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Impact of clinico-biochemical variations on the etiopathogenesis of cataract: a case-control study. J Circ Biomark 2023; 12:1-11. [PMID: 36685068 PMCID: PMC9851602 DOI: 10.33393/jcb.2023.2479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023] Open
Abstract
Purpose: Cataract is a major cause of blindness worldwide with a greater prevalence in developing countries like India. Owing to speculations about the relationship of various biochemical markers and cataract formation this case-control study was designed with the aim to know the impact of serum blood sugar, serum electrolytes and serum calcium on the etiopathogenesis of cataract in Kashmiri population. Methods: A total of 300 cases diagnosed with cataract and 360 healthy controls were taken for the study. Serum of all the cases and controls was analyzed for blood sugar and calcium using spectrometric techniques. Sodium and potassium were analyzed using Ion-Selective Electrode technology. All the investigations were done on ABBOTT c4000 fully automatic clinical chemistry analyzer. Results: Most of the patients in our study were ≥50 years of age having posterior subcapsular cataract. The mean levels of serum fasting blood sugar (mg/dL), serum sodium (mmol/L), serum potassium (mmol/L) and serum calcium (mg/dL) were 99.4 ± 7.7; 140.4 ± 2.5; 4.2 ± 0.5; and 8.9 ± 0.5, respectively, in cases compared to 107.7 ± 12.3; 142.9 ± 5.0; 3.8 ± 0.5; and 8.3 ± 1.7, respectively, in healthy controls. A significantly higher number of cataract cases had elevated serum glucose and sodium levels, low serum potassium and calcium levels compared to healthy controls. Conclusions: Hyperglycemia, hypernatremia, hypokalemia and hypocalcemia can independently increase the patients’ risk to cataracts. Corrections in these biochemical parameters may reduce cataract incidence.
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Ameliorative effect of pioglitazone on glucose induced glycation of α-crystallin: Management of complications associated with diabetic retinopathy. Int J Biol Macromol 2022; 209:107-116. [PMID: 35378163 DOI: 10.1016/j.ijbiomac.2022.03.202] [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: 12/30/2021] [Revised: 02/28/2022] [Accepted: 03/29/2022] [Indexed: 11/22/2022]
Abstract
The glycation and aggregation of lens proteins significantly contribute to the onset of diabetic cataracts as well as the retinopathy. The glycation exerts numerous alterations in the tertiary structural of proteins. Moreover, the covalent crosslinking of lens crystallins also contribute to the cataract formation. In this article, the effect of pioglitazone on glucose induced glycation and aggregation α-crystallin was examined. A remarkable inhibition of early glycation products (~80%) and advanced glycation products (~75%) was recorded by the treatment of pioglitazone. There was >75% recovery in biochemical marker (carbonyl content). The presence of 150 μM of pioglitazone reduced the free lysine modifications to 35%. Treatment of pioglitazone also protected the secondary structural alterations induced by glycation and inhibited the formation of protein aggregates. The interaction studies showed that pioglitazone interacted with α-crystallin via moderate binding affinity. The interaction between pioglitazone interacted and α-crystallin was energetically and entropically favourable. The complex of pioglitazone with studied protein stable in which RMSF, Rg, SASA, RMSD, and the secondary structural components was not affected. The findings show antiglycation activity of pioglitazone along with its mechanism of action highlighting the ability of drug to be possibly developed novel as glycation inhibitor.
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Umarani S, Dollaiah A, Vallabha K. Prospective clinical study of ocular manifestations in patients with type 2 diabetes mellitus. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2022. [DOI: 10.4103/tjosr.tjosr_153_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Yang R, Li X, Mei J, Wan W, Huang X, Yang Q, Wei X. Protective effect of syringic acid via restoring cells biomechanics and organelle structure in human lens epithelial cells. J Bioenerg Biomembr 2021; 53:275-284. [PMID: 33704647 PMCID: PMC8124055 DOI: 10.1007/s10863-021-09873-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/13/2021] [Indexed: 11/29/2022]
Abstract
We have previously reported that syringic acid (SA) extracted from D. aurantiacum var. denneanum (kerr) may be used to prevent diabetic cataract (DC). However, the underlying mechanisms through which SA prevents DC in human lens epithelial cells (HLECs) remained unclear. In the present study, we employed single-molecule optics technologies, including transmission electron microscopy (TEM), atomic force microscopy (AFM), laser scanning confocal microscopy (LSCM) and Raman spectroscopy, to monitor the effect of SA on HLECs biomechanics and organelle structure in real-time. TEM suggested that SA improved the ultrastructure of HLECs with regard to nuclear chromatin condensation and reducing mitochondrial swelling and degeneration, which may aid in the maintenance of HLECs integrity in the presence of glucose. AFM revealed a reduced surface roughness and stiffness following SA treatment, suggesting an improved viscoelasticity of HELCs. Raman spectrometry and LSCM further revealed that these changes were related to a modification of cell liquidity and cytoskeletal structure by SA. Taken together, these results provide insights into the effects of SA on the biomechanics of HLECs and further strengthen the evidence for its potential use as a novel therapeutic strategy for DC prevention.
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Affiliation(s)
- Rong Yang
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Xue Li
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Jie Mei
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Wencheng Wan
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Xinduo Huang
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Qiaohong Yang
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
| | - Xiaoyong Wei
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
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Alam M, Zhang Y, Lim JI, Chan R, Yang M, Yao X. QUANTITATIVE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FEATURES FOR OBJECTIVE CLASSIFICATION AND STAGING OF DIABETIC RETINOPATHY. Retina 2020; 40:322-332. [PMID: 31972803 PMCID: PMC6494740 DOI: 10.1097/iae.0000000000002373] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aims to characterize quantitative optical coherence tomography angiography (OCTA) features of nonproliferative diabetic retinopathy (NPDR) and to validate them for computer-aided NPDR staging. METHODS One hundred and twenty OCTA images from 60 NPDR (mild, moderate, and severe stages) patients and 40 images from 20 control subjects were used for this study conducted in a tertiary, subspecialty, academic practice. Both eyes were photographed and all the OCTAs were 6 mm × 6 mm macular scans. Six quantitative features, that is, blood vessel tortuosity, blood vascular caliber, vessel perimeter index, blood vessel density, foveal avascular zone area, and foveal avascular zone contour irregularity (FAZ-CI) were derived from each OCTA image. A support vector machine classification model was trained and tested for computer-aided classification of NPDR stages. Sensitivity, specificity, and accuracy were used as performance metrics of computer-aided classification, and receiver operation characteristics curve was plotted to measure the sensitivity-specificity tradeoff of the classification algorithm. RESULTS Among 6 individual OCTA features, blood vessel density shows the best classification accuracies, 93.89% and 90.89% for control versus disease and control versus mild NPDR, respectively. Combined feature classification achieved improved accuracies, 94.41% and 92.96%, respectively. Moreover, the temporal-perifoveal region was the most sensitive region for early detection of DR. For multiclass classification, support vector machine algorithm achieved 84% accuracy. CONCLUSION Blood vessel density was observed as the most sensitive feature, and temporal-perifoveal region was the most sensitive region for early detection of DR. Quantitative OCTA analysis enabled computer-aided identification and staging of NPDR.
