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Arianti A, Rusmayani E, Viona V. Insights into Ocular Emergencies: case Series on Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) Secondary to Acute Angle Closure Glaucoma. Int Med Case Rep J 2024; 17:507-519. [PMID: 38799384 PMCID: PMC11123065 DOI: 10.2147/imcrj.s458142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
This case series aims to report the manifestation of acute secondary optic neuropathy attributed to optic nerve injury associated with a singular episode of markedly elevated intraocular pressure (IOP) during an acute glaucoma attack. The correlation between acute primary angle-closure (APAC) and non-arteritic anterior ischemic optic neuropathy (NAION) remains uncertain within the context of current knowledge. Definitive conclusions regarding the causal relationship between APAC and NAION or their mutual influence cannot be established based on the current evidence. The association between these conditions is recognized as a potential link, and comprehensive research is imperative to elucidate their interrelationship thoroughly. This case series emphasizes the importance of promptly addressing acute optic nerve injury and neuropathy associated with elevated intraocular pressure (IOP) in patients with crowded disc anatomical risk factors. It underscores the need for proactive interventions to prevent irreversible damage, highlighting the infrequent yet vision-compromising occurrence of non-arteritic anterior ischemic optic neuropathy (NAION) in acute primary angle-closure (APAC).
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Affiliation(s)
- Alia Arianti
- Department of Neuro-Ophthalmology, Jakarta Eye Center (JEC) Eye Hospitals and Clinics, Jakarta, Indonesia
| | - Emma Rusmayani
- Department of Glaucoma, Jakarta Eye Center (JEC) Eye Hospitals and Clinics, Jakarta, Indonesia
| | - Viona Viona
- Department of Research, Jakarta Eye Center (JEC) Eye Hospitals and Clinics, Jakarta, Indonesia
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Li H, Li B, Zheng Y. Role of microglia/macrophage polarisation in intraocular diseases (Review). Int J Mol Med 2024; 53:45. [PMID: 38551157 PMCID: PMC10998719 DOI: 10.3892/ijmm.2024.5369] [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: 11/18/2023] [Accepted: 03/05/2024] [Indexed: 04/02/2024] Open
Abstract
Macrophages form a crucial component of the innate immune system, and their activation is indispensable for various aspects of immune and inflammatory processes, tissue repair, and maintenance of the balance of the body's state. Macrophages are found in all ocular tissues, spanning from the front surface, including the cornea, to the posterior pole, represented by the choroid/sclera. The neural retina is also populated by specialised resident macrophages called microglia. The plasticity of microglia/macrophages allows them to adopt different activation states in response to changes in the tissue microenvironment. When exposed to various factors, microglia/macrophages polarise into distinct phenotypes, each exhibiting unique characteristics and roles. Furthermore, extensive research has indicated a close association between microglia/macrophage polarisation and the development and reversal of various intraocular diseases. The present article provides a review of the recent findings on the association between microglia/macrophage polarisation and ocular pathological processes (including autoimmune uveitis, optic neuritis, sympathetic ophthalmia, retinitis pigmentosa, glaucoma, proliferative vitreoretinopathy, subretinal fibrosis, uveal melanoma, ischaemic optic neuropathy, retinopathy of prematurity and choroidal neovascularization). The paradoxical role of microglia/macrophage polarisation in retinopathy of prematurity is also discussed. Several studies have shown that microglia/macrophages are involved in the pathology of ocular diseases. However, it is required to further explore the relevant mechanisms and regulatory processes. The relationship between the functional diversity displayed by microglia/macrophage polarisation and intraocular diseases may provide a new direction for the treatment of intraocular diseases.
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Affiliation(s)
- Haoran Li
- School of Opthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610072, P.R. China
| | - Biao Li
- School of Opthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610072, P.R. China
| | - Yanlin Zheng
- School of Opthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610072, P.R. China
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Majeed HA, Al-Rubiay Y, Abbas AA, AL Nuaimi ME, Khammas HM, Alsaedi ZA, Al Jammal AM, Abdlhasn MM, Abdul-Gaffar AM, Mohammed OS, Abbood ZB, Badr BD, Fahad ZK, Abd-alzahra HAA, Al-dabbag HS, Mahmood L, Al-Qaseer MFT, Al-Khafaji ZNH, Shareef L. An overview of neuro-ophthalmic disorders at Jenna Ophthalmic Center, Baghdad, Iraq (2021-2022). J Med Life 2024; 17:99-108. [PMID: 38737659 PMCID: PMC11080512 DOI: 10.25122/jml-2023-0499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/05/2024] [Indexed: 05/14/2024] Open
Abstract
Neuro-ophthalmic disorders are often documented individually for each illness, with little data available on their overall incidence and pattern. The overall incidence of neuro-ophthalmic illnesses in Iraq is still not recorded. This study aimed to evaluate the clinical, demographic, and etiological features of patients seeking consultation at an Iraqi neuro-ophthalmology clinic. A prospective cross-sectional observational research was conducted at the Janna Ophthalmic Center in Baghdad, Iraq. The center serves a diverse patient population from various governorates. All newly diagnosed patients with neuro-ophthalmic disorders who visited the neuro-ophthalmological clinic, regardless of gender or age group, were included. The neuro-ophthalmologist established a diagnosis for each case by reviewing the patient's medical history, doing physical examinations, administering specific tests, and, in certain cases, using neuroimaging methods. The duration of the study was extended from March 2021 to November 2022. Among the 6440 patients evaluated, 613 cases were confirmed at the neuro-ophthalmology clinic. Ischemic optic neuropathy (NAION, AION, and PION) was the most prevalent diagnosis, accounting for 17.61% of newly reported cases in the field of neuro-ophthalmology. This was followed by sixth nerve palsy. Diabetes mellitus affected 42.7% of the cases, followed by hypertension, which affected 39.3% of the participants. The incidence of neuro-ophthalmic diseases tended to be high. Ischemic optic neuropathy and sixth nerve palsy, traumatic/compressive optic neuropathy, and papilledema were the most common neuro-ophthalmic disorders reported.
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Affiliation(s)
- Husam Abdulhadi Majeed
- Ibn Al-Haitham Teaching Eye Hospital, Baghdad Al-Russafa Health Directorate, Baghdad, Iraq
| | - Yasser Al-Rubiay
- Department of Surgery, College of Medicine, University of Baghdad, Baghdad, Iraq
| | | | | | | | | | | | - Mohamed Mosa Abdlhasn
- Ibn Al-Haitham Teaching Eye Hospital, Baghdad Al-Russafa Health Directorate, Baghdad, Iraq
| | - Ali Mhawi Abdul-Gaffar
- Ibn Al-Haitham Teaching Eye Hospital, Baghdad Al-Russafa Health Directorate, Baghdad, Iraq
| | | | - Zainab Basim Abbood
- Imamain Al-Kathimain Medical City, Al-Karkh Health Directorate, Baghdad, Iraq
| | | | | | | | - Hasan Sameer Al-dabbag
- Ibn Al-Haitham Teaching Eye Hospital, Baghdad Al-Russafa Health Directorate, Baghdad, Iraq
| | - Labeeb Mahmood
- Ibn Al-Haitham Teaching Eye Hospital, Baghdad Al-Russafa Health Directorate, Baghdad, Iraq
| | | | | | - Laith Shareef
- Department of Pharmacy, Al-Rasheed University College, Baghdad, Iraq
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4
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Salvetat ML, Pellegrini F, Spadea L, Salati C, Zeppieri M. Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION): A Comprehensive Overview. Vision (Basel) 2023; 7:72. [PMID: 37987292 PMCID: PMC10661278 DOI: 10.3390/vision7040072] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/25/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
Non-arteritic anterior ischemic optic neuropathy (NA-AION) represents one of the most important causes of blindness or severely impaired vision in middle-aged and elderly people. Unilateral optic disc edema and abrupt, painless vision loss are its defining features. It is commonly assumed that NA-AION is caused by an ischemic infarction of the optic nerve head, and, although the exact pathogenesis is still unknown, several risk factors and comorbidities associated with its development have been found. NA-AION occurs generally in patients older than 50 years who have small optic discs and vasculopathy risk factors. Even though numerous treatment options have been proposed, no available effective medical or surgical therapy or prophylactic measure for NA-AION currently exists. The purpose of present-day therapeutic strategies is therefore to identify and possibly control any underlying modifiable risk factors, aiming to prevent the development of new NA-AION episodes in the affected and fellow eye. A thorough assessment of NAION, including its history, epidemiology, etiology, pathophysiology, risk factors, associated comorbidities, clinical findings, diagnostic tests, treatment choices, prognosis, and future research, is the goal of this work.
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Affiliation(s)
- Maria Letizia Salvetat
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy; (M.L.S.)
| | - Francesco Pellegrini
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy; (M.L.S.)
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, 00142 Rome, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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Salvetat ML, Pellegrini F, Spadea L, Salati C, Zeppieri M. Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION): A Comprehensive Overview. Vision (Basel) 2023; 7:72. [DOI: : 10.3390/vision7040072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
Non-arteritic anterior ischemic optic neuropathy (NA-AION) represents one of the most important causes of blindness or severely impaired vision in middle-aged and elderly people. Unilateral optic disc edema and abrupt, painless vision loss are its defining features. It is commonly assumed that NA-AION is caused by an ischemic infarction of the optic nerve head, and, although the exact pathogenesis is still unknown, several risk factors and comorbidities associated with its development have been found. NA-AION occurs generally in patients older than 50 years who have small optic discs and vasculopathy risk factors. Even though numerous treatment options have been proposed, no available effective medical or surgical therapy or prophylactic measure for NA-AION currently exists. The purpose of present-day therapeutic strategies is therefore to identify and possibly control any underlying modifiable risk factors, aiming to prevent the development of new NA-AION episodes in the affected and fellow eye. A thorough assessment of NAION, including its history, epidemiology, etiology, pathophysiology, risk factors, associated comorbidities, clinical findings, diagnostic tests, treatment choices, prognosis, and future research, is the goal of this work.
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Affiliation(s)
- Maria Letizia Salvetat
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy
| | - Francesco Pellegrini
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, 00142 Rome, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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6
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Beyer TR, van Oterendorp C. [Nonarteritic anterior ischemic optic neuropathy (nAION)]. DIE OPHTHALMOLOGIE 2023; 120:1159-1169. [PMID: 37851117 DOI: 10.1007/s00347-023-01938-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/19/2023]
Abstract
Nonarteritic anterior ischemic optic neuropathy (nAION) is the second most common degenerative disease of the optic nerve. The pathogenesis remains elusive. A transient ischemia in the short posterior ciliary arteries not triggered by thromboembolic events is suspected. The typical history of a sudden onset of scotoma without associated pain in conjunction with (sectorial) optic disc swelling, an afferent pupillary defect and a visual field defect are of decisive diagnostic importance. The most urgent diagnostic measure is the exclusion of arteritic AION. There are no proven treatment approaches. Frequently used but without clear study results, is the treatment with steroids and secondary prophylaxis with acetylsalicylic acid (ASA). Recurrence in the ipsilateral or contralateral eye is possible.
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Affiliation(s)
- Tabea Rebecca Beyer
- Klinik für Augenheilkunde, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Christian van Oterendorp
- Klinik für Augenheilkunde, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
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Soucy JR, Aguzzi EA, Cho J, Gilhooley MJ, Keuthan C, Luo Z, Monavarfeshani A, Saleem MA, Wang XW, Wohlschlegel J, Baranov P, Di Polo A, Fortune B, Gokoffski KK, Goldberg JL, Guido W, Kolodkin AL, Mason CA, Ou Y, Reh TA, Ross AG, Samuels BC, Welsbie D, Zack DJ, Johnson TV. Retinal ganglion cell repopulation for vision restoration in optic neuropathy: a roadmap from the RReSTORe Consortium. Mol Neurodegener 2023; 18:64. [PMID: 37735444 PMCID: PMC10514988 DOI: 10.1186/s13024-023-00655-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023] Open
Abstract
Retinal ganglion cell (RGC) death in glaucoma and other optic neuropathies results in irreversible vision loss due to the mammalian central nervous system's limited regenerative capacity. RGC repopulation is a promising therapeutic approach to reverse vision loss from optic neuropathies if the newly introduced neurons can reestablish functional retinal and thalamic circuits. In theory, RGCs might be repopulated through the transplantation of stem cell-derived neurons or via the induction of endogenous transdifferentiation. The RGC Repopulation, Stem Cell Transplantation, and Optic Nerve Regeneration (RReSTORe) Consortium was established to address the challenges associated with the therapeutic repair of the visual pathway in optic neuropathy. In 2022, the RReSTORe Consortium initiated ongoing international collaborative discussions to advance the RGC repopulation field and has identified five critical areas of focus: (1) RGC development and differentiation, (2) Transplantation methods and models, (3) RGC survival, maturation, and host interactions, (4) Inner retinal wiring, and (5) Eye-to-brain connectivity. Here, we discuss the most pertinent questions and challenges that exist on the path to clinical translation and suggest experimental directions to propel this work going forward. Using these five subtopic discussion groups (SDGs) as a framework, we suggest multidisciplinary approaches to restore the diseased visual pathway by leveraging groundbreaking insights from developmental neuroscience, stem cell biology, molecular biology, optical imaging, animal models of optic neuropathy, immunology & immunotolerance, neuropathology & neuroprotection, materials science & biomedical engineering, and regenerative neuroscience. While significant hurdles remain, the RReSTORe Consortium's efforts provide a comprehensive roadmap for advancing the RGC repopulation field and hold potential for transformative progress in restoring vision in patients suffering from optic neuropathies.
