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Kitahata S, Inoue T, Tanaka S, Chin JYH, Shinoda S, Maruyama-Inoue M, Kadonosono K. Temporal Changes in the Retinal Pigment Epithelium-Bruch's Membrane Complex Thickness After Autologous Retinal Transplantation in Myopic Eyes. Invest Ophthalmol Vis Sci 2024; 65:25. [PMID: 39417750 DOI: 10.1167/iovs.65.12.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2024] Open
Abstract
Purpose To investigate the association between the thickness of the retinal pigment epithelium (RPE)-Bruch's membrane (BM) complex and the development of retinal autograft edema as a postoperative complication following autologous retinal transplantation (ART). Methods This retrospective study examined data from 28 eyes of 28 patients (14 males, 14 females; mean age, 61.5 ± 19.8 years) who underwent ART and were followed for 1 year. The RPE-BM complex thickness was measured 2000 µm from the fovea using Image J software. Additionally, the graft blood flow was also evaluated by optical coherence tomography angiography and fluorescein angiography. Results Macular hole (MH) diameters ranged from 711.2 ± 251.9 µm to 1299.9 ± 333.0 µm, with MH closure achieved in all patients. RPE-BM complex thickness decreased by 4.17 µm at 6 months and 4.34 µm at 1 year, showing significant differences from preoperative measurements (29.88 ± 4.99 µm; 6 months: 95% confidence interval [CI], 1.62-6.71, P = 0.0018; 1 year: 95% CI, 2.03-6.65 µm, P = 0.00044). The decrease was significantly greater in the edema-positive group (95% CI, -8.33 to -0.82, P = 0.020). Furthermore, the rates of ellipsoid zone (EZ) recovery, alignment of neurosensory layers (ANL), and graft reperfusion were lower in the edema-positive group (EZ, P = 0.017; ANL, P = 0.0098; reperfusion, P = 0.039). Conclusions After ART, RPE-BM complex thickness decreases, particularly in cases with postoperative edema, suggesting a potential relationship between RPE function and postoperative outcomes, highlighting the importance of monitoring RPE-BM complex thickness after surgery.
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Affiliation(s)
- Shohei Kitahata
- Department of Ophthalmology and Micro-technology, Yokohama City University, Minami-ku, Yokohama, Japan
| | - Tatsuya Inoue
- Department of Ophthalmology and Micro-technology, Yokohama City University, Minami-ku, Yokohama, Japan
| | - Shin Tanaka
- Department of Ophthalmology and Micro-technology, Yokohama City University, Minami-ku, Yokohama, Japan
| | - Jacob Y H Chin
- Department of Ophthalmology and Micro-technology, Yokohama City University, Minami-ku, Yokohama, Japan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Satoru Shinoda
- Department of Biostatistics, School of Medicine, Yokohama City University, Kanazawa-ku, Yokohama, Japan
| | - Maiko Maruyama-Inoue
- Department of Ophthalmology and Micro-technology, Yokohama City University, Minami-ku, Yokohama, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology and Micro-technology, Yokohama City University, Minami-ku, Yokohama, Japan
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Lee SJ, Noh SE, Jo DH, Cho CS, Park KS, Kim JH. IL-10-induced modulation of macrophage polarization suppresses outer-blood-retinal barrier disruption in the streptozotocin-induced early diabetic retinopathy mouse model. FASEB J 2024; 38:e23638. [PMID: 38713098 DOI: 10.1096/fj.202400053r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/26/2024] [Accepted: 04/18/2024] [Indexed: 05/08/2024]
Abstract
Diabetic retinopathy (DR) is associated with ocular inflammation leading to retinal barrier breakdown, vascular leakage, macular edema, and vision loss. DR is not only a microvascular disease but also involves retinal neurodegeneration, demonstrating that pathological changes associated with neuroinflammation precede microvascular injury in early DR. Macrophage activation plays a central role in neuroinflammation. During DR, the inflammatory response depends on the polarization of retinal macrophages, triggering pro-inflammatory (M1) or anti-inflammatory (M2) activity. This study aimed to determine the role of macrophages in vascular leakage through the tight junction complexes of retinal pigment epithelium, which is the outer blood-retinal barrier (BRB). Furthermore, we aimed to assess whether interleukin-10 (IL-10), a representative M2-inducer, can decrease inflammatory macrophages and alleviate outer-BRB disruption. We found that modulation of macrophage polarization affects the structural and functional integrity of ARPE-19 cells in a co-culture system under high-glucose conditions. Furthermore, we demonstrated that intravitreal IL-10 injection induces an increase in the ratio of anti-inflammatory macrophages and effectively suppresses outer-BRB disruption and vascular leakage in a mouse model of early-stage streptozotocin-induced diabetes. Our results suggest that modulation of macrophage polarization by IL-10 administration during early-stage DR has a promising protective effect against outer-BRB disruption and vascular leakage. This finding provides valuable insights for early intervention in DR.
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Affiliation(s)
- Seok Jae Lee
- Fight against Angiogenesis-Related Blindness (FARB) Laboratory, Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Global Excellence Center for Gene & Cell Therapy (GEC-GCT), Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung-Eun Noh
- Fight against Angiogenesis-Related Blindness (FARB) Laboratory, Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Global Excellence Center for Gene & Cell Therapy (GEC-GCT), Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Hyun Jo
- Global Excellence Center for Gene & Cell Therapy (GEC-GCT), Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Sik Cho
- Fight against Angiogenesis-Related Blindness (FARB) Laboratory, Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Global Excellence Center for Gene & Cell Therapy (GEC-GCT), Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyu-Sang Park
- Department of Physiology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jeong Hun Kim
- Fight against Angiogenesis-Related Blindness (FARB) Laboratory, Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Global Excellence Center for Gene & Cell Therapy (GEC-GCT), Seoul National University Hospital, Seoul, Republic of Korea
- Department of Biomedical Sciences & Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Reproductive Medicine and Population, Seoul National University College of Medicine, Seoul, Republic of Korea
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Mei JH, Lin Z. Subthreshold micropulse diode laser treatment in diabetic macular edema: biological impact, therapeutic effects, and safety. Int Ophthalmol 2024; 44:3. [PMID: 38315299 DOI: 10.1007/s10792-024-02973-6] [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: 03/25/2023] [Accepted: 12/04/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE To introduce the treatment of diabetic macular edema (DME) with subthreshold micropulse diode laser (SMPL), to summarize the biological impact, therapeutic effects, and safety of this treatment, and to discuss the response to DME when SMPL is combined with anti-vascular endothelial growth factor (anti-VEGF) or steroid. METHODS The literature search was performed on the PubMed database, with a selection of English-language articles published from 2000 to 2023 with the following combinations of search terms: diabetes macular (o) edema, micropulse laser or subthreshold micropulse laser, anti-vascular endothelial growth factor, and steroid. RESULTS SMPL is a popular, invisible retinal laser phototherapy that is inexpensive, safe, and effective in the treatment of DME. It can selectively target the retinal pigment epithelium, reduce the expression of pro-inflammatory factors, promote the absorption of macular edema, and exert a similar and lasting clinical effect to traditional lasers. No significant difference was found in the therapeutic effects of SMPL between different wavelengths. However, HbA1c level and pretreatment central macular thickness (CMT) may affect the therapeutic outcomes of SMPL. CONCLUSION SMPL has a slow onset and produces lasting clinical effects similar to conventional photocoagulation. It has been reported that SMPL combined with the intravitreal anti-VEGF injection can significantly reduce the number of injections without influencing the therapeutic effect, which is essential for clinical applications and research. Although 577 nm SMPL is widely used clinically, there are no standardized protocols for SMPL. Additionally, some important problems regarding the treatment of SMPL require further discussion and exploration.
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Affiliation(s)
- Jing Hao Mei
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No. 207, Xueyuan West Road, Wenzhou, 325027, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, No. 207, Xueyuan West Road, Wenzhou, 325027, Zhejiang, China
| | - Zhong Lin
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, No. 207, Xueyuan West Road, Wenzhou, 325027, Zhejiang, China.
- National Clinical Research Center for Ocular Diseases, No. 207, Xueyuan West Road, Wenzhou, 325027, Zhejiang, China.
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Gao Y, Tuokedaerhan Z, Zhang J, Yang L, Zhang Y, Cheng W, Zhao Y, Wang J. Comparative study of the vascular structures of the retina and choroid in Chinese Han and Uygur populations with proliferative diabetic retinopathy: An OCTA study. Photodiagnosis Photodyn Ther 2024; 45:103995. [PMID: 38286214 DOI: 10.1016/j.pdpdt.2024.103995] [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: 12/19/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND To compare the vascular structures of the retina and choroid in Chinese Han and Uygur populations with proliferative diabetic retinopathy (PDR) using swept-source OCTA (SS-OCTA). METHODS Fifty-three eyes of 53 healthy volunteers (25 from Hans and 28 from Uygurs) and 40 eyes of 40 PDR patients (20 from Hans and 20 from Uygurs) were included. Retinal and choroidal parameters, including thickness, vessel flow density (VFD), foveal avascular zone (FAZ) area, choroidal vascularity volume and index (CVV and CVI) were evaluated. RESULTS Compared with the respective controls, superficial capillary plexus (SCP)-VFD and deep capillary plexus (DCP)-VFD, the areas of FAZ in SCP and DCP were significantly decreased in both Han and Uygur PDR patients. choroidal parameters analysis found that Uygur controls had substantially higher choroidal thickness (CT) than Han controls (p = 0.020) and PDR eyes showed significantly decreased CT. Both races with PDR exhibited significantly reduced choriocapillaris layer-VFD, large and medium choroidal vessel (LMCV) layer-VFD, CVV and CVI, however, Uygur PDR patients had significant lower LMCV layer-VFD, CVV and CVI compared to Han PDR patients. Diabetes duration was the most significant factor affecting CVV and CVI. CONCLUSION Both Han and Uygur PDR patients had significantly lower CT and decreased vessel densities compared to controls, but the Uygur PDR patients had more severe choroidal damage than Han PDR patients, which is most likely related to worse visual prognosis. These findings indicate that more frequent screenings and prompt therapy are urgent for Uygur PDR patients.
