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Leong E, Cifuentes-González C, Hu Y W J, Perumal Samy R, Khairallah M, Rojas-Carabali W, Putera I, de-la-Torre A, Agrawal R. Clinical Insights: Antimicrobial Therapy for Infectious Uveitis. Ocul Immunol Inflamm 2024:1-21. [PMID: 38759216 DOI: 10.1080/09273948.2024.2345848] [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: 08/09/2023] [Accepted: 04/16/2024] [Indexed: 05/19/2024]
Abstract
Infectious uveitis is a major global cause of vision impairment. Despite the eye's immune privilege, afforded by the blood-ocular barrier that restricts microbial entry, several pathogens such as bacteria, viruses, fungi, and parasites can still infiltrate and cause ocular infections and complications. Clinicians often encounter significant challenges in treating infectious uveitis due to limited or ineffective treatment options. Modern molecular techniques and imaging can aid in diagnosing and assessing intraocular infections. Various antimicrobial therapies exist, spanning topical and systemic treatments, but these are constrained by issues like drug concentration, penetration, effective duration, toxicity, and side effects. Treatment approaches also differ based on the infection's etiology. This review provides recent updates on antimicrobial therapies from a clinical perspective, covering topical, systemic, and regional treatments for infectious uveitis.
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Affiliation(s)
- Evangeline Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Carlos Cifuentes-González
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jeremy Hu Y W
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ramar Perumal Samy
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Ocular Infections and Antimicrobial Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Moncef Khairallah
- Department of Ophthalmology, Faculty of Medicine, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - William Rojas-Carabali
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ikhwanuliman Putera
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Kirana Eye Hospital, Jakarta, Indonesia
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alejandra de-la-Torre
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Ocular Infections and Antimicrobial Group, Singapore Eye Research Institute, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
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Zhu L, Li H, Peng X, Li Z, Zhao S, Wu D, Chen J, Li S, Jia R, Li Z, Su W. Beneficial mechanisms of dimethyl fumarate in autoimmune uveitis: insights from single-cell RNA sequencing. J Neuroinflammation 2024; 21:112. [PMID: 38684986 PMCID: PMC11059727 DOI: 10.1186/s12974-024-03096-6] [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: 02/20/2024] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Dimethyl fumarate (DMF) is a fumaric acid ester that exhibits immunoregulatory and anti-inflammatory properties. However, the function of DMF in autoimmune uveitis (AU) is incompletely understood, and studies comprehensively exploring the impact of DMF on immune cells are still lacking. METHODS To explore the function of DMF in uveitis and its underlying mechanisms, we conducted single-cell RNA sequencing (scRNA-seq) on the cervical draining lymph node (CDLN) cells of normal, experimental autoimmune uveitis (EAU), and DMF-treated EAU mice. Additionally, we integrated scRNA-seq data of the retina and CDLNs to identify the potential impact of DMF on ocular immune cell infiltration. Flow cytometry was conducted to verify the potential target molecules of DMF. RESULTS Our study showed that DMF treatment effectively ameliorated EAU symptoms. The proportional and transcriptional alterations in each immune cell type during EAU were reversed by DMF treatment. Bioinformatics analysis in our study indicated that the enhanced expression of Pim1 and Cxcr4 in EAU was reversed by DMF treatment. Further experiments demonstrated that DMF restored the balance between effector T (Teff) /regulatory T (Treg) cells through inhibiting the pathway of PIM1-protein kinase B (AKT)-Forkhead box O1 (FOXO1). By incorporating the scRNA-seq data of the retina from EAU mice into analysis, our study identified that T cells highly expressing Pim1 and Cxcr4 were enriched in the retina. DMF repressed the ocular infiltration of Teff cells, and this effect might depend on its inhibition of PIM1 and CXCR4 expression. Additionally, our study indicated that DMF might reduce the proportion of plasma cells by inhibiting PIM1 expression in B cells. CONCLUSIONS DMF effectively attenuated EAU symptoms. During EAU, DMF reversed the Teff/Treg cell imbalance and suppressed the ocular infiltration of Teff cells by inhibiting PIM1 and CXCR4 expression. Thus, DMF may act as a new drug option for the treatment of AU.
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Affiliation(s)
- Lei Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - He Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Xuening Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Zhaohuai Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Sichen Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Dongting Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China
| | - Jialing Chen
- Sun Yat-sen University, Guangzhou, 510060, China
| | - Si Li
- Sun Yat-sen University, Guangzhou, 510060, China
| | - Renbing Jia
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200025, China.
| | - Zuohong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China.
| | - Wenru Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China.
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Lu A, Liu Z, Su G, Yang P. Global Research Status Regarding Uveitis in the Last Decade. Ocul Immunol Inflamm 2024; 32:326-335. [PMID: 36698094 DOI: 10.1080/09273948.2023.2170251] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE To provide an overview on global uveitis research in the last decade in terms of countries/regions, organizations, scholars, journals, trending topics, and fundings. METHODS This cross-sectional bibliometric analysis yielded 10656 uveitis publications in English for subsequent bibliometric analysis. RESULTS In terms of the number of publications, the leading country/region was the USA (3007). The most productive organization was the University College London (420). The most productive research team was Professor Yang's group (146). A higher h-index was noted in University College London (48). Professor Rosenbaum was the first h-index holder (32). Keywords of interest included topics such as biologics, COVID and OCT. Publications by Ocular Immunology and Inflammation (968) ranked the first position. CONCLUSIONS The USA is the leading force in uveitis study. Asian countries/regions, such as China (mainland) and India, are exerting a substantial role worldwide. Trendy topics cover COVID-19, OCTA.
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Affiliation(s)
- Ao Lu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Zhangluxi Liu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
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Migliorisi G, Vella G, Dal Buono A, Gabbiadini R, Busacca A, Loy L, Bezzio C, Vinciguerra P, Armuzzi A. Ophthalmological Manifestations in Inflammatory Bowel Diseases: Keep an Eye on It. Cells 2024; 13:142. [PMID: 38247834 PMCID: PMC10814681 DOI: 10.3390/cells13020142] [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: 12/15/2023] [Revised: 12/31/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND AND AIMS Inflammatory bowel diseases (IBD) are multifactorial chronic inflammatory disorders affecting the gastrointestinal tract. However, a broad spectrum of extraintestinal manifestations (EIMs) is associated with IBD, affecting several organs and systems, such as the skin, musculoskeletal and hepatobiliary systems, and, not least, the eye. Approximately 10% of IBD patients can develop ocular EIMs (O-EIMs) with a higher prevalence in Crohn's disease (CD). Eye-redness, photophobia, pain, and blurred vision are the common symptoms, with a wide rate of severity and clinical impact on the quality of life. This narrative review aims to summarize the prevalence, pathogenesis, and current evidence-based management of O-EIMs, underlying the importance of a holistic approach and specialties collaboration for a prompt diagnosis and treatment. METHODS PubMed was searched up to December 2023 to identify relevant studies investigating the pathogenesis, epidemiology, and treatment of O-EIMs in IBD patients. RESULTS The mechanisms underlying O-EIMs are partially unknown, encompassing immune dysregulation, shared antigens between the eye and the gut, genetic predisposition, and systemic inflammation driven by high levels of interleukins and cytokines in IBD patients. The complexity of O-EIMs' pathogenesis reflects in the management of these conditions, varying from topical and systemic steroids to immunomodulatory molecules and biologic therapy, such as anti-tumor necrosis factor (TNF)-alpha. A multidisciplinary approach is the backbone of the management of O-EIMs.
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Affiliation(s)
- Giulia Migliorisi
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.M.); (A.D.B.); (R.G.); (A.B.); (L.L.); (C.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy;
| | - Giovanna Vella
- Department of Ophtalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Arianna Dal Buono
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.M.); (A.D.B.); (R.G.); (A.B.); (L.L.); (C.B.)
| | - Roberto Gabbiadini
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.M.); (A.D.B.); (R.G.); (A.B.); (L.L.); (C.B.)
| | - Anita Busacca
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.M.); (A.D.B.); (R.G.); (A.B.); (L.L.); (C.B.)
| | - Laura Loy
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.M.); (A.D.B.); (R.G.); (A.B.); (L.L.); (C.B.)
| | - Cristina Bezzio
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.M.); (A.D.B.); (R.G.); (A.B.); (L.L.); (C.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy;
| | - Paolo Vinciguerra
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy;
- Department of Ophtalmology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (G.M.); (A.D.B.); (R.G.); (A.B.); (L.L.); (C.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy;
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Gentile P, Aldigeri R, Mastrofilippo V, Bolletta E, De Simone L, Gozzi F, Ragusa E, Ponti L, Adani C, Zanelli M, Belloni L, Bonacini M, Croci S, Zerbini A, De Maria M, Neri A, Vecchi M, Cappella M, Fastiggi M, De Fanti A, Citriniti G, Crescentini F, Galli E, Muratore F, Montepietra S, Contardi G, Massari M, Paci M, Facciolongo NC, Beltrami M, Cavallini GM, Salvarani C, Cimino L. Reggio Emilia (Northern Italy) Interdisciplinary Uveitis Clinic: What We Have Learned in the Last 20 Years. Ocul Immunol Inflamm 2024:1-11. [PMID: 38814046 DOI: 10.1080/09273948.2023.2296617] [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: 07/21/2023] [Accepted: 12/13/2023] [Indexed: 05/31/2024]
Abstract
PURPOSE To analyze the referral patterns and the clinical and therapeutic features of patients diagnosed with uveitis in an Italian tertiary referral center to provide a comparison with previously published series from the same center. METHODS Retrospective retrieval of data on all new referrals to the Ocular Immunology Unit in Reggio Emilia (Italy) between November 2015 and April 2022 and comparison with previously published series from the same center. RESULTS Among the 1557 patients, the male-to-female ratio was 1:1.27. Anterior uveitis was the most common diagnosis (53.7%), followed by posterior (21.6%), pan- (18.5%), and intermediate (6.2%) uveitis. The most identifiable specific diagnoses were anterior herpetic uveitis (18.4%), Fuchs uveitis (12.8%), and tuberculosis (6.1%). Infectious etiologies were the most frequent (34.1%) and were more diffuse among non-Caucasian patients (p < 0.001), followed by systemic disease-associated uveitis (26.5%), and ocular-specific conditions (20%). Idiopathic uveitis accounted for 19.4% of cases. Fuchs uveitis presented the longest median diagnostic delay (21 months). Immunosuppressants were administered to 25.2% of patients. Antimetabolites, calcineurin inhibitors, and biologicals were prescribed to 18.4%, 3%, and 11.4% of cases, respectively. Compared to our previous reports, we observed a significant increase in foreign-born patients and in infectious uveitis, a decrease in idiopathic conditions, and an increasing use of non-biological and biological steroid-sparing drugs. CONCLUSIONS The patterns of uveitis in Italy have been changing over the last 20 years, very likely due to migration flows. Diagnostic improvements and a more widespread interdisciplinary approach could reduce the incidence of idiopathic uveitis as well as diagnostic delay.
