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Sjöbom U, Hellqvist T, Humayun J, Nilsson AK, Gyllensten H, Hellström A, Löfqvist C. Circulating VEGF-A Levels in Relation to Retinopathy of Prematurity and Treatment Effects: A Systematic Review and Meta-Analysis. OPHTHALMOLOGY SCIENCE 2024; 4:100548. [PMID: 39184225 PMCID: PMC11342886 DOI: 10.1016/j.xops.2024.100548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/18/2024] [Accepted: 04/29/2024] [Indexed: 08/27/2024]
Abstract
Topic Retinopathy of prematurity (ROP) is a severe retinal vascular disorder affecting preterm infants, potentially leading to retinal detachment and blindness. This review aims to elucidate the relationship between systemic VEGF levels and ROP. Clinical Relevance This systematic review aims to consolidate evidence from available studies to guide future research and inform clinical practice. In particular, the role of circulating VEGF-A levels in predicting ROP onset and progression, and evaluating the impact of anti-VEGF therapy on these levels, is crucial in ensuring efficacy and safety in patient care. Methods Scopus and PubMed were searched to identify studies investigating circulating VEGF-gene products in ROP patients using immunologic assays. Two authors independently screened the literature and extracted data, employing a random-effects meta-analysis to compare VEGF levels as the ratio of means between ROP patients and controls before and after treatment, heterogeneity was reported by I2-statistics. Risks of bias and publication bias were assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and funnel plots/Egger's tests, respectively. Results Out of 941 papers, 54 were included, with 26 providing posttreatment data and 31 providing biomarker data. Findings show a significant decrease in VEGF-A levels in the first week after ROP treatment (ratio of means [95% confidence interval] 0.34 [0.25-0.45], I2 = 97%, 17 publications). Anti-VEGF therapy showed a significantly more pronounced decrease (0.31 [0.25-0.38], I2 = 40%, 7 publications) than laser treatment in the first week after treatment (0.77 [0.61-0.97], I2 = 42%, 2 publications, subgroup difference, P < 0.01), among studies with a low risk of bias. Serum samples demonstrated a more marked decrease in VEGF-A than plasma (subgroup difference P < 0.01). However, the use of blood VEGF-A concentration as a biomarker for ROP prediction has shown inconsistent trends. The risk of bias mainly stems from unclear patient selection and lack of sample timing or analytical method details. Conclusion While anti-VEGF treatment significantly reduced blood VEGF-A levels in the first week post-ROP treatment, blood VEGF-A levels did not consistently predict ROP development. Heterogeneity in the results underscores the need for optimized analytical methods and emphasizes the importance of considering individual variation in VEGF-A concentrations independent of ROP diagnosis. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Ulrika Sjöbom
- Learning and Leadership for Health Care Professionals At the Institute of Health and Care Science at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience At the Institution of Neuroscience and Physiology at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Tove Hellqvist
- Department of Clinical Neuroscience At the Institution of Neuroscience and Physiology at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jhangir Humayun
- Learning and Leadership for Health Care Professionals At the Institute of Health and Care Science at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anders K. Nilsson
- Department of Clinical Neuroscience At the Institution of Neuroscience and Physiology at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Hanna Gyllensten
- Learning and Leadership for Health Care Professionals At the Institute of Health and Care Science at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Ann Hellström
- Department of Clinical Neuroscience At the Institution of Neuroscience and Physiology at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Chatarina Löfqvist
- Learning and Leadership for Health Care Professionals At the Institute of Health and Care Science at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience At the Institution of Neuroscience and Physiology at Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Dayoub AS, Acharya E, Dibas A, Jones HP, Acharya S. Novel Small Molecules with Anti-Inflammatory and Anti-Angiogenic Activity in a Mouse Model of Oxygen-Induced Retinopathy. Cells 2024; 13:1371. [PMID: 39195259 DOI: 10.3390/cells13161371] [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: 07/17/2024] [Revised: 08/10/2024] [Accepted: 08/14/2024] [Indexed: 08/29/2024] Open
Abstract
Retinopathy of prematurity (ROP) has a dual-phase disease pathology; in phase 1, hyperoxia-induced vaso-obliteration occurs in the retinal vasculature due to increased oxidative stress (OS) and inflammation, followed by phase 2, where hypoxia increases the overproduction of growth factors, inducing retinal neovascularization. Toll-like receptor 2 and -4 (TLR2 and TLR4) overactivation, hyper-inflammation, macrophages, and neutrophil infiltration contribute to the developing ROP. AVR-121 and AVR-123 are novel classes of small-molecule dual inhibitors of TLR2/4 tested in a human leukemia monocytic cell line (THP-1) and cord-blood-derived mononuclear cells (CBMCs). Both compounds inhibited TLR2/4 signaling-related inflammatory cytokines in THP-1 cells and inhibited VEGF-induced neovascularization in human retinal endothelial cells (HRECs), which are hallmarks of ROP. In an oxygen-induced retinopathy (OIR) murine model, the intraperitoneal injection of AVR-123 in the hyperoxia phase (P7-P12) or a nanosuspension eyedrop of AVR-123 in the hypoxic phase (P12-P17) significantly reduced vaso-obliteration, angiogenesis, and inflammatory cytokine profiles while not inhibiting the necessary growth factor VEGF in the juvenile mouse eyes. The results are consistent with our hypothesis that targeting the dual TLR2/4 pathway will reduce inflammation, angiogenesis, and vaso-obliteration in vitro and in vivo and reduce cytotoxic immune cells. AVR-123 has the potential to be developed as a therapy for ROP.
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Affiliation(s)
| | | | - Adnan Dibas
- The North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Harlan P Jones
- The North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Suchismita Acharya
- AyuVis Research Inc., Fort Worth, TX 76107, USA
- The North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
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El Emrani S, van der Meeren LE, Jansen EJS, Goeman JJ, Termote JUM, Lopriore E, Schalij-Delfos NE. Early-Onset Sepsis as an Early Predictor for Retinopathy of Prematurity: A Meta-analysis. Am J Perinatol 2024. [PMID: 39029916 DOI: 10.1055/a-2369-6690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
OBJECTIVE Neonatal sepsis has been established as a risk factor for retinopathy of prematurity (ROP) but previous meta-analyses have predominately focused on late-onset sepsis (LOS). This meta-analysis aims to explore the association between early-onset sepsis (EOS) and the risk of ROP. STUDY DESIGN Observational studies reporting (unadjusted) data on proven EOS in neonates with ROP were included. PubMed, Embase, and Cochrane Library were searched. Proven EOS was defined as a positive blood or cerebrospinal fluid culture. Effect sizes were calculated by using logistic random-effects models and meta-regression analyses. Primary outcomes were any stage ROP and severe ROP (≥stage 3, type I, aggressive [posterior] ROP, plus disease or requiring treatment). Potential confounders explored were gestational age at birth, birth weight, small for gestational age, maternal steroid use, necrotizing enterocolitis, LOS, and mechanical ventilation duration. RESULTS Seventeen studies reporting the incidence of proven EOS in neonates with ROP were included. Proven EOS showed no significant association with any stage ROP (odds ratio [OR] = 1.90; 95% confidence interval [CI]: 0.96-3.79, p = 0.067) but heterogeneity between studies was significantly high. Neonates with proven EOS had an increased risk for severe ROP (OR = 2.21; 95% CI: 1.68-2.90), and no significant confounders influencing this effect size were found in the meta-regression analysis. CONCLUSION Neonates with proven EOS are at increased risk of severe ROP. Neonatologists need to be aware that EOS is an early predictor of ROP and should adapt their policy and treatment decisions where possible to reduce ROP. KEY POINTS · This meta-analysis reveals a 2.2-fold increased risk of severe ROP in neonates with proven EOS.. · Future studies should distinguish between EOS and LOS when investigating risk factors of ROP.. · Treatment decisions should be adapted where possible in neonates with EOS before ROP screening begins..
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Affiliation(s)
- Salma El Emrani
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
- Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Lotte E van der Meeren
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Esther J S Jansen
- Neonatology, Department of Women and Neonate, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jelle J Goeman
- Medical Statistics, Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacqueline U M Termote
- Neonatology, Department of Women and Neonate, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Enrico Lopriore
- Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
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El Emrani S, Jansen EJS, Goeman JJ, Lopriore E, Termote JUM, Schalij-Delfos NE, van der Meeren LE. Histological Chorioamnionitis and Funisitis as New Risk Factors for Retinopathy of Prematurity: A Meta-analysis. Am J Perinatol 2024; 41:e3264-e3273. [PMID: 37989252 PMCID: PMC11150066 DOI: 10.1055/a-2215-0662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVE The role of placental inflammation in neonatal morbidities is underestimated due to lack of placental examination. This meta-analysis aims to assess the association between histological chorioamnionitis (HCA) with and without funisitis (FUN) and risk of retinopathy of prematurity (ROP). STUDY DESIGN Forty-five studies reporting (unadjusted) data on HCA without FUN and HCA with FUN in neonates with ROP were included. Primary outcomes were any stage ROP and severe ROP. Potential confounders explored were gestational age (GA) at birth, birthweight, maternal steroid use, necrotizing enterocolitis, sepsis (suspected/proven) and mechanical ventilation duration. RESULTS Neonates with HCA had increased risk for any stage ROP (odds ratio [OR] 1.8; 95% confidence interval [CI] 1.3-2.4) and severe ROP (OR 1.5; 95% CI 1.2-1.8) compared with neonates without HCA. The rates of any stage ROP (OR 1.8; 95% CI 1.4-2.2) and severe ROP (OR 1.4; 95% CI 1.1-1.6) were higher in neonates with FUN compared with neonates without FUN. Multivariate meta-regression analysis suggests that lower GA increases the effect size between FUN and severe ROP. CONCLUSION This meta-analysis confirms that presence of HCA and FUN are risk factors for any stage ROP and severe ROP. Structured histological placental examination of HCA and FUN may be a tool to further refine the ROP risk profile. KEY POINTS · This systematic review confirms that HCA is a risk factor for ROP.. · This meta-analysis reveals that FUN results in an even higher risk for developing ROP.. · Placental examination of HCA/FUN may be a tool to further refine the ROP risk profile..
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Affiliation(s)
- Salma El Emrani
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
- Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther J S Jansen
- Division of Neonatology, Department of Women and Neonate, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jelle J Goeman
- Division of Medical Statistics, Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacqueline U M Termote
- Division of Neonatology, Department of Women and Neonate, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Lotte E van der Meeren
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
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Almutairi M, Chechalk K, Deane E, Fox R, Janes A, Maguire-Henry T, McCabe D, O'Connor C, Quirk J, Swan E, White K, McCreery K, Isweisi E, Stewart P, Branagan A, Roche EF, Meehan J, Molloy EJ. Biomarkers in retinopathy of prematurity: a systematic review and meta-analysis. Front Pediatr 2024; 12:1371776. [PMID: 38571701 PMCID: PMC10987861 DOI: 10.3389/fped.2024.1371776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/01/2024] [Indexed: 04/05/2024] Open
Abstract
Aim Retinopathy of prematurity is a significant global cause of childhood blindness. This study aims to identify serum biomarkers that are associated with the development of ROP. Methods A systematic review and meta-analysis was conducted using PRISMA guidelines. Three databases were searched (Pubmed, Scopus and Web of Science) from 2003 to March 2023. Only studies investigating serum biomarker levels in preterm infants (<37 weeks gestation) were included. Results Meta-analysis suggests that low serum IGF-1 levels have a strong association with the development of ROP [SMD (95% CI) of -.46 [-.63, -.30], p < .001]. Meta-analysis suggests that higher serum glucose levels were associated with the development of ROP [SMD (95% CI) of 1.25 [.94, 1.55], p < .001]. Meta-analysis suggests that thrombocytopenia is associated with the development of ROP [SMD (95% CI) of -.62 [-.86, -.37], p < .001]. Conclusion Low levels of serum IGF-1, high levels of serum glucose and thrombocytopenia all appear to have the strongest association with the development of ROP out of the 63 biomarkers investigated in this review. These associations highlight their potential use as diagnostic biomarkers in ROP, though further research is needed to establish the exact relationship between these biomarkers and disease pathogenesis.
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Affiliation(s)
- Mariam Almutairi
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Katherine Chechalk
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Emelia Deane
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Rebecca Fox
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Ava Janes
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Tidgh Maguire-Henry
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Devin McCabe
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Cole O'Connor
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Joseph Quirk
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Evan Swan
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Katherine White
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Kathryn McCreery
- Paediatric Ophthalmology, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Eman Isweisi
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Philip Stewart
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Aoife Branagan
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Paediatrics, Coombe Hospital, Dublin, Ireland
| | - Edna F. Roche
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
- Endocrinology, Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
| | - Judith Meehan
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
- Trinity College Dublin, Trinity Translational Medicine Institute (TTMI), Trinity Centre for Health Sciences, St James Hospital, The University of Dublin, Dublin, Ireland
| | - Eleanor J. Molloy
- Discipline of Paediatrics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- Paediatrics, Coombe Hospital, Dublin, Ireland
- Trinity Research in Childhood Centre (TRiCC), Trinity College Dublin, Dublin, Ireland
- Endocrinology, Children's Health Ireland (CHI) at Tallaght, Dublin, Ireland
- Trinity College Dublin, Trinity Translational Medicine Institute (TTMI), Trinity Centre for Health Sciences, St James Hospital, The University of Dublin, Dublin, Ireland
- Neurodisability, Children’s Health Ireland (CHI) at Tallaght, Dublin, Ireland
- Neonatology, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
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Zhang L, Buonfiglio F, Fieß A, Pfeiffer N, Gericke A. Retinopathy of Prematurity-Targeting Hypoxic and Redox Signaling Pathways. Antioxidants (Basel) 2024; 13:148. [PMID: 38397746 PMCID: PMC10885953 DOI: 10.3390/antiox13020148] [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: 12/30/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/25/2024] Open
Abstract
Retinopathy of prematurity (ROP) is a proliferative vascular ailment affecting the retina. It is the main risk factor for visual impairment and blindness in infants and young children worldwide. If left undiagnosed and untreated, it can progress to retinal detachment and severe visual impairment. Geographical variations in ROP epidemiology have emerged over recent decades, attributable to differing levels of care provided to preterm infants across countries and regions. Our understanding of the causes of ROP, screening, diagnosis, treatment, and associated risk factors continues to advance. This review article aims to present the pathophysiological mechanisms of ROP, including its treatment. Specifically, it delves into the latest cutting-edge treatment approaches targeting hypoxia and redox signaling pathways for this condition.