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Affiliation(s)
- Jonathan R Soucy
- Department of Ophthalmology, Schepens Eye Research Institute of Mass. Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Erika A Aguzzi
- The Institute of Ophthalmology, University College London, London, England, UK
| | - Julie Cho
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Michael James Gilhooley
- The Institute of Ophthalmology, University College London, London, England, UK
- Moorfields Eye Hospital, London, England, UK
| | - Casey Keuthan
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ziming Luo
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Aboozar Monavarfeshani
- Center for Brain Science and Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, USA
- Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, USA
| | - Meher A Saleem
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, FL, USA
| | - Xue-Wei Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Petr Baranov
- Department of Ophthalmology, Schepens Eye Research Institute of Mass. Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Adriana Di Polo
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
- University of Montreal Hospital Research Centre, Montreal, QC, Canada
| | - Brad Fortune
- Discoveries in Sight Research Laboratories, Devers Eye Institute and Legacy Research Institute, Legacy Health, Portland, OR, USA
| | - Kimberly K Gokoffski
- Department of Ophthalmology, Roski Eye Institute, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey L Goldberg
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - William Guido
- Department of Anatomical Sciences and Neurobiology, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Alex L Kolodkin
- The Solomon H Snyder, Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carol A Mason
- Departments of Pathology and Cell Biology, Neuroscience, and Ophthalmology, College of Physicians and Surgeons, Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY, USA
| | - Yvonne Ou
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Thomas A Reh
- Department of Biological Structure, University of Washington, Seattle, WA, USA
| | - Ahmara G Ross
- Departments of Ophthalmology and Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian C Samuels
- Department of Ophthalmology and Visual Sciences, Callahan Eye Hospital, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Derek Welsbie
- Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California, San Diego, CA, USA
| | - Donald J Zack
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, 21287 MD, USA
- Departments of Neuroscience, Molecular Biology & Genetics, and Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas V Johnson
- Departments of Neuroscience, Molecular Biology & Genetics, and Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Cellular & Molecular Medicine Program, Johns Hopkins University School of Medicine, Baltimore, 21287 MD, USA.
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Engin KN, Harmancı Karagülle D, Durmaz Engin C, Kant M, Yaman A, Akış M, Özel Yıldız S, İşlekel H, Güner Akdoğan G, Söylev Bajin M. Is the clinical course of non-arteritic ischemic optic neuropathy associated with oxidative damage and the dynamics of the antioxidant response? Int Ophthalmol 2023; 43:2935-2945. [PMID: 37029212 DOI: 10.1007/s10792-023-02699-x] [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: 12/06/2021] [Accepted: 03/24/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE Oxidative stress is known to be a decisive factor in the wide etiopathogenesis of optic neuropathy. This study aimed to comprehensively evaluate the interaction of optic neuropathy's clinical course with systemic oxidative damage and antioxidant response dynamics in a large series. METHODS This case-controlled clinical study included 33 non-arteritic anterior ischemic optic neuropathy (NAION) patients and 32 healthy individuals. Extensive systemic oxidation profiles were statistically compared between the two groups, and correlations between the clinical and biochemical data in the study group were analyzed. RESULTS Vitamin E and malondialdehyde (MDA) levels were significantly higher in the study group. Significant correlations were observed in the analyses between clinical findings and oxidative stress parameters. Correlations between vitamin E and intraocular pressure (IOP), between B12 and cup-to-disk ratio (c/d), between antioxidant glutathione and superoxide dismutase (SOD) enzyme systems, and between uric acid (UA) and age were found to be very significant. As significant correlations were found in either clinical and biochemical data or in oxidative stress parameters, correlations between vitamin E and cholesterol, MDA were found to be very significant. CONCLUSIONS This study not only supplies significant information regarding oxidative damage and antioxidant response in NAION, but also points out the specific interactions of neuromodulators, like vitamin E, in intracellular signaling pathways and regulation mechanisms. A better reading of these connections may help improve diagnosis, follow-ups and treatment criteria and strategies.
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Affiliation(s)
- Kaya Nusret Engin
- Department of Ophthalmology, Ümraniyemraniye Education and Research Hospital, Sağlık University, Elmalıkent Mh. Ümraniye, 34764, Istanbul, Turkey.
| | - Duygu Harmancı Karagülle
- Graduate School of Health Science, Department of Molecular Genetics, Dokuz Eylül University, Izmir, Turkey
| | - Ceren Durmaz Engin
- Faculty of Medicine, Department of Ophthalmology, Dokuz Eylül University, Izmir, Turkey
| | - Melis Kant
- Faculty of Medicine, Department of Biochemistry, Dokuz Eylül University, Izmir, Turkey
| | - Aylin Yaman
- Faculty of Medicine, Department of Ophthalmology, Dokuz Eylül University, Izmir, Turkey
| | - Merve Akış
- Faculty of Medicine, Department of Biochemistry, Dokuz Eylül University, Izmir, Turkey
| | - Sevda Özel Yıldız
- Istanbul Faculty of Medicine, Department of Biostatistics, Istanbul University, Istanbul, Turkey
| | - Hüray İşlekel
- Graduate School of Health Science, Department of Molecular Genetics, Dokuz Eylül University, Izmir, Turkey
- Faculty of Medicine, Department of Biochemistry, Dokuz Eylül University, Izmir, Turkey
| | - Gül Güner Akdoğan
- Department of Medical Biochemistry, School of Medicine, Izmir University of Economics, Izmir, Turkey
| | - Meltem Söylev Bajin
- Faculty of Medicine, Department of Ophthalmology, Dokuz Eylül University, Izmir, Turkey
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Ganatra S, Panchal B, Pathengay A, Sachdeva V. Differentiating Occult Neuroretinitis and Non-Arteritic Anterior Ischaemic Optic Neuropathy: Clinical and Optical Coherence Tomography Characteristics. Neuroophthalmology 2023; 47:208-217. [PMID: 37434671 PMCID: PMC10332201 DOI: 10.1080/01658107.2023.2220778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/01/2023] [Accepted: 05/23/2023] [Indexed: 07/13/2023] Open
Abstract
We report clinical and optical coherence tomography (OCT) differences among patients with occult neuroretinitis and non-arteritic anterior ischaemic optic neuropathy (NAAION). We retrospectively reviewed records of patients with a final diagnosis of occult neuroretinitis and NAAION seen at our institute. Data were collected regarding patient demographics, clinical features, concomitant systemic risk factors, visual function, and optical coherence tomography (OCT) findings at presentation and subsequent follow-up. Fourteen and 16 patients were diagnosed to have occult neuroretinitis and NAAION, respectively. Patients with NAAION were slightly older (median age 49, inter-quartile range [IQR]: 45-54 years, versus 41, IQR: 31-50 years) than patients with neuroretinitis. Seventy-five per cent of patients with NAAION were male versus 43% with neuroretinitis (p = 0.07). Systemic risk factors were present in 87.5% of patients with NAAION versus 21.4% in patients with neuroretinitis (p = 0.001). At presentation, all patients presented with blurred vision, had similar visual function, and had optic disc oedema. In addition, none of the patients had evident retinitis lesions, but 10 (71%) showed evident retinitis lesion at follow-up. Neuroretinitis patients had more often vitreous cells (64% versus 6%, p = 0.001), and subretinal fluid (78.6% versus 37.5%, p = 0.03) than the patients with NAAION. In summary, NAAION patients tended to be slightly older, more often male, and had associated systemic diseases more often than those with neuroretinitis. Neuroretinitis patients more often had posterior vitreous cells and subretinal fluid on OCT. However, larger prospective studies are needed.
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Affiliation(s)
- Snehal Ganatra
- Child Sight Institute, Nimmagadda Prasad Children’s Eye Care Centre, L V Prasad Eye Institute, Visakhapatnam, India
| | - Bhavik Panchal
- Vitreoretina and Uveitis Services, L V Prasad Eye Institute, Visakhapatnam, India
| | - Avinash Pathengay
- Vitreoretina and Uveitis Services, L V Prasad Eye Institute, Visakhapatnam, India
| | - Virender Sachdeva
- Child Sight Institute, Nimmagadda Prasad Children’s Eye Care Centre, L V Prasad Eye Institute, Visakhapatnam, India
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10
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Chen YH, Huang YC, Chen CH, Wen YT, Tsai RK, Chen C. Investigation of the Protective Effect of Extracellular Vesicle miR-124 on Retinal Ganglion Cells Using a Photolabile Paper-Based Chip. Invest Ophthalmol Vis Sci 2023; 64:17. [PMID: 36689234 PMCID: PMC9896847 DOI: 10.1167/iovs.64.1.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Purpose Photolabile paper-based chips were developed to isolate extracellular vesicles (EVs) from small-volume samples (less than 30 µL), such as vitreous humor. Putative neuroprotective effects of EVs' microRNAs were investigated by using the paper chip and a rodent model with nonarteritic anterior ischemic optic neuropathy (rNAION). Methods rNAION was established using laser-induced photoactivation of rose bengal administered intravenously. On days 0, 0.25, 1, 3, and 7 after rNAION induction, CD63-positive EV microRNAs (CD63+-EV miRNAs) in vitreous humor samples were enriched using the paper chip and assessed using microarray and quantitative RT-PCR analyses. The viability and visual function of retinal ganglion cells (RGCs) were further assessed by measuring photopic flash visual evoked potentials (FVEPs). Results We identified 38 different variations of CD63+-EV miRNAs with more than twofold altered expressions. Among them, M1-related miRNA, mR-31a-5p, and M2-related miRNA, miR-125a-5p, miR-182, miR-181a-5p, and miR-124-3, were capable of coordinating anti-inflammatory reactions during rNAION because of their capacity to activate macrophages. In particular, miR-124, having the most dramatic alteration of gene expression, was synthesized and injected intravitreally. Compared to controls, rats that received miR-124 had shown increased RGC survivability and improved visual function. Conclusions Our research team has developed a paper-based chip capable of capturing EVs that can be released after UV exposure. The quantity and quality of EV-miRNAs extracted are adequate for microarray and quantitative RT-PCR analyses. Animal studies suggest that miR-124 may play a neuroprotective role in the natural recovery of rNAION and holds the potential to be a novel treatment option.
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Affiliation(s)
- Yi-Hsun Chen
- Institution of NanoEngineering and MicroSystems, Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, Taiwan,Biomedical Technology and Device Research Laboratories (BDL), Industrial Technology Research Institute (ITRI), Hsinchu, Taiwan
| | - Yu Chuan Huang
- School of Pharmacy & Institute Pharmacy, National Defense Medical Center, Taipei, Republic of China,Department of Research and Development, National Defense Medical Center, Taipei, Republic of China
| | - Chih-Hung Chen
- Biomedical Technology and Device Research Laboratories (BDL), Industrial Technology Research Institute (ITRI), Hsinchu, Taiwan
| | - Yao-Tseng Wen
- Institute of Eye Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Rong-Kung Tsai
- Institute of Eye Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Chihchen Chen
- Institution of NanoEngineering and MicroSystems, Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, Taiwan
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Pugazhendhi S, Yu M, Zhou G, Chen Y, Wang R, Liao YJ. Peripapillary and macular microvasculature features of non-arteritic anterior ischemic optic neuropathy. Front Med (Lausanne) 2023; 9:1033838. [PMID: 36714135 PMCID: PMC9877420 DOI: 10.3389/fmed.2022.1033838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023] Open
Abstract
Purpose The hallmark of non-arteritic anterior ischemic optic neuropathy (NAION) is vascular compromise to the anterior optic nerve and thinning of the retinal nerve fiber layer (RNFL) and secondary degeneration of the retinal ganglion cell body or thinning of the ganglion cell complex (GCC). This study investigates optical coherence tomography (OCT) and OCT Angiography (OCTA) changes in chronic NAION and identifies imaging biomarkers that best predict disease. Methods We performed a retrospective case-control study of 24 chronic NAION eyes (18 patients) and 70 control eyes (45 patients) to compare both whole-eye and regional OCT, OCTA, static perimetry measurements. OCT measurements were quantified automatically using commercial software, and OCTA was analyzed using custom MATLAB script with large vessel removal to measure 154 total parameters per eye. Results We confirmed that static perimetry mean deviation (MD) was significantly worse in chronic NAION (-13.53 ± 2.36) than control (-0.47 ± 0.72; P < 0.001) eyes, and NAION eyes had 31 μm thinner RNFL (control: 95.9 ± 25.8 μm; NAION: 64.5 ± 18.0, P < 0.001), and 21.8 μm thinner GCC compared with controls (control: 81.5 ± 4.4 μm; NAION: 59.7 ± 10.5, P < 0.001). Spearman correlation analysis of OCTA parameters reveal that vessel area density (VAD) and flux are highly correlated with visual field MD and OCT measurements. Hierarchical clustering two distinct groups (NAION and control), where standardized measurements of NAION eyes were generally lower than controls. Two-way mixed ANOVAs showed significant interaction between patient status (control and chronic NAION) and structure (optic disk and macula) for annulus VAD and flux values and mean RNFL and GCC thickness. Post-hoc tests showed this effect stems from lower peripapillary values in NAION compared to controls. Separate logistic regression models with LASSO regularization identified VAD and flux are one of the best OCTA parameters for predicting NAION. Conclusion Ischemic insult to the optic disk is more severe likely from primary degeneration of the affected peripapillary region while macula is affected by secondary retrograde degeneration and loss of retinal ganglion cells. In addition to OCT measurements, peripapillary and macular vascular parameters such as VAD and flux are good predictors of optic nerve and retinal changes in NAION.
