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Ortiz-Morales G, Vera-Duarte GR, Jimenez-Collado D, Arteaga-Rivera J, Arteaga-Rivera K, Domene-Hickman JL, Müller-Morales CA, Navas A, Ramirez-Miranda A, Chodosh J, Graue-Hernandez EO. Results of Lucia Keratoprosthesis Implantation in Severe Corneal Disease.: Results of Lucia KPro. Am J Ophthalmol 2024:S0002-9394(24)00394-5. [PMID: 39244000 DOI: 10.1016/j.ajo.2024.08.035] [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: 05/09/2024] [Revised: 08/22/2024] [Accepted: 08/23/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE Describe complications, functional success, and retention of the Lucia Keratoprosthesis (KPro). DESIGN Retrospective interventional case series METHODS: The demographic data, baseline characteristics, complications, functional success, and retention were analyzed for Lucia KPro at Instituto de Oftalmologia Conde de Valenciana in Mexico City from 2021-2023. Multivariate regression analysis and Kaplan-Meier plots were performed to identify associations with functional failure. The main outcome measures were postoperative complications; functional success defined as best-corrected visual acuity (BCVA) ≥ 20/200 (LogMAR 1.0); and device retention rate. RESULTS Forty-eight eyes of 48 patients (56.88% male) were studied. The mean age at implantation was 57.29 ± 15.63 years (range 27-91) with a mean follow-up of 20.5 ± 8.83 months (range: 3-40). Diagnostic indications for implantation included recurrent graft rejection (54.17%), autoimmune disease (20.83%), chemical injury (12.5%), and other (12.5%). At least one postoperative complication occurred in 75% of patients leading to 65 additional interventions (mean number of subsequent procedures: 1.35 ± 1.3, range 0-5). The preoperative BCVA was 2.40 ± 0.36 LogMAR. At the final follow-up, 62.5% had achieved functional success and 22.92% had a BCVA of 20/40 (LogMAR 0.3) or better. Glaucoma (adjusted OR: 469.74, 95% CI 5.02 - 43939.14, p=0.007) and retinal pathology before KPro (adjusted OR: 372.38, 95% CI 4.18 - 33162.11, p=0.009) were associated with functional failure. The device remained in place in 95.83% of recipients over the follow-up period. CONCLUSION The Lucia KPro offers functional success in severe corneal diseases and excellent retention in the short to intermediate term.
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Affiliation(s)
- Gustavo Ortiz-Morales
- Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico, Mexico
| | | | - David Jimenez-Collado
- Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico, Mexico
| | - Jose Arteaga-Rivera
- Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico, Mexico
| | - Karla Arteaga-Rivera
- Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico, Mexico
| | | | | | - Alejandro Navas
- Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico, Mexico
| | - Arturo Ramirez-Miranda
- Instituto de Oftalmologia Fundacion Conde de Valenciana IAP, Mexico City, Mexico, Mexico
| | - James Chodosh
- Department of Ophthalmology and Visual Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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Xu X, Wu Y, Gu R, Zhang Z, Liu X, Hu Y, Li X, Lin D, Bao Z. Nanoparticle-hydrogel composite as dual-drug delivery system for the potential application of corneal graft rejection. Eur J Pharm Biopharm 2024; 201:114351. [PMID: 38851460 DOI: 10.1016/j.ejpb.2024.114351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/29/2024] [Accepted: 06/06/2024] [Indexed: 06/10/2024]
Abstract
Immune rejection remains the major cause of corneal graft failure. Immunosuppressants (such as rapamycin; RAPA) adjunctive to antibiotics (such as levofloxacin hydrochloride; Lev) are a clinical mainstay after corneal grafts but suffer from poor ocular bioavailability associated with severe side effects. In this study, we fabricated a Lev@RAPA micelle loaded cationic peptide-based hydrogel (NapFFKK) as a dual-drug delivery system by integrating RAPA micelles with Lev into a cationic NapFFKK hydrogel to potentially reduced the risk of corneal graft rejection. The properties of the resulting hydrogels were characterized using transmission electronmicroscopy and rheometer. Lev@RAPA micelles loaded NapFFKK hydrogel provided sustained in vitro drug release without compromising their inherent pharmacological activities. Topical instillation of Lev@RAPA micelles loaded NapFFKK hydrogel resulted in the great ocular tolerance and extended precorneal retention over 60 min, thus significantly enhancing the ocular bioavailability of both Lev and RAPA. Overall, such dual-drug delivery system might be a promising formulation for the suppression of corneal graft failure.