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Affiliation(s)
- P Gentile
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - R Aldigeri
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - V Mastrofilippo
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - E Bolletta
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - L De Simone
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - F Gozzi
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - E Ragusa
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
| | - L Ponti
- Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy
| | - C Adani
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - L Belloni
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Bonacini
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - S Croci
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A Zerbini
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M De Maria
- Ophthalmology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A Neri
- Ophthalmology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Vecchi
- Ophthalmology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Cappella
- Pediatric Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Fastiggi
- Pediatric Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A De Fanti
- Pediatrics Unit, Santa Maria Nuova Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - G Citriniti
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - F Crescentini
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - E Galli
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - F Muratore
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Montepietra
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - G Contardi
- Infectious Disease Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Massari
- Infectious Disease Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - M Paci
- Thoracic Surgery Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - N C Facciolongo
- Pulmonology Unit, Azienda USL di Reggio Emilia- IRCCS, Reggio Emilia, Italy
| | - M Beltrami
- Medicine and Gastroenterology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - G M Cavallini
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - C Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - L Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Thng ZX, Bromeo AJ, Mohammadi SS, Khatri A, Tran ANT, Akhavanrezayat A, T T Than N, Nguyen KS, Yoo WS, Mobasserian A, Or CCM, Nguyen QD. Recent advances in uveitis therapy: focus on selected phase 2 and 3 clinical trials. Expert Opin Emerg Drugs 2023; 28:297-309. [PMID: 38129984 DOI: 10.1080/14728214.2023.2293049] [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: 09/19/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Uveitis is a heterogeneous group of ocular conditions characterized by inflammation of the uveal tract. It is a leading cause of blindness in developed countries and exerts significant psychological, social, and economic impact on both patients and the larger society. While there are numerous pharmacotherapy options, posterior segment noninfectious uveitis remains a significant challenge to treat due to its severity, chronicity, and high recurrence rates. AREAS COVERED The index review highlights the unmet needs of uveitis pharmacotherapy and its research and the shortcomings of existing ocular and systemic therapeutic options for noninfectious uveitis. The more promising novel ocular drug delivery methods and therapeutic targets/drugs are discussed, and evidence from the clinical trials is evaluated. EXPERT OPINION There has been incredible growth in the number of treatment options available to uveitis patients today, especially with the new generation of biologic drugs. Available evidence suggests that these newer options may be superior to conventional immunosuppressive therapies in terms of efficacy and side effect profiles. Further high-quality research and additional clinical trials will be needed to clarify their roles in the stepladder treatment approach of noninfectious uveitis.
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Affiliation(s)
- Zheng Xian Thng
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Albert John Bromeo
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Asian Eye Institute, Makati, Philippines
| | - S Saeed Mohammadi
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Anadi Khatri
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Birat Aankha Aspatal, Biratnagar, Nepal
- Department of Ophthalmology, Birat Medical College and Teaching Hospital, Kathmandu University, Biratnagar, Nepal
| | - Anh N T Tran
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | | | - Ngoc T T Than
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Khiem S Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Woong-Sun Yoo
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Department of Ophthalmology, Gyeongsang National University College of Medicine, and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | | | | | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
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Shareef Khan M, Rao Ravi P, Shrikant Dhavan D. Design, optimization and pharmacokinetic evaluation of PLGA phosphatidylcholine hybrid nanoparticles of triamcinolone acetonide loaded in situ gel for topical ocular delivery. Int J Pharm 2023; 647:123530. [PMID: 37858638 DOI: 10.1016/j.ijpharm.2023.123530] [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: 07/15/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
Posterior uveitis (PU), which often has an autoimmune origin, can be treated effectively with synthetic glucocorticoid triamcinolone acetonide (TAA). Due to the limitations of topical TAA administration reaching the posterior segment of the eye, the drug is injected directly into the eye through an intravitreal injection. In this study, we prepared TAA loaded poly(lactic-co-glycolic acid) phosphatidylcholine hybrid nanoparticles (TAA-PLHNPs) using the principles of design of experiments (DoE) for topical ocular administration. The mean particle size (nm) and drug loading efficiency (LE%) for the optimized formulations were 163 ± 2.8 nm and 39 ± 1.9%, respectively. The TAA-PLHNPs were then loaded into the dual responsive in situ gel that we reported in our previous work. In vitro assessments were done to show that the formulations are safe for ocular administration. Finally, in vivo ocular pharmacokinetic studies were performed to compare pharmacokinetic parameters of TAA-PLHNPs and TAA-PLHNPs loaded in situ gel with each other and with the previously reported conventional formulation of TAA (aqueous suspension of TAA with 20% hydroxypropyl β-cyclodextrin (TAA-HP-β-CD-Susp)). TAA-PLHNPs loaded dual responsive in situ gel (TAA-PLHNP-ISG) achieved higher concentrations of TAA in the vitreous humor (Cmax of 946.53 ng/mL) and sustained (MRT0-∞ of 16.26 h) the drug concentrations for longer period of time compared to aqueous suspension of TAA-PLHNPs (TAA-PLHNP-Susp) and TAA-HP-β-CD-Susp.
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Affiliation(s)
- Mohammed Shareef Khan
- Department of Pharmacy, BITS-Pilani, Hyderabad Campus, Jawahar Nagar, Kapra Mandal, Medchal (District), Hyderabad 500078, India
| | - Punna Rao Ravi
- Department of Pharmacy, BITS-Pilani, Hyderabad Campus, Jawahar Nagar, Kapra Mandal, Medchal (District), Hyderabad 500078, India.
| | - Divya Shrikant Dhavan
- Department of Pharmacy, BITS-Pilani, Hyderabad Campus, Jawahar Nagar, Kapra Mandal, Medchal (District), Hyderabad 500078, India
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Wu X, Tao M, Zhu L, Zhang T, Zhang M. Pathogenesis and current therapies for non-infectious uveitis. Clin Exp Med 2023; 23:1089-1106. [PMID: 36422739 PMCID: PMC10390404 DOI: 10.1007/s10238-022-00954-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
Non-infectious uveitis (NIU) is a disorder with various etiologies and is characterized by eye inflammation, mainly affecting people of working age. An accurate diagnosis of NIU is crucial for appropriate therapy. The aim of therapy is to improve vision, relieve ocular inflammation, prevent relapse, and avoid treatment side effects. At present, corticosteroids are the mainstay of topical or systemic therapy. However, repeated injections are required for the treatment of chronic NIU. Recently, new drug delivery systems that may ensure intraocular delivery of therapeutic drug levels have been highlighted. Furthermore, with the development of immunosuppressants and biologics, specific therapies can be selected based on the needs of each patient. Immunosuppressants used in the treatment of NIU include calcineurin inhibitors and antimetabolites. However, systemic immunosuppressive therapy itself is associated with adverse effects due to the inhibition of immune function. In patients with refractory NIU or those who cannot tolerate corticosteroids and immunosuppressors, biologics have emerged as alternative treatments. Thus, to improve the prognosis of patients with NIU, NIU should be managed with different drugs according to the response to treatment and possible side effects.
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Affiliation(s)
- Xue Wu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2000, Australia
| | - Mengying Tao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ling Zhu
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2000, Australia
| | - Ting Zhang
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2000, Australia
| | - Ming Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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9
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Zhang C, Liu X, Xiao J, Jiang F, Fa L, Jiang H, Zhou L, Su W, Xu Z. γδ T cells in autoimmune uveitis pathogenesis: A promising therapeutic target. Biochem Pharmacol 2023; 213:115629. [PMID: 37257721 DOI: 10.1016/j.bcp.2023.115629] [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: 03/16/2023] [Revised: 05/24/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
Autoimmune uveitis is a non-infectious, inflammatory intraocular disease that affects the uveal and adjacent tissues. It frequently causes varying degrees of visual loss. Evidence for the strong association between activated γδ T cells and the development of autoimmune uveitis is growing. The innate and adaptive immune response are connected in the early phases by the γδ T cells that contain the γ and δ chains. γδ T cells can identify antigens in a manner that is not constrained by the MHC. When activated by various pathways, γδ T cells can not only secrete pro-inflammatory factors early on (such as IL-17), but they can also promote Th17 cells responses, which ultimately exacerbates autoimmune uveitis. Therefore, we review the mechanisms by which γδ T cells affect autoimmune uveitis in different activation and disease states. Moreover, we also prospect for immunotherapies targeting different γδ T cell-related action pathways, providing a reference for exploring new drug for the treatment of autoimmune uveitis.
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Affiliation(s)
- Chun Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiuxing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
| | - Jing Xiao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Fanwen Jiang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Luzhong Fa
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Hui Jiang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Lin Zhou
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Wenru Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China.
| | - Zhuping Xu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
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10
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Calvo-Río V, Sánchez-Bilbao L, Álvarez-Reguera C, Castañeda S, González-Mazón I, Demetrio-Pablo R, González-Gay MA, Blanco R. Baricitinib in severe and refractory peripheral ulcerative keratitis: a case report and literature review. Ther Adv Musculoskelet Dis 2022; 14:1759720X221137126. [PMID: 36419482 PMCID: PMC9677317 DOI: 10.1177/1759720x221137126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 10/12/2022] [Indexed: 10/02/2023] Open
Abstract
Ocular disease, such as scleritis and peripheral ulcerative keratitis (PUK), may be a serious ocular complication. We present a patient with severe and refractory PUK treated with baricitinib. A review of the literature on Janus kinase inhibitors (JAKINIB) in refractory ocular surface pathology was also performed. For the literature review, the search in PubMed, Embase, and the Cochrane library was carried out from inception until 31 May 2021, including conference proceedings from four major rheumatology congresses. All original research articles studying JAKINIB treatment in patients with inflammatory eye disease were included. We present an 85-year-old woman with rheumatoid arthritis (RA) and secondary Sjögren's syndrome refractory to methotrexate, leflunomide, certolizumab pegol, adalimumab, and tocilizumab (TCZ). However, 10 months after starting TCZ, the patient suffered a perforation secondary to PUK, requiring urgent surgical intervention. In the absence of infection, she was treated with boluses of intravenous methylprednisolone followed by oral prednisone at high doses in a decreasing pattern together with baricitinib at a dose of 2 mg/day with a very rapid and persistent favorable response to eye and joint symptoms. After 18 months of treatment, the patient had not presented serious side effects or signs of reactivation of her disease. In addition to this report, three other studies including one PUK associated with RA and two non-infectious scleritis treated with tofacitinib were included in this literature review. All three patients had experienced an insufficient response to conventional treatment, including biologic agents, before being switched to JAKINIB, leading to a complete or partial recovery in all of them without significant adverse effects so far. JAKINIBs (baricitinib and tofacitinib) may be an effective and safe therapy in patients with severe autoimmune and refractory ocular surface pathology, such as scleritis and PUK.
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Affiliation(s)
- Vanesa Calvo-Río
- Rheumatology and Ophthalmology, Hospital
Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Lara Sánchez-Bilbao
- Rheumatology and Ophthalmology, Hospital
Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Carmen Álvarez-Reguera
- Rheumatology and Ophthalmology, Hospital
Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Santos Castañeda
- Rheumatology, Hospital Universitario La
Princesa and IIS-IP, Madrid, Spain
| | - Iñigo González-Mazón
- Rheumatology and Ophthalmology, Hospital
Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Rosalía Demetrio-Pablo
- Rheumatology and Ophthalmology, Hospital
Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Miguel A. González-Gay
- Rheumatology Division, Hospital Universitario
Marqués de Valdecilla, Avda. Valdecilla s/n., Santander 39008, Spain
| | - Ricardo Blanco
- Rheumatology Division, Hospital Universitario
Marqués de Valdecilla, Avda. Valdecilla s/n., Santander 39008, Spain
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11
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Patel S, Belamkar A, Hajrasouliha AR, Jusufbegovic D, Ciulla TA. Progress in the pharmacotherapy of uveitis: the art of personalized care. Expert Opin Pharmacother 2022; 23:1445-1455. [PMID: 35880543 DOI: 10.1080/14656566.2022.2104637] [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: 11/04/2022]
Abstract
INTRODUCTION Uveitis is a heterogeneous group of inflammatory intraocular disorders which can lead to blindness, but prompt diagnosis and management can improve visual outcomes and reduce treatment burden. AREAS COVERED In this review, the authors provide an overview of commonly used treatments of the management of non-infectious uveitis. EXPERT OPINION Initially, the treatment of non-infectious uveitis was limited to corticosteroids which have a broad range of adverse ocular and systemic effects. Now new options, such as biological response modulators, are a novel yet exciting addition to this armory and have the potential to change the course of treatment as well as prognostic outcomes for uveitis patients. Additionally, further research is needed to evaluate the efficacy of this novel class of immunomodulators in uveitis therapy.