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Affiliation(s)
- Yunxian Gao
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyhur Autonomous Region, Urumqi, China
| | - Zhumahan Tuokedaerhan
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyhur Autonomous Region, Urumqi, China
| | - Jie Zhang
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyhur Autonomous Region, Urumqi, China
| | - Lei Yang
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyhur Autonomous Region, Urumqi, China
| | - Yani Zhang
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyhur Autonomous Region, Urumqi, China
| | - Wanying Cheng
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyhur Autonomous Region, Urumqi, China
| | - Yong Zhao
- Department of Ophthalmology, Traditional Chinese Medicine Hospital of Xinjiang Uyhur Autonomous Region, Urumqi, China.
| | - Jiawei Wang
- Department of Ophthalmology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Wright DM, Chakravarthy U, Das R, Graham KW, Naskas TT, Perais J, Kee F, Peto T, Hogg RE. Identifying the severity of diabetic retinopathy by visual function measures using both traditional statistical methods and interpretable machine learning: a cross-sectional study. Diabetologia 2023; 66:2250-2260. [PMID: 37725107 PMCID: PMC10627908 DOI: 10.1007/s00125-023-06005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/14/2023] [Indexed: 09/21/2023]
Abstract
AIMS/HYPOTHESIS To determine the extent to which diabetic retinopathy severity stage may be classified using machine learning (ML) and commonly used clinical measures of visual function together with age and sex. METHODS We measured the visual function of 1901 eyes from 1032 participants in the Northern Ireland Sensory Ageing Study, deriving 12 variables from nine visual function tests. Missing values were imputed using chained equations. Participants were divided into four groups using clinical measures and grading of ophthalmic images: no diabetes mellitus (no DM), diabetes but no diabetic retinopathy (DM no DR), diabetic retinopathy without diabetic macular oedema (DR no DMO) and diabetic retinopathy with DMO (DR with DMO). Ensemble ML models were fitted to classify group membership for three tasks, distinguishing (A) the DM no DR group from the no DM group; (B) the DR no DMO group from the DM no DR group; and (C) the DR with DMO group from the DR no DMO group. More conventional multiple logistic regression models were also fitted for comparison. An interpretable ML technique was used to rank the contribution of visual function variables to predictions and to disentangle associations between diabetic eye disease and visual function from artefacts of the data collection process. RESULTS The performance of the ensemble ML models was good across all three classification tasks, with accuracies of 0.92, 1.00 and 0.84, respectively, for tasks A-C, substantially exceeding the accuracies for logistic regression (0.84, 0.61 and 0.80, respectively). Reading index was highly ranked for tasks A and B, whereas near visual acuity and Moorfields chart acuity were important for task C. Microperimetry variables ranked highly for all three tasks, but this was partly due to a data artefact (a large proportion of missing values). CONCLUSIONS/INTERPRETATION Ensemble ML models predicted status of diabetic eye disease with high accuracy using just age, sex and measures of visual function. Interpretable ML methods enabled us to identify profiles of visual function associated with different stages of diabetic eye disease, and to disentangle associations from artefacts of the data collection process. Together, these two techniques have great potential for developing prediction models using untidy real-world clinical data.
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Affiliation(s)
- David M Wright
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
| | | | - Radha Das
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Katie W Graham
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Timos T Naskas
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Jennifer Perais
- Wellcome Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ruth E Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Wirkkala J, Kubin AM, Ohtonen P, Falck A, Hautala N. Outcomes of 35-year duration of type 1 diabetes and proliferative diabetic retinopathy on functional vision and quality of life: Benefits of good glycemic control. J Diabetes Complications 2023; 37:108408. [PMID: 36708699 DOI: 10.1016/j.jdiacomp.2023.108408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
AIMS To evaluate clinical outcomes, functional vision and quality of life (QoL) after 35-year duration of type 1 diabetes (T1D) and proliferative diabetic retinopathy (PDR). METHODS A population-based cohort study of T1D. Data from laboratory tests, ophthalmic examinations, multifunctional vision-test, and 15D-QoL measurements were analysed. RESULTS 35 % of the original cohort (n = 216) had PDR, and 48 % of them were re-evaluated. They were 41 ± 3 [34-46] years old and 62 % were males. The duration of T1D was 35 ± 4 [29-41] years. 76 % had transdermal glucose monitoring. HbA1c had decreased from 80.1 mmol/mol to 63.6 mmol/mol (p < 0.001). Visual acuity was 73-77 ETDRS-letters. Two patients had visual impairment. Visual field sensitivities were lower in PDR vs. healthy controls (23.2 ± 3.9 dB vs. 26.9 ± 1.0 dB, and 14.9 ± 5.6 dB vs. 21.0 ± 2.0 dB, respectively, p < 0.001). Contrast sensitivity was similar, but the reaction time was longer in the PDR group (490.5 ms vs. 462.8 ms, p = 0.004). QoL-parameters concerning sleeping, usual activities, discomfort and symptoms, and sexual activity had decreased, but improved for mobility and distress. CONCLUSIONS Long-term visual prognosis and QoL remained good despite the declined functional vision caused by PDR.
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Affiliation(s)
- Joonas Wirkkala
- Department of Ophthalmology, Research Unit of Clinical Medicine and Medical Research Centre, University of Oulu, Finland; Oulu University Hospital, Oulu, Finland
| | - Anna-Maria Kubin
- Department of Ophthalmology, Research Unit of Clinical Medicine and Medical Research Centre, University of Oulu, Finland; Oulu University Hospital, Oulu, Finland
| | - Pasi Ohtonen
- Research Service Unit, Oulu, Finland; The Research Unit of Surgery, Anaesthesia and Intensive Care, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Aura Falck
- Department of Ophthalmology, Research Unit of Clinical Medicine and Medical Research Centre, University of Oulu, Finland; Oulu University Hospital, Oulu, Finland
| | - Nina Hautala
- Department of Ophthalmology, Research Unit of Clinical Medicine and Medical Research Centre, University of Oulu, Finland; Oulu University Hospital, Oulu, Finland.
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Tang P, Chen C, Huang X. miR-29b Modulates Bone Marrow Mesenchymal Stem Cells (BMSCs) Differentiation and Induces Nerve Repair in Diabetic Retina Rat Model. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.3116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
microRNAs are involved in diabetic retinopathy (DR). This study intends to analyze miR-29b’s role in bone marrow mesenchymal stem cells (BMSCs) differentiation in DR rat models to induce nerve repair. BMSCs from DR rat models were cultured and transfected with miR-29b mimics and
inhibitors followed by measuring miR-29b level, cell proliferation and apoptosis. Retinal ganglion cells (RGC) were treated with high glucose for 24 h, and BMSCs and si-miR-29b-BMSC were cocultured for 24 h, respectively followed by assessing cell proliferation and apoptosis, inflammatory
cytokines by ELISA, MDA, SOD, brain-derived neurotrophic factor (BDNF) and ciliary neurotrophic factor (CNTF) level by ELISA. MiR-29b was up-regulated in BMSCs of DR rats. miR-29b mimics significantly up-regulated miR-29b, inhibited cell proliferation and promoted apoptosis (P <
0.05), which were reversed by miR-29b inhibitor (P < 0.05). Co-culture of BMSCs with si-miR-29b-BMSC promoted RGC proliferation, inhibited apoptosis and IL-6 secretion, decreased MDA, increased SOD, BDNF and CNTF expression (P < 0.05) with more significant changes in si-miR-29b-BMSC
group (P < 0.05). In conclusion, down-regulation of miR-29b promotes BMSCs proliferation in DR rat models, inhibits BMSCs apoptosis, and promotes the recovery of retinal ganglion cell function.
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Affiliation(s)
- Ping Tang
- Department of Ophthalmology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, 570102, China
| | - Chunmei Chen
- Department of Ophthalmology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, 570102, China
| | - Xionggao Huang
- Department of Ophthalmology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, 570102, China
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Yin J, Chen X. Edaravone prevents high glucose-induced injury in retinal Müller cells through thioredoxin1 and the PGC-1α/NRF1/TFAM pathway. PHARMACEUTICAL BIOLOGY 2021; 59:1233-1244. [PMID: 34506218 PMCID: PMC8439237 DOI: 10.1080/13880209.2021.1972123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/10/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Oxidative injury in a high-glucose (HG) environment may be a mechanism of diabetic retinopathy (DR) and edaravone can protect retinal ganglion cells by scavenging ROS. OBJECTIVE To explore the effect of edaravone on HG-induced injury. MATERIALS AND METHODS First, Müller cells were cultured by different concentrations of glucose for different durations to obtain a suitable culture concentrations and duration. Müller cells were then divided into Control, HG + Vehicle, HG + Eda-5 μM, HG + Eda-10 μM, HG + Eda-20 μM, and HG + Eda-40 μM groups. Cells were cultured by 20 mM glucose and different concentrations of edaravone for 72 h. RESULTS The IC50 of glucose at 12-72 h is 489.3, 103.5, 27.92 and 20.71 mM, respectively. When Müller cells were cultured in 20 mM glucose for 72 h, the cell viability was 52.3%. Edaravone significantly increased cell viability compared to Vehicle (68.4% vs 53.3%; 78.6% vs 53.3%). The EC50 of edaravone is 34.38 μM. HG induced high apoptosis rate (25.5%), while edaravone (20 and 40 μM) reduced it to 12.5% and 6.89%. HG increased the DCF fluorescence signal (189% of Control) and decreased the mitochondrial membrane potential by 57%. Edaravone significantly decreased the DCF fluorescence signal (144% and 132% of Control) and recovered the mitochondrial membrane potential to 68% and 89% of Control. Furthermore, HG decreased the expression of TRX1, PGC-1α, NRF1 and TFAM, which were restored by edaravone. DISCUSSION AND CONCLUSION These findings provide a new potential approach for the treatment of DR and indicated new molecular targets in the prevention of DR.
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Affiliation(s)
- Juanping Yin
- Department of Ophthalmology, The Fourth Hospital of Changsha, Changsha Hospital of Hunan Normal University, Changsha, China
| | - Xinke Chen
- Department of Ophthalmology, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Işık MU, Değirmenci MFK, Sağlık A. Factors affecting the response to subthreshold micropulse laser therapy used in center-involved diabetic macular edema. Lasers Med Sci 2021; 37:1865-1871. [PMID: 34657215 DOI: 10.1007/s10103-021-03441-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to investigate the effect of the status of retinal pigment epithelium (RPE) and HbA1c levels on the efficacy of the subthreshold micropulse laser (SMPL) in the treatment of center-involving diabetic macular edema (DME). A total of 20 eyes of 20 patients (mean age 57.9 ± 9.7 years) who were diagnosed with center-involving DME and treated with SMPL for refusing intravitreal injection and 20 eyes of 20 age- and sex-matched healthy participants were enrolled. All patients were followed up in the 1st and 3rd months after SMPL. For measurement of RPE area central 1000 microns, macular EDI-OCT scans were binarized by using the public domain software ImageJ, with a semi-automated technique. There was a significant increase in BCVA values and a significant decrease in CMT values during follow-up. The area of RPE before SMPL was significantly thinner in the patient group (p: 0.004). When the areas of RPE before and 3 months after SMPL were compared, no significant change was observed (p: 0.437). When the relationship between pre-treatment area of RPE and HbA1c was examined, an inverse correlation was observed (p: 0.018). The patients were evaluated by dividing them into 2 groups as 2nd session SMPL required and not required, and the area of RPE was smaller in the group requiring 2nd session SMPL (p: 0.030). The status of central RPE may be a determining factor on the response to treatment. Additionally, HbA1c levels may have an impact on treatment efficacy.
