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Goss R, Adams VJ, Heinrich C, Grundon R, Linn-Pearl R, Scurrell E, Hamzianpour N. Progressive ulcerative keratitis in dogs in the United Kingdom: Microbial isolates, antimicrobial sensitivity, and resistance patterns. Vet Ophthalmol 2024; 27:330-346. [PMID: 37933885 DOI: 10.1111/vop.13160] [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: 06/17/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES The objective of the study was to identify bacterial pathogens and their antimicrobial sensitivity profile associated with cases of canine progressive ulcerative keratitis. MATERIALS AND METHODS Analysis of microbial culture and sensitivity results from dogs with progressive ulcerative keratitis presenting to a UK referral practice between December 2018 and August 2020. RESULTS Positive bacterial cultures were obtained from 80/148 (54%) of the canine ulcers sampled with 99 bacterial isolates cultured. Streptococcus canis (n = 29), Pseudomonas aeruginosa (n = 19), and Staphylococcus pseudintermedius (n = 16) were the most common isolates. Pseudomonas aeruginosa was more likely to be isolated whether the ulcer was clinically malacic at the time of sampling (OR = 10.1, p < .001). Ulcers treated prior to culture with fusidic acid were 7.6 times more likely to be positive than those treated with any other antimicrobial(s). Bacterial isolates demonstrated resistance against neomycin (85%), fusidic acid (78%), and tetracycline (68%). Conversely, isolates were most likely to be sensitive to gentamicin (88%), ofloxacin (77%), ciprofloxacin (73%), and chloramphenicol (64%). Antimicrobial combinations of chloramphenicol or gentamicin with a fluoroquinolone (ofloxacin or ciprofloxacin) or chloramphenicol combined with gentamicin were the most effective on in vitro analysis (over 90% susceptibility of all isolates). CONCLUSION The most common bacterial species associated with canine progressive ulcerative keratitis in a UK referral population were S. canis, P. aeruginosa, and S. pseudintermedius. Combination antimicrobial therapy is recommended pending culture and sensitivity results given the varied antimicrobial susceptibility profiles and significant bacterial in vitro resistance to antimicrobial monotherapy.
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Okurowska K, Monk PN, Karunakaran E. Increased tolerance to commonly used antibiotics in a Pseudomonas aeruginosa ex vivo porcine keratitis model. MICROBIOLOGY (READING, ENGLAND) 2024; 170:001459. [PMID: 38739119 PMCID: PMC11165664 DOI: 10.1099/mic.0.001459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
Introduction. Bacterial keratitis, particularly caused by Pseudomonas aeruginosa, is challenging to treat because of multi-drug tolerance, often associated with the formation of biofilms. Antibiotics in development are typically evaluated against planktonic bacteria in a culture medium, which may not accurately represent the complexity of infections in vivo.Hypothesis/Gap Statement. Developing a reliable, economic ex vivo keratitis model that replicates some complexity of tissue infections could facilitate a deeper understanding of antibiotic efficacy, thus aiding in the optimization of treatment strategies for bacterial keratitis.Methodology. Here we investigated the efficacy of three commonly used antibiotics (gentamicin, ciprofloxacin and meropenem) against Pseudomonas aeruginosa cytotoxic strain PA14 and invasive strain PA01 using an ex vivo porcine keratitis model.Results. Both strains of P. aeruginosa were susceptible to the MIC of the three tested antibiotics. However, significantly higher concentrations were necessary to inhibit bacterial growth in the minimum biofilm eradication concentration (MBEC) assay, with both strains tolerating concentrations greater than 512 mg l-1 of meropenem. When MIC and higher concentrations than MBEC (1024 mg l-1) of antibiotics were applied, ciprofloxacin exhibited the highest potency against both P. aeruginosa strains, followed by meropenem, while gentamicin showed the least potency. Despite this, none of the antibiotic concentrations used effectively cleared the infection, even after 18 h of continuous exposure.Conclusions. Further exploration of antibiotic concentrations and aligning dosing with clinical studies to validate the model is needed. Nonetheless, our ex vivo porcine keratitis model could be a valuable tool for assessing antibiotic efficacy.
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Affiliation(s)
- Katarzyna Okurowska
- Department of Chemical and Biological Engineering, University of Sheffield, Sheffield S10 2TN, UK
- National Institute for Health and Care Research, University of Leeds, Leeds LS2 9JT, UK
| | - Peter N. Monk
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK
| | - Esther Karunakaran
- Department of Chemical and Biological Engineering, University of Sheffield, Sheffield S10 2TN, UK
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Ch S, Mishra P, Padaga SG, Ghosh B, Roy S, Biswas S. 3D-Printed Inherently Antibacterial Contact Lens-Like Patches Carrying Antimicrobial Peptide Payload for Treating Bacterial Keratitis. Macromol Biosci 2024; 24:e2300418. [PMID: 38258356 DOI: 10.1002/mabi.202300418] [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: 09/15/2023] [Revised: 01/12/2024] [Indexed: 01/24/2024]
Abstract
Delivery of therapeutic agents through contact lenses-like patches is a promising strategy to achieve significant bioavailability with negligible eye drainage. The present study investigates the preparation and 3D printing of mucoadhesive gelatin methacryloyl (GelMA)/chitosan methacryloyl (ChiMA) hydrogels to fabricate them as contact lens-like patches (CLP) loaded with antimicrobial peptide, S100A12 (AMP) for treating bacterial keratitis (BK). Extrusion technology is used to print the patches layer by layer to form a hemispherical scaffold suitable for eyewear, and 3D-printed CLP is crosslinked using Irgacure 2959 under UV light. The results from the in vivo experiment conducted on Pseudomonas aeruginosa-infected BK rabbit model after the treatment with AMP-loaded CLP have shown a significant decrease in bacterial load when plated for CFU. The newly developed delivery system containing AMP has great potential to overcome the treatment challenges of multidrug resistance (MDR) in bacteria and eliminate the frequent dosing associated with eye drops. The presence of chitosan in the formulation provides a synergetic effect on the AMP in disrupting bacterial biofilms. The ease of using 3D printing will open new avenues for optimizing the dosage depending on the severity of the BK in the patients, which can be used as personalized medicine.
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Affiliation(s)
- Sanjay Ch
- Nanomedicine Research Laboratory, Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad, Telangana, 500078, India
| | - Priyasha Mishra
- Prof. Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, 500034, India
- Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - Sri Ganga Padaga
- Nanomedicine Research Laboratory, Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad, Telangana, 500078, India
| | - Balaram Ghosh
- Nanomedicine Research Laboratory, Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad, Telangana, 500078, India
| | - Sanhita Roy
- Prof. Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, 500034, India
| | - Swati Biswas
- Nanomedicine Research Laboratory, Department of Pharmacy, Birla Institute of Technology & Science-Pilani, Hyderabad Campus, Medchal, Hyderabad, Telangana, 500078, India
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Hafezi NL, Aydemir ME, Lu NJ, Torres-Netto EA, Hillen M, Koppen C. Effect of accelerated high-fluence riboflavin and rose bengal-mediated corneal cross-linking on resistance to enzymatic digestion. BMC Ophthalmol 2024; 24:37. [PMID: 38267904 PMCID: PMC10809678 DOI: 10.1186/s12886-024-03293-0] [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: 08/10/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024] Open
Abstract
PURPOSE This study evaluated the effect of high-fluence accelerated corneal cross-linking on the resistance to enzymatic digestion, assessing two chromophore/light combinations: riboflavin/UV-A light (RF/UV-A) and rose bengal/green light (RB/green). METHODS Freshly prepared ex-vivo porcine corneas (n = 189) were divided into 8 groups groups. Group A corneas were unirradiated controls without chromophore soaking (A0), or soaked with riboflavin (A1) or rose bengal (A2). Group B corneas underwent accelerated epi-off RF/UV-A CXL at fluences of 5.4 J/cm² (B1), 10 J/cm² (B2), or 15 J/cm² (B3). Group C corneas underwent accelerated epi-off RB/green CXL at fluences of either 10 J/cm² (C1) or 15 J/cm² (C2). Following CXL, all corneas were digested in 0.3% collagenase-A solution, and the time until complete dissolution was measured. RESULTS Non-irradiated controls exposed to RF and RB enhanced corneal resistance to collagenase digestion, with RB having a stronger effect than RF. RF/UV-A-treated corneas showed significantly increased digestion resistance with increasing fluence levels. RB/green-treated corneas displayed enhanced digestion resistance with each increase in fluence up to 10 J/cm²; a 15 J/cm² fluence yielded similar digestion resistance times to a 10 J/cm² fluence, suggesting a plateau effect in accelerated RB/green CXL protocols. CONCLUSIONS When compared to standard-fluence treatments, high-fluence accelerated epi-off CXL using both riboflavin and rose bengal significantly increases resistance to enzymatic digestion. The optimal settings for clinical protocols might be 15 J/cm² (30 mW/cm² for 8 min 20 s) for RF/UV-A and 10 J/cm² (15 mW/cm² for 11 min 7 s) for RB/Green Light.
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Affiliation(s)
- Nikki L Hafezi
- Faculty of Medicine, University of Antwerp, Wilrijk, Antwerp, Belgium.
- ELZA Institute, Zurich, Switzerland.
| | | | - Nan-Ji Lu
- Faculty of Medicine, University of Antwerp, Wilrijk, Antwerp, Belgium
- ELZA Institute, Zurich, Switzerland
| | | | | | - Carina Koppen
- Faculty of Medicine, University of Antwerp, Wilrijk, Antwerp, Belgium
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Antwerp, Belgium
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Kuo MT, Hsu BWY, Lin YS, Fang PC, Yu HJ, Hsiao YT, Tseng VS. Monitoring the Progression of Clinically Suspected Microbial Keratitis Using Convolutional Neural Networks. Transl Vis Sci Technol 2023; 12:1. [PMID: 37910082 PMCID: PMC10627292 DOI: 10.1167/tvst.12.11.1] [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: 04/27/2023] [Accepted: 10/05/2023] [Indexed: 11/03/2023] Open
Abstract
Purpose For this study, we aimed to determine whether a convolutional neural network (CNN)-based method (based on a feature extractor and an identifier) can be applied to monitor the progression of keratitis while managing suspected microbial keratitis (MK). Methods This multicenter longitudinal cohort study included patients with suspected MK undergoing serial external eye photography at the 5 branches of Chang Gung Memorial Hospital from August 20, 2000, to August 19, 2020. Data were primarily analyzed from January 1 to March 25, 2022. The CNN-based model was evaluated via F1 score and accuracy. The area under the receiver operating characteristic curve (AUROC) was used to measure the precision-recall trade-off. Results The model was trained using 1456 image pairs from 468 patients. In comparing models via only training the identifier, statistically significant higher accuracy (P < 0.05) in models via training both the identifier and feature extractor (full training) was verified, with 408 image pairs from 117 patients. The full training EfficientNet b3-based model showed 90.2% (getting better) and 82.1% (becoming worse) F1 scores, 87.3% accuracy, and 94.2% AUROC for 505 getting better and 272 becoming worse test image pairs from 452 patients. Conclusions A CNN-based approach via deep learning applied in suspected MK can monitor the progress/regress during treatment by comparing external eye image pairs. Translational Relevance The study bridges the gap between the investigation of the state-of-the-art CNN-based deep learning algorithm applied in ocular image analysis and the clinical care of suspected patients with MK.