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Affiliation(s)
- Shivam Patel
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN 46202
| | - Aditya Belamkar
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN 46202
| | - Amir R Hajrasouliha
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN 46202
| | - Denis Jusufbegovic
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN 46202
| | - Thomas A Ciulla
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St, Indianapolis, IN 46202.,Midwest Eye Institute, Springmill Medical Building, 10300 N. Illinois St., Suite 1000, Carmel, IN 46290, USA.,Clearside Biomedical, 900 North Point Pkwy # 200, Alpharetta, GA 30005
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12
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Single subcutaneous injection of the minocycline nanocomposite-loaded thermosensitive hydrogel for the effective attenuation of experimental autoimmune uveitis. Int J Pharm 2022; 622:121836. [PMID: 35597394 DOI: 10.1016/j.ijpharm.2022.121836] [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: 02/10/2022] [Revised: 04/30/2022] [Accepted: 05/14/2022] [Indexed: 11/24/2022]
Abstract
Autoimmune uveitis induces a serious pathological and inflammatory response in the retina/choroid and results in vision impairment and blindness. Here, we report a minocycline (Mino) nanocomposite-loaded hydrogel offering a high drug payload and sustained drug release for the effective control of ocular inflammation via a single subcutaneous injection. In the presence of divalent cations (i.e., Ca2+), Mino was found to co-assemble with a phosphorylated peptide (i.e., NapGFFpY) via electrostatic interaction and consequently generating Mino nanocomposite. The drug entrapment efficiency (EE) of the Mino nanocomposite varied from 29.93±0.76% to 67.90±6.57%, depending on different component concentrations. After incorporation into 30 wt% poly (D,L-lactide)-b-poly (ethylene glycol)-b-poly (D,L-lactide) (PDLLA-PEG-PDLLA) thermosensitive hydrogel, the resulting Mino nanocomposite-loaded hydrogel provided a sustained drug release over 21 days. In the experimental autoimmune uveitis (EAU) rat model, a single subcutaneous injection of the Mino nanocomposite-loaded hydrogel effectively alleviated ocular inflammation in a dose-dependent manner. As indicated by optical coherence tomography (OCT) and electroretinogram (ERG) measurements, the Mino nanocomposite-loaded hydrogel treatment not only remarkably reduced destruction of the retina by EAU, but also greatly rescued retinal functions. Moreover, the proposed Mino nanocomposite-loaded hydrogel exerted its therapeutic effect on EAU primarily through a significant reduction of the influx of leukocytes and Th17 cells as well as suppression of microglia activation and apoptosis in the retina. Overall, the proposed Mino nanocomposite-loaded hydrogel might be a promising strategy for the clinical management of EAU.
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13
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Shome A, Mugisho OO, Niederer RL, Rupenthal ID. Blocking the inflammasome: A novel approach to treat uveitis. Drug Discov Today 2021; 26:2839-2857. [PMID: 34229084 DOI: 10.1016/j.drudis.2021.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/24/2021] [Accepted: 06/30/2021] [Indexed: 12/11/2022]
Abstract
Uveitis is a complex ocular inflammatory disease often accompanied by bacterial or viral infections (infectious uveitis) or underlying autoimmune diseases (non-infectious uveitis). Treatment of the underlying infection along with corticosteroid-mediated suppression of acute inflammation usually resolves infectious uveitis. However, to develop more effective therapies for non-infectious uveitis and to better address acute inflammation in infectious disease, an improved understanding of the underlying inflammatory pathways is needed. In this review, we discuss the disease aetiology, preclinical in vitro and in vivo uveitis models, the role of inflammatory pathways, as well as current and future therapies. In particular, we highlight the involvement of the inflammasome in the development of non-infectious uveitis and how it could be a future target for effective treatment of the disease.
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Affiliation(s)
- Avik Shome
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Odunayo O Mugisho
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand; Auckland District Health Board, Auckland, New Zealand
| | - Ilva D Rupenthal
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand.
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14
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Tong Y, Huang X, Qi CX, Shen Y. Altered Functional Connectivity of the Primary Visual Cortex in Patients With Iridocyclitis and Assessment of Its Predictive Value Using Machine Learning. Front Immunol 2021; 12:660554. [PMID: 34025659 PMCID: PMC8137842 DOI: 10.3389/fimmu.2021.660554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/21/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose To explore the intrinsic functional connectivity (FC) alteration of the primary visual cortex (V1) between individuals with iridocyclitis and healthy controls (HCs) by the resting-state functional magnetic resonance imaging (fMRI) technique, and to investigate whether FC findings be used to differentiate patients with iridocyclitis from HCs. Methods Twenty-six patients with iridocyclitis and twenty-eight well-matched HCs were recruited in our study and underwent resting-state fMRI examinations. The fMRI data were analyzed by Statistical Parametric Mapping (SPM12), Data Processing and Analysis for Brain Imaging (DPABI), and Resting State fMRI Data Analysis Toolkit (REST) software. Differences in FC signal values of the V1 between the individuals with iridocyclitis and HCs were compared using independent two-sample t-tests. Significant differences in FC between two groups were chosen as classification features for distinguishing individuals with iridocyclitis from HCs using a support vector machine (SVM) classifier that involved machine learning. Classifier performance was evaluated using permutation test analysis. Results Compared with HCs, patients with iridocyclitis displayed significantly increased FC between the left V1 and left cerebellum crus1, left cerebellum 10, bilateral inferior temporal gyrus, right hippocampus, and left superior occipital gyrus. Moreover, patients with iridocyclitis displayed significantly lower FC between the left V1 and both the bilateral calcarine and bilateral postcentral gyrus. Patients with iridocyclitis also exhibited significantly higher FC values between the right V1 and left cerebellum crus1, bilateral thalamus, and left middle temporal gyrus; while they displayed significantly lower FC between the right V1 and both the bilateral calcarine and bilateral postcentral gyrus (voxel-level P<0.01, Gaussian random field correction, cluster-level P<0.05). Our results showed that 63.46% of the participants were correctly classified using the leave-one-out cross-validation technique with an SVM classifier based on the FC of the left V1; and 67.31% of the participants were correctly classified based on the FC of the right V1 (P<0.001, non-parametric permutation test). Conclusion Patients with iridocyclitis displayed significantly disturbed FC between the V1 and various brain regions, including vision-related, somatosensory, and cognition-related regions. The FC variability could distinguish patients with iridocyclitis from HCs with substantial accuracy. These findings may aid in identifying the potential neurological mechanisms of impaired visual function in individuals with iridocyclitis.
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Affiliation(s)
- Yan Tong
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xin Huang
- Department of Ophthalmology, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Chen-Xing Qi
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yin Shen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China.,Frontier Science Center for Immunology and Metabolism, Medical Research Institute, Wuhan University, Wuhan, China
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15
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Paiva MRBD, Vasconcelos-Santos DVD, Coelho MM, Machado RR, Lopes NP, Silva-Cunha A, Fialho SL. Licarin A as a Novel Drug for Inflammatory Eye Diseases. J Ocul Pharmacol Ther 2021; 37:290-300. [PMID: 33761287 DOI: 10.1089/jop.2020.0129] [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: 01/16/2023] Open
Abstract
Purpose: This study investigated the safety and therapeutic efficacy of licarin A (LCA) in the treatment of intraocular inflammation. Methods: In vitro safety of LCA in retinal pigmented epithelial cells (ARPE-19) and human embryonic stem cell derived-retinal pigmented epithelial cells (hES-RPE) was evaluated using CellTiter-Blue® kit. The chorioallantoic membrane (CAM) assay was used to investigate LCA safety and antiangiogenic activity. In vivo safety of intravitreal LCA was accomplished by clinical examination (including assessment of intraocular pressure), electroretinography (ERG), and histopathology. Uveitis was induced in rats by subcutaneous and intravitreal injection of bacillus Calmette-Guérin (BCG) antigen of Mycobacterium bovis. Intraocular inflammation was graded by slit-lamp and fundus examination, ERG, and histopathology. Results: LCA was safe to cells and to the CAM at concentration below 12.0 μM. LCA significantly reduced the percentage of blood vessels in the CAM. Retinal safety and anti-inflammatory efficacy of intravitreal injection of LCA 6.0 μM were confirmed through clinical, functional, and histopathological evaluation. Significant reduction of inflammatory cytokines (tumor necrosis factor-α and interleukin-6) was also found, when compared to untreated animals. Conclusion: The results suggest that LCA is a potential new drug for the treatment of inflammatory eye disease.
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Affiliation(s)
| | | | - Márcio Matos Coelho
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Norberto Peporine Lopes
- NPPNS, Department of Biomolecular Sciences, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Armando Silva-Cunha
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Silvia Ligório Fialho
- Pharmaceutical Research and Development, Ezequiel Dias Foundation, Belo Horizonte, Brazil
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16
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Tallouzi MO, Mathers JM, Moore DJ, Bucknall N, Calvert MJ, Murray PI, Denniston AK. Development of a Core Outcome Set for Clinical Trials in Non-infectious Uveitis of the Posterior Segment. Ophthalmology 2021; 128:1209-1221. [PMID: 33515595 DOI: 10.1016/j.ophtha.2021.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To develop an agreed upon set of outcomes known as a "core outcome set" (COS) for noninfectious uveitis of the posterior segment (NIU-PS) clinical trials. DESIGN Mixed-methods study design comprising a systematic review and qualitative study followed by a 2-round Delphi exercise and face-to-face consensus meeting. PARTICIPANTS Key stakeholders including patients diagnosed with NIU-PS, their caregivers, and healthcare professionals involved in decision-making for patients with NIU-PS, including ophthalmologists, nurse practitioners, and policymakers/commissioners. METHODS A long list of outcomes was developed based on the results of (1) a systematic review of clinical trials of NIU-PS and (2) a qualitative study of key stakeholders including focus groups and interviews. The long list was used to generate a 2-round Delphi exercise of stakeholders rating the importance of outcomes on a 9-point Likert scale. The proportion of respondents rating each item was calculated, leading to recommendations of "include," "exclude," or "for discussion" that were taken to a face-to-face consensus meeting of key stakeholders at which they agreed on the final COS. MAIN OUTCOME MEASURE Items recommended for inclusion in the COS for NIU-PS. RESULTS A total of 57 outcomes grouped in 11 outcome domains were presented for evaluation in the Delphi exercise, resulting in 9 outcomes directly qualifying for inclusion and 15 outcomes being carried forward to the consensus meeting, of which 7 of 15 were agreed on for inclusion. The final COS contained 16 outcomes organized into 4 outcome domains comprising visual function, health-related quality of life, treatment side effects, and disease control. CONCLUSIONS This study builds on international work across the clinical trials community and our qualitative research to construct the world's first COS for NIU-PS. The COS provides a list of outcomes that represent the priorities of key stakeholders and provides a minimum set of outcomes for use in all future NIU-PS clinical trials. Adoption of this COS can improve the value of future uveitis clinical trials and reduce noninformative research. Some of the outcomes identified do not yet have internationally agreed upon methods for measurement and should be the subject of future international consensus development.
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Affiliation(s)
- Mohammad O Tallouzi
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | - Jonathan M Mathers
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - David J Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | | | - Melanie J Calvert
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre and NIHR Applied Research Collaboration West Midlands at the University Hospitals Birmingham NHS Foundation Trust, and the University of Birmingham, Birmingham, United Kingdom
| | - Philip I Murray
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alastair K Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; Centre for Patient Reported Outcome Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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17
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Varela-Fernández R, Díaz-Tomé V, Luaces-Rodríguez A, Conde-Penedo A, García-Otero X, Luzardo-Álvarez A, Fernández-Ferreiro A, Otero-Espinar FJ. Drug Delivery to the Posterior Segment of the Eye: Biopharmaceutic and Pharmacokinetic Considerations. Pharmaceutics 2020; 12:E269. [PMID: 32188045 PMCID: PMC7151081 DOI: 10.3390/pharmaceutics12030269] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/06/2020] [Accepted: 03/11/2020] [Indexed: 01/22/2023] Open
Abstract
The treatment of the posterior-segment ocular diseases, such as age-related eye diseases (AMD) or diabetic retinopathy (DR), present a challenge for ophthalmologists due to the complex anatomy and physiology of the eye. This specialized organ is composed of various static and dynamic barriers that restrict drug delivery into the target site of action. Despite numerous efforts, effective intraocular drug delivery remains unresolved and, therefore, it is highly desirable to improve the current treatments of diseases affecting the posterior cavity. This review article gives an overview of pharmacokinetic and biopharmaceutics aspects for the most commonly-used ocular administration routes (intravitreal, topical, systemic, and periocular), including information of the absorption, distribution, and elimination, as well as the benefits and limitations of each one. This article also encompasses different conventional and novel drug delivery systems designed and developed to improve drug pharmacokinetics intended for the posterior ocular segment treatment.