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Affiliation(s)
- Mehmed Uğur Işık
- Retina Department, Department of Ophthalmology, Kastamonu University Faculty of Medicine, 37100, Kastamonu, Turkey.
| | | | - Ayhan Sağlık
- Cornea Department, Department of Ophthalmology, Harran University Faculty of Medicine, Şanlıurfa, Turkey
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10
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Tonade D, Kern TS. Photoreceptor cells and RPE contribute to the development of diabetic retinopathy. Prog Retin Eye Res 2021; 83:100919. [PMID: 33188897 PMCID: PMC8113320 DOI: 10.1016/j.preteyeres.2020.100919] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/27/2020] [Accepted: 10/31/2020] [Indexed: 12/26/2022]
Abstract
Diabetic retinopathy (DR) is a leading cause of blindness. It has long been regarded as vascular disease, but work in the past years has shown abnormalities also in the neural retina. Unfortunately, research on the vascular and neural abnormalities have remained largely separate, instead of being integrated into a comprehensive view of DR that includes both the neural and vascular components. Recent evidence suggests that the most predominant neural cell in the retina (photoreceptors) and the adjacent retinal pigment epithelium (RPE) play an important role in the development of vascular lesions characteristic of DR. This review summarizes evidence that the outer retina is altered in diabetes, and that photoreceptors and RPE contribute to retinal vascular alterations in the early stages of the retinopathy. The possible molecular mechanisms by which cells of the outer retina might contribute to retinal vascular damage in diabetes also are discussed. Diabetes-induced alterations in the outer retina represent a novel therapeutic target to inhibit DR.
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Affiliation(s)
- Deoye Tonade
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH, USA
| | - Timothy S Kern
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH, USA; Veterans Administration Medical Center Research Service, Cleveland, OH, USA; Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, USA; Veterans Administration Medical Center Research Service, Long Beach, CA, USA.
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11
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Ţălu Ş, Nicoara SD. Malfunction of outer retinal barrier and choroid in the occurrence and progression of diabetic macular edema. World J Diabetes 2021; 12:437-452. [PMID: 33889289 PMCID: PMC8040083 DOI: 10.4239/wjd.v12.i4.437] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/23/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetic macular edema (DME) is the most common cause of vision loss in diabetic retinopathy, affecting 1 in 15 patients with diabetes mellitus (DM). The disruption of the inner blood-retina barrier (BRB) has been largely investigated and attributed the primary role in the pathogenesis and progression in DME, but there is increasing evidence regarding the role of outer BRB, separating the RPE from the underlying choriocapillaris, in the occurrence and evolution of DME. The development of novel imaging technologies has led to major improvement in the field of in vivo structural analysis of the macula allowing us to delve deeper into the pathogenesis of DME and expanding our vision regarding this condition. In this review we gathered the results of studies that investigated specific outer BRB optical coherence tomography parameters in patients with DM with the aim to outline the current status of its role in the pathogenesis and progression of DME and identify new research pathways contributing to the advancement of knowledge in the understanding of this condition.
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Affiliation(s)
- Ştefan Ţălu
- Directorate of Research, Development and Innovation Management (DMCDI), Technical University of Cluj-Napoca, Cluj-Napoca 400020, Romania
| | - Simona Delia Nicoara
- Department of Ophthalmology, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca 400012, Romania
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12
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Fickweiler W, Wolfson EA, Paniagua SM, Yu MG, Adam A, Bahnam V, Sampani K, Wu IH, Musen G, Aiello LP, Shah H, Sun JK, King GL. Association of Cognitive Function and Retinal Neural and Vascular Structure in Type 1 Diabetes. J Clin Endocrinol Metab 2021; 106:1139-1149. [PMID: 33378459 PMCID: PMC7993575 DOI: 10.1210/clinem/dgaa921] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Cognitive dysfunction is a growing and understudied public health issue in the aging type 1 diabetic population and is difficult and time-consuming to diagnose. Studies in long duration type 1 diabetes have reported the presence of proliferative diabetic retinopathy was associated with cognitive dysfunction. OBJECTIVE This study assessed whether structural and vascular abnormalities of the retina, representing an extension of the central nervous system, are associated with cognitive impairment and other complications of type 1 diabetes. METHODS An observational cross-sectional study of individuals with 50 or more years of type 1 diabetes (Joslin Medalist Study) was conducted at a university hospital in the United States. The study included 129 participants with complete cognitive testing. Validated cognitive testing measures included psychomotor speed, and immediate, and delayed memory. Optical coherence tomography (OCT) and OCT angiography (OCTA) were performed to obtain neural retinal layer thicknesses and vascular density for superficial (SCP) and deep retinal capillary plexus (DCP). Multivariable modeling was adjusted for potential confounders associated with outcomes in unadjusted analyses. RESULTS Decreased vessel density of the SCP and DCP was associated with worse delayed memory (DCP: P = .002) and dominant hand psychomotor speed (SCP: P = .01). Thinning of the retinal outer nuclear layer was associated with worse psychomotor speed both in nondominant and dominant hands (P = .01 and P = .05, respectively). Outer plexiform layer thickness was associated with delayed memory (P = .04). CONCLUSION These findings suggest that noninvasive retinal imaging using OCT and OCTA may assist in estimating the risks for cognitive dysfunction in people with type 1 diabetes.
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Affiliation(s)
- Ward Fickweiler
- Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Emily A Wolfson
- Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA
| | | | - Marc Gregory Yu
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Atif Adam
- Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Vanessa Bahnam
- Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Konstantina Sampani
- Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - I-Hsien Wu
- Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Gail Musen
- Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Lloyd P Aiello
- Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Hetal Shah
- Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer K Sun
- Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - George L King
- Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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13
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Wang H, Zhang M, Zhou H, Cao L, Zhou J, Chen Q, Zhang X. Salusin-β Mediates High Glucose-Induced Inflammation and Apoptosis in Retinal Capillary Endothelial Cells via a ROS-Dependent Pathway in Diabetic Retinopathy. Diabetes Metab Syndr Obes 2021; 14:2291-2308. [PMID: 34054302 PMCID: PMC8153208 DOI: 10.2147/dmso.s301157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/22/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is characterized by retinal vascular endothelial cell death and vascular inflammation, which are microvascular complications of diabetes mellitus (DM). Salusin-β, a newly identified peptide, is closely associated with hypertension, atherosclerosis and diabetic cardiomyopathy. However, the exact role of salusin-β in high glucose (HG)-induced retinal capillary endothelial cell (REC) inflammation and apoptosis remains unclear. PATIENTS AND METHODS A total of 60 patients with type 2 diabetes and 20 healthy controls were included in this study. Based on fundus fluorescein angiography findings, the diabetic patients were divided into three subgroups: diabetes without retinopathy (DWR), non-proliferative DR (NPDR) and proliferative DR (PDR). Serum salusin-β levels were measured by enzyme-linked immunosorbent assay. Human RECs (HRECs) were cultured in normal glucose (NG) and HG medium with or without salusin-β. Salusin-β expression was analysed by Western blotting and immunofluorescence staining. Expression of the pro-inflammatory cytokines MCP-1, IL-1β, TNF-α, and VCAM-1 was analysed by Western blotting. Reactive oxygen species (ROS) production was measured with 2',7'-dichlorofluorescein diacetate (DCFH-DA). Cell apoptosis rates were determined by flow cytometry. The levels of p38, JNK, p-p38, and p-JNK and the apoptosis-related proteins cleaved caspase-3, Bax, and cl2 were analysed by Western blotting. RESULTS Serum salusin-β levels were higher in diabetic patients than in healthy controls (p = 0.0027), especially in patients with NPDR and PDR (both p<0.01). HG upregulated salusin-β expression in HRECs in a time-dependent manner. Salusin-β exacerbated inflammation and apoptosis, upregulated intracellular ROS production in HG-induced HRECs, and activated ROS-dependent JNK and p38 MAPK signalling, while knockdown of salusin-β suppressed these effects. CONCLUSION Our findings indicate that salusin-β can promote inflammation and apoptosis via ROS-dependent JNK and p38 MAPK signalling in HG-induced HRECs and could be a therapeutic target for DR.
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Affiliation(s)
- Hao Wang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Department of Ophthalmology, Fuling Center Hospital of Chongqing City, Chongqing, People’s Republic of China
- Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, People’s Republic of China
| | - Meng Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, People’s Republic of China
| | - Hongli Zhou
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, People’s Republic of China
| | - Lang Cao
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, People’s Republic of China
| | - Jie Zhou
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, People’s Republic of China
| | - Qinyun Chen
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, People’s Republic of China
| | - Xuedong Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, People’s Republic of China
- Correspondence: Xuedong Zhang Department of Ophthalmology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Chongqing, People’s Republic of China Email
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14
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Vergmann AS, Grauslund J. Changes of visual fields in treatment of proliferative diabetic retinopathy: a systematic review. Acta Ophthalmol 2020; 98:763-773. [PMID: 32421255 DOI: 10.1111/aos.14474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 04/24/2020] [Indexed: 01/20/2023]
Abstract
The aim of this systematic review was to compare certain side-effects [visual fields (VF), dark adaptation, colour vision (CV) and contrast sensitivity (CS)] of conventional panretinal photocoagulation (PRP) with those of other treatments in proliferative diabetic retinopathy (PDR). A systematic literature search was conducted on 30 November 2018 in PubMed and Embase. The search comprised the keywords 'proliferative diabetic retinopathy', 'laser', 'treatment' and 'anti-vegf'. We included prospective studies and randomized controlled trials that investigated certain side-effects (VF, dark adaptation, CV, CS) in treatment of PDR (primary outcome). In total, 1867 articles were screened, and 10 studies were included (2176 eyes of 2086 patients examined in the VF studies and 1360 eyes of 1360 patients examined in the CV and CS studies). Visual fields (VF) were investigated in 10 studies, CV in one study and CS in one study. Treatment modalities included conventional PRP, other modalities of laser treatment and vascular endothelial growth factor (VEGF) inhibitors. Four studies demonstrated a worse VF impact of PRP than VEGF inhibitors. Seven studies reported of an overall worsening in VF after laser with no differences between different laser approaches. No differences were found in CV or CS. Overall, we found a trend, confirmed in four large studies, towards VEGF inhibitors causing less harm to VF compared to conventional PRP. Whilst VF was generally depressed after laser, it did not differ between different treatment approaches. Furthermore, it was not possible to make certain conclusions of CV or CS, with only one study in each field.
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Affiliation(s)
- Anna Stage Vergmann
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Research Unit of Ophthalmology Department of Clinical Research Faculty of Health Science University of Southern Denmark Odense Denmark
| | - Jakob Grauslund
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Research Unit of Ophthalmology Department of Clinical Research Faculty of Health Science University of Southern Denmark Odense Denmark
- Steno Diabetes Center Odense Odense Denmark
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15
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Abstract
Based on clinical findings, diabetic retinopathy (DR) has traditionally been defined as a retinal microvasculopathy. Retinal neuronal dysfunction is now recognized as an early event in the diabetic retina before development of overt DR. While detrimental effects of diabetes on the survival and function of inner retinal cells, such as retinal ganglion cells and amacrine cells, are widely recognized, evidence that photoreceptors in the outer retina undergo early alterations in diabetes has emerged more recently. We review data from preclinical and clinical studies demonstrating a conserved reduction of electrophysiological function in diabetic retinas, as well as evidence for photoreceptor loss. Complementing in vivo studies, we discuss the ex vivo electroretinography technique as a useful method to investigate photoreceptor function in isolated retinas from diabetic animal models. Finally, we consider the possibility that early photoreceptor pathology contributes to the progression of DR, and discuss possible mechanisms of photoreceptor damage in the diabetic retina, such as enhanced production of reactive oxygen species and other inflammatory factors whose detrimental effects may be augmented by phototransduction.
