1
|
Mueller A, Lam I, Kishor K, Lee RK, Bhattacharya S. Secondary glaucoma: Toward interventions based on molecular underpinnings. WIREs Mech Dis 2024; 16:e1628. [PMID: 37669762 DOI: 10.1002/wsbm.1628] [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: 02/07/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/07/2023]
Abstract
Glaucoma is a heterogeneous group of progressive diseases that leads to irreversible blindness. Secondary glaucoma refers to glaucoma caused by a known underlying condition. Pseudoexfoliation and pigment dispersion syndromes are common causes of secondary glaucoma. Their respective deposits may obstruct the trabecular meshwork, leading to aqueous humor outflow resistance, ocular hypertension, and optic neuropathy. There are no disease-specific interventions available for either. Pseudoexfoliation syndrome is characterized by fibrillar deposits (pseudoexfoliative material) on anterior segment structures. Over a decade of multiomics analyses taken together with the current knowledge on pseudoexfoliative glaucoma warrant a re-think of mechanistic possibilities. We propose that the presence of nucleation centers (e.g., vitamin D binding protein), crosslinking enzymes (e.g., transglutaminase 2), aberrant extracellular matrix, flawed endocytosis, and abnormal aqueous-blood barrier contribute to the formation of proteolytically resistant pseudoexfoliative material. Pigment dispersion syndrome is characterized by abnormal iridolenticular contact that disrupts iris pigment epithelium and liberates melanin granules. Iris melanogenesis is aberrant in this condition. Cytotoxic melanogenesis intermediates leak out of melanosomes and cause iris melanocyte and pigment epithelium cell death. Targeting melanogenesis can likely decrease the risk of pigmentary glaucoma. Skin and melanoma research provides insights into potential therapeutics. We propose that specific prostanoid agonists and fenofibrates may reduce melanogenesis by inhibiting cholesterol internalization and de novo synthesis. Additionally, melatonin is a potent melanogenesis suppressor, antioxidant, and hypotensive agent, rendering it a valuable agent for pigmentary glaucoma. In pseudoexfoliative glaucoma, where environmental insults drive pseudoexfoliative material formation, melatonin's antioxidant and hypotensive properties may offer adjunct therapeutic benefits. This article is categorized under: Neurological Diseases > Molecular and Cellular Physiology.
Collapse
Affiliation(s)
- Anna Mueller
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Isabel Lam
- Idaho College of Osteopathic Medicine, Meridian, Idaho, USA
| | - Krishna Kishor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Richard K Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sanjoy Bhattacharya
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
2
|
Sorkou KN, Theotokis P, Deftereou TE, Maria L, Meditskou S, Manthou ME. Detecting Apoptotic Human Lens Epithelial Cells With Transmission Electron Microscopy. Cureus 2023; 15:e45916. [PMID: 37885524 PMCID: PMC10599265 DOI: 10.7759/cureus.45916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction Cataract formation is a prevalent issue worldwide, and understanding the cellular processes involved is crucial to advancing treatment options. The scope of the study was to explore the presence of apoptotic cells in the lens epithelium of Greek patients with senile cataracts using transmission electron microscopy (TEM). Methods Twenty-one patients with senile cataracts were included in this cross-sectional study, and their anterior lens capsules were thoroughly examined. The presence of apoptosis was ultrastructurally investigated, and its association with age, gender, biomicroscopic type of cataract, the coexistence of exfoliation syndrome (XFS), diabetes mellitus, and glaucoma was statistically correlated. Results We detected apoptotic cells in nine of the 21 patients. Morphological features indicative of apoptosis in the nuclei included degradation, nuclear membrane irregularity, reduction of nuclear volume, condensation, and margination of chromatin. The cytoplasm either appeared denser or contained vacuoles. Budding with membrane blebbing and pinopode-like projections were frequently observed. Apoptotic cells appeared smaller, exhibiting loose connections with neighboring cells and the basement membrane (BM). Interestingly, apoptotic bodies were also detected. Conclusions None of the examined risk factors showed a connection to apoptosis, whereas neighboring lens epithelial cells (LECs) phagocytose apoptotic bodies, seemingly assumed the role of macrophages. Comparing apoptosis rates between populations with different sun exposure levels could help reveal the relationship between ultraviolet B radiation exposure, apoptosis, and cataract formation.