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Affiliation(s)
- Rubén Varela-Fernández
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), Campus vida, 15782 Santiago de Compostela, Spain; (R.V.-F.); (V.D.-T.); (A.L.-R.); (A.C.-P.); (X.G.-O.); (A.L.-Á.)
- Clinical Neurosciences Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Victoria Díaz-Tomé
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), Campus vida, 15782 Santiago de Compostela, Spain; (R.V.-F.); (V.D.-T.); (A.L.-R.); (A.C.-P.); (X.G.-O.); (A.L.-Á.)
- Clinical Pharmacology Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Andrea Luaces-Rodríguez
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), Campus vida, 15782 Santiago de Compostela, Spain; (R.V.-F.); (V.D.-T.); (A.L.-R.); (A.C.-P.); (X.G.-O.); (A.L.-Á.)
- Clinical Pharmacology Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Andrea Conde-Penedo
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), Campus vida, 15782 Santiago de Compostela, Spain; (R.V.-F.); (V.D.-T.); (A.L.-R.); (A.C.-P.); (X.G.-O.); (A.L.-Á.)
- Paraquasil Group, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Xurxo García-Otero
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), Campus vida, 15782 Santiago de Compostela, Spain; (R.V.-F.); (V.D.-T.); (A.L.-R.); (A.C.-P.); (X.G.-O.); (A.L.-Á.)
- Molecular Imaging Group. University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Asteria Luzardo-Álvarez
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), Campus vida, 15782 Santiago de Compostela, Spain; (R.V.-F.); (V.D.-T.); (A.L.-R.); (A.C.-P.); (X.G.-O.); (A.L.-Á.)
- Paraquasil Group, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Anxo Fernández-Ferreiro
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), Campus vida, 15782 Santiago de Compostela, Spain; (R.V.-F.); (V.D.-T.); (A.L.-R.); (A.C.-P.); (X.G.-O.); (A.L.-Á.)
- Clinical Pharmacology Group, University Clinical Hospital, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
| | - Francisco J. Otero-Espinar
- Department of Pharmacology, Pharmacy and Pharmaceutical Technology, University of Santiago de Compostela (USC), Campus vida, 15782 Santiago de Compostela, Spain; (R.V.-F.); (V.D.-T.); (A.L.-R.); (A.C.-P.); (X.G.-O.); (A.L.-Á.)
- Paraquasil Group, Health Research Institute of Santiago de Compostela (IDIS), Travesía da Choupana s/n, 15706 Santiago de Compostela, Spain
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18
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Zhang W, Dai L, Li X, Li Y, Hung Yap MK, Liu L, Deng H. SARI prevents ocular angiogenesis and inflammation in mice. J Cell Mol Med 2020; 24:4341-4349. [PMID: 32119762 PMCID: PMC7171405 DOI: 10.1111/jcmm.15096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/22/2019] [Accepted: 11/26/2019] [Indexed: 02/05/2023] Open
Abstract
SARI (Suppressor of AP‐1, regulated by IFN‐β) is known to play an important role in some systemic disease processes such an inflammatory conditions and cancer. We hypothesize that SARI may also play a role in ocular diseases involving inflammation and neovascularization. To explore our hypothesis, further, we investigated an endotoxin‐induced uveitis (EIU) and experimental argon laser‐induced choroidal neovascularization (CNV) model in SARI wild‐type (SARIWT) and SARI‐deficient (SARI−/−) mice. Through imaging, morphological and immunohistochemical (IHC) studies, we found that SARI deficiency exacerbated the growth of CNV. More VEGF‐positive cells were presented in the retina of SARI−/− mice with CNV. Compared to SARIWT mice, more inflammatory cells infiltrated the ocular anterior segment and posterior segments in SARI−/− mice with EIU. Collectively, the results point to a potential dual functional role of SARI in inflammatory ocular diseases, suggesting that SARI could be a potential therapy target for ocular inflammation and neovascularization.
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Affiliation(s)
- Wenqiu Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Ophthalmology and Vision Sciences, West China Hospital, Sichuan University, Chengdu, China.,Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Dai
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Xun Li
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Ophthalmology and Vision Sciences, West China Hospital, Sichuan University, Chengdu, China
| | - Yiming Li
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | | | - Longqian Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
| | - Hongxin Deng
- State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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19
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Rosenbaum JT, Bodaghi B, Couto C, Zierhut M, Acharya N, Pavesio C, Tay-Kearney ML, Neri P, Douglas K, Pathai S, Song AP, Kron M, Foster CS. New observations and emerging ideas in diagnosis and management of non-infectious uveitis: A review. Semin Arthritis Rheum 2019; 49:438-445. [DOI: 10.1016/j.semarthrit.2019.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 04/18/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023]
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20
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Veale DJ, McGonagle D, McInnes IB, Krueger JG, Ritchlin CT, Elewaut D, Kanik KS, Hendrikx T, Berstein G, Hodge J, Telliez JB. The rationale for Janus kinase inhibitors for the treatment of spondyloarthritis. Rheumatology (Oxford) 2019; 58:197-205. [PMID: 29618084 PMCID: PMC6343466 DOI: 10.1093/rheumatology/key070] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Indexed: 12/25/2022] Open
Abstract
The pathogenesis of SpA is multifactorial and involves a range of immune cell types and cytokines, many of which utilize Janus kinase (JAK) pathways for signaling. In this review, we summarize the animal and pre-clinical data that have demonstrated the effects of JAK blockade on the underlying molecular mechanisms of SpA and provide a rationale for JAK inhibition for the treatment of SpA. We also review the available clinical trial data evaluating JAK inhibitors tofacitinib, baricitinib, peficitinib, filgotinib and upadacitinib in PsA, AS and related inflammatory diseases, which have demonstrated the efficacy of these agents across a range of SpA-associated disease manifestations. The available clinical trial data, supported by pre-clinical animal model studies demonstrate that JAK inhibition is a promising therapeutic strategy for the treatment of SpA and may offer the potential for improvements in multiple articular and extra-articular disease manifestations of PsA and AS.
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Affiliation(s)
- Douglas J Veale
- The Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital, Dublin, Ireland.,University College, Dublin, Ireland
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - James G Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, USA
| | - Christopher T Ritchlin
- Allergy, Immunology & Rheumatology Division, University of Rochester Medical Center, Rochester, NY, USA
| | - Dirk Elewaut
- Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center, Ghent University and Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
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21
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Schechtmann SA, Stine JM, Miller TR, Welihozkiy A, Michau TM. A retrospective analysis of lipid-laden aqueous humor in dogs: Thirty cases. Vet Ophthalmol 2019; 23:277-285. [PMID: 31733041 DOI: 10.1111/vop.12719] [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] [Received: 03/18/2019] [Revised: 10/06/2019] [Accepted: 10/18/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To describe the clinical presentation and outcome of canine patients that present with lipid-laden aqueous humor (LLA) and to evaluate its association with other ocular and systemic disorders. METHODS Medical records were identified and reviewed of 30 dogs presenting with clinical signs of LLA between 2013 and 2017 and compared to the canine referral population during the same time period. The percentage of dogs affected by LLA and potential risk factors were compared between groups. RESULTS There were 40 eyes in 30 dogs with LLA out of 8011 (0.4%) referrals. The mean age of dogs with LLA was significantly younger than dogs without LLA (P = .0334). Sex was not associated with LLA. Miniature Schnauzers were more likely to have LLA than mixed breeds (P < .0001). Incidence of LLA was significantly higher in eyes also affected by corneal ulceration (P = .0018) or phacoemulsification (P = .0001). Sixty-two percent and 51% of dogs with LLA had concurrent diabetes mellitus and hypertriglyceridemia, respectively. Average triglyceride level of dogs with LLA was 1087 mg/dL (±544) (reference 50-150 mg/dL) and average cholesterol level was 575 mg/dL (±232) (reference 125-300 mg/dL). Complete resolution of LLA was achieved in all dogs re-examined with an average of 20.2 days (range 4-175 days) after diagnosis. There were 6/30 dogs lost to follow-up. Recurrence of LLA occurred at least once in 4/24 dogs (16.7%) after resolution. CONCLUSIONS Lipid-laden aqueous humor occurs more frequently in Miniature Schnauzers. Corneal ulceration and phacoemulsification are risk factors. Complete resolution was seen in all cases with a low incidence of recurrence.
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Affiliation(s)
- Simone A Schechtmann
- BluePearl Veterinary Partners, Clearwater, FL, USA.,BluePearl Veterinary Partners, Sarasota, FL, USA.,BluePearl Veterinary Partners, Tampa, FL, USA
| | | | - Thomas R Miller
- Tampa Bay Veterinary Specialists and Emergency Care Center, Largo, FL, USA
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22
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Zhao L, Huang X, Peng M, Tan Q, Lin W, Khan MA, Tang Q, Lin D. Sub-Tenon Sustained Controllable Delivery of Dexamethasone for Treating Severe Acute Experimental Uveitis. Ocul Immunol Inflamm 2019; 28:984-993. [PMID: 31429619 DOI: 10.1080/09273948.2019.1643027] [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: 10/26/2022]
Abstract
PURPOSE To evaluate the efficacy of dexamethasone (DXM) through sub-tenon sustained controllable drug delivery system (SSCDDS) for treating severe acute experimental uveitis. METHODS Rabbits were treated with either DXM (treated group) or normal saline (control group) through SSCDDS. Clinical signs of uveitis were assessed at days 1, 3, 5, 7, and 14 after treatment. Histopathologic examinations were performed to evaluate inflammatory cell infiltration on posttreatment days 7 and 14. RESULTS All signs of experimental uveitis were reduced by SSCDDS of DXM according to clinical criteria, and the treated group had significantly less inflammation than the control group (p<0.05). Histopathologic examinations showed severe inflammation and marked inflammatory cell infiltration in the control group, but minimal inflammation in the treated group. CONCLUSIONS Sub-tenon sustained controllable delivery of DXM effectively suppresses severe acute inflammation in a rabbit model of uveitis. The proposed minimal invasive system might be a promising candidate for managing severe ocular diseases.
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Affiliation(s)
- Libei Zhao
- Department of Ophthalmology, Changsha Aier Eye Hospital, Aier School of Ophthalmology, Central South University , Changsha, China
| | - Xuetao Huang
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, China
| | - Manqiang Peng
- Department of Ophthalmology, Changsha Aier Eye Hospital, Aier School of Ophthalmology, Central South University , Changsha, China
| | - Qian Tan
- Department of Ophthalmology, Changsha Aier Eye Hospital, Aier School of Ophthalmology, Central South University , Changsha, China
| | - Wenxiang Lin
- Department of Ophthalmology, Changsha Aier Eye Hospital, Aier School of Ophthalmology, Central South University , Changsha, China
| | - Muhammad Ahmad Khan
- Department of Ophthalmology, Changsha Aier Eye Hospital, Aier School of Ophthalmology, Central South University , Changsha, China
| | - Qiongyan Tang
- Department of Ophthalmology, Changsha Aier Eye Hospital, Aier School of Ophthalmology, Central South University , Changsha, China
| | - Ding Lin
- Department of Ophthalmology, Changsha Aier Eye Hospital, Aier School of Ophthalmology, Central South University , Changsha, China
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23
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Zou Y, Hu X, Schewitz-Bowers LP, Stimpson M, Miao L, Ge X, Yang L, Li Y, Bible PW, Wen X, Li JJ, Liu Y, Lee RWJ, Wei L. The DNA Methylation Inhibitor Zebularine Controls CD4 + T Cell Mediated Intraocular Inflammation. Front Immunol 2019; 10:1950. [PMID: 31475011 PMCID: PMC6706956 DOI: 10.3389/fimmu.2019.01950] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/01/2019] [Indexed: 01/13/2023] Open
Abstract
CD4+ T cell mediated uveitis is conventionally treated with systemic immunosuppressive agents, including corticosteroids and biologics targeting key inflammatory cytokines. However, their long-term utility is limited due to various side effects. Here, we investigated whether DNA methylation inhibitor zebularine can target CD4+ T cells and control intraocular inflammation. Our results showed that zebularine restrained the expression of inflammatory cytokines IFN-γ and IL-17 in both human and murine CD4+ T cells in vitro. Importantly, it also significantly alleviated intraocular inflammation and retinal tissue damage in the murine experimental autoimmune uveitis (EAU) model in vivo, suggesting that the DNA methylation inhibitor zebularine is a candidate new therapeutic agent for uveitis.