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16
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A critical review: Psychophysical assessments of diabetic retinopathy. Surv Ophthalmol 2020; 66:213-230. [PMID: 32866468 DOI: 10.1016/j.survophthal.2020.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 02/08/2023]
Abstract
Diabetic retinal disease remains a leading cause of vision loss despite currently available screening methods, ocular treatments, and efforts to control metabolic dysfunction. It is now understood that diabetes damages the entire retina and the cellular components of the neurovascular unit. Multiple studies have demonstrated impairment of various aspects of retinal function across the spectrum of retinopathy severity. Here we review these tests, the principles underlying their use, clinical data from multiple publications, the strengths and limitations of the studies, and prospects for their application to understand the pathophysiology of diabetic retinal disease and monitor its response to therapy. We focus on visual acuity, contrast sensitivity, color vision, visual field, and dark adaptation and their use to understand the pathophysiology of diabetic retinopathy and as potential endpoints for clinical trials.
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17
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Vergmann AS, Nguyen TT, Lee Torp T, Kawasaki R, Wong TY, Peto T, Grauslund J. Efficacy and Side Effects of Individualized Panretinal Photocoagulation. Ophthalmol Retina 2020; 4:642-644. [PMID: 32278741 DOI: 10.1016/j.oret.2020.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Anna Stage Vergmann
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark; Research Unit of Ophthalmology, Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Denmark; OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Thao Thi Nguyen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Thomas Lee Torp
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark; Research Unit of Ophthalmology, Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Denmark
| | - Ryo Kawasaki
- Research Unit of Ophthalmology, Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Denmark; Department of Vision Informatics, Osaka University School of Medicine, Osaka, Japan
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tunde Peto
- Research Unit of Ophthalmology, Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Denmark; School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark; Research Unit of Ophthalmology, Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Denmark; Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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Ren X, Sun L, Wei L, Liu J, Zhu J, Yu Q, Kong H, Kong L. Liraglutide Up-regulation Thioredoxin Attenuated Müller Cells Apoptosis in High Glucose by Regulating Oxidative Stress and Endoplasmic Reticulum Stress. Curr Eye Res 2020; 45:1283-1291. [PMID: 32180468 DOI: 10.1080/02713683.2020.1737137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose: Diabetic retinopathy (DR) has become one of the most important complications of diabetes which is the leading cause of vision impairment and blindness all over the world. Increasing evidence shows that reactive gliosis are basic pathological features of early DR. The study was aimed to explore the protective effect and mechanism of Liraglutide (LIRA) which has similar properties to Glucagon-like peptide-1 (GLP-1) on Müller cell damage induced by diabetes. Materials and methods: In vitro, the Müller cell was cultured in high glucose (HG) to establish the model of diabetic retinopathy. The apoptosis was detected using flow cytometry. Western blot and immunofluorescence were used to detect the expression of related proteins. DCFH-DA probe was used to detect the ROS generation. Results: The data showed that the apoptosis and the expression of GFAP were increased significantly with HG treatment. However, the apoptosis percentage and the expression of GFAP were decreased after LIRA treatment. Moreover, the expression of p-Erk/Nrf2/Trx-signaling pathway proteins was also up-regulated and the generation of ROS was decreased after LIRA treatment which was inhibited after treatment with U0126 (Erk inhibitor). Besides, endoplasmic reticulum stress (ER stress) related proteins were up-regulated after Trx down-regulation by transfection with sh-RNA. Conclusions: LIRA could protect Müller cells from HG-induced damage via activating p-Erk pathway through increasing Trx expression which attenuated oxidative stress and ER stress. Trx could play a key role in the process.
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Affiliation(s)
- Xiang Ren
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University , Dalian, China
| | - Lingmin Sun
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University , Dalian, China.,Department of Anatomy, Jiangsu College of Nursing , Huai'an, Jiangsu Province, China
| | - Limin Wei
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University , Dalian, China
| | - Junli Liu
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University , Dalian, China
| | - Jiaxu Zhu
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University , Dalian, China
| | - Quanquan Yu
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University , Dalian, China
| | - Hui Kong
- Department of Otorhinolaryngology, The Second Hospital of Dalian Medical University , Dalian, Liaoning Province, China
| | - Li Kong
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University , Dalian, China
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Chen XD, Omari A, Hwang M, Kwark L, Dakki N, Farsiu S, Gardner TW. Treated PDR Reveals Age-Appropriate Vision Deterioration But Distorted Retinal Organization. Transl Vis Sci Technol 2020; 9:3. [PMID: 32704423 PMCID: PMC7347280 DOI: 10.1167/tvst.9.3.3] [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] [Indexed: 02/06/2023] Open
Abstract
Purpose We determined the progression of visual function, macular structure, and quality of life in patients with regressed proliferative diabetic retinopathy (PDR) after panretinal photocoagulation (PRP). Methods In this prospective study, 22 patients who underwent PRP for PDR and 11 age-matched control participants underwent examinations at baseline and after 5 years. Visual acuity, contrast sensitivity, reading acuity, frequency doubling perimetry, Humphrey field analyzer, and dark adaptation were measured. The Low Luminance Questionnaire and National Eye Institute Vision Function Questionnaire-25 were administered. Macular spectral-domain optical coherence tomography was taken. Results After 5 years, patients who had previously undergone PRP for PDR (18.4 ± 7.9 years previously) showed significant deterioration in contrast sensitivity, reading acuity, frequency doubling perimetry 24-2 pattern standard deviation, and Humphrey field analyzer 10-2 foveal sensitivity, which were equivalent to age-related decreases in control participants. They revealed no further impairment in vision-related activities on questionnaires. In contrast with controls, their maculas showed pathologic disorganization of the retinal layers, especially the nerve fiber layer, which were thicker and constituted a greater proportion of the overall retinal thickness than the norm and associated with impaired vision. Conclusions Patients with treated PDR had age-related decreases in vision, but stable quality of life. Prior injuries from the diabetes and, possibly, laser treatment led to substantial disruption in the retinal structure, which may explain the loss of vision. Translational Relevance Despite PRP treatment, patients with regressed PDR had pathologic progression of the nerve fiber layer; further investigation may identify a new therapeutic target to reverse the visual deficits.
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Affiliation(s)
- Xing D Chen
- Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Amro Omari
- Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Min Hwang
- Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Leon Kwark
- Departments of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - Natalie Dakki
- Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Sina Farsiu
- Departments of Ophthalmology, Duke University Medical Center, Durham, NC, USA.,Departments of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Thomas W Gardner
- Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
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Damian I, Nicoara SD. Optical Coherence Tomography Biomarkers of the Outer Blood-Retina Barrier in Patients with Diabetic Macular Oedema. J Diabetes Res 2020; 2020:8880586. [PMID: 33110922 PMCID: PMC7578732 DOI: 10.1155/2020/8880586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/13/2020] [Accepted: 09/24/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Numerous studies confirmed the main role of the inner blood-retinal barrier in the development of Diabetic Macular Oedema (DMO). Lately, the focus of research shifted towards the external retinal barrier with potential involvement in the pathogenesis of DMO. OBJECTIVE We aim to identify the OCT changes of the external blood-retinal barrier in patients with DMO and to define them as biomarkers with predictive value. Materials and method. We set up retrospectively 3 groups of patients diagnosed with nonproliferative diabetic retinopathy (NPDR) and DMO, proliferative diabetic retinopathy (PDR) and DMO, and controls. We compared the RPE thickness in every quadrant between groups and performed correlations between best-corrected visual acuity (BCVA) and the thickness of the retinal layers. The Social Science Statistics platform was used for statistical tests. RESULTS The NPDR-DMO group consisted of 18 eyes, the PDR-DMO group consisted of 19 eyes, and the control group included 36 eyes. In the PDR-DMO group, RPE thickness was decreased in almost all quadrants (p < 0.001); in the NPDR-DMO group, only the central minimum and central maximum values of the RPE thickness were significantly different from the control group. We did not find any strong correlation between BCVA and the thickness of the retinal layers. CONCLUSION The thickness of the RPE layer is an OCT biomarker able to predict the functioning of the outer BRB. Eyes with PDR-DMO exhibited decreased thickness of the RPE layer in almost all quadrants, highlighting the degenerative changes occurring in a hypoxic environment. The thickness of a specific layer could not be identified as a biomarker to correlate significantly with BCVA, most likely because we did not analyze specific morphologic features, such as continuity and reflectivity. The analysis of the RPE thickness could clarify the unexplained decrease of BCVA and predict early the evolution of DR.
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Affiliation(s)
- Ioana Damian
- Department of Ophthalmology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 8 V. Babes str., 400012 Cluj-Napoca, Romania
- Medical Doctoral School 1, Universitatii Str, 410087 Oradea, Romania
| | - Simona Delia Nicoara
- Department of Ophthalmology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 8 V. Babes str., 400012 Cluj-Napoca, Romania
- Clinic of Ophthalmology, Emergency County Hospital, 3 – 5 Clinicilor Str, 400006 Cluj-Napoca, Romania
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21
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Beyond Performance Metrics: Automatic Deep Learning Retinal OCT Analysis Reproduces Clinical Trial Outcome. Ophthalmology 2019; 127:793-801. [PMID: 32019699 DOI: 10.1016/j.ophtha.2019.12.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To validate the efficacy of a fully automatic, deep learning-based segmentation algorithm beyond conventional performance metrics by measuring the primary outcome of a clinical trial for macular telangiectasia type 2 (MacTel2). DESIGN Evaluation of diagnostic test or technology. PARTICIPANTS A total of 92 eyes from 62 participants with MacTel2 from a phase 2 clinical trial (NCT01949324) randomized to 1 of 2 treatment groups METHODS: The ellipsoid zone (EZ) defect areas were measured on spectral domain OCT images of each eye at 2 time points (baseline and month 24) by a fully automatic, deep learning-based segmentation algorithm. The change in EZ defect area from baseline to month 24 was calculated and analyzed according to the clinical trial protocol. MAIN OUTCOME MEASURE Difference in the change in EZ defect area from baseline to month 24 between the 2 treatment groups. RESULTS The difference in the change in EZ defect area from baseline to month 24 between the 2 treatment groups measured by the fully automatic segmentation algorithm was 0.072±0.035 mm2 (P = 0.021). This was comparable to the outcome of the clinical trial using semiautomatic measurements by expert readers, 0.065±0.033 mm2 (P = 0.025). CONCLUSIONS The fully automatic segmentation algorithm was as accurate as semiautomatic expert segmentation to assess EZ defect areas and was able to reliably reproduce the statistically significant primary outcome measure of the clinical trial. This approach, to validate the performance of an automatic segmentation algorithm on the primary clinical trial end point, provides a robust gauge of its clinical applicability.
