Glucose 6-phosphate dehydrogenase deficiency and cataract of patients in northern Sardinia

Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency and Late-stage Age-Related Macular Degeneration

Purpose: Age-related macular degeneration (AMD) is the leading cause of blindness in the elderly in Western Countries. Evidence indicates that Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency, a common genetic abnormality, may protect against ischemic heart and cerebrovascular disease, ocular vascular disorders, and colorectal cancer. This study was undertaken to ascertain whether G6PD deficiency may protect against AMD. Materials and Methods: 79 men with late-stage AMD and 79 male, age-matched cataract controls without AMD were recruited in March-December 2016. Smoking status, clinical history, and drug use were recorded. A blood sample was taken from each participant. Complete blood count, hemoglobin, glucose, creatinine, cholesterol, triglycerides, transaminases, bilirubin, and erythrocyte G6PD activity were measured. Stepwise logistic regression was used to investigate the association between G6PD deficiency and AMD. Results: G6PD deficiency was found in 7 (8.9%) AMD patients and 8 (10.1%) controls, a not statistically significant difference. Stepwise logistic regression disclosed that AMD was significantly associated with increased diastolic blood pressure (OR=1.09, 95% CI=1.03-1.15, P=0.02) and LDL-cholesterol (OR=1.02, 95% CI=1.0001-1.03, P=0.049) and lower values of white blood cell (WBC) count (OR=0.71, 95% CI=0.56-0.88, P=0.02) and aspartate aminotransferase (AST) (OR=0.92, 95% CI=0.85-0.99, P=0.044). Conclusion: Results suggest that G6PD deficiency has no protective effect on nor is a risk factor for AMD. Larger studies are necessary to confirm whether increased diastolic blood pressure and LDL-cholesterol and lower values of WBC count and AST are risk factors for AMD.

Glucose-6-phosphate dehydrogenase deficiency and diabetes mellitus with severe retinal complications in a Sardinian population, Italy

BACKGROUND

Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is one of the most common human genetic abnormalities, with a high prevalence in Sardinia, Italy. Evidence indicates that G6PD-deficient patients are protected against vascular disease. Little is known about the relationship between G6PD deficiency and diabetes mellitus. The purpose of this study was to compare G6PD deficiency prevalence in Sardinian diabetic men with severe retinal vascular complications and in age-matched non-diabetic controls and ascertain whether G6PD deficiency may offer protection against this vascular disorder.

METHODS

Erythrocyte G6PD activity was determined using a quantitative assay in 390 diabetic men with proliferative diabetic retinopathy (PDR) and 390 male non-diabetic controls, both aged ≥50 years. Conditional logistic regression models were used to investigate the association between G6PD deficiency and diabetes with severe retinal complications.

RESULTS

G6PD deficiency was found in 21 (5.4 %) diabetic patients and 33 (8.5 %) controls (P=0.09). In a univariate conditional logistic regression model, G6PD deficiency showed a trend for protection against diabetes with PDR, but the odds ratio (OR) fell short of statistical significance (OR=0.6, 95% confidence interval=0.35-1.08, P=0.09). In multivariate conditional logistic regression models, including as covariates G6PD deficiency, plasma glucose, and systemic hypertension or systolic or diastolic blood pressure, G6PD deficiency showed no statistically significant protection against diabetes with PDR.

CONCLUSIONS

The prevalence of G6PD deficiency in diabetic men with PDR was lower than in age-matched non-diabetic controls. G6PD deficiency showed a trend for protection against diabetes with PDR, but results were not statistically significant.