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Affiliation(s)
- Yanli Zou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiao Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lauren P Schewitz-Bowers
- Translational Health Sciences, University of Bristol, Bristol, United Kingdom.,National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Madeleine Stimpson
- Translational Health Sciences, University of Bristol, Bristol, United Kingdom.,National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Li Miao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaofei Ge
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Liu Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Paul W Bible
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaofeng Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jing Jing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Richard W J Lee
- Translational Health Sciences, University of Bristol, Bristol, United Kingdom.,National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Lai Wei
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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24
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25
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Leal I, Rodrigues FB, Sousa DC, Duarte GS, Romão VC, Marques-Neves C, Costa J, Fonseca JE. Anti-TNF Drugs for Chronic Uveitis in Adults-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Med (Lausanne) 2019; 6:104. [PMID: 31179280 PMCID: PMC6543521 DOI: 10.3389/fmed.2019.00104] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 04/29/2019] [Indexed: 11/13/2022] Open
Abstract
Background: We aimed to assess efficacy and safety of anti-tumor necrosis factor (TNF) drugs for adult chronic non-infectious uveitis (NIU). Methods: CENTRAL, MEDLINE, and EMBASE, were searched from inception to January 2019. Double-masked randomized placebo-controlled trials, assessing any anti-TNF vs. best medical intervention/standard of care in adults with chronic NIU were considered. The PRISMA and SAMPL guidelines were followed. The risk of bias was assessed using the Cochrane risk of bias tool. Overall quality of the evidence was assessed according to GRADE. PROSPERO registration: #CRD42016039068. The primary efficacy and safety outcomes were preservation of visual acuity (VA) and withdrawals due to adverse events, respectively. Meta-analysis of efficacy analysis was not performed due to significant clinical heterogeneity between studies' population and interventions. Results: A total of 1,157 references were considered and 3 studies were included. The overall risk of bias was moderate. In active NIU, adalimumab group showed an increased likelihood of VA preservation (risk ratio (RR) 1.75, 95%CI 1.32 to 2.32, n = 217), whereas the etanercept group did not (RR 0.81, 95%CI 0.57 to 1.14, n = 20). In inactive NIU, adalimumab was associated with increased likelihood of VA preservation (RR 1.31, 95%CI 1.12 to 1.53, n = 226). The rate of adverse events did not differ between anti-TNF and control arms (RR 1.03, 95%CI 0.94 to 1.13, n = 410). Conclusions: There is high quality evidence that adalimumab decreases the risk of worsening VA in active and inactive NIU and very low quality evidence that the risk of etanercept worsening VA in inactive NIU is not different from placebo. Moderate quality evidence suggests that anti-TNF agents are not different from placebo on the risk of study withdrawal.
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Affiliation(s)
- Inês Leal
- Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.,Faculdade de Medicina, Centro de Estudos das Ciências da Visão, Universidade de Lisboa, Lisbon, Portugal
| | - Filipe B Rodrigues
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Clinical Pharmacology Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - David Cordeiro Sousa
- Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.,Faculdade de Medicina, Centro de Estudos das Ciências da Visão, Universidade de Lisboa, Lisbon, Portugal
| | - Gonçalo S Duarte
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Clinical Pharmacology Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Vasco C Romão
- Department of Rheumatology, Hospital de Santa Maria, Lisbon, Portugal.,Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
| | - Carlos Marques-Neves
- Department of Ophthalmology, Hospital de Santa Maria, Lisbon, Portugal.,Faculdade de Medicina, Centro de Estudos das Ciências da Visão, Universidade de Lisboa, Lisbon, Portugal
| | - João Costa
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Clinical Pharmacology Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal.,Faculdade de Medicina, Centro de Medicina Baseada na Evidência, Universidade de Lisboa, Lisbon, Portugal.,Cochrane Portugal, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Department of Rheumatology, Hospital de Santa Maria, Lisbon, Portugal.,Rheumatology Research Unit, Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal
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26
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Damodaran K, Sridharan S. Immunosuppressives and biologicals in uveitis: The way forward – Current concepts. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2019. [DOI: 10.4103/tjosr.tjosr_14_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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27
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Yu X, Zhang R, Lei L, Song Q, Li X. High drug payload nanoparticles formed from dexamethasone-peptide conjugates for the treatment of endotoxin-induced uveitis in rabbit. Int J Nanomedicine 2019; 14:591-603. [PMID: 30666116 PMCID: PMC6336024 DOI: 10.2147/ijn.s179118] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To develop and demonstrate the effectiveness of a novel dexamethasone (Dex) nanoformulation for treating uveitis. MATERIALS AND METHODS We designed and screened a dexamethasone-peptide conjugate (Dex-SA-FFFE), formed via a biodegradable ester bond linkage, that could spontaneously form high drug payload nanoparticles in aqueous solution for treating uveitis. RESULTS An in vitro release study indicated that Dex and Dex-SA-FFFE sustainably released from Dex-SA-FFFE nanoparticles over a 48 h study period. Meanwhile, the formed Dex-SA-FFFE nanoparticles hardly caused cytotoxicity in human corneal epithelial cell at drug concentrations up to 1 mM after 24 h of incubation but reduced cell viability after 48 h and 72 h of incubation. An in vitro anti-inflammatory efficacy assay showed that the Dex-SA-FFFE nanoparticles exhibited a comparable anti-inflammatory efficacy to that of Dex in lipopolysaccharide (LPS)-activated RAW264.7 macrophages via significant decreases in the secretion of various pro-inflammatory cytokines (e.g., nitric oxide, tumor necrosis factor-α, interleukin-6). Topical instillation of Dex-SA-FFFE nanoparticles showed good ocular tolerance without causing changes in corneal thickness and intraocular pressure during the entire study period. Furthermore, topical instillation of Dex-SA-FFFE nanoparticles displayed a comparable in vivo therapeutic efficacy to that of dexamethasone sodium phosphate (Dexp) aqueous solutions in an endotoxin-induced uveitis (EIU) rabbit model. CONCLUSION Based on these results, it is reasonable to believe that the proposed Dex-SA-FFFE nanoparticles might have great application for the treatment of anterior uveitis.
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Affiliation(s)
- Xinxin Yu
- Institute of Biomedical Engineering, School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, People's Republic of China,
| | - Renshu Zhang
- Institute of Biomedical Engineering, School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, People's Republic of China,
| | - Lei Lei
- Institute of Biomedical Engineering, School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, People's Republic of China,
| | - Qianqian Song
- Institute of Biomedical Engineering, School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, People's Republic of China,
| | - Xingyi Li
- Institute of Biomedical Engineering, School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, People's Republic of China,
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28
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Ghiță AC, Ilie L, Ghiță AM. The effects of inflammation and anti-inflammatory treatment on corneal endothelium in acute anterior uveitis. Rom J Ophthalmol 2019; 63:161-165. [PMID: 31334395 PMCID: PMC6626932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To establish the magnitude of endothelial cells alterations in acute anterior uveitis (AAU) and the clinical impact of local anti-inflammatory treatment. Methods: 27 patients at first episode of unilateral AAU were included. According to the moment of presentation in our departments, two different groups were created, early treatment uveitis group (ETUG) and delayed treatment uveitis group (DTUG). Each patient underwent a corneal endothelial specular microscopy, in both eyes, two weeks after we begun the topical treatment. Results: A statistically significant endothelial cells loss in the uveitis eye was identified in both groups, more important in DTUG. Also, in this group, the pleomorfism, polimegathism and central corneal thickness (CCT) were statistically significant increased. Conclusions: The patients with unilateral AAU and delayed presentation showed more important alterations, first structural and then functional, due to a prolonged inflammatory response. This, in association with other favorable ocular conditions can progress to a permanent corneal endothelial decompensation. The sooner the anti-inflammatory treatment was initiated, the more limited were the destructive processes. Abbreviations: AAU = Acute Anterior Uveitis, ETUG = Early Treatment Uveitis Group, DTUG = Delayed Treatment Uveitis Group, CCT = Central Corneal Thickness, CV = Coefficient of Variation, ECD = Endothelial Cells Density, HEX = Percentage of Hexagonal Cells.
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Affiliation(s)
| | - Larisa Ilie
- Department of Ophthalmology, University Emergency Hospital, Bucharest, Romania
| | - Aurelian Mihai Ghiță
- Ocularcare Eye Clinic, Bucharest, Romania
,Department of Ophthalmology, University Emergency Hospital, Bucharest, Romania
,Department of Physiology II, “Carol Davila” University of Medicine and Pharmacy,
Bucharest, Romania
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29
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The Management of Acute Anterior Uveitis Complicating Spondyloarthritis: Present and Future. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9460187. [PMID: 30406148 PMCID: PMC6204187 DOI: 10.1155/2018/9460187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 09/05/2018] [Accepted: 09/26/2018] [Indexed: 12/12/2022]
Abstract
Spondyloarthropathies (SpA) encompass a group of chronic inflammatory diseases sharing common genetic and clinical features, including the association with HLA-B27 antigen, the involvement of both the axial and the peripheral skeleton, the presence of dactylitis, enthesitis, and typical extra-articular manifestations such as psoriasis, inflammatory bowel disease, and acute anterior uveitis (AAU). The latter is commonly reported as a noninfectious acute inflammation of the anterior uveal tract and its adjacent structures. AAU may affect more than 20% of SpA patients representing the most common extra-articular manifestation of the disease. Considering the potential consequences of untreated AAU, early diagnosis and aggressive treatment are crucial to avoid complications of remittent or chronic eye inflammation, such as visual loss and blindness. The management of SpA has dramatically improved over the last decades due to the development of new treat-to-target strategies and to the introduction of biologic disease modifying antirheumatic drugs (bDMARDs), particularly tumor necrosis factor alpha inhibitors (TNFis), currently used for the treatment of nonresponder patients to conventional synthetic agents. Along with the improvement of musculoskeletal features of SpA, bDMARDs provided an additional effect also in the management of AAU in those patients who are failures to topical and systemic conventional therapies. Nowadays, five TNFis, one interleukin-17, and one interleukin 12/23 blocker are licensed for the treatment of SpA, with different proven efficacy in preventing and treating ocular involvement. The aim of this review is to summarize the current options and to analyze the future perspectives for the management of SpA-associated AAU.