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Affiliation(s)
- Minhaj Alam
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Yue Zhang
- Department of Mathematics, Statistics and Computer Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Jennifer I. Lim
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - R.V.P. Chan
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Min Yang
- Department of Mathematics, Statistics and Computer Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
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Alam M, Toslak D, Lim JI, Yao X. Color Fundus Image Guided Artery-Vein Differentiation in Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci 2019; 59:4953-4962. [PMID: 30326063 PMCID: PMC6187950 DOI: 10.1167/iovs.18-24831] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose This study aimed to develop a method for automated artery-vein classification in optical coherence tomography angiography (OCTA), and to verify that differential artery-vein analysis can improve the sensitivity of OCTA detection and staging of diabetic retinopathy (DR). Methods For each patient, the color fundus image was used to guide the artery-vein differentiation in the OCTA image. Traditional mean blood vessel caliber (m-BVC) and mean blood vessel tortuosity (m-BVT) in OCTA images were quantified for control and DR groups. Artery BVC (a-BVC), vein BVC (v-BVC), artery BVT (a-BVT), and vein BVT (a-BVT) were calculated, and then the artery-vein ratio (AVR) of BVC (AVR-BVC) and AVR of BVT (AVR-BVT) were quantified for comparative analysis. Sensitivity, specificity, and accuracy were used as performance metrics of artery-vein classification. One-way, multilabel ANOVA with Bonferroni's test and Student's t-test were employed for statistical analysis. Results Forty eyes of 20 control subjects and 80 eyes of 48 NPDR patients (18 mild, 16 moderate, and 14 severe NPDR) were evaluated in this study. The color fundus image-guided artery-vein differentiation reliably identified individual arteries and veins in OCTA. AVR-BVC and AVR-BVT provided significant (P < 0.001) and moderate (P < 0.05) improvements, respectively, in detecting and classifying NPDR stages, compared with traditional m-BVC analysis. Conclusions Color fundus image-guided artery-vein classification provides a feasible method to differentiate arteries and veins in OCTA. Differential artery-vein analysis can improve the sensitivity of OCTA detection and classification of DR. AVR-BVC is the most-sensitive feature, which can classify control and mild NPDR, providing a quantitative biomarker for objective detection of early DR.
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Affiliation(s)
- Minhaj Alam
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Devrim Toslak
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States.,Department of Ophthalmology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Jennifer I Lim
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States.,Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States
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Bahmani F, Bathaie SZ, Aldavood SJ, Ghahghaei A. Prevention of α-crystallin glycation and aggregation using l-lysine results in the inhibition of in vitro catalase heat-induced-aggregation and suppression of cataract formation in the diabetic rat. Int J Biol Macromol 2019; 132:1200-1207. [PMID: 30965074 DOI: 10.1016/j.ijbiomac.2019.04.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 03/13/2019] [Accepted: 04/05/2019] [Indexed: 01/02/2023]
Abstract
The principle role of α-crystallin is chaperoning activity that protect s other proteins against different stresses. High glucose concentration induces the osmotic stress and results in biomacromolecules glycation, which is subsequently cause their conformational and functional changes. Here, the roles of l-lysine (Lys) on the prevention of α-crystallin glycation in both in vitro and in vivo conditions are investigated. The catalase (CAT) activity was considered as a marker of α-crystallin functionality in both conditions. Streptozotocin-induced diabetic rats were treated with 0.1% of the Lys in drinking water. The purified α-crystallin was also incubated with glucose, in the presence or absence of the Lys and its structure-function was compared. The results showed that the visual cataract score was significantly lower in the diabetic rats treated with Lys. After Lys treatment, CAT, superoxide dismutase, aldose reductase and other biochemical parameters in the lens and serum of the diabetic rats returned to the normal value. Formation of the advanced glycation endproducts (AGEs), protein cross-linking, and the hydrophobicity of α-crystallin were changed due to glycation, but they were reversed by Lys treatment. The glycated α-crystallin lost its chaperone activity against heat denatured-CAT, but in the presence of Lys, it preserved its activity and prevented CAT aggregation. In conclusion, Lys treatment significantly inhibited the progression of diabetic cataract in rats. These effects were due to the Lys antiglycating and antioxidant effects, in addition to its protective effect against α-crystallin chaperoning activity.
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Affiliation(s)
- Fereshteh Bahmani
- Department of Clinical Biochemistry, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - S Zahra Bathaie
- Department of Clinical Biochemistry, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - S Javid Aldavood
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.
| | - Arezou Ghahghaei
- Department of Biology, Faculty of Science, University of Sistan and Baluchestan, Zahedan, Iran.
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Abdel-Ghaffar A, Ghanem HM, Ahmed EK, Hassanin OA, Mohamed RG. Ursodeoxycholic acid suppresses the formation of fructose/streptozotocin-induced diabetic cataract in rats. Fundam Clin Pharmacol 2018; 32:627-640. [PMID: 29863796 DOI: 10.1111/fcp.12385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/04/2018] [Accepted: 06/01/2018] [Indexed: 12/11/2022]
Abstract
The main objective of this study was to investigate the potential protective effect of ursodeoxycholic acid (UDCA) on fructose/streptozotocin-induced diabetic cataract in rats. The diabetic model (DM) was induced through the administration of 10% fructose in drinking water for 2 weeks followed by streptozotocin injection (intraperitoneal). One week later, hyperglycemia was assisted and diabetic animals were treated with UDCA either as local eye drops (0.5% solution, four times/day) or orally (100 mg/kg b.w.). Cataract formation was monitored biweekly and scored into four stages. After 12 weeks of treatment, rats were subjected to ophthalmological examination, and then, their blood and lenses were prepared for biochemical analysis of glucose, insulin, reduced glutathione, total antioxidant capacity, malondialdehyde, hydrogen peroxide, caspase-12, and lenticular total proteins. In addition, tertiary structure and conformational changes of lenticular soluble proteins were analyzed using SDS-PAGE and UV absorption while changes in lenticular α-crystallin structure were investigated using intrinsic tryptophan fluorescence. Results demonstrated that both local and oral UDCA restored the normal levels of lens T-AOC, MDA, H2 O2 , and caspase-12 and improved noticeably the levels of the lens GSH and total proteins. In addition, conformational and tertiary structure changes of soluble lens proteins were significantly reduced in UDCA-treated groups. Morphological examination of lenses revealed decreased score of cataract progression in UDCA-treated groups compared to DM animals. It was concluded that UDCA decreased the incidence of diabetic cataract by maintaining the antioxidant status, reducing the endoplasmic reticulum stress, and suppressing the structural changes of soluble lens proteins.