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22
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Omari A, Niziol LM, Gardner TW. Reading deficits in diabetic patients treated with panretinal photocoagulation and good visual acuity. Acta Ophthalmol 2019; 97:e1013-e1018. [PMID: 30968579 DOI: 10.1111/aos.14097] [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: 10/15/2018] [Accepted: 03/04/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Patients with proliferative diabetic retinopathy (PDR) treated with panretinal photocoagulation (PRP) can have abnormal visual functioning that may be missed by Snellen visual acuity alone. We investigated reading deficits in patients treated with PRP for PDR using the Minnesota reading (MNREAD) test. METHODS Thirty patients treated with PRP and 15 controls underwent best-corrected visual acuity (BCVA), the MNREAD, frequency doubling perimetry (FDP), and fundus photography. Panretinal photocoagulation (PRP)-treated subjects were compared to controls on MNREAD results by two-sample t-tests and Wilcoxon tests and Pearson correlations were used to assess the association between performance on MNREAD and other central visual function tests within PRP subjects. RESULTS Panretinal photocoagulation (PRP)-treated patients had reduced MNREAD acuity (p < 0.0001) and increased critical print size (p = 0.01) compared to controls but not a significantly reduced maximum reading speed (p = 0.06). Logmar MNREAD acuity was strongly positive correlated with logMAR BCVA (r = 0.58, p = 0.0098) and strongly negatively correlated with FDP foveal threshold (r = -0.63, p = 0.0030). Maximum reading speed was positively correlated with FDP foveal threshold (r = 0.57, p = 0.0143) and FDP mean deviation (r = 0.51, p = 0.0432). Visual acuity did not correlate with the sensitivities on the FDP. CONCLUSION The MNREAD test reveals that PRP reduces reading ability and other aspects of macular function, and thus provides new understanding of how vision-related quality of life is impaired. These findings may lead to improved means to evaluate and enhance vision following treatment for PDR.
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Affiliation(s)
- Amro Omari
- Department of Ophthalmology and Visual Sciences W. K. Kellogg Eye Center University of Michigan Ann Arbor Michigan USA
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences W. K. Kellogg Eye Center University of Michigan Ann Arbor Michigan USA
| | - Thomas W Gardner
- Department of Ophthalmology and Visual Sciences W. K. Kellogg Eye Center University of Michigan Ann Arbor Michigan USA
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23
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Chen XD, Gardner TW. Patient-Reported Outcomes Reveal Impairments Not Explained by Psychophysical Testing in Patients With Regressed PDR. Transl Vis Sci Technol 2019; 8:11. [PMID: 31380143 PMCID: PMC6664865 DOI: 10.1167/tvst.8.4.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/28/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose We evaluated the correlations between visual deficits and patient-reported symptoms in patients with regressed proliferative diabetic retinopathy (PDR) to determine whether there is a psychophysical basis for vision-related impairments. Methods Visual acuity, reading acuity, contrast sensitivity, frequency doubling perimetry (FDP), Humphrey field analyzer (HFA), and dark adaptation assessed visual function. The National Eye Institute Vision Function Questionnaire-25 (NEI VFQ-25) and Low Luminance Questionnaire (LLQ) assessed quality of life. Results We recruited 30 adults who received panretinal photocoagulation (PRP) for PDR and 15 control subjects; 22 diabetic and 11 control participants completed a second evaluation 5 years later. Visual acuity of the worse-seeing eyes tended to correlate better with NEI VFQ-25 and LLQ than did the acuity of the better-seeing eyes. Other vision measures were generally not associated with either questionnaire, especially responses related to driving ability and mental health. Visual acuity only detected subnormal performance in 43% to 45% of patients, while FDP 24-2, HFA 60-4, and LLQ detected abnormal performance in >80% of patients. Conclusions Poor visual acuity may explain some vision-related impairments in daily function. However, many patients with regressed PDR have normal acuity but reduced visual field and poor quality of life. In these patients, their reported symptoms were not fully explained by visual acuity or any psychophysical tests alone. Translational Relevance Visual acuity is a poor indicator of overall visual function in people with regressed PDR. In clinical settings, visual field tests and patient-reported outcomes may provide more comprehensive assessments of their functional deficits than visual acuity.
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Affiliation(s)
- Xing D Chen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Thomas W Gardner
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
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Wang XN, Li ST, Li W, Hua YJ, Wu Q. The thickness and volume of the choroid, outer retinal layers and retinal pigment epithelium layer changes in patients with diabetic retinopathy. Int J Ophthalmol 2018; 11:1957-1962. [PMID: 30588430 PMCID: PMC6288528 DOI: 10.18240/ijo.2018.12.14] [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: 01/25/2017] [Accepted: 03/01/2018] [Indexed: 01/18/2023] Open
Abstract
AIM To evaluate the thickness and volume changes of the choroidal, outer retinal layers (ORL) and retinal pigment epithelium (RPE) in patients with diabetic retinopathy (DR) using optical coherence tomography (OCT) and correlate them with visual acuity. METHODS We carried out a retrospective observational case series. Consecutive DR patients were recruited for color fundus photography and OCT assessment. The RPE, ORL and choroidal thickness were measured. The correlation with the best-corrected visual acuity (BCVA) was also investigated. RESULTS The study included 128 eyes, comprising 45 eyes of 25 diabetic macular edema (DME) patients, 34 eyes of 20 DR without DME (non-DME) patients, and 49 eyes of 25 age-matched normal individuals. The choroidal thickness in DR patients were decreased statistically significantly compared with the control group (P<0.05). The mean macular ORL thickness in DME (73.02±15.34 µm) and non-DME groups (76.35±7.32 µm) were decreased statistically significantly compared with the control group (80.20±5.85 µm; P=0.006, P=0.013, respectively). In both the non-DME and DME groups, the RPE thickness were decreased compared with the control group (P<0.05), except in the macular and central ring. The BCVA were significant interactions with the total inner retinal volume and macular RPE thickness in the DME group (r=0.115, P<0.001, r=-0.013, P=0.017, respectively). CONCLUSION The choroid, ORL and RPE thickness are significantly decreased in DR patients compared with controls in different segments.
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Affiliation(s)
- Xiang-Ning Wang
- Department of Ophthalmology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Shu-Ting Li
- Department of Ophthalmology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Wei Li
- Department of Ophthalmology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Yan-Jun Hua
- Department of Ophthalmology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Qiang Wu
- Department of Ophthalmology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
- Shanghai Key Laboratory of Diabetes Mellitus, Shanghai 200233, China
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Retinal Vessel Diameter Changes in Relation to Dark Adaptation and Acute Hyperglycemia. J Ophthalmol 2018; 2018:7064359. [PMID: 30319819 PMCID: PMC6167562 DOI: 10.1155/2018/7064359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 08/16/2018] [Indexed: 11/17/2022] Open
Abstract
The purpose of this experimental clinical study was to assess the effects of dark adaptation and acute changes in glycemia on retinal vessel diameters in men. The study included 14 patients (mean age 63 years, range 48–74 years) with type 2 diabetes mellitus and minimal or no diabetic retinopathy. Retinal vessel diameters were assessed using infrared photography before and after dark adaptation, first while fasting and then at peak hyperglycemia during an oral glucose tolerance test (OGTT). Dark adaptation was accompanied by retinal vasodilatation, both during fasting (mean glycemia 7.6 ± 1.7 mM) and postprandial hyperglycemia (15.7 ± 4.2 mM). When fasting, the increase in vein diameter during dark adaptation was 2.0% after 20 min (P=0.018) and 2.9% after 40 min (P=0.010). When subjects were hyperglycemic, the increase during dark adaptation was 2.8% for retinal vein diameters (P=0.027) and 2.0% for retinal artery diameters after 20 min (P=0.002) and 1.7% for retinal artery diameters after 40 min (P=0.022). For identical conditions of light/dark adaptation, retinal vessels were dilated when subjects were fasting compared to postprandial hyperglycemia. Thus, darkness and fasting were both associated with retinal vasodilation in this short-term experiment in patients with type 2 diabetes. Future studies should determine whether both the stimuli of vasodilation lead to retinal hyperperfusion, which would support that they may be involved in the aggravation of diabetic retinopathy.
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Loss of CD40 attenuates experimental diabetes-induced retinal inflammation but does not protect mice from electroretinogram defects. Vis Neurosci 2018; 34:E009. [PMID: 28965505 DOI: 10.1017/s0952523817000074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Chronic low grade inflammation is considered to contribute to the development of experimental diabetic retinopathy (DR). We recently demonstrated that lack of CD40 in mice ameliorates the upregulation of inflammatory molecules in the diabetic retina and prevented capillary degeneration, a hallmark of experimental diabetic retinopathy. Herein, we investigated the contribution of CD40 to diabetes-induced reductions in retinal function via the electroretinogram (ERG) to determine if inflammation plays a role in the development of ERG defects associated with diabetes. We demonstrate that diabetic CD40-/- mice are not protected from reduction to the ERG b-wave despite failing to upregulate inflammatory molecules in the retina. Our data therefore supports the hypothesis that retinal dysfunction found in diabetics occurs independent of the induction of inflammatory processes.
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Hautala N, Siiskonen M, Hannula V, Järvinen K, Falck A. Early glycaemic control for maintaining visual function in type 1 diabetes: The Oulu cohort study of diabetic retinopathy. Eur J Ophthalmol 2018; 28:684-689. [PMID: 29554811 DOI: 10.1177/1120672117750053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE: The purpose of this study was to evaluate the visual function and the ophthalmic status of young Finnish adults with long duration of type 1 diabetes in relation to the history of the metabolic control. METHODS: A population-based cohort of children with type 1 diabetes examined in the Northern Ostrobothnia hospital district in 1989 (n = 216) was re-examined 18 years later. High-contrast visual acuity (best-corrected visual acuity), contrast sensitivity, refractive error, lens status, intraocular pressure, stage of diabetic retinopathy and received treatments were evaluated. The metabolic control was reflected by the mean of glycated haemoglobin A1 or glycated haemoglobin A1c values of the years 1983-1989 and 1992-2007, respectively. RESULTS: In all, 96 men and 76 women age 30 ± 3 years with type 1 diabetes duration of 23 ± 4 years attended the re-evaluation. About 60% (103/172) had normal best-corrected visual acuity and 3% had low vision. Contrast sensitivity was abnormal in two-thirds. Half had myopia. Four patients had cataract surgery. Low childhood glycated haemoglobin A1 was indicative, and favourable glycated haemoglobin A1c during youth was a significant predictor of better contrast sensitivity and ocular state in adulthood. CONCLUSION: The majority of the patients have useful vision, although minor functional impairments are commonly detectable. Long duration of type 1 diabetes in association with non-optimal glycaemic control threatens visual function already at young adulthood. Thus, strong emphasis to control diabetes from onset is important in maintaining good visual function.