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Affiliation(s)
- Ming-Tse Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Benny Wei-Yun Hsu
- Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yi Sheng Lin
- Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Po-Chiung Fang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- School of Medicine, Chang Gung University, Taoyuan City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Hun-Ju Yu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Yu-Ting Hsiao
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Vincent S. Tseng
- Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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Hicks PM, Niziol LM, Newman-Casey PA, Salami K, Singh K, Woodward MA. Social Risk Factor Associations With Presenting Visual Acuity in Patients With Microbial Keratitis. JAMA Ophthalmol 2023; 141:727-734. [PMID: 37318786 PMCID: PMC10273131 DOI: 10.1001/jamaophthalmol.2023.2415] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/23/2023] [Indexed: 06/16/2023]
Abstract
Importance Neighborhood-level social risk factors may contribute to health disparities in microbial keratitis (MK) disease presentation. Understanding neighborhood-level factors may identify areas for revised health policies to address inequities that impact eye health. Objective To investigate if social risk factors were associated with presenting best-corrected visual acuity (BCVA) for patients with MK. Design, Setting, and Participants This was a cross-sectional study of patients with a diagnosis of MK. Patients presenting to the University of Michigan with a diagnosis of MK between August 1, 2012, and February 28, 2021, were included in the study. Patient data were obtained from the University of Michigan electronic health record. Main Outcomes and Measures Individual-level characteristics (age, self-reported sex, self-reported race and ethnicity), presenting log of the minimum angle of resolution (logMAR) BCVA, and neighborhood-level factors, including measures on deprivation, inequity, housing burden, and transportation at the census block group, were obtained. Univariate associations of presenting BCVA (< 20/40 vs ≥20/40) with individual-level characteristics were assessed with 2-sample t, Wilcoxon, and χ2 tests. Logistic regression was used to test associations of neighborhood-level characteristics with the probability of presenting BCVA worse than 20/40 after adjustment for patient demographics. Results A total of 2990 patients with MK were identified and included in the study. Patients had a mean (SD) age of 48.6 (21.3) years, and 1723 were female (57.6%). Patients self-identified with the following race and ethnicity categories: 132 Asian (4.5%), 228 Black (7.8%), 99 Hispanic (3.5%), 2763 non-Hispanic (96.5%), 2463 White (84.4%), and 95 other (3.3%; included any race not previously listed). Presenting BCVA had a median (IQR) value of 0.40 (0.10-1.48) logMAR units (Snellen equivalent, 20/50 [20/25-20/600]), and 1508 of 2798 patients (53.9%) presented with BCVA worse than 20/40. Patients presenting with logMAR BCVA less than 20/40 were older than those who presented with 20/40 or higher (mean difference, 14.7 years; 95% CI, 13.3-16.1; P < .001). Furthermore, a larger percentage of male vs female sex patients presented with logMAR BCVA less than 20/40 (difference, 5.2%; 95% CI, 1.5-8.9; P = .04), as well as Black race (difference, 25.7%; 95% CI, 15.0%-36.5%;P < .001) and White race (difference, 22.6%; 95% CI, 13.9%-31.3%; P < .001) vs Asian race, and non-Hispanic vs Hispanic ethnicity (difference, 14.6%; 95% CI, 4.5%-24.8%; P = .04). After adjusting for age, self-reported sex, and self-reported race and ethnicity, worse Area Deprivation Index (odds ratio [OR], 1.30 per 10-unit increase; 95% CI, 1.25-1.35; P < .001), increased segregation (OR, 1.44 per 0.1-unit increase in Theil H index; 95% CI, 1.30-1.61; P < .001), higher percentage of households with no car (OR, 1.25 per 1 percentage point increase; 95% CI, 1.12-1.40; P = .001), and lower average number of cars per household (OR, 1.56 per 1 less car; 95% CI, 1.21-2.02; P = .003) were associated with increased odds of presenting BCVA worse than 20/40. Conclusion and Relevance Findings of this cross-sectional study suggest that in a sample of patients with MK, patient characteristics and where they live were associated with disease severity at presentation. These findings may inform future research on social risk factors and patients with MK.
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Affiliation(s)
- Patrice M. Hicks
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Leslie M. Niziol
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Paula Anne Newman-Casey
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Kassim Salami
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Karandeep Singh
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Maria A. Woodward
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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Jiang B, Luo Y, Yan N, Shen Z, Li W, Hou C, Xiao L, Ma C, Zhang L, Chen Y, Cheng X, Lian M, Ji C, Zhu Z, Wang Z. An X-ray inactivated vaccine against Pseudomonas aeruginosa Keratitis in mice. Vaccine 2023:S0264-410X(23)00627-8. [PMID: 37353454 DOI: 10.1016/j.vaccine.2023.05.066] [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: 11/14/2022] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/25/2023]
Abstract
Pseudomonas aeruginosa (P. aeruginosa) is one of the most prevalent pathogens of bacterial keratitis. Bacterial keratitis is a major cause of blindness worldwide. The rising incidence of multidrug resistance of P. aeruginosa precludes treatment with conventional antibiotics. Herein, we evaluated the protective efficiency and explored the possible underlying mechanism of an X-ray inactivated vaccine (XPa) using a murine P. aeruginosa keratitis model. Mice immunized with XPa exhibit reduced corneal bacterial loads and pathology scores. XPa vaccination induced corneal macrophage polarization toward M2, averting an excessive inflammatory reaction. Furthermore, histological observations indicated that XPa vaccination suppressed corneal fibroblast activation and prevented irreversible visual impairment. The potency of XPa against keratitis highlights its potential utility as an effective and promising vaccine candidate for P. aeruginosa.
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Affiliation(s)
- Boguang Jiang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Yingjie Luo
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Naihong Yan
- Research Laboratory of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhixue Shen
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Wenfang Li
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Chen Hou
- Research Laboratory of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lirong Xiao
- Research Laboratory of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Cuicui Ma
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Li Zhang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Yanwei Chen
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Xingjun Cheng
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Mao Lian
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Chengjie Ji
- Department of Laboratory Medicine, The People's Hospital of Jianyang City, Chengdu 641400, China
| | - Ziyi Zhu
- Department of Laboratory Medicine, The People's Hospital of Jianyang City, Chengdu 641400, China
| | - Zhenling Wang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China.
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Fang Y, Zhuo L, Yuan H, Zhao H, Zhang L. Construction of Graphene Quantum Dot-based Dissolving Microneedle Patches for the Treatment of Bacterial Keratitis. Int J Pharm 2023; 639:122945. [PMID: 37044225 DOI: 10.1016/j.ijpharm.2023.122945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/06/2023] [Accepted: 04/08/2023] [Indexed: 04/14/2023]
Abstract
Bacterial keratitis (BK) is an ophthalmic infection caused by bacteria and poses a risk of blindness. Numerous drugs have been used to treat BK, the majority suffered from limited effect owing to their backward antimicrobial and delivery efficacy. Herein, we evaluated the antibacterial effect of a cationic carbon-based nanomaterial, i.e., imidazole-modified graphene quantum dots (IMZ-GQDs), which exhibits disinfection rates of >90% against three typical Gram-positive strains within 3 h owing to the loss of membrane integrity and decline in membrane potential. For ocular application, we further developed IMZ-GQDs-loaded dissolving microneedle patches (IMZ-GQDs MNs) via a typical two-step micromolding method. IMZ-GQDs MNs showed sufficient dissolution and penetration for intrastromal delivery in vitro and successfully overcome the rabbit corneal epithelial layer in vivo. The excellent biocompatibility of IMZ-GQDs MNs was demonstrated both in cell and animal models, and they exhibited low cytotoxicity, low invasiveness and low ocular irritation. The topical application of IMZ-GQDs MNs has the benefits of both high antibacterial activity and effective drug delivery, thereby leading to the resolution of Staphylococcus aureus-induced BK in rabbits in 7 days. Therefore, IMZ-GQDs MNs is a promising approach for BK treatment, which is safe and efficient.
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Affiliation(s)
- Yirong Fang
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou,Zhejiang, 325027, P.R. China
| | - Lin Zhuo
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou,Zhejiang, 325027, P.R. China
| | - Hang Yuan
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou,Zhejiang, 325027, P.R. China
| | - Hao Zhao
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou,Zhejiang, 325027, P.R. China
| | - Lishu Zhang
- Institute of Advanced Materials for Nano-Bio Applications, School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Xi Road, Wenzhou,Zhejiang, 325027, P.R. China.
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9
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Ung L, Chodosh J. Urgent unmet needs in the care of bacterial keratitis: An evidence-based synthesis. Ocul Surf 2023; 28:378-400. [PMID: 34461290 PMCID: PMC10721114 DOI: 10.1016/j.jtos.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/21/2022]
Abstract
Bacterial corneal infections, or bacterial keratitis (BK), are ophthalmic emergencies that frequently lead to irreversible visual impairment. Though increasingly recognized as a major cause of global blindness, modern paradigms of evidence-based care in BK have remained at a diagnostic and therapeutic impasse for over half a century. Current standards of management - based on the collection of corneal cultures and the application of broad-spectrum topical antibiotics - are beset by important yet widely underrecognized limitations, including approximately 30% of all patients who will develop moderate to severe vision loss in the affected eye. Though recent advances have involved a more clearly defined role for adjunctive topical corticosteroids, and novel therapies such as corneal crosslinking, overall progress to improve patient and population-based outcomes remains incommensurate to the chronic morbidity caused by this disease. Recognizing that the care of BK is guided by the clinical axiom, "time equals vision", this chapter offers an evidence-based synthesis for the clinical management of these infections, underscoring critical unmet needs in disease prevention, diagnosis, and treatment.