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Affiliation(s)
- Amany Abdel-Ghaffar
- Unit of Biochemistry and Pharmacology, Research Institute of Ophthalmology, El Ahram st, Giza, 12557, Egypt
| | - Hala M Ghanem
- Department of Biochemistry, Faculty of Science, Ain Shams University, Khalifa El-Maamon st, Abbasiya sq., Cairo, 11566, Egypt
| | - Emad K Ahmed
- Department of Biochemistry, Faculty of Science, Ain Shams University, Khalifa El-Maamon st, Abbasiya sq., Cairo, 11566, Egypt
| | - Olfat A Hassanin
- Department of Cornea and Refractive Surgery, Research Institute of Ophthalmology, El Ahram st, Giza, 12557, Egypt
| | - Rawda G Mohamed
- Department of Biochemistry, Faculty of Science, Ain Shams University, Khalifa El-Maamon st, Abbasiya sq., Cairo, 11566, Egypt
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Suraida AR, Ibrahim M, Zunaina E. Correlation of the anterior ocular segment biometry with HbA1c level in type 2 diabetes mellitus patients. PLoS One 2018; 13:e0191134. [PMID: 29324896 PMCID: PMC5764367 DOI: 10.1371/journal.pone.0191134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/28/2017] [Indexed: 11/20/2022] Open
Abstract
Objectives To compare the anterior ocular segment biometry among Type 2 diabetes mellitus (DM) with no diabetic retinopathy (DR) and non-proliferative diabetic retinopathy (NPDR), and to evaluate the correlation of anterior ocular segment biometry with HbA1c level. Methods A cross-sectional study was conducted in Hospital Universiti Sains Malaysia, Kelantan from November 2013 till May 2016 among Type 2 DM patients (DM with no DR and DM with NPDR). The patients were evaluated for anterior ocular segment biometry [central corneal thickness (CCT), anterior chamber width (ACW), angle opening distance (AOD) and anterior chamber angle (ACA)] by using Anterior Segment Optical Coherence Tomography (AS-OCT). Three ml venous blood was taken for the measurement of HbA1c. Results A total of 150 patients were included in this study (DM with no DR: 50 patients, DM with NPDR: 50 patients, non DM: 50 patients as a control group). The mean CCT and ACW showed significant difference among the three groups (p < 0.001 and p = 0.015 respectively). Based on post hoc result, there were significant mean difference of CCT between non DM and DM with NPDR (mean difference 36.14 μm, p < 0.001) and also between non DM and DM with no DR (mean difference 31.48 μm, p = 0.003). The ACW was significantly narrower in DM with NPDR (11.39 mm SD 0.62) compared to DM with no DR (11.76 mm SD 0.53) (p = 0.012). There were no significant correlation between HbA1c and all the anterior ocular segment biometry. Conclusion Diabetic patients have significantly thicker CCT regardless of retinopathy status whereas ACW was significantly narrower in DM with NPDR group compared to DM with no DR. There was no significant correlations between HbA1c and all anterior ocular segment biometry in diabetic patients regardless of DR status.
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Affiliation(s)
- Abd-Rashid Suraida
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Kelantan, Malaysia
| | - Mohtar Ibrahim
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Kelantan, Malaysia
| | - Embong Zunaina
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Kelantan, Malaysia
- * E-mail:
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Wojnar W, Kaczmarczyk-Sedlak I, Zych M. Diosmin ameliorates the effects of oxidative stress in lenses of streptozotocin-induced type 1 diabetic rats. Pharmacol Rep 2017; 69:995-1000. [DOI: 10.1016/j.pharep.2017.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/25/2017] [Accepted: 04/03/2017] [Indexed: 12/25/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review is to determine the prevalence of uveitis in the diabetic population, the clinical features of the uveitis and diabetes when coexisting and pathophysiology of a possible correlation. We also aim to review the cases of diabetes and uveitis in the literature. RECENT FINDINGS The basis of an association between uveitis and diabetes mellitus (DM) is the common pathophysiology of inflammation. There are several reports on a DM-related uveitis, defined as idiopathic anterior uveitis in the presence of poorly controlled DM, but causation has not been established. There are conflicting results in the literature regarding an association between uveitis and DM. More studies are needed to determine if an association truly exists.
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Affiliation(s)
- Wajiha J Kheir
- Department of Ophthalmology, Ocular Immunology and Uveitis Service, American University of Beirut, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Huda A Sheheitli
- Department of Ophthalmology, Ocular Immunology and Uveitis Service, American University of Beirut, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Rola N Hamam
- Department of Ophthalmology, Ocular Immunology and Uveitis Service, American University of Beirut, Riad El Solh, Beirut, 1107 2020, Lebanon.
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Gestational diabetes mellitus is a significant risk factor for long-term ophthalmic morbidity. Arch Gynecol Obstet 2017; 295:1477-1482. [PMID: 28389884 DOI: 10.1007/s00404-017-4362-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/29/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate whether patients with a history of gestational diabetes mellitus (GDM) have an increased risk for long-term ophthalmic morbidity. METHODS Design a population-based study compared the incidence of long-term maternal ophthalmic morbidity in a cohort of women with and without a history of GDM. Setting Soroka University Medical Center. PARTICIPANTS All singleton pregnancies of women who delivered between 1988 and 2013. Main outcome measure(s) Diagnosis of ophthalmic morbidity. Analyses A Kaplan-Meier survival curve was used to estimate cumulative incidence of ophthalmic morbidity. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HR) for ophthalmic morbidity. RESULTS During the study period, 104,751 deliveries met the inclusion criteria; 9.4% (n = 9888) of which occurred in patients with a diagnosis of GDM during at least one of their pregnancies. Patients with GDM had a significantly higher incidence of ophthalmic morbidity such as glaucoma, diabetic retinopathy, and retinal detachment compared with controls (0.1 vs. 0.02%, p < 0.001; 0.2 vs. 0.04%, p < 0.001; 0.2 vs. 0.1%, p < 0.001, respectively). Patients with concurrent GDM and preeclampsia had a significantly higher incidence of total ophthalmic complications compared to patients with GDM only (1 vs. 0.6%, respectively, p < 0.001). Using Kaplan-Meier survival curve, patients with a previous diagnosis of GDM had significantly higher cumulative incidence of ophthalmic morbidity (p < 0.001, log-rank test). In the Cox proportional hazards model, a history of GDM remained independently associated with ophthalmic morbidity (adjusted HR 2.0; 95% CI 1.5-2.8; p < 0.001). CONCLUSIONS GDM is an independent risk factor for long-term maternal ophthalmic morbidity.
