The effect of timolol on the concentrations of albumin and IgG in the aqueous humor of the human eye

CLINICAL CHARACTERIZATION OF AQUEOUS AND VITREOUS RETINOL-BINDING PROTEIN 3 CONCENTRATIONS IN RELATION TO DIABETIC RETINOPATHY SEVERITY, RETINAL STRUCTURES, AND SYSTEMIC COMPLICATIONS

PURPOSE

To evaluate Retinol-Binding Protein 3 (RBP3) from photoreceptors in aqueous and its association with vitreous concentrations, diabetic retinopathy (DR) severity, retinal layer thickness, and clinical characteristics in people with diabetes.

METHODS

RBP3 concentration was measured by custom-developed enzyme-linked immunosorbent assay in aqueous and correlated with vitreous concentrations in patients from the 50-Year Medalist study and Beetham Eye Institute at Joslin Diabetes Center.

RESULTS

Aqueous RBP3 concentration (N = 131) was elevated in eyes with no to mild DR (mean ± SD 0.7 nM ± 0.2) and decreased in eyes with moderate to severe DR (0.65 nM ± 0.3) and proliferative DR (0.5 nM ± 0.2, P < 0.001) compared to eyes without diabetes. Aqueous and vitreous RBP3 concentrations correlated with each other (r = 0.34, P = 0.001) and between fellow eyes (P < 0.0001). History of retinal surgery did not affect aqueous RBP3 concentrations, but cataract surgery affected both vitreous and aqueous levels. Elevated aqueous RBP3 concentration associated with increased thickness of the outer nuclear layer (P = 0.004) and correlated with hemoglobin A1c, whereas vitreous RBP3 concentrations correlated with diabetic systemic complications.

CONCLUSION

These findings suggest that aqueous RBP3 concentration may be an important endogenous clinical retinal protective factor, a biomarker for DR severity, and a promising VEGF-independent clinical intervention target in DR.

Microelectrode-Based Electrochemical Impedance Determination of Brain-Derived Neurotrophic Factor in Aqueous Humor for Diagnosis of Glaucoma

The abundance of brain-derived neurotrophic factor (BDNF) in aqueous humor (AH) is an ideal biomarker for the diagnosis of glaucoma, a chronic progressive optic neuropathy and the most frequent cause of irreversible blindness. The difficulty of AH-based BDNF detection is from the small amount of extracted AH in a paracentesis (<100 μL) and the ultra-low abundance of BDNF. In this work, we systematically studied the non-specific adsorption of biofluids on the bare gold electrode by electrochemistry and Raman spectroscopy techniques, revealing the unexpected negative correlation of the extent of non-specific adsorption with the size of the electrode. Based on it, a simple microelectrode-based sensor without the introduction of the blocking layer was developed for the detection of BDNF in the AH sample. Using electrochemical impedance spectroscopy (EIS) and extracting the changes of electron-transfer resistance of the electrochemical probe [Fe(CN)6]3-/4- on the sensor surface, the BDNF was quantified. The dynamic range was from 0.5 to 50 pg·mL-1, with a detection limit of 0.3 pg·mL-1 and a sample consumption of 5 μL. The real AH sample analysis confirmed the significant decrease of BDNF abundance in the AH of glaucoma patients. Our microelectrode-based EIS sensor displayed prominent advantages on simplified preparation, sensitive response, and low sample consumption. This AH-based BDNF analysis is expected to be used for the screening and diagnosis of glaucoma, especially for the high-risk population who have ocular diseases and have to undergo surgeries.