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Affiliation(s)
| | - Miaomiao Yu
- Department of Ophthalmology, School of Medicine, Stanford University, Stanford, CA, United States
| | - Gabriella Zhou
- Department of Bioengineering, University of Washington, Seattle, WA, United States
| | - Yuxuan Chen
- Department of Bioengineering, University of Washington, Seattle, WA, United States
| | - Ruikang Wang
- Department of Bioengineering, University of Washington, Seattle, WA, United States,Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | - Yaping Joyce Liao
- Department of Ophthalmology, School of Medicine, Stanford University, Stanford, CA, United States,Department of Neurology, School of Medicine, Stanford University, Stanford, CA, United States,*Correspondence: Yaping Joyce Liao,
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12
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Rangel B, Mesentier-Louro LA, Lowe LL, Shariati AM, Dalal R, Imventarza JA, Liao YJ. Upregulation of retinal VEGF and connexin 43 in murine nonarteritic anterior ischemic optic neuropathy induced with 577 nm laser. Exp Eye Res 2022; 225:109139. [PMID: 35691373 PMCID: PMC10870834 DOI: 10.1016/j.exer.2022.109139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/08/2022] [Accepted: 06/01/2022] [Indexed: 12/29/2022]
Abstract
Nonarteritic anterior ischemic optic neuropathy (NAION) is a common acute optic neuropathy and cause of irreversible vision loss in those older than 50 years of age. There is currently no effective treatment for NAION and the biological mechanisms leading to neuronal loss are not fully understood. Promising novel targets include glial cells activation and intercellular communication mediated by molecules such as gap junction protein Connexin 43 (Cx43), which modulate neuronal fate in central nervous system disorders. In this study, we investigated retinal glial changes and neuronal loss following a novel NAION animal model using a 577 nm yellow laser. We induced unilateral photochemical thrombosis using rose bengal at the optic nerve head vasculature in adult C57BL/6 mice using a 577 nm laser and performed morphometric analysis of the retinal structure using serial in vivo optical coherence tomography (OCT) and histology for glial and neuronal markers. One day after experimental NAION, in acute phase, OCT imaging revealed peripapillary thickening of the retinal ganglion cell complex (GCC, baseline: 79.5 ± 1.0 μm, n = 8; NAION: 93.0 ± 2.5 μm, n = 8, P < 0.01) and total retina (baseline: 202.9 ± 2.4 μm, n = 8; NAION: 228.1 ± 6.8 μm, n = 8, P < 0.01). Twenty-one days after ischemia, at a chronic phase, there was significant GCC thinning (baseline 78.3 ± 2.1 μm, n = 6; NAION: 72.2 ± 1.9 μm, n = 5, P < 0.05), mimicking human disease. Examination of molecular changes in the retina one day after ischemia revealed that NAION induced a significant increase in retinal VEGF levels (control: 2319 ± 195, n = 5; NAION: 4549 ± 683 gray mean value, n = 5, P < 0.05), which highly correlated with retinal thickness (r = 0.89, P < 0.05). NAION also led to significant increase in mRNA level for Cx43 (Gj1a) at day 1 (control: 1.291 ± 0.38; NAION: 3.360 ± 0.58 puncta/mm2, n = 5, P < 0.05), but not of glial fibrillary acidic protein (Gfap) at the same time (control: 2,800 ± 0.59; NAION: 4,690 ± 0.90 puncta/mm2 n = 5, P = 0.19). Retinal ganglion cell loss at day 21 was confirmed by a 30% decrease in Brn3a+ cells (control: 2,844 ± 235; NAION: 2,001 ± 264 cells/mm2, n = 4, P < 0.05). We described a novel protocol of NAION induction by photochemical thrombosis using a 577 nm laser, leading to retinal edema and VEGF increase at day 1 and RGCs loss at day 21 after injury, consistent with the pathophysiology of human NAION. Early changes in glial cells intercommunication revealed by increased Cx43+ gap junctions are consistent with a retinal glial role in mediating cell-to-cell signaling after an ischemic insult. Our study demonstrates an early glial response in a novel NAION animal model and reveals glial intercommunication molecules such as Cx43 as a promising therapeutic target in acute NAION.
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Affiliation(s)
- Barbara Rangel
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, 94303, USA
| | | | - Lauryn L Lowe
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, 94303, USA
| | - Ali Mohammad Shariati
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, 94303, USA
| | - Roopa Dalal
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, 94303, USA
| | - Joel A Imventarza
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, 94303, USA
| | - Yaping Joyce Liao
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, 94303, USA; Department of Neurology, Stanford University School of Medicine, Stanford, CA, 94304, USA.
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13
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Construction and functional enrichment analysis of the competitive endogenous RNA regulatory network for nonarteritic anterior ischemic optic neuropathy based on high-throughput sequencing. Funct Integr Genomics 2022; 22:1253-1267. [DOI: 10.1007/s10142-022-00914-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/26/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022]
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14
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Transcriptomic Analysis Reveals That Granulocyte Colony-Stimulating Factor Trigger a Novel Signaling Pathway (TAF9-P53-TRIAP1-CASP3) to Protect Retinal Ganglion Cells after Ischemic Optic Neuropathy. Int J Mol Sci 2022; 23:ijms23158359. [PMID: 35955492 PMCID: PMC9368818 DOI: 10.3390/ijms23158359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023] Open
Abstract
Optic nerve head (ONH) infarct can result in progressive retinal ganglion cell (RGC) death. The granulocyte colony-stimulating factor (GCSF) protects the RGC after ON infarct. However, protective mechanisms of the GCSF after ONH infarct are complex and remain unclear. To investigate the complex mechanisms involved, the transcriptome profiles of the GCSF-treated retinas were examined using microarray technology. The retinal mRNA samples on days 3 and 7 post rat anterior ischemic optic neuropathy (rAION) were analyzed by microarray and bioinformatics analyses. GCSF treatment influenced 3101 genes and 3332 genes on days 3 and 7 post rAION, respectively. ONH infarct led to changes in 702 and 179 genes on days 3 and 7 post rAION, respectively. After cluster analysis, the levels of TATA box-binding protein (TBP)-associated factor were significantly reduced after ONH infarct, but these significantly increased after GCSF treatment. The network analysis revealed that TBP associated factor 9 (TAF9) can bind to P53 to induce TP53-regulated inhibitor of apoptosis 1 (TRIAP1) expression. To evaluate the function of TAF9 in RGC apoptosis, GCSF plus TAF9 siRNA-treated rats were evaluated using retrograde labeling with FluoroGold assay, TUNEL assay, and Western blotting in an rAION model. The RGC densities in the GCSF plus TAF9 siRNA-treated rAION group were 1.95-fold (central retina) and 1.75-fold (midperipheral retina) lower than that in the GCSF-treated rAION group (p < 0.05). The number of apoptotic RGC in the GCSF plus TAF9 siRNA-treated group was threefold higher than that in the GCSF-treated group (p < 0.05). Treatment with TAF9 siRNA significantly reduced GCSF-induced TP53 and TRIAP1 expression by 2.4-fold and 4.7-fold, respectively, in the rAION model. Overexpression of TAF9 significantly reduced apoptotic RGC and CASP3 levels, and induced TP53 and TRIAP1 expression in the rAION model. Therefore, we have demonstrated that GCSF modulated a new pathway, TAF9-P53-TRIAP1-CASP3, to control RGC death and survival after ON infarct.
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15
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Sharif NA. Degeneration of retina-brain components and connections in glaucoma: Disease causation and treatment options for eyesight preservation. CURRENT RESEARCH IN NEUROBIOLOGY 2022; 3:100037. [PMID: 36685768 PMCID: PMC9846481 DOI: 10.1016/j.crneur.2022.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 01/25/2023] Open
Abstract
Eyesight is the most important of our sensory systems for optimal daily activities and overall survival. Patients who experience visual impairment due to elevated intraocular pressure (IOP) are often those afflicted with primary open-angle glaucoma (POAG) which slowly robs them of their vision unless treatment is administered soon after diagnosis. The hallmark features of POAG and other forms of glaucoma are damaged optic nerve, retinal ganglion cell (RGC) loss and atrophied RGC axons connecting to various brain regions associated with receipt of visual input from the eyes and eventual decoding and perception of images in the visual cortex. Even though increased IOP is the major risk factor for POAG, the disease is caused by many injurious chemicals and events that progress slowly within all components of the eye-brain visual axis. Lowering of IOP mitigates the damage to some extent with existing drugs, surgical and device implantation therapeutic interventions. However, since multifactorial degenerative processes occur during aging and with glaucomatous optic neuropathy, different forms of neuroprotective, nutraceutical and electroceutical regenerative and revitalizing agents and processes are being considered to combat these eye-brain disorders. These aspects form the basis of this short review article.
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Affiliation(s)
- Najam A. Sharif
- Duke-National University of Singapore Medical School, Singapore,Singapore Eye Research Institute (SERI), Singapore,Department of Pharmacology and Neuroscience, University of North Texas Health Sciences Center, Fort Worth, Texas, USA,Department of Pharmaceutical Sciences, Texas Southern University, Houston, TX, USA,Department of Surgery & Cancer, Imperial College of Science and Technology, St. Mary's Campus, London, UK,Department of Pharmacy Sciences, School of School of Pharmacy and Health Professions, Creighton University, Omaha, NE, USA,Ophthalmology Innovation Center, Santen Incorporated, 6401 Hollis Street (Suite #125), Emeryville, CA, 94608, USA,Ophthalmology Innovation Center, Santen Incorporated, 6401 Hollis Street (Suite #125), Emeryville, CA, 94608, USA.
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16
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The Efficacy of Glucocorticoids in the Treatment of Nonarteritic Anterior Ischemic Optic Neuropathy: A Systematic Review and Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2935992. [PMID: 35341003 PMCID: PMC8956449 DOI: 10.1155/2022/2935992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 01/30/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022]
Abstract
Background. To evaluate the clinical effects and safety of glucocorticoids for patients with nonarteritic anterior ischemic optic neuropathy (NAION). Methods. The databases MEDLINE, Embase, PubMed, Cochrane Database, and Web of Science were used to search for the relevant studies, and full-text articles that reported on the evaluation of glucocorticoids vs. no-treatment or placebo for patients with NAION. Review Manager 5.4 was used to estimate the pooled effects of the results among selected studies. Forest plots, funnel plots, and Begg’s rank correlation were also performed on the included articles. Results. A total of 983 patients were contained in the 9 studies that satisfied the eligibility criteria. The meta-analysis showed that, compared with the control group, the glucocorticoid group had significantly improved the VA (MD: -0.25, 95% CI [-0.45, -0.05],
), VF (MD: -0.50, 95% CI [-0.94, -0.07],
), and RNFL (MD: -14.10, 95% CI [-26.41, -1.79],
) in NAION patients and had a high improvement rate of VA (RR 1.31, 95% CI [1.12, 1.52],
). No significant publication bias was observed in our study. Discussion. Our research preliminarily confirmed the effectiveness of glucocorticoids for NAION treatment, but more high-quality RCTs focusing on the hormone adverse reactions should be performed to verify our conclusions.
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17
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Gibbons A, Henderson AD. Non-Arteritic Anterior Ischemic Optic Neuropathy: Challenges for the Future. FRONTIERS IN OPHTHALMOLOGY 2022; 2:848710. [PMID: 38983540 PMCID: PMC11182325 DOI: 10.3389/fopht.2022.848710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/23/2022] [Indexed: 07/11/2024]
Affiliation(s)
- Alison Gibbons
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Amanda D Henderson
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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18
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Chou YY, Chien JY, Ciou JW, Huang SP. The Protective Effects of n-Butylidenephthalide on Retinal Ganglion Cells during Ischemic Injury. Int J Mol Sci 2022; 23:ijms23042095. [PMID: 35216208 PMCID: PMC8877670 DOI: 10.3390/ijms23042095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/05/2022] [Accepted: 02/10/2022] [Indexed: 12/13/2022] Open
Abstract
Clinically, acute ischemic symptoms in the eyes are one of the main causes of vision loss, with the associated inflammatory response and oxidative stress being the key factors that cause injury. Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common type of ischemic optic neuropathy (ION); however, there are still no effective or safe treatment options to date. In this study, we investigated the neuroprotective effects of n-butylidenephthalide (BP) treatment in an experimental NAION rodent model (rAION). BP (10 mg/kg) or PBS (control group) were administered on seven consecutive days in the rAION model. Rats were evaluated for visual function by flash visual evoked potentials (FVEPs) at 4 weeks after NAION induction. The retina and optic nerve were removed for histological examination after the rats were euthanized. The molecular machinery of BP treatment in the rAION model was analyzed using Western blotting. We discovered that BP effectively improves retinal ganglion cell survival rates by preventing apoptotic processes after AION induction and reducing the inflammatory response through which blood-borne macrophages infiltrate the optic nerve. In addition, BP significantly preserved the integrity of the myelin sheath in the rAION model, demonstrating that BP can prevent the development of demyelination. Our immunoblotting results revealed the molecular mechanism through which BP mitigates the neuroinflammatory response through inhibition of the NF-κB signaling pathway. Taken together, these results demonstrate that BP can be used as an exceptional neuroprotective agent for ischemic injury.
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Affiliation(s)
- Yu-Yau Chou
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 970, Taiwan; (Y.-Y.C.); (J.-W.C.)
| | - Jia-Ying Chien
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan;
| | - Jhih-Wei Ciou
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 970, Taiwan; (Y.-Y.C.); (J.-W.C.)
| | - Shun-Ping Huang
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 970, Taiwan; (Y.-Y.C.); (J.-W.C.)