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López-Valverde G, Garcia-Martin E, Fernández-Mateos J, Cruz-González F, Larrosa-Povés JM, Polo-Llorens V, Pablo-Júlvez LE. Asociación de factores de riesgo ambientales en el desarrollo de las cataratas preseniles. REVISTA MEXICANA DE OFTALMOLOGÍA 2017. [DOI: 10.1016/j.mexoft.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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14
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Sanchis-Gimeno JA, Alonso L, Rahhal M, Bastir M, Perez-Bermejo M, Belda-Salmeron L. Corneal thickness differences between type 2 diabetes and non-diabetes subjects during preoperative laser surgery examination. J Diabetes Complications 2017; 31:209-212. [PMID: 27623389 DOI: 10.1016/j.jdiacomp.2016.08.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/02/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Abstract
AIMS To evaluate the differences in corneal thickness between type 2 diabetes subjects with HbA1c under 7.0% and non-diabetes subjects during their preoperative laser surgery examinations. METHODS The mean of five consecutive corneal thickness measurements at the central and mid-peripheral cornea was obtained by means of noncontact scanning-slit corneal topography (Orbscan Topography System II; Orbscan, Inc., Salt Lake City, UT, USA) in 35 myopic non-insulin dependent type 2 diabetes subjects (17 males and 18 females) and 48 healthy myopic controls (23 males and 25 females). RESULTS The corneal thickness values at the central and mid-peripheral cornea were significantly higher in the diabetic group (p<.001). The diabetic subjects presented the highest thickness value in the superior cornea (n=22; 62.9%) followed by the nasal (n=9; 25.7%) and the temporal (n=4; 11.4%) cornea, but never in the inferior cornea. The control subjects presented the highest thickness value in the superior cornea (n=19; 39.6%) followed by the nasal (n=18; 37.5%), the inferior (n=6; 12.5%), and the temporal (n=3; 6.3%) cornea. The central corneal thickness (CCT) of the diabetes patients was not statistically correlated with their HbA1c (r2=.078; p=.104), body mass index (r2=.007; p=.633), and time from diagnosis of diabetes (r2=.025; p=.363), but it was correlated with their corneal endothelial cell density values (r2=.543; p<.001). CONCLUSIONS Diabetes subjects with HbA1c under 7.0% who are candidates for laser refractive surgery present thicker corneas than their age-matched control subjects. In these patients, there is a correlation between their CCT values and their corneal endothelial cell density values, so when higher CCT values were found, lower corneal endothelial cell density values were observed.
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Affiliation(s)
- Juan A Sanchis-Gimeno
- Ocular Anatomy Unit, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Avda. Blasco Ibanez 15, E46010, Valencia, Spain.
| | - Luis Alonso
- Rahhal Ophthalmology Clinic, Calle de Cirilo Amoros, 52, E46004, Valencia, Spain
| | - Mohammed Rahhal
- Rahhal Ophthalmology Clinic, Calle de Cirilo Amoros, 52, E46004, Valencia, Spain
| | - Markus Bastir
- National Museum of Natural Sciences - CSIC, Calle de Jose Gutierrez Abascal, 2, E28006, Madrid, Spain
| | - Marcelino Perez-Bermejo
- Ocular Anatomy Unit, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Avda. Blasco Ibanez 15, E46010, Valencia, Spain
| | - Lurdes Belda-Salmeron
- Ocular Anatomy Unit, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Avda. Blasco Ibanez 15, E46010, Valencia, Spain
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15
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Abstract
Diabetes mellitus represents a growing international public health issue with a near quadrupling in its worldwide prevalence since 1980. Though it has many known microvascular complications, vision loss from diabetic retinopathy is one of the most devastating for affected individuals. In addition, there is increasing evidence to suggest that diabetic patients have a greater risk for glaucoma as well. Though the pathophysiology of glaucoma is not completely understood, both diabetes and glaucoma appear to share some common risk factors and pathophysiologic similarities with studies also reporting that the presence of diabetes and elevated fasting glucose levels are associated with elevated intraocular pressure-the primary risk factor for glaucomatous optic neuropathy. While no study has completely addressed the possibility of detection bias, most recent epidemiologic evidence suggests that diabetic populations are likely enriched with glaucoma patients. As the association between diabetes and glaucoma becomes better defined, routine evaluation for glaucoma in diabetic patients, particularly in the telemedicine setting, may become a reasonable consideration to reduce the risk of vision loss in these patients.
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Affiliation(s)
- Brian J Song
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA.
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Harvard Medical School, 1 Joslin Place, Boston, MA, 02115, USA
| | - Louis R Pasquale
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Avenue, Boston, MA, 02215, USA
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Wu J, Li X, Fang H, Yi Y, Chen D, Long Y, Gao X, Wei X, Chen CYO. Investigation of synergistic mechanism and identification of interaction site of aldose reductase with the combination of gigantol and syringic acid for prevention of diabetic cataract. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:286. [PMID: 27520089 PMCID: PMC4983052 DOI: 10.1186/s12906-016-1251-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 07/29/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Gigantol and syringic acid (SA) have been shown to synergistically prevent formation of diabetic cataract (DC). However, the exact mechanism of this effect is unknown. Here, we investigate the effect of these compounds on the activity of aldose reductase (AR) and cataract formation. METHODS We examined the synergistic anti-cataract efficacy of gigantol and SA in the high glucose- and streptozotocin -induced DC rat model; synergism was evaluated using Jin's formula. We investigated possible mechanisms of action by measuring AR expression and activity and levels of sorbitol using enzyme kinetics, Western blot, and RT-PCR. Finally, we examined binding interaction between AR and both compounds using a combination of site-directed mutagenesis, recombinant expression of wild-type and mutant proteins, and enzyme kinetics. RESULTS Combination treatment of gigantol and SA synergistically protected both HLECs(human lens epithelial cells) grown in vitro and DC formation in STZ-induced rats in vivo. Synergism was attributed to inhibition of AR activity, downregulation of AR expression via impaired transcription, and decreased sorbitol levels. Enzyme kinetics studies showed that the activity of an AR Asn160Ala mutant protein was significantly decreased compared to wild-type AR, confirming that Asn160 is a key residue for interaction between AR and both compounds. CONCLUSION Combined administration of gigantol and SA synergize to enhance anti-cataract efficacy. The synergistic effect is mainly attributed to disruption of the polyol pathway and inhibition of AR activity.
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Affiliation(s)
- Jie Wu
- Department of Histology and Embryology, Guangzhou University of Chinese Medicine, 510006, Guangzhou, China
| | - Xue Li
- Department of Histology and Embryology, Guangzhou University of Chinese Medicine, 510006, Guangzhou, China
| | - Hua Fang
- Department of Histology and Embryology, Guangzhou University of Chinese Medicine, 510006, Guangzhou, China.
| | - Yanqun Yi
- Department of Histology and Embryology, Guangzhou University of Chinese Medicine, 510006, Guangzhou, China
| | - Dan Chen
- Department of Histology and Embryology, Guangzhou University of Chinese Medicine, 510006, Guangzhou, China
| | - Yan Long
- Department of Histology and Embryology, Guangzhou University of Chinese Medicine, 510006, Guangzhou, China
| | - Xinxin Gao
- Department of Histology and Embryology, Guangzhou University of Chinese Medicine, 510006, Guangzhou, China
| | - Xiaoyong Wei
- Department of Histology and Embryology, Guangzhou University of Chinese Medicine, 510006, Guangzhou, China.