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Affiliation(s)
- Xiaoning Xu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Yuqin Wu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Ruiling Gu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Zhaoliang Zhang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Xiangyi Liu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Yuhan Hu
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Xingyi Li
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China.
| | - Deqing Lin
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China.
| | - Zhishu Bao
- National Clinical Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China.
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Wiedemann J, Hos D, Limburg E, Zettelmeyer U, Schiller P, Franklin J, Bachmann B, Böhringer D, Dietrich-Ntoukas T, Fuchsluger TA, Geerling G, Lang SJ, Mayer WJ, Priglinger S, Reinhard T, Seitz B, Cursiefen C. UV light-mediated corneal crosslinking as (lymph)angioregressive pretreatment to promote graft survival after subsequent high-risk corneal transplantation (CrossCornealVision): protocol for a multicenter, randomized controlled trial. Trials 2024; 25:169. [PMID: 38448965 PMCID: PMC10916195 DOI: 10.1186/s13063-024-08011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/23/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Good vision highly depends on the transparency of the cornea, which is the "windscreen" of the eye. In fact, corneal blindness due to transparency loss is the second most common cause of blindness worldwide, and corneal transplantation is the main cure. Importantly, the cornea is normally avascular but can secondarily be invaded by pathological (blood and lymphatic) vessels due to severe inflammation, and the survival prognosis of a corneal graft mainly depends on the preoperative vascular condition of the recipient's cornea. Whereas transplants placed into avascular recipient beds enjoy long-term survival rates of > 90%, survival rates significantly decrease in pathologically pre-vascularized, so-called high-risk recipients, which account for around 10% of all performed transplants in Germany and > 75% in lower and middle-income countries worldwide. METHODS This parallel-grouped, open-randomized, multicenter, prospective controlled exploratory investigator-initiated trial (IIT) intends to improve graft survival by preconditioning pathologically vascularized recipient corneas by (lymph)angioregressive treatment before high-risk corneal transplantation. For this purpose, corneal crosslinking (CXL) will be used, which has been shown to potently regress corneal blood and lymphatic vessels. Prior to transplantation, patients will be randomized into 2 groups: (1) CXL (intervention) or (2) no pretreatment (control). CXL will be repeated once if insufficient reduction of corneal neovascularization should be observed. All patients (both groups) will then undergo corneal transplantation. In the intervention group, remaining blood vessels will be additionally regressed using fine needle diathermy (on the day of transplantation). Afterwards, the incidence of graft rejection episodes will be evaluated for 24 months (primary endpoint). Overall graft survival, as well as regression of corneal vessels and/or recurrence, among other factors, will be analyzed (secondary endpoints). DISCUSSION Based on preclinical and early pilot clinical evidence, we want to test the novel concept of temporary (lymph)angioregressive pretreatment of high-risk eyes by CXL to promote subsequent corneal graft survival. So far, there is no evidence-based approach to reliably improve graft survival in the high-risk corneal transplantation setting available in clinical routine. If successful, this approach will be the first to promote graft survival in high-risk transplants. It will significantly improve vision and quality of life in patients suffering from corneal blindness. TRIAL REGISTRATION ClinicalTrials.gov NCT05870566. Registered on 22 May 2023.
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Affiliation(s)
- Johanna Wiedemann
- Department of Ophthalmology, University Hospital Cologne, Cologne, Germany
| | - Deniz Hos
- Department of Ophthalmology, University Hospital Cologne, Cologne, Germany.
