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Hammadi S, Tzoumas N, Ferrara M, Meschede IP, Lo K, Harris C, Lako M, Steel DH. Bruch's Membrane: A Key Consideration with Complement-Based Therapies for Age-Related Macular Degeneration. J Clin Med 2023; 12:2870. [PMID: 37109207 PMCID: PMC10145879 DOI: 10.3390/jcm12082870] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
The complement system is crucial for immune surveillance, providing the body's first line of defence against pathogens. However, an imbalance in its regulators can lead to inappropriate overactivation, resulting in diseases such as age-related macular degeneration (AMD), a leading cause of irreversible blindness globally affecting around 200 million people. Complement activation in AMD is believed to begin in the choriocapillaris, but it also plays a critical role in the subretinal and retinal pigment epithelium (RPE) spaces. Bruch's membrane (BrM) acts as a barrier between the retina/RPE and choroid, hindering complement protein diffusion. This impediment increases with age and AMD, leading to compartmentalisation of complement activation. In this review, we comprehensively examine the structure and function of BrM, including its age-related changes visible through in vivo imaging, and the consequences of complement dysfunction on AMD pathogenesis. We also explore the potential and limitations of various delivery routes (systemic, intravitreal, subretinal, and suprachoroidal) for safe and effective delivery of conventional and gene therapy-based complement inhibitors to treat AMD. Further research is needed to understand the diffusion of complement proteins across BrM and optimise therapeutic delivery to the retina.
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Affiliation(s)
- Sarah Hammadi
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Nikolaos Tzoumas
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Sunderland Eye Infirmary, Queen Alexandra Rd., Sunderland SR2 9H, UK
| | | | - Ingrid Porpino Meschede
- Gyroscope Therapeutics Limited, a Novartis Company, Rolling Stock Yard, 6th Floor, 188 York Way, London N7 9AS, UK
| | - Katharina Lo
- Gyroscope Therapeutics Limited, a Novartis Company, Rolling Stock Yard, 6th Floor, 188 York Way, London N7 9AS, UK
| | - Claire Harris
- Gyroscope Therapeutics Limited, a Novartis Company, Rolling Stock Yard, 6th Floor, 188 York Way, London N7 9AS, UK
- Clinical and Translational Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Majlinda Lako
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - David H. Steel
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Sunderland Eye Infirmary, Queen Alexandra Rd., Sunderland SR2 9H, UK
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Parrulli S, Cozzi M, Airaldi M, Romano F, Viola F, Sarzi‐Puttini P, Staurenghi G, Invernizzi A. Quantitative autofluorescence findings in patients undergoing hydroxychloroquine treatment. Clin Exp Ophthalmol 2022; 50:500-509. [PMID: 35503294 PMCID: PMC9545387 DOI: 10.1111/ceo.14090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Salvatore Parrulli
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Sacco Hospital University of Milan Milan Italy
| | - Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Sacco Hospital University of Milan Milan Italy
| | - Matteo Airaldi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Sacco Hospital University of Milan Milan Italy
| | - Francesco Romano
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Sacco Hospital University of Milan Milan Italy
| | - Francesco Viola
- Ophthalmological Unit Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
| | | | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Sacco Hospital University of Milan Milan Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco”, Sacco Hospital University of Milan Milan Italy
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology Sydney Medical School Sydney New South Wales Australia
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Pröbster C, Tarau IS, Berlin A, Kleefeldt N, Hillenkamp J, Nentwich MM, Sloan KR, Ach T. Quantitative Fundus Autofluorescence in the Developing and Maturing Healthy Eye. Transl Vis Sci Technol 2021; 10:15. [PMID: 34003900 PMCID: PMC7884289 DOI: 10.1167/tvst.10.2.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose Quantitative fundus autofluorescence (QAF) enables comparisons of autofluorescence intensities among participants. While clinical QAF reports mostly focused on the healthy and diseased adult retina, only very limited data of QAF in the maturing eye are available. Here, we report QAF in a large cohort of healthy children. Methods In this prospective monocentric cross-sectional study, 70 healthy Caucasian children (5–18 years) were multimodal imaged, including QAF and spectral domain optical coherence tomography. QAF and retinal thicknesses were measured at predefined locations (along horizontal meridian; Early Treatment Diabetic Retinopathy Study [ETDRS] grid) and correlated using custom written Fiji plugins. Standard retinae for different age groups were generated. Results Fifty-three participants were included. QAF was low in childhood but increased steadily (P < 0.001), also at the fovea (P < 0.001), with no gender differences (P = 0.61). The QAF distribution was similar to adults showing highest values superior-temporally. At individual points, retinal thickness remained stable, while using the ETDRS pattern, the retinal pigment epithelium (RPE) thickness increased significantly with aging. Standard QAF retinae of age groups also showed an increase with aging. Conclusions QAF can be reliably performed in young children. Function–structure correlation showed a thickening of the RPE and an increasing QAF with aging, probably related to the histologic low number of RPE autofluorescent granules at a younger age but further deposition of these granules during maturation. Standard retinae help to distinguish abnormal QAF in the diseased retina of age-matched patients. Translational Relevance Our data bridge the gap between preclinical QAF and clinical data application and structural OCT correlation in children.