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30
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Huang J, Yu X, Zhou Y, Zhang R, Song Q, Wang Q, Li X. Directing the nanoparticle formation by the combination with small molecular assembly and polymeric assembly for topical suppression of ocular inflammation. Int J Pharm 2018; 551:223-231. [PMID: 30213683 DOI: 10.1016/j.ijpharm.2018.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/20/2018] [Accepted: 09/08/2018] [Indexed: 01/03/2023]
Abstract
In this paper, we presented a simple yet versatile strategy to generate a high drug payload nanoparticles by the combination with small molecular assembly and polymeric assembly for topical suppression of ocular inflammation. Upon physical mixing of the succinated triamcinolone acetonide (TA-SA) supramolecular hydrogel with the poly (ethylene glycol)-poly (ɛ-caprolactone)-poly (ethylene glycol) (PECE) aqueous solution at 37 °C, TA-SA/PECE nanoparticles formed spontaneously and characterized thoroughly by transmission electron microscopy (TEM), X-ray diffraction (XRD) and differential scanning calorimetry (DSC). The formed TA-SA/PECE nanoparticles displayed a comparable in vitro anti-inflammatory efficacy to that of native triamcinolone acetonide (TA), through a significant downregulation of various proinflammatory cytokines levels (e.g., NO, TNF-α) in a lipopolysaccharide (LPS) actived RAW264.7 macrophage. Meanwhile, the enhanced transcorneal drug permeability of TA-SA/PECE nanoparticles over that of TA suspension was clearly observed in an isolated rabbit cornea. Intraocular biocompatibility test demonstrated that TA-SA/PECE nanoparticles presented good biocompatibility after topical instillation during entire study period. More importantly, the TA-SA/PECE nanoparticles displayed superior therapeutic efficacy over that of the TA suspension in the endotoxin-induced uveitis (EIU) rabbit model via decreasing neutrophil infiltration in anterior chamber. Overall, the proposed TA-SA/PECE nanoparticles might be a promising candidate for uveitis therapy.
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Affiliation(s)
- Jinhai Huang
- Institute of Biomedical Engineering, School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China
| | - Xinxin Yu
- Institute of Biomedical Engineering, School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China
| | - Yanfang Zhou
- Institute of Biomedical Engineering, School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China
| | - Renshu Zhang
- Institute of Biomedical Engineering, School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China
| | - Qianqian Song
- Institute of Biomedical Engineering, School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China
| | - Qinmei Wang
- Institute of Biomedical Engineering, School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China.
| | - Xingyi Li
- Institute of Biomedical Engineering, School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou 325027, PR China.
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Leal I, Rodrigues FB, Sousa DC, Romão VC, Duarte GS, Carreño E, Dick AD, Marques-Neves C, Costa J, Fonseca JE. Efficacy and safety of intravitreal anti-tumour necrosis factor drugs in adults with non-infectious uveitis - a systematic review. Acta Ophthalmol 2018; 96:e665-e675. [PMID: 29577629 DOI: 10.1111/aos.13699] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 12/09/2017] [Indexed: 12/29/2022]
Abstract
Anti-tumour necrosis factor (TNF) drugs have been extensively used in non-infectious uveitis (NIU), when corticosteroids or conventional immunosuppressive drugs cannot adequately control inflammation or intolerable side-effects occur. However, systemic anti-TNF therapies are also associated with a myriad of side-effects. Therefore, intravitreal administration of anti-TNF biologics has been employed to minimize patient morbidity and systemic adverse effects, while maintaining therapeutic effectivity. We undertook a systematic review to determine evidence of efficacy and safety of intravitreal administration of anti-TNF drugs in adults with NIU. We conducted this systematic review according to the PRISMA guidelines. The protocol was registered with PROSPERO (CRD42016041946). We searched CENTRAL, MEDLINE and EMBASE, from inception to April 2017, as well as clinical trial registries and grey literature. The qualitative analysis included all studies of adult patients with a diagnosis of NIU and who received intravitreal anti-TNF drugs with a 4-week minimum follow-up. A total of 4840 references were considered for title and abstract screening. Seven full texts were screened, and five studies were considered for analysis. All studies were open-label, single-centre, prospective, non-randomized, interventional case series with a follow-up between 4 and 26 weeks, employing either adalimumab in two studies and infliximab in three. Three studies showed a treatment effect of anti-TNF intravitreal injections, while one study revealed short-term improvement and one study revealed no efficacy of anti-TNF intravitreal therapy. None of the studies reported ocular adverse effects but only two studies included electrophysiological assessment in the safety analysis and no study assessed systemic human anti-drug antibodies. The available evidence is not sufficiently robust to conclude about the clinical effectivity of intravitreal anti-TNF in NIU and so no recommendation can be made. In conclusion, intravitreal injection of anti-TNF antibodies remains a possible treatment option to be explored through robust clinical investigation.
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Affiliation(s)
- Inês Leal
- Department of Ophthalmology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisboa Portugal
- Department of Ophthalmology; Faculdade de Medicina; Universidade de Lisboa; Lisboa Portugal
- Centro de Estudos das Ciências da Visão; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Filipe B Rodrigues
- Laboratory of Clinical Pharmacology and Therapeutics; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Clinical Pharmacology Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Huntington's Disease Centre; University College London; London UK
| | - David Cordeiro Sousa
- Department of Ophthalmology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisboa Portugal
- Department of Ophthalmology; Faculdade de Medicina; Universidade de Lisboa; Lisboa Portugal
- Centro de Estudos das Ciências da Visão; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Vasco C Romão
- Department of Rheumatology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisbon Portugal
- Rheumatology Research Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Gonçalo S Duarte
- Laboratory of Clinical Pharmacology and Therapeutics; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Clinical Pharmacology Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Ester Carreño
- Clinical Research Unit; Bristol Eye Hospital NHS Foundation Trust; Bristol UK
| | - Andrew D Dick
- Clinical Research Unit; Bristol Eye Hospital NHS Foundation Trust; Bristol UK
- School of Clinical Sciences; Faculty of Medicine and Dentistry; University of Bristol; Bristol UK
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology; London UK
| | - Carlos Marques-Neves
- Department of Ophthalmology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisboa Portugal
- Department of Ophthalmology; Faculdade de Medicina; Universidade de Lisboa; Lisboa Portugal
- Centro de Estudos das Ciências da Visão; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Clinical Pharmacology Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Evidence Based Medicine Centre; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Portuguese Collaborating Centre of the Cochrane Iberoamerican Network; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - João Eurico Fonseca
- Department of Rheumatology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisbon Portugal
- Rheumatology Research Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
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Li J, Qiu C, Zhang Z, Yuan W, Ge Z, Tan B, Yang P, Liu J, Zhu X, Qiu C, Lai D, Guo L, Yu L. Subretinal Transplantation of Human Amniotic Epithelial Cells in the Treatment of Autoimmune Uveitis in Rats. Cell Transplant 2018; 27:1504-1514. [PMID: 30168350 PMCID: PMC6180726 DOI: 10.1177/0963689718796196] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
As a featured ocular inflammatory disease, autoimmune uveitis is the major cause of blindness in the clinic. Although current immunosuppressive regimens can alleviate the progression of autoimmune uveitis, they have serious side effects. Therefore, an alternative therapeutic strategy is urgently required. The present study investigated the therapeutic efficacy of human amniotic epithelial cells (hAECs) on autoimmune uveitis in a rat model. Herein, experimental autoimmune uveitis (EAU) was induced in rats via a subcutaneous injection of interphotoreceptor retinoid-binding protein. EAU rats were treated with hAECs or the vehicle solution via a subretinal injection on day 0 and day 6 after immunization, and rats were sacrificed on day 12 and day 18 for further analysis. The pathological development of EAU was evaluated by slit lamp microscopy. Immune cell infiltration and retinal structure damage were examined by histological examination of hematoxylin and eosin (H&E) and immunofluorescence staining. T-cell subsets were detected by flow cytometry, and the levels of inflammatory cytokines were quantified by enzyme-linked immunosorbent assay (ELISA). hAEC treatment ameliorated the pathological progression of EAU and preserved the retinal structure organization and thickness, especially in the preventive group that received a subretinal injection on day 0. Moreover, hAECs inhibited the retinal infiltration of macrophages and T-cells. Mechanistically, hAECs modulated the balance of T-cell subsets by downregulating T helper (Th)17 cells and upregulating T regulatory (Treg) cells, as confirmed by decreased interleukin (IL)-17 and increased IL-10 levels in the spleens and lymph nodes of EAU rats. Furthermore, hAECs improved the local cytokine environment in EAU rats by suppressing the monocyte chemoattractant protein (MCP)-1, IL-17 and interferon (IFN)-γ levels and enhancing the IL-10 in the aqueous humor. Therefore, subretinal transplantation of hAECs in EAU rats ameliorated ocular inflammation, preserved the retinal structure and coordinated the immune balance. The current study provides a novel therapeutic strategy for autoimmune uveitis and related ocular inflammatory diseases in the clinic.
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Affiliation(s)
- Jinying Li
- 1 Institute of Genetics and Regenerative Biology, College of Life Sciences, Hangzhou, Zhejiang, China.,2 College of Life Sciences-iCell Biotechnology Regenerative Biomedicine Laboratory, Hangzhou, Zhejiang, China.,3 Center for Stem Cell and Regenerative Medicine, Hangzhou, Zhejiang, China
| | - Chen Qiu
- 1 Institute of Genetics and Regenerative Biology, College of Life Sciences, Hangzhou, Zhejiang, China.,2 College of Life Sciences-iCell Biotechnology Regenerative Biomedicine Laboratory, Hangzhou, Zhejiang, China.,3 Center for Stem Cell and Regenerative Medicine, Hangzhou, Zhejiang, China
| | - Zheng Zhang
- 4 The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Weixin Yuan
- 1 Institute of Genetics and Regenerative Biology, College of Life Sciences, Hangzhou, Zhejiang, China.,2 College of Life Sciences-iCell Biotechnology Regenerative Biomedicine Laboratory, Hangzhou, Zhejiang, China.,3 Center for Stem Cell and Regenerative Medicine, Hangzhou, Zhejiang, China
| | - Zhen Ge
- 5 Institute of Materia Medica, Zhejiang Academy of Medical Sciences, Hangzhou, Zhejiang, China
| | - Bing Tan
- 1 Institute of Genetics and Regenerative Biology, College of Life Sciences, Hangzhou, Zhejiang, China.,2 College of Life Sciences-iCell Biotechnology Regenerative Biomedicine Laboratory, Hangzhou, Zhejiang, China.,3 Center for Stem Cell and Regenerative Medicine, Hangzhou, Zhejiang, China
| | - Pengjie Yang
- 1 Institute of Genetics and Regenerative Biology, College of Life Sciences, Hangzhou, Zhejiang, China.,2 College of Life Sciences-iCell Biotechnology Regenerative Biomedicine Laboratory, Hangzhou, Zhejiang, China.,3 Center for Stem Cell and Regenerative Medicine, Hangzhou, Zhejiang, China
| | - Jia Liu
- 1 Institute of Genetics and Regenerative Biology, College of Life Sciences, Hangzhou, Zhejiang, China.,2 College of Life Sciences-iCell Biotechnology Regenerative Biomedicine Laboratory, Hangzhou, Zhejiang, China.,3 Center for Stem Cell and Regenerative Medicine, Hangzhou, Zhejiang, China
| | - Xiaolong Zhu
- 1 Institute of Genetics and Regenerative Biology, College of Life Sciences, Hangzhou, Zhejiang, China.,2 College of Life Sciences-iCell Biotechnology Regenerative Biomedicine Laboratory, Hangzhou, Zhejiang, China.,3 Center for Stem Cell and Regenerative Medicine, Hangzhou, Zhejiang, China
| | - Cong Qiu
- 1 Institute of Genetics and Regenerative Biology, College of Life Sciences, Hangzhou, Zhejiang, China.,2 College of Life Sciences-iCell Biotechnology Regenerative Biomedicine Laboratory, Hangzhou, Zhejiang, China.,3 Center for Stem Cell and Regenerative Medicine, Hangzhou, Zhejiang, China
| | - Dongmei Lai
- 6 International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lihe Guo
- 7 Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China.,8 Shanghai iCELL Biotechnology Co Ltd, Shanghai, China
| | - Luyang Yu
- 1 Institute of Genetics and Regenerative Biology, College of Life Sciences, Hangzhou, Zhejiang, China.,2 College of Life Sciences-iCell Biotechnology Regenerative Biomedicine Laboratory, Hangzhou, Zhejiang, China.,3 Center for Stem Cell and Regenerative Medicine, Hangzhou, Zhejiang, China
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Glycosylation-enhanced biocompatibility of the supramolecular hydrogel of an anti-inflammatory drug for topical suppression of inflammation. Acta Biomater 2018; 73:275-284. [PMID: 29660509 DOI: 10.1016/j.actbio.2018.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/01/2018] [Accepted: 04/09/2018] [Indexed: 01/12/2023]
Abstract
Intravitreal/periocular injection of triamcinolone acetonide (TA) suspension is a common uveitis treatment, but it displays a high risk for serious side effects (e.g., high intraocular pressure, retinal toxicity). We report here an intravitreally injectable thermosensitive glycosylated TA (TA-SA-Glu) hydrogel, formed by covalently conjugating glucosamine (Glu) with succinate TA (TA-SA), for treating uveitis. The TA-SA-Glu hydrogelator forms a supramolecular hydrogel spontaneously in aqueous solution with a minimal gelation concentration of 0.25 wt%. Structural analysis revealed that hydrogen bonds assisted by hydrophobic interaction resulted in self-assembled nanofibers. Rheology analysis demonstrated that this TA-SA-Glu hydrogel exhibited a typical thixotropic property. Sustained release of both TA-SA-Glu and TA from the hydrogel occurred throughout the 3-day in vitro release study. The obtained TA-SA-Glu hardly caused cytotoxicity against ARPE-19 and RAW264.7 cells after 24 h of incubation at drug concentration up to 600 μM. In particular, TA-SA-Glu exhibited a comparable anti-inflammatory efficacy to TA in terms of inhibiting the production of nitric oxide, tumor necrosis factor-α, and interleukin-6 in activated RAW264.7 macrophages. Following a single intravitreal injection, 69 nmol TA-SA-Glu hydrogel caused minimal apparent retinal toxicity, whereas the TA suspension displayed significant effects in terms of localized retinal toxicity. A single intravitreal injection of TA-SA-Glu hydrogel was more effective in controlling inflammatory response than that of the TA suspension treatment, particularly in down-regulating the pro-inflammatory Th1 and Th17 effector responses for treating experimental autoimmune uveitis. This study strongly indicates that supramolecular TA-SA-Glu hydrogels may represent a new option for posterior uveitis management. STATEMENT OF SIGNIFICANCE Intravitreal/periocular injection of triamcinolone acetonide (TA) suspension is a common uveitis treatment, but suffers a high risk for serious side effects (e.g., high intraocular pressure, retinal toxicity). We generated an injectable glycosylated triamcinolone acetonide hydrogelator (TA-SA-Glu) hydrogel for treating uveitis. Following a single intravitreal injection, the proposed TA-SA-Glu hydrogel hardly caused apparent retinal toxicity at a dosage of 69 nmol per eye. Furthermore, TA-SA-Glu hydrogel was more effective in controlling non-infectious uveitis over than a TA suspension, particularly in terms of down-regulating the pro-inflammatory Th1 and Th17 effector responses for treating experimental autoimmune uveitis (EAU). This study strongly indicates that TA-SA-Glu supramolecular hydrogels may represent a new option for the management of various intraocular inflammations.