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan;
- Department of Ophthalmology, Taichung Tzu Chi Hospital, Taichung 472, Taiwan
- Correspondence: ; Tel.: +886-3-8565-301 (ext. 2664)
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19
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Johnson MA, Mehrabian Z, Guo Y, Ghosh J, Brigell MG, Bernstein SL. Anti-NOGO Antibody Neuroprotection in a Rat Model of NAION. Transl Vis Sci Technol 2021; 10:12. [PMID: 34904998 PMCID: PMC8684297 DOI: 10.1167/tvst.10.14.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose To evaluate the efficacy and mechanisms of anti-NOGO receptor monoclonal antibody 11C7mAb in a rat model of nonarteritic anterior ischemic optic neuropathy (rNAION). Methods The rNAION was induced in one eye of 20 Long-Evans rats, which were studied in 10 groups of two rats, each group containing a sham rat receiving intravitreal injections of vehicle and a treatment rat receiving intravitreal injections of 11C7mAb. Fellow eyes served as naïve controls. The rats were tested using flash electroretinograms (ERGs), flash visual evoked potentials (VEPs), and optical coherence tomography (OCT). Thirty days after induction, they were euthanized, and the eyes were prepared for immunohistochemistry (two groups), hematoxylin and eosin staining (two groups) or transmission electron microscopy (TEM; six groups). Results Ninety-five percent of the VEP amplitude was preserved in eyes treated with 11C7mAb, versus 69% in the control eyes. Immunohistochemistry revealed a large reduction in microglia and extrinsic macrophages with axon sparing. In addition to axon preservation, TEM also showed reduced extracellular debris and only slight myelin damage compared with the vehicle-treated animals. There were no significant differences in retinal ganglion cell counts, nor was there a difference in optic nerve swelling as measured by OCT. ERGs were used to exclude eyes with retinal vascular occlusions, an occasional complication of the induction technique. Conclusions The 11C7mAb preserves optic nerve integrity and reduces inflammation in rNAION. Translational Relevance This study evaluates the efficacy of an anti-NOGO receptor antibody in a rat model of NAION, a disorder that currently has no universally-acknowledged treatment.
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Affiliation(s)
- Mary A Johnson
- Department of Ophthalmology & Visual Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Zara Mehrabian
- Department of Ophthalmology & Visual Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yan Guo
- Department of Ophthalmology & Visual Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joy Ghosh
- Eventide Asset Management, LLC, Boston, MA, USA
| | | | - Steven L Bernstein
- Department of Ophthalmology & Visual Science, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Anatomy and Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
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Chien JY, Chou YY, Ciou JW, Liu FY, Huang SP. The Effects of Two Nrf2 Activators, Bardoxolone Methyl and Omaveloxolone, on Retinal Ganglion Cell Survival during Ischemic Optic Neuropathy. Antioxidants (Basel) 2021; 10:antiox10091466. [PMID: 34573098 PMCID: PMC8470542 DOI: 10.3390/antiox10091466] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 12/19/2022] Open
Abstract
Nonarteritic anterior ischemic optic neuropathy (NAION) is one of the most common acute optic neuropathies that affect the over 55-year-old population. NAION causes the loss of visual function, and it has no safe and effective therapy. Bardoxolone methyl (methyl 2-cyano-3,12-dioxooleana-1,9(11)-dien-28-oate; CDDO-Me; RTA 402) is a semisynthetic triterpenoid with effects against antioxidative stress and inflammation in neurodegeneration and kidney disease that activates the nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway. Moreover, RTA 402 is an FDA-approved compound for the treatment of solid tumors, lymphoid malignancies, melanoma, and chronic kidney disease. Omaveloxolone (RTA 408) is an activator of Nrf2 and an inhibitor of NFκB, possessing antioxidative and anti-inflammatory activities in mitochondrial bioenergetics. RTA 408 is also under clinical investigation for Friedreich ataxia (FA). In this study, a rodent anterior ischemic optic neuropathy (rAION) model induced by photothrombosis was used to examine the therapeutic effects of RTA 402 and RTA 408. Treatment with RTA402 results in antiapoptotic, antioxidative stress, anti-inflammatory, and myelin-preserving effects on retinal ganglion cell (RGC) survival and visual function via regulation of NQO1 and HO-1, reduced IL-6 and Iba1 expression in macrophages, and promoted microglial expression of TGF-β and Ym1 + 2 in the retina and optic nerve. However, these effects were not observed after RTA 408 treatment. Our results provide explicit evidence that RTA 402 modulates the Nrf2 and NFκB signaling pathways to protect RGCs from apoptosis and maintain the visual function in an rAION model. These findings indicate that RTA 402 may a potential therapeutic agent for ischemic optic neuropathy.
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Affiliation(s)
- Jia-Ying Chien
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan;
| | - Yu-Yau Chou
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 970, Taiwan; (Y.-Y.C.); (J.-W.C.); (F.-Y.L.)
| | - Jhih-Wei Ciou
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 970, Taiwan; (Y.-Y.C.); (J.-W.C.); (F.-Y.L.)
| | - Fang-Yun Liu
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 970, Taiwan; (Y.-Y.C.); (J.-W.C.); (F.-Y.L.)
| | - Shun-Ping Huang
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan;
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 970, Taiwan; (Y.-Y.C.); (J.-W.C.); (F.-Y.L.)
- Department of Ophthalmology, Tzu Chi University, Hualien 970, Taiwan
- Correspondence: ; Tel.: +886-3-8565301 (ext. 2664)
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21
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Chien JY, Lin SF, Chou YY, Huang CYF, Huang SP. Protective Effects of Oroxylin A on Retinal Ganglion Cells in Experimental Model of Anterior Ischemic Optic Neuropathy. Antioxidants (Basel) 2021; 10:antiox10060902. [PMID: 34204966 PMCID: PMC8226497 DOI: 10.3390/antiox10060902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 12/13/2022] Open
Abstract
Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common cause of acute vision loss in older people, and there is no effective therapy. The effect of the systemic or local application of steroids for NAION patients remains controversial. Oroxylin A (OA) (5,7-dihydroxy-6-methoxyflavone) is a bioactive flavonoid extracted from Scutellariae baicalensis Georgi. with various beneficial effects, including anti-inflammatory and neuroprotective effects. A previous study showed that OA promotes retinal ganglion cell (RGC) survival after optic nerve (ON) crush injury. The purpose of this research was to further explore the potential actions of OA in ischemic injury in an experimental anterior ischemic optic neuropathy (rAION) rat model induced by photothrombosis. Our results show that OA efficiently attenuated ischemic injury in rats by reducing optic disc edema, the apoptotic death of retinal ganglion cells, and the infiltration of inflammatory cells. Moreover, OA significantly ameliorated the pathologic changes of demyelination, modulated microglial polarization, and preserved visual function after rAION induction. OA activated nuclear factor E2 related factor (Nrf2) signaling and its downstream antioxidant enzymes NAD(P)H:quinone oxidoreductase (NQO-1) and heme oxygenase 1 (HO-1) in the retina. We demonstrated that OA activates Nrf2 signaling, protecting retinal ganglion cells from ischemic injury, in the rAION model and could potentially be used as a therapeutic approach in ischemic optic neuropathy.
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Affiliation(s)
- Jia-Ying Chien
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan;
| | - Shu-Fang Lin
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
| | - Yu-Yau Chou
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 970, Taiwan;
| | - Chi-Ying F. Huang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
- Institute of Biopharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Correspondence: (C.-Y.F.H.); (S.-P.H.); Tel.: +886-2-28267904 (C.-Y.F.H.); +886-3-8565301#2664 (S.-P.H.)
| | - Shun-Ping Huang
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan;
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien 970, Taiwan;
- Department of Ophthalmology, Taichung Tzu Chi Hospital, Taichung 472, Taiwan
- Correspondence: (C.-Y.F.H.); (S.-P.H.); Tel.: +886-2-28267904 (C.-Y.F.H.); +886-3-8565301#2664 (S.-P.H.)
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22
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Wen YT, Huang CW, Liu CP, Chen CH, Tu CM, Hwang CS, Chen YH, Chen WR, Lin KL, Ho YC, Chen TC, Tsai RK. Inhibition of Retinal Ganglion Cell Loss By a Novel ROCK Inhibitor (E212) in Ischemic Optic Nerve Injury Via Antioxidative and Anti-Inflammatory Actions. Invest Ophthalmol Vis Sci 2021; 62:21. [PMID: 34015079 PMCID: PMC8142697 DOI: 10.1167/iovs.62.6.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose This study investigated the neuroprotective effects of administration of ROCK inhibitor E212 on ischemic optic neuropathy. Methods Rats received an intravitreal injection of either E212 or PBS immediately after optic nerve infarct. The oxidative stress in the retina was detected by performing superoxide dismutase activity and CellROX assays. The integrity of retinal pigment epithelium was determined by staining of zona occludens 1. The visual function, retinal ganglion cell (RGC) density, and RGC apoptosis were determined by using flash visual-evoked potential analysis, retrograde FluoroGold labeling, and TdT-dUTP nick end-labeling assay. Macrophage infiltration was detected by staining for ED1. The protein levels of TNF-α, p-CRMP, p-AKT1, p-STAT3, and CD206 were evaluated using Western blotting. Results Administration of E212 resulted in a 1.23-fold increase in the superoxide dismutase activity of the retina and 2.28-fold decrease in RGC-produced reactive oxygen species as compared to the levels observed upon treatment with PBS (P < 0.05). Moreover, E212 prevented the disruption of the blood-retinal barrier (BRB) in contrast to PBS. The P1-N2 amplitude and RGC density in the E212-treated group were 1.75- and 2.05-fold higher, respectively, than those in the PBS-treated group (P < 0.05). The numbers of apoptotic RGCs and macrophages were reduced by 2.93- and 2.54-fold, respectively, in the E212-treated group compared with those in the PBS-treated group (P < 0.05). The levels of p-AKT1, p-STAT3, and CD206 were increased, whereas those of p-PTEN, p-CRMP2, and TNF-α were decreased after treatment with E212 (P < 0.05). Conclusions Treatment with E212 suppresses oxidative stress, BRB disruption, and neuroinflammation to protect the visual function in ischemic optic neuropathy.
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Affiliation(s)
- Yao-Tseng Wen
- Institute of Eye Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ching-Wen Huang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Peng Liu
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Chih-Hung Chen
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Chia-Mu Tu
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Chrong-Shiong Hwang
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Yi-Hsun Chen
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Wan-Ru Chen
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Keh-Liang Lin
- Department of Medical laboratory and Biotechnology, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Chieh Ho
- Institute of Eye Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Rong-Kung Tsai
- Institute of Eye Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
- Doctoral Degree Program in Translational Medicine, Tzu Chi University and Academia Sinica, Hualien, Taiwan
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Biomarkers of lesion severity in a rodent model of nonarteritic anterior ischemic optic neuropathy (rNAION). PLoS One 2021; 16:e0243186. [PMID: 33764998 PMCID: PMC7993789 DOI: 10.1371/journal.pone.0243186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/28/2021] [Indexed: 11/25/2022] Open
Abstract
The rodent model of nonarteritic anterior ischemic optic neuropathy (rNAION) is similar in many of its pathophysiological responses to clinical NAION. Like human NAION, there is significant variability in the severity of the lesion produced, and little is known of the parameters associated with rNAION induction severity or if pre- or early post-induction biomarkers can be identified that enable prediction of lesion severity and ultimate loss of retinal ganglion cells (RGCs). Adult male Sprague-Dawley outbred rats were evaluated for various parameters including physiological characteristics (heart rate, respiratory rate, temperature, hematocrit [Hct]), optic nerve head (ONH) appearance, pre- and post-induction mean diameter, and intravenous fluorescein and indocyanine green angiographic patterns of vascular leakage at 5 hours post-induction, performed using a spectral domain-optical coherence tomography (SD-OCT) instrument. Early changes were correlated with ultimate RGC loss by Brn3a (+) immunohistology. RGC loss also was correlated with the relative level of laser exposure. The severity of ONH edema 2d, but not 5hr, post induction was most closely associated with the degree of RGC loss, revealing a threshold effect, and consistent with a compartment syndrome where a minimum level of capillary compression within a tight space is responsible for damage. RGC loss increased dramatically as the degree of laser exposure increased. Neither physiological parameters nor the degree of capillary leakage 5hr post induction were informative as to the ultimate degree of RGC loss. Similar to human NAION, the rNAION model exhibits marked variability in lesion severity. Unlike clinical NAION, pre-induction ONH diameter likely does not contribute to ultimate lesion severity; however, cross-sectional ONH edema can be used as a biomarker 2d post-induction to determine randomization of subjects prior to inclusion in specific neuroprotection or neuroregeneration studies.