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Affiliation(s)
- Carla Pröbster
- Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany
| | - Ioana-Sandra Tarau
- Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany
| | - Andreas Berlin
- Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany
| | - Nikolai Kleefeldt
- Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany
| | - Jost Hillenkamp
- Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany
| | - Martin M Nentwich
- Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany
| | - Kenneth R Sloan
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas Ach
- Department of Ophthalmology, University Hospital Würzburg, Würzburg, Germany.,Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
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Sevik MO, Aykut A, Özkan G, Dericioğlu V, Şahin Ö. The effect of COVID-19 pandemic restrictions on neovascular AMD patients treated with treat-and-extend protocol. Int Ophthalmol 2021; 41:2951-2961. [PMID: 33864577 PMCID: PMC8052549 DOI: 10.1007/s10792-021-01854-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/08/2021] [Indexed: 12/21/2022]
Abstract
Purpose To investigate the adherence rate of neovascular age-related macular degeneration (nAMD) patients in treat-and-extend (TAE) protocol to their anti-vascular endothelial growth factor (anti-VEGF) intravitreal injection (IVI) appointments and to evaluate the functional and anatomical outcomes of the patients who attended and did not attend their IVI appointments during the coronavirus disease 2019 (COVID-19) restriction period (RP). Methods The patients with nAMD having IVI appointments between March 16 and June 1, 2020 (RP in Turkey) were included in this retrospective study. For adherence analysis, the patients who attended (Group 1, n = 44) and who did not attend (Group 2, n = 60) their IVI appointment visits during the RP (VRP) were evaluated according to their last visit before the RP (V0). For outcome analysis, the patients who attend VRP and have follow-up (Group 1a, 46 eyes) and who did not attend VRP but later attended for follow-up (Group 2a, 33 eyes) were evaluated for functional (best-corrected visual acuity, BCVA [logMAR]) and anatomical (optical coherence tomography [OCT] disease activity) outcomes at the first visit after RP (V1) and last visit within six months after RP (V2). Patients received a complete ophthalmologic evaluation with anti-VEGF (Aflibercept) IVI administration at all visits. Results The adherence rate of the patients to VRP was 42.3% (44/104). The patients in Group 1 were significantly younger (mean ± SD years, 71.0 ± 8.1 vs. 74.7 ± 8.0, p = 0.024), had better median [IQR] BCVA at their first presentation (0.30 [0.54] vs. 0.61 [1.08], p = 0.023) and V0 (0.40 [0.48] vs. 0.52 [0.70], p = 0.031), and had less hypertension (36.4% vs. 58.3%, p = 0.044) than Group 2. The mean ± SD delay of planned IVI at VRP in Group 2a was 13.9 ± 6.2 weeks. Disease activity in OCT was significantly higher in Group 2a than Group 1a at V1 (60.6% vs. 32.6%, p = 0.025). In Group 2a, the median (IQR) BCVA was significantly worse at V1 (0.70 [0.58]) and V2 (0.70 [0.59]) than V0 (0.52 [0.40], p = 0.047 and p = 0.035, respectively). Conclusions More than half of the scheduled nAMD patients in TAE protocol missed their IVI visits during the RP, which resulted in a delay of their treatments. The delay of IVI treatment in those patients resulted in an increase in OCT disease activity and a decrease in BCVA.
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Affiliation(s)
- Mehmet Orkun Sevik
- Department of Ophthalmology, Marmara University School of Medicine, Fevzi Çakmak Mah, Muhsin Yazıcıoğlu Cd, No: 10, Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi, Kat: 3, Oftalmoloji Servisi, Pendik, 34899, Istanbul, Turkey.
| | - Aslan Aykut
- Department of Ophthalmology, Marmara University School of Medicine, Fevzi Çakmak Mah, Muhsin Yazıcıoğlu Cd, No: 10, Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi, Kat: 3, Oftalmoloji Servisi, Pendik, 34899, Istanbul, Turkey
| | - Gamze Özkan
- Department of Ophthalmology, Marmara University School of Medicine, Fevzi Çakmak Mah, Muhsin Yazıcıoğlu Cd, No: 10, Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi, Kat: 3, Oftalmoloji Servisi, Pendik, 34899, Istanbul, Turkey
| | - Volkan Dericioğlu
- Department of Ophthalmology, Marmara University School of Medicine, Fevzi Çakmak Mah, Muhsin Yazıcıoğlu Cd, No: 10, Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi, Kat: 3, Oftalmoloji Servisi, Pendik, 34899, Istanbul, Turkey
| | - Özlem Şahin
- Department of Ophthalmology, Marmara University School of Medicine, Fevzi Çakmak Mah, Muhsin Yazıcıoğlu Cd, No: 10, Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi, Kat: 3, Oftalmoloji Servisi, Pendik, 34899, Istanbul, Turkey
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