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Zhou M, Luo J, Zhang H. Role of Sirtuin 1 in the pathogenesis of ocular disease (Review). Int J Mol Med 2018; 42:13-20. [PMID: 29693113 DOI: 10.3892/ijmm.2018.3623] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/29/2018] [Indexed: 11/06/2022] Open
Abstract
Sirtuin (SIRT)1, a member of the SIRT family, is a highly conserved NAD+‑dependent histone deacetylase, which has a regulatory role in numerous physiological and pathological processes by removing acetyl groups from various proteins. SIRT1 controls the activity of numerous transcription factors and cofactors, which impacts the downstream gene expression, and eventually alleviates oxidative stress and associated damage. Numerous studies have revealed that dysfunction of SIRT1 is linked with ocular diseases, including cataract, age‑associated macular degeneration, diabetic retinopathy and glaucoma, while ectopic upregulation of SIRT1 protects against various ocular diseases. In the present review, the significant role of SIRT1 and the potential therapeutic value of modulating SIRT1 expression in ocular development and eye diseases is summarized.
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Affiliation(s)
- Mengwen Zhou
- Department of Ophthalmology, Hunan Clinical Research Center of Ophthalmic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Jing Luo
- Department of Ophthalmology, Hunan Clinical Research Center of Ophthalmic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Huiming Zhang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
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35
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Long-term results of pars plana vitrectomy as an anti-inflammatory therapy of pediatric intermediate uveitis resistant to standard medical treatment. Eur J Ophthalmol 2018; 28:98-102. [PMID: 28862736 DOI: 10.5301/ejo.5001020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the efficacy of pars plana vitrectomy (PPV) as an anti-inflammatory therapy in pediatric recurrent intermediate uveitis. METHODS A retrospective study evaluated the long-term results of PPV indicated for intermediate uveitis with a mean observation period of 10.3 years (range 7-15.6 years) in 6 children (mean age 8 years, range 6-12 years). Pars plana vitrectomy was performed on 10 eyes in the standard manner and was initiated by vitreous sampling for laboratory examination. Data recorded were perioperative or postoperative vitrectomy complications, anatomic and functional results of PPV, and preoperative and postoperative best-corrected Snellen visual acuity. RESULTS No perioperative or postoperative complications were observed. Bacteriologic, virologic, mycotic, and cytologic analysis of the vitreous was negative in all tested children. Five eyes were subsequently operated on for posterior subcapsular cataracts. An average preoperative visual acuity of 0.32 improved to an average postoperative visual acuity of 0.8. CONCLUSIONS In the case of systemic immunosuppressive treatment failure in pediatric uveitis, particularly in eyes with cystoid macular edema, we recommend PPV relatively early.
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Montesano G, Way CM, Ometto G, Ibrahim H, Jones PR, Carmichael R, Liu X, Aslam T, Keane PA, Crabb DP, Denniston AK. Optimizing OCT acquisition parameters for assessments of vitreous haze for application in uveitis. Sci Rep 2018; 8:1648. [PMID: 29374239 PMCID: PMC5785990 DOI: 10.1038/s41598-018-20092-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/12/2018] [Indexed: 12/19/2022] Open
Abstract
Detection and evaluation of inflammatory activity in uveitis is essential to the management of the condition, and yet continues to be largely dependent on subjective clinical measures. Optical coherence tomography (OCT) measurement of vitreous activity is an alternative to clinical vitreous haze scoring and has passed a number of early validation studies. In this study we aimed to evaluate the impact of ‘operator factors’ on the variability of the technique as part of the validation process, and to help evaluate its suitability for ‘real world’ use. Vitreous haze index was calculated as a ratio between the reflectivity of the vitreous and of the outer retina in each scan. Different scanning conditions were tested and their effect on the measurement is reported. Our results show that the ‘quantitative imaging’ technique of OCT-measured vitreous activity had good reliability in normal subjects under a range of ‘real world’ conditions, such as when the operator changes the averaging value. The technique was however vulnerable to highly inaccurate focussing or abnormal downward displacement of the image. OCT-based quantification of vitreous activity is a promising alternative to current subjective clinical estimates, with sufficient ‘tolerance’ to be used in routine clinical practice as well as clinical trials.
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Affiliation(s)
- G Montesano
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
| | - C M Way
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - G Ometto
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
| | - H Ibrahim
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - P R Jones
- City, University of London, Optometry and Visual Sciences, London, United Kingdom.,NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - R Carmichael
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - X Liu
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - T Aslam
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom.,School of Built Environment, Heriot-Watt University, Edinburgh, United Kingdom
| | - P A Keane
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - D P Crabb
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
| | - A K Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom. .,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom. .,NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom.
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Ratay ML, Bellotti E, Gottardi R, Little SR. Modern Therapeutic Approaches for Noninfectious Ocular Diseases Involving Inflammation. Adv Healthc Mater 2017; 6:10.1002/adhm.201700733. [PMID: 29034584 PMCID: PMC5915344 DOI: 10.1002/adhm.201700733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/25/2017] [Indexed: 12/12/2022]
Abstract
Dry eye disease, age-related macular degeneration, and uveitis are ocular diseases that significantly affect the quality of life of millions of people each year. In these diseases, the action of chemokines, proinflammatory cytokines, and immune cells drives a local inflammatory response that results in ocular tissue damage. Multiple therapeutic strategies are developed to either address the symptoms or abate the underlying cause of these diseases. Herein, the challenges to deliver drugs to the relevant location in the eye for each of these diseases are reviewed along with current and innovative therapeutic approaches that attempt to restore homeostasis within the ocular microenvironment.
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Affiliation(s)
- Michelle L. Ratay
- Department of Bioengineering, University of Pittsburgh, 427 Benedum Hall 3700 O’Hara Street Pittsburgh, Pa 15261
| | - Elena Bellotti
- Department of Chemical Engineering, University of Pittsburgh, 427 Benedum Hall 3700 O’Hara Street Pittsburgh, Pa 15261
| | - Riccardo Gottardi
- Department of Chemical Engineering, Department of Orthopedic Surgery, Ri.MED Foundation, 427 Benedum Hall 3700 O’Hara Street Pittsburgh, Pa 15261
| | - Steven R. Little
- Department of Chemical Engineering, Department of Bioengineering, Department of Ophthalmology, Department of Immunology, Department of Pharmaceutical Sciences, The McGowan Institute for Regenerative Medicine, 940 Benedum Hall 3700 O’Hara Street Pittsburgh Pa 15261
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38
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Liu R, Rong B, Tu P, Tang Y, Song W, Toyos R, Toyos M, Yan X. Analysis of Cytokine Levels in Tears and Clinical Correlations After Intense Pulsed Light Treating Meibomian Gland Dysfunction. Am J Ophthalmol 2017; 183:81-90. [PMID: 28887117 DOI: 10.1016/j.ajo.2017.08.021] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE To investigate the change from baseline of inflammatory markers in tears of dry eye disease (DED) subjects owing to meibomian gland dysfunction (MGD) after intense pulsed light (IPL) treatment and meibomian gland expression (MGE) compared to sham treatment, and the correlations with ocular surface parameters. DESIGN Randomized, double-masked, controlled study. METHODS Those randomized into the active treatment arm received 3 consecutive treatments (14∼16 J/cm2) approximately 4 weeks apart in the periocular region. Control eyes received 3 treatments in the same intervals of 0 J/cm2. Tear samples in all eyes were collected and analyzed at baseline, week 12, and/or week 4 for interleukin (IL)-17A, IL-6, and prostaglandin E2 (PGE2). The correlations between cytokines and ocular surface parameters were analyzed before and after IPL treatment. RESULTS All of the inflammatory markers declined in value compared to baselines. IL-17A and IL-6 showed statistically significant decreases compared to sham treatment at each measured time point. PGE2 showed statistically significant decreases compared to sham at week 12. Results showed that the expressions of IL-17A and IL-6 correlated well with ocular surface parameters of the lower eyelid before IPL. The changed values of IL-6 and PGE2 in tears correlated with the changed values of partial ocular surface parameters after IPL treatment in study eyes, respectively. CONCLUSIONS The study results suggest that IPL can significantly reduce inflammatory markers in tears of patients suffering with DED owing to MGD after IPL treatment. These findings indicate that IL-17A and IL-6 play roles in the pathogenesis of DED owing to MGD, and the reduction of the inflammatory factors is consistent with the improvement of partial clinical symptoms and signs.
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Affiliation(s)
- Ruixing Liu
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Bei Rong
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Ping Tu
- Department of Dermatology, Peking University First Hospital, Beijing, China
| | - Yun Tang
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | - Wenjing Song
- Department of Ophthalmology, Peking University First Hospital, Beijing, China
| | | | | | - Xiaoming Yan
- Department of Ophthalmology, Peking University First Hospital, Beijing, China.