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Affiliation(s)
| | | | | | | | - Adrian Gericke
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (L.Z.); (F.B.); (A.F.); (N.P.)
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Thu PP, Tauro J, Russell H, Kirpalani A. Analysis of trends in retinopathy of prematurity over 5 years in a tertiary neonatal intensive care unit. J Paediatr Child Health 2023; 59:1289-1295. [PMID: 37837258 DOI: 10.1111/jpc.16504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023]
Abstract
AIM The aim of the study was to look at the incidence and trend of retinopathy of prematurity (ROP) between 2017 and 2021 in a tertiary neonatal intensive care unit (NICU) in Australia and to compare potential modifiable risk factors of ROP between preterm infants who required treatment for ROP and who did not need treatment. METHODS This retrospective study used the data of newborn infants who were <31 weeks gestational age (GA) or birth weight (BW) of <1250 g born between 2017 and 2021 at a tertiary NICU in Australia (n = 261). Univariate analysis using t test for continuous data, Fischer exact test for categorical data and multiple logistic regression analysis were undertaken to identify any significant differences between two groups. RESULTS A total number of 261 infants were studied. 55.9% of infants developed any type of ROP (146 infants out of 261 infants), type 1 ROP was 5.4% (14 out of 261) and aggressive ROP (AROP) was 3% (8 out of 261). Out of 146 infants who were diagnosed with ROP, 22 (15%) of them required treatment. Mean GA for those who underwent ROP treatment was 25.6 (±1.47) weeks and for those who did not require treatment was 27.6 (±1.95) weeks. The mean BWs for those who needed treatment was 764 (±189.32) g and for those who did not need treatment was 1039 (±306.06) g. The mean duration of invasive ventilation for infants with ROP requiring treatment and those who did not require treatment were 23.95 (±22.41) days and 9.89 (±17.2) days. The total duration of oxygen requirement was 235.54 (±160.5) days and 121.11 (±117.34) days for those who needed treatment and those who did not need treatment respectively. Among infants who required treatment for ROP, 68.18% required blood transfusion whereas among those who did not need treatment, 24.19% required blood transfusion. CONCLUSION Lower GA, lower BW, longer duration of invasive ventilation, longer total duration of oxygen requirement and blood transfusion in first 2 weeks of life were significant in preterm infants who required treatment for ROP compared with those who did not.
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Affiliation(s)
- Pyae Pyae Thu
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Joseph Tauro
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Heather Russell
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Aditi Kirpalani
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
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Carré C, Acar N, Daruich A, Grégoire S, Martine L, Buteau B, Aho S, Eid P, Arnould L, Bron AM, Driessen M, Kermorvant E, Simon E, Creuzot-Garcher C, Gabrielle PH. Study protocol of OmegaROP-2 prospective study: expression of placental fatty acid receptors in preterm newborns with retinopathy of prematurity. BMC Ophthalmol 2023; 23:404. [PMID: 37803473 PMCID: PMC10559396 DOI: 10.1186/s12886-023-03156-0] [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: 01/10/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Incomplete vascularization of the retina in preterm infants carries a risk of retinopathy of prematurity (ROP). Progress in neonatal resuscitation in developing countries has led to the survival of an increasing number of premature infants, resulting in an increased rate of ROP and consequently in visual disability. Strategies to reduce ROP involve optimizing oxygen saturation, nutrition, and normalizing factors such as insulin-like growth factor 1 and n-3 long-chain polyunsaturated fatty acids (LC-PUFA). Our previous study, OmegaROP, showed that there is an accumulation or retention of docosahexaenoic acid (DHA) in mothers of infants developing ROP, suggesting abnormalities in the LC-PUFA placental transfer via fatty acid transporting proteins. The present study aims to better understand the LC-PUFA transport dysfunction in the fetoplacental unit during pregnancy and to find a novel target for the prevention of ROP development. METHODS The study protocol is designed to evaluate the correlation between the expression level of placental fatty acid receptors and ROP occurrence. This ongoing study will include 100 mother-infant dyads: mother-infant dyads born before 29 weeks of gestational age (GA) and mother-infant dyads with full-term pregnancies. Recruitment is planned over a period of 46 months. Maternal and cord blood samples as well as placental tissue samples will be taken following delivery. ROP screening will be performed using wide-field camera imaging according to the International Classification of ROP consensus statement. DISCUSSION The results of this study will have a tangible impact on public health. Indeed, if we show a correlation between the expression level of placental omega-3 receptors and the occurrence of ROP, it would be an essential step in discovering novel pathophysiological mechanisms involved in this retinopathy. TRIAL REGISTRATION NCT04819893.
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Affiliation(s)
- Chloé Carré
- Department of Ophthalmology, Dijon University Hospital, 14 Rue Paul Gaffarel, 21000, Dijon, France
| | - Niyazi Acar
- Eye and Nutrition Research Group, Centre Des Sciences du Goût Et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | | | - Stéphane Grégoire
- Eye and Nutrition Research Group, Centre Des Sciences du Goût Et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Lucy Martine
- Eye and Nutrition Research Group, Centre Des Sciences du Goût Et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Bénédicte Buteau
- Eye and Nutrition Research Group, Centre Des Sciences du Goût Et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Serge Aho
- Department of Epidemiology & Biostatistics, Dijon University Hospital, Dijon, France
| | - Petra Eid
- Department of Ophthalmology, Dijon University Hospital, 14 Rue Paul Gaffarel, 21000, Dijon, France
| | - Louis Arnould
- Department of Ophthalmology, Dijon University Hospital, 14 Rue Paul Gaffarel, 21000, Dijon, France
| | - Alain Marie Bron
- Department of Ophthalmology, Dijon University Hospital, 14 Rue Paul Gaffarel, 21000, Dijon, France
- Eye and Nutrition Research Group, Centre Des Sciences du Goût Et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | | | | | - Emmanuel Simon
- Department of Gynecology, Dijon University Hospital, Dijon, France
| | - Catherine Creuzot-Garcher
- Department of Ophthalmology, Dijon University Hospital, 14 Rue Paul Gaffarel, 21000, Dijon, France
- Eye and Nutrition Research Group, Centre Des Sciences du Goût Et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France
| | - Pierre-Henry Gabrielle
- Department of Ophthalmology, Dijon University Hospital, 14 Rue Paul Gaffarel, 21000, Dijon, France.
- Eye and Nutrition Research Group, Centre Des Sciences du Goût Et de L'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, Dijon, France.
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Fevereiro-Martins M, Marques-Neves C, Guimarães H, Bicho M. Retinopathy of prematurity: A review of pathophysiology and signaling pathways. Surv Ophthalmol 2023; 68:175-210. [PMID: 36427559 DOI: 10.1016/j.survophthal.2022.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina and a leading cause of visual impairment and childhood blindness worldwide. The disease is characterized by an early stage of retinal microvascular degeneration, followed by neovascularization that can lead to subsequent retinal detachment and permanent visual loss. Several factors play a key role during the different pathological stages of the disease. Oxidative and nitrosative stress and inflammatory processes are important contributors to the early stage of ROP. Nitric oxide synthase and arginase play important roles in ischemia/reperfusion-induced neurovascular degeneration. Destructive neovascularization is driven by mediators of the hypoxia-inducible factor pathway, such as vascular endothelial growth factor and metabolic factors (succinate). The extracellular matrix is involved in hypoxia-induced retinal neovascularization. Vasorepulsive molecules (semaphorin 3A) intervene preventing the revascularization of the avascular zone. This review focuses on current concepts about signaling pathways and their mediators, involved in the pathogenesis of ROP, highlighting new potentially preventive and therapeutic modalities. A better understanding of the intricate molecular mechanisms underlying the pathogenesis of ROP should allow the development of more effective and targeted therapeutic agents to reduce aberrant vasoproliferation and facilitate physiological retinal vascular development.
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Affiliation(s)
- Mariza Fevereiro-Martins
- Laboratório de Genética and Grupo Ecogenética e Saúde Humana, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Portugal; Instituto de Investigação Científica Bento da Rocha Cabral, Lisboa, Portugal; Departamento de Oftalmologia, Hospital Cuf Descobertas, Lisboa, Portugal.
| | - Carlos Marques-Neves
- Centro de Estudos das Ci.¼ncias da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; Grupo Ecogenética e Saúde Humana, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - Hercília Guimarães
- Departamento de Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Manuel Bicho
- Laboratório de Genética and Grupo Ecogenética e Saúde Humana, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Portugal; Instituto de Investigação Científica Bento da Rocha Cabral, Lisboa, Portugal.
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10
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Dogra MR, Vinekar A. Role of Anti-Vascular Endothelial Growth Factor (Anti-VEGF) in the Treatment of Retinopathy of Prematurity: A Narrative Review in the Context of Middle-Income Countries. Pediatric Health Med Ther 2023; 14:59-69. [PMID: 36814935 PMCID: PMC9939806 DOI: 10.2147/phmt.s391591] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Abstract
The rise in preterm births and higher survival rates of premature infants have led to a global increase in retinopathy of prematurity (ROP), a vasoproliferative retinal disorder common in premature infants. ROP is one of the leading causes of childhood blindness. Clinical manifestation of ROP ranges from mild abnormal retinal neovascularization to bilateral retinal detachment and vision loss. The incidence of ROP is higher in middle income countries, including India, which has the highest number of global preterm births. Low birth weight and low gestational age are the primary risk factors for ROP; however, anemia, cardiac defects, blood transfusion, apnea, sepsis, respiratory distress syndrome, high exposure to oxygen and poor postnatal weight gain may also contribute to its development. India has stringent ROP screening guidelines revised in 2018, and screening of infants with either birth weight <2000 grams or gestational age <34 weeks is mandated. With an improved understanding of the pathogenesis of ROP in the past decades and advances in clinical research, treatment for ROP has evolved from cryotherapy to laser retinal ablation. Most recently, anti-vascular endothelial growth factor (anti-VEGF) drugs have emerged as a favorable treatment option for zone-I and II ROP. This article reviews the current approaches for ROP treatment in India with a particular focus on anti-VEGF drugs. The article also integrates the understanding of safety and risk-benefit evaluation of the current approaches in ROP management. The review concluded that there is a need to increase the ROP screening not only for preterm and low birth weight but also for optimal gestational age infants with healthy birth weight. Anti-VEGF therapies have shown improved efficacy, although studies are required to establish the long-term safety.
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Affiliation(s)
| | - Anand Vinekar
- Narayana Nethralaya Eye Institute, Bangalore, India,Correspondence: Anand Vinekar, Narayana Nethralaya Eye Institute, Bangalore, India, Email
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11
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Korkmaz L, Alan C, Topal İ, Tayfur M, Bozkurt AS, Gürsul C, Baştuğ O. Can amniotic fluid protect developing fetal lungs against the harmful effects of oxidative stress? Turk J Med Sci 2023; 53:109-120. [PMID: 36945927 PMCID: PMC10387876 DOI: 10.55730/1300-0144.5564] [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: 04/23/2022] [Accepted: 09/18/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Preterm births cause fetuses to be born without completing the development of their organs. Due to this undesirable situation, it is the pulmonary tissue which has to be most exposed to harmful effects of extrauterine environment. Early disappearance of the prophylactic and constructive effects of amniotic fluid (AF) on developing tissues, such as pulmonary tissue, facilitates the formation of pulmonary morbidities resulting from oxygen. Setting out from this knowledge, we wanted, in addition to assessing the beneficent effects of AF on pulmonary tissue, to study the importance of AF in morbidities of this tissue thought to originate from oxygen. METHODS In this experimental study, while the study group was made up of the fetuses of pregnant rats exposed to hyperbaric oxygen, (hyperoxic pregnant rat fetuses-HPRF), the control group was formed of the fetuses of the rats pregnant in the usual room setting (normoxic pregnant rat fetuses-NPRF). The pulmonary and hepatic tissues taken from the fetuses of these pregnant rats on the 21st day of their pregnancy were compared biochemically and histologically. For biochemical assessment, total glutathione (tGSH), catalase (CAT), malondialdehyde (MDA), tumor necrosis factor-alpha (TNF-α) values and for histopathological assessment, apoptosis, alveolar wall count (AWC), vena centralis count (VCC) were included. RESULTS Statistical significance was found in the pulmonary tissue values of tGSH on behalf of NPRF, and MDA on behalf of HPRF (p < 0.05). In liver tissue, statistical significance was detected in tGSH and CAT values in favor of NPRF and in MDA, and TNF-α values in favor of HPRF (p < 0.05). DISCUSSION : Our study has demonstrated that AF protects the pulmonary tissue from the harmful effects of oxygen in the intrauterine period. In addition, our data have suggested that the pulmonary tissue's being deprived of the useful effects of AF owing to premature birth may be an important trigger in the occurrence of the pulmonary morbidities thought to result from oxygen.