| | - Endrik Limburg
- Clinical Trials Centre of Cologne (CTCC), University of Cologne, Cologne, Germany
| | - Ulrike Zettelmeyer
- Clinical Trials Centre of Cologne (CTCC), University of Cologne, Cologne, Germany
| | - Petra Schiller
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Jeremy Franklin
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Björn Bachmann
- Department of Ophthalmology, University Hospital Cologne, Cologne, Germany
| | - Daniel Böhringer
- Department of Ophthalmology, University of Freiburg, Freiburg, Germany
| | - Tina Dietrich-Ntoukas
- Department of Ophthalmology, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Gerd Geerling
- Department of Ophthalmology, University of Düsseldorf, Düsseldorf, Germany
| | - Stefan J Lang
- Department of Ophthalmology, University of Freiburg, Freiburg, Germany
| | | | | | - Thomas Reinhard
- Department of Ophthalmology, University of Freiburg, Freiburg, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University Hospital Cologne, Cologne, Germany
- CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
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Cao Z, Ramadan A, Tai A, Zetterberg F, Panjwani N. Anti-Angiogenic and Anti-Scarring Dual Effect of Galectin-3 Inhibition in Mouse Models of Corneal Wound Healing. THE AMERICAN JOURNAL OF PATHOLOGY 2024; 194:447-458. [PMID: 38159722 DOI: 10.1016/j.ajpath.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/05/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024]
Abstract
Corneal scarring is the third leading cause of global blindness. Neovascularization of ocular tissues is a major predisposing factor in scar development. Although corneal transplantation is effective in restoring vision, some patients are at high risk for graft rejection due to the presence of blood vessels in the injured cornea. Current treatment options for controlling corneal scarring are limited, and outcomes are typically poor. In this study, topical application of a small-molecule inhibitor of galectin-3, GB1265, in mouse models of corneal wound healing, led to the reduction of the following in injured corneas: i) corneal angiogenesis; ii) corneal fibrosis; iii) infiltration of immune cells; and iv) expression of the proinflammatory cytokine IL-1β. Four independent techniques (RNA sequencing, NanoString, real-time quantitative RT-PCR, and Western blot analysis) determined that decreased corneal opacity in the galectin-3 inhibitor-treated corneas was associated with decreases in the numbers of genes and signaling pathways known to promote fibrosis. These findings allowed for a high level of confidence in the conclusion that galectin-3 inhibition by the small-molecule inhibitor GB1265 has dual anti-angiogenic and anti-scarring effects. Targeting galectin-3 by GB1265 is, thus, attractive for the development of innovative therapies for a myriad of ocular and nonocular diseases characterized by pathologic angiogenesis and fibrosis.
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Affiliation(s)
- Zhiyi Cao
- New England Eye Center/Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts
| | - Abdulraouf Ramadan
- New England Eye Center/Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts
| | - Albert Tai
- Department of Immunology, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Noorjahan Panjwani
- New England Eye Center/Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts; Department of Developmental, Molecular, and Chemical Biology, Tufts University School of Medicine, Boston, Massachusetts.
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Xu C, Guo R, Hou C, Ma M, Dong X, Ouyang C, Wu J, Huang T. Resveratrol regulates macrophage recruitment and M1 macrophage polarization and prevents corneal allograft rejection in rats. Front Med (Lausanne) 2023; 10:1250914. [PMID: 37937143 PMCID: PMC10626464 DOI: 10.3389/fmed.2023.1250914] [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] [Received: 06/30/2023] [Accepted: 09/15/2023] [Indexed: 11/09/2023] Open
Abstract
Introduction Resveratrol is an immune modulator that can reduce M1 macrophage polarization in vitro. Reducing macrophage recruitment and M1 polarization can prevent corneal allograft rejection (CGR). In this study, rat corneal allograft rejection models were established to explore the effects of resveratrol on CGR and macrophages and the underlying mechanisms after corneal transplantation. Methods Corneal allograft models were established, and 100 mg/kg resveratrol was injected intraperitoneally. The corneal allografts were assessed clinically using the Holland rejection scoring system, anterior segment photography, and anterior segment optical coherence tomography. Corneal macrophages, pro-inflammatory cytokines, and corneal lymphatic vessels were detected using hematoxylin and eosin staining, immunofluorescence staining, and real-time quantitative polymerase chain reaction (qRT-PCR). Dendritic cells (DCs) in cervical lymph nodes were explored using flow cytometry. RNA sequencing experiments were conducted to identify the mechanisms through which resveratrol affected CGR. The results were verified using Simple Western analysis. Pro-inflammatory cytokines by macrophages in vitro were measured using qRT-PCR and enzyme-linked immunosorbent assays. Results Resveratrol significantly prolonged the survival of corneal grafts and reduced graft edema and central corneal thickness. Corneal macrophage recruitment and M1 macrophage polarization decreased significantly after corneal transplantation in the resveratrol group. Resveratrol also reduced pro-inflammatory cytokines in corneal grafts and suppressed the early generation of cornea lymphatic vessels and the recruitment of cornea inflammatory cells 14 days after surgery. Resveratrol decreased the proportion of DCs in ipsilateral cervical lymph nodes. The effect of resveratrol on CGR was related to the phosphatidylinositol 3-kinase/protein kinase-B (PI3K/Akt) pathway. Resveratrol reduced the secretion of pro-inflammatory cytokines by M1 macrophages in vitro. Conclusion Our findings suggest that resveratrol can reduce corneal macrophage recruitment and M1 macrophage polarization after corneal transplantation in rats and prevent CGR. The PI3K/Akt pathway may be an important mechanism that warrants further research.