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 02111, Boston, MA, USA.
| | - C-Y Oliver Chen
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 02111, Boston, MA, USA
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Hayashi Y, Toshida H, Matsuzaki Y, Matsui A, Ohta T. Persistent corneal epithelial defect responding to rebamipide ophthalmic solution in a patient with diabetes. Int Med Case Rep J 2016; 9:113-6. [PMID: 27257394 PMCID: PMC4872273 DOI: 10.2147/imcrj.s103299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objective Rebamipide ophthalmic suspension was developed for the treatment of dry eyes and for other corneal diseases, promoting the secretion of both mucin in tear fluid and membrane-associated mucin, increasing the number of goblet cells, and restoring the barrier function of the corneal epithelium. We report a case of a persistent corneal epithelial defect in a patient with diabetes treated with topical application of rebamipide ophthalmic suspension. Case presentation A 73-year-old woman had a history of type 2 diabetes for 35 years and nonproliferative diabetic retinopathy for 23 years. She presented to our department with discharge and ophthalmalgia in the left eye. A corneal ulcer was detected, and culture of corneal scrapings was performed, with Staphylococcus aureus and Streptococcus canis being isolated. The infection was treated with levofloxacin eye drops and ofloxacin ophthalmic ointment based on the sensitivity profile of the isolate. However, a corneal epithelial defect persisted for approximately 2 months despite continuing treatment with 0.1% hyaluronic acid ophthalmic suspension and 0.3% ofloxacin eye ointment. Her hemoglobin A1c was 7.3%. The persistent corneal epithelial defect showed improvement at 2 weeks after treatment with rebamipide unit dose 2% ophthalmic suspension, and it did not recur even when vitrectomy was subsequently performed for vitreous hemorrhage due to progression of diabetic retinopathy. Conclusion This is the first report about efficacy of rebamipide unit dose 2% ophthalmic suspension for presenting persistent corneal epithelial defect in a patient with diabetes. In the present case, the suggested mechanisms are the following: improving the corneal barrier function, stabilization of mucin on the keratoconjunctival epithelium, and improving the wettability and stability of the tear film, which resulted in the promotion of healing of the corneal epithelial defect in a short time period.
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Affiliation(s)
- Yusuke Hayashi
- Department of Ophthalmology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Hiroshi Toshida
- Department of Ophthalmology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Yusuke Matsuzaki
- Department of Ophthalmology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Asaki Matsui
- Department of Ophthalmology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Toshihiko Ohta
- Department of Ophthalmology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
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Mirsky N, Cohen R, Eliaz A, Dovrat A. Featured Article: Inhibition of diabetic cataract by glucose tolerance factor extracted from yeast. Exp Biol Med (Maywood) 2016; 241:817-29. [PMID: 26825353 PMCID: PMC4950394 DOI: 10.1177/1535370215627031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 12/11/2015] [Indexed: 01/30/2023] Open
Abstract
Diabetes leads to many complications; among them is the development of cataract. Hyperglycemia brings to increased polyol concentration in the lens, to glycation of lens proteins, and to elevated level of ROS (Reactive Oxygen Species) causing oxidative stress. The glucose tolerance factor (GTF) was found by several groups to decrease hyperglycemia and oxidative stress both in diabetic animals and humans. The aim of our study was to explore the damages induced by high glucose to the eye lens and to assess the protective effects of GTF both in vivo and in vitro The in vivo study included control healthy rats, streptozotocin (STZ) diabetic untreated rats, and STZ diabetic rats orally treated with 15 doses of GTF. The diabetic untreated rats developed cataracts, whereas the development of cataract was totally or partially prevented in GTF treated animals. In vitro studies were done on bovine lenses incubated for 14 days. Half of the lenses were incubated in normal glucose conditions, and half in high glucose conditions (450 mg%). To one group of the normal or high glucose condition GTF was added. The optical quality of all the lenses was measured daily by an automated scanning laser system. The control lenses, whether with or without GTF addition, did not show any reduction in their quality. High glucose conditions induced optical damage to the lenses. Addition of GTF to high glucose conditions prevented this damage. High glucose conditions affected the activity of aldose reductase and sodium potassium ATPase in lens epithelial cell. Addition of GTF decreased the destructive changes induced by high glucose conditions. The amount of soluble cortical lens proteins was decreased and structural changes were detected in lenses incubated in high glucose medium. These changes could be prevented when GTF was added to high glucose medium. Our findings demonstrate the anticataractogenic potential of GTF.
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Affiliation(s)
- Nitsa Mirsky
- Department of Biology, Faculty of Natural Sciences, University of Haifa at Oranim, Tivon 3600600, Israel
| | - Revital Cohen
- B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525406, Israel
| | - Anat Eliaz
- B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525406, Israel
| | - Ahuva Dovrat
- B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3525406, Israel
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The effect of topical sodium diclofenac on macular thickness in diabetic eyes after phacoemulsification: a randomized controlled trial. Int Ophthalmol 2016; 37:13-18. [PMID: 26975399 DOI: 10.1007/s10792-016-0209-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
Abstract
To evaluate the efficacy of prophylactic administration of the topical diclofenac 0.1 % on macular thickness in diabetic patients following phacoemulsification and intraocular lens implantation surgery. In a Randomized double-masked clinical trial, 108 eyes of 108 diabetic patients underwent phacoemulsification and intraocular lens implantation surgery were enrolled. Fifty four eyes received the conventional postoperative care with steroid drop, whereas the other group (54 eyes) was given a preoperative diclofenac drop four times daily in addition to steroid drop and continued 6 weeks after surgery. All patients were evaluated by optical coherence tomography (OCT) preoperatively and days 1, 30, and 90. The outcome measures including best-corrected visual acuity and OCT findings were compared in and between both groups. Mean CMT changed from 239 ± 16 and 235 ± 17 at baseline to 249 ± 15 and 254 ± 28 at 3 months in the case and control groups, respectively(p = 0.003). Mean total volume of macula changed from 7.61 ± 0.22 and 7.56 ± 0.3 at baseline to 7.64 ± 0.22 and 7.65 ± 0.31 at 3 months in the case and control groups, respectively (p = 0.820). In comparison to the quadrants thicknesses and mean of them between groups did not reach the significant level. This study showed that there is a beneficial effect of topical diclofenac for prevention of macular thickness increasing following phacoemulsification in diabetic patients.
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Wu J, Lu C, Li X, Fang H, Wan W, Yang Q, Sun X, Wang M, Hu X, Chen CYO, Wei X. Synthesis and Biological Evaluation of Novel Gigantol Derivatives as Potential Agents in Prevention of Diabetic Cataract. PLoS One 2015; 10:e0141092. [PMID: 26517726 PMCID: PMC4627826 DOI: 10.1371/journal.pone.0141092] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 10/05/2015] [Indexed: 11/25/2022] Open
Abstract
As a continuation of our efforts directed towards the development of natural anti-diabetic cataract agents, gigantol was isolated from Herba dendrobii and was found to inhibit both aldose reductase (AR) and inducible nitric oxide synthase (iNOS) activity, which play a significant role in the development and progression of diabetic cataracts. To improve its bioefficacy and facilitate use as a therapeutic agent, gigantol (compound 14f) and a series of novel analogs were designed and synthesized. Analogs were formulated to have different substituents on the phenyl ring (compounds 4, 5, 8, 14a-e), substitute the phenyl ring with a larger steric hindrance ring (compounds 10, 17c) or modify the carbon chain (compounds 17a, 17b, 21, 23, 25). All of the analogs were tested for their effect on AR and iNOS activities and on D-galactose-induced apoptosis in cultured human lens epithelial cells. Compounds 5, 10, 14a, 14b, 14d, 14e, 14f, 17b, 17c, 23, and 25 inhibited AR activity, with IC50 values ranging from 5.02 to 288.8 μM. Compounds 5, 10, 14b, and 14f inhibited iNOS activity with IC50 ranging from 432.6 to 1188.7 μM. Compounds 5, 8, 10, 14b, 14f, and 17c protected the cells from D-galactose induced apoptosis with viability ranging from 55.2 to 76.26%. Of gigantol and its analogs, compound 10 showed the greatest bioefficacy and is warranted to be developed as a therapeutic agent for diabetic cataracts.