Glutathione-Related Enzymes and the Eye

Glutathione and the related enzymes belong to the defence system protecting the eye against chemical and oxidative stress. This review focuses on GSH and two key enzymes, glutathione reductase and glucose-6-phosphate dehydrogenase in lens, cornea, and retina. Lens contains a high concentration of reduced glutathione, which maintains the thiol groups in the reduced form. These contribute to lens complete transparency as well as to the transparent and refractive properties of the mammalian cornea, which are essential for proper image formation on the retina. In cornea, gluthatione also plays an important role in maintaining normal hydration level, and in protecting cellular membrane integrity. In retina, glutathione is distributed in the different types of retinal cells. Intracellular enzyme, glutathione reductase, involved in reducing the oxidized glutathione has been found at highest activity in human and primate lenses, as compared to other species. Besides the enzymes directly involved in maintaining the normal redox status of the cell, glucose-6-phosphate dehydrogenase which catalyzes the first reaction of the pentose phosphate pathway, plays a key role in protection of the eye against reactive oxygen species. Cornea has a high activity of the pentose phosphate pathway and glucose-6-phosphate dehydrogenase activity. Glycation, the non-enzymic reaction between a free amino group in proteins and a reducing sugar, slowly inactivates gluthathione-related and other enzymes. In addition, glutathione can be also glycated. The presence of glutathione, and of the related enzymes has been also reported in other parts of the eye, such as ciliary body and trabecular meshwork, suggesting that the same enzyme systems are present in all tissues of the eye to generate NADPH and to maintain gluthatione in the reduced form. Changes of glutathione and related enzymes activity in lens, cornea, retina and other eye tissues, occur with ageing, cataract, diabetes, irradiation and administration of some drugs.

Glucose-6-phosphate dehydrogenase deficiency and idiopathic presenile cataract in Dalmatia, Croatia

BACKGROUND

Impaired activity of the enzyme glucose-6-phosphate dehydrogenase (G6PD) has been suggested as a risk factor in cataractogenesis. The aim of this study was to determine the G6PD activity level in 89 male subjects of Dalmatian origin with idiopathic presenile cataracts.

METHODS

G6PD activity was determined by a quantitative spectrophotometric method.

RESULTS

Of 89 males with presenile cataracts only one (1.1%) had G6PD deficiency. The G6PD deficiency prevalence rate among males with presenile cataracts is not significantly different (p > 0.05) from the prevalence of G6PD deficiency in the general population of Dalmatia (0.75% among men).

INTERPRETATION

The results of this study suggest that G6PD deficiency does not represent a pathogenetic factor in presenile cataract, at least not in the population of the southern part of Croatia.

The effects of some antibiotics on sheep lens glucose 6-phosphate dehydrogenase in vitro

PURPOSE

To investigate the in vitro effects of gentamicin sulfate, vancomycin hydrochloride, sodium cefazolin and ceftriaxone on glucose 6-phosphate dehydrogenase enzyme (G6PD) purified from sheep lenses.

METHODS

G6PD was purified from sheep lenses with a yield of 66.8% and a specific activity of 7.8 U/mg proteins, and 10,400-fold using ammonium sulfate fractionation and 2',5'-ADP Sepharose 4B affinity gel. The enzyme activity was determined by Beutler's method.

RESULTS

Gentamicin sulfate and vancomycin hydrochloride strongly inhibited the enzyme in vitro. The concentrations causing 50% inhibition (IC50 were 15.34, and 8.0 mM, respectively. Conversely, cefazolin sodium strongly activated this enzyme, and ceftriaxone caused milder activation.

CONCLUSIONS

If a patient with G6PD deficiency requires gentamicin sulfate or vancomycin hydrochloride, routine ophthalmic did not inhibit this enzyme. Postmortem studies are now needed to investigate the activity of G6PD and how it is affected by these antibiotics.

Blood and lens lipid peroxidation and antioxidant status in normal individuals, senile and diabetic cataractous patients

PURPOSE

Oxidative mechanisms are believed to play an important role in the pathogenesis of cataract, the most important cause of visual impairment at advanced age. To determine the body's antioxidant status as well as its lipid peroxidation levels, both blood and lens parameters were evaluated.

METHODS

This study was performed on the blood samples and lenses obtained from 46 patients diagnosed as having cataract and 20 control subjects. The control group was composed of 10 women and 10 men who do not smoke. Control subjects without any lens opacity or vacuoles when observed with a slit lamp were recruited on the same exclusion criteria as far as disease and treatment were concerned. No antioxidant medicines were used. They were all healthy individuals without any systemic diseases. Superoxide dismutase (SOD), glucose-6-phosphate dehydrogenase (G6PD), glutathione reductase (GSSG-Red) activities in red blood cell (RBC) lysates as well as whole blood glutathione (GSH) and plasma thiobarbituric acid reactive substances (TBARS), the indicator of lipid peroxidation concentrations, were determined quantitatively both in the blood samples and the lenses of the patients with senile and diabetic cataracts.