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Tode J, Richert E, Koinzer S, Klettner A, Pickhinke U, Garbers C, Rose-John S, Nölle B, Roider J. Intravitreal injection of anti-Interleukin (IL)-6 antibody attenuates experimental autoimmune uveitis in mice. Cytokine 2017; 96:8-15. [PMID: 28267649 DOI: 10.1016/j.cyto.2017.02.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/29/2017] [Accepted: 02/24/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate the effect of an intravitreally applied anti-IL-6 antibody for the treatment of experimental autoimmune uveitis (EAU). METHODS EAU was induced in female B10.RIII mice by Inter-Photoreceptor-Binding-Protein (IRBP) in complete Freund's adjuvant, boosted by Pertussis toxin. Single blinded intravitreal injections of anti-IL-6 antibody were applied 5-7days as well as 8-10days (3day interval) after EAU induction into the randomized treatment eye and phosphate buffered saline (PBS) into the fellow control eye. Clinical and fluorescein angiography scoring (6 EAU grades) was done at each injection day and at enucleation day 14. Enucleated eyes were either scored histologically (6 EAU grades) or examined by ELISA for levels of IL-6, IL-17 and IL-6 soluble Receptor (sIL-6R). RESULTS Uveitis developed in all 12 mice. Clinical uveitis score was significantly reduced (p=0.035) in treated eyes (median 2.0, range 0-4.0, n=12) compared to the fellow control eyes (median 3.0, range 1.0-4.0, n=12). Angiography scores were reduced in 9/12 treated eyes and histological scores in 3/4 treated eyes compared to the fellow control eyes. Cytokine levels were determined in 8 mice, of which 4 responded to anti-IL-6 treatment and 4 did not respond. All mice responding to treatment had a significant reduction of IL-6 (p<0.01) and IL-17 (p=0.01) levels in treated eyes compared to the fellow control eyes. This difference was not seen in non-responding mice. CONCLUSIONS Intravitreal anti-IL-6 treatment significantly attenuates experimental autoimmune uveitis in mice. EAU activity correlates with ocular IL-6 and IL-17 levels.
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Affiliation(s)
- Jan Tode
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany.
| | - Elisabeth Richert
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Stefan Koinzer
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Alexa Klettner
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Ute Pickhinke
- Christian-Albrechts-University of Kiel, Institute of Biochemistry, Kiel, Germany
| | - Christoph Garbers
- Christian-Albrechts-University of Kiel, Institute of Biochemistry, Kiel, Germany
| | - Stefan Rose-John
- Christian-Albrechts-University of Kiel, Institute of Biochemistry, Kiel, Germany
| | - Bernhard Nölle
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Johann Roider
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
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Efficacy of systemic diclofenac sodium on intravitreal concentration. Int Ophthalmol 2017; 38:99-104. [PMID: 28074420 DOI: 10.1007/s10792-016-0428-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 12/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs), as an alternative, are replacing corticosteroids in ocular inflammatory diseases. Diclofenac has been used mainly topically, and recent focus has been on intravitreal delivery. Both of these methods have been shown to have complications in long-term application. PURPOSE To assess the efficacy of slow release oral diclofenac sodium on intravitreal concentration in experimental model of chemically injured eyes. METHODS In an experimental double-masked clinical trial, right eyes of 24 albino rabbits were chemically injured by 1 N NaOH. One hour after chemical injury, 10 cc suspension gavage containing 100 mg slow release diclofenac sodium was administered in all cases. 2, 4, 6, 12, 24, 48 h after gavage, vitreous samples were obtained in all cases. Intravitreal concentration of diclofenac sodium was evaluated in all samples using high-performance liquid chromatography (HPLC) method. RESULTS Intravitreal diclofenac levels by oral intake were enhanced by the inflammation in all the measurements. In inflamed eyes, diclofenac concentration was ten times more than control eye (2.658 ± 0.344 vs. 0.242 ± 0.0279 and 1.617 ± 0.527 vs. 0.148 ± 0.095; in 2 and 4 h, respectively). After 6 h, diclofenac concentration was statistically different, although it reduced below 1 μg/ml. CONCLUSION Diclofenac is delivered to the inflamed eye more than healthy eye. It seems that by oral diclofenac consumption, it is possible to make a significant intravitreal concentration.
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Abstract
Non-infectious uveitis mainly affects the working-age population and can contribute to significant social and economic burden. It comprises a heterogeneous group of conditions with varied aetiology. Precise and early diagnosis, excluding masquerade syndromes, is the key to early therapeutic intervention. Treatment should be appropriately selected according to the anatomical sites of inflammation, the diagnosis and known prognosis, and whether there is a systemic inflammatory drive. Corticosteroids in the form of local or systemic therapy form the mainstay of treatment; however, due to unacceptable side effects, the need for long-term use or suboptimal response, corticosteroid-sparing medications may need to be considered early on in the management of non-infectious uveitis. With newer insights into the immunopathology of uveitis and the availability of biologic agents, treatment can be tailored according to individual needs. Many patients have systemic involvement, and hence a multidisciplinary approach is often required to achieve the best outcome in an individual. Patient involvement in the management of non-infectious uveitis, ensuring compliance, and continual monitoring of both the treatment and therapeutic response are the key to achieving optimal outcomes.
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Manage non-infectious uveitis in adults with individualized immunosuppressive therapy and regular monitoring. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ao J, Goldblatt F, Casson RJ. Review of the ophthalmic manifestations of gout and uric acid crystal deposition. Clin Exp Ophthalmol 2016; 45:73-80. [DOI: 10.1111/ceo.12749] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/03/2016] [Accepted: 03/18/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Jack Ao
- South Australian Institute of Ophthalmology; University of Adelaide; Adelaide South Australia Australia
| | - Fiona Goldblatt
- Department of Rheumatology; The Repatriation General Hospital; Adelaide South Australia Australia
- Flinders Medical Centre; Adelaide South Australia Australia
| | - Robert J Casson
- South Australian Institute of Ophthalmology; University of Adelaide; Adelaide South Australia Australia
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Therapie der posterioren, nichtinfektiösen Uveitis. Ophthalmologe 2016; 113:380-90. [DOI: 10.1007/s00347-016-0267-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kheir V, Vaudaux J, Guex-Crosier Y. Review of the latest systemic treatments for chronic non-infectious uveitis. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1586/17469899.2016.1153425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Hou S, Ye Z, Liao D, Bai L, Liu Y, Zhang J, Kijlstra A, Yang P. miR-23a, miR-146a and miR-301a confer predisposition to Vogt-Koyanagi-Harada syndrome but not to Behcet's disease. Sci Rep 2016; 6:20057. [PMID: 26818976 PMCID: PMC4730241 DOI: 10.1038/srep20057] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/09/2015] [Indexed: 12/12/2022] Open
Abstract
Ninety-eight miRNAs are involved in the immune response. However, the genetic roles of these miRNAs remain unclear in Behcet's disease (BD) and Vogt-Koyanagi-Harada (VKH) syndrome. This study aimed to explore the association and functional roles of copy number variants (CNV) in several miRNAs with BD and VKH syndrome. Genotyping of CNVs was examined by TaqMan PCR. The expression of miR-23a, transfection efficiency and cytokine production were measured by real-time PCR, flow cytometry or ELISA. First, replication and combined studies for miR-23a, miR-146a and miR-301a demonstrated a similar association with VKH syndrome (Combined: P = 5.53 × 10(-8); P = 8.43 × 10(-31); P = 9.23 × 10(-8), respectively). No association of CNVs of the above mentioned miRNAs was observed in BD patients. mRNA expression of miR-23a showed a positive association with its copy numbers. Additionally, individuals with high copy number of miR-23a show an increased production of interleukin-6 (IL-6), but not IL-8 and monocyte chemoattractant protein-1 (MCP-1) by stimulated PBMCs. miR-23a transfected ARPE-19 cells modulated the production of IL-6 and IL-8, but not MCP-1. Our results suggest that CNVs of miR-146a, miR-23a and miR-301a confer susceptibility to VKH syndrome, but not to BD. The contribution of miR-23a to VKH syndrome may be mediated by increasing the production of IL-6.
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Affiliation(s)
- Shengping Hou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Eye Institute and Chongqing Key Laboratory of Ophthalmology, Chongqing, China
| | - Zi Ye
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Eye Institute and Chongqing Key Laboratory of Ophthalmology, Chongqing, China
| | - Dan Liao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Eye Institute and Chongqing Key Laboratory of Ophthalmology, Chongqing, China
| | - Lin Bai
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Eye Institute and Chongqing Key Laboratory of Ophthalmology, Chongqing, China
| | - Yunjia Liu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Eye Institute and Chongqing Key Laboratory of Ophthalmology, Chongqing, China
| | - Jun Zhang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Eye Institute and Chongqing Key Laboratory of Ophthalmology, Chongqing, China
| | - Aize Kijlstra
- University Eye Clinic Maastricht, Maastricht, The Netherlands
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Eye Institute and Chongqing Key Laboratory of Ophthalmology, Chongqing, China
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Foster CS, Kothari S, Anesi SD, Vitale AT, Chu D, Metzinger JL, Cerón O. The Ocular Immunology and Uveitis Foundation preferred practice patterns of uveitis management. Surv Ophthalmol 2016; 61:1-17. [DOI: 10.1016/j.survophthal.2015.07.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 06/25/2015] [Accepted: 07/02/2015] [Indexed: 12/17/2022]
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Salazar-Méndez R, Yilmaz T, Cordero-Coma M. Moving forward in uveitis therapy: preclinical to phase II clinical trial drug development. Expert Opin Investig Drugs 2015; 25:195-214. [DOI: 10.1517/13543784.2016.1128893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Intérêt de l’ustékinumab pour le traitement des uvéites antérieures chez une patiente avec un rhumatisme psoriasique. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Keane PA, Balaskas K, Sim DA, Aman K, Denniston AK, Aslam T, And For The Equator Study Group. Automated Analysis of Vitreous Inflammation Using Spectral-Domain Optical Coherence Tomography. Transl Vis Sci Technol 2015; 4:4. [PMID: 26396930 DOI: 10.1167/tvst.4.5.4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/27/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To develop an automated method for quantifying vitreous signal intensity on optical coherence tomography (OCT), with particular application for use in the assessment of vitreous inflammation. METHODS This retrospective, observational case-control series comprised 30 patients (30 eyes), with vitreous haze secondary to intermediate, posterior, or panuveitis; 12 patients (12 eyes) with uveitis without evidence of vitreous haze; and 18 patients (18 eyes) without intraocular inflammation or vitreoretinal disease. The presence and severity of vitreous haze was classified according to the National Eye Institute system; other inflammatory indices and clinical parameters were also documented. Spectral-domain OCT images were analyzed using custom VITreous ANalysis software (termed 'VITAN'), which is fully automated and avoids the need for manual segmentation. RESULTS VITAN performed accurate segmentation in all scans. Automated measurements of the vitreous:retinal pigment epithelium (RPE) signal ratio showed a moderate correlation with clinical vitreous haze scores (r = 0.585, P < 0.001), comparable to that reported using manual segmentation in our previous study (r = 0.566, P = 0.0001). The novel parameter of vitreous:RPE textural ratio showed a marginally stronger correlation (r = 0.604, P < 0.001) with clinical vitreous haze scores than the Vitreous:RPE signal ratio. CONCLUSIONS The custom OCT image analysis software (VITAN) allows rapid and automated measurement of vitreous parameters, that is comparable to our previously reported vitreous:RPE index, and correlates with clinically measured disease activity. Such OCT-based indices may provide the much needed objective markers of vitreous activity, which may be used in both clinical assessment, and as outcome measures in clinical trials for intermediate, posterior, and panuveitis. TRANSLATIONAL RELEVANCE We describe a rapid automated method for quantifying vitreous signal intensity on optical coherence tomography (OCT) and show that this correlates with clinical assessment of vitreous inflammation. Such OCT-based indices may provide the much needed objective markers of vitreous activity, which may be used both in routine clinical assessment, and as outcome measures in clinical trials for intermediate, posterior, and panuveitis.
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Affiliation(s)
- Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Konstantinos Balaskas
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Dawn A Sim
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Kiran Aman
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Alastair K Denniston
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ; Centre for Translational Inflammation Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK ; Birmingham & Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Tariq Aslam
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK ; Faculty of Medical and Human Sciences, University of Manchester, UK ; School of Built Environment, Herriot-Watt University, UK
| | - And For The Equator Study Group
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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