogenic factor in several ocular diseases. In this review, we present the current evidence for oxidative stress and mitochondrial dysfunction in conditions affecting both the anterior segment (e.g., dry eye disease, keratoconus, cataract) and posterior segment (age-related macular degeneration, proliferative vitreoretinopathy, diabetic retinopathy, glaucoma) of the human eye. We posit that further development of therapeutic interventions to promote pro-regenerative responses and maintenance of the redox balance may delay or prevent the progression of these major ocular pathologies. Continued efforts in this field will not only yield a better understanding of the molecular mechanisms underlying the pathogenesis of ocular diseases but also enable the identification of novel druggable redox targets and antioxidant therapies.
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Affiliation(s)
- Daisy Y. Shu
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Suman Chaudhary
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Kin-Sang Cho
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Anton Lennikov
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - William P. Miller
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - David C. Thorn
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA 02138, USA
| | - Menglu Yang
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA
| | - Tina B. McKay
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Zhao X, Yuan Y, Sun T, Zhang Y, Chen Y. Associations Between Keratoconus and the Level of Sex Hormones: A Cross-Sectional Study. Front Med (Lausanne) 2022; 9:828233. [PMID: 35280869 PMCID: PMC8908379 DOI: 10.3389/fmed.2022.828233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To analyze the level of sex hormone in relation to keratoconus (KC). Methods Sixty-two eyes of 62 patients (12 females, 50 males) classified as KC and 120 eyes of 120 patients (21 females, 99 males) with mild to moderate myopia and astigmatism were analyzed. Plasma samples were collected and analyzed using a chemiluminescence immunoassay to determine the concentrations of estriol (E3), estradiol (E2), progesterone (P), and testosterone (T). Corneal morphological parameters, such as the central corneal thickness (CCT), thinnest corneal thickness (TCT), and maximum simulated keratometry (Kmax), were measured using Pentacam and Sirius. Results The mean age was 23.73 ± 5.16 years for patients with KC and 23.68 ± 6.10 years for patients treated with laser vision correction (LVC). Among the patients with KC, 12 were female (19.35%) and 50 were male (80.65%). The majority of patients with KC were between 20 and 30 years old. In female patients, the concentration of T in the KC group was significantly lower than that in the LVC group (0.86 ± 0.33 vs. 1.18 ± 0.58 nmol/L; P = 0.044). There were positive correlations between T, CCT (r = 0.395, P = 0.023) and TCT (r = 0.378, P = 0.030) in female patients. In male patients, E2 was higher in the KC group than the LVC group (143.75 ± 34.82 vs. 124.80 ± 43.56 pmol/L; P = 0.013), while T was significantly lower (11.59 ± 2.85 vs. 13.58 ± 4.77 nmol/L; P = 0.026). A positive correlation was found between E2 and Kmax (r = 0.222, P = 0.007) in male patients. Conclusions Conclusively, our results showed that T level was reduced in both female and male KC plasma, while E2 was increased in male KC plasma. Different levels of sex hormones are correlated with KC, which, may provide the basis of a new technique for screening and diagnosing KC with or without the assistance of current imaging techniques. Moreover, the correlations between sex hormone alterations and KC provide compelling insight into KC etiopathogenesis.
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Affiliation(s)
- Xiaorui Zhao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Yifei Yuan
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Tong Sun
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Yu Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Yueguo Chen
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
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Lasagni Vitar RM, Bonelli F, Rama P, Ferrari G. Nutritional and Metabolic Imbalance in Keratoconus. Nutrients 2022; 14:nu14040913. [PMID: 35215563 PMCID: PMC8876314 DOI: 10.3390/nu14040913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/18/2022] [Indexed: 12/31/2022] Open
Abstract
Keratoconus (KC) is a progressive corneal degeneration characterized by structural changes consisting of progressive thinning and steepening of the cornea. These alterations result in biomechanical weakening and, clinically, in vision loss. While the etiology of KC has been the object of study for over a century, no single agent has been found. Recent reviews suggest that KC is a multifactorial disease that is associated with a wide variety of genetic and environmental factors. While KC is typically considered a disease of the cornea, associations with systemic conditions have been well described over the years. In particular, nutritional and metabolic imbalance, such as the redox status, hormones, metabolites, and micronutrients (vitamins and metal ions), can deeply influence KC initiation and progression. In this paper, we comprehensively review the different nutritional (vitamins and minerals) and metabolic (hormones and metabolites) factors that are altered in KC, discussing their possible implication in the pathophysiology of the disease.