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Abri Aghdam K, Aghajani A, Ashraf Khorasani M, Soltan Sanjari M, Chaibakhsh S, Habibi A, Falavarjani KG. Intravitreal Injection Of The Granulocyte-Colony Stimulating Factor For The Treatment Of Non-Arteritic Anterior Ischemic Optic Neuropathy: A Pilot Study. Semin Ophthalmol 2021; 36:649-657. [PMID: 33689586 DOI: 10.1080/08820538.2021.1896749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose To investigate the efficacy of intravitreal injection of granulocyte colony-stimulating factor (G-CSF) for the treatment of non-arteritic anterior ischemic optic neuropathy (NAION).Methods: Patients with acute NAION were enrolled in this prospective interventional case series. They received an intravitreal injection of 60 micrograms in 0.1 ml of G-CSF within 2 weeks of the onset of the disease. Visual acuity, visual field, intraocular pressure (IOP), corneal endothelial cell density, and peripapillary retinal nerve fiber layer (RNFL) thickness were recorded before injections and 1 week, 1 month, 3 months, 6 months, and one year after the injections. Full-field electroretinography (ERG) was obtained at the baseline, 1 month, and 12 months post- injections.Results: Fourteen eyes of 14 patients entered the study. Best-corrected visual acuity (BCVA) significantly improved in the first month following injections (p = .007), decreased subsequently, and the final BCVA showed no significant improvement (p = .278) compared to the baseline measurements. A significant decrease in RNFL thickness was observed in all quadrants compared to the baseline measurements. Also, no improvement in the visual field parameters was observed. From the toxicity aspect, no significant changes in the corneal endothelial cell density, IOP, and ERG recordings were observed.Conclusion: Intravitreal injection of G-CSF seems to be safe. The effect may last for one month and then decline.
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Affiliation(s)
- Kaveh Abri Aghdam
- , Eye Research Center, the Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Aghajani
- , Eye Research Center, the Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Ashraf Khorasani
- , Eye Research Center, the Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Soltan Sanjari
- , Eye Research Center, the Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Chaibakhsh
- , Eye Research Center, the Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Habibi
- , Eye Research Center, the Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Wen YT, Ho YC, Lee YC, Ding DC, Liu PK, Tsai RK. The Benefits and Hazards of Intravitreal Mesenchymal Stem Cell (MSC) Based-Therapies in the Experimental Ischemic Optic Neuropathy. Int J Mol Sci 2021; 22:ijms22042117. [PMID: 33672743 PMCID: PMC7924624 DOI: 10.3390/ijms22042117] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/05/2021] [Accepted: 02/14/2021] [Indexed: 02/07/2023] Open
Abstract
Mesenchymal stem cell (MSC) therapy has been investigated intensively for many years. However, there is a potential risk related to MSC applications in various cell niches. Methods: The safety of intravitreal MSC application and the efficacy of MSC-derived conditioned medium (MDCM) were evaluated in the normal eye and the diseased eye, respectively. For safety evaluation, the fundus morphology, visual function, retinal function, and histological changes of the retina were examined. For efficacy evaluation, the MDCM was intravitreally administrated in a rodent model of anterior ischemic optic neuropathy (rAION). The visual function, retinal ganglion cell (RGC) density, and neuroinflammation were evaluated at day 28 post-optic nerve (ON) infarct. Results: The fundus imaging showed that MSC transplantation induced retinal distortion and venous congestion. The visual function, retinal function, and RGC density were significantly decreased in MSC-treated eyes. MSC transplantation induced astrogliosis, microgliosis, and macrophage infiltration in the retina due to an increase in the HLA-DR-positive MSC proportion in vitreous. Treatment with the MDCM preserved the visual function and RGC density in rAION via inhibition of macrophage infiltration and RGC apoptosis. Conclusions: The vitreous induced the HLA-DR expression in the MSCs to cause retinal inflammation and retina injury. However, the MDCM provided the neuroprotective effects in rAION.
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Affiliation(s)
- Yao-Tseng Wen
- Institute of Eye Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan; (Y.-T.W.); (Y.-C.H.); (Y.-C.L.)
| | - Yu-Chieh Ho
- Institute of Eye Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan; (Y.-T.W.); (Y.-C.H.); (Y.-C.L.)
| | - Yueh-Chang Lee
- Institute of Eye Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan; (Y.-T.W.); (Y.-C.H.); (Y.-C.L.)
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan;
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan
| | - Pei-Kang Liu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
| | - Rong-Kung Tsai
- Institute of Eye Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan; (Y.-T.W.); (Y.-C.H.); (Y.-C.L.)
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan
- Doctoral Degree Program in Translational Medicine, Tzu Chi University and Academia Sinica, Hualien 970, Taiwan
- Correspondence: ; Tel.: +886-3-8561-825 (ext. 2112)
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Li D, Gong Y. A Promising Strategy for Non-Arteritic Anterior Ischemic Optic Neuropathy: Intravitreal Mesenchymal Stem Cell Exosome. Curr Stem Cell Res Ther 2021; 16:109-114. [PMID: 32798377 DOI: 10.2174/1574888x15666200814121849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 11/22/2022]
Abstract
Non-arteritic anterior ischemic optic neuropathy (NAION) is a leading cause of optic nerverelated permanent visual impairment among individuals of over 50 years of age after glaucoma. Due to perplexing disorder regarding its pathogenesis, there is still no widely accepted and established treatment plan. Mesenchymal stem cells (MSCs) are one of the rare stem cell types that therapeutic agents for immunomodulation and ischemic tissue repair in clinical practice. However, there are certain disadvantages in using MSCs, such as potential tumorigenicity, need for autologous collection, and short survival time. Previous evidence suggested that MSC-exosome significantly attenuated post-ischemic neuronal damage and induced long-term neuroprotection associated with enhanced angiogenesis in MSCs. Therefore, we hypothesized that the intravitreal administration of MSC-exosome could be a potentially effective therapeutic approach for NAION by using a similar mechanism via promoting angiogenesis, neuro-regeneration, and neurological recovery, suppressing oxidative stress and reducing apoptosis, and suppressing inflammation and immunity based on its biological structure and function in NAION. Questions that need to be answered before testing clinically include dose regimen, injection frequency, the optimal duration of treatment, and duration of medication.
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Affiliation(s)
- Dongli Li
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 20080, China
| | - Yuanyuan Gong
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 20080, China
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Koçak N, Eraydın B, Turunç M, Yeter V, Güngör İ. Serum Inflammatory Biomarkers in Patients with Nonarteritic Anterior Ischemic Optic Neuropathy. KOREAN JOURNAL OF OPHTHALMOLOGY 2020; 34:478-484. [PMID: 33307608 PMCID: PMC7738228 DOI: 10.3341/kjo.2020.0075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose To evaluate the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) in patients with non-arteritic anterior ischemic optic neuropathy (NAION). Methods Fifty-six patients with NAION and 60 age-sex matched healthy controls were included in the study. Demographic characteristics and laboratory findings of the patients and the controls were obtained from the electronic medical records. NLR, PLR, MLR, and SII were calculated and compared between the groups. Cutoff values were also determined. Results Neutrophil, monocyte and platelet counts were higher in the NAION group than in the control group, but the difference was not statistically significant (p > 0.05). The mean NLR and SII were higher in the NAION group than in the control group (p = 0.004 and p = 0.011, respectively). In the receiver operating characteristic curve analysis, the areas under the curve for NLR were 0.67, and NLR >1.79 predicted NAION with a sensitivity of 71% and specificity of 59%. The areas under the curve for SII was 0.66, and SII of >417 predicted NAION with a sensitivity of 71% and specificity of 49%. There was no significant difference in PLR and MLR between the groups (p = 0.105 and p = 0.347, respectively). Conclusions The current study demonstrated that NAION patients had increased NLR and SII levels compared with control subjects. Elevated NLR and SII might serve as readily available inflammatory predictors in NAION patients.
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Affiliation(s)
- Nurullah Koçak
- Department of Ophthalmology, Ondokuzmayıs University Hospital, Samsun, Turkey
| | - Bilge Eraydın
- Department of Ophthalmology, Erbaa State Hospital, Tokat, Turkey
| | - Mustafa Turunç
- Department of Ophthalmology, Ondokuzmayıs University Hospital, Samsun, Turkey
| | - Volkan Yeter
- Department of Ophthalmology, Ondokuzmayıs University Hospital, Samsun, Turkey
| | - İnci Güngör
- Department of Ophthalmology, Ondokuzmayıs University Hospital, Samsun, Turkey
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Optical Coherence Tomography Angiography Assessment of the Peripapillary Vessel Density and Structure in Patients with Nonarteritic Anterior Ischemic Optic Neuropathy: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1359120. [PMID: 33178816 PMCID: PMC7647740 DOI: 10.1155/2020/1359120] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 01/22/2023]
Abstract
Background This meta-analysis is aimed at assessing the peripapillary vessel density (VD) and structural outcomes using optical coherence tomography angiography (OCTA) in patients with nonarteritic anterior ischemic optic neuropathy (NAION). Methods A comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science databases for literature comparing VD and structural outcomes in patients with NAION and controls was performed. Mean differences (MDs) and its 95% confidence interval (CI) were calculated for continuous estimates. Review Manager (V5.30) was used for analysis. Results Fourteen published studies met the requirement. The radial peripapillary capillary (RPC) whole enface VD measured by OCTA was significantly lower in patients with NAION compared to that of the controls (MD = −10.51, P < 0.00001). The RPC inside disc VD was significantly decreased in the NAION group than that in the control group (MD = −8.47, P < 0.00001). For RPC peripapillary VD, there was a statistically significant difference between patients with NAION and the controls (MD = −12.48, P < 0.00001). The peripapillary retinal nerve fibre layer (p-RNFL) thickness was significantly lower in patients with NAION in comparison to the controls (MD = −22.18, P = 0.004). The ganglion cell complex (GCC) thickness in the macular zone of NAION patients was remarkably reduced compared to that in the controls (MD = −17.18, P = 0.0002). Conclusions The findings suggested that the peripapillary VD and RNFL thickness were attenuated, and the macular GCC thickness was reduced in patients with NAION. OCTA, in the future, may facilitate the diagnosis and monitoring of patients with NAION.
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Protective Effects of Intravitreal Injection of the Rho-Kinase Inhibitor Y-27632 in a Rodent Model of Nonarteritic Anterior Ischemic Optic Neuropathy (rAION). J Ophthalmol 2020; 2020:1485425. [PMID: 32724667 PMCID: PMC7366220 DOI: 10.1155/2020/1485425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose We sought to explore the effects of intravitreal injection of the Rho-kinase inhibitor Y-27632 in a rodent model of nonarteritic anterior ischemic optic neuropathy (rAION). Methods The rAION model was established by using laser-induced photoactivation of intravenously administered Rose Bengal in rats. The rats received intravitreal injections of Y-27632 or PBS 1, 3, and 6 days after rAION induction. Optical coherence tomography (OCT) was performed at 2 days and 4 weeks after induction. Visual evoked potential (VEP) was used to evaluate the visual function at 4 weeks. Brn3a immunofluorescence staining of surviving RGCs and apoptosis assays of RGCs were performed at 4 weeks. Results Optic nerve head (ONH) width was significantly reduced in the Y-27632 group compared with that in the PBS group at 2 days after induction (p < 0.05). At 4 weeks, the P1 amplitude of flash-VEP (FVEP) in the Y-27632 group was significantly higher than that of the PBS group (p < 0.05). The RGC densities in the central and midperipheral retinas in the Y-27632 group were significantly higher than those in the PBS group (p < 0.05). Furthermore, there was a significant decrease in apoptotic RGCs in the Y-27632 group than in the PBS group (p < 0.05). Conclusions Intravitreal injection of Y-27632 had neuroprotective effects on ONH edema, RGC survival, and visual function preservation in rAION.
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Liu PK, Wen YT, Lin W, Kapupara K, Tai M, Tsai RK. Neuroprotective effects of low-dose G-CSF plus meloxicam in a rat model of anterior ischemic optic neuropathy. Sci Rep 2020; 10:10351. [PMID: 32587280 PMCID: PMC7316837 DOI: 10.1038/s41598-020-66977-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 05/19/2020] [Indexed: 11/29/2022] Open
Abstract
Non-arteritic anterior ischemic optic neuropathy (NAION) causes a sudden loss of vision and lacks effective treatment. Granulocyte colony-stimulating factor (G-CSF) provides neuroprotection against the experimental optic nerve injuries but also induce leukocytosis upon typical administration. We found synergetic neuroprotective effects of meloxicam and low dose G-CSF without leukocytosis in a rat model of anterior ischemic optic neuropathy (rAION). The WBC counts in the low-dose G-CSF-plus meloxicam-treated group were similar to the sham-operated group. Combination treatment of low-dose G-CSF plus meloxicam preserved RGCs survival and visual function, reduced RGC apoptosis and the macrophages infiltration, and promote more M2 phenotype of macrophage/microglial transition than the low-dose GCSF treatment or the meloxicam treatment. Moreover, the combination treatment induced higher serine/threonine kinase 1 (Akt1) expression. The combination treatment of low-dose G-CSF plus meloxicam lessened the leukocytotic side effect and provided neuroprotective effects via Akt1 activation in the rAION model. This approach provides crucial preclinical information for the development of alternative therapy in AION.