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Affiliation(s)
- Levent Korkmaz
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Cumali Alan
- Department of Pediatrics, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - İsmail Topal
- Department of Pediatrics, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Mahir Tayfur
- Department of Pathology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Ali Seydi Bozkurt
- Department of Urology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Cebrail Gürsul
- Department of Physiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Osman Baştuğ
- Division of Neonatology, Department of Pediatrics, Kayseri Training and Research Hospital, Kayseri, Turkey
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12
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Estrada MM, Tomlinson LA, Yu Y, Ying GS, Binenbaum G. Daily Oxygen Supplementation and Risk of Retinopathy of Prematurity. Ophthalmic Epidemiol 2022; 30:317-325. [PMID: 36093765 DOI: 10.1080/09286586.2022.2111687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE Excessive oxygen supplementation increases risk of retinopathy of prematurity (ROP). While numerous oxygen parameters could be considered when predicting ROP (saturation targets, actual saturation, fraction of inspired oxygen, etc.), complicated measures are impractical as screening criteria. We sought to develop a simple, clinically useful measure of daily oxygen supplementation during ages 0-28 days to improve prediction of ROP. METHODS Secondary analysis of two Postnatal Growth and ROP (G-ROP) Study cohorts (G-ROP-1 and G-ROP-2) at 45 hospitals. Infants with a known ROP outcome and complete oxygen data were included. Associations between severe ROP and days on supplemental oxygen (FiO2 > 21%), during ages 0-28 days (DSO28) were assessed, controlling for birth weight (BW) and gestational age (GA). New screening criteria incorporating DSO were developed and compared to current guidelines. RESULTS Among 8,949 studied infants, 459 (5.1%) developed type 1 ROP. DSO28 was associated with severe ROP (adjusted-OR 1.05 per day supplemental oxygen, 95%CI 1.03-1.07, p < .0001). The following criteria had 100% sensitivity for type 1 ROP and higher specificity than current guidelines: new BW/GA criteria with DSO (BW<901 g, GA<26 weeks, or DSO >3), 23.4% fewer infants examined; modified G-ROP criteria including DSO, 29.0% fewer infants; original G-ROP criteria, 31.8% fewer infants. CONCLUSION In high-level neonatal-care settings, incorporating DSO (a simple measure of oxygen supplementation) into screening criteria improves sensitivity and specificity for type 1 ROP over current BW-GA criteria, but does not perform as well as the validated G-ROP criteria.
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Affiliation(s)
- Marcela M. Estrada
- Department of Ophthalmology, University of California, Sacramento, California, USA
| | | | - Yinxi Yu
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gil Binenbaum
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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13
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Aydoğan S, Dilli D, Kabataş EU, Akduman H, Şah Ipek M, Oğuz B, Ataş N, Zenciroğlu A. The Serum Levels of Asymmetric Dimethylarginine, Vascular Endothelial Growth Factor, and Insulin-Like Growth Factor-1 in Preterms with Retinopathy of Prematurity. Fetal Pediatr Pathol 2022; 41:634-639. [PMID: 34289792 DOI: 10.1080/15513815.2021.1948644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective:To determine the serum levels of asymmetric dimethylarginine (ADMA), vascular endothelial growth factor (VEGF), and insulin-like growth factor-1 (IGF-1) in preterms with retinopathy of prematurity (ROP). Materials and Methods: We included 37 preterm infants. The first blood samples were obtained within the first 5 days of life and repeated at the time of the first ophthalmologic examination for ROP. The levels of ADMA, IGF-1, and VEGF were measured in all samples. Results: ROP was detected in 12 of the subjects (32.4%). We categorized the subjects as non-ROP (Group 1; n = 25), untreated ROP (Group 2; n = 7), and treated ROP (Group 3; n = 5) according to the eye findings. There were no significant differences among the groups for serum levels of ADMA, VEGF, and IGF-1 at the first sampling. Conclusion: We did not find any differences in terms of serum ADMA, IGF-1, and VEGF levels in preterm infants with or without ROP.
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Affiliation(s)
- Seda Aydoğan
- Department of Neonatology, University of Health Sciences of Turkey, Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
| | - Dilek Dilli
- Department of Neonatology, University of Health Sciences of Turkey, Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
| | - Emrah Utku Kabataş
- Department of Ophtalmology, University of Health Sciences of Turkey, Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
| | - Hasan Akduman
- Department of Neonatology, University of Health Sciences of Turkey, Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
| | - Mehmet Şah Ipek
- Department of Neonatology, Memorial Dicle Hospital, Diyarbakır, Turkey
| | - Baran Oğuz
- Department of Neonatology, Şanlıurfa Research and Training Hospital, Şanlıurfa, Turkey
| | - Nurgül Ataş
- Department of Neonatology, Şanlıurfa Research and Training Hospital, Şanlıurfa, Turkey
| | - Ayşegül Zenciroğlu
- Department of Neonatology, University of Health Sciences of Turkey, Dr. Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
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14
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Bancalari E, Claure N. Importance and Challenges Associated with Oxygen Control in Premature Infants. J Pediatr 2022; 247:8-9. [PMID: 35640674 DOI: 10.1016/j.jpeds.2022.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Eduardo Bancalari
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida.
| | - Nelson Claure
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
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15
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Seliniotaki AK, Haidich AB, Moutzouri S, Lithoxopoulou M, Ziakas N, Lundgren P, Hellstrom A, Mataftsi A. Association of platelet deficiency with severe retinopathy of prematurity: a review. Acta Paediatr 2022; 111:2056-2070. [PMID: 35778901 DOI: 10.1111/apa.16472] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 11/27/2022]
Abstract
AIM The aim of this review was to compile existing evidence on the role of platelets in the development of severe retinopathy of prematurity (ROP), highlight the strengths and weaknesses of the available studies and critically discuss the reported data. METHODS A comprehensive literature search was conducted on PubMed from January 2000 to January 2022, and the reference lists of the included studies were screened manually. RESULTS There were 19 primary studies that fulfilled the eligibility criteria. Experimental research indicated lower platelet count in mice oxygen-induced retinopathy model compared with normoxia controls, while platelet transfusions suppressed neovascularisation. The latter finding was not consistently confirmed in clinical research, where a low platelet count, an increased number of thrombopenic episodes and of platelet transfusions have all been implicated in the development of ROP requiring treatment, either type I or aggressive posterior or both. However, existing studies exhibit significant clinical heterogeneity and present methodological limitations that imperil their reliability and validity. CONCLUSION Platelet deficiency has been associated with severe ROP. However, critical thresholds of platelet parameters are still unrecognised. Future research is required to determine whether platelet parameters can be predictive biomarkers for ROP requiring treatment and at what thresholds.
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Affiliation(s)
- Aikaterini K Seliniotaki
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Moutzouri
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Lithoxopoulou
- 2nd Department of Neonatology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pia Lundgren
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Hellstrom
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Asimina Mataftsi
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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16
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Marra KV, Aguilar E, Wei G, Usui-Ouchi A, Ideguchi Y, Sakimoto S, Friedlander M. Bioactive extracellular vesicles from a subset of endothelial progenitor cells rescue retinal ischemia and neurodegeneration. JCI Insight 2022; 7:e155928. [PMID: 35639473 PMCID: PMC9309054 DOI: 10.1172/jci.insight.155928] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
Disruption of the neurovascular unit (NVU) underlies the pathophysiology of various CNS diseases. One strategy to repair NVU dysfunction uses stem/progenitor cells to provide trophic support to the NVU's functionally coupled and interdependent vasculature and surrounding CNS parenchyma. A subset of endothelial progenitor cells, endothelial colony-forming cells (ECFCs) with high expression of the CD44 hyaluronan receptor (CD44hi), provides such neurovasculotrophic support via a paracrine mechanism. Here, we report that bioactive extracellular vesicles from CD44hi ECFCs (EVshi) are paracrine mediators, recapitulating the effects of intact cell therapy in murine models of ischemic/neurodegenerative retinopathy; vesicles from ECFCs with low expression levels of CD44 (EVslo) were ineffective. Small RNA sequencing comparing the microRNA cargo from EVshi and EVslo identified candidate microRNAs that contribute to these effects. EVshi may be used to repair NVU dysfunction through multiple mechanisms to stabilize hypoxic vasculature, promote vascular growth, and support neural cells.
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Affiliation(s)
- Kyle V. Marra
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
- Department of Bioengineering, University of California, San Diego, La Jolla, California, USA
| | - Edith Aguilar
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Guoqin Wei
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Ayumi Usui-Ouchi
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Yoichiro Ideguchi
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Susumu Sakimoto
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Martin Friedlander
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
- Lowy Medical Research Institute, La Jolla, California, USA
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Tao K. Postnatal administration of systemic steroids increases severity of retinopathy in premature infants. Pediatr Neonatol 2022; 63:220-226. [PMID: 34879992 DOI: 10.1016/j.pedneo.2021.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/06/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Postnatal systemic steroids are known to increase the risk of developing retinopathy of prematurity (ROP). However, whether the total dosage and type of postnatal systemic steroids are related to the development and severity of ROP in premature infants remains unclear. This study was conducted to identify the risk factors for ROP and investigate the relationship between photocoagulation (PC)-demanding severe ROP and the postnatal dosage of any type of systemic steroids. METHODS A total of 75 infants born at <28 weeks of postmenstrual age (PMA) were enrolled. The number of PC procedures for ROP was evaluated as the objective variable. This study analyzed the following independent variables: gestational age; birth weight; sex; Apgar scores; duration of mechanical ventilation; duration of nasal intermittent positive pressure ventilation; mean saturation and mean oxygen concentration administration until 36 weeks of PMA; total accumulation dosage of hydrocortisone, dexamethasone, and systemic steroids; dosage number of times of erythropoietin; total dosage of red cell concentrates (RCC); incidence of necrotizing enterocolitis (NEC) and focal intestinal perforation; sepsis; bronchopulmonary dysplasia (BPD); and intraventricular hemorrhage (IVH). Logistic regression was used to estimate the relative risk (odds ratio (OR)) associated with risk factors for PC-demanding severe ROP. RESULTS Compared with infants in the non-PC group, PC-treated infants had younger gestational age, longer mechanical ventilation periods, and higher dosage of systemic steroids and dexamethasone. Multivariate logistic regression analysis revealed total dosage of systemic steroids as the only risk factor for PC-demanding severe ROP. Based on receiver operating characteristic (ROC) curve analysis, a cutoff value of 8.95 mg/kg of postnatal systemic steroid administration was identified as a useful marker to predict PC-demanding severe ROP. CONCLUSION By focusing on the method of systemic steroid administration and avoiding excessive doses for infants born at <28 weeks of PMA, preventing the development of severe ROP is possible.
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Affiliation(s)
- Katsuo Tao
- Department of Cardiology, Fukuoka Children's Hospital, 5-1-1, Kashiiteriha, Higasi-ku, Fukuoka city, Fukuoka, 813-0017, Japan.
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18
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Retinopathy of prematurity: contribution of inflammatory and genetic factors. Mol Cell Biochem 2022; 477:1739-1763. [PMID: 35262882 DOI: 10.1007/s11010-022-04394-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/16/2022] [Indexed: 12/14/2022]
Abstract
Retinopathy of prematurity (ROP) is a retinal vasoproliferative disorder that represents an important cause of childhood visual impairment and blindness. Although oxidative stress has long been implicated in ROP etiology, other prenatal and perinatal factors are also involved. This review focuses on current research involving inflammation and genetic factors in the pathogenesis of ROP. Increasing evidence suggests that perinatal inflammation or infection contributes to ROP pathogenesis. Cytokines and chemokines with a fundamental role in inflammatory responses and that significantly contributing to angiogenesis are analyzed. Microglia cells, the retinal-resident macrophages, are crucial for retinal homeostasis, however, under sustained pathological stimuli release exaggerated amounts of inflammatory mediators and can promote pathological neovascularization. Current modulation of angiogenic cytokines, such as treatment with antibodies to vascular endothelial growth factor (anti-VEGF), has shown efficacy in the treatment of ocular neovascularization; however, some patients are refractory to anti-VEGF agents, suggesting that other angiogenic or anti-angiogenic cytokines need to be identified. Much evidence suggests that genetic factors contribute to the phenotypic variability of ROP. Several studies have implicated the involvement of candidate genes from different signaling pathways in the development of ROP. However, a genetic component with a major impact on ROP has not yet been discovered. Most studies have limitations and did not replicate results. Future research involving bioinformatics, genomics, and proteomics may contribute to finding more genes associated with ROP and may allow discovering better solutions in the management and treatment of ROP.
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19
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Tök L, Seyrek L, Yalçın Tök Ö. Low-dose ranibizumab administration in retinopathy of prematurity. Int Ophthalmol 2022; 42:1545-1552. [PMID: 34993841 DOI: 10.1007/s10792-021-02145-w] [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: 09/19/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficiency of low-dose intravitreal ranibizumab therapy in the treatment of aggressive retinopathy of prematurity (A-ROP). METHODS A total of 124 eyes of 62 patients who underwent intravitreal ranibizumab after an A-ROP diagnosis between January 2015 and January 2021 were evaluated retrospectively. After receiving family-approved informed consent, low-dose intravitreal ranibizumab was administered, and regular follow-ups were performed. RESULTS Patients included in the study had a mean birth week of 26.6 (23-33 weeks), a mean birth weight of 905 (450-1970) grams, and an average injection postnatal time of 9.1 (4-19) weeks. The mean follow-up period was 63 (24-250) weeks. In all eyes, ROP regressed in the first week after injection, and no asymmetrical response was observed in the eyes of any baby. A total of 58 eyes recovered with a single dose of intravitreal injection therapy, and peripheral retinal vascularization was completed. A second injection was required in 38 eyes. Rescue treatment was applied in addition to intravitreal ranibizumab treatment in 22 eyes of 11 babies. None of the patients had any ocular or systemic side effects. CONCLUSION Low-dose intravitreal ranibizumab injection with close follow-up and appropriate timing is an effective treatment modality in A-ROP. Even among patients undergoing rescue laser treatment, the treatment can be completed with a wide visual field.