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Affiliation(s)
| | | | | | - Giulio Ferrari
- Correspondence: ; Tel.: +39-02-26436186; Fax: +39-02-26436164
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Hao XD, Gao H, Xu WH, Shan C, Liu Y, Zhou ZX, Wang K, Li PF. Systematically Displaying the Pathogenesis of Keratoconus via Multi-Level Related Gene Enrichment-Based Review. Front Med (Lausanne) 2022; 8:770138. [PMID: 35141241 PMCID: PMC8818795 DOI: 10.3389/fmed.2021.770138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/31/2021] [Indexed: 01/20/2023] Open
Abstract
Keratoconus (KC) is an etiologically heterogeneous corneal ectatic disorder. To systematically display the pathogenesis of keratoconus (KC), this study reviewed all the reported genes involved in KC, and performed an enrichment analysis of genes identified at the genome, transcription, and protein levels respectively. Combined analysis of multi-level results revealed their shared genes, gene ontology (GO), and pathway terms, to explore the possible pathogenesis of KC. After an initial search, 80 candidate genes, 2,933 transcriptional differential genes, and 947 differential proteins were collected. The candidate genes were significantly enriched in extracellular matrix (ECM) related terms, Wnt signaling pathway and cytokine activities. The enriched GO/pathway terms of transcription and protein levels highlight the importance of ECM, cell adhesion, and inflammatory once again. Combined analysis of multi-levels identified 13 genes, 43 GOs, and 12 pathways. The pathogenic relationships among these overlapping factors maybe as follows. The gene mutations/variants caused insufficient protein dosage or abnormal function, together with environmental stimulation, leading to the related functions and pathways changes in the corneal cells. These included response to the glucocorticoid and reactive oxygen species; regulation of various signaling (P13K-AKT, MAPK and NF-kappaB), apoptosis and aging; upregulation of cytokines and collagen-related enzymes; and downregulation of collagen and other ECM-related proteins. These undoubtedly lead to a reduction of extracellular components and induction of cell apoptosis, resulting in the loosening and thinning of corneal tissue structure. This study, in addition to providing information about the genes involved, also provides an integrated insight into the gene-based etiology and pathogenesis of KC.
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Affiliation(s)
- Xiao-Dan Hao
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, China
- *Correspondence: Xiao-Dan Hao
| | - Hua Gao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
- Shandong Eye Hospital, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Wen-Hua Xu
- Department of Inspection, The Medical Faculty of Qingdao University, Qingdao, China
| | - Chan Shan
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, China
| | - Ying Liu
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, China
| | - Zhi-Xia Zhou
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, China
| | - Kun Wang
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, China
- Kun Wang
| | - Pei-Feng Li
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, College of Medicine, Qingdao University, Qingdao, China
- Pei-Feng Li
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The Role of Estriol and Estrone in Keratoconic Stromal Sex Hormone Receptors. Int J Mol Sci 2022; 23:ijms23020916. [PMID: 35055103 PMCID: PMC8779160 DOI: 10.3390/ijms23020916] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 02/04/2023] Open
Abstract
Keratoconus (KC) is a progressive corneal thinning disease that manifests in puberty and worsens during pregnancy. KC onset and progression are attributed to diverse factors that include: environmental, genetics, and hormonal imbalances; however, the pathobiology remains elusive. This study aims to determine the role of corneal stroma sex hormone receptors in KC and their interplay with estrone (E1) and estriol (E3) using our established 3D in vitro model. Healthy cornea stromal cells (HCFs) and KC cornea stromal cells (HKCs), both male and female, were stimulated with various concentrations of E1 and E3. Significant changes were observed between cell types, as well as between males and females in the sex hormone receptors tested; androgen receptor (AR), progesterone receptor (PR), estrogen receptor alpha (ERα), and estrogen receptor beta (ERβ) using Western blot analysis. E1 and E3 stimulations in HCF females showed AR, PR, and ERβ were significantly upregulated compared to HCF males. In contrast, ERα and ERβ had significantly higher expression in HKC's females than HKC's males. Our data suggest that the human cornea is a sex-dependent, hormone-responsive tissue that is significantly influenced by E1 and E3. Therefore, it is plausible that E1, E3, and sex hormone receptors are involved in the KC pathobiology, warranting further investigation.