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Affiliation(s)
- Pei-Kang Liu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Ophthalmology, Yuan's General Hospital, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yao-Tseng Wen
- Institute of Eye Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Wei Lin
- Department of Optometry, Da-Yeh University, Changhwa, Taiwan
| | - Kishan Kapupara
- Institute of Eye Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Minghong Tai
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan. .,Center for Neuroscience, National Sun Yat-Sen University, Kaohsiung, Taiwan. .,Graduate Program in Marine Biotechnology, National Sun Yat-Sen University, Kaohsiung, Taiwan.
| | - Rong-Kung Tsai
- Institute of Eye Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan. .,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
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Nikkhah H, Feizi M, Abedi N, Karimi S, Yaseri M, Esfandiari H. Choroidal Thickness in Acute Non-arteritic Anterior Ischemic Optic Neuropathy. J Ophthalmic Vis Res 2020; 15:59-68. [PMID: 32095210 PMCID: PMC7001011 DOI: 10.18502/jovr.v15i1.5946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 06/19/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose To compare the choroidal thickness in eyes with acute non-arteritic anterior ischemic optic neuropathy (NAION) with healthy contralateral eye and normal controls. Methods Thirty-eight eyes with NAION, thirty-eight unaffected fellow eyes, and seventy-four eyes from 37 healthy, age- and sex-matched subjects were included in this prospective comparative case-control study. Choroidal thickness was measured by enhanced depth imaging (EDI) of spectral domain optical coherence tomography (SD-OCT). Peripapillary choroidal thickness (PCT) was measured at 1000 and 1500 μm from Bruch's membrane opening (BMO). Subfoveal choroidal thickness (SFCT) was measured in central subfoveal area, and 500 microns apart in temporal and nasal sides. Choroidal thickness among NAION eyes, uninvolved fellow eyes, and control eyes were compared. Results The mean of PCT at 1000 μm was significantly thicker in NAION and fellow eyes compared to control eyes (169.7 ± 47, 154.4 ± 42.1, and 127.7 ± 49.9 μm, respectively, P< 0.001 and P = 0.42). The mean PCT at 1500 μm was also significantly thicker in NAION and fellow eyes compared to control eyes (178.6 ± 52.8, 162.6 ± 46.1, and 135.1 ± 59 μm, respectively, P = 0.007 and P = 0.048). The mean PCT at 1000 and 1500 μm was significantly greater in NAION compared to fellow eyes (P = 0.027 and P = 0.035, respectively). The mean of SFCT was significantly thicker in NAION compared to control eyes (P = 0.032); however, there was no significant difference between uninvolved fellow and control eyes (P = 0.248). Conclusion Thicker choroidal thickness in acute NAION and uninvolved fellow eyes compared to normal eyes suggests a primary choroidal role in NAION pathophysiology.
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Affiliation(s)
- Homayoun Nikkhah
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohadeseh Feizi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naser Abedi
- Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Karimi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Esfandiari
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, USA
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Gokoffski KK, Peng M, Alas B, Lam P. Neuro-protection and neuro-regeneration of the optic nerve: recent advances and future directions. Curr Opin Neurol 2020; 33:93-105. [PMID: 31809331 PMCID: PMC8153234 DOI: 10.1097/wco.0000000000000777] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Optic neuropathies refer to a collection of diseases in which retinal ganglion cells (RGCs), the specialized neuron of the retina whose axons make up the optic nerve, are selectively damaged. Blindness secondary to optic neuropathies is irreversible as RGCs do not have the capacity for self-renewal and have a limited capacity for self-repair. Numerous strategies are being developed to either prevent further RGC degeneration or replace the cells that have degenerated. In this review, we aim to discuss known limitations to regeneration in central nervous system (CNS), followed by a discussion of previous, current, and future strategies for optic nerve neuroprotection as well as approaches for neuro-regeneration, with an emphasis on developments in the past two years. RECENT FINDINGS Neuro-regeneration in the CNS is limited by both intrinsic and extrinsic factors. Environmental barriers to axon regeneration can be divided into two major categories: failure to clear myelin and formation of glial scar. Although inflammatory scars block axon growth past the site of injury, inflammation also provides important signals that activate reparative and regenerative pathways in RGCs. Neuroprotection with neurotrophins as monotherapy is not effective at preventing RGC degeneration likely secondary to rapid clearance of growth factors. Novel approaches involve exploiting different technologies to provide sustained delivery of neurotrophins. Other approaches include application of anti-apoptosis molecules and anti-axon retraction molecules. Although stem cells are becoming a viable option for generating RGCs for cell-replacement-based strategies, there are still many critical barriers to overcome before they can be used in clinical practice. Adjuvant treatments, such as application of electrical fields, scaffolds, and magnetic field stimulation, may be useful in helping transplanted RGCs extend axons in the proper orientation and assist with new synapse formation. SUMMARY Different optic neuropathies will benefit from neuro-protective versus neuro-regenerative approaches. Developing clinically effective treatments for optic nerve disease will require a collaborative approach that not only employs neurotrophic factors but also incorporates signals that promote axonogenesis, direct axon growth towards intended targets, and promote appropriate synaptogenesis.
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Affiliation(s)
- Kimberly K Gokoffski
- Department of Ophthalmology, Roski Eye Institute, University of Southern California, Los Angeles, California, USA
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MacIntosh PW, Kumar SV, Saravanan VR, Shah VM. Acute changes in ganglion cell layer thickness in ischemic optic neuropathy compared to optic neuritis using optical coherence tomography. Int J Ophthalmol 2020; 13:120-123. [PMID: 31956579 DOI: 10.18240/ijo.2020.01.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/22/2019] [Indexed: 01/12/2023] Open
Abstract
AIM To elucidate the changes of different ganglion cell layer (GCL) thinning patterns between the optic neuritis (ON) and non-arteritic anterior ischemic optic neuropathy (NAION). METHODS A prospective, observational study was conducted to evaluate the timing of GCL changes between acute ON and NAION using optical coherence tomography. RESULTS Thinning on optical coherence tomography in the NAION group occurs as early as 11d after symptomatic onset of vision loss and follows an altitudinal pattern. The mean superior-inferior GCL thickness difference in the NAION cohort was clinically significant at 5.7 µm in the NAION cohort compared to controls of 0.8 µm (P=0.032), but not significant in the ON group compared to controls with both groups measuring 1.1 µm. Global thinning was significant for the ON group compared to controls at 7.2 µm (P=0.011) but not the NAION group compared to controls at 1.35 µm. CONCLUSION These findings suggest that future treatments for NAION should be given early, and possibly before 11d in order to prevent GCL and irreversible vision loss.
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Affiliation(s)
- Peter W MacIntosh
- Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - S Vijay Kumar
- Neuro-Ophthalmology Service, Aravind Eye Hospital, Coimbatore 641014, India
| | - V R Saravanan
- Neuro-Ophthalmology Service, Aravind Eye Hospital, Coimbatore 641014, India
| | - Virna M Shah
- Neuro-Ophthalmology Service, Aravind Eye Hospital, Coimbatore 641014, India
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Nguyen Ngo Le MA, Wen YT, Ho YC, Kapupara K, Tsai RK. Therapeutic Effects of Puerarin Against Anterior Ischemic Optic Neuropathy Through Antiapoptotic and Anti-Inflammatory Actions. Invest Ophthalmol Vis Sci 2019; 60:3481-3491. [PMID: 31408114 DOI: 10.1167/iovs.19-27129] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose This study investigated the therapeutic effects of puerarin (PR) on a rat model of anterior ischemic optic neuropathy (rAION). Methods The neuroprotective effects of PR on rAION were evaluated using flash visual-evoked potentials (FVEP), retrograde labeling of retinal ganglion cells (RGCs), TUNEL assay of the retina, optical coherence tomography (OCT) images of optic nerve width, and ED1 staining of the optic nerve (ON). The inflammatory response of ON and Akt signaling pathways were analyzed through Western blot. M2 polarization was determined by immunostaining and immunoblotting in ONs. Results In FVEP analysis, the amplitude of P1-N2 and the RGC density in the PR-treated group were 2.3- and 1.6-fold higher than those in the PBS-treated group, respectively (P < 0.05). The number of apoptotic RGC in the PR-treated group was 2.8-fold lower than that in the PBS-treated group. OCT images demonstrated that PR treatment-reduced ON edema in the acute phase compared to PBS treatment (P < 0.05). Macrophage infiltration was reduced by 5.2-fold by PR treatment compared with the PBS treatment (P < 0.05). PR treatment inhibited the levels of iNOS, IL-1β, and TNF-α, induced the levels of IL-10, Arg1, and Fizz1 in the rAION model. The levels of p-Akt1 and C/EBPβ in the PR-treated group increased by 3.4-fold and 5.89-fold compared with those in the PBS-treated group (P < 0.05). Inhibition of Akt activation reduced the number of M2 macrophage in the PR-treated group (P < 0.05). Conclusions PR treatment provided the neuroprotective effects in the rAION model, which may lead to new clinical applications.
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Affiliation(s)
- Minh-Anh Nguyen Ngo Le
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.,Institute of Eye Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yao-Tseng Wen
- Institute of Eye Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yu-Chieh Ho
- Institute of Eye Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Master Program in Medical Physiology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Kishan Kapupara
- Institute of Eye Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Rong-Kung Tsai
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.,Institute of Eye Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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Guo Y, Mehrabian Z, Johnson MA, Albers DS, Rich CC, Baumgartner RA, Bernstein SL. Topical Trabodenoson Is Neuroprotective in a Rodent Model of Anterior Ischemic Optic Neuropathy (rNAION). Transl Vis Sci Technol 2019; 8:47. [PMID: 31879569 PMCID: PMC6927734 DOI: 10.1167/tvst.8.6.47] [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: 03/05/2019] [Accepted: 10/20/2019] [Indexed: 01/15/2023] Open
Abstract
Purpose Nonarteritic anterior ischemic optic neuropathy (NAION) is the leading cause of sudden optic nerve-related vision loss currently without effective treatment. We evaluated the neuroprotective potential of ocular (topical) delivery of trabodenoson, a selective A1 receptor mimetic, in a rodent model of NAION (rNAION). Methods Daily topical delivery of 3% trabodenoson or vehicle administered in both eyes 3 days prior to rNAION induction and for 21 days post induction. Retinal appearance and optic nerve head (ONH) edema was evaluated using spectral-domain optical coherence tomography (SD-OCT). Retinal function was evaluated before and after induction by ganzfeld electroretinography (ERG). Brn3a(+) retinal ganglion cells (RGCs) were quantified by stereology. Axonal ultrastructure was evaluated by electron microscopy. Results Trabodenoson-treated eyes had significantly reduced optic nerve (ON) edema compared with vehicle-treated eyes (ANOVA, P < 0.05). Electrophysiologically, there was a nonsignificant trend toward b-wave and oscillatory potential (OP) preservation in the trabodenoson-treated eyes. RGC counts were higher in trabodenoson-treated eyes compared to vehicle (74% versus 47% of the contralateral eye; two-tailed t-test; P = 0.01), as were ON axons. No overt morphologic differences in cell inflammation were observed between vehicle- and trabodenoson-treated ONHs, but trabodenoson-treated ONHs revealed increased expression of astrocyte-related neuroprotective responses. Conclusions Trabodenoson preserves RGCs in the rodent NAION model. While previous clinical trials focused on trabodenoson's ocular antihypertensive effect, our data suggest trabodenoson's primary target may be both the retina and ONH. Selective adenosine A1 agonists may prove an appropriate neuroprotective adjunctive for ischemia-related ON diseases such as NAION and glaucoma. Translational Relevance RGC and ON neuroprotection in ischemic neuropathies may be achievable by topical administration of A1 adenosine agonists rather than by simply relying on intraocular pressure reduction.
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Affiliation(s)
- Yan Guo
- Department of Ophthalmology and Visual Sciences, University of Maryland at Baltimore-School of Medicine, Baltimore, MD, USA
| | - Zara Mehrabian
- Department of Ophthalmology and Visual Sciences, University of Maryland at Baltimore-School of Medicine, Baltimore, MD, USA
| | - Mary A Johnson
- Department of Ophthalmology and Visual Sciences, University of Maryland at Baltimore-School of Medicine, Baltimore, MD, USA
| | | | | | | | - Steven L Bernstein
- Department of Ophthalmology and Visual Sciences, University of Maryland at Baltimore-School of Medicine, Baltimore, MD, USA
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Kurtul BE, Ozer PA. Neutrophil-to-lymphocyte ratio in ocular diseases: a systematic review. Int J Ophthalmol 2019; 12:1951-1958. [PMID: 31850181 DOI: 10.18240/ijo.2019.12.18] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 05/18/2019] [Indexed: 12/30/2022] Open
Abstract
AIM To summarize the results of studies investigating neutrophil-to-lymphocyte ratio (NLR) and to identify the role of NLR in ocular diseases. METHODS With the aim of identifying the studies related to NLR, a search was conducted on http://www.ncbi.nlm.nih.gov/pubmed by utilizing the key words "neutrophil lymphocyte ratio, ocular diseases, and eye diseases" up to February 2018. All of the original articles were assessed according to date of publications, countries, clinics and topics. Studies about ocular inflammatory diseases were evaluated according to their qualifications, review methods and results. RESULTS A total of 4473 publications, including original research articles and reviews were screened. The number of publications was shown a regular logarithmic increase over the years. The majority of studies were performed by clinics in Turkey and many of these publications were performed by oncology and cardiology clinics. A total of 75 publications were identified to be about ocular diseases. CONCLUSION Elevated NLR as a cheap, reproducible, and readily available marker could be used as a diagnostic and/or prognostic marker in ocular diseases.