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Affiliation(s)
- Jie Wu
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Chuanjun Lu
- College of Chemical Engineering, Zhejiang University of Technology, Hangzhou, 310014, China
- Institute of Drug Synthesis and Pharmaceutical Processing, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
| | - Xue Li
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Hua Fang
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Wencheng Wan
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Qiaohong Yang
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Xiaosheng Sun
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Meiling Wang
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Xiaohong Hu
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - C.-Y. Oliver Chen
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, United States of America
| | - Xiaoyong Wei
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, 02111, United States of America
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González-Cortés J. Treatment of Diabetic Macular Edema (DME): Shifting paradigms. MEDICINA UNIVERSITARIA 2015. [DOI: 10.1016/j.rmu.2016.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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González-Cortés J, Toledo-Negrete J, Butrón-Valdez K, Zapata-Elizondo V, Martínez-Gamero B, Treviño-Cavazos E, Guerra-Leal J, Mohamed-Hamsho J. Combined therapy in diabetic macular edema. MEDICINA UNIVERSITARIA 2015. [DOI: 10.1016/j.rmu.2015.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ishibashi T, Li X, Koh A, Lai TYY, Lee FL, Lee WK, Ma Z, Ohji M, Tan N, Cha SB, Shamsazar J, Yau CL. The REVEAL Study: Ranibizumab Monotherapy or Combined with Laser versus Laser Monotherapy in Asian Patients with Diabetic Macular Edema. Ophthalmology 2015; 122:1402-15. [PMID: 25983216 DOI: 10.1016/j.ophtha.2015.02.006] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 02/05/2015] [Accepted: 02/05/2015] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE The primary study hypothesis was that ranibizumab 0.5 mg monotherapy or combined with laser is superior to laser monotherapy based on mean average change in best-corrected visual acuity (BCVA) over 12 months in Asian patients with visual impairment resulting from diabetic macular edema (DME). DESIGN A 12-month, randomized, double-masked, multicenter, laser-controlled, phase III study. PARTICIPANTS Three hundred ninety-six patients aged ≥18 years, with type 1 or 2 diabetes mellitus, BCVA of 78-39 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, and visual impairment resulting from DME. METHODS Patients were randomized to ranibizumab + sham laser (n = 133), ranibizumab + active laser (n = 132), or sham injection + active laser (n = 131). Ranibizumab/sham injections were administered on day 1 and continued monthly. As of month 3, monthly injections were continued if stable vision was not reached. Treatment was reinitiated if BCVA decreased because of DME progression. Active/sham laser was administered on day 1 and thereafter according to ETDRS guidelines. MAIN OUTCOME MEASURES Average change in BCVA from baseline to months 1 through 12, central retinal subfield thickness (CRST), and safety over 12 months. RESULTS Ranibizumab monotherapy or combined with laser was superior to laser in improving mean average change in BCVA from baseline to months 1 through 12 (+5.9 and +5.7 vs +1.4 letters). At month 12, greater proportion of patients gained ≥15 letters with ranibizumab and ranibizumab + laser compared with laser (18.8% and 17.8% vs 7.8%). Mean CRST reduced significantly from baseline to month 12 with ranibizumab (-134.6 μm) and ranibizumab + laser (-171.8 μm) versus laser (-57.2 μm). Patients received a mean of 7.8 and 7.0 ranibizumab injections in the ranibizumab and ranibizumab + laser arms, respectively, and 1.5-1.9 active laser across treatment arms over 12 months. Conjunctival hemorrhage was the most common ocular, whereas nasopharyngitis and hypertension were the most common nonocular adverse events. Ranibizumab was not associated with any cases of cerebrovascular hemorrhage and cerebrovascular ischemia. No death related to study treatment was reported. CONCLUSIONS Ranibizumab monotherapy or combined with laser showed superior BCVA improvements over laser treatment alone in Asian patients with visual impairment resulting from DME. No new ocular or nonocular safety findings were observed and treatment was well tolerated over 12 months.
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Affiliation(s)
- Tatsuro Ishibashi
- Department of Ophthalmology, Kyushu University Hospital, Fukuoka, Japan
| | - Xiaoxin Li
- Peking University People's Hospital, Beijing, China.
| | - Adrian Koh
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - Timothy Y Y Lai
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Fenq-Lih Lee
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Won-Ki Lee
- Department of Ophthalmology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Zhizhong Ma
- Peking University Third Hospital, Beijing, China
| | - Masahito Ohji
- Shiga University of Medical Science Hospital, Ohtsu, Japan
| | - Nikolle Tan
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Republic of Singapore; National Healthcare Group Eye Institute, Singapore, Republic of Singapore
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Evaluation of neonatal streptozotocin induced diabetic rat model for the development of cataract. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2014; 2014:463264. [PMID: 25505935 PMCID: PMC4253707 DOI: 10.1155/2014/463264] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 08/02/2014] [Indexed: 01/30/2023]
Abstract
Type 2 diabetes (T2D) generally follows prediabetes (PD) conditions such as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). Although studies reported an association of IGT or IFG with cataract, the experimental basis for PD associated cataract is not known. Hence, we evaluated neonatal streptozotocin (nSTZ) induced rat model to study PD associated cataractogenesis by injecting STZ to two-day old rats. While majority (70%) of nSTZ injected pups developed IGT (nSTZ-PD) by two months but not cataract even after seven months, remaining (30%) nSTZ rats developed hyperglycemia (nSTZ-D) by two months and mature cataract by seven months. Lens biochemical analysis indicated increased oxidative stress as indicated by increased SOD activity, lipid peroxidation, and protein carbonyl levels in nSTZ-D cataractous lens. There was also increased polyol pathway as assessed by aldose reductase activity and sorbitol levels. Though nSTZ-PD animals have not shown any signs of lenticular opacity, insolubilization of proteins along with enhanced polyol pathway was observed in the lens. Further there was increased oxidative stress in lens of IGT animals. These results suggest that oxidative stress along with increased polyol pathway might play a role in IGT-associated lens abnormalities. In conclusion, nSTZ-PD rat model could aid to investigate IGT-associated lens abnormalities.