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Affiliation(s)
- Levent Tök
- Department of Ophthalmology, Faculty of Medicine, Süleyman Demirel University Hospital, 32260, Çünür, Isparta, Turkey.
| | - Lütfi Seyrek
- Department of Ophthalmology, Faculty of Medicine, Süleyman Demirel University Hospital, 32260, Çünür, Isparta, Turkey.,Konya Eye Private Hospital, Isparta, Turkey
| | - Özlem Yalçın Tök
- Department of Ophthalmology, Faculty of Medicine, Süleyman Demirel University Hospital, 32260, Çünür, Isparta, Turkey
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20
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Sato Y, Gray A, Takahashi K, Dufour V, Lutty G, Miyadera K, Aguirre G. Monocular retinopathy of prematurity-like retinal vasculopathy in a dog. Vet Ophthalmol 2022; 25:78-84. [PMID: 34861080 PMCID: PMC9548383 DOI: 10.1111/vop.12959] [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: 06/30/2021] [Revised: 10/07/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe a case of monocular retinopathy of prematurity (ROP)-like vasculopathy without oxygen supplementation in the dog. METHODS Fundus photographs (RetCam), spectral-domain optical coherence tomography (sdOCT), confocal scanning laser ophthalmoscopy (cSLO), and fluorescein angiography (FA), as well as postmortem histology and immunohistochemistry (Collagen IV and anti-vWF antibodies), were carried out to characterize the vascular abnormalities. RESULTS Ophthalmic examination showed peripheral and mid-temporal avascular areas in the tapetal region, neovascularization and abnormally dilated and tortuous retinal vessels in the left eye. sdOCT demonstrated not only cross-sectional views of preretinal fibrovascular proliferation but also extensive proliferation extraretinally into the vitreous. FA emphasized demarcation of vascular and avascular zones with neovascular tufts "popcorns." Histology and immunohistochemistry confirmed presence of abnormally dilated vessels and the intravitreal blood vessels. CONCLUSIONS ROP is a disease of abnormally developed retinal vascularization associated with oxygen supplementation therapy, potentially causing blindness in premature infants. Although the mechanism of ROP-like vasculopathy in our case is unclear, it is important to appreciate that the abnormal vascular pattern seen in ROP in premature infants can occur in canines without oxygen administration.
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Affiliation(s)
- Yu Sato
- Section of Ophthalmology and Division of Experimental Retinal Therapies, Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexa Gray
- Section of Ophthalmology and Division of Experimental Retinal Therapies, Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kei Takahashi
- Section of Ophthalmology and Division of Experimental Retinal Therapies, Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Molecular Pharmacology, Department of Biofunctional Evaluation, Gifu Pharmaceutical University, Gifu, Japan
| | - Valerie Dufour
- Section of Ophthalmology and Division of Experimental Retinal Therapies, Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gerard Lutty
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Keiko Miyadera
- Section of Ophthalmology and Division of Experimental Retinal Therapies, Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gustavo Aguirre
- Section of Ophthalmology and Division of Experimental Retinal Therapies, Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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21
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Özkaya D. The Role of Thrombocyte Parameters in Retinopathy of Prematurity Development. Int J Clin Pract 2022; 2022:7518533. [PMID: 35685577 PMCID: PMC9159192 DOI: 10.1155/2022/7518533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/24/2021] [Accepted: 12/31/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate the role of thrombocyte parameters in retinopathy of prematurity (ROP) development. MATERIALS AND METHODS This retrospective study included 120 preterm infants in total. Group 1 was formed by infants who developed type-1 ROP and received treatment. Group 2 was formed by infants who developed ROP and were not treated for ROP. Infants who did not develop ROP and whose retinal vascularization was completed in their follow-up formed Group 3. Gestational age, birth weight, and genders of groups were recorded. Platelet (PLT) count, mean platelet volume (MPV), and platelet distribution width (PDW) values were obtained from complete blood count. Platelet mass index (PMI) was calculated by multiplying the PLT count by MPV value. Thrombocytopenia was defined as PLT count <150 × 1000/μL. All parameters were compared between the groups. RESULTS There were 40 preterm infants in each group. The mean PLT count was 272.43 ± 122.67 in Group 1, 333.32 ± 133.06 in Group 2, and 310.03 ± 119.41 in Group 3. The difference in PLT count between the groups was not significant (p=0.094). Thrombocytopenia was observed in 25% of Group 1, 10% of Group 2, and 10% of Group 3 (p=0.095). No statistically significant difference was found in terms of MPV, PDW, and PMI values between the groups (p=0.102, p=0.097, and p=0.298, respectively). CONCLUSIONS Although PLT count was lower and thrombocytopenia rate was higher in the type-1 ROP group, the differences were not found to be significant. Further prospective studies are required to evaluate the role of thrombocytes in ROP pathogenesis.
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Affiliation(s)
- Dilek Özkaya
- Department of Ophthalmology, Süleyman Demirel University, Faculty of Medicine, Isparta, Turkey
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22
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Xu M, Jiang Y, Su L, Chen X, Shao X, Ea V, Shang Z, Zhang X, Barnstable CJ, Li X, Tombran-Tink J. Novel Regulators of Retina Neovascularization: A Proteomics Approach. J Proteome Res 2021; 21:101-117. [PMID: 34919406 DOI: 10.1021/acs.jproteome.1c00547] [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: 12/12/2022]
Abstract
The purpose of this study was to identify proteins that regulate vascular remodeling in an ROP mouse model. Pups were subjected to fluctuating oxygen levels and retinas sampled during vessel regression (PN12) or neovascularization (PN17) for comparative SWATH-MS proteomics using liquid chromatography-tandem mass spectrometry (LC-MS/MS). We developed a human retinal endothelial cell (HREC) ROP correlate to validate the expression of retina neovascular-specific markers. A total of 5191 proteins were identified in OIR retinas with 498 significantly regulated in elevated oxygen and 345 after a return to normoxia. A total of 122 proteins were uniquely regulated during vessel regression and 69 during neovascularization (FC ≥ 1.5; p ≤ 0.05), with several validated by western blot analyses. Expressions of 56/69 neovascular-specific proteins were confirmed in hypoxic HRECs with 23 regulated in the same direction as OIR neovascular retinas. These proteins control angiogenesis-related processes including matrix remodeling, cell migration, adhesion, and proliferation. RNAi and transfection overexpression studies confirmed that VASP and ECH1, showing the highest levels in hypoxic HRECs, promoted human umbilical vein (HUVEC) and HREC cell proliferation, while SNX1 and CD109, showing the lowest levels, inhibited their proliferation. These proteins are potential biomarkers and exploitable intervention tools for vascular-related disorders. The proteomics data set generated has been deposited to the ProteomeXchange/iProX Consortium with the Identifier:PXD029208.
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Affiliation(s)
- Manhong Xu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Yilin Jiang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Lin Su
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xin Chen
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xianfeng Shao
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, Beijing Institute of Lifeomics, National Center for Protein Sciences (The PHOENIX Center, Beijing), Beijing 102206, China
| | - Vicki Ea
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Zhenying Shang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xiaomin Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Colin J Barnstable
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China.,Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, Pennsylvania 17033-0850, United States
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Joyce Tombran-Tink
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China.,Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, Pennsylvania 17033-0850, United States
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23
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Badeeb N, Raffa L, AhmedHussain H, Bamefleh D, Mgharbil E, Alessa S, Alamri A, Albahiti M. Retinopathy of prematurity in Saudi Arabia: Exploring maternal risk factors. Taiwan J Ophthalmol 2021; 11:359-366. [PMID: 35070664 PMCID: PMC8757521 DOI: 10.4103/tjo.tjo_72_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/24/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE: Retinopathy of prematurity (ROP) is a preventable blinding disorder affecting preterm infants. To date, maternal risk factors have not been studied in Saudi Arabia. This study aims to identify possible maternal risk factors for any stage and type 1 ROP. MATERIALS AND METHODS: A total of 295 preterm infants screened for ROP between November 2013 and December 2018 at a Saudi Arabian tertiary-care hospital were included. We included infants with a gestational age ≤ 32 weeks and/or birth weight (BW) ≤1500 g. We analyzed 28 maternal and neonatal risk factors. RESULTS: The incidence of ROP at any stage and Type 1 were 31.9% and 7%, respectively. In the univariate analysis, the only maternal factor associated with any stage of ROP was spontaneous vaginal delivery (P = 0.049), but no maternal factor was an independent risk factor for type 1 ROP. Multivariate logistic regression analysis identified lower BW, lower gestational age and longer neonatal intensive care unit stay as independent risk factors for the development of ROP at any stage (P < 0.05). For Type 1 ROP, lower BW, and intraventricular hemorrhage were significant independent risk factors (P < 0.05). CONCLUSION: The only maternal risk factor related to ROP was spontaneous vaginal delivery, which increased the risk of any stage of ROP. The single most predictive risk factor for any stage of ROP and Type 1 ROP was low BW. These findings emphasize the role of the obstetrician in promoting health care and modifying maternal risk factors to prevent preterm births related to a low BW.
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Affiliation(s)
- Nooran Badeeb
- Department of Ophthalmology, University of Jeddah, Jeddah, Saudi Arabia
| | - Lina Raffa
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Huda AhmedHussain
- Department of Ophthalmology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Dania Bamefleh
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Enas Mgharbil
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sarah Alessa
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Aliaa Alamri
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed Albahiti
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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24
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Li X, Cai S, He Z, Reilly J, Zeng Z, Strang N, Shu X. Metabolomics in Retinal Diseases: An Update. BIOLOGY 2021; 10:944. [PMID: 34681043 PMCID: PMC8533136 DOI: 10.3390/biology10100944] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 12/17/2022]
Abstract
Retinal diseases are a leading cause of visual loss and blindness, affecting a significant proportion of the population worldwide and having a detrimental impact on quality of life, with consequent economic burden. The retina is highly metabolically active, and a number of retinal diseases are associated with metabolic dysfunction. To better understand the pathogenesis underlying such retinopathies, new technology has been developed to elucidate the mechanism behind retinal diseases. Metabolomics is a relatively new "omics" technology, which has developed subsequent to genomics, transcriptomics, and proteomics. This new technology can provide qualitative and quantitative information about low-molecular-weight metabolites (M.W. < 1500 Da) in a given biological system, which shed light on the physiological or pathological state of a cell or tissue sample at a particular time point. In this article we provide an extensive review of the application of metabolomics to retinal diseases, with focus on age-related macular degeneration (AMD), diabetic retinopathy (DR), retinopathy of prematurity (ROP), glaucoma, and retinitis pigmentosa (RP).
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Affiliation(s)
- Xing Li
- School of Basic Medical Sciences, Shaoyang University, Shaoyang 422000, China; (X.L.); (Z.H.)
| | - Shichang Cai
- Department of Human Anatomy, School of Medicine, Hunan University of Medicine, Huaihua 418000, China;
| | - Zhiming He
- School of Basic Medical Sciences, Shaoyang University, Shaoyang 422000, China; (X.L.); (Z.H.)
| | - James Reilly
- Department of Biological and Biomedical Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK;
| | - Zhihong Zeng
- College of Biological and Environmental Engineering, Changsha University, Changsha 410022, China;
| | - Niall Strang
- Department of Vision Science, Glasgow Caledonian University, Glasgow G4 0BA, UK;
| | - Xinhua Shu
- School of Basic Medical Sciences, Shaoyang University, Shaoyang 422000, China; (X.L.); (Z.H.)
- Department of Biological and Biomedical Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK;
- Department of Vision Science, Glasgow Caledonian University, Glasgow G4 0BA, UK;
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25
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Wickramasinghe LC, van Wijngaarden P, Tsantikos E, Hibbs ML. The immunological link between neonatal lung and eye disease. Clin Transl Immunology 2021; 10:e1322. [PMID: 34466225 PMCID: PMC8387470 DOI: 10.1002/cti2.1322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/02/2021] [Accepted: 07/13/2021] [Indexed: 01/02/2023] Open
Abstract
Bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) are two neonatal diseases of major clinical importance, arising in large part as a consequence of supplemental oxygen therapy used to promote the survival of preterm infants. The presence of coincident inflammation in the lungs and eyes of neonates receiving oxygen therapy indicates that a dysregulated immune response serves as a potential common pathogenic factor for both diseases. This review examines the current state of knowledge of immunological dysregulation in BPD and ROP, identifying similarities in the cellular subsets and inflammatory cytokines that are found in the alveoli and retina during the active phase of these diseases, indicating possible mechanistic overlap. In addition, we highlight gaps in the understanding of whether these responses emerge independently in the lung and retina as a consequence of oxygen exposure or arise because of inflammatory spill-over from the lung. As BPD and ROP are anatomically distinct, they are often considered discreet disease entities and are therefore treated separately. We propose that an improved understanding of the relationship between BPD and ROP is key to the identification of novel therapeutic targets to treat or prevent both conditions simultaneously.