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Affiliation(s)
- Bengi Ece Kurtul
- Department of Ophthalmology, Hatay Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay 31040, Turkey
| | - Pinar Altiaylik Ozer
- Department of Ophthalmology, Ufuk University Faculty of Medicine, Ankara 06830, Turkey
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Harvey JP. Intravitreal Triamcinolone Acetonide Injection in a Rodent Model of Anterior Ischemic Optic Neuropathy: Comment. J Neuroophthalmol 2019; 39:545. [PMID: 31490344 DOI: 10.1097/wno.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Joshua P Harvey
- Ophthalmology Department, King's College Hospital, London, United Kingdom
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Kumar V, Mesentier-Louro LA, Oh AJ, Heng K, Shariati MA, Huang H, Hu Y, Liao YJ. Increased ER Stress After Experimental Ischemic Optic Neuropathy and Improved RGC and Oligodendrocyte Survival After Treatment With Chemical Chaperon. Invest Ophthalmol Vis Sci 2019; 60:1953-1966. [PMID: 31060051 PMCID: PMC6735778 DOI: 10.1167/iovs.18-24890] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Increased endoplasmic reticulum (ER) stress is one of the earliest subcellular changes in neuro-ophthalmic diseases. In this study, we investigated the expression of key molecules in the ER stress pathways following nonarteritic anterior ischemic optic neuropathy (AION), the most common acute optic neuropathy in adults over 50, and assessed the impact of chemical chaperon 4-phenylbutyric acid (4-PBA) in vivo. Methods We induced AION using photochemical thrombosis in adult mice and performed histologic analyses of key molecules in the ER stress pathway in the retina and optic nerve. We also assessed the effects of daily intraperitoneal injections of 4-PBA after AION. Results In the retina at baseline, there was low proapoptotic transcriptional regulator C/EBP homologous protein (CHOP) and high prosurvival chaperon glucose-regulated protein 78 (GRP78) expression in retinal ganglion cells (RGCs). One day after AION, there was significantly increased CHOP and reduced GRP78 expressions in the ganglion cell layer. In the optic nerve at baseline, there was little CHOP and high GRP78 expression. One day after AION, there was significantly increased CHOP and no change in GRP78 expression. Treatment immediately after AION using daily intraperitoneal injection of chemical chaperone 4-PBA for 19 days significantly rescued Brn3A+ RGCs and Olig2+ optic nerve oligodendrocytes. Conclusions We showed for the first time that acute AION resulted in increased ER stress and differential expression of ER stress markers CHOP and GRP78 in the retina and optic nerve. Rescue of RGCs and oligodendrocytes with 4-PBA provides support for ER stress reduction as possible treatment for AION.
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Affiliation(s)
- Varun Kumar
- Department of Ophthalmology, Stanford University, School of Medicine, Stanford, California, United States
| | | | - Angela Jinsook Oh
- Department of Ophthalmology, Stanford University, School of Medicine, Stanford, California, United States
| | - Kathleen Heng
- Department of Ophthalmology, Stanford University, School of Medicine, Stanford, California, United States
| | - Mohammad Ali Shariati
- Department of Ophthalmology, Stanford University, School of Medicine, Stanford, California, United States
| | - Haoliang Huang
- Department of Ophthalmology, Stanford University, School of Medicine, Stanford, California, United States
| | - Yang Hu
- Department of Ophthalmology, Stanford University, School of Medicine, Stanford, California, United States
| | - Yaping Joyce Liao
- Department of Ophthalmology, Stanford University, School of Medicine, Stanford, California, United States.,Department of Neurology, Stanford University, School of Medicine, Stanford, California, United States
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Optic Nerve Regeneration: Considerations on Treatment of Acute Optic Neuropathy and End-Stage Disease. CURRENT OPHTHALMOLOGY REPORTS 2019. [DOI: 10.1007/s40135-019-00194-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Devoldere J, Peynshaert K, De Smedt SC, Remaut K. Müller cells as a target for retinal therapy. Drug Discov Today 2019; 24:1483-1498. [PMID: 30731239 DOI: 10.1016/j.drudis.2019.01.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/20/2018] [Accepted: 01/30/2019] [Indexed: 12/28/2022]
Abstract
Müller cells are specialized glial cells that span the entire retina from the vitreous cavity to the subretinal space. Their functional diversity and unique radial morphology render them particularly interesting targets for new therapeutic approaches. In this review, we reflect on various possibilities for selective Müller cell targeting and describe how some of their cellular mechanisms can be used for retinal neuroprotection. Intriguingly, cross-species investigation of their properties has revealed that Müller cells also have an essential role in retinal regeneration. Although many questions regarding this subject remain, it is clear that Müller cells have unique characteristics that make them suitable targets for the prevention and treatment of numerous retinal diseases.
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Affiliation(s)
- Joke Devoldere
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Karen Peynshaert
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Stefaan C De Smedt
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Katrien Remaut
- Ghent Research Group on Nanomedicines, Laboratory of General Biochemistry and Physical Pharmacy, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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Ali Shariati M, Kumar V, Yang T, Chakraborty C, Barres BA, Longo FM, Liao YJ. A Small Molecule TrkB Neurotrophin Receptor Partial Agonist as Possible Treatment for Experimental Nonarteritic Anterior Ischemic Optic Neuropathy. Curr Eye Res 2018; 43:1489-1499. [PMID: 30273053 PMCID: PMC10710940 DOI: 10.1080/02713683.2018.1508726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/25/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Brain-derived neurotrophic factor (BDNF) and activation of its high affinity receptor tropomyosin kinase (Trk) B promote retinal ganglion cells (RGCs) survival following injury. In this study, we tested the effects of LM22A-4, a small molecule TrkB receptor-specific partial agonist, on RGC survival in vitro and in experimental nonarteritic anterior ischemic optic neuropathy (AION), the most common acute optic neuropathy in those older than 50 years. METHODS We assessed drug effects on immunopanned, cultured RGCs and calculated RGC survival and assessed TrkB receptor activation by mitogen-activated protein (MAP) kinase translocation. To assess effects in vivo, we induced murine AION and treated the animals with one intravitreal injection and three-week systemic treatment. We measured drug effects using serial spectral-domain optical coherence tomography (OCT) and quantified retinal Brn3A+ RGC density three weeks after ischemia. RESULTS In vitro, LM22A-4 significantly increased the survival of cultured RGCs at day 2 (95% CI control: 8.4-13.6; LM22A-4: 23.7-30.3; BDNF: 24.3-29.9; P ≤ 0.0001), similar to the effect of the endogenous TrkB receptor ligand BDNF. There was also significant nuclear and cytoplasmic translocation of MAP kinase (95% CI control: 0.9-6.8; LM22A-4: 38.8-84.4; BDNF: 64.0-93.0; P = 0.0002), a known downstream event of TrkB receptor activation. Following AION, LM22A-4 treatment led to significant preservation of the ganglion cell complex (95% CI: AION-PBS: 66.8-70.7%; AION-LM22A-4: 70.0-73.1; P = 0.03) and total retinal thickness (95% CI: AION-PBS: 185-196%; AION-LM22A-4: 195-203; P = 0.002) as measured by OCT compared with non-treated eyes. There was also significant rescue of the Brn3A+ RGC density on morphometric analysis of whole mount retinae (95% CI control: 2360-2629; AION-PBS: 1647-2008 cells/mm2; AION-LM22A-4: 1958-2216 cells/mm2; P = 0.02). CONCLUSIONS TrkB receptor partial agonist LM22A-4 promoted survival of cultured RGCs in vitro by TrkB receptor activation, and treatment in vivo led to increased survival of RGCs after optic nerve ischemia, providing support that LM22A-4 may be effective therapy to treat ischemic optic neuropathy. ABBREVIATIONS AION: anterior ischemic optic neuropathy, BDNF: Brain-derived neurotrophic factor, GCC: ganglion cell complex, MAP: mitogen-activated protein, OCT: spectral-domain optical coherence tomography, OD: right eye, ON: optic nerve, ONH: optic nerve head, OS: left eye, RGC: retinal ganglion cell; Trk: tropomyosin kinase.
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Affiliation(s)
- Mohammad Ali Shariati
- a Departments of Ophthalmology , Stanford University School of Medicine , Stanford , CA , USA
| | - Varun Kumar
- a Departments of Ophthalmology , Stanford University School of Medicine , Stanford , CA , USA
| | - Tao Yang
- b Neurobiology , Stanford University School of Medicine , Stanford , CA , USA
| | | | - Ben Anthony Barres
- b Neurobiology , Stanford University School of Medicine , Stanford , CA , USA
| | - Frank Michael Longo
- b Neurobiology , Stanford University School of Medicine , Stanford , CA , USA
| | - Yaping Joyce Liao
- a Departments of Ophthalmology , Stanford University School of Medicine , Stanford , CA , USA
- b Neurobiology , Stanford University School of Medicine , Stanford , CA , USA
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Pereira LS, Ávila MP, Salustiano LX, Paula AC, Arnhold E, McCulley TJ. Intravitreal Triamcinolone Acetonide Injection in a Rodent Model of Anterior Ischemic Optic Neuropathy. J Neuroophthalmol 2018; 38:561-565. [PMID: 29521709 DOI: 10.1097/wno.0000000000000639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The management of nonarteritic anterior ischemic optic neuropathy centers around prevention of second eye involvement, without a uniformly accepted therapy for the involved eye. Several researchers have assessed the benefit of steroids with conflicting results. This experimental study was designed to evaluate the efficacy of a single intravitreal triamcinolone acetonide injection (IVTA) in preserving retinal ganglion cells (RGCs) in a rodent model of anterior ischemic optic neuropathy (rAION). METHODS The rAION was induced in female Wistar rats. Animals were randomized into 3 groups: 1) untreated, 2) treated with 56 μg IVTA, and 3) intravitreal saline (placebo). Procedures were performed in the left eye, with the right eye serving as control. After 30 days, animals were sacrificed and eyes were assessed histologically for RGC number. RESULTS The average number of RGC was significantly lower in rAION subgroups when compared with the control group (P < 0.001). No significant difference was seen between rAION eyes treated with IVTA, placebo, and untreated eyes (P > 0.05%). CONCLUSIONS In this rodent model for AION, no therapeutic benefit of intravitreal steroid injection was identified.
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Affiliation(s)
- Luciano S Pereira
- Departments of Ophthalmology (LSP, MPA, ACP), Pathology (LXS), and Statistics (EA), Universidade Federal de Goiás, Goiânia, Brazil; and The Wilmer Eye Institute (TJM), Johns Hopkins University, Baltimore, Maryland
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Min JY, Lv Y, Mao L, Gong YY, Gu Q, Wei F. A rodent model of anterior ischemic optic neuropathy (AION) based on laser photoactivation of verteporfin. BMC Ophthalmol 2018; 18:304. [PMID: 30466418 PMCID: PMC6251118 DOI: 10.1186/s12886-018-0937-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 10/12/2018] [Indexed: 01/29/2023] Open
Abstract
Background A rodent model of photodynamic AION resulting from intravenous verteporfin is presented. The analysis of the morphological function, the pathological changes and the potential mechanism of action were further investigated. Methods Photodynamic treatment was conducted on the optic nerve head (ONH) following administration of the photosensitizer. The fellow eye was considered as sham control. Fundus Fluorescein angiography (FFA), spectral domain optical coherence tomography (SD-OCT) and Flash-visual evoked potential (F-VEP) recordings were conducted at different time points. Immunohistochemistry was used to observe apoptotic cell death (TUNEL) and macrophage infiltration (ED-1/Iba-1). Retrograde labeling of retinal ganglion cells (RGCs) was used to evaluate the loss of RGCs. Results After laser treatment, SD-OCT indicated optic nerve edema, while FFA indicated late leakage of the ONH. F-VEPs were distinctly reduced compared to control eyes. The number of apoptotic RGCs peaked on day 14 (5.71 ± 0.76, p < 0.01). The infiltration of ED-1 and Iba-1 increased on the 3rd day following PDT, while it peaked on day 14 (67.5 ± 9.57 and 77.5 ± 12.58 respectively, p < 0.01). Following 3 weeks of AION, the densities of RGCs in the central retinas of the normal and AION eyes were 3075 ± 298/mm2 and 2078 ± 141/mm2 (p < 0.01), respectively. Conclusions Verteporfin photodynamic treatment on rodents ONH can lead to functional, histological, and pathological changes. This type of animal model of AION is easy to establish and stable. It can be used for studying the mechanism and neuroprotective medicine of AION injury.
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Affiliation(s)
- Jing-Yu Min
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China.,Shanghai Engineering Center for Visual Science and Photomedicine, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China
| | - Yanan Lv
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China.,Shanghai Engineering Center for Visual Science and Photomedicine, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China
| | - Lei Mao
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China.,Shanghai Engineering Center for Visual Science and Photomedicine, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China
| | - Yuan-Yuan Gong
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China. .,Shanghai Key Laboratory of Ocular Fundus Diseases, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China. .,Shanghai Engineering Center for Visual Science and Photomedicine, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China.
| | - Qing Gu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China.,Shanghai Engineering Center for Visual Science and Photomedicine, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China
| | - Fang Wei
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China.,Shanghai Key Laboratory of Ocular Fundus Diseases, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China.,Shanghai Engineering Center for Visual Science and Photomedicine, NO.100, Haining Road, Hongkou District, Shanghai, 200080, China
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Yang HK, Park SJ, Byun SJ, Park KH, Kim JW, Hwang JM. Obstructive sleep apnoea and increased risk of non-arteritic anterior ischaemic optic neuropathy. Br J Ophthalmol 2018; 103:1123-1128. [PMID: 30413419 DOI: 10.1136/bjophthalmol-2018-312910] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/24/2018] [Accepted: 09/30/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To determine whether the development of non-arteritic anterior ischaemic optic neuropathy (NAION) is increased among patients newly diagnosed with obstructive sleep apnoea (OSA) in a large general population. METHODS A 12-year nationwide, population-based, retrospective cohort study including 1 025 340 beneficiaries in the 2002-2013 Korean National Health Insurance Service database was performed. We identified 919 patients newly diagnosed with OSA aged ≥40 years and matched 9190 non-OSA controls using estimated propensity scores in reference to age, sex, demographics, comorbidities and co-medications. We applied Kaplan-Meier curves and Cox proportional hazard models to determine the risk of developing NAION in the OSA group compared with the non-OSA group. RESULTS The 10-year incidence probability of NAION was higher in the OSA group (0.92%; 95% CI 0.88 to 0.97) than the non-OSA group (0.42%; 95% CI 0.41 to 0.44, p=0.002, log-rank test). The OSA group was at increased risk of developing NAION compared with the non-OSA group (HR 3.80; 95% CI 1.46 to 9.90) after adjusting for demographics, comorbidities and co-medications. CONCLUSIONS Our results suggest that patients with newly diagnosed OSA have an increased risk of NAION, although the absolute risk of NAION is low.