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McKay TB, Priyadarsini S, Karamichos D. Sex Hormones, Growth Hormone, and the Cornea. Cells 2022; 11:cells11020224. [PMID: 35053340 PMCID: PMC8773647 DOI: 10.3390/cells11020224] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 12/31/2022] Open
Abstract
The growth and maintenance of nearly every tissue in the body is influenced by systemic hormones during embryonic development through puberty and into adulthood. Of the ~130 different hormones expressed in the human body, steroid hormones and peptide hormones are highly abundant in circulation and are known to regulate anabolic processes and wound healing in a tissue-dependent manner. Of interest, differential levels of sex hormones have been associated with ocular pathologies, including dry eye disease and keratoconus. In this review, we discuss key studies that have revealed a role for androgens and estrogens in the cornea with focus on ocular surface homeostasis, wound healing, and stromal thickness. We also review studies of human growth hormone and insulin growth factor-1 in influencing ocular growth and epithelial regeneration. While it is unclear if endogenous hormones contribute to differential corneal wound healing in common animal models, the abundance of evidence suggests that systemic hormone levels, as a function of age, should be considered as an experimental variable in studies of corneal health and disease.
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Affiliation(s)
- Tina B. McKay
- Department of Cell Biology, University of Oklahoma Health Sciences, Oklahoma City, OK 73104, USA;
| | | | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Correspondence: ; Tel.: +1-817-735-2101
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Karamichos D, Escandon P, Vasini B, Nicholas SE, Van L, Dang DH, Cunningham RL, Riaz KM. Anterior pituitary, sex hormones, and keratoconus: Beyond traditional targets. Prog Retin Eye Res 2021; 88:101016. [PMID: 34740824 PMCID: PMC9058044 DOI: 10.1016/j.preteyeres.2021.101016] [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: 08/03/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/13/2022]
Abstract
"The Diseases of the Horny-coat of The Eye", known today as keratoconus, is a progressive, multifactorial, non-inflammatory ectatic corneal disorder that is characterized by steepening (bulging) and thinning of the cornea, irregular astigmatism, myopia, and scarring that can cause devastating vision loss. The significant socioeconomic impact of the disease is immeasurable, as patients with keratoconus can have difficulties securing certain jobs or even joining the military. Despite the introduction of corneal crosslinking and improvements in scleral contact lens designs, corneal transplants remain the main surgical intervention for treating keratoconus refractory to medical therapy and visual rehabilitation. To-date, the etiology and pathogenesis of keratoconus remains unclear. Research studies have increased exponentially over the years, highlighting the clinical significance and international interest in this disease. Hormonal imbalances have been linked to keratoconus, both clinically and experimentally, with both sexes affected. However, it is unclear how (molecular/cellular signaling) or when (age/disease stage(s)) those hormones affect the keratoconic cornea. Previous studies have categorized the human cornea as an extragonadal tissue, showing modulation of the gonadotropins, specifically luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Studies herein provide new data (both in vitro and in vivo) to further delineate the role of hormones/gonadotropins in the keratoconus pathobiology, and propose the existence of a new axis named the Hypothalamic-Pituitary-Adrenal-Corneal (HPAC) axis.