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Affiliation(s)
- Lakshanie C Wickramasinghe
- Leukocyte Signalling LaboratoryDepartment of Immunology and PathologyCentral Clinical SchoolMonash UniversityMelbourneVICAustralia
| | - Peter van Wijngaarden
- OphthalmologyDepartment of SurgeryUniversity of MelbourneMelbourneVICAustralia
- Centre for Eye Research AustraliaRoyal Victorian Eye and Ear HospitalEast MelbourneVICAustralia
| | - Evelyn Tsantikos
- Leukocyte Signalling LaboratoryDepartment of Immunology and PathologyCentral Clinical SchoolMonash UniversityMelbourneVICAustralia
| | - Margaret L Hibbs
- Leukocyte Signalling LaboratoryDepartment of Immunology and PathologyCentral Clinical SchoolMonash UniversityMelbourneVICAustralia
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26
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Parikh NA, Sharma P, He L, Li H, Altaye M, Illapani VSP. Perinatal Risk and Protective Factors in the Development of Diffuse White Matter Abnormality on Term-Equivalent Age Magnetic Resonance Imaging in Infants Born Very Preterm. J Pediatr 2021; 233:58-65.e3. [PMID: 33259857 PMCID: PMC8290900 DOI: 10.1016/j.jpeds.2020.11.058] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/24/2020] [Accepted: 11/24/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To identify perinatal clinical diseases and treatments that are associated with the development of objectively diagnosed diffuse white matter abnormality (DWMA) on structural magnetic resonance imaging (MRI) at term-equivalent age in infants born very preterm. STUDY DESIGN A prospective cohort of 392 infants born very preterm (≤32 weeks of gestational age) was enrolled from 5 level III/IV neonatal intensive care units between September 2016 and November 2019. MRIs of the brain were collected at 39 to 45 weeks of postmenstrual age to evaluate DWMA volume. A predefined list of pertinent maternal characteristics, pregnancy/delivery data, and neonatal intensive care unit data were collected for enrolled patients to identify antecedents of objectively diagnosed DWMA. RESULTS Of the 392 infants in the cohort, 377 (96%) had high-quality MRI data. Their mean (SD) gestational age was 29.3 (2.5) weeks. In multivariable linear regression analyses, pneumothorax (P = .027), severe bronchopulmonary dysplasia (BPD) (P = .009), severe retinopathy of prematurity (P < .001), and male sex (P = .041) were associated with increasing volume of DWMA. The following factors were associated with decreased risk of DWMA: postnatal dexamethasone therapy for severe BPD (P = .004), duration of caffeine therapy for severe BPD (P = .009), and exclusive maternal milk diet at neonatal intensive care unit discharge (P = .049). CONCLUSIONS Severe retinopathy of prematurity and BPD exhibited the strongest adverse association with development of DWMA. We also identified treatments and nutritional factors that appear protective against the development of DWMA that also have implications for the clinical care of infants born very preterm.
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Affiliation(s)
- Nehal A. Parikh
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, United States,Department of Pediatrics, University of Cincinnati, College of Medicine United States,Correspondence: Nehal A. Parikh, DO, MS, Professor of Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 4009, Cincinnati, OH, 45229, United States, , Phone number: 513.803.7584
| | - Puneet Sharma
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, United States,Department of Pediatrics, University of Cincinnati, College of Medicine United States
| | - Lili He
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, United States,Department of Pediatrics, University of Cincinnati, College of Medicine United States
| | - Hailong Li
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, United States
| | - Mekibib Altaye
- Department of Pediatrics, University of Cincinnati, College of Medicine United States,Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, United States
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27
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Dani C, Coviello C, Panin F, Frosini S, Costa S, Purcaro V, Lepore D, Vento G. Incidence and risk factors of retinopathy of prematurity in an Italian cohort of preterm infants. Ital J Pediatr 2021; 47:64. [PMID: 33712037 PMCID: PMC7953747 DOI: 10.1186/s13052-021-01011-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/26/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Non-negligible differences in retinopathy of prematurity (ROP) and its risk factors between different neonatal intensive care units (NICUs) are reported. Our aim was to assess the incidence and risk factors for ROP development in a large cohort of very preterm infants who were assisted in two Italian NICUs. METHODS Preterm infants with gestational age between 23+ 0 and 29+ 6 weeks were stratified into subgroups of infants who developed ROP and those who did not; their clinical characteristics were compared with univariate and multivariable logistic regression analyses. RESULTS We studied a total of 178 infants of whom 67 (38%) developed ROP (stage 1: n = 12; stage 2: n = 41; stage 3: n = 14). Regression analysis demonstrated that maternal milk (OR 0.979, 95% Cl 0.961-0.998) decreased the risk of developing ROP, while intraventricular hemorrhage (IVH) (OR 2.055, 95% Cl 1.120-3.772) increased it. Moreover, maternal milk was found to decrease (OR 0.981, 95% Cl 0.964-0.997) the risk of ROP at discharge, while RBC transfusion increased it (OR 1.522, 95% Cl 1.208-1.916). CONCLUSIONS In our cohort the occurrence of ROP was similar to that previously reported. Strategies for promoting the use of mother's own milk, preventing IVH, and standardizing the approach to RBC transfusions could contribute to decreasing the risk of ROP in very preterm infants.
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Affiliation(s)
- Carlo Dani
- Division of Neonatology, Careggi University Hospital, Largo Brambilla 3, 50141, Florence, Italy.
- Department of Neurosciences, Psychology, Drug Research and Child Health, Careggi University Hospital of Florence, Florence, Italy.
| | - Caterina Coviello
- Division of Neonatology, Careggi University Hospital, Largo Brambilla 3, 50141, Florence, Italy
| | - Fiorenza Panin
- Division of Neonatology, Careggi University Hospital, Largo Brambilla 3, 50141, Florence, Italy
| | - Saverio Frosini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, Florence, Italy
| | - Simonetta Costa
- Division of Neonatology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Velia Purcaro
- Division of Neonatology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Domenico Lepore
- Department of Ophthalmology, Gemelli Foundation IRCSS, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Vento
- Division of Neonatology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of Sacred Heart, Rome, Italy
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28
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Hellgren G, Lundgren P, Pivodic A, Löfqvist C, Nilsson AK, Ley D, Sävman K, Smith LE, Hellström A. Decreased Platelet Counts and Serum Levels of VEGF-A, PDGF-BB, and BDNF in Extremely Preterm Infants Developing Severe ROP. Neonatology 2021; 118:18-27. [PMID: 33611321 PMCID: PMC10539685 DOI: 10.1159/000512282] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Thrombocytopenia has been identified as an independent risk factor for retinopathy of prematurity (ROP), although underlying mechanisms are unknown. In this study, the association of platelet count and serum platelet-derived factors with ROP was investigated. METHODS Data for 78 infants born at gestational age (GA) <28 weeks were included. Infants were classified as having no/mild ROP or severe ROP. Serum levels of vascular endothelial growth factor A, platelet-derived growth factor BB, and brain-derived neurotrophic factor were measured in serum samples collected from birth until postmenstrual age (PMA) 40 weeks. Platelet counts were obtained from samples taken for clinical indication. RESULTS Postnatal platelet counts and serum concentrations of the 3 growth factors followed the same postnatal pattern, with lower levels in infants developing severe ROP at PMA 32 and 36 weeks (p < 0.05-0.001). With adjustment for GA, low platelet counts and low serum concentrations of all 3 factors at PMA 32 weeks were significantly associated with severe ROP. Serum concentrations of all 3 factors also strongly correlated with platelet count (p < 0.001). CONCLUSION In this article, we show that ROP, platelet counts, and specific pro-angiogenic factors correlate. These data suggest that platelet-released factors might be involved in the regulation of retinal and systemic angiogenesis after extremely preterm birth. Further investigations are needed.
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Affiliation(s)
- Gunnel Hellgren
- Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - Pia Lundgren
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Aldina Pivodic
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Chatarina Löfqvist
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders K Nilsson
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - David Ley
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
| | - Karin Sävman
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Neonatology, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lois E Smith
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ann Hellström
- The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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29
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Qadri A, Cai CL, Deslouches K, Siddiqui F, Aranda JV, Beharry KD. Ocular Versus Oral Propranolol for Prevention and/or Treatment of Oxygen-Induced Retinopathy in a Rat Model. J Ocul Pharmacol Ther 2021; 37:112-130. [PMID: 33535016 DOI: 10.1089/jop.2020.0092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose: Propranolol, a nonselective B1/B2 adrenoceptor antagonist, promotes the regression of infantile hemangiomas likely through suppression of vascular endothelial growth factor (VEGF), which prompted its use for the prevention of retinopathy of prematurity. We tested the hypothesis that topical ocular propranolol is safe and effective for reducing the severity of oxygen-induced retinopathy (OIR) in the neonatal rat intermittent hypoxia (IH) model. Methods: At birth (P0), rat pups were randomly assigned to room air or neonatal intermittent hypoxia (IH) consisting of 50% O2 with brief episodes of hypoxia (12% O2) from P0 to P14, during which they received a single daily dose of oral propranolol (1 mg/kg/day in 50 μL in sterile normal saline) or topical ocular propranolol (0.2% in 10 μL in normal saline) from P5 to P14. Placebo-controlled littermates received 50 μL oral or 10 μL topical ocular sterile normal saline. Retinal vascular and astrocyte integrity; retinal histopathology and morphometry; and angiogenesis biomarkers were determined. Results: Topical ocular propranolol improved retinal vascular damage and preserved the astrocytic template, but did not completely prevent OIR. The beneficial effects of propranolol were associated with reduced ocular VEGF and increased endogenous soluble inhibitor, sVEGFR-1, when administered topically. Conclusions: Propranolol failed to completely prevent severe OIR, however, it prevented astrocyte degeneration resulting from neonatal IH-induced damage. We conclude that the mechanisms of propranolol's beneficial effects in neonatal IH may involve in part, astrocyte preservation.
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Affiliation(s)
- Areej Qadri
- Division of Neonatal/Perinatal Medicine, Department of Pediatrics, State University of New York, Brooklyn, New York, USA
| | - Charles L Cai
- Division of Neonatal/Perinatal Medicine, Department of Pediatrics, State University of New York, Brooklyn, New York, USA
| | - Karen Deslouches
- Division of Neonatal/Perinatal Medicine, Department of Pediatrics, State University of New York, Brooklyn, New York, USA
| | - Faisal Siddiqui
- Division of Neonatal/Perinatal Medicine, Department of Pediatrics, State University of New York, Brooklyn, New York, USA
| | - Jacob V Aranda
- Division of Neonatal/Perinatal Medicine, Department of Pediatrics, State University of New York, Brooklyn, New York, USA.,Department of Ophthalmology, Downstate Medical Center, State University of New York, Brooklyn, New York, USA.,State University of New York Eye Institute, New York, New York, USA
| | - Kay D Beharry
- Division of Neonatal/Perinatal Medicine, Department of Pediatrics, State University of New York, Brooklyn, New York, USA.,Department of Ophthalmology, Downstate Medical Center, State University of New York, Brooklyn, New York, USA.,State University of New York Eye Institute, New York, New York, USA
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30
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Potential Effects of Nutraceuticals in Retinopathy of Prematurity. Life (Basel) 2021; 11:life11020079. [PMID: 33499180 PMCID: PMC7912639 DOI: 10.3390/life11020079] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 02/07/2023] Open
Abstract
Retinopathy of prematurity (ROP), the most common cause of childhood blindness, is a hypoxia-induced eye disease characterized by retinal neovascularization. In the normal retina, a well-organized vascular network provides oxygen and nutrients as energy sources to maintain a normal visual function; however, it is disrupted when pathological angiogenesis is induced in ROP patients. Under hypoxia, inadequate oxygen and energy supply lead to oxidative stress and stimulate neovasculature formation as well as affecting the function of photoreceptors. In order to meet the metabolic needs in the developing retina, protection against abnormal vascular formation is one way to manage ROP. Although current treatments provide beneficial effects in reducing the severity of ROP, these invasive therapies may also induce life-long consequences such as systemic structural and functional complications as well as neurodevelopment disruption in the developing infants. Nutritional supplements for the newborns are a novel concept for restoring energy supply by protecting the retinal vasculature and may lead to better ROP management. Nutraceuticals are provided in a non-invasive manner without the developmental side effects associated with current treatments. These nutraceuticals have been investigated through various in vitro and in vivo methods and are indicated to protect retinal vasculature. Here, we reviewed and discussed how the use of these nutraceuticals may be beneficial in ROP prevention and management.
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Markasz L, Olsson KW, Holmström G, Sindelar R. Cluster Analysis of Early Postnatal Biochemical Markers May Predict Development of Retinopathy of Prematurity. Transl Vis Sci Technol 2020; 9:14. [PMID: 33344058 PMCID: PMC7726592 DOI: 10.1167/tvst.9.13.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/19/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose Growth factors and inflammatory and angiogenetic proteins are involved in the development of retinopathy of prematurity (ROP). However, no early biochemical markers are in clinical use to predict ROP. By performing cluster analysis of multiple biomarkers, we aimed to determine patient groups with high and low risk for developing ROP. Methods In total, 202 protein markers in plasma were quantified by proximity extension assay from 35 extremely preterm infants on day 2 of life. Infants were sorted in groups by automated two-dimensional hierarchical clustering of all biomarkers. ROP was classified as stages I to III with or without surgical treatment. Predictive biomarkers were evaluated by analysis of variance and detected differences by two-sided paired t-test with Bonferroni corrections for multiple comparisons. Results Differences in 39 biochemical markers divided infants without ROP into two control groups (control 1, n = 7; control 2, n = 5; P < 0.05). Sixty-six biochemical markers defined differences between the control groups (n = 13) and all ROP infants (n = 23; P < 0.05). PARK7, VIM, MPO, CD69, and NEMO were markedly increased in control 1 compared to all ROP infants (P < 0.001). Lower TNFRSF4 and higher HER2 and GAL appeared in infants with ROP as compared to control 1 and/or 2 (P < 0.05, respectively). Conclusions Our data suggest that early elevated levels of PARK7, VIM, MPO, CD69, and NEMO may be associated with lower risk of developing ROP. Lower levels of TNFRSF4 with higher levels of HER2 and GAL may predict ROP development. Translational Relevance Cluster analysis of early postnatal biomarkers may help to identify infants with low or high risk of developing ROP.