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Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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10
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Meijome TE, Wozniak R, Kang L, Azzouz L, Niziol LM, Johnson WL, Kriegel M, Woodward MA. Assessment of Keratitis Severity Using Quantitative Image Analysis in an In Vivo Murine Model of Staphylococcus aureus Bacterial Keratitis. Transl Vis Sci Technol 2022; 11:12. [DOI: 10.1167/tvst.11.11.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Tomas E. Meijome
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Rachel Wozniak
- Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Linda Kang
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Lyna Azzouz
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Leslie M. Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - William L. Johnson
- Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Matthias Kriegel
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
- Augenzentrum am St. Franziskus Hospital, Muenster, Germany
| | - Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
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Polat HK, Kurt N, Aytekin E, Bozdağ Pehlivan S, Çalış S. Novel Drug Delivery Systems to Improve the Treatment of Keratitis. J Ocul Pharmacol Ther 2022; 38:376-395. [PMID: 35763406 DOI: 10.1089/jop.2021.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Keratitis is a disease characterized by inflammation of the cornea caused by different pathogens. It can cause serious visual morbidity if not treated quickly. Depending on the pathogen causing keratitis, eye drops containing antibacterial, antifungal, or antiviral agents such as besiloxacin, moxifloxacin, ofloxacin, voriconazol, econazole, fluconazole, and acyclovir are used, and these drops need to be applied frequently due to their low bioavailability. Studies are carried out on formulations with extended residence time in the cornea and increased permeability. These formulations include various new drug delivery systems such as inserts, nanoparticles, liposomes, niosomes, cubosomes, microemulsions, in situ gels, contact lenses, nanostructured lipid carriers, carbon quantum dots, and microneedles. Ex vivo and in vivo studies with these formulations have shown that the residence time of the active substances in the cornea is prolonged, and their ocular bioavailability is increased. In addition, in vivo studies have shown that these formulations successfully treat keratitis. However, it has been observed that fluoroquinolones are used in most of the studies; similar drug delivery systems are generally preferred for antifungal drugs, and studies for viral and acanthameba keratitis are limited. There is a need for new studies on different types of keratitis and different drug active substances. At the same time, proving the efficacy of drug delivery systems, which give promising results in in vivo animal models, with clinical studies is of great importance for progress in the treatment of keratitis.
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Affiliation(s)
- Heybet Kerem Polat
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey.,Department of Pharmaceutical Technology, Faculty of Pharmacy, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Nihat Kurt
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey.,Department of Pharmaceutical Technology, Faculty of Pharmacy, Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Eren Aytekin
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Sibel Bozdağ Pehlivan
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Sema Çalış
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
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12
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Das S, D’Souza S, Gorimanipalli B, Shetty R, Ghosh A, Deshpande V. Ocular Surface Infection Mediated Molecular Stress Responses: A Review. Int J Mol Sci 2022; 23:ijms23063111. [PMID: 35328532 PMCID: PMC8952005 DOI: 10.3390/ijms23063111] [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: 12/31/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/16/2022] Open
Abstract
Infection mediated ocular surface stress responses are activated as early defense mechanisms in response to host cell damage. Integrated stress responses initiate the host response to different types of infections and modulate the transcription of key genes and translation of proteins. The crosstalk between host and pathogen results in profound alterations in cellular and molecular homeostasis triggering specific stress responses in the infected tissues. The amplitude and variations of such responses are partly responsible for the disease severity and clinical sequelae. Understanding the etiology and pathogenesis of ocular infections is important for early diagnosis and effective treatment. This review considers the molecular status of infection mediated ocular surface stress responses which may shed light on the importance of the host stress-signaling pathways. In this review, we collated literature on the molecular studies of all ocular surface infections and summarize the results from such studies systematically. Identification of important mediators involved in the crosstalk between the stress response and activation of diverse signaling molecules in host ocular surface infection may provide novel molecular targets for maintaining the cellular homeostasis during infection. These targets can be then explored and validated for diagnostic and therapeutic purposes.
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Affiliation(s)
- Samayitree Das
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore 560 099, India;
| | - Sharon D’Souza
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore 560 010, India; (S.D.); (B.G.); (R.S.)
| | - Bhavya Gorimanipalli
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore 560 010, India; (S.D.); (B.G.); (R.S.)
| | - Rohit Shetty
- Cornea and Refractive Services, Narayana Nethralaya, Bangalore 560 010, India; (S.D.); (B.G.); (R.S.)
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore 560 099, India;
- Correspondence: (A.G.); (V.D.)
| | - Vrushali Deshpande
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore 560 099, India;
- Correspondence: (A.G.); (V.D.)
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Wu W, Huang S, Xie X, Chen C, Yan Z, Lv X, Fan Y, Chen C, Yue F, Yang B. Raman spectroscopy may allow rapid noninvasive screening of keratitis and conjunctivitis. Photodiagnosis Photodyn Ther 2021; 37:102689. [PMID: 34933166 DOI: 10.1016/j.pdpdt.2021.102689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/30/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
Keratitis and conjunctivitis are the most common ocular diseases, their symptoms are similar and easy to confuse, however infectious conjunctivitis is highly contagious. If misdiagnosed, it may worsen the disease and pose a threat to public health.This is a preclinical study to propose a method for rapid and accurate screening of keratitis and conjunctivitis by combining tear Raman spectroscopy with deep learning models that may be applied to clinical applications in the future.The tears of 16 cases of keratitis patients, 13 cases of conjunctivitis patients and 46 cases of healthy subjects were collected, and their Raman spectra were compared and analyzed. By adding different decibels of Gaussian white noise to expand the data, the performance of the tear Raman spectra with a large sample size in the deep learning model was discussed. Principal component analysis (PCA), partial least squares (PLS) and maximum correlation minimum redundancy (mRMR) were used for feature extraction. The processed data were imported into convolutional neural network (CNN) and recurrent neural network (RNN) depth models for classification. After the data were enhanced and processed by PLS, the highest classification accuracy of healthy subjects and keratitis patients, healthy subjects and conjunctivitis patients, and keratitis and conjunctivitis patients reached 94.8%, 95.4%, and 92.7%, respectively. The results of this study show that the use of large sample tear Raman spectra data combined with PLS feature extraction and depth learning algorithms may have great potential in clinical screening of keratitis and conjunctivitis.
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Affiliation(s)
- Wei Wu
- College of Software, Xinjiang University, Urumqi 830046, China
| | - Shengsong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060 China
| | - Xiaodong Xie
- People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Ophthalmology, Urumqi 830001, China.
| | - Cheng Chen
- College of Information Science and Engineering, Xinjiang University, Urumqi 830046, China.
| | - Ziwei Yan
- College of Information Science and Engineering, Xinjiang University, Urumqi 830046, China; Key Laboratory of signal detection and processing, Xinjiang University, Urumqi 830046, China
| | - Xiaoyi Lv
- College of Software, Xinjiang University, Urumqi 830046, China; Key Laboratory of signal detection and processing, Xinjiang University, Urumqi 830046, China
| | - Yangyang Fan
- College of Software, Xinjiang University, Urumqi 830046, China
| | - Chen Chen
- College of Information Science and Engineering, Xinjiang University, Urumqi 830046, China; Key Laboratory of signal detection and processing, Xinjiang University, Urumqi 830046, China
| | - Feilong Yue
- College of Software, Xinjiang University, Urumqi 830046, China
| | - Bo Yang
- College of Information Science and Engineering, Xinjiang University, Urumqi 830046, China
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14
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Khan M, Michelson S, Newman-Casey PA, Woodward MA. Medication Adherence Among Patients With Corneal Diseases. Cornea 2021; 40:1554-1560. [PMID: 33661137 PMCID: PMC8418623 DOI: 10.1097/ico.0000000000002680] [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: 10/20/2020] [Accepted: 12/26/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Medication nonadherence is a ubiquitous problem. However, the adherence of patients to medications to manage corneal conditions is unknown. A prospective cohort study investigated the patterns of eye drop adherence among patients with corneal conditions. METHODS Patients older than or equal to 18 years taking prescription eye medications were recruited from an academic center's corneal clinic. Data collected included age, sex, total doses of eye medications, and category of primary corneal diagnosis. Participants completed adapted versions of the 12-question Adherence to Refills and Medications Scale (ARMS) and the 3-question Voils' Medication Adherence Scale (VMAS). Survey data were dichotomized as "adherent" and "nonadherent," and subscales reported for reasons of nonadherence. Logistic regression analyses were used to test associations with adherence. RESULTS A total of 199 participants were surveyed from February to March 2019 (95% response rate). Participants were aged 19 to 93 years with a mean age of 59 years (SD 17.8). The percent of participants considered nonadherent was 72% by the ARMS and 33% by the VMAS. Older age was associated with higher adherence by the ARMS (odds ratio = 1.48, 95% confidence interval, 1.14-1.93, P = 0.004) and by the VMAS (odds ratio = 1.24, confidence interval, 1.04-1.48, P = 0.012). Adherence was not significantly associated with race, sex, education, total doses of eye medications, or primary cornea diagnosis. CONCLUSIONS Medication adherence was lower than expected, particularly on the ARMS scale that asks more detailed questions. Clinicians should engage in conversations about adherence, especially with younger patients, if they are not seeing an expected clinical response.
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Affiliation(s)
- Mariam Khan
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Sarah Michelson
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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15
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Singh RB, Das S, Chodosh J, Sharma N, Zegans ME, Kowalski RP, Jhanji V. Paradox of complex diversity: Challenges in the diagnosis and management of bacterial keratitis. Prog Retin Eye Res 2021; 88:101028. [PMID: 34813978 DOI: 10.1016/j.preteyeres.2021.101028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 12/12/2022]
Abstract
Bacterial keratitis continues to be one of the leading causes of corneal blindness in the developed as well as the developing world, despite swift progress since the dawn of the "anti-biotic era". Although, we are expeditiously developing our understanding about the different causative organisms and associated pathology leading to keratitis, extensive gaps in knowledge continue to dampen the efforts for early and accurate diagnosis, and management in these patients, resulting in poor clinical outcomes. The ability of the causative bacteria to subdue the therapeutic challenge stems from their large genome encoding complex regulatory networks, variety of unique virulence factors, and rapid secretion of tissue damaging proteases and toxins. In this review article, we have provided an overview of the established classical diagnostic techniques and therapeutics for keratitis caused by various bacteria. We have extensively reported our recent in-roads through novel tools for accurate diagnosis of mono- and poly-bacterial corneal infections. Furthermore, we outlined the recent progress by our group and others in understanding the sub-cellular genomic changes that lead to antibiotic resistance in these organisms. Finally, we discussed in detail, the novel therapies and drug delivery systems in development for the efficacious management of bacterial keratitis.