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Affiliation(s)
- Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
| | - Paulina Escandon
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Brenda Vasini
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Sarah E Nicholas
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Lyly Van
- University of Oklahoma Health Sciences Center, 940 Stanton L Young, Oklahoma City, OK, USA; Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Deanna H Dang
- College of Medicine, University of Oklahoma Health Sciences Center, 940 Stanton L Young, Oklahoma City, OK, USA
| | - Rebecca L Cunningham
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Kamran M Riaz
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Anitha V, Vanathi M, Raghavan A, Rajaraman R, Ravindran M, Tandon R. Pediatric keratoconus - Current perspectives and clinical challenges. Indian J Ophthalmol 2021; 69:214-225. [PMID: 33463562 PMCID: PMC7933850 DOI: 10.4103/ijo.ijo_1263_20] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/18/2020] [Accepted: 07/16/2020] [Indexed: 01/09/2023] Open
Abstract
Keratoconus is an ectatic corneal disease characterized by progressive stromal thinning, irregular astigmatism, and defective vision. It can be unilateral or bilateral with asymmetric presentation. It starts at puberty and either progresses rapidly to an advanced stage of the disease or stops in case of delayed onset and slow progression. Pediatric keratoconus is more aggressive than in adults and the management protocols differ because of various rationales such as accelerated progression, advanced stage of disease at the time of diagnosis and co-morbidities. It poses a burden to the society as it affects the quality of life, social, and educational development in children. Hence early diagnosis, recognition of progression, and timely intervention with collagen crosslinking is imperative to arrest the worsening. Association with systemic syndromes and ocular comorbidities can be of concern in pediatric keratoconus. Severe ocular allergy when associated hastens progress and complicates timely intervention of crosslinking treatment and compliance to contact lens wear. Keratoplasty in pediatric keratoconus has good outcomes but can encounter frequent suture-related concerns. This article discusses the epidemiology, etiopathogenesis, clinical challenges, and current perspectives of management of pediatric keratoconus.
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Affiliation(s)
- Venugopal Anitha
- Cornea Consultant, Aravind Eye Hospital & Postgraduate Institute, Tirunelveli, Tamil Nadu, India
| | - Murugesan Vanathi
- Prof of Ophthalmology, Cornea, Cataract & Refractive Services, Dr R P Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Anita Raghavan
- Cornea Consultant, Aravind Eye Hospital & Postgraduate Institute, Coimbatore, Tamil Nadu, India
| | - Revathi Rajaraman
- Cornea Consultant, Aravind Eye Hospital & Postgraduate Institute, Coimbatore, Tamil Nadu, India
| | - Meenakshi Ravindran
- Cornea Consultant, Aravind Eye Hospital & Postgraduate Institute, Tirunelveli, Tamil Nadu, India
| | - Radhika Tandon
- Prof of Ophthalmology, Cornea, Cataract & Refractive Services, Dr R P Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Shetty R, D'Souza S, Khamar P, Ghosh A, Nuijts RMMA, Sethu S. Biochemical Markers and Alterations in Keratoconus. Asia Pac J Ophthalmol (Phila) 2020; 9:533-540. [PMID: 33323707 DOI: 10.1097/apo.0000000000000332] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Keratoconus (KC) is a corneal ectatic condition characterized by focal structural changes, resulting in progressive thinning, biomechanical weakening, and steeping of the cornea that can lead to worsening visual acuity due to irregular astigmatism and corneal scarring in more advanced cases. It is a relatively common ectatic disease of the cornea predominantly affecting the younger population. Despite its worldwide prevalence, its incidence is rather varied with a higher incidence among the Middle Eastern and South Asian population. Dysregulated corneal extracellular matrix remodeling underlies KC pathogenesis. However, a lack of absolute clarity regarding the factors that initiate and drive progression poses a significant challenge in its prevention and management. KC is a complex multifactorial disease as it is associated with a wide variety of etiological factors such as environmental stimuli/insults, oxidative stress, genetic predisposition, comorbidities, and eye rubbing. A series of studies using corneal tissues (epithelium, stroma), cultured corneal fibroblasts/keratocytes, tear fluid, aqueous humor, and blood from KC subjects has reported significant alterations in various biochemical factors such as extracellular matrix components, cellular homeostasis regulators, inflammatory factors, hormones, metabolic products, and chemical elements. It has become apparent that alterations in the biochemical mediators (related to various etiologies) could contribute to KC pathogenesis by altering the dynamics of extracellular matrix remodeling events such as collagen deposition, degradation, and cross-linking in the cornea. Determining key disease contributing biochemical mediators would aid in disease monitoring, prediction or abatement of disease progression, and development of targeted therapeutics to improve disease prognosis.