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Affiliation(s)
- Laszlo Markasz
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Karl-Wilhelm Olsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Gerd Holmström
- Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
| | - Richard Sindelar
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Suzumura A, Terao R, Kaneko H. Protective Effects and Molecular Signaling of n-3 Fatty Acids on Oxidative Stress and Inflammation in Retinal Diseases. Antioxidants (Basel) 2020; 9:E920. [PMID: 32993153 PMCID: PMC7600094 DOI: 10.3390/antiox9100920] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 02/06/2023] Open
Abstract
Oxidative stress and inflammation play crucial roles in the development and progression of retinal diseases. Retinal damage by various etiologies can result in retinopathy of prematurity (ROP), diabetic retinopathy (DR), and age-related macular degeneration (AMD). n-3 fatty acids are essential fatty acids and are necessary for homeostasis. They are important retinal membrane components and are involved in energy storage. n-3 fatty acids also have antioxidant and anti-inflammatory properties, and their suppressive effects against ROP, DR, and AMD have been previously evaluated. α-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and their metabolites have been shown to alleviate retinal oxidative stress and inflammation involving various biological signaling pathways. In this review, we summarize the current understanding of the n-3 fatty acids effects on the mechanisms of these retinal diseases and how they exert their therapeutic effects, focusing on ALA, EPA, DHA, and their metabolites. This knowledge may provide new remedial strategies for n-3 fatty acids in the prevention and treatment of retinal diseases associated with oxidative stress and inflammation.
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Affiliation(s)
- Ayana Suzumura
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan;
| | - Ryo Terao
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan;
| | - Hiroki Kaneko
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan;
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de Alba Campomanes AG, Espinoza Navarro J, Shaffer J, Ying GS, Zepeda-Romero LC, González-Bernal C, Gutierrez-Padilla JA, Schbib VL, Galan MM, Binenbaum G. Postnatal Serum Insulin-Like Growth Factor I and Retinopathy of Prematurity in Latin American Infants. Ophthalmic Epidemiol 2020; 28:213-219. [PMID: 32838611 DOI: 10.1080/09286586.2020.1812090] [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: 10/23/2022]
Abstract
PURPOSE Identifying at-risk infants for retinopathy of prematurity (ROP) is complex in countries with emerging economies as infants that lack conventional risk factors, such as low birth weight (BW) and young gestational age (GA), still go on to develop severe ROP. Potential biomarkers, like serum insulin-like growth factor 1 (IGF-1) and slow postnatal weight gain, have been identified as good predictors for ROP in developed countries. We sought to determine the relationship between IGF-1 levels and ROP in two Latin American countries where the burden of disease is still significant. METHODS Prospective cohort study of infants in Guadalajara, Mexico and La Plata, Argentina. Filter-paper bloodspot IGF-1 assays were performed weekly from birth until hospital discharge or 40 weeks' postmenstrual age (PMA). RESULTS 112 infants were studied with a median BW of 1412 g (range 620 g-2390 g) and a median GA of 33 weeks (range 25-37). There was no significant difference in IGF-1 between infants who developed ROP and those who did not. CONCLUSION Low IGF-1 was not associated with ROP in these infants. The lack of an association between ROP and IGF-1 in Latin America supports the observation that growth-based predictive models do not perform as well in this setting where more mature babies still develop severe ROP.
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Affiliation(s)
| | | | - James Shaffer
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Luz Consuelo Zepeda-Romero
- Hospital Civil "Fray Antonio Alcalde", Centro Universitario De Ciencias De La Salud, Universidad De Guadalajara, Guadalajara, Mexico
| | - Cesareo González-Bernal
- Unidades Medicas De Alta Especialidad (UMAE), Hospital De Pediatría Centro Médico Nacional De Occidente (CMNO), Instituto Mexicano Del Seguro Social (IMSS) Guadalajara, Mexico
| | - José Alfonso Gutierrez-Padilla
- Hospital Civil "Fray Antonio Alcalde", Centro Universitario De Ciencias De La Salud, Universidad De Guadalajara, Guadalajara, Mexico
| | - Vanina Laura Schbib
- Department of Ophthalmology, Nueva Clinica Del Niño De La Plata, La Plata, Argentina
| | - Maria Marta Galan
- Department of Ophthalmology, Nueva Clinica Del Niño De La Plata, La Plata, Argentina
| | - Gil Binenbaum
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
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Beharry KD, Cai CL, Siddiqui F, D’Agrosa C, Zangaladze A, Mustafa G, Qadri A, Duggan TJ, Aranda JV. Combination Antioxidant/NSAID Therapies and Oral/Topical Ocular Delivery Modes for Prevention of Oxygen-Induced Retinopathy in a Rat Model. Nutrients 2020; 12:nu12071980. [PMID: 32635350 PMCID: PMC7400869 DOI: 10.3390/nu12071980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022] Open
Abstract
Given the complexity of oxygen-induced retinopathy (OIR), we tested the hypothesis that combination therapies and modes of administration would synergistically optimize efficacy for prevention of OIR. Newborn rats were exposed to neonatal intermittent hypoxia (IH) from the first day of life (P0) until P14 during which they received: (1) oral glutathione nanoparticles (nGSH) with topical ocular phosphate buffered saline (PBS); (2) nGSH with topical ocular Acuvail (ACV); (3) oral coenzyme Q10 (CoQ10) + ACV; (4) oral omega 3 polyunsaturated fatty acids (n-3 PUFAs) + ACV; (5) CoQ10 + n-3 PUFAs + PBS; or (6) CoQ10 + n-3 PUFAs + ACV. Treated groups raised in room air (RA) served as controls. At P14, pups were placed in RA with no treatment until P21. Retinal vascular pathology, ocular angiogenesis biomarkers, histopathology, and morphometry were determined. All combination treatments in IH resulted in the most beneficial retinal outcomes consistent with suppression of angiogenesis growth factors during reoxygenation/reperfusion and no significant adverse effects on somatic growth. nGSH + PBS also reversed IH-induced retinopathy, but had negative effects on growth. Simultaneously targeting oxidants, inflammation, and poor growth mitigates the damaging effects of neonatal IH on the developing retina. Therapeutic synergy with combination delivery methods enhance individual attributes and simultaneously target multiple pathways involved in complex diseases such as OIR.
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Affiliation(s)
- Kay D. Beharry
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
- Department of Ophthalmology, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
- SUNY Eye Institute, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
- Correspondence: ; Tel.: +01-718-270-1475
| | - Charles L. Cai
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
| | - Faisal Siddiqui
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
| | - Christina D’Agrosa
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
| | - Anano Zangaladze
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
| | - Ghassan Mustafa
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
| | - Areej Qadri
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
| | - Thomas J. Duggan
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
| | - Jacob V. Aranda
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA; (C.L.C.); (F.S.); (A.Z.); (G.M.); (A.Q.); (T.J.D.); (J.V.A.)
- Department of Ophthalmology, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
- SUNY Eye Institute, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
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Wongnophirun A, Khuwuthyakorn V, Tantiprabha W, Wiwatwongwana A. Association between severe retinopathy of prematurity and postnatal weight gain in very low-birthweight infants at Chiang Mai University Hospital, Thailand. Paediatr Int Child Health 2020; 40:85-91. [PMID: 31272307 DOI: 10.1080/20469047.2019.1631588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Poor postnatal weight gain has been associated with low serum IGF-1, a key factor in the pathogenesis of retinopathy of prematurity (ROP).Aim: To investigate an association between relative weight gain (RWG) and severe ROP in very low-birthweight (VLBW) Thai infants.Methods: The medical records of VLBW infants who were admitted to the neonatal intensive care unit in Chiang Mai University Hospital from June 2014 to December 2016 and screened for ROP were reviewed. RWG and total calorie intake (TCI) in the 2nd, 4rth and 6th week of age were calculated and those with no ROP/mild ROP and severe ROP requiring laser treatment were compared.Results: The study included 139 VLBW infants, 24 (17.3%) of whom had ROP requiring laser treatment. Infants with severe ROP requiring laser treatment had a lower median birthweight (840 vs 1,195 g, p < 0.001) and median gestational age (GA) (27 vs 30 wk, p < 0.001) than those with no ROP/mild ROP. When RWG and TCI were compared, the infants with severe ROP requiring laser treatment had a lower RWG at the 2nd (p < 0.01) and 4th weeks of age (p < 0.05) and had a lower TCI at the 2nd week of age (p < 0.001) than those with no ROP/mild ROP. Multivariate logistic analysis demonstrated that GA <29.5 w (p < 0.01), hypotension (p < 0.05), RWG <2.9 g/kg/d (p < 0.05) and TCI <98.5 kcal/kg/day (p < 0.001) at the 2nd week of age were independent risk factors for severe ROP requiring laser treatment.Conclusions: Poor weight gain and low calorie intake at the 2nd week of age were associated with severe ROP requiring laser treatment in VLBW infants. Monitoring weight gain and calorie intake during this period are essential and may improve the outcome of ROP.Abbreviations: BPD, bronchopulmonary dysplasia; IVH, intraventricular haemorrhage; NEC, necrotising enterocolitis; PDA, patent ductus arteriosus; PRC, packed red cells; PVL, periventricular leucomalacia; RDS, respiratory distress syndrome; ROP, retinopathy of prematurity; RWG, relative weight gain; SGA, small for gestational age; TCI, total calorie intake; VLBW, very low birthweight.
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Affiliation(s)
- Ananya Wongnophirun
- Department of Paediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Varangthip Khuwuthyakorn
- Division of Neonatology, Department of Paediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Watcharee Tantiprabha
- Division of Neonatology, Department of Paediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Atchareeya Wiwatwongwana
- ROP Unit, Division of Paediatric Ophthalmology and Strabismus, Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand
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Antecedents of Objectively Diagnosed Diffuse White Matter Abnormality in Very Preterm Infants. Pediatr Neurol 2020; 106:56-62. [PMID: 32139164 PMCID: PMC7500641 DOI: 10.1016/j.pediatrneurol.2020.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/22/2020] [Accepted: 01/26/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Diffuse white matter abnormality (diffuse excessive high signal intensity) is the most common finding on structural brain magnetic resonance imaging (MRI) at term-equivalent age in very preterm infants. Yet, there remains a large gap in our understanding of the etiology of diffuse white matter abnormality. Our objective was to evaluate perinatal and neonatal inflammation-associated antecedents of diffuse white matter abnormality on MRI. METHODS We prospectively enrolled 110 very preterm infants born at ≤31 weeks gestational age and collected data on multiple perinatal/neonatal exposures, especially inflammation initiating-illnesses. We performed structural MRI at term-equivalent age and quantified the volume of diffuse white matter abnormality objectively. Multivariable regression was used to identify clinical antecedents of diffuse white matter abnormality. RESULTS The mean (S.D.) birth gestational age of the final study sample of 98 very preterm infants was 28.3 (2.5) weeks. Multiple inflammation initiating-illnesses were associated with diffuse white matter abnormality in univariate analyses. In multivariable linear regression analyses controlling for gestational age, severe retinopathy of prematurity (P < 0.001) and bronchopulmonary dysplasia (P = 0.006) were independent risk factors, whereas maternal treatment with 17-hydroxyprogesterone (P < 0.001) was protective of later development of objectively quantified diffuse white matter abnormality. CONCLUSIONS We identified several perinatal and neonatal antecedent clinical factors associated with diffuse white matter abnormality. Although we found some support for inflammation as a common underlying mechanism, larger studies are needed to validate inflammation as a potential common pathway to the development of diffuse white matter abnormality in very preterm infants.
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Carroll L, Owen LA. Current evidence and outcomes for retinopathy of prematurity prevention: insight into novel maternal and placental contributions. EXPLORATION OF MEDICINE 2020; 1:4-26. [PMID: 32342063 PMCID: PMC7185238 DOI: 10.37349/emed.2020.00002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a blinding morbidity of preterm infants, which represents a significant clinical problem, accounting for up to 40% of all childhood blindness. ROP displays a range of severity, though even mild disease may result in life-long visual impairment. This is complicated by the fact that our current treatments have significant ocular and potentially systemic effects. Therefore, disease prevention is desperately needed to mitigate the life-long deleterious effects of ROP for preterm infants. Although ROP demonstrates a delayed onset of retinal disease following preterm birth, representing a potential window for prevention, we have been unable to sufficiently alter the natural disease course and meaningfully prevent ROP. Prevention therapeutics requires knowledge of early ROP molecular changes and risk, occurring prior to clinical retinal disease. While we still have an incomplete understanding of these disease mechanisms, emerging data integrating contributions of maternal/placental pathobiology with ROP are poised to inform novel approaches to prevention. Herein, we review the molecular basis for current prevention strategies and the clinical outcomes of these interventions. We also discuss how insights into early ROP pathophysiology may be gained by a better understanding of maternal and placental factors playing a role in preterm birth.