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Affiliation(s)
- Rohan Bir Singh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Leiden University Medical Center, 2333, ZA Leiden, the Netherlands
| | - Sujata Das
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Bhubaneshwar, India
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Michael E Zegans
- Department of Ophthalmology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Regis P Kowalski
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; The Charles T Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; The Charles T Campbell Ophthalmic Microbiology Laboratory, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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16
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Ung L, Chodosh J. Foundational concepts in the biology of bacterial keratitis. Exp Eye Res 2021; 209:108647. [PMID: 34097906 PMCID: PMC8595513 DOI: 10.1016/j.exer.2021.108647] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/28/2021] [Accepted: 05/27/2021] [Indexed: 12/12/2022]
Abstract
Bacterial infections of the cornea, or bacterial keratitis (BK), are notorious for causing rapidly fulminant disease and permanent vision loss, even among treated patients. In the last sixty years, dramatic upward trajectories in the frequency of BK have been observed internationally, driven in large part by the commercialization of hydrogel contact lenses in the late 1960s. Despite this worsening burden of disease, current evidence-based therapies for BK - including broad-spectrum topical antibiotics and, if indicated, topical corticosteroids - fail to salvage vision in a substantial proportion of affected patients. Amid growing concerns of rapidly diminishing antibiotic utility, there has been renewed interest in urgently needed novel treatments that may improve clinical outcomes on an individual and public health level. Bridging the translational gap in the care of BK requires the identification of new therapeutic targets and rational treatment design, but neither of these aims can be achieved without understanding the complex biological processes that determine how bacterial corneal infections arise, progress, and resolve. In this chapter, we synthesize the current wealth of human and animal experimental data that now inform our understanding of basic BK pathophysiology, in context with modern concepts in ocular immunology and microbiology. By identifying the key molecular determinants of clinical disease, we explore how novel treatments can be developed and translated into routine patient care.
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Affiliation(s)
- Lawson Ung
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Infectious Disease Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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17
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Mohan P, Kesavan K. Cationic Polyelectrolyte Nanocapsules of Moxifloxacin for Microbial Keratitis Therapy: Development, Characterization, and Pharmacodynamic Study. AAPS PharmSciTech 2021; 22:195. [PMID: 34184117 DOI: 10.1208/s12249-021-02039-1] [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: 02/12/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022] Open
Abstract
Microbial keratitis (MK) is a vision-threatening disease and the fourth leading cause of blindness worldwide. In this work, we aim to develop moxifloxacin (MXN)-loaded chitosan-based cationic mucoadhesive polyelectrolyte nanocapsules (PENs) for the effective treatment of MK. PENs were formulated by polyelectrolyte complex coacervation method and characterized for their particle size, surface charge, morphology, mucoadhesive property, in-vitro and ex-vivo release, ocular tolerance, and antimicrobial efficacy studies. The pharmacodynamic study was conducted on rabbit eye model of induced keratitis and it is compared with marketed formulation (MF). Developed PENs showed the size range from 230.7 ± 0.64 to 249.0 ± 0.49 nm and positive surface charge, spherical shape along with appropriate physico-chemical parameters. Both in-vitro and ex-vivo examination concludes that PENs having more efficiency in sustained release of MXN compared to MF. Ocular irritation studies demonstrated that no corneal damage or ocular irritation. The in-vivo study proved that the anti-bacterial efficacy of PENs was improved when compared with MF. These results suggested that PENs are a feasible choice for MK therapy because of their ability to enhance ocular retention of loaded MXN through interaction with the corneal surface of the mucous membrane.
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18
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Ulag S, Ilhan E, Demirhan R, Sahin A, Yilmaz BK, Aksu B, Sengor M, Ficai D, Titu AM, Ficai A, Gunduz O. Propolis-Based Nanofiber Patches to Repair Corneal Microbial Keratitis. Molecules 2021; 26:molecules26092577. [PMID: 33925130 PMCID: PMC8125036 DOI: 10.3390/molecules26092577] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 11/20/2022] Open
Abstract
In this research, polyvinyl-alcohol (PVA)/gelatin (GEL)/propolis (Ps) biocompatible nanofiber patches were fabricated via electrospinning technique. The controlled release of Propolis, surface wettability behaviors, antimicrobial activities against the S. aureus and P. aeruginosa, and biocompatibility properties with the mesenchymal stem cells (MSCs) were investigated in detail. By adding 0.5, 1, and 3 wt.% GEL into the 13 wt.% PVA, the morphological and mechanical results suggested that 13 wt.% PVA/0.5 wt.% GEL patch can be an ideal matrix for 3 and 5 wt.% propolis addition. Morphological results revealed that the diameters of the electrospun nanofiber patches were increased with GEL (from 290 nm to 400 nm) and Ps addition and crosslinking process cause the formation of thicker nanofibers. The tensile strength and elongation at break enhancement were also determined for 13 wt.% PVA/0.5 wt.% GEL/3 wt.% Ps patch. Propolis was released quickly in the first hour and arrived at a plateau. Cell culture and contact angle results confirmed that the 3 wt.% addition of propolis reinforced mesenchymal stem cell proliferation and wettability properties of the patches. The antimicrobial activity demonstrated that propolis loaded patches had antibacterial activity against the S. aureus, but for P. aeruginosa, more studies should be performed.
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Affiliation(s)
- Songul Ulag
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, 34722 Istanbul, Turkey; (S.U.); (E.I.); (R.D.); (M.S.)
- Metallurgical and Materials Engineering, Institute of Pure and Applied Sciences, Marmara University, 34722 Istanbul, Turkey
| | - Elif Ilhan
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, 34722 Istanbul, Turkey; (S.U.); (E.I.); (R.D.); (M.S.)
- Department of Bioengineering, Institute of Pure and Applied Sciences, Marmara University, 34722 Istanbul, Turkey
| | - Ramazan Demirhan
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, 34722 Istanbul, Turkey; (S.U.); (E.I.); (R.D.); (M.S.)
| | - Ali Sahin
- Department of Biochemistry, Faculty of Medicine, Marmara University, 34718 Istanbul, Turkey; (A.S.); (B.K.Y.)
- Genetic and Metabolic Diseases Research and Investigation Center, Marmara University, 34722 Istanbul, Turkey
| | - Betul Karademir Yilmaz
- Department of Biochemistry, Faculty of Medicine, Marmara University, 34718 Istanbul, Turkey; (A.S.); (B.K.Y.)
- Genetic and Metabolic Diseases Research and Investigation Center, Marmara University, 34722 Istanbul, Turkey
| | - Burak Aksu
- Department of Medical Microbiology, Marmara University School of Medicine, 34854 Istanbul, Turkey;
| | - Mustafa Sengor
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, 34722 Istanbul, Turkey; (S.U.); (E.I.); (R.D.); (M.S.)
- Metallurgical and Materials Engineering Faculty of Technology, Marmara University, 34722 Istanbul, Turkey
| | - Denisa Ficai
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania;
- National Centre for Micro- and Nanomaterials, University Politehnica of Bucharest, 060042 Bucharest, Romania
| | - Aurel Mihail Titu
- Industrial Engineering and Management Department, Faculty of Engineering, Lucian Blaga University of Sibiu, 550025 Sibiu, Romania;
- Academy of Romanian Scientists, 050094 Bucharest, Romania
| | - Anton Ficai
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania;
- National Centre for Micro- and Nanomaterials, University Politehnica of Bucharest, 060042 Bucharest, Romania
- Academy of Romanian Scientists, 050094 Bucharest, Romania
- Correspondence: (A.F.); (O.G.)
| | - Oguzhan Gunduz
- Center for Nanotechnology & Biomaterials Application and Research (NBUAM), Marmara University, 34722 Istanbul, Turkey; (S.U.); (E.I.); (R.D.); (M.S.)
- Metallurgical and Materials Engineering Faculty of Technology, Marmara University, 34722 Istanbul, Turkey
- Correspondence: (A.F.); (O.G.)
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Xie X, Chen C, Sun T, Mamati G, Wan X, Zhang W, Gao R, Chen F, Wu W, Fan Y, Lv X, Wu G. Rapid, non-invasive screening of keratitis based on Raman spectroscopy combined with multivariate statistical analysis. Photodiagnosis Photodyn Ther 2020; 31:101932. [PMID: 32717454 DOI: 10.1016/j.pdpdt.2020.101932] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/29/2020] [Accepted: 07/17/2020] [Indexed: 02/07/2023]
Abstract
This study proposes a multivariate statistical analysis method based on Raman spectroscopy and different dimensionality reduction methods combined with the support vector machine (SVM) algorithm for rapid, non-invasive, high-accuracy classification of keratitis screenings. In this experiment, tear samples from 19 subjects with keratitis and 27 healthy subjects were detected, Raman spectra of the two groups of subjects were compared and analysed, and we found that their spectral intensities were different at 1005 cm-1 and 1155 cm-1 Principal component analysis (PCA) and partial least squares (PLS) were used for feature extraction, which greatly reduced the dimensionality of the high-dimensional spectral data. Then, the above two feature extraction methods were used as input to an SVM to build the discriminant diagnosis model. The average accuracy obtained from the PCA-SVM and PLS-SVM models was 77.86 % and 100 %, respectively. Our results suggest that tear Raman spectroscopy combined with multivariate statistical analysis has great potential in screening for keratitis. We expect this technology to could lead to the development of a portable, non-invasive and highly accurate keratitis screening device.
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Affiliation(s)
- Xiaodong Xie
- People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Ophthalmology, Urumqi 830001, China
| | - Cheng Chen
- School of Information Science and Engineering, Xinjiang University, Urumqi 830046, China
| | - Tiantian Sun
- School of Information Science and Engineering, Xinjiang University, Urumqi 830046, China
| | - Gulinur Mamati
- People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Ophthalmology, Urumqi 830001, China
| | - Xinjuan Wan
- People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Ophthalmology, Urumqi 830001, China
| | - Wenjuan Zhang
- People's Hospital of Xinjiang Uygur Autonomous Region, 91 Tianchi Road, Ophthalmology, Urumqi 830001, China
| | - Rui Gao
- School of Information Science and Engineering, Xinjiang University, Urumqi 830046, China
| | - Fangfang Chen
- School of Information Science and Engineering, Xinjiang University, Urumqi 830046, China
| | - Wei Wu
- School of Software, Xinjiang University, Urumqi 840046, China
| | - Yangyang Fan
- School of Software, Xinjiang University, Urumqi 840046, China
| | - Xiaoyi Lv
- School of Software, Xinjiang University, Urumqi 840046, China.
| | - Guohua Wu
- School of Electronic Engineering, Beijing University of Posts and Telecommunications, Beijing 100876, China.
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20
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NLRP3 Inflammasome and Inflammatory Diseases. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:4063562. [PMID: 32148650 PMCID: PMC7049400 DOI: 10.1155/2020/4063562] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/14/2020] [Accepted: 01/17/2020] [Indexed: 02/06/2023]
Abstract
Almost all human diseases are strongly associated with inflammation, and a deep understanding of the exact mechanism is helpful for treatment. The NLRP3 inflammasome composed of the NLRP3 protein, procaspase-1, and ASC plays a vital role in regulating inflammation. In this review, NLRP3 regulation and activation, its proinflammatory role in inflammatory diseases, interactions with autophagy, and targeted therapeutic approaches in inflammatory diseases will be summarized.
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21
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Nguyen DD, Lai JY. Advancing the stimuli response of polymer-based drug delivery systems for ocular disease treatment. Polym Chem 2020. [DOI: 10.1039/d0py00919a] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Recent exploitations of stimuli-responsive polymers as ophthalmic drug delivery systems for the treatment of eye diseases are summarized and discussed.