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Diabetes, glucose metabolism, and glaucoma: the 2005-2008 National Health and Nutrition Examination Survey. PLoS One 2014; 9:e112460. [PMID: 25393836 PMCID: PMC4231045 DOI: 10.1371/journal.pone.0112460] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/14/2014] [Indexed: 11/23/2022] Open
Abstract
Background Diabetes may affect vascular autoregulation of the retina and optic nerve and may be associated with an increased risk of glaucoma,but the association of prediabetes, insulin resistance, markers of glucose metabolismwith glaucoma has not beenevaluated in general population samples. Objective To examine the relation between diabetes, pre-diabetes, metabolic syndrome and its components and the levels of fasting glucose, HbA1c and HOMA-IR with the prevalence of glaucoma in the general U.S. population. Methods Cross-sectional study of 3,299 adult men and women from the 2005–2008 National Health and NutritionExamination Survey (NHANES). The presence of diabetes, prediabetes, the metabolic syndrome and its individual components and biomarkers of glucose metabolisms were based on standardized questionnaire and physical exam data and laboratory tests. The history of glaucoma was assessed through questionnaire during the home interview. Results Diabetes was strongly associated with prevalent glaucoma.In fully adjusted models, the odds ratiofor glaucoma comparing participants with diabetes with participants in the reference group with neither pre-diabetes nor diabetes was 2.12 (95% CI: 1.23, 3.67). The corresponding odd ratio comparing participants with pre-diabetes to those in the reference group was 1.01 (95% CI: 0.57, 1.82). Patients with 5 or more years of diabetes duration hadan OR for glaucoma of 3.90 (95% CI: 1.63, 9.32) compared with patients with <5 years of diabetes duration. We also found a hockey-stick shaped associations between biomarkers of glucose metabolisms and the prevalence of glaucoma. Conclusions Diabetes was associated with higher risk of glaucoma. Participants without diabetes but at the higher levels of fasting glucose, fasting insulin, HbA1c and HOMA-IR spectrum may also be at greater risk of glaucoma.
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Reddy VS, Kumar CU, Reddy GB. Effect of chronic hyperglycemia on crystallin levels in rat lens. Biochem Biophys Res Commun 2014; 446:602-7. [DOI: 10.1016/j.bbrc.2014.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/04/2014] [Indexed: 12/17/2022]
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Storr-Paulsen A, Singh A, Jeppesen H, Norregaard JC, Thulesen J. Corneal endothelial morphology and central thickness in patients with type II diabetes mellitus. Acta Ophthalmol 2014; 92:158-60. [PMID: 23387877 DOI: 10.1111/aos.12064] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate corneal endothelial cell density and morphology in type II diabetic and non-diabetic patients and to relate potential differences to the glycaemic status. METHODS A prospective clinical study including 107 patients with type II diabetes and 128 non-diabetic patients. Sample size was based on a power calculation (power = 0.90; p = 0.05). The diabetic patients had on average more than four HbA1c tests performed (mean 4.1; range 2-14) with intervals of at least 3 months as a reflection of the long-term glycaemic status. The controls had no diabetes confirmed by two causal blood tests. The endothelial cell density, the variation in endothelial cell size (CV), the percentage of hexagonal cells, and the central corneal thickness (CCT) were recorded. RESULTS Type II diabetic subjects did not differ from the non-diabetic control subjects with regards to endothelial cell density, hexagonality or variation in CV, but showed a significant increase in CCT (538 versus 546 μm, p < 0.05). In the diabetic group, lower cell counts were associated with higher HbA1c values (p < 0.05). The HbA1c did not, however, have any impact on the CCT. CONCLUSION Type II diabetes has no impact on corneal cell density or morphology in subjects with good glycaemic status. However, higher HbA1c was associated with lower endothelial cell density. CCT was significantly increased in the diabetic group.
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Affiliation(s)
- Allan Storr-Paulsen
- Department of Ophthalmology, Frederiksberg University Hospital, Frederiksberg, DenmarkRoskilde Eye Clinic, Roskilde, Denmark
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Muthenna P, Raghu G, Akileshwari C, Sinha SN, Suryanarayana P, Reddy GB. Inhibition of protein glycation by procyanidin-B2 enriched fraction of cinnamon: Delay of diabetic cataract in rats. IUBMB Life 2013; 65:941-50. [DOI: 10.1002/iub.1214] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 08/27/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Puppala Muthenna
- Biochemistry Division; National Institute of Nutrition; Tarnaka Hyderabad India
| | - Ganugula Raghu
- Biochemistry Division; National Institute of Nutrition; Tarnaka Hyderabad India
| | | | | | - Palla Suryanarayana
- Biochemistry Division; National Institute of Nutrition; Tarnaka Hyderabad India
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Aldebasi Y, El-Gendy SM, Kamel A, Mohieldein A. Aldo-keto reductase and sorbitol dehydrogenase enzymes in Egyptian diabetic patients with and without proliferative diabetic retinopathy. Clin Exp Optom 2013; 96:303-9. [PMID: 23452182 DOI: 10.1111/cxo.12014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 08/29/2012] [Accepted: 09/05/2012] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Activation of the polyol pathway due to increased aldo-keto reductase (AKR) activity has been implicated in the development of diabetic complications, including proliferative diabetic retinopathy (PDR); however, the relationship between hyperglycaemia-induced activation of the polyol pathway in the retina and PDR is still uncertain. METHODS This study was conducted on 73 individuals, who were categorised into three groups: healthy individuals as normal control (15 age-matched subjects), diabetic patients treated with oral hypoglycaemic drugs (OHD, 34 patients), six of whom (17.7 per cent) were diagnosed with PDR and the rest were diagnosed with non-proliferative diabetic retinopathy (NPDR) and diabetic patients treated with insulin (INS, 24 patients), 12 of whom (50 per cent) were diagnosed with PDR and the rest had NPDR. RESULTS The AKR level in diabetic subjects showed a significant increase compared with the normal controls. Interestingly, AKR levels were significantly increased in the INS compared with the OHD group. Also the AKR level was significantly increased in the patients with proliferative compared with the non-proliferative retinopathy in both the insulin and oral diabetic groups. The sorbitol dehydrogenase (SDH) level in diabetic patients showed a significant decrease compared with the normal control level. Interestingly, the SDH level was significantly decreased in the INS compared with the OHD group. Also, the SDH level was significantly decreased in patients with proliferative compared with non-proliferative retinopathy in both INS and OHD groups. The HbA(1c) level in both INS and OHD subjects showed a significant increase compared with normal controls. In addition, the triglyceride level in insulin proliferative retinopathy showed a significant increase compared with other groups. CONCLUSIONS The AKR level was significantly increased in patients with proliferative compared with non-proliferative retinopathy in both insulin and oral diabetic groups. The SDH level was significantly decreased in patients with proliferative compared with non-proliferative retinopathy in both insulin and oral diabetic groups. Both AKR and SDH could be used as indicators for diabetic control.