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Affiliation(s)
- Lara Carroll
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 4132, USA
| | - Leah A. Owen
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 4132, USA
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Oral propranolol in prevention of severe retinopathy of prematurity: a systematic review and meta-analysis. J Perinatol 2019; 39:1584-1594. [PMID: 31570797 DOI: 10.1038/s41372-019-0503-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/10/2019] [Accepted: 07/31/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To systematically assess the efficacy of oral beta blockage treatment in primary (before established) and secondary (in threshold stages) prevention of severe retinopathy of prematurity (ROP) in premature infants born ≤32 weeks gestational age. STUDY DESIGN Following the PRISMA guidelines, published literature was systematically assessed up to April 27, 2018. Trials and observational studies, in which beta blockage was used to prevent severe ROP (defined as stage ≥3, or requiring treatment) were included. Meta-analyses including random effects models were conducted to determine the overall effect of oral beta blockage on prevention of ROP. RESULTS Six studies (five clinical trials and one observational study) including 461 infants met inclusion criteria using propranolol. The pooled relative risk (RR) of severe ROP in the primary and secondary prophylaxis groups were 0.65 (95% CI 0.43-0.98, NNT = 7) and 0.48 (95% CI 0.35-0.65, NNT = 6) in RCTs, respectively. The RR of severe ROP in one observational study was 0.21 (95% CI 0.08-0.55) with a NNT of 3. There were low heterogeneity and publication bias. Side effects occurred in 8.4% of participants on propranolol. CONCLUSIONS Systematic assessment of studies showed that prophylactic oral propranolol appeared to be effective in preventing severe ROP in premature infants ≤32 weeks gestational age. Additional well powered, multinational, randomized control trials reporting on long-term outcomes are needed.
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Ng TR, Wong IB, Ngo CS, Niduvaje K, Ngiam XY, Sensaki S, Lee LY. Case control study of risk factors and ophthalmological outcomes of very low birth weight infants with Type 1 retinopathy of prematurity. Singapore Med J 2019; 61:426-434. [PMID: 31388685 DOI: 10.11622/smedj.2019095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We evaluated the risk factors associated with Type 1 retinopathy of prematurity (ROP) in very low birth weight (VLBW) infants and compared ophthalmologic outcomes between cases with Type 1 ROP who received treatment and gestational age-matched controls with mild or no ROP not requiring treatment. METHODS This was a retrospective case-control study of VLBW infants born in National University Hospital, Singapore, from January 2001 to December 2013. 17 cases with Type 1 ROP were each matched for gestational age with controls who had either mild (below Stage 2) or no ROP. Antenatal, perinatal and postnatal variables, as well as childhood ophthalmologic outcomes, were collected from their clinical records and analysed. RESULTS The number of packed cell transfusions and highest fraction of inspired oxygen given at weeks 7-10 were found to be statistically significant on multivariate analysis (p = 0.045 and p = 0.049, respectively). None of the infants had blindness or retinal detachment, and there were no significant differences in refractive errors between the groups at 1-4 years of age. Strabismus at four years of age was more common in the group with Type 1 ROP (p = 0.023). CONCLUSION Increased episodes of blood transfusions and chronic lung disease requiring high oxygen supplementation at 7-10 weeks of life are significant risk factors associated with Type 1 ROP in VLBW infants in our study. Strabismus at four years is more common in this group of patients. This study highlights the importance of long-term ophthalmologic surveillance for these high-risk children.
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Affiliation(s)
- Tryphena Rachel Ng
- Khoo Teck Puat-National University Children's Medical Institute, Singapore
| | - Inez B Wong
- Department of Ophthalmology, National University Hospital, National University Health System, Singapore
| | - Cheryl S Ngo
- Department of Ophthalmology, National University Hospital, National University Health System, Singapore
| | - Krishnamoorthy Niduvaje
- Department of Neonatology, National University Hospital, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xin Ying Ngiam
- Department of Neonatology, National University Hospital, National University Health System, Singapore
| | - Sonoko Sensaki
- Department of Neonatology, National University Hospital, National University Health System, Singapore
| | - Le Ye Lee
- Department of Neonatology, National University Hospital, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Wooff Y, Man SM, Aggio-Bruce R, Natoli R, Fernando N. IL-1 Family Members Mediate Cell Death, Inflammation and Angiogenesis in Retinal Degenerative Diseases. Front Immunol 2019; 10:1618. [PMID: 31379825 PMCID: PMC6646526 DOI: 10.3389/fimmu.2019.01618] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/28/2019] [Indexed: 12/22/2022] Open
Abstract
Inflammation underpins and contributes to the pathogenesis of many retinal degenerative diseases. The recruitment and activation of both resident microglia and recruited macrophages, as well as the production of cytokines, are key contributing factors for progressive cell death in these diseases. In particular, the interleukin 1 (IL-1) family consisting of both pro- and anti-inflammatory cytokines has been shown to be pivotal in the mediation of innate immunity and contribute directly to a number of retinal degenerations, including Age-Related Macular Degeneration (AMD), diabetic retinopathy, retinitis pigmentosa, glaucoma, and retinopathy of prematurity (ROP). In this review, we will discuss the role of IL-1 family members and inflammasome signaling in retinal degenerative diseases, piecing together their contribution to retinal disease pathology, and identifying areas of research expansion required to further elucidate their function in the retina.
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Affiliation(s)
- Yvette Wooff
- The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia.,ANU Medical School, The Australian National University, Canberra, ACT, Australia
| | - Si Ming Man
- The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
| | - Riemke Aggio-Bruce
- The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
| | - Riccardo Natoli
- The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia.,ANU Medical School, The Australian National University, Canberra, ACT, Australia
| | - Nilisha Fernando
- The John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
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Alteration of erythrocyte membrane polyunsaturated fatty acids in preterm newborns with retinopathy of prematurity. Sci Rep 2019; 9:7930. [PMID: 31138879 PMCID: PMC6538605 DOI: 10.1038/s41598-019-44476-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 05/17/2019] [Indexed: 12/02/2022] Open
Abstract
Extremely preterm infants are at high risk for retinopathy of prematurity (ROP), a potentially blinding disease characterized by abnormalities in retinal vascularization. Whereas animal studies revealed that n-3 polyunsaturated fatty acids (PUFAs) may be of benefit in preventing ROP, human studies conducted on preterm infants during the 1st weeks of life showed no association between blood n-3 PUFA bioavailability and ROP incidence and/or severity, probably because of the influence of nutrition on the lipid status of infants. In the OmegaROP prospective cohort study, we characterized the erythrocyte concentrations of PUFAs in preterm infants aged less than 29 weeks gestational age (GA) without any nutritional influence. We show that GA is positively associated with the erythrocyte n-6 to n-3 PUFA ratio, and particularly with the ratio of arachidonic acid (AA) to docosahexaenoic acid (DHA), in infants with ROP. A time-dependent accumulation of AA at the expense of DHA seems to occur in utero in erythrocytes of preterm infants who will develop ROP, thus reinforcing previous data on the beneficial properties of DHA on this disease. In addition, preliminary data on maternal erythrocyte membrane lipid concentrations suggest modifications in placental transfer of fatty acids. Documenting the erythrocyte AA to DHA ratio at birth in larger cohorts might be useful to set up new prognostic factors for ROP.
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Mohd Khair SZN, Ismail AS, Embong Z, Mohamed Yusoff AA. Detection of FZD4, LRP5 and TSPAN12 Genes Variants in Malay Premature Babies with Retinopathy of Prematurity. J Ophthalmic Vis Res 2019; 14:171-178. [PMID: 31114654 PMCID: PMC6504731 DOI: 10.4103/jovr.jovr_210_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose: To determine the mutational analyses of familial exudative vitreoretinopathy (FEVR)-causing genes in Malay patients with retinopathy of prematurity (ROP) to obtain preliminary data for gene alterations in the Malay community. Methods: A comparative cross-sectional study involving 86 Malay premature babies (ROP = 41 and non-ROP = 45) was performed from September 2012 to December 2014. Mutation analyses in (FEVR)-causing genes (NDP, FZD4, LRP5, and TSPAN12) were performed using DNA from premature babies using polymerase chain reaction (PCR) and direct sequencing. Sequencing results were confirmed with PCR-Restriction Fragment Length Polymorphism (RFLP). Results: We found variants of FZD4, LRP5, and TSPAN12 in this study. One patient from each group showed a non-synonymous alteration in FZD4, c.502C>T (p.P168S). A synonymous variant of LRP5 [c.3357G>A (p.V1119V)] was found in 30 ROP and 28 non-ROP patients. Two variants of TSPAN12, c.765G>T (p.P255P) and c.*39C>T (3′UTR), were also recorded (29 and 21 in ROP, 33 and 26 in non-ROP, respectively). Gestational age and birth weight were found to be significantly associated with ROP (P value < 0.001 and 0.001, respectively). Conclusion: Analysis of data obtained from the ROP Malay population will enhance our understanding of these FEVR-causing gene variants. The c.3357G>A (p.V1119V) variant of LRP5, and c.765G>T (p.P255P) and c.*39C>T variants of TSPAN12 could be common polymorphisms in the Malay ethnic group; however, this requires further elucidation. Future studies using larger groups and higher numbers of advanced cases are necessary to evaluate the relationship between FEVR-causing gene variants and the risk of ROP susceptibility in Malaysian infants.
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Affiliation(s)
- Siti Zulaikha Nashwa Mohd Khair
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Abdul Salim Ismail
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zunaina Embong
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Abdul Aziz Mohamed Yusoff
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
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The Effect of Serum Igf-1,Igfbp-3 And Erythrocyte Transfusıons on Development of Mıld Retınopathy of Prematurıty. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/gopctd.535602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chen TA, Schachar IH, Moshfeghi DM. Outcomes of Intravitreal Bevacizumab and Diode Laser Photocoagulation for Treatment-Warranted Retinopathy of Prematurity. Ophthalmic Surg Lasers Imaging Retina 2019; 49:126-131. [PMID: 29443362 DOI: 10.3928/23258160-20180129-07] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/21/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVE To investigate the outcomes of infants with treatment-warranted retinopathy of prematurity (TW-ROP) who received intravitreal bevacizumab (Avastin; Genentech, South San Francisco, CA) (IVB) injections as compared to diode laser photocoagulation (DLP). PATIENTS AND METHODS Data from the Stanford University Network for Diagnosis of Retinopathy of Prematurity database and inpatients at Stanford Children's Hospital were retrospectively reviewed for premature newborns with TW-ROP treated with DLP or 0.625 mg of IVB. Patient characteristics, hospital course, and neurodevelopmental outcomes were compared. RESULTS In all, 49 eyes from 25 patients were included; 10 infants (20 eyes) received DLP and 15 infants (29 eyes) received IVB. The IVB infants had significantly fewer diagnoses at the time of discharge and fewer readmissions after initial hospital discharge than the DLP infants (four versus six diagnoses, P = .004; zero versus one readmission, P = .038). At an average of 20 months corrected age, there was no significant difference in neurodevelopmental delay (adjusted odds ratio = 0.87; 95% CI, 0.08-9.46). CONCLUSION Systemic morbidity may be similar among infants treated initially with bevacizumab compared to DLP. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:126-131.].
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Bernabe-García M, Villegas-Silva R, Villavicencio-Torres A, Calder PC, Rodríguez-Cruz M, Maldonado-Hernández J, Macías-Loaiza D, López-Alarcón M, Inda-Icaza P, Cruz-Reynoso L. Enteral Docosahexaenoic Acid and Retinopathy of Prematurity: A Randomized Clinical Trial. JPEN J Parenter Enteral Nutr 2019; 43:874-882. [PMID: 30614004 DOI: 10.1002/jpen.1497] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a disorder of the retina of low-birth-weight preterm infants that potentially leads to blindness. Docosahexaenoic acid (DHA), is protective in experimental models, but its administration as part of parenteral nutrition has shown inconsistent results. We test the effect of enteral DHA to prevent ROP and/or severity and to reduce hospital stay. METHODS This was a double-blind parallel clinical trial. Preterm infants (n = 110; 55 per group) with birth weight <1500 g but ≥1000 g were recruited in a neonatal intensive care unit. Infants were randomized to receive 75 mg of DHA/kg/d (DHA group) or high oleic sunflower oil (control group) for 14 days by enteral feeding. The effect of DHA was evaluated on any stage of ROP, severe ROP (stage ≥3) incidence, and hospital stay. Groups were compared with relative risk (RR) and 95% confidence interval (CI), Fisher's exact test, Student's t-test, or Mann-Whitney U-test, as appropriate. Logistic regression was applied to adjust for confounders. RESULTS There was no difference between the DHA and control groups in ROP risk (RR for DHA = 0.79; 95% CI, 0.49-1.27; P = 0.33). However, patients who received DHA showed lower risk for stage 3 ROP (RR for DHA = 0.66; 95% CI, 0.44-0.99; P = 0.03). After adjusting for confounders, this decreased risk remained significant (adjusted odds ratio = 0.10; 95% CI, 0.011-0.886; P = 0.04). Hospital stay was similar between groups. CONCLUSION Enteral DHA may reduce the incidence of stage 3 ROP.