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Affiliation(s)
- Duc Dung Nguyen
- Graduate Institute of Biomedical Engineering
- Chang Gung University
- Taoyuan 33302
- Republic of China
| | - Jui-Yang Lai
- Graduate Institute of Biomedical Engineering
- Chang Gung University
- Taoyuan 33302
- Republic of China
- Department of Ophthalmology
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22
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Evaluating the potential of drug eluting contact lenses for treatment of bacterial keratitis using an ex vivo corneal model. Int J Pharm 2019; 565:499-508. [DOI: 10.1016/j.ijpharm.2019.05.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/08/2019] [Accepted: 05/11/2019] [Indexed: 01/10/2023]
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23
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Punitan R, Sulaiman SA, Hasan HB, Shatriah I. Clinical and Antibacterial Effects of Tualang Honey on Pseudomonas-induced Keratitis in Rabbit Eyes. Cureus 2019; 11:e4332. [PMID: 31186997 PMCID: PMC6541235 DOI: 10.7759/cureus.4332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Pseudomonas aeruginosa is a common cause of microbial keratitis that can cause a significant loss of visual acuity. Antibiotics, including fluoroquinolones and aminoglycosides, are clinically effective against Pseudomonas-induced keratitis, but their effectiveness has been conspicuously reduced as resistant pathogens have become more potent. This study sought to evaluate the clinical and antibacterial effects of tualang honey as an alternative therapeutic agent against Pseudomonas-induced keratitis. Methods We conducted a randomized control trial in which 30 rabbits were injected intrastromally with 1,000 colony-forming units (CFU) of Pseudomonas aeruginosa in the right eye of each rabbit (n = 30). The rabbits were then randomized into three groups of 10 rabbits each. Group A was treated with topical gentamicin 0.3%, group B was treated with topical tualang honey 30%, and group C received both treatments. The specified treatments were administered every two hours from 24 to 48 hours post injection, and subsequently every four hours for six days. Clinical examinations were performed on days one, two, three, five, and seven, and the mean results of slit lamp examinations (SLEs) were documented. On day seven after pseudomonas induction, the rabbits were euthanized and their corneas were harvested to determine the median CFU per cornea. Results There were no statistically significant differences (p > 0.05) in mean SLE scores (p = 0.209) or median CFU values (p = 0.820) between the three groups. Conclusion Topical gentamicin, topical tualang honey, and the combination of the two all showed similar clinical and antimicrobial effects in treating Pseudomonas-induced keratitis in rabbits. These findings should be verified in further studies with larger sample sizes and the addition of a control group.
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Affiliation(s)
- Rajendran Punitan
- Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Siti Amrah Sulaiman
- Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Habsah B Hasan
- Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Ismail Shatriah
- Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
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Sustained release of decorin to the surface of the eye enables scarless corneal regeneration. NPJ Regen Med 2018; 3:23. [PMID: 30588331 PMCID: PMC6303295 DOI: 10.1038/s41536-018-0061-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/15/2018] [Indexed: 11/25/2022] Open
Abstract
Disorganization of the transparent collagenous matrix in the cornea, as a consequence of a variety of infections and inflammatory conditions, leads to corneal opacity and sight-loss. Such corneal opacities are a leading cause of blindness, according to the WHO. Public health programs target prevention of corneal scarring, but the only curative treatment of established scarring is through transplantation. Although attempts to minimize corneal scarring through aggressive control of infection and inflammation are made, there has been little progress in the development of anti-scarring therapies. This is owing to eye drop formulations using low viscosity or weak gelling materials having short retention times on the ocular surface. In this study, we report an innovative eye drop formulation that has the ability to provide sustained delivery of decorin, an anti-scarring agent. The novelty of this eye drop lies in the method of structuring during manufacture, which creates a material that can transition between solid and liquid states, allowing retention in a dynamic environment being slowly removed through blinking. In a murine model of Pseudomonaskeratitis, applying the eye drop resulted in reductions of corneal opacity within 16 days. More remarkably, the addition of hrDecorin resulted in restoration of corneal epithelial integrity with minimal stromal opacity endorsed by reduced α-smooth muscle actin (αSMA), fibronectin, and laminin levels. We believe that this drug delivery system is an ideal non-invasive anti-fibrotic treatment for patients with microbial keratitis, potentially without recourse to surgery, saving the sight of many in the developing world, where corneal transplantation may not be available. An eye drop formulation that applies anti-scarring drugs to the surface of the eye helps reverse infection-induced corneal damage in mice. Hill et al. from the University of Birmingham, UK, formulated a fluid gel loaded with a wound-healing protein called decorin that conforms to the ocular surface and is cleared gradually through blinking. With colleagues in California, they applied the therapeutic eye drop to mice with bacterial eye infections that trigger sight-threatening corneal scarring. Within a matter of days, the team saw improvements in corneal transparency, with reductions in scar tissue and reconstitution of healthy cells. Such a drug delivery system, if successful in humans, could help save many people’s sight and reduce the need for corneal transplantation.
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Ekanayaka SA, McClellan SA, Barrett RP, Hazlett LD. Topical Glycyrrhizin Is Therapeutic for Pseudomonas aeruginosa Keratitis. J Ocul Pharmacol Ther 2018; 34:239-249. [PMID: 29236588 PMCID: PMC5899296 DOI: 10.1089/jop.2017.0094] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/09/2017] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Glycyrrhizin (GLY), an inhibitor of high-mobility group box 1 (HMGB1) protects prophylactically against Pseudomonas aeruginosa keratitis. However, the therapeutic potential of GLY to enhance an antibiotic has not been tested and is our purpose. METHODS C57BL/6 mice (B6) were infected with a clinical isolate (KEI 1025) of P. aeruginosa and treated topically at 6 h postinfection (p.i.) with GLY or phosphate-buffered saline (PBS). Clinical scores, photography with a slit lamp, enzyme-linked immunosorbent assay, myeloperoxidase assay, bacterial plate counts, histopathology, reactive oxygen/nitrogen species (ROS/RNS) assays, and in vitro macrophage (Mφ) stimulation assays were used to assess effects of GLY treatment. In separate similar experiments, the ability of GLY to bioenhance the antibiotic, tobramycin (TOB), was assessed. RESULTS In vivo, GLY versus PBS topical treatment began at 6 h p.i., improved disease outcome by significantly reducing clinical scores, proinflammatory proteins (HMGB1, RAGE, TLR4, TNF-α, and CXCL2), neutrophil infiltrate, bacterial load, ROS/RNS, and nitric oxide. In vitro, GLY downregulated iNOS and COX-2 expression (mRNA) in both mouse and human (THP-1) Mφ. At 6 and 24 h p.i., treatment with GLY enhanced the effects of TOB compared with TOB alone by significantly reducing corneal bacterial load and/or protein levels of cytokines CXCL2 and IL-1β. CONCLUSIONS Data provide evidence that GLY is not only therapeutic for Pseudomonas keratitis through its ability to reduce HMGB1, bacterial load, and oxidative damage but also through its bioenhancement of an antibiotic, even when treatment is initiated at 24 h after infection.
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Affiliation(s)
- Sandamali A Ekanayaka
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine , Detroit, Michigan
| | - Sharon A McClellan
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine , Detroit, Michigan
| | - Ronald P Barrett
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine , Detroit, Michigan
| | - Linda D Hazlett
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine , Detroit, Michigan
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Brothers KM, Kowalski RP, Tian S, Kinchington PR, Shanks RMQ. Bacteria induce autophagy in a human ocular surface cell line. Exp Eye Res 2017; 168:12-18. [PMID: 29288646 DOI: 10.1016/j.exer.2017.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/24/2017] [Indexed: 12/18/2022]
Abstract
Autophagy protects cells from intracellular pathogens, but can be exploited by some infectious agents to their benefit. Currently it is not known if bacteria induce autohpagy in cells of the cornea. The goal of this study was to develop an ocular surface autophagy reporter cell line and determine whether ocular bacterial pathogens influence host responses through autophagy induction. The cell line was made using lentivirus transduction of an LC3-GFP fusion protein in human corneal limbal epithelial (HCLE) cells. LC3-GFP puncta in HCLEs were induced by rapamycin and ammonium chloride treatments, and prevented by the autophagy inhibitors 3-methyladenine (3'MA) and bafilomycin. Importantly, secretomes from Escherichia coli, Serratia marcescens, Staphylococcus aureus, methicillin sensitive (MSSA) and resistant (MRSA), were found to induce autophagy, whereas other bacteria, including Acinetobacter baumannii, Achromobacter xylosoxidans, Enterococcus faecalis, Klebsiella pneumoniae, Moraxella sp., and Stenotrophomonas maltophilia, did not. Our data indicates differences between tested ocular isolates of MRSA and MSSA in the activation of autophagy. HCLEs treated with 3'MA were slightly more susceptible to cytotoxic factors produced by S. marcescens and MRSA keratitis isolates, by contrast, bafilomycin A1 treatment caused no difference. This work demonstrates the successful development and validation of an autophagy reporter corneal cell line and indicates differences between ocular bacterial isolates in the activation of autophagy.