Collapse
Affiliation(s)
- Konstantina N Sorkou
- Department of Ophthalmology, Frimley Park Hospital, National Health Service (NHS), Camberley, GBR
- 2nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Paschalis Theotokis
- Laboratory of Histology and Embryology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
- Laboratory of Experimental Neurology and Neuroimmunology, 2nd Department of Neurology, AHEPA University Hospital, Thessaloniki, GRC
| | | | - Lambropoulou Maria
- Laboratory of Histology and Embryology, Democritus University of Thrace, Alexandroupolis, GRC
| | - Soultana Meditskou
- Laboratory of Histology and Embryology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Maria Eleni Manthou
- Laboratory of Histology and Embryology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
| |
Collapse
|
3
|
Mullany S, Marshall H, Zhou T, Thomson D, Schmidt JM, Qassim A, Knight LSW, Hollitt G, Berry EC, Nguyen T, To MS, Dimasi D, Kuot A, Dubowsky J, Fogarty R, Sun M, Chehade L, Kuruvilla S, Supramaniam D, Breen J, Sharma S, Landers J, Lake S, Mills RA, Hassall MM, Chan WO, Klebe S, Souzeau E, Siggs OM, Craig JE. RNA Sequencing of Lens Capsular Epithelium Implicates Novel Pathways in Pseudoexfoliation Syndrome. Invest Ophthalmol Vis Sci 2022; 63:26. [PMID: 35348588 PMCID: PMC8982629 DOI: 10.1167/iovs.63.3.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose Pseudoexfoliation syndrome (PEX) is a common systemic disease that results in severe and often irreversible vision loss. Despite considerable research effort, PEX remains incompletely understood. This study sought to perform the first RNAseq study in elucidate the pathophysiology of PEX, and contribute a publicly available transcriptomic data resource for future research. Methods Human ocular lens capsular epithelium samples were collected from 25 patients with PEX and 39 non-PEX controls undergoing cataract surgery. RNA extracted from these specimens was subjected to polyadenylated (mRNA) selection and deep bulk RNA sequencing. Differential expression analysis investigated protein-coding gene transcripts. Exploratory analyses used pathway analysis tools, and curated class- and disease-specific gene sets. Results Differential expression analysis demonstrated that 2882 genes were differentially expressed according to PEX status. Genes associated with viral gene expression pathways were among the most upregulated, alongside genes encoding ribosomal and mitochondrial respiratory transport chain proteins. Cell adhesion protein transcripts including type 4 collagen subunits were downregulated. Conclusions This comparative transcriptomic dataset highlights novel and previously recognized pathogenic pathways in PEX and provides the first comprehensive transcriptomic resource, adding an additional layer to build further understanding of PEX pathophysiology.
Collapse
Affiliation(s)
- Sean Mullany
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Henry Marshall
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Tiger Zhou
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Daniel Thomson
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Joshua M Schmidt
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Ayub Qassim
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Lachlan S W Knight
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Georgina Hollitt
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Ella C Berry
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Thi Nguyen
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Minh-Son To
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - David Dimasi
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Abraham Kuot
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Joshua Dubowsky
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Rhys Fogarty
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Michelle Sun
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Luke Chehade
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Shilpa Kuruvilla
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Devaraj Supramaniam
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - James Breen
- SAHMRI Bioinformatics Core, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Shiwani Sharma
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - John Landers
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Stewart Lake
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Richard A Mills
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Mark M Hassall
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Weng O Chan
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Sonja Klebe
- Flinders Department of Pathology, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Emmanuelle Souzeau
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Owen M Siggs
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia.,Garvan Institute of Medical Research Institute, Darlinghurst, Sydney, Australia
| | - Jamie E Craig
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| |
Collapse
|
4
|
Pathological Changes of the Anterior Lens Capsule. J Ophthalmol 2021; 2021:9951032. [PMID: 34055399 PMCID: PMC8113000 DOI: 10.1155/2021/9951032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/27/2021] [Indexed: 01/19/2023] Open
Abstract
The anterior lens capsule (ALC), as the thickest basement membrane in the body, is an acellular, soft, smooth, transparent membrane secreted by lens epithelial cells. The ALC has its unique biomechanical properties to serve as a barrier and separate the lens from infectious viruses and bacteria together with the posterior capsule and pericapsular membrane. However, the biomechanical and ultrastructural properties of the ALC can be changed under certain conditions. Here, we provide a brief review of the pathological changes of the ALC in several eye disorders, including cataract, aniridia, climatic droplet keratopathy, exfoliation syndrome, true exfoliation syndrome, Alport syndrome, and silicone oil tamponade.
Collapse
|
5
|
Abstract
Purpose: The aim of this study is to show the pseudoexfoliation syndrome (PES) material accumulated in the lens anterior capsule and the trace elements directly with using scanning electron microscopy (SEM) and to investigate the effect of PES materials on aqueous humor by chemical analyses.Methods: The study groups consisted of 30 patients with PES and 30 patients without PES. 0.1-0.3 mL of aqueous humor was aspirated from anterior chamber and anterior capsule sample was obtained by applying continuous curvilinear capsulorhexis. The level of selected elements (Zn, Cu, Se, Fe, Si, Al, Ca, K) were determined from aqueous humor samples via Inductively coupled plasma - optical emission spectrometry (ICP-OES) machine. The morphology and elemental distribution of anterior lens capsules were carried out via a Zeiss Sigma 300 scanning electron microscope with energy dispersive X-ray spectroscopy (semiquantitative EDX).Results: For aqueous humor, the ICP-OES results show that Cu and Zn levels is higher (p < .001, both of them) in PES group than that the obtained from control group. It was noticed that the ratio of Cu/Zn was higher (p = .008) in aqueous humor, while Cu/Se ratio was higher in both aqueous humor (p < .001) and anterior capsule (p < .001) for PES group. The SEM images show that different metal precipitates were obtained from anterior lens capsules with PES. However, there is no obvious element precipitates on the anterior lens capsules without PES.Conclusion: The results observed that the level of selected elements can be obtained at different level in both PES group and control group. Especially, if the oxidative behavior of these elements which is thought to play a role in PES formation can be clarified, new approaches will be done to evaluate the structure of PES.