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Affiliation(s)
- Yousef Aldebasi
- Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
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Spadea L, Paroli MP. Laser refractive surgery in diabetic patients: a review of the literature. Clin Ophthalmol 2012; 6:1775-83. [PMID: 23152656 PMCID: PMC3497454 DOI: 10.2147/opth.s37384] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the current recommendations regarding laser refractive surgery in patients with diabetes mellitus and to assess whether these patients make appropriate candidates for laser vision correction. METHODS A literature search was conducted to identify current research on the ocular complications of diabetes and original publications on laser refractive surgery in diabetic patients. RESULTS Diabetes was associated with several ocular complications. Initially the US Food and Drug Administration listed these complications as justification to advise against refractive surgery in patients with diabetes. However, recent studies on laser in situ keratomileusis in diabetic patients indicate that this procedure may be safe in diabetic patients with very well controlled systemic disease and no ocular manifestations. CONCLUSION Laser refractive surgery may be performed safely in a very selected group of patients with diabetes.
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Affiliation(s)
- Leopoldo Spadea
- University of L'Aquila, Department of Biotechnological and Applied Clinical Sciences, Eye Clinic, L'Aquila
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Olafsdottir E, Andersson DKG, Stefánsson E. The prevalence of cataract in a population with and without type 2 diabetes mellitus. Acta Ophthalmol 2012; 90:334-40. [PMID: 22176834 DOI: 10.1111/j.1755-3768.2011.02326.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the prevalence and risk factors of lens opacities in a geographically defined population of subjects with type 2 diabetes mellitus compared with a control population. METHODS Subjects in the community of Laxå with a diagnosis of type 2 diabetes mellitus (n = 275) and a control group (n = 256) participated in the study. Lens opacities were graded with Lens Opacities Classification System II in all participants. Lens Opacities Classification System score ≥ 2 was considered as significant lens opacity. Anthropometric and blood chemistry data were collected for all participants in connection with the eye examination. For the diabetic population, yearly updated information on glucose control, blood pressure and body mass index was available through medical records from diabetes diagnosis until the time of the eye examination. RESULTS The prevalence of significant cortical, posterior subcapsular and nuclear cataract was 65.5%, 42.5% and 48.0%, respectively, in the type 2 diabetes population in Laxå. In logistic regression analyses, all types of lens opacities were strongly associated with age (p < 0.0001). Cortical lens opacity was also associated with a diagnosis of diabetes (p < 0.0001), posterior subcapsular lens opacity with HbA1c (p < 0.0001) and nuclear lens opacity with female gender and higher heart rate (both p = 0.0004). In the diabetic population, all types of cataract were likewise strongly associated with age (p < 0.0001), posterior subcapsular cataract with HbA1c (p = 0.0032), nuclear cataract with female gender (p = 0.0002) and higher heart rate (p = 0.0008). CONCLUSIONS Our study shows that cortical cataract is associated with diabetes mellitus, not necessarily defined by glucose control, whereas posterior subcapsular cataract is associated with glucose levels. Nuclear cataract is not associated with diabetes mellitus, but is more frequent in women and is also associated with higher heart rate.
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Affiliation(s)
- Eydis Olafsdottir
- Department of Ophthalmology, The National University Hospital, Reykjavik, Iceland.
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Diabetic cataract-pathogenesis, epidemiology and treatment. J Ophthalmol 2010; 2010:608751. [PMID: 20634936 PMCID: PMC2903955 DOI: 10.1155/2010/608751] [Citation(s) in RCA: 222] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 04/02/2010] [Indexed: 12/15/2022] Open
Abstract
Cataract in diabetic patients is a major cause of blindness in developed and developing countries. The pathogenesis of diabetic cataract development is still not fully understood. Recent basic research studies have emphasized the role of the polyol pathway in the initiation of the disease process.
Population-based studies have greatly increased our knowledge concerning the association between diabetes and cataract formation and have defined risk factors for the development of cataract. Diabetic patients also have a higher risk of complications after phacoemulsification cataract surgery compared to nondiabetics. Aldose-reductase inhibitors and antioxidants have been proven beneficial in the prevention or treatment of this sightthreatening condition in in vitro and in vivo experimental studies.
This paper provides an overview of the pathogenesis of diabetic cataract, clinical studies investigating the association between diabetes and cataract development, and current treatment of cataract in diabetics.
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Abstract
Aldose reductase (AKR1B1) is an NADPH-dependent aldo-keto reductase best known as the rate-limiting enzyme of the polyol pathway. Accelerated glucose metabolism through this pathway has been implicated in diabetic cataract and retinopathy. Some human tissues contain AKR1B1 as well as AKR1B10, a closely related member of the aldo-keto reductase gene superfamily. This opens the possibility that AKR1B10 may also contribute to diabetic complications. The goal of the current study was to characterize the expression profiles of AKR1B1 and AKR1B10 in the human eye. Using quantitative reverse transcriptase-PCR and immunohistochemical staining, we observed expression of both AKR genes in cornea, iris, ciliary body, lens, and retina. Expression of AKR1B1 was the highest in lens and retina, whereas AKR1B10 was the highest in cornea. Lenses from transgenic mice designed for overexpression of AKR1B10 were not significantly different from nontransgenic controls, although a significant number developed a focal defect in the anterior lens epithelium following 6 months of experimentally induced diabetes. However, lenses from AKR1B10 mice remained largely transparent following longterm diabetes. These results indicate that AKR1B1 and AKR1B10 may have different functional properties in the lens and suggest that AKR1B10 does not contribute to the pathogenesis of diabetic cataract in humans.
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Bozulic LD, Dean WL, Delamere NA. The influence of protein tyrosine phosphatase-1B on Na,K-ATPase activity in lens. J Cell Physiol 2004; 200:370-6. [PMID: 15254964 DOI: 10.1002/jcp.20029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The abnormal sodium content of many cataracts suggests Na,K-ATPase is vital for maintenance of eye lens transparency. Since tyrosine phosphorylation is considered a possible regulatory mechanism for Na,K-ATPase, experiments were conducted to test the influence of protein tyrosine phosphatase-1B (PTP-1B) on Na,K-ATPase activity. Membrane material was isolated separately from porcine lens epithelium and fiber cells. Tyrosine phosphoproteins, Na,K-ATPase alpha1 polypeptide and PTP-1B were examined by Western blot. Na,K-ATPase activity was determined by measuring ATP hydrolysis in the presence or absence of ouabain. Western blot analysis revealed tyrosine phosphorylation of multiple membrane proteins in both lens cell types, the differentiated fiber cells and non-differentiated epithelium. When membrane material was subjected to immunoprecipitation using an antibody directed against Na,K-ATPase alpha1, a colocalized phosphotyrosine band was detected in lens fibers but not epithelium. Incubation with PTP-1B caused a approximately 50% increase of Na,K-ATPase activity in fiber membrane material. Na,K-ATPase activity in lens epithelium membrane material was not significantly altered by PTP-1B treatment even though PTP-1B was demonstrated to cause dephosphorylation of multiple membrane proteins in the epithelium as well as fibers. While endogenous PTP-1B was detected in both cell types, endogenous tyrosine phosphatase activity was low in both epithelium and fiber membrane material. The results illustrate endogenous tyrosine phosphorylation of Na,K-ATPase alpha1 polypeptide in fibers. Na,K-ATPase alpha1 in lens fibers may be a potential target for PTP-1B.
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Affiliation(s)
- Larry D Bozulic
- Department of Biochemistry and Molecular Biology, University of Louisville, School of Medicine, Louisville, Kentucky 40292, USA
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