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Affiliation(s)
- Kimberly M Brothers
- The Charles T. Campbell Ophthalmic Microbiology Laboratory, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Regis P Kowalski
- The Charles T. Campbell Ophthalmic Microbiology Laboratory, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shenghe Tian
- The Charles T. Campbell Ophthalmic Microbiology Laboratory, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Paul R Kinchington
- The Charles T. Campbell Ophthalmic Microbiology Laboratory, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Robert M Q Shanks
- The Charles T. Campbell Ophthalmic Microbiology Laboratory, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Thermosensitive hydrogel as an in situ gelling antimicrobial ocular dressing. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 78:203-209. [DOI: 10.1016/j.msec.2017.04.065] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/07/2017] [Accepted: 04/12/2017] [Indexed: 01/12/2023]
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Del Mar Cendra M, Christodoulides M, Hossain P. Effect of Different Antibiotic Chemotherapies on Pseudomonas aeruginosa Infection In Vitro of Primary Human Corneal Fibroblast Cells. Front Microbiol 2017; 8:1614. [PMID: 28878761 PMCID: PMC5572282 DOI: 10.3389/fmicb.2017.01614] [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: 05/17/2017] [Accepted: 08/08/2017] [Indexed: 12/11/2022] Open
Abstract
Pseudomonas aeruginosa is a major cause of bacterial keratitis (BK) worldwide. Inappropriate or non-optimal antibiotic chemotherapy can lead to corneal perforation and rapid sight loss. In this study, we tested the hypothesis that P. aeruginosa strain PAO1 invades primary human corneal fibroblasts (hCFs) in vitro and persists intracellularly, despite chemotherapy with antibiotics used commonly to treat BK. In rank order, ciprofloxacin, levofloxacin and polymyxin B showed the highest activity against planktonic PAO1 growth (100% inhibitory concentration ≤10 μg/mL; 50% inhibitory concentration ≤1 μg/mL), followed by gentamicin and ofloxacin (100% inhibitory concentration ≤50 μg/mL; 50% inhibitory concentration ≤10 μg/mL). These bactericidal antibiotics (50–200 μg/mL concentrations) all killed PAO1 in the extracellular environment of infected hCF monolayers. By contrast, the bactericidal antibiotic cefuroxime and the bacteriostatic antibiotic chloramphenicol failed to sterilize both PAO1 broth cultures, even at a concentration of ≥200 μg/mL) and infected hCF monolayers. Statistically, all antibiotics were able to prevent LDH release from PAO1-infected hCF monolayers at both concentrations tested. Intracellular Pseudomonas were significantly reduced (>99%, P < 0.05) following treatment with ciprofloxacin, levofloxacin and ofloxacin, whereas gentamicin, polymyxin B and cefuroxime failed to clear intracellular bacteria over 24 h. Intracellular Pseudomonas infection was resistant to chloramphenicol, with hCF death observed by 9 h. Eventual growth of remaining intracellular Pseudomonas was observed in hCF after removal of all antibiotics, resulting in re-infection cycles and cell death by 48 h. All of the antibiotics reduced significantly (P < 0.05) IL-1β secretion by hCF infected with a Multiplicity Of Infection (MOI) = 1 of PAO1. With higher MOI, no pro-inflammatory effects were observed with antibiotic treatment, expect with polymyxin B and ofloxacin, which induced significant increased IL-1β secretion (P < 0.001). The findings from our study demonstrated that bactericidal and bacteriostatic antibiotics, routinely used to treat BK, failed to eradicate Pseudomonas infection of hCFs in vitro and that their bactericidal efficacies were influenced by the cellular location of the organism.
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Affiliation(s)
- Maria Del Mar Cendra
- Molecular Microbiology, Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of SouthamptonSouthampton, United Kingdom
| | - Myron Christodoulides
- Molecular Microbiology, Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of SouthamptonSouthampton, United Kingdom
| | - Parwez Hossain
- Eye Unit, Academic Unit of Clinical and Experimental Sciences, University Hospital Southampton NHS Foundation Trust, Southampton General HospitalSouthampton, United Kingdom
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Ahsan SM, Rao CM. Condition responsive nanoparticles for managing infection and inflammation in keratitis. NANOSCALE 2017; 9:9946-9959. [PMID: 28681884 DOI: 10.1039/c7nr00922d] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Keratitis is a major cause of avoidable visual impairment. About 30% of patients with fungal keratitis eventually become permanently blind in the developing world. Proteases, secreted by the pathogen and the host, damage the cornea before the infection is resolved. Treating keratitis is a challenge because both infection and inflammation need to be addressed. An additional challenge is to maintain a therapeutic dose at the corneal surface as blinking and tear film wash away the drugs, administered as eye drops. We have developed a nanoparticle-based drug delivery system that enhances the drug residence time by anchoring to the cornea, down-regulates inflammation and releases the antifungal drug: all in a condition-responsive manner. The expression of Toll-Like Receptors (TLR4) on the corneal epithelial cells increases in response to infection. We have conjugated anti-TLR4 antibodies on the surface of ketoconazole-encapsulated gelatin nanoparticles. The anti-TLR4 antibody not only facilitates binding of nanoparticles to the cornea, enhancing their residence time, but also reduces the levels of inflammatory cytokines. Host and fungal proteases degrade the gelatin nanoparticle, an alternative substrate for proteases, thereby reducing corneal damage and releasing the encapsulated drug, ketoconazole, proportional to the severity of infection. After testing the efficacy of the system with human corneal epithelial cells, we have extended our studies to a rat model of keratitis. The results show a significantly increased corneal retention, suppressed inflammation and resolution of infection in the infected eyes. We believe that this will be an excellent approach to manage keratitis as well as other topical ocular infections.
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Affiliation(s)
- Saad M Ahsan
- Centre for Cellular and Molecular Biology (CCMB), Council of Scientific and Industrial Research (CSIR), Uppal Road, Hyderabad - 500 007, Telangana, India.
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Bozkurt Oflaz A, Bozkurt B, Kamış Ü, Ekinci Köktekir B. Corneal Collagen Crosslinking Treatment in a Case with Pneumococcal Keratitis. Turk J Ophthalmol 2017. [PMID: 28630792 PMCID: PMC5468530 DOI: 10.4274/tjo.98470] [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] [Indexed: 12/01/2022] Open
Abstract
Bacterial keratitis is a serious ocular infectious disease that can threaten vision. The disease generally progresses rapidly and can lead to corneal scar, stromal abscess formation, perforation, and dissemination to adjacent tissues if not treated properly. Recent studies showed that corneal collagen crosslinking (CCC) using ultraviolet-A/riboflavin is effective in the treatment of bacterial keratitis refractory to topical antibiotic treatment. In addition to being bactericidal, CCC also decreases risk of perforation by strengthening the corneal collagen structure. Herein, we report a male patient with Streptococcus pneumonia keratitis 6 months after a keratoplasty procedure, which did not respond to fortified topical antibiotic therapy and was treated successfully with riboflavin/ultraviolet-A CCC. His pain decreased remarkably in a few days. The corneal epithelial defect healed and infiltration regressed within 2 weeks after CCC. His vision improved significantly from hand movement to 20/400. CCC might be used as adjuvant treatment in bacterial keratitis refractory to medical treatment.
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Affiliation(s)
- Ayşe Bozkurt Oflaz
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Banu Bozkurt
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Ümit Kamış
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
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Sharma A, Taniguchi J. Review: Emerging strategies for antimicrobial drug delivery to the ocular surface: Implications for infectious keratitis. Ocul Surf 2017; 15:670-679. [PMID: 28602948 DOI: 10.1016/j.jtos.2017.06.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 04/06/2017] [Accepted: 06/02/2017] [Indexed: 12/27/2022]
Abstract
Infectious keratitis is a medical emergency that can cause severe visual morbidity if not treated promptly. Depending upon the causative microorganism, effective management of infectious keratitis requires frequent application of antibacterial, antifungal, or antiviral eye drops, which may have low bioavailability, undesirable side effects, and poor patient compliance. Ocular formulations of antimicrobials that can increase corneal permeation and provide extended presence on ocular surface are being developed. Such formulations include nanoparticles, mucoadhesives, in situ forming hydrogels, and contact lenses. Testing of these formulations in in vitro models and ex vivo excised corneas, and in vivo rabbit testing have demonstrated increased bioavailability and extended presence on the cornea. Many of these formulations have also demonstrated success in treating infectious keratitis in animal models. However, the majority of studies have evaluated fluoroquinolone antibacterials, and more studies are needed to test the delivery of antifungal drugs. Moreover, additional efficacy data in animal models and future studies in humans to determine the duration of inhibitory concentrations of these antimicrobials in tear fluid will be required to prove the effectiveness of these formulations for clinical management of infectious keratitis.
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Affiliation(s)
- Ajay Sharma
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Chapman University, Irvine, CA, USA.
| | - Jonathan Taniguchi
- Department of Biomedical and Pharmaceutical Sciences, Chapman University School of Pharmacy, Chapman University, Irvine, CA, USA
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Cendra MDM, Christodoulides M, Hossain P. Signaling Mediated by Toll- Like Receptor 5 Sensing of Pseudomonas aeruginosa Flagellin Influences IL-1β and IL-18 Production by Primary Fibroblasts Derived from the Human Cornea. Front Cell Infect Microbiol 2017; 7:130. [PMID: 28469996 PMCID: PMC5395653 DOI: 10.3389/fcimb.2017.00130] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/29/2017] [Indexed: 12/24/2022] Open
Abstract
Pseudomonas aeruginosa is the principal cause of bacterial keratitis worldwide and overstimulation of the innate immune system by this organism is believed to contribute significantly to sight loss. In the current study, we have used primary human corneal fibroblast (hCF) cells as an ex vivo model of corneal infection to examine the role of P. aeruginosa flagellum and type three secretion system (TTSS) in inducing inflammasome-associated molecules that trigger IL-1β and IL-18 production during the early stages of the infection. Our results show that P. aeruginosa infection stimulated the non-canonical pathway for IL-1β and IL-18 expression and pathway stimulation was influenced predominantly by the flagellum. Both IL-1β and IL-18 cytokines were expressed intracellularly during bacterial infection, but only the former was released and detected in the extracellular environment. We also investigated the signaling pathways in hCFs mediated by Toll-Like Receptor (TLR)4 and TLR5 sensing of P. aeruginosa, and our data show that the signal triggered by TLR5-flagellin sensing significantly contributed to IL-1β and IL-18 cytokine production in our model. Our study suggests that IL-18 expression is wholly dependent on extracellular flagellin sensing by TLR5, whereas IL-1β expression is also influenced by P. aeruginosa lipopolysacharide. Additionally, we demonstrate that IL-1β and IL-18 production by hCFs can be triggered by both MyD88-dependent and -independent pathways. Overall, our study provides a rationale for the development of targeted therapies, by proposing an inhibition of flagellin-PRR-signaling interactions, in order to ameliorate the inflammatory response characteristic of P. aeruginosa keratitis.
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Affiliation(s)
- Maria Del Mar Cendra
- Division of Clinical and Experimental Sciences, Department of Molecular Microbiology, Faculty of Medicine, University of SouthamptonSouthampton, UK
| | - Myron Christodoulides
- Division of Clinical and Experimental Sciences, Department of Molecular Microbiology, Faculty of Medicine, University of SouthamptonSouthampton, UK
| | - Parwez Hossain
- Eye Unit, Division of Clinical and Experimental Sciences, Faculty of Medicine, University of SouthamptonSouthampton, UK
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Lakhundi S, Siddiqui R, Khan NA. Pathogenesis of microbial keratitis. Microb Pathog 2017; 104:97-109. [DOI: 10.1016/j.micpath.2016.12.013] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 11/30/2016] [Accepted: 12/05/2016] [Indexed: 01/03/2023]
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Gratieri T, Santer V, Kalia YN. Basic principles and current status of transcorneal and transscleral iontophoresis. Expert Opin Drug Deliv 2016; 14:1091-1102. [DOI: 10.1080/17425247.2017.1266334] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Taís Gratieri
- Laboratory of Food Drugs and Cosmetics (LTMAC), University of Brasilia, Brasília, DF, Brazil
| | - Verena Santer
- School of Pharmaceutical Sciences, University of Geneva & University of Lausanne, Geneva, Switzerland
| | - Yogeshvar N. Kalia
- School of Pharmaceutical Sciences, University of Geneva & University of Lausanne, Geneva, Switzerland
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Gallagher AG, Alorabi JA, Wellings DA, Lace R, Horsburgh MJ, Williams RL. A Novel Peptide Hydrogel for an Antimicrobial Bandage Contact Lens. Adv Healthc Mater 2016; 5:2013-8. [PMID: 27276231 DOI: 10.1002/adhm.201600258] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/05/2016] [Indexed: 12/20/2022]
Abstract
A peptide hydrogel with an antimicrobial activity is developed as a bandage contact lens. The antimicrobial activity is enhanced with the addition of the biomolecules penicillin G or poly-ε-lysine and is positive against Staphylococcus aureus and Escherichia coli. The lens is also noncytotoxic toward a human corneal epithelial cell line and as a consequence is of great potential as a drug-eluting bandage lens replacing conventional corneal ulcer treatment.