A contemporary concept of the blood-aqueous barrier

This review traces the evolution of the concept of the blood-aqueous barrier (BAB) during the past 20 years. The Classical model simply stipulated that the tight junctions of the iris vasculature and ciliary epithelium excluded plasma proteins from the aqueous humor (AH). It failed to reconcile the presence of AH protein levels equal to 1% of that found in plasma. Moreover, models of barrier kinetics assumed that the processes of AH secretion and plasma protein entry were directly linked. Thus, elevations of AH protein levels could only be explained by a pathological breakdown of the BAB. Over the last 20 years it has been shown that the plasma proteins in normal AH by-pass the posterior chamber entirely. Instead, these proteins diffuse from the capillaries of ciliary body stroma, into the iris stroma and then into the anterior chamber. This creates a reservoir of plasma-proteins in the iris stroma that is not derived from the iris vessels. This reservoir is prevented from diffusing posteriorly by tight junctions in the posterior iris epithelium. The one-way valve created by the pupil resting on the anterior lens capsule, combined with the continuous, forward flow of AH through the pupil, prevents protein reflux into the posterior chamber. Importantly, in the new paradigm, secretion of AH and the entry of plasma proteins into AH, are semi-independent events. This opens the possibility that AH protein levels could increase in the absence of breakdown of the BAB. Clinical consequences of this new paradigm of the BAB are discussed.

Measurement of intraocular IgA and IgM synthesis and filtration through the blood-aqueous barrier in cataract patients

The authors have tested two formulas by means of which the filtrated and the intraocularly (intrathecally) synthesized fraction of particular protein can be distinguished. The laser nephelometric method was applied to determine the serum (IgG, IgA, IgM, C3, albumin), aqueous humor (IgA, IgM, albumin) and CSF (IgG, IgM, C3, albumin) protein values in 42 subjects to test two models in physiological conditions. It was confirmed that the best results were achieved using the formula after Stambuk. Computer simulation performed to compare the formulas after Stambuk and Reiber & Felgenhauer showed a strong correlation (r greater than 0.98) between the calculated filtrated fractions of both models in a wide range of different barrier permeabilities. Laser nephelometry proved to be a useful method to determine low IgA and IgM values in aqueous humor.

Quantitative assessment of aqueous flare intensity in diabetes

Aqueous flare intensity was measured with the laser flare-cell meter in 231 eyes of diabetic patients and 31 eyes of normal age-matched controls. Diabetic patients were divided into four groups based on the degree of retinopathy: (1) non-retinopathy, 42 eyes; (2) background retinopathy, 72; (3) preproliferative retinopathy, 23; and (4) proliferative retinopathy, 94. There was no significant difference between the normal controls and the non-retinopathy group, whereas the rest of the diabetic groups showed significantly higher flare values than did normal controls (P less than 0.001). Flare intensity increased with the progression of retinopathy. Our results demonstrate that clinical use of the flare-cell meter enables the quantitative assessment of blood-aqueous barrier function in diabetics and suggest that diabetic iridopathy, as one of the manifestations of diabetes in the anterior part of the eye, exists even in the early stages of this disease and progresses in parallel with retinopathy.

Studies on equine recurrent uveitis. I: Levels of immunoglobulin and albumin in the aqueous humor of horses with and without intraocular disease

A radioimmunoassay was developed for detection of immunoglobulin in the aqueous of normal horses and horses with intraocular diseases. Levels of albumin were detected by radial immunodiffusion. Results of assays on samples from normal eyes from which aqueous was obtained by paracentesis under anesthesia were 32.10 +/- 21.50 microgram/ml for IgG, 0.05 +/- 0.01 microgram/ml for IgM, 0.04 +/- 0.02 microgram/ml for IgA and 34.0 +/- 38.0 microgram/ml for albumin. Results in 138 normal eyes sampled post mortem were 41.56 +/- 38.65 microgram/ml for IgG, 0.18 +/- 0.43 microgram/ml for IgM, 0.46 +/- 1.45 microgram/ml for IgE and 184 +/- 240 microgram/ml for albumin. Levels in abnormal eyes were some 50-120% greater, and very high levels were noted in cases of clinically documented uveitis. The aqueous to serum ratio of the proteins measured generally varied in relation to the molecular weights and was increased in diseased eyes. The ratio of IgG/albumin in the diseased eyes was less which suggested leakage of protein from an impaired blood/aqueous barrier rather than intraocular antibody synthesis.