RESULTS

Whole blood GSH values, and erythrocyte SOD activities were significantly lower in the cataractous patients than those in the control group. The values in the diabetic cataractous group were also less than those in the senile cataractous group. Significantly decreased erythrocyte GSSG-Red and G6PD activities were detected in the diabetic cataractous group. Plasma TBARS values were higher both in the senile and diabetic groups when compared to those in the control group. Significantly decreased values were observed for GSSG-Red activities and TBARS values in the lenses of the senile cataractous patients in comparison with those in the diabetic cataractous patients. The lens GSH values were found to be higher in the senile cataractous group than the values obtained in the diabetic cataractous group.

CONCLUSIONS

A strong correlation was found between lens GSH and lens TBARS concentrations in the diabetic group. This emphasized the vital role of GSH as an antioxidant in the lens over the other antioxidant parameters, e.g., enzymes, and the oxidative stress is at the highest level in lens.

Synergistic effect of UVB radiation and age on HMPS enzymes in rat lens homogenate

The behaviour of rat lenticular enzymes, glucose-6-phosphate dehydrogenase (G6PD, EC: 1.1.1.49) and 6-phosphogluconate dehydrogenase (6PGD, EC: 1.1.1.44) as a function of age and UVB irradiation (in vitro) was investigated by irradiating the lens homogenate from 3- and 12-month-old rats at 300 nm (100 microW cm-2). In the 3-month-old group the specific activities of G6PD and 6PGD were reduced by 26% and 42%, respectively, after 24 h of irradiation, whereas in the 12-month-old group the decrease was 38% and 49% respectively, which suggests that the susceptibility of HMPS enzymes to UVB damage is higher in older lenses. The decrease in specific activity was associated with a change in apparent K(m) and Vmax (marginal in 3 months and significant in 12 months) of these enzymes due to UVB irradiation. UVB irradiation also decreased the levels of NADPH and NADPH/NADP ratio. These changes, altered activities of G6PD and 6PGD and altered levels of NADPH, may in turn have a bearing on lens transparency.

A new lease of life for an old enzyme

We review here some recent data about glucose-6-phosphate dehydrogenase (G6PD), the first and key regulatory enzyme of the pentose phosphate pathway. New evidence has been presented to suggest that malaria is a selective agent for G6PD deficiency, which is the most common enzymopathy in man, and that G6PD deficiency, generally considered to be a mild and benign condition, is significantly disadvantageous in certain environmental conditions. At the molecular level, the enzyme structure has recently been elucidated and mechanisms regulating G6PD gene expression have been determined. A G6PD knock-out mutation introduced in mouse cells makes them exquisitely sensitive to oxidative stress, indicating that this ubiquitous metabolic enzyme has a major role in the defence against oxidative stress, even in eukaryotic nucleated cells, which have several alternative routes for providing the same protection. Because of the high prevalence of G6PD deficiency in many populations, it is expected that these findings will prompt further studies to ascertain the putative role of G6PD deficiency in conditions such as carcinogenesis and ageing.

UV-mediated cataractogenesis: a radical perspective

A number of epidemiologic and experimental studies indirectly support the idea that solar ultraviolet radiation may be cataractogenic. However, the physical and cellular processes which might be involved in such cataractogenesis are by no means clear. Because a major consequence of the UV irradiation of oxygenated organic matter is the production of activated oxygen species, the involvement of oxidants has been suspected to be of importance. However, because the lens may normally exist in an hypoxic or even anoxic environment, the extent of availability of oxygen for such reactions is presently unknown. So also are the possible mechanism through which putative UV damage of the lens might eventuate in cataract. In addition to possible rapid and direct lethal damage to lens epithelium, possible cumulative damage to both lenticular DNA and proteins may occur. Furthermore, UV radiation has the potential to photolytically destroy light-sensitive nutrients and to generate damaging oxidants through interaction with ferruginous compounds. Given that Nature has probably provided the lens with substantial protective devices to ward off damaging effects of UV light, it is still an open question as to whether solar radiation contributes to cataract formation and, if so, by what mechanisms.

Cataracts in glucose-6-phosphate dehydrogenase deficiency

Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency plays an important biochemical role in the metabolism of the lens. Controversies exist in the literature on the possible association between G-6-PD deficiency and the development of cataracts. The authors present ten patients, aged between infancy and 40 years of age, who were admitted for bilateral congenital or presenile cataracts. These patients had no ocular or systemic disease which might have caused their cataract. The only systemic finding they had was G-6-PD deficiency. Two other patients among the families described suffered from bilateral congenital or presenile cataracts with no G-6-PD deficiency. This deficiency state does not appear to play a role in the production of their cataracts.