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Affiliation(s)
- Andrew G Gallagher
- Institute of Ageing and Chronic Diseases, Department of Eye and Vision Science, University of Liverpool, Apex Building, West Derby Street, Liverpool, L7 8TX, UK
- SpheriTech Ltd, The Heath Business and Technical Park, Runcorn, Cheshire, WA7 4QX, UK
| | - Jamal A Alorabi
- Institute of Integrative Biology, University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7ZB, UK
| | - Donald A Wellings
- SpheriTech Ltd, The Heath Business and Technical Park, Runcorn, Cheshire, WA7 4QX, UK
| | - Rebecca Lace
- Institute of Ageing and Chronic Diseases, Department of Eye and Vision Science, University of Liverpool, Apex Building, West Derby Street, Liverpool, L7 8TX, UK
| | - Mal J Horsburgh
- Institute of Integrative Biology, University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7ZB, UK
| | - Rachel L Williams
- Institute of Ageing and Chronic Diseases, Department of Eye and Vision Science, University of Liverpool, Apex Building, West Derby Street, Liverpool, L7 8TX, UK
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Proteomics in the Study of Bacterial Keratitis. Proteomes 2015; 3:496-511. [PMID: 28248282 PMCID: PMC5217394 DOI: 10.3390/proteomes3040496] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/13/2015] [Accepted: 12/07/2015] [Indexed: 11/16/2022] Open
Abstract
Bacterial keratitis is a serious ocular infection that can cause severe visual loss if treatment is not initiated at an early stage. It is most commonly caused by Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumoniae, or Serratia species. Depending on the invading organism, bacterial keratitis can progress rapidly, leading to corneal destruction and potential blindness. Common risk factors for bacterial keratitis include contact lens wear, ocular trauma, ocular surface disease, ocular surgery, lid deformity, chronic use of topical steroids, contaminated ocular medications or solutions, and systemic immunosuppression. The pathogenesis of bacterial keratitis, which depends on the bacterium-host interaction and the virulence of the invading bacterium, is complicated and not completely understood. This review highlights some of the proteomic technologies that have been used to identify virulence factors and the host response to infections of bacterial keratitis in order to understand the disease process and develop improved methods of diagnosis and treatment. Although work in this field is not abundant, proteomic technologies have provided valuable information toward our current knowledge of bacterial keratitis. More studies using global proteomic approaches are warranted because it is an important tool to identify novel targets for intervention and prevention of corneal damage caused by these virulent microorganisms.
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Sayed WF, Salem WMA, Haridy MAM, Hassan NH. Efficacy of Caltropis procera and Ficus sycomorus extracts in treating MRSA (methicillin-resistant Staphylococcus aureus)-keratitis in rabbit. EXCLI JOURNAL 2015; 14:747-57. [PMID: 26648824 PMCID: PMC4669905 DOI: 10.17179/excli2015-350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 05/20/2015] [Indexed: 11/29/2022]
Abstract
MRSA-induced keratitis in rabbit was used to evaluate the therapeutic effect of F. sycomorus leaves and C. procera latex extracts. Within the 6 rabbit groups tested, group 1 received sterilized saline, while other groups (2 to 6) received 100 μl of intrastromal injections of 1.5×103 colony forming unit (cfu) ml-1 of methicillin-resistant Staphylococcus aureus (MRSA). After 12 hours, groups 3 to 6 also received chloramphenicol, aqueous extract of C. procera latex, aqueous and alcoholic extracts of F. sycomorus leaves, respectively 3 times daily for 12 successive days. The tested extracts inhibited MRSA growth in vitro (i.e. on culture medium). Colony counts in cornea discs from groups 3 to 6 were significantly reduced (P ≤ 0.001) compared to group 2 (untreated). Clinical signs of keratitis were observed on group 2 until the end of experiment. In groups 3 to 6, gradual recovery was observed and signs disappeared by the 12th DPI (days post inoculation). Only mild symptoms persisted in group 5 (aqueous extract of leaves). In group 3 and 5, cornea, iris, ciliary body and conjunctiva showed mild leukocytic infiltration and depigmentation of melanin cells while recovery of cornea and iris was observed in groups 4 and 6. In conclusion, the used extracts have potential therapeutic effects on MRSA-induced keratitis in rabbit.
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Affiliation(s)
- Waiel F Sayed
- Department of Botany, Faculty of Science, South Valley University, 83523 Qena, Egypt
| | - Wesam M A Salem
- Department of Botany, Faculty of Science, South Valley University, 83523 Qena, Egypt
| | - Mohie A M Haridy
- Department of Pathology and Clinical Pathology, Faculty of Veterinary Medicine, South Valley University, 83523 Qena, Egypt
| | - Ne'mat H Hassan
- The Egyptian Organization for Standardization and Quality, Cairo, Egypt
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Omali NB, Subbaraman LN, Coles-Brennan C, Fadli Z, Jones LW. Biological and Clinical Implications of Lysozyme Deposition on Soft Contact Lenses. Optom Vis Sci 2015; 92:750-7. [PMID: 26002002 PMCID: PMC5638422 DOI: 10.1097/opx.0000000000000615] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 02/17/2015] [Indexed: 12/28/2022] Open
Abstract
Within a few minutes of wear, contact lenses become rapidly coated with a variety of tear film components, including proteins, lipids, and mucins. Tears have a rich and complex composition, allowing a wide range of interactions and competitive processes, with the first event observed at the interface between a contact lens and tear fluid being protein adsorption. Protein adsorption on hydrogel contact lenses is a complex process involving a variety of factors relating to both the protein in question and the lens material. Among tear proteins, lysozyme is a major protein that has both antibacterial and anti-inflammatory functions. Contact lens materials that have high ionicity and high water content have an increased affinity to accumulate lysozyme during wear, when compared with other soft lens materials, notably silicone hydrogel lenses. This review provides an overview of tear film proteins, with a specific focus on lysozyme, and examines various factors that influence protein deposition on contact lenses. In addition, the impact of lysozyme deposition on various ocular physiological responses and bacterial adhesion to lenses and the interaction of lysozyme with other tear proteins are reviewed. This comprehensive review suggests that deposition of lysozyme on contact lens materials may provide a number of beneficial effects during contact lens wear.
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Song HY, Qiu BF, Liu C, Zhu SX, Wang SC, Miao J, Jing J, Shao YX. Identification of causative pathogens in mouse eyes with bacterial keratitis by sequence analysis of 16S rDNA libraries. Exp Anim 2014; 64:49-56. [PMID: 25312507 PMCID: PMC4329515 DOI: 10.1538/expanim.14-0046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The clone library method using PCR amplification of the 16S ribosomal RNA (rRNA) gene was
used to identify pathogens from corneal scrapings of C57BL/6-corneal opacity (B6-Co) mice
with bacterial keratitis. All 10 samples from the eyes with bacterial keratitis showed
positive PCR results. All 10 samples from the normal cornea showed negative PCR results.
In all 10 PCR-positive samples, the predominant and second most predominant species
accounted for 20.9 to 40.6% and 14.7 to 26.1%, respectively, of each clone library. The
predominant species were Staphylococcus lentus, Pseudomonas
aeruginosa, and Staphylococcus epidermidis. The microbiota
analysis detected a diverse group of microbiota in the eyes of B6-Co mice with bacterial
keratitis and showed that the causative pathogens could be determined based on percentages
of bacterial species in the clone libraries. The bacterial species detected in this study
were mostly in accordance with results of studies on clinical bacterial keratitis in human
eyes. Based on the results of our previous studies and this study, the B6-Co mouse should
be considered a favorable model for studying bacterial keratitis.
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Affiliation(s)
- Hong-Yan Song
- Laboratory Animal Center of Nantong University, No. 19 Qixiu Road, Chongchuan District, Nantong, Jiangsu 226001, P. R. China
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Abstract
INTRODUCTION Cornea ulceration and infectious keratitis are leading causes of corneal morbidity and blindness. Infectious causes are among the most frequent and most severe. Management strategies for bacterial corneal ulcers have changed significantly over the last decades, however with a more limited progress in the treatment and management of nonbacterial, infectious ulcers. AREAS COVERED This paper provides an overview of the current principles, strategies and treatment choices for infectious corneal ulcers in adults. EXPERT OPINION Topical application with a broad-spectrum antimicrobial remains the preferred method for the pharmacological management of infectious corneal ulcers. Increasing reports of clinical failures and in vitro resistance to antibiotics to treat the most common infectious (bacterial) corneal ulcers are increasing concerns. New approaches for improvement in the pharmacological management of corneal ulcers should focus on strategies for a more rational and evidence-based use of current antimicrobials and development of products to modulate the host immune response and to neutralize microbial toxins and other immune modulators.
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Affiliation(s)
- Darlene Miller
- University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Anne Bates Leach Eye Hospital, Miami, Florida 33136, USA.
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Jiang X, McClellan SA, Barrett RP, Zhang Y, Foldenauer ME, Hazlett LD. The role of VIP in cornea. Invest Ophthalmol Vis Sci 2012; 53:7560-6. [PMID: 23074208 DOI: 10.1167/iovs.12-10437] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Exogenous vasoactive intestinal peptide (VIP) down-regulates pro-inflammatory but up-regulates anti-inflammatory cytokines, growth factors (GFs) and Toll-like receptors promoting healing in experimental Pseudomonas aeruginosa (P. aeruginosa) keratitis. Whether VIP is required for GF or GF receptor (R) expression in normal and infected corneas is unknown and is the purpose of this study. METHODS VIP knockout ((-/-)) and wild-type (WT) C57BL/6 (B6) mice were infected and tested using PCR array, real-time RT-PCR, ELISA, and immunostaining. VIP antagonist treatment studies also were done using B6 and BALB/c mice. RESULTS Infected corneas of VIP(-/-) versus WT B6 mice perforated earlier (2 vs. 5 days postinfection [p.i.]), and array data showed that GFs were differentially changed between groups. RT-PCR revealed that the infected cornea of VIP(-/-) versus WT mice expressed higher mRNA levels of epidermal growth factor (EGF) and hepatocyte growth factor (HGF), reduced FGF, EGFR, and HGFR, with no difference in FGFR; differences between groups were not seen in normal cornea. Immunostaining for GF and GFR in the normal cornea of VIP(-/-) versus WT mice was similar. However, at 1 day p.i., VIP(-/-) versus WT mice had more intense EGF and HGF, similar FGFR, and reduced FGF, EGFR, and HGFR staining. VIP antagonist treatment decreased protein levels for GFR at 5 days p.i. in both B6 and BALB/c mice, with no significant changes in normal cornea. CONCLUSIONS The data showed that endogenous VIP is not requisite for GF or GFR expression in the normal cornea but, after infection, its absence or reduction is critical for their regulation.