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Affiliation(s)
- Mariela Bernabe-García
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Raúl Villegas-Silva
- Neonatología, Hospital Infantil de México Federico Gómez, México City, México
| | - Astrid Villavicencio-Torres
- Oftalmología Pediátrica, General Hospital, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Philip C Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK.,National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton National Health Service Foundation Trust and University of Southampton, Southampton, UK
| | - Maricela Rodríguez-Cruz
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Jorge Maldonado-Hernández
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Denisse Macías-Loaiza
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Mardia López-Alarcón
- Unidad de Investigación Médica en Nutrición, Hospital de Pediatría, Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Patricia Inda-Icaza
- Nutrición, Universidad Anáhuac México, Campus Norte, Huixquilucan, Estado de México, México
| | - Leonardo Cruz-Reynoso
- División de Pediatría, Hospital de Gineco-Obstetricia No.3, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
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Richter AE, Bos AF, Huiskamp EA, Kooi EMW. Postnatal Cerebral Hyperoxia Is Associated with an Increased Risk of Severe Retinopathy of Prematurity. Neonatology 2019; 116:356-362. [PMID: 31487704 PMCID: PMC6979427 DOI: 10.1159/000501859] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 07/01/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND High arterial oxygen saturation (SaO2) is associated with the development of retinopathy of prematurity (ROP), but difficult to avoid. OBJECTIVE To assess the association between severe ROP and a burden of cerebral and arterial hyperoxia. METHODS We retrospectively analyzed 225 preterm infants born ≤30 weeks' gestation. The cerebral oxygen saturation (rcSO2) and SaO2 were measured within the first 96 h after birth. We determined the burden of both cerebral and arterial hyperoxia, which was defined as the percentage of time spent at saturation thresholds exceeding 85 and 90%, respectively. Their association with severe ROP (prethreshold disease type 1) was tested using logistic regression analyses. RESULTS Median gestational age (GA) was 28.0 weeks (interquartile range 26.7-29.0) and mean birth weight 1,032 g (±281 SD). Eight infants developed severe ROP. Infants with severe ROP spent more time at cerebral hyperoxic levels than infants without severe ROP (medians 30 vs. 16%). Adjusted for GA, for every 10% increase in burden of cerebral hyperoxia, the OR for developing ROP was 1.50 (95% CI 1.09 - 2.06, p = 0.013). A burden of arterial hyperoxia was not associated with ROP. Infants with severe ROP experienced even less arterial hyperoxia, although not statistically significant. CONCLUSIONS Cerebral hyperoxia may be a better early predictor of severe ROP than arterial hyperoxia. Moreover, under strict oxygen management, cerebral hyperoxia in these infants may result from cerebral immaturity rather than a high SaO2. Whether reducing cerebral hyperoxia is feasible and might prevent ROP needs to be further examined.
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Affiliation(s)
- Anne E Richter
- Division of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands,
| | - Arend F Bos
- Division of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - E Angela Huiskamp
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth M W Kooi
- Division of Neonatology, University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
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Elmasry K, Ibrahim AS, Abdulmoneim S, Al-Shabrawey M. Bioactive lipids and pathological retinal angiogenesis. Br J Pharmacol 2019; 176:93-109. [PMID: 30276789 PMCID: PMC6284336 DOI: 10.1111/bph.14507] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/14/2018] [Accepted: 08/22/2018] [Indexed: 12/22/2022] Open
Abstract
Angiogenesis, disruption of the retinal barrier, leukocyte-adhesion and oedema are cardinal signs of proliferative retinopathies that are associated with vision loss. Therefore, identifying factors that regulate these vascular dysfunctions is critical to target pathological angiogenesis. Given the conflicting role of bioactive lipids reported in the current literature, the goal of this review is to provide the reader a clear road map of what has been accomplished so far in the field with specific focus on the role of polyunsaturated fatty acids (PUFAs)-derived metabolites in proliferative retinopathies. This necessarily entails a description of the different retina cells, blood retina barriers and the role of (PUFAs)-derived metabolites in diabetic retinopathy, retinopathy of prematurity and age-related macular degeneration as the most common types of proliferative retinopathies.
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Affiliation(s)
- Khaled Elmasry
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
- Cellular Biology and Anatomy, MCG, Augusta University, Augusta, GA, USA
- Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Schepens Eye Research Institute/Massachusetts Eye and Ear & Department of ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Ahmed S Ibrahim
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
- Department of Biochemistry, Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
- Department of Ophthalmology and Culver Vision Discovery Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
| | - Samer Abdulmoneim
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
- Cellular Biology and Anatomy, MCG, Augusta University, Augusta, GA, USA
| | - Mohamed Al-Shabrawey
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA, USA
- Cellular Biology and Anatomy, MCG, Augusta University, Augusta, GA, USA
- Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Department of Ophthalmology and Culver Vision Discovery Institute, Medical College of Georgia (MCG), Augusta University, Augusta, GA, USA
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Beharry KD, Cai CL, Siddiqui F, Chowdhury S, D'Agrosa C, Valencia GB, Aranda JV. Comparative Effects of Coenzyme Q10 or n-3 Polyunsaturated Fatty Acid Supplementation on Retinal Angiogenesis in a Rat Model of Oxygen-Induced Retinopathy. Antioxidants (Basel) 2018; 7:E160. [PMID: 30423931 PMCID: PMC6262377 DOI: 10.3390/antiox7110160] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/19/2018] [Accepted: 11/05/2018] [Indexed: 12/27/2022] Open
Abstract
Neonatal intermittent hypoxia (IH) or apnea afflicts 70% to 90% of all preterm infants <28 weeks gestation, and is associated with severe retinopathy of prematurity (ROP). We tested the hypotheses that coenzyme Q10 (CoQ10) or omega-3 polyunsaturated fatty acids (n-3 PUFAs) supplementation during neonatal IH reduces the severity of oxygen-induced retinopathy (OIR). Newborn rats were exposed to two IH paradigms: (1) 50% O₂ with brief hypoxia (12% O₂); or (2) 21% O₂ with brief hypoxia, until postnatal day 14 (P14), during which they received daily oral CoQ10 in olive oil, n-3 PUFAs in fish oil, or olive oil only and compared to room air (RA) treated groups. Pups were examined at P14, or placed in RA until P21. Retinal angiogenesis, histopathology, and morphometry were determined. Both IH paradigms produced severe OIR, but these were worsened with 50/12% O₂ IH. CoQ10 and n-3 PUFAs reduced the severity of OIR, as well as ocular growth factors in both IH paradigms, but CoQ10 was more effective in 50/12% O₂ IH. Supplementation with either CoQ10 or n-3 PUFAs targeting IH-induced retinal injury is individually effective for ameliorating specific characteristics consistent with ROP. Given the complexity of ROP, further studies are needed to determine whether combined CoQ10 and n-3 PUFAs supplementation would optimize their efficacy and result in a better outcome.
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Affiliation(s)
- Kay D Beharry
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.
- Department of Ophthalmology; State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.
- State University of New York Department of Ophthalmology Eye Institute, New York, NY 10062, USA.
| | - Charles L Cai
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.
| | - Faisal Siddiqui
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.
| | - Sara Chowdhury
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.
| | - Christina D'Agrosa
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.
| | - Gloria B Valencia
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.
| | - Jacob V Aranda
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.
- Department of Ophthalmology; State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.
- State University of New York Department of Ophthalmology Eye Institute, New York, NY 10062, USA.
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Abstract
PURPOSE Continuous peripheral pulse oximetry for monitoring adequacy of oxygenation is probably the most important technological advance for patients' monitoring and safety in the last decades. Pulse oximetry has the disadvantage of measuring the peripheral circulation, and the only mean to measure oxygen content of the central circulation is by invasive technology. Determination of blood oxyhaemoglobin saturation in the retinal vessels of the eye can be achieved noninvasively through spectrophotometric retinal oximetry which provides access to the central nervous system circulation. The aim of the thesis was to determine whether retinal oximetry technique can be applied for estimation of the central nervous system circulation which until now has only been possible invasively. This was achieved by measuring oxyhaemoglobin saturation in three adult subject study groups: in people with central retinal vein occlusion (CRVO) to observe local tissue hypoxia, in patients with severe chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy to observe systemic hypoxaemia and in healthy subjects during hyperoxic breathing to observe systemic hyperoxemia. In addition, the fourth study that is mentioned was performed to test whether retinal oximetry is feasible for neonates. METHODS Retinal oximetry in central retinal vein occlusion: Sixteen subjects with central retinal vein occlusion participated in the study. The oxyhaemoglobin saturation of the central retinal vein occlusion affected eye was compared with the fellow unaffected eye. Retinal oximetry in healthy people under hyperoxia: Thirty healthy subjects participated in the study, and the oxyhaemoglobin saturation of retinal arterioles and venules was compared between normoxic and hyperoxic breathing. Retinal oximetry in severe chronic obstructive pulmonary disease: Eleven patients with severe chronic obstructive pulmonary disease participated in the study. Retinal oximetry measurements were made with and without their daily supplemental oxygen therapy. Retinal arteriolar oxyhaemoglobin saturation when inspiring ambient air was compared with blood samples from the radial artery and finger pulse oximetry and healthy controls. The healthy control group was assembled from our database for comparison of oxyhaemoglobin saturation of retinal arterioles and venules during the ambient air breathing. The retinal oximeter is based on a conventional fundus camera and a specialized software. A beam splitter coupled with two high-resolution digital cameras allows for simultaneous acquisition of retinal images at separative wavelengths for calculation of oxyhaemoglobin saturation. In addition, retinal images of 28 full-term healthy neonates were obtained with scanning laser ophthalmoscope combined with modified Oxymap analysis software for calculation of the optical density ratio and vessel diameter RESULTS: Retinal oximetry in central retinal vein occlusion: Mean retinal venous oxyhaemoglobin saturation was 31 ± 12% in CRVO eyes and 52 ± 11% in unaffected fellow eyes (mean ± SD, n = 14, p < 0.0001). The arteriovenous oxygen difference (AV-difference) was 63 ± 11% in CRVO eyes and 43 ± 7% in fellow eyes (p < 0.0001). The variability of retinal venous oxyhaemoglobin saturation was considerable within and between eyes affected by CRVO. There was no difference in oxyhaemoglobin saturation of retinal arterioles between the CRVO eyes and the unaffected eyes (p = 0.49). Retinal oximetry in healthy people under hyperoxia: During hyperoxic breathing, the oxyhaemoglobin saturation in retinal arterioles increased to 94.5 ± 3.8% as compared with 92.0 ± 3.7% at baseline (n = 30, p < 0.0001). In venules, the mean oxyhaemoglobin saturation increased to 76.2 ± 8.0% from 51.3 ± 5.6% (p < 0.0001) at baseline. The AV-difference was markedly lower during hyperoxic breathing as compared with the normoxic breathing (18.3 ± 9.0% versus 40.7 ± 5.7%, p < 0.0001). Retinal oximetry in severe chronic obstructive pulmonary disease: During ambient air breathing, chronic obstructive pulmonary disease subjects had significantly lower oxyhaemoglobin saturation than healthy controls in both retinal arterioles (87.2 ± 4.9% versus 93.4 ± 4.3%, p = 0.02, n = 11) and venules (45.0 ± 10.3% versus 55.2 ± 5.5%, p = 0.01) but the AV-difference was not markedly different (p = 0.17). Administration of their prescribed oxygen therapy significantly increased the oxyhaemoglobin saturation in retinal arterioles (87.2 ± 4.9% to 89.5 ± 6.0%, p = 0.02) but not in venules (45.0 ± 10.3% to 46.7 ± 12.8%, p = 0.3). Retinal oximetry values were slightly lower than finger pulse oximetry (mean percentage points difference = -3.1 ± 5.5) and radial artery blood values (-5.0 ± 5.4). Retinal oximetry study in neonates: The modified version of the retinal oximetry instrument estimated the optical density ratio in retinal arterioles to be 0.256 ± 0.041 that was significantly different from the 0.421 ± 0.089 in venules (n = 28, p < 0.001, paired t-test). The vascular diameter of retinal arterioles was markedly narrower than of venules (14.1 ± 2.7 and 19.7 ± 3.7 pixels, p < 0.001). CONCLUSION The results of this thesis indicate that spectrophotometric retinal oximetry is sensitive to both local and systemic changes in oxyhaemoglobin saturation. Retinal oxyhaemoglobin saturation values are slightly lower than radial artery blood sample and finger pulse oximetry values. The discrepancies between the different modalities are expected to derive from countercurrent exchange between central retinal artery and vein within the optic nerve but calibration issues cannot be excluded as contributing to this difference. Despite these differences, the findings indicate the potential of retinal oximetry for noninvasive real-time measurements of oxyhaemoglobin saturation in central nervous system vessels. Following calibration upgrade and technological improvement, verification retinal oximetry may potentially be applied to critically ill and anaesthesia care patients. The study on combined scanning laser ophthalmoscope and retinal oximetry supports the feasibility of the technique for oximetry analysis in newly born babies.
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Alajbegovic-Halimic J, Zvizdic D, Alimanovic-Halilovic E, Dodik I, Duvnjak S. Risk Factors for Retinopathy of Prematurity in Premature Born Children. Med Arch 2018; 69:409-13. [PMID: 26843736 PMCID: PMC4720470 DOI: 10.5455/medarh.2015.69.409-413] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Retinopathy of Prematurity (ROP) represent disease of the eye in premature born children which affects immature blood vessels of the retina during their development. The emergence of retinopathy of prematurity depends on the interaction of multiple factors, such as: gestational age, low birth weight, hypoxia, duration of oxygen supplementation, respiratory distress syndrome, twin pregnancy, anemia, blood transfusions, sepsis, intraventricular hemorrhage, hypotension, hypothermia, etc. If remain unrecognized and untreated it can cause severe visual impairment and blindness in children, but can also be prevented with timely screening. GOALS To establish the number of patients with development of retinopathy of prematurity active forms in the observed time period and examine which risk factors have most significant impact on its origin. MATERIAL AND METHODS In a clinical, retrospective study we observed a total of 80 premature born children in the period from January to May 2015 with regard to listed risk factors identified for eye examination. RESULTS From a total of 80 premature newborns sample included 48.8% male and 51.2% female children. The active form of ROP developed in 6.2% of cases, while in 93.8% of cases there was a spontaneous resolution. Patients who developed active form of ROP have significantly younger gestational age (26.4±1.5 weeks) and lower birth weight (874±181 grams), lower Apgar score in the first and fifth minute and were longer on oxygen therapy (20±3.4 days). CONCLUSION Of the potential risk factors that could affect the development of ROP active form following factors have a statistically significant influence: early gestational age, low birth weight, lower Apgar score and prolonged oxygen therapy (p <0.05).
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Affiliation(s)
| | - Denisa Zvizdic
- Eye Clinic, University Clinic Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Irena Dodik
- Medical Faculty, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Sanela Duvnjak
- Medical Faculty, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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