Collapse
Affiliation(s)
- Kamil Yavuzer
- Van Training and Research Hospital, Ophthalmology Clinic, University of Health Sciences, Van, Turkey
| | - Yuksel Akinay
- Engineering Faculty, Van Yuzuncu Yil University, Van, Turkey
| |
Collapse
|
6
|
Sorkou KN, Manthou ME, Meditskou S, Tsinopoulos IT, Ziakas N, Kouzi-Koliakou K. Lens Epithelial Surface Disorders in Exfoliation Syndrome: A Scanning and Transmission Electron Microscopy Study. Ophthalmic Res 2020; 64:216-223. [PMID: 32403107 DOI: 10.1159/000508631] [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: 03/18/2020] [Accepted: 05/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hydrodissection was recently reported to occur more easily in patients with exfoliation syndrome (XFS). Transmission electron microscopy (TEM) studies have already revealed alterations of the lens epithelial cells (LECs) and their apical membrane towards the lens fibers. OBJECTIVE The aim of this work was to examine the three-dimensional appearance of the lens epithelium in patients with XFS. METHODS Fourteen patients with senile cataract, 7 of whom had XFS, were included. Anterior lens capsules (aLCs) were obtained with continuous curvilinear capsulorrhexis (CCC) during phacoemulsification and were examined with scanning electron microscopy (SEM) and TEM. RESULTS Exfoliation samples exhibited an overall more irregular apical surface of the lens epithelium compared to control aLCs. The height of LECs varied extensively. On the apical surface of LECs, amorphous, crystalline-like, or microgranular extracellular material and membranous, oval-shaped structures were documented with SEM. All findings were connected to corresponding observations with TEM and were not correlated to the type of cataract. CONCLUSIONS In XFS patients, the lens epithelial surface exhibited a highly irregular margin, with extracellular material covering the apical membrane of LECs. We suggest that XFS probably causes both epithelial and lens fiber degeneration which, during CCC and mechanical extraction of the aLC from the lens cortex, result in diverse alterations.
Collapse
Affiliation(s)
- Konstantina N Sorkou
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece, .,2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece,
| | - Maria Eleni Manthou
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Soultana Meditskou
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis T Tsinopoulos
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kokkona Kouzi-Koliakou
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
7
|
Sorkou KN, Tsinopoulos IT, Tsaousis KT, Karamitsos A, Meditskou S, Ziakas N, Manthou ME. Ease of Hydrodissection during Phacoemulsification: A Comparison between Patients with and Those without Exfoliation Syndrome. Ophthalmic Res 2020; 63:497-500. [PMID: 32163946 DOI: 10.1159/000507121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/08/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Exfoliation syndrome (XFS), which is associated with increased surgical complications during phacoemulsification, has a relatively high incidence in Greece. Multiannual surgical experience in XFS patients has led to the clinical observation that hydrodissection occurs more easily in XFS patients. OBJECTIVE To compare the ease of hydrodissection between cataract patients with and those without XFS. METHODS One hundred and fifteen patients with senile cataract were included in the study. Forty-two of them had XFS. All patients underwent uneventful phacoemulsification by the same surgeon. For hydrodissection, three 1-mL insulin syringes were filled with 0.5 mL balanced salt solution (BSS). Sequentially, each one was quickly and continuously injected underneath the 3, 6, and 9 o'clock positions of the anterior lens capsule. If lens mobilization was achieved with this procedure, hydrodissection was characterized as "easy." RESULTS The two groups were matched for age, gender, the biomicroscopic type of cataract, and the presence of diabetes mellitus. Glaucoma occurred more often among the XFS patients (p = 0.002). In 39 of the 42 exfoliation patients (92.8%), "easy" hydrodissection was recorded. In the control group, the corresponding number was 47 out of 73 (64.3%). The two groups differed significantly (p = 0.001). CONCLUSIONS Hydrodissection was more easily performed on the XFS patients than on the controls. This finding could be related to the extensive ultrastructural subepithelial alterations of the anterior lens capsule in XFS, as recently described in electron microscopy studies. We suggest that less BSS can be used for hydrodissection in XFS patients during phacoemulsification.
Collapse
Affiliation(s)
- Konstantina N Sorkou
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece, .,Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece,
| | - Ioannis T Tsinopoulos
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos T Tsaousis
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Karamitsos
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Soultana Meditskou
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2nd Department of Ophthalmology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Eleni Manthou
- Laboratory of Histology and Embryology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|