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Affiliation(s)
- Xiaoyu Jiang
- Department of Anatomy & Cell Biology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
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Mohammadpour M, Mohajernezhadfard Z, Khodabande A, Vahedi P. Antibiotic susceptibility patterns of pseudomonas corneal ulcers in contact lens wearers. Middle East Afr J Ophthalmol 2011; 18:228-31. [PMID: 21887079 PMCID: PMC3162736 DOI: 10.4103/0974-9233.84053] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To evaluate the resistance or susceptibility of Pseudomonas aeruginosa, the most common pathogen in contact lens keratitis and corneal ulcer, to different antibiotic regimens. MATERIALS AND METHODS This cross-sectional study included all patients with recently diagnosed contact lens corneal ulcer whose culture results were positive for P. aeruginosa, from March 2009 to March 2010. The empirical antibiotic therapy was changed to appropriate antibiotics according to the culture results, provided that satisfactory clinical improvement was not achieved with the initial antibiotic regimen. The overall sensitivity or resistance of P. aeruginosa to the most commonly used antibiotics was assessed based on the results of the antibiograms. RESULTS Fifty-two patients (43 females and 9 males) were included. Forty-five patients (86%) were wearing cosmetic contact lenses, while 7 patients (14%) were using therapeutic contact lenses. Thirty-nine patients (75%) were hospitalized and13 patients (25%) were followed up through an outpatient clinic. Thirty patients (58%) had central ulcers, whereas 22 patients (42%) had peripheral ulcers. Twelve patients (23%) had hypopyon in their first exam. The mean time to diagnose the ulcer after the last time wearing was 2 days (range: 12 hours to 5 days). AMT was required for 10 patients (19%). Based on the antibiograms, PA was shown to be sensitive in 100% of cases to ceftazidime and ciprofloxacin. Amikacin, imipenem, and gentamicin were the second most effective antibiotics. CONCLUSION P. aeruginosa was highly sensitive to ceftazidime, ciprofloxacin, and amikacin. All cases were resistant to cefazolin. Resistance to multiple antibiotics might be a significant concern in patients with corneal ulcers. In referral centers dealing with corneal ulcers, the initial antibiotic regimens should be changed from time to time to prevent this phenomenon.
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Affiliation(s)
- Mehrdad Mohammadpour
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Willcox MDP. Review of resistance of ocular isolates of Pseudomonas aeruginosa and staphylococci from keratitis to ciprofloxacin, gentamicin and cephalosporins. Clin Exp Optom 2010; 94:161-8. [PMID: 21083760 DOI: 10.1111/j.1444-0938.2010.00536.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Microbial keratitis is a rare disease but most commonly caused by bacterial infection. Two of the most common bacteria to cause microbial keratitis are Pseudomonas aeruginosa and Staphylococcus aureus. Antibiotic therapy to treat keratitis caused by these bacteria is either monotherapy with a fluoroquinolone or combination therapy with fortified gentamicin. METHODS Literature searches were made in Medline and Pubmed using the search terms [Pseudomonas] or [Staphylococcus] and [fluoroquinolone] or [cephalosporin] or [gentamicin] and [keratitis] or [cornea]. Rates of resistance to ciprofloxacin, gentamicin or cephalosporins were then compared for isolates from different geographic regions. RESULTS There are low resistance rates of P. aeruginosa and S. aureus to ciprofloxacin in isolates from Australia. Isolates from the Indian subcontinent are more commonly resistant to ciprofloxacin, with resistance rates of greater than 20 per cent being reported. Data from USA and Europe indicate that if the S. aureus is a methicillin resistant strain, then resistance to ciprofloxacin increases, often to greater than 80 per cent of isolates. Resistance to gentamicin and cephalosporins is also generally low in isolates from Australia. Again resistance is increased in isolates from the Indian subcontinent, as well as from South America. CONCLUSION In Australia, the major ocular pathogens are generally sensitive to the most commonly used antibiotics to treat microbial keratitis. The prescription of fluoroquinolones, aminoglycosides and cephalosporins is generally reserved for treatment of significant or sight-threatening conditions such as microbial keratitis. This approach is not likely to contribute to an increase in resistance rates.
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Affiliation(s)
- Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney NSW 2052, Australia.
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Erdem U, Hurmeric V, Muftuoglu O, Kerimoglu H. Linear Corneal Epithelial Keratitis with a Horseshoe Pattern. Ocul Immunol Inflamm 2009; 15:131-4. [PMID: 17558840 DOI: 10.1080/09273940701244210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To report the treatment and follow-up of a linear epithelial keratitis with a horseshoe pattern. METHODS A 21-year-old Turkish soldier, who presented with epithelial keratitis with a horseshoe pattern that did not respond to immunosuppressive and multiple anti-microbial treatment, was studied clinically. RESULTS No microorganism was identified with different stains, cultures, and herpes simplex virus-polymerase chain reaction. The impression cytology revealed prominent polymorphonuclear leukocyte infiltration at the keratitis line. The keratitis did not respond to different antimicrobial treatment or local and systemic corticosteroids. After a fourth scraping was perfomed deeply with a disc-knife, the lesion healed and did not recur in six months. CONCLUSION Linear epitheliitis of cornea with a horseshoe pattern was not found to be associated with any microorganism or systemic disease.
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Affiliation(s)
- Uzeyir Erdem
- Gülhane Military Medical School, Department of Ophthalmology, Ankara, Turkey
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Sensoy D, Cevher E, Sarici A, Yilmaz M, Ozdamar A, Bergişadi N. Bioadhesive sulfacetamide sodium microspheres: evaluation of their effectiveness in the treatment of bacterial keratitis caused by Staphylococcus aureus and Pseudomonas aeruginosa in a rabbit model. Eur J Pharm Biopharm 2009; 72:487-95. [PMID: 19223014 DOI: 10.1016/j.ejpb.2009.02.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 01/17/2009] [Accepted: 02/09/2009] [Indexed: 11/19/2022]
Abstract
The aim of this study was to prepare bioadhesive sulfacetamide sodium (SA) microspheres to increase their residence time on the ocular surface and to enhance their treatment efficacy on ocular keratitis. Microspheres were fabricated by spray drying method using mixture of polymers such as pectin, polycarbophil and hydroxypropylmethyl cellulose (HPMC) at different ratios. The particle size and distribution, morphological characteristics, thermal behavior, encapsulation efficiency, mucoadhesion and in vitro drug release studies on formulations have been investigated. After optimisation studies, SA-loaded polycarbophil microsphere formulation with polymer:drug ratio of 2:1 was found to be the most suitable for ocular application and used in in vivo studies. In vivo studies were carried out on New Zealand male rabbit eyes with keratitis caused by Pseudomonas aeruginosa and Staphylococcus aureus. Sterile microsphere suspension in light mineral oil was applied to infected eyes twice a day. Plain SA suspension was used as a positive control. On 3rd and 6th days of the antimicrobial therapy, the eyes were examined in respect to clinical signs of infection (blepharitis, conjunctivitis, iritis, corneal oedema and corneal infiltrates) which are the main symptoms of bacterial keratitis and then cornea samples were counted microbiologically. The rabbit eyes treated with microspheres demonstrated significantly lower clinical scores than those treated with SA alone. A significant decrease in the number of viable bacteria in eyes treated with microspheres was observed in both infection models when compared to those treated with SA alone. In conclusion, in vitro and in vivo studies showed that SA-loaded microspheres were proven to be highly effective in the treatment of ocular keratitis.
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Affiliation(s)
- Demet Sensoy
- Department of Pharmaceutical Technology, Istanbul University, Istanbul, Turkey.
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Affiliation(s)
- Jaya Devi Chidambaram
- Department of Ophthalmology, St. Bartholomew's and Royal London Hospitals, University of London, London, UK
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Mizota A, Haki K, Shiina C, Tanaka M, Nakazawa T, Yazawa K, Mikami Y. The first case of keratitis caused by Nocardia exalbida. Int Ophthalmol 2007; 27:333-6. [PMID: 17476571 DOI: 10.1007/s10792-007-9079-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 03/14/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nocardia exalbida was first reported in 2006. We describe a first case of keratitis caused by Nocardia exalbida. METHODS Case report RESULTS A patient presented after two weeks of unsuccessful treatment of a corneal ulcer in her right eye. Nocardia keratitis was diagnosed from her culture results, and the species Nocardia exalbida was determined by phylogenetic studies using gene sequence analysis of 16S RNA. The disk diffusion method showed that this Norcardia sp. was sensitive to many antibiotics. Initially, the patient was treated with topical and systemic antibiotics, and corneal epithelium quickly regenerated. But when corticosteroid eyedrops were added, there was a recurrence of the keratitis. Corticosteroids were stopped, and systemic trimethoprim-sulfamethoxazole and topical tobramycin, colistin, chloramphenicol and sulfisoxazole were given. Within one month the corneal ulcer and infiltration disappeared. CONCLUSION This is the first report of keratitis caused by Nocardia exalbida. This species is susceptible to many antibiotics in vitro and clinically. However, supplementation with corticosteroids can lead to recurrence, and care should be taken when corticosteroids are being considered.
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Affiliation(s)
- Atsushi Mizota
- Department of Ophthalmology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Japan.
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Abstract
Fortified preparations of ophthalmic antibiotics are made with commercially available antibiotics (parenteral or lyophilized preparations). These fortified eyedrops have two main advantages: the increase in the antibiotic concentration in the corneal stroma and the wide choice of available antibiotics. Fortified ophthalmic solutions are used in severe keratitis (large diameter, stroma infiltration, inflammation of the anterior chamber, old patient). The following associations are recommended: ticarcillin+gentamicin+vancomycin or cephazolin+amikacin since they provide a broad-spectrum antibiotic activity against the wide range of bacteria that may cause keratitis. The main toxicity of these preparations is the retardation effect of the epithelial-healing rate (aminoglycosides, vancomycin) and the corneal and conjunctival toxic effects (aminoglycosides). However, fortified antibiotic drops remain the standard therapy for severe bacterial keratitis, given their corneal penetration and the possibility of the synergic and combined effect of an antibiotic association.
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Affiliation(s)
- C Chiquet
- Service d'Ophtalmologique, CHU de Grenoble, Université Joseph Fourier, Grenoble, France.
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