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Affiliation(s)
- Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Pooja Khamar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Arkasubhra Ghosh
- GROW Research Lab, Narayana Nethralaya Foundation, Bangalore, India
| | - Rudy M M A Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
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Ferrari G, Rama P. The keratoconus enigma: A review with emphasis on pathogenesis. Ocul Surf 2020; 18:363-373. [PMID: 32234342 DOI: 10.1016/j.jtos.2020.03.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/11/2020] [Accepted: 03/19/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To review the literature on the etiopathogenesis of keratoconus (KC). METHODS A literature search was conducted using PUBMED and Google Scholar for keratoconus. The authors analyzed epidemiology studies, reviews, and case reports. RESULTS Atopy and ocular surface inflammation are a common features of KC and should lead to a reconsideration of the traditional definition of KC as a "non inflammatory" condition. Co-morbidities suggest that KC may be the ocular manifestation of a systemic disease. Finally, KC shows higher prevalence in certain ethnicities, which calls into question the status of KC as a rare disease, at least in these communities. CONCLUSION We believe that future studies should test whether selected, high prevalence populations exhibit specific genetic background and/or ethno-specific environmental risk factors.
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Affiliation(s)
- Giulio Ferrari
- San Raffaele Hospital, Cornea and Ocular Surface Unit, Eye Repair Lab, Italy.
| | - Paolo Rama
- San Raffaele Hospital, Cornea and Ocular Surface Unit, Eye Repair Lab, Italy
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McKay TB, Priyadarsini S, Karamichos D. Mechanisms of Collagen Crosslinking in Diabetes and Keratoconus. Cells 2019; 8:cells8101239. [PMID: 31614631 PMCID: PMC6830090 DOI: 10.3390/cells8101239] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/14/2022] Open
Abstract
Collagen crosslinking provides the mechanical strength required for physiological maintenance of the extracellular matrix in most tissues in the human body, including the cornea. Aging and diabetes mellitus (DM) are processes that are both associated with increased collagen crosslinking that leads to increased corneal rigidity. By contrast, keratoconus (KC) is a corneal thinning disease associated with decreased mechanical stiffness leading to ectasia of the central cornea. Studies have suggested that crosslinking mediated by reactive advanced glycation end products during DM may protect the cornea from KC development. Parallel to this hypothesis, riboflavin-mediated photoreactive corneal crosslinking has been proposed as a therapeutic option to halt the progression of corneal thinning by inducing intra- and intermolecular crosslink formation within the collagen fibrils of the stroma, leading to stabilization of the disease. Here, we review the pathobiology of DM and KC in the context of corneal structure, the epidemiology behind the inverse correlation of DM and KC development, and the chemical mechanisms of lysyl oxidase-mediated crosslinking, advanced glycation end product-mediated crosslinking, and photoreactive riboflavin-mediated corneal crosslinking. The goal of this review is to define the biological and chemical pathways important in physiological and pathological processes related to collagen crosslinking in DM and KC.
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Affiliation(s)
- Tina B McKay
- Schepens Eye Research Institute/Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA.
| | - Shrestha Priyadarsini
- Department of Ophthalmology/Dean McGee Eye Institute, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA.
| | - Dimitrios Karamichos
- Department of Ophthalmology/Dean McGee Eye Institute, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA.
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Mazzotta C, Wollensak G, Raiskup F, Pandolfi AM, Spoerl E. The meaning of the demarcation line after riboflavin-UVA corneal collagen crosslinking. EXPERT REVIEW OF OPHTHALMOLOGY 2019. [DOI: 10.1080/17469899.2019.1611425] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Cosimo Mazzotta
- Department of Medicine, Surgery and Neurosciences, Post Graduate Ophthalmology School, University of Siena, Siena, Italy
- Siena Crosslinking Center, Siena, Italy
| | - Gregor Wollensak
- AugenMVZ Hoyerswerda, Hoyerswerda, Germany
- Department of Ophthalmology, Carl Thiem Klinikum Cottbus, Cottbus, Germany
| | - Frederik Raiskup
- Department of Ophthalmology, C. G. Carus University Hospital, Dresden, Germany
| | | | - Eberhard Spoerl
- Department of Ophthalmology, C. G. Carus University Hospital, Dresden, Germany
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