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Affiliation(s)
- Nina Hautala
- Department of Ophthalmology, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital, Oulu University, Oulu, Finland
| | - Mira Siiskonen
- Department of Ophthalmology, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital, Oulu University, Oulu, Finland
| | - Virva Hannula
- Department of Ophthalmology, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital, Oulu University, Oulu, Finland
| | - Kaisu Järvinen
- Department of Ophthalmology, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital, Oulu University, Oulu, Finland
| | - Aura Falck
- Department of Ophthalmology, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital, Oulu University, Oulu, Finland
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Dellaa A, Benlarbi M, Hammoum I, Gammoudi N, Dogui M, Messaoud R, Azaiz R, Charfeddine R, Khairallah M, Lachapelle P, Ben Chaouacha-Chekir R. Electroretinographic evidence suggesting that the type 2 diabetic retinopathy of the sand rat Psammomys obesus is comparable to that of humans. PLoS One 2018; 13:e0192400. [PMID: 29420665 PMCID: PMC5805270 DOI: 10.1371/journal.pone.0192400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 01/23/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose Type 2 diabetic retinopathy is the main cause of acquired blindness in adults. The aim of this work was to examine the retinal function of the sand rat Psammomys obesus as an animal model of diet-induced type 2 diabetes when subjected to a hypercaloric regimen. Materials and methods Hyperglycemia was induced in Psammomys obesus by high caloric diet (4 kcal/g). The visual function of control (n = 7) and diabetic (n = 7) adult rodents were followed up during 28 consecutive weeks with full-field electroretinogram(ERG) recordings evoked to flashes of white light according to the standard protocol of the International Society for Clinical Electrophysiology of Vision protocol (ISCEV). Results Twenty-eight weeks following the induction of diabetes, results revealed significantly reduced and delayed photopic and scotopic ERG responses in diabetic rats compared to control rats. More specifically, we noted a significant decrease in the amplitude of the dark-adapted 0.01ERG (62%), a- and b-wave amplitudes of the dark-adapted 3.0 ERG (33.6%, 55.1%) and the four major oscillatory potentials components (OP1-OP4) (39.0%, 75.2%, 54.8% and 53.7% respectively). In photopic conditions, diabetic rats showed a significant decrease in a- and b-wave (30.4%, 43.4%), photopic negative response (55.3%), 30 Hz flicker (63.7%), OP1-OP4(51.6%, 61.8%, 68.3% and 47.5% respectively) and S-cone (34.7%). Significantly delayed implicit times were observed for all ERG components in the diabetic animals. Results obtained are comparable to those characterizing the retinal function of patients affected with advanced stage of diabetic retinopathy. Conclusion Psammomys obesus is a useful translational model to study the pathophysiology of diabetic retinopathy in order to explore new therapeutic avenues in human patients.
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Affiliation(s)
- Ahmed Dellaa
- Laboratory of Physiopathology, Food and Biomolecules of the Higher Institute of Biotechnology Sidi Thabet, Manouba University, BiotechPole Sidi Thabet, Ariana, Tunisia
- Faculty of Sciences of Bizerte, Carthage University, Bizerte, Tunisia
| | - Maha Benlarbi
- Laboratory of Physiopathology, Food and Biomolecules of the Higher Institute of Biotechnology Sidi Thabet, Manouba University, BiotechPole Sidi Thabet, Ariana, Tunisia
| | - Imane Hammoum
- Laboratory of Physiopathology, Food and Biomolecules of the Higher Institute of Biotechnology Sidi Thabet, Manouba University, BiotechPole Sidi Thabet, Ariana, Tunisia
| | - Nouha Gammoudi
- Department of functional explorations of the nervous system, University Hospital of Sahloul, Sousse, Tunisia
| | - Mohamed Dogui
- Department of functional explorations of the nervous system, University Hospital of Sahloul, Sousse, Tunisia
| | - Riadh Messaoud
- Department of Ophthalmology, University Hospital of Fattouma Bourguiba, Monastir, Tunisia
| | - Rached Azaiz
- UNIMED Pharmaceutical Industry, industrial area Kalaa Kebira, Sousse, Tunisia
| | - Ridha Charfeddine
- UNIMED Pharmaceutical Industry, industrial area Kalaa Kebira, Sousse, Tunisia
| | - Moncef Khairallah
- Department of Ophthalmology, University Hospital of Fattouma Bourguiba, Monastir, Tunisia
| | - Pierre Lachapelle
- Department of Ophthalmology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Rafika Ben Chaouacha-Chekir
- Laboratory of Physiopathology, Food and Biomolecules of the Higher Institute of Biotechnology Sidi Thabet, Manouba University, BiotechPole Sidi Thabet, Ariana, Tunisia
- * E-mail:
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PANRETINAL PHOTOCOAGULATION VERSUS RANIBIZUMAB FOR PROLIFERATIVE DIABETIC RETINOPATHY: Comparison of Peripapillary Retinal Nerve Fiber Layer Thickness in a Randomized Clinical Trial. Retina 2017; 39:69-78. [PMID: 29135802 DOI: 10.1097/iae.0000000000001909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Compare changes in retinal nerve fiber layer (RNFL) thickness between eyes assigned to intravitreous ranibizumab or panretinal photocoagulation and assess correlations between changes in RNFL and visual field sensitivity and central subfield thickness. METHODS Eyes with proliferative diabetic retinopathy were randomly assigned to ranibizumab or panretinal photocoagulation. Baseline and annual follow-up spectral domain optical coherence tomography RNFL imaging, optical coherence tomography macular imaging, and automated static perimetry (Humphrey visual field 60-4 algorithm) were performed. RESULTS One hundred forty-six eyes from 120 participants were analyzed. At 2 years, for the ranibizumab (N = 74) and panretinal photocoagulation (N = 66) groups, respectively, mean change in average RNFL thickness was -10.9 ± 11.7 μm and -4.3 ± 11.6 μm (difference, -4.9 μm; 95% confidence interval [-7.2 μm to -2.6 μm]; P < 0.001); the correlation between change in RNFL thickness and 60-4 Humphrey visual field mean deviation was -0.27 (P = 0.07) and +0.33 (P = 0.035); the correlation between change in RNFL thickness and central subfield thickness was +0.63 (P < 0.001) and +0.34 (P = 0.005), respectively. CONCLUSION At 2 years, eyes treated with ranibizumab had greater RNFL thinning than eyes treated with panretinal photocoagulation. Correlations between changes in RNFL thickness, visual field, and central subfield thickness suggest that the decrease in RNFL thickness with ranibizumab is likely due to decreased edema rather than loss of axons.
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Soares DCF, de Paula Oliveira DC, Barcelos LS, Barbosa AS, Vieira LC, Townsend DM, Rubello D, de Barros ALB, Duarte LP, Silva-Cunha A. Antiangiogenic activity of PLGA-Lupeol implants for potential intravitreal applications. Biomed Pharmacother 2017; 92:394-402. [PMID: 28558353 DOI: 10.1016/j.biopha.2017.05.093] [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: 03/28/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 02/06/2023] Open
Abstract
Uncontrolled angiogenesis is directly associated with ocular diseases such as macular degeneration and diabetic retinopathy. Implantable polymeric drug delivery systems have been proposed for intravitreal applications and in the present work, we evaluated the antiangiogenic potential of PLGA ocular implants loaded with the triterpene lupeol using in vitro and in vivo models. The drug/polymer physiochemical properties of the lupeol-loaded PLGA were validated as functionally similar using differential scanning calorimetry, Fourier transform infrared spectroscopy, and scanning electron microscopy. Interestingly, in an in vitro culture system, lupeol (100μg/mL and 250μg/mL) was capable to inhibited the proliferation as well as the migration of Human Umbilical Vein Endothelial Cells (HUVEC), without interfering in cell viability, promoting a significant reduction in the percentage of vessels (39.41% and 44.12%, respectively), compared with the control group. In vivo test, by using the chorioallantoic membrane (CAM) model, lupeol-loaded PLGA ocular implants showed antiangiogenic activity comparable to the FDA-approved anti-VEGF antibody Bevacizumab. Overall, our results suggest lupeol-loaded PLGA ocular implants were able to inhibit the angiogenic process by impairing both proliferation and migration of endothelial cells.
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Affiliation(s)
| | - Diogo Coelho de Paula Oliveira
- Department of Pharmaceutical Products, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Luciola Silva Barcelos
- Department of Physiology and Biophysics, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alan Sales Barbosa
- Department of Physiology and Biophysics, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lorena Carla Vieira
- Department of Pharmaceutical Products, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Danyelle M Townsend
- Department of Drug Discovery and Pharmaceutical Sciences, Medical University of South Carolina, United States
| | - Domenico Rubello
- Department of Nuclear Medicine, Imaging and Clinical Pathology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - André Luis Branco de Barros
- Department of Clinical and Toxicological Analyses, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Lucienir Pains Duarte
- Department of Chemistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Armando Silva-Cunha
- Department of Pharmaceutical Products, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Involvement of a gut-retina axis in protection against dietary glycemia-induced age-related macular degeneration. Proc Natl Acad Sci U S A 2017; 114:E4472-E4481. [PMID: 28507131 DOI: 10.1073/pnas.1702302114] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Age-related macular degeneration (AMD) is the major cause of blindness in developed nations. AMD is characterized by retinal pigmented epithelial (RPE) cell dysfunction and loss of photoreceptor cells. Epidemiologic studies indicate important contributions of dietary patterns to the risk for AMD, but the mechanisms relating diet to disease remain unclear. Here we investigate the effect on AMD of isocaloric diets that differ only in the type of dietary carbohydrate in a wild-type aged-mouse model. The consumption of a high-glycemia (HG) diet resulted in many AMD features (AMDf), including RPE hypopigmentation and atrophy, lipofuscin accumulation, and photoreceptor degeneration, whereas consumption of the lower-glycemia (LG) diet did not. Critically, switching from the HG to the LG diet late in life arrested or reversed AMDf. LG diets limited the accumulation of advanced glycation end products, long-chain polyunsaturated lipids, and their peroxidation end-products and increased C3-carnitine in retina, plasma, or urine. Untargeted metabolomics revealed microbial cometabolites, particularly serotonin, as protective against AMDf. Gut microbiota were responsive to diet, and we identified microbiota in the Clostridiales order as being associated with AMDf and the HG diet, whereas protection from AMDf was associated with the Bacteroidales order and the LG diet. Network analysis revealed a nexus of metabolites and microbiota that appear to act within a gut-retina axis to protect against diet- and age-induced AMDf. The findings indicate a functional interaction between dietary carbohydrates, the metabolome, including microbial cometabolites, and AMDf. Our studies suggest a simple dietary intervention that may be useful in patients to arrest AMD.