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Affiliation(s)
| | | | | | | | | | | | | | - Ting Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
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Yang Y, Zhong J, Cui D, Jensen LD. Up-to-date molecular medicine strategies for management of ocular surface neovascularization. Adv Drug Deliv Rev 2023; 201:115084. [PMID: 37689278 DOI: 10.1016/j.addr.2023.115084] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023]
Abstract
Ocular surface neovascularization and its resulting pathological changes significantly alter corneal refraction and obstruct the light path to the retina, and hence is a major cause of vision loss. Various factors such as infection, irritation, trauma, dry eye, and ocular surface surgery trigger neovascularization via angiogenesis and lymphangiogenesis dependent on VEGF-related and alternative mechanisms. Recent advances in antiangiogenic drugs, nanotechnology, gene therapy, surgical equipment and techniques, animal models, and drug delivery strategies have provided a range of novel therapeutic options for the treatment of ocular surface neovascularization. In this review article, we comprehensively discuss the etiology and mechanisms of corneal neovascularization and other types of ocular surface neovascularization, as well as emerging animal models and drug delivery strategies that facilitate its management.
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Affiliation(s)
- Yunlong Yang
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China.
| | - Junmu Zhong
- Department of Ophthalmology, Longyan First Hospital Affiliated to Fujian Medical University, Longyan 364000, Fujian Province, China
| | - Dongmei Cui
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen 518040, Guangdong Province, China
| | - Lasse D Jensen
- Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine, Unit of Cardiovascular Medicine, Linköping University, Linköping, Sweden.
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Urbańska K, Woźniak M, Więsyk P, Konarska N, Bartos W, Biszewski M, Bielak M, Chorągiewicz T, Rejdak R. Management and Treatment Outcomes of High-Risk Corneal Transplantations. J Clin Med 2022; 11:jcm11195511. [PMID: 36233379 PMCID: PMC9572799 DOI: 10.3390/jcm11195511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 12/01/2022] Open
Abstract
Corneal transplantation is the most effective treatment for corneal blindness. Standard planned keratoplasties have a high success rate. Conditions such as active inflammation at the time of surgery, the presence of ocular surface disease, previous graft disease, or neovascularization make them more susceptible to rejection. These are so-called high-risk corneal transplantations. In our study, we selected 52 patients with a higher risk of graft rejection. A total of 78 procedures were performed. The main indications for the first keratoplasty were infections (59.6%) and traumas (21.2%). Visual acuity (VA) significantly improved from 2.05 logMAR on the day of keratoplasty to 1.66 logMAR in the latest examination (p = 0.003). An analysis of the graft survival showed a 1-year survival of 54% and a 5-year survival of 19.8% of grafts. The mean observation time without complications after the first, second, and third surgery was 23, 13, and 14 months, respectively. The best results were noted among patients with infectious indications for keratoplasty (p = 0.001). Among them, those with bacterial infection had the best visual outcomes (p = 0.047).
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Therapeutic Applications of Adeno-Associated Virus (AAV) Gene Transfer of HLA-G in the Eye. Int J Mol Sci 2022; 23:ijms23073465. [PMID: 35408825 PMCID: PMC8998501 DOI: 10.3390/ijms23073465] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 01/09/2023] Open
Abstract
The purpose of this paper is to review human leukocyte antigen G (HLA-G) in the eye, its role in immune tolerance, and the potential therapeutic use of AAV gene transfer and expression of HLA-G in various ocular tissues. Several studies are reviewed that demonstrate efficacy in animal models of disease, including intracorneal delivery of AAV-HLA-G to treat corneal inflammation and prevent corneal graft rejection, subconjunctival injection of AAV-HLA-G for ocular graft vs. host disease and potentially dry eye disease, and intravitreal injection of AAV-HLA-G to inhibit uveitis. Furthermore, due to the anti-vascular function of HLA-G, AAV-HLA-G may be an effective therapy for posterior ocular diseases, such as neovascular age-related macular degeneration, diabetic retinopathy, and choroidal neovascularization. Therefore, AAV-mediated gene transfer of HLA-G may be an effective treatment for common immune-mediated, inflammatory, and neovascular diseases of the eye.