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Affiliation(s)
- Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seong Jun Byun
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Pardue MT, Allen RS. Neuroprotective strategies for retinal disease. Prog Retin Eye Res 2018; 65:50-76. [PMID: 29481975 PMCID: PMC6081194 DOI: 10.1016/j.preteyeres.2018.02.002] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/14/2018] [Accepted: 02/20/2018] [Indexed: 12/20/2022]
Abstract
Diseases that affect the eye, including photoreceptor degeneration, diabetic retinopathy, and glaucoma, affect 11.8 million people in the US, resulting in vision loss and blindness. Loss of sight affects patient quality of life and puts an economic burden both on individuals and the greater healthcare system. Despite the urgent need for treatments, few effective options currently exist in the clinic. Here, we review research on promising neuroprotective strategies that promote neuronal survival with the potential to protect against vision loss and retinal cell death. Due to the large number of neuroprotective strategies, we restricted our review to approaches that we had direct experience with in the laboratory. We focus on drugs that target survival pathways, including bile acids like UDCA and TUDCA, steroid hormones like progesterone, therapies that target retinal dopamine, and neurotrophic factors. In addition, we review rehabilitative methods that increase endogenous repair mechanisms, including exercise and electrical stimulation therapies. For each approach, we provide background on the neuroprotective strategy, including history of use in other diseases; describe potential mechanisms of action; review the body of research performed in the retina thus far, both in animals and in humans; and discuss considerations when translating each treatment to the clinic and to the retina, including which therapies show the most promise for each retinal disease. Despite the high incidence of retinal diseases and the complexity of mechanisms involved, several promising neuroprotective treatments provide hope to prevent blindness. We discuss attractive candidates here with the goal of furthering retinal research in critical areas to rapidly translate neuroprotective strategies into the clinic.
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Affiliation(s)
- Machelle T Pardue
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA; Department of Biomedical Engineering, Georgia Institute of Technology, 313 Ferst Drive, Atlanta, GA, 30332, USA.
| | - Rachael S Allen
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA, 30033, USA
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Araz-Ersan HB, Sayin N, Bayramoğlu SE, Pirhan D, Sanli K, Kara N. The Effect of Acute Hypovolemia on the Eye. Curr Eye Res 2018; 43:949-954. [PMID: 29617159 DOI: 10.1080/02713683.2018.1453077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION To investigate the effects of acute hypovolemia induced by blood donation on the eye. Methods or Study Design: This prospective, observational study included a single eye from each of 48 healthy men between 20 and 40 years of age who had donated 500 ml of blood and 28 eyes of 28 healthy, age- and gender-matched control subjects. The ocular parameters including ocular perfusion pressure (OPP), intraocular pressure (IOP), axial length (AL), central corneal thickness (CCT), choroidal and retinal thicknesses, and retinal nerve fiber layer (RNFL) were measured before blood donation and at 10 min and 1, 2, 3, and 4 h after blood donation. RESULTS The mean OPP was significantly reduced following blood donation (baseline, 43.4 ± 4.9 vs. 40.8 ± 4.6 mmHg; p = 0.003). The mean subfoveal choroidal thickness (SFCT) was measured as 322.96 ± 76.23, 291.63 ± 77.85, 309.77 ± 75.72, 312.31 ± 75.98, 315.73 ± 75.43, and 317.75 ± 75.73 µm before blood donation, at baseline, 10 min, and 1, 2, 3, and 4 h following donation, respectively [F(2.462, 115.731) = 22.618, p < 0.001]. In the control group, the SFCT was measured as 302.04 ± 32.04, 301.43 ± 35.16, 298.07 ± 37.33, 298.96 ± 39.17, 302.54 ± 39.24, and 301.61 ± 40.41 µm at baseline, 10 min, and 1, 2, 3, and 4 h following donation, respectively [F(2.124, 57.340) = 0.592, p = 0.566]. There was no difference in AL, CCT, RNFL, retinal thicknesses, and IOP measurements performed before and after blood donation (p > 0.05). CONCLUSIONS Acute hypovolemia caused a significant reduction in SFCT which persisted for 3 h. This study may pave way for better understanding of choroidal thickness changes in disease states.
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Affiliation(s)
- Hatice Bilge Araz-Ersan
- a Department of Ophthalmology , Istanbul Şişli Hamidiye Etfal Education and Research Hospital , Istanbul , Turkey
| | - Nihat Sayin
- b Department of Ophthalmology , Kanuni Sultan Suleyman Education and Research Hospital , Istanbul , Turkey
| | - Sadık Etka Bayramoğlu
- b Department of Ophthalmology , Kanuni Sultan Suleyman Education and Research Hospital , Istanbul , Turkey
| | - Dilara Pirhan
- c Department of Ophthalmology , Kocaeli University Faculty of Medicine , Kocaeli , Turkey
| | - Kamuran Sanli
- d Department of Microbiology , Istanbul Kanuni Sultan Suleyman Education and Research Hospital , Istanbul , Turkey
| | - Necip Kara
- e Department of Ophthalmology , Gaziantep University Faculty of Medicine , Gaziantep , Turkey
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Lee S, Choi DYD, Lim DH, Chung TY, Han JC, Kee C. Lamina Cribrosa Changes after Laser In Situ Keratomileusis in Myopic Eyes. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:95-102. [PMID: 29611373 PMCID: PMC5906408 DOI: 10.3341/kjo.2017.0111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/28/2017] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine deep optic nerve head structure changes after transient intraocular pressure elevation during laser in situ keratomileusis (LASIK) for myopia. METHODS Enhanced depth imaging-optical coherence tomography was performed in each myopic eye that underwent LASIK surgery. Enhanced depth imaging-optical coherence tomography images were created at postoperative 1 day, 1 week, 2 weeks, and 1 month. Lamina cribrosa (LC) thickness, LC depth and prelaminar thickness at the superior, middle and inferior portions of the optic nerve head were measured by two investigators. RESULTS Forty eyes in 40 patients were included in the present study. During follow-up, there were no significant differences in prelaminar thickness or LC depth. The LC demonstrated increased thickness at postoperative 1 day at all three locations (superior, middle, and inferior) (p < 0.001, p < 0.001, p < 0.001, respectively). However, no significant changes were observed at postoperative 1 week, 2 weeks, and 1 month. CONCLUSIONS The LC thickness could increase at 1 day after LASIK surgery. However, the thickness will gradually return to baseline morphology. Temporary intraocular pressure increase during LASIK does not appear to induce irreversible LC thickness changes.
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Affiliation(s)
- Soomin Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Da Ye Diana Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hui Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Chul Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Weiss JN, Levy S, Benes SC. Stem Cell Ophthalmology Treatment Study: bone marrow derived stem cells in the treatment of non-arteritic ischemic optic neuropathy (NAION). Stem Cell Investig 2017; 4:94. [PMID: 29270420 DOI: 10.21037/sci.2017.11.05] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/13/2017] [Indexed: 12/17/2022]
Abstract
Background Ten patients with bilateral visual loss due to sequential non-arteritic ischemic optic neuropathy (NAION) underwent autologous Bone Marrow Derived Stem Cell (BMSC) therapy within the Stem Cell Ophthalmology Treatment Study (SCOTS). SCOTS is an Institutional Review Board approved clinical study utilizing autologous BMSC in the treatment of optic nerve and retinal diseases that meet inclusion criteria. Methods The average age of the patients treated was 69.8 years. The average duration of visual loss in eyes treated was 9.8 years and ranged from 1 to 35 years. Affected eyes were treated with either retrobulbar, subtenons and intravenous BMSC or, following vitrectomy, intra-optic nerve, subtenons and intravenous BMSC. The primary outcome was visual acuity as measured by Snellen or converted to LogMAR. Results Following therapy in SCOTS, 80% of patients experienced improvement in Snellen binocular vision (P=0.029) with 20% remaining stable; 73.6% of eyes treated gained vision (P=0.019) and 15.9% remained stable in the post-operative period. There was an average of 3.53 Snellen lines of vision improvement per eye with an average 22.74% and maximum 83.3% improvement in LogMAR acuity per eye. The average LogMAR change in treated eyes was a gain of 0.364 (P=0.0089). Improvements typically manifested no later than 6 months post procedure. Conclusions The use of BMSC in the Stem Cell Ophthalmology Treatment Study achieved meaningful visual improvements in a significant percentage of the NAION patients reported. Improvements typically manifested no later than 6 months post-procedure. Duration of visual loss did not appear to affect the ability of the eyes to respond to treatment. Possible mechanisms by which visual improvement occurred may include BMSC paracrine secretion of proteins and hormones, transfer of mitochondria, release of messenger RNA or other compounds via exosomes or microvesicles and neuronal transdifferentiation of the stem cells.
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Affiliation(s)
- Jeffrey N Weiss
- The Healing Institute, 1308 North State Road 7, Margate, FL 33063, USA
| | - Steven Levy
- MD Stem Cells, 3 Sylvan Road South, Westport, CT 06880, USA
| | - Susan C Benes
- The Eye Center of Columbus, 9262 Neil Avenue, The Ohio State University, Columbus, OH 43205, USA
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Biocompatibility of intravitreal injection of human mesenchymal stem cells in immunocompetent rabbits. Graefes Arch Clin Exp Ophthalmol 2017; 256:125-134. [PMID: 29168045 DOI: 10.1007/s00417-017-3842-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 09/25/2017] [Accepted: 11/04/2017] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate the feasibility, safety, and biocompatibility of intravitreal injection of human mesenchymal stem cells (MSCs) in immunocompetent pigmented rabbits. MATERIALS AND METHODS Thirty-two pigmented rabbits (24 females, 8 males; Chinchilla-New Zealand White) were divided into 8 groups of 4 animals. Commercially prepared human MSCs were injected (0.05 ml) into the post-lens vitreous of the right eyes. Groups 1 and 4 received isotonic medium (Ringer lactate-based), groups 2, 5, 7, and 8 received a low dose of 15 × 106 cells/ml. Groups 3 and 6 received a high dose of 30 × 106 cells/ml. Clinical signs were evaluated and scored before MSCs injection and weekly for 2 or 6 weeks. Animals were sacrificed at 2 or 6 weeks after injection. Eyes, liver, spleen, and gonads were assessed by histology and by fluorescent in situ hybridization to evaluate survival and extraocular migration of MSCs. RESULTS There were no relevant clinical findings between control and MSC-injected rabbit eyes at any time point. There were also no relevant histological findings between control and MSC-injected rabbits related to ocular, liver, spleen, or gonad tissues modifications. MSCs survived intravitreally for at least 2 weeks after injection. Extraocular migration of MSCs was not detected. CONCLUSIONS MSCs are safe and well-tolerated when administered intravitreally at a dose of 15 × 106 cells/ml in pigmented rabbits. These findings enable future research to explore the intravitreal use of commercially prepared allogenic human MSCs in clinical trials of retinal diseases.
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Kapupara K, Wen YT, Tsai RK, Huang SP. Soluble P-selectin promotes retinal ganglion cell survival through activation of Nrf2 signaling after ischemia injury. Cell Death Dis 2017; 8:e3172. [PMID: 29144506 PMCID: PMC5775414 DOI: 10.1038/cddis.2017.566] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/17/2017] [Accepted: 09/20/2017] [Indexed: 12/21/2022]
Abstract
Retinal ischemic injuries play an important role in the pathogenesis of several eye disorders. Inflammation and oxidative stress are key players in ischemic injuries. Following retinal ischemia, vascular endothelial cells and leukocytes express several inflammatory adhesion receptors, such as selectins and cell adhesion molecules. P-selectin stimulates leukocyte recruitment to platelet aggregates and has an important role in vascular homeostasis and inflammatory leukocyte extravasation. Soluble P-selectin can be neuroprotective through competitive binding to the receptors of endogenous P-selectin molecules. Here, we demonstrate the neuroprotective effect of a recombinant P-selectin immunoglobin G (P-sel-IgG) chimeric fusion protein in a rat anterior ischemic optic neuropathy (rAION) model. rAION was induced by photodynamic therapy. P-sel-IgG treatment reduced optic nerve edema and stabilized the blood-optic nerve barrier (BONB) in the acute phase of rAION. Further, P-sel-IgG increased the retinal ganglion cell (RGC) survival rate, reduced RGC apoptosis, preserved visual function, maintained retinal nerve fiber layer thickness, and reduced macrophage infiltration in optic nerve tissue in the chronic phase (day 28). Increased NAD(P)H quinone dehydrogenase 1 (NQO1) and heme oxygenase 1(HO-1) expression levels, along with increased transcription factor Nrf2, suggesting an antioxidant role of P-sel-IgG via the Nrf2 signaling pathway. In conclusion, this study is the first to demonstrate that P-sel-IgG treatment promotes RGC survival by stabilizing the BONB and activating the Nrf2 signaling pathway in a rAION model.
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Affiliation(s)
- Kishan Kapupara
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien, Taiwan
| | - Yao-Tseng Wen
- Institute of Eye Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Rong-Kung Tsai
- Institute of Eye Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Shun-Ping Huang
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien, Taiwan
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