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Li ST, Wang XN, Du XH, Wu Q. Comparison of spectral-domain optical coherence tomography for intra-retinal layers thickness measurements between healthy and diabetic eyes among Chinese adults. PLoS One 2017; 12:e0177515. [PMID: 28493982 PMCID: PMC5426752 DOI: 10.1371/journal.pone.0177515] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/29/2017] [Indexed: 12/02/2022] Open
Abstract
PURPOSE To compare intra-retinal layer thickness measurements between eyes with no or mild diabetic retinopathy (DR) and age-matched controls using Spectralis spectral-domain optical coherence tomography (SD-OCT). METHODS Cross-sectional observational analysis study. High-resolution macular volume scans (30° * 25°) were obtained for 133 type 2 diabetes mellitus (T2DM) patients with no DR, 42 T2DM patients with mild DR and 115 healthy controls. The mean thickness was measured in all 9 Early Treatment Diabetic Retinopathy Study (ETDRS) sectors for 8 separate layers, inner retinal layer (IRL), outer retinal layer (ORL) and total retina (TR), after automated segmentation. The ETDRS grid consisted of three concentric circles of 1-, 3-, and 6-mm diameter. The superior, inferior, temporal, and nasal sectors of the 3- and 6-mm circles were respectively designated as S3, I3, T3, and N3 and S6, I6, T6, and N6. Linear regression analyses were conducted to evaluate the associations between the intra-retinal layer thicknesses, age, diabetes duration, fasting blood glucose and HbA1c. RESULTS The mean age and duration of T2DM were 61.1 and 13.7 years, respectively. Although no significant differences in the average TR and ORL volumes were observed among the groups, significant differences were found in the volume and sectorial thicknesses of the inner plexiform layer (IPL), outer plexiform layer (OPL) and IRL among the groups. In particular, the thicknesses of the IPL (S3, T3, S6, I6 and T6 sectors) and the IRL (S6 sector) were decreased in the no-DR group compared with the controls (P < 0.05). The thickness of the OPL (S3, N3, S6 and N6 sectors) was thinner in the no-DR group than in mild DR (P < 0.05). The average IPL thickness was significantly negatively correlated with age and the duration of diabetes. CONCLUSION The assessment of the intra-retinal layer thickness showed a significant decrease in the IPL and IRL thicknesses in Chinese adults with T2DM, even in the absence of visible microvascular signs of DR.
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Affiliation(s)
- Shu-ting Li
- Department of Ophthalmology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Xiang-ning Wang
- Department of Ophthalmology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Xin-hua Du
- Department of Ophthalmology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Qiang Wu
- Department of Ophthalmology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, China
- Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
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Linsenmeier RA, Zhang HF. Retinal oxygen: from animals to humans. Prog Retin Eye Res 2017; 58:115-151. [PMID: 28109737 DOI: 10.1016/j.preteyeres.2017.01.003] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/13/2017] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
This article discusses retinal oxygenation and retinal metabolism by focusing on measurements made with two of the principal methods used to study O2 in the retina: measurements of PO2 with oxygen-sensitive microelectrodes in vivo in animals with a retinal circulation similar to that of humans, and oximetry, which can be used non-invasively in both animals and humans to measure O2 concentration in retinal vessels. Microelectrodes uniquely have high spatial resolution, allowing the mapping of PO2 in detail, and when combined with mathematical models of diffusion and consumption, they provide information about retinal metabolism. Mathematical models, grounded in experiments, can also be used to simulate situations that are not amenable to experimental study. New methods of oximetry, particularly photoacoustic ophthalmoscopy and visible light optical coherence tomography, provide depth-resolved methods that can separate signals from blood vessels and surrounding tissues, and can be combined with blood flow measures to determine metabolic rate. We discuss the effects on retinal oxygenation of illumination, hypoxia and hyperoxia, and describe retinal oxygenation in diabetes, retinal detachment, arterial occlusion, and macular degeneration. We explain how the metabolic measurements obtained from microelectrodes and imaging are different, and how they need to be brought together in the future. Finally, we argue for revisiting the clinical use of hyperoxia in ophthalmology, particularly in retinal arterial occlusions and retinal detachment, based on animal research and diffusion theory.
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Affiliation(s)
- Robert A Linsenmeier
- Biomedical Engineering Department, Northwestern University, 2145 Sheridan Road, Evanston 60208-3107, IL, USA; Neurobiology Department, Northwestern University, 2205 Tech Drive, Evanston 60208-3520, IL, USA; Ophthalmology Department, Northwestern University, 645 N. Michigan Ave, Suite 440, Chicago 60611, IL, USA.
| | - Hao F Zhang
- Biomedical Engineering Department, Northwestern University, 2145 Sheridan Road, Evanston 60208-3107, IL, USA; Ophthalmology Department, Northwestern University, 645 N. Michigan Ave, Suite 440, Chicago 60611, IL, USA.
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Arroba AI, Mazzeo A, Cazzoni D, Beltramo E, Hernández C, Porta M, Simó R, Valverde ÁM. Somatostatin protects photoreceptor cells against high glucose-induced apoptosis. Mol Vis 2016; 22:1522-1531. [PMID: 28050125 PMCID: PMC5204461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/28/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Many cellular and molecular studies in experimental animals and early retinal function tests in patients with diabetic retinopathy (DR) have shown that retinal neurodegeneration is an early event in the pathogenesis of the disease. Somatostatin (SST) is one of the most important neuroprotective factors synthesized by the retina: SST levels are decreased in parallel to retinal neurodegeneration in early stages of DR. In this study, we characterized the induction of apoptosis (programmed cell death) in a 661W photoreceptor-like cell line cultured under high glucose (HG) conditions and the effect of SST. METHODS A 661W photoreceptor-like cell line and retinal explants from 10-week-old male C57BL/6 mice were cultured under HG conditions and treated with SST. RESULTS Hyperglycemia significantly reduced the cellular viability by increasing the percentage of apoptotic cells, and this effect was ameliorated by SST (p˂0.05). Activation of caspase-8 by hyperglycemia was found in the 661W cells and retinal explants and decreased in the presence of SST (p˂0.05). Moreover, we detected activation of calpain-2 associated with hyperglycemia-induced cell death, as well as increased protein tyrosine phosphatase 1B (PTP1B) protein levels; both had a pattern of cleavage that was absent in the presence of SST (p˂0.05). Treatment of the 661W cells and retinal explants with SST for 24 h increased the phosphorylation of type 1 insulin-like growth factor receptor (IGF-IR; tyrosine 1165/1166) and protein kinase B (Akt; serine 473), suggesting this survival signaling is activated in the neuroretina by SST (p˂0.05). CONCLUSIONS This study has provided new mechanistic insights first into the involvement of calpain-2 and PTP1B in the loss of cell survival and increased caspase-8-dependent apoptosis induced by hyperglycemia in photoreceptor cells and second, on the protective effect of SST against apoptosis by the enhancement of IGF-IR-mediated Akt phosphorylation.
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Affiliation(s)
- Ana I. Arroba
- Alberto Sols Biomedical Research Institute (IIBm) (CSIC/UAM), 28029 Madrid, Spain,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERdem), ISCIII, Madrid, Spain
| | | | - Daniele Cazzoni
- Alberto Sols Biomedical Research Institute (IIBm) (CSIC/UAM), 28029 Madrid, Spain
| | | | - Cristina Hernández
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERdem), ISCIII, Madrid, Spain
| | | | - Rafael Simó
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERdem), ISCIII, Madrid, Spain
| | - Ángela M. Valverde
- Alberto Sols Biomedical Research Institute (IIBm) (CSIC/UAM), 28029 Madrid, Spain,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERdem), ISCIII, Madrid, Spain
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Knoll B, Simonett J, Volpe NJ, Farsiu S, Ward M, Rademaker A, Weintraub S, Fawzi AA. Retinal nerve fiber layer thickness in amnestic mild cognitive impairment: Case-control study and meta-analysis. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 4:85-93. [PMID: 27722194 PMCID: PMC5045947 DOI: 10.1016/j.dadm.2016.07.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction Retinal structural changes in subjects with mild cognitive impairment (MCI) remain a subject of controversy. Methods We investigated the correlation between optical coherence tomography (OCT) of the retinal sublayers, including the retinal nerve fiber layer (RNFL), and cognitive function in subjects with amnestic MCI and compared the OCT findings with matched controls. We also performed a meta-analysis of the world literature using a random-effects model. Results We found no statistically significant differences in OCT between amnestic MCI (aMCI) and controls. In aMCI subjects, we found an inverse relationship between RNFL thickness and two cognitive tests (delayed story recall and a word-list learning test and the word-list test). The meta-analysis revealed a statistically significant decrease in RNFL thickness in MCI subjects. Discussion The inverse relationship between cognitive testing and RNFL thickness suggests that retinal involvement may include paradoxically increased thickness of the RNFL, which could suggest gliotic reactive changes.
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Affiliation(s)
- Brianna Knoll
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joseph Simonett
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nicholas J Volpe
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sina Farsiu
- Department of Biomedical Engineering and Ophthalmology, Duke University, Durham, NC, USA
| | - Mallory Ward
- Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alfred Rademaker
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sandra Weintraub
- Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amani A Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Bavinger JC, Dunbar GE, Stem MS, Blachley TS, Kwark L, Farsiu S, Jackson GR, Gardner TW. The Effects of Diabetic Retinopathy and Pan-Retinal Photocoagulation on Photoreceptor Cell Function as Assessed by Dark Adaptometry. Invest Ophthalmol Vis Sci 2016; 57:208-17. [PMID: 26803796 PMCID: PMC4877135 DOI: 10.1167/iovs.15-17281] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose The pathophysiology of vision loss in persons with diabetic retinopathy (DR) is complex and incompletely defined. We hypothesized that retinal pigment epithelium (RPE) and rod and cone photoreceptor dysfunction, as measured by dark adaptometry, would increase with severity of DR, and that pan-retinal photocoagulation (PRP) would exacerbate this dysfunction. Methods Dark adaptation (DA) was measured in subjects with diabetes mellitus and healthy controls. Dark adaptation was measured at 5° superior to the fovea following a flash bleach, and the data were analyzed to yield cone and rod sensitivity curves. Retinal layer thicknesses were quantified using spectral-domain optical coherence tomography (OCT). Results The sample consisted of 23 controls and 73 diabetic subjects. Subjects with moderate nonproliferative diabetic retinopathy (NPDR) exhibited significant impairment of rod recovery rate compared with control subjects (P = 0.04). Cone sensitivity was impaired in subjects with proliferative diabetic retinopathy (PDR) (type 1 diabetes mellitus [T1DM]: P = 0.0047; type 2 diabetes mellitus [T2DM]: P < 0.001). Subjects with untreated PDR compared with subjects treated with PRP exhibited similar rod recovery rates and cone sensitivities. Thinner RPE as assessed by OCT was associated with slower rod recovery and lower cone sensitivity, and thinner photoreceptor inner segment/outer segment layer was associated with lower cone sensitivity. Conclusions The results suggest that RPE and photoreceptor cell dysfunction, as assessed by cone sensitivity level and rod- and RPE-mediated dark adaptation, progresses with worsening DR, and rod recovery dysfunction occurs earlier than cone dysfunction. Function was preserved following PRP. The findings suggest multiple defects in retinoid function and provide potential points to improve visual function in persons with PDR.