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Li X, Huang Y, Liang Q, Li G, Feng S, Song Y, Zhang Y, Wang L, Jie Y, Pan Z. Local immunosuppression in WZS-pig to rhesus monkey Descemet's stripping automated endothelial keratoplasty: An innovative method to promote the survival of xeno-grafts. Ophthalmic Res 2021; 65:196-209. [PMID: 34915515 DOI: 10.1159/000521193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 11/20/2021] [Indexed: 11/19/2022]
Abstract
Corneal xenotransplantation is an effective solution for the shortage of human corneas. We investigated the feasibility and efficacy of different postoperative protocols on xeno-Descemet's stripping automated endothelial keratoplasty (DSAEK) grafts. Thirty rhesus monkeys were randomly divided into three groups: control group (C), only Descemet's membrane (DM) stripping; DSAEK 1 (D1) and DSAEK 2 (D2) groups, DM stripping followed by endothelial keratoplasty. Betamethasone 3.5 mg was subconjunctival injected in groups control and D1 postoperatively, while animals in group D2 were treated with topical 0.1% tacrolimus and topical steroids. All groups were evaluated by slit-lamp microscopy, anterior segment OCT and LSCM for at least nine months. A total of 24 monkeys (24 eyes) met the inclusion criteria. Nine months after DSAEK surgery, all xenografts showed good attachment, and most corneas were transparent. Graft rejection occurred in 25% of the cases in group D1 and 28.57% of those in group D2 (P > 0.05). The corneal endothelium density in the DSAEK groups was 2715.83±516.20/mm² (D1) and 2220.00 ± 565.13/mm² (D2) (P > 0.05). Xenogeneic corneal endothelial grafts can survive and function in rhesus monkey eyes for a long time with subconjunctival steroid or topical tacrolimus and steroid treatment.
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Affiliation(s)
- Xu Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ying Huang
- National Center for Safety Evaluation of Drugs (NCSED), Beijing, China
| | - Qingfeng Liang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Guoping Li
- Beijing Grand Life Science and Technology, Ltd. PRC, Beijing, China
| | - Shutang Feng
- Beijing Grand Life Science and Technology, Ltd. PRC, Beijing, China
| | - Yaowen Song
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Yang Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Li Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ying Jie
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Zhiqiang Pan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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Cursiefen C, Hos D. Cutting Edge: Novel Treatment Options Targeting Corneal Neovascularization to Improve High-Risk Corneal Graft Survival. Cornea 2021; 40:1512-1518. [PMID: 34116541 DOI: 10.1097/ico.0000000000002736] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Corneal neovascularization is an important risk factor for graft rejection after keratoplasty, although its role in posterior lamellar keratoplasty is not yet well defined. The aim of this work was to describe clinically available approaches that target corneal neovascularization preoperatively to improve graft survival after subsequent penetrating keratoplasty (PK) and to present findings on Descemet membrane endothelial keratoplasty (DMEK) in eyes with neovascularization. METHODS Recent work on the use of anti-vascular endothelial growth factor agents, fine needle diathermy (FND), and corneal collagen crosslinking (CXL) to regress corneal neovascularization before PK is summarized. Furthermore, studies that have investigated the outcome of DMEK in vascularized eyes are presented. RESULTS Pretreatment of recipient corneas with FND combined with anti-vascular endothelial growth factor agents is an effective method to reduce long-standing corneal neovascularization and results in relatively low rejection rates after subsequent high-risk PK. Peripheral CXL also seems to be a potent method to regress corneal neovascularization, although data on the impact of pretransplant CXL on long-term graft survival are not yet available. There are only limited data on graft rejection rates after DMEK in vascularized eyes, but initial studies indicate that DMEK seems to be a viable therapeutic option when no stromal scars are present. Furthermore, preexisting stromal neovascularization seems to regress after high-risk DMEK. CONCLUSIONS Several angioregressive strategies to treat corneal neovascularization before PK have entered the clinic with promising initial results, which warrants larger trials with longer follow-up. Studies will also have to define the precise role of preexisting corneal neovascularization in high-risk DMEK.
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Affiliation(s)
- Claus Cursiefen
- Department of Ophthalmology, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany ; and
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Deniz Hos
- Department of Ophthalmology, University of Cologne, Faculty of Medicine, University Hospital Cologne, Cologne, Germany ; and
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
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11
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Corneal Crosslinking to Regress Pathologic Corneal Neovascularization Before High-Risk Keratoplasty. Cornea 2021; 40:147-155. [PMID: 33395116 DOI: 10.1097/ico.0000000000002406] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/26/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE Corneal neovascularization is the main risk factor for graft rejection after high-risk penetrating keratoplasty (PK). Corneal crosslinking (CXL) has been shown to regress pathological corneal blood and lymphatic vessels and to reduce the risk of graft rejection after high-risk PK experimentally in mice. The aim of this work was to analyze whether CXL is also able to regress corneal neovascularization in patients and is a safe procedure in the context of high-risk PK. METHODS This retrospective case series included 5 patients with progressive corneal neovascularization and the need for high-risk PK because of graft rejection and/or keratitis that received CXL and PK between April 2019 and January 2020. CXL was performed before or in combination with PK and the effect of CXL on corneal neovascularization was assessed morphometrically on slit-lamp images. Patients were followed up to determine the incidence of adverse effects and graft rejection. RESULTS In 1 case, peripheral corneal CXL was performed first as a single procedure, followed by an additional peripheral CXL procedure combined with PK. In all other cases, peripheral CXL was directly combined with PK. No intraoperative or postoperative complications were observed. Peripheral CXL resulted in a reduction of corneal neovascularization (mean reduction of 70.5% ± 22.7%). Revascularization was not observed. All transplants remained clear and without immune reactions (mean follow-up 16.4 ± 14.9 weeks, range 4-42 weeks). CONCLUSIONS CXL is able to reduce pathological corneal neovascularization and might therefore be a novel treatment option to improve graft survival after high-risk PK.
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12
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Liu Y, Zhu R, Jin X, Wang Y, Shi Y, Zhang N, Wang J, Dong Y, Zhang H. Activation of Conjunctiva-Associated Lymphoid Tissue in Patients With Infectious Keratitis Using In Vivo Confocal Microscopy. Invest Ophthalmol Vis Sci 2021; 62:27. [PMID: 34427624 PMCID: PMC8399476 DOI: 10.1167/iovs.62.10.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose We aimed to evaluate activation of conjunctiva-associated lymphoid tissue (CALT) in patients with keratitis using in vivo confocal microscopy (IVCM) and conjunctival impression cytology (CIC). Methods In addition to anterior segment photography and corneal fluorescein staining, IVCM revealed the palpebral conjunctiva in all subjects, and CIC and immunofluorescence staining were performed. Results Diffuse lymphoid tissue cell density in the eyes of patients with keratitis was significantly greater compared with healthy volunteers (P < 0.001). Similar trends were found in perifollicular lymphocyte density (P < 0.001), follicular density (P = 0.029), follicular center reflection intensity (P = 0.011), and follicular area (P < 0.001). Immunofluorescence staining showed that the proportions of CD4+ (61.7% ± 8.0% vs. 17.3% ± 10.2%, respectively, P < 0.001) and CD8+ (46.9% ± 10.0% vs. 19.6% ± 11.5%, respectively, P < 0.001) cells in patients with keratitis was greater compared with healthy volunteers. Interestingly, we also observed changes in the contralateral eye in subjects with keratitis. Conclusions Our research suggests that CALT, as an ocular immune structure, is activated and plays an important role in the pathogenesis of keratitis. This has been overlooked previously. CALT is also active in the contralateral eye of subjects with keratitis.
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Affiliation(s)
- Yuting Liu
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, Harbin, China.,Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Heilongjiang Province, Harbin, China
| | - Rui Zhu
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, Harbin, China.,Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Heilongjiang Province, Harbin, China
| | - Xin Jin
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, Harbin, China.,Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Heilongjiang Province, Harbin, China
| | - Yingbin Wang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, Harbin, China.,Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Heilongjiang Province, Harbin, China
| | - Yan Shi
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, Harbin, China.,Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Heilongjiang Province, Harbin, China
| | - Nan Zhang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, Harbin, China
| | - Jingrao Wang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, Harbin, China.,Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Heilongjiang Province, Harbin, China
| | - Yueyan Dong
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, Harbin, China.,Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Heilongjiang Province, Harbin, China
| | - Hong Zhang
- Eye Hospital, The First Affiliated Hospital of Harbin Medical University, Harbin City, Nangang District, Heilongjiang Province, Harbin, China.,Key Laboratory of Basic and Clinical Research of Heilongjiang Province, Heilongjiang Province, Harbin, China
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13
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Niederkorn JY. "Corneal Nerves, CD11c + Dendritic Cells and Their Impact on Ocular Immune Privilege". Front Immunol 2021; 12:701935. [PMID: 34220866 PMCID: PMC8253307 DOI: 10.3389/fimmu.2021.701935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/19/2021] [Indexed: 11/19/2022] Open
Abstract
The eye and the brain have limited capacities for regeneration and as such, immune-mediated inflammation can produce devastating consequences in the form of neurodegenerative diseases of the central nervous system or blindness as a result of ocular inflammatory diseases such as uveitis. Accordingly, both the eye and the brain are designed to limit immune responses and inflammation - a condition known as "immune privilege". Immune privilege is sustained by physiological, anatomical, and regulatory processes that conspire to restrict both adaptive and innate immune responses.
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Affiliation(s)
- Jerry Y. Niederkorn
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, United States
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14
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Zhu J, Inomata T, Fujimoto K, Uchida K, Fujio K, Nagino K, Miura M, Negishi N, Okumura Y, Akasaki Y, Hirosawa K, Kuwahara M, Eguchi A, Shokirova H, Yanagawa A, Midorikawa-Inomata A, Murakami A. Ex Vivo-Induced Bone Marrow-Derived Myeloid Suppressor Cells Prevent Corneal Allograft Rejection in Mice. Invest Ophthalmol Vis Sci 2021; 62:3. [PMID: 34061951 PMCID: PMC8185403 DOI: 10.1167/iovs.62.7.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 05/02/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose To investigate the effects of ex vivo-induced bone marrow myeloid-derived suppressor cells (BM-MDSCs) on allogeneic immune responses in corneal transplantation. Methods Bone marrow cells from C57BL/6J (B6) mice were cultured with IL-6 and GM-CSF for four days. The ex vivo induction of the BM-MDSCs was assessed using flow cytometry, inducible nitric oxide synthase (iNOS) mRNA expression using reverse transcription-quantitative polymerase chain reaction, and nitric oxide (NO) production in allogeneic stimulation. T-cell proliferation and regulatory T-cell (Treg) expansion were investigated on allogeneic stimulation in the presence of ex vivo-induced BM-MDSCs. IFN-γ, IL-2, IL-10, and TGF-β1 protein levels were measured using enzyme-linked immunosorbent assays. After subconjunctival injection of ex vivo-induced BM-MDSCs, the migration of the BM-MDSCs into corneal grafts, allogeneic corneal graft survival, neovascularization, and lymphangiogenesis were assessed using flow cytometry, slit-lamp microscopy, and immunohistochemistry. Results The combination of GM-CSF and IL-6 significantly induced BM-MDSCs with increased iNos mRNA expression. The ex vivo-induced BM-MDSCs promoted NO release in allogeneic stimulation in vitro. The ex vivo-induced BM-MDSCs inhibited T-cell proliferation and promoted Treg expansion. Decreased IFN-γ and increased IL-2, IL-10, and TGF-β1 production was observed in coculture of ex vivo-induced BM-MDSCs. Injected ex vivo-induced BM-MDSCs were confirmed to migrate into the grafts. The injected BM-MDSCs also prolonged corneal graft survival and prevented angiogenesis and lymphangiogenesis. Conclusions The ex vivo-induced BM-MDSCs have suppressive effects on allogeneic immune responses and prolong corneal allograft survival via the iNOS pathway, indicating that they may be a potential therapeutic tool for corneal transplantation.
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Affiliation(s)
- Jun Zhu
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Ophthalmology, Subei People's Hospital Affiliated to Yangzhou University, Jiangsu Province, China
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takenori Inomata
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Strategic Operating Room Management and Improvement, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Keiichi Fujimoto
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koichiro Uchida
- Atopy Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kenta Fujio
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ken Nagino
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Maria Miura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Naoko Negishi
- Atopy Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Indoor Environment Neurophysiology Research, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuichi Okumura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Strategic Operating Room Management and Improvement, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasutsugu Akasaki
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kunihiko Hirosawa
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mizu Kuwahara
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsuko Eguchi
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hurramhon Shokirova
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ai Yanagawa
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akie Midorikawa-Inomata
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Ophthalmology, Juntendo University Faculty of Medicine, Tokyo, Japan
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
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15
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Collagen analogs with phosphorylcholine are inflammation-suppressing scaffolds for corneal regeneration from alkali burns in mini-pigs. Commun Biol 2021; 4:608. [PMID: 34021240 PMCID: PMC8140136 DOI: 10.1038/s42003-021-02108-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 03/16/2021] [Indexed: 12/11/2022] Open
Abstract
The long-term survival of biomaterial implants is often hampered by surgery-induced inflammation that can lead to graft failure. Considering that most corneas receiving grafts are either pathological or inflamed before implantation, the risk of rejection is heightened. Here, we show that bioengineered, fully synthetic, and robust corneal implants can be manufactured from a collagen analog (collagen-like peptide-polyethylene glycol hybrid, CLP-PEG) and inflammation-suppressing polymeric 2-methacryloyloxyethyl phosphorylcholine (MPC) when stabilized with the triazine-based crosslinker 4-(4,6-Dimethoxy-1,3,5-triazin-2-yl)-4-methylmorpholinium chloride. The resulting CLP-PEG-MPC implants led to reduced corneal swelling, haze, and neovascularization in comparison to CLP-PEG only implants when grafted into a mini-pig cornea alkali burn model of inflammation over 12 months. Implants incorporating MPC allowed for faster nerve regeneration and recovery of corneal sensation. CLP-PEG-MPC implants appear to be at a more advanced stage of regeneration than the CLP-PEG only implants, as evidenced by the presence of higher amounts of cornea-specific type V collagen, and a corresponding decrease in the presence of extracellular vesicles and exosomes in the corneal stroma, in keeping with the amounts present in healthy, unoperated corneas.
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16
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Hadrian K, Willenborg S, Bock F, Cursiefen C, Eming SA, Hos D. Macrophage-Mediated Tissue Vascularization: Similarities and Differences Between Cornea and Skin. Front Immunol 2021; 12:667830. [PMID: 33897716 PMCID: PMC8058454 DOI: 10.3389/fimmu.2021.667830] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/19/2021] [Indexed: 12/16/2022] Open
Abstract
Macrophages are critical mediators of tissue vascularization both in health and disease. In multiple tissues, macrophages have been identified as important regulators of both blood and lymphatic vessel growth, specifically following tissue injury and in pathological inflammatory responses. In development, macrophages have also been implicated in limiting vascular growth. Hence, macrophages provide an important therapeutic target to modulate tissue vascularization in the clinic. However, the molecular mechanisms how macrophages mediate tissue vascularization are still not entirely resolved. Furthermore, mechanisms might also vary among different tissues. Here we review the role of macrophages in tissue vascularization with a focus on their role in blood and lymphatic vessel formation in the barrier tissues cornea and skin. Comparing mechanisms of macrophage-mediated hem- and lymphangiogenesis in the angiogenically privileged cornea and the physiologically vascularized skin provides an opportunity to highlight similarities but also tissue-specific differences, and to understand how macrophage-mediated hem- and lymphangiogenesis can be exploited for the treatment of disease, including corneal wound healing after injury, graft rejection after corneal transplantation or pathological vascularization of the skin.
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Affiliation(s)
- Karina Hadrian
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Felix Bock
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Sabine A Eming
- Department of Dermatology, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Developmental Biology Unit, Institute of Zoology, University of Cologne, Cologne, Germany
| | - Deniz Hos
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
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17
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Sanjuán P, Julio G, Bolaños J, Álvarez de Toledo J, García de Oteyza G, Temprano J, Barraquer RI. Long-term anatomical and functional outcomes after autokeratoplasty. Br J Ophthalmol 2020; 105:1063-1068. [PMID: 32829305 DOI: 10.1136/bjophthalmol-2020-316289] [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: 03/12/2020] [Revised: 06/29/2020] [Accepted: 07/27/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND To evaluate the anatomical and functional outcomes of autologous contralateral penetrating keratoplasty (autokeratoplasty). METHODS