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Affiliation(s)
- J Clay Bavinger
- Department of Ophthalmology and Visual Sciences W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Grace E Dunbar
- Department of Ophthalmology and Visual Sciences W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Maxwell S Stem
- Department of Ophthalmology and Visual Sciences W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Taylor S Blachley
- Department of Ophthalmology and Visual Sciences W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Leon Kwark
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States
| | - Sina Farsiu
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States 3Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States
| | | | - Thomas W Gardner
- Department of Ophthalmology and Visual Sciences W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
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Diabetic retinal pigment epitheliopathy: fundus autofluorescence and spectral-domain optical coherence tomography findings. Graefes Arch Clin Exp Ophthalmol 2016; 254:1931-1940. [DOI: 10.1007/s00417-016-3336-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/19/2016] [Accepted: 03/28/2016] [Indexed: 11/26/2022] Open
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Stem MS, Dunbar GE, Jackson GR, Farsiu S, Pop-Busui R, Gardner TW. Glucose variability and inner retinal sensory neuropathy in persons with type 1 diabetes mellitus. Eye (Lond) 2016; 30:825-32. [PMID: 27034201 DOI: 10.1038/eye.2016.48] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/27/2016] [Indexed: 01/05/2023] Open
Abstract
PurposeTo quantify early neuroretinal alterations in patients with type 1 diabetes mellitus (T1DM) and to assess whether glycemic variability contributes to alterations in neuroretinal structure or function.MethodsThirty patients with T1DM and 51 controls underwent comprehensive ophthalmic examination and assessment of retinal function or structure with frequency doubling perimetry (FDP), contrast sensitivity, dark adaptation, fundus photography, and optical coherence tomography (OCT). Diabetic participants wore a subcutaneous continuous glucose monitor for 5 days, from which makers of glycemic variability including the low blood glucose index (LGBI) and area under the curve (AUC) for hypoglycemia were derived.ResultsSixteen patients had no diabetic retinopathy (DR), and 14 had mild or moderate DR. Log contrast sensitivity for the DM group was significantly reduced (mean±SD=1.63±0.06) compared with controls (1.77±0.13, P<0.001). OCT analysis revealed that the inner temporal inner nuclear layer (INL) was thinner in patients with T1DM (34.9±2.8 μm) compared with controls (36.5±2.9 μm) (P=0.023), although this effect lost statistical significance after application of the Bonferroni correction for multiple comparisons. Both markers of glycemic variability, the AUC for hypoglycemia (R=-0.458, P=0.006) and LGBI (R=-0.473, P=0.004), were negatively correlated with inner temporal INL thickness.ConclusionsPatients with T1DM and no to moderate DR exhibit alterations in inner retinal structure and function. Increased glycemic variability correlates with retinal thinning on OCT imaging, suggesting that fluctuations in blood glucose may contribute to neurodegeneration.
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Affiliation(s)
- M S Stem
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - G E Dunbar
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | | | - S Farsiu
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - R Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - T W Gardner
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
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Layton CJ. Diabetic levels of glucose increase cellular reducing equivalents but reduce survival in three models of 661W photoreceptor-like cell injury. BMC Ophthalmol 2015; 15:174. [PMID: 26653778 PMCID: PMC4675021 DOI: 10.1186/s12886-015-0164-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 12/02/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The effect of excess glucose on retinal cellular health remains controversial, and cellular reducing equivalents, as indicators of cellular energy production, are widely used as substitute indicators of retinal cellular health. These investigations hypothesised that excess energy substrate availability, as occurs in the diabetic retina, increases the susceptibility of retinal neurons to injury in the presence of increased cellular reducing equivalents. METHODS The response of 661W cells to phototoxicity, oxidative stress induced by H2O2 and apoptosis induction by staurosporine was characterised in the presence of 5mM glucose and B27 defined media without insulin. Cellular insult was produced by phototoxicity, H2O2 and the apoptosis induction agent staurosporine. The effect of physiologically relevant alterations in environmental glucose on cellular reducing equivalents was assessed by MTT dye reduction and NAD(P)H assays, and cell survival was assessed via caspase 3/7 activation and Annexin V/PI flow cytometry. RESULTS 661W photoreceptor-like cells underwent dose dependent cell death primarily by apoptosis in response to phototoxic insult, H2O2, and staurosporine by all measures of cellular viability. Exposure of cells to 25mM glucose (diabetic-type conditions) increased cell death in response to all insults as measured by caspase 3/7 activation and Annexin V/PI flow cytometry. Cellular reducing equivalents were nonetheless increased in all models of injury in the presence of excess glucose. The mechanism of this increase was partly due to increased NADPH but not NADH levels in the presence of 25mM glucose. CONCLUSIONS Acute exposure to 25mM glucose decreased the resilience of 661W photoreceptor-like cells to a range of cellular stressors whilst maintaining or increasing cellular reducing equivalents, partly be increasing NADPH levels. This shows that in 661W cells, diabetic levels of glucose decrease cellular resilience to injury. The decoupling of cellular reducing equivalents levels from cell survival has important implications when investigating the mechanisms of neuronal damage in diabetic retinal neuropathy.
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Affiliation(s)
- Christopher J Layton
- Ophthalmology Research Unit, Gallipoli Medical Research Institute, Newdegate St, Greenslopes, Brisbane, 4120, Australia. .,School of Medicine, University of Queensland, Herston Rd, Herston, Brisbane, 4006, Australia. .,Ophthalmology Department, Greenslopes Hospital, Newdegate St, Greenslopes, Brisbane, Australia.
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Zhao H, Zhang J, Yu J. HMGB-1 as a Potential Target for the Treatment of Diabetic Retinopathy. Med Sci Monit 2015; 21:3062-7. [PMID: 26454330 PMCID: PMC4604733 DOI: 10.12659/msm.894453] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Diabetic retinopathy (DR) is one of the most important complications of diabetes mellitus (DM) and is the leading cause of blindness in diabetic patients. Recent studies showed that as important inflammatory mediators, high mobility group box 1 (HMGB-1) is associated with diabetic peripheral neuropathy and can participate in the occurrence and development of DR. This study explored HMGB-1 as a therapeutic target for DR treatment through observing its role in retinal ganglion cells (GRCs) in a high glucose environment. Material/Methods RGCs were randomly divided into 3 groups: the normal control group, the high glucose group, and the siRNA HMGB-1 group. Real-time PCR was used to detect HMGB-1 mRNA expression. ELISA was used to test HMGB-1 protein expression in the supernatant. MTT assay was performed to determine cell proliferation. Real-time PCR and Western blotting were used to analyze TLR4 and NF-κB expression. Results HMGB-1 mRNA was up-regulated (P=0.015) and protein secretion increased (P=0.022) in the high glucose environment. RGCs survival decreased (P=0.026), while TLR4 and NF-κB mRNA (P=0.009 and P=0.017, respectively) and protein expression increased significantly (P=0.041 and P=0.024, respectively). SiRNA HMGB-1 transfection obviously inhibited HMGB-1 mRNA expression (P=0.032), reduced HMGB-1 secretion (P=0.012), and decreased TLR4 and NF-κB mRNA (P=0.033 and P=0.024, respectively) and protein expression (P=0.032; P=0.027, respectively). Compared with the high glucose group, the RGCs survival rate increased significantly (P=0.037). Conclusions As a therapeutic target, HMGB-1 can inhibit inflammation and promote RGCs survival to delay DR progress through the HMGB-1-TLR4-NF-κB signaling pathway.
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Affiliation(s)
- Hailan Zhao
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Jingzhuang Zhang
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Jie Yu
- Department of Ophthalmology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (mainland)
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Jiang Q, Zhao F, Liu X, Li R, Liu J. Effect of miR-200b on retinal endothelial cell function under high glucose environment. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:10482-10487. [PMID: 26617758 PMCID: PMC4637573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/28/2015] [Indexed: 06/05/2023]
Abstract
As one of the important complications of diabetes, diabetic retinopathy (DR) presented high incidence worldwide. Hyperglycemia is an important promoting factor for DR occurrence and development. It can damage retinal endothelial cell, resulting in retinal structure and function disorder. Studies have shown that miR-200b may involve in regulating DR occurrence and development, but its specific function and mechanism have not been elucidated. This study aimed to investigate miR-200b effect and mechanism on human retinal endothelial cells (hRECs) under high glucose environment. hRECs were cultured under high glucose or normal environment. Real time PCR was applied to detect miR-200b expression. MiR-200b was transfected to hRECs and MTT was used to detect its effect on hRECs proliferation under high glucose environment. Real time PCR and Western blot were performed to determine VEGF and TGFβ1 expression in the retina endothelial cells. MiR-200b expression decreased significantly under high glucose environment, whereas hRECs proliferated obviously. Compared with normal control, VEGF and TGFβ1 mRNA and protein expression increased markedly (P < 0.05). After miR-200b transfection, miR-200b expression increased, while VEGF and TGFβ1 mRNA and protein expression decreased obviously. Compared with high glucose group, hRECs proliferation was inhibited (P < 0.05). MiR-200b can regulate RECs growth and proliferation by changing VEGF and TGFβ1 expression to delay DR.
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Affiliation(s)
- Qun Jiang
- Department of Ophthalmology, The Second Xiangya Hospital of Central South UniversityChangsha 410011, China
| | - Fei Zhao
- Department of Ophthalmology, The Second Xiangya Hospital of Central South UniversityChangsha 410011, China
| | - Xinmin Liu
- Department of Ophthalmology, The Second Xiangya Hospital of Central South UniversityChangsha 410011, China
| | - Rongrong Li
- The Third Xiangya Hospital of Central South UniversityChangsha 410013, China
| | - Jianming Liu
- The Third Xiangya Hospital of Central South UniversityChangsha 410013, China
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Vaziri K, Schwartz SG, Relhan N, Kishor KS, Flynn Jr HW. New Therapeutic Approaches in Diabetic Retinopathy. Rev Diabet Stud 2015; 12:196-210. [PMID: 26676668 PMCID: PMC5397990 DOI: 10.1900/rds.2015.12.196] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 04/30/2015] [Indexed: 12/15/2022] Open
Abstract
Diabetic retinopathy is a common microvascular complication of diabetes mellitus. It affects a substantial proportion of US adults over age 40. The condition is a leading cause of visual loss. Much attention has been given to expanding the role of current treatments along with investigating various novel therapies and drug delivery methods. In the treatment of diabetic macular edema (DME), intravitreal pharmacotherapies, especially anti-vascular endothelial growth factor (anti-VEGF) agents, have gained popularity. Currently, anti-VEGF agents are often used as first-line agents in center-involved DME, with recent data suggesting that among these agents, aflibercept leads to better visual outcomes in patients with worse baseline visual acuities. While photocoagulation remains the standard treatment for proliferative diabetic retinopathy (PDR), recent FDA approvals of ranibizumab and aflibercept in the management of diabetic retinopathy associated with DME may suggest a potential for pharmacologic treatments of PDR as well. Novel therapies, including small interfering RNAs, chemokines, kallikrein-kinin inhibitors, and various anti-angiogenic agents, are currently being evaluated for the management of diabetic retinopathy and DME. In addition to these strategies, novel drug delivery methods such as sustained-release implants and refillable reservoir implants are either under active evaluation or have recently gained FDA approval. This review provides an update on the novel developments in the treatment of diabetic retinopathy.
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Affiliation(s)
| | - Stephen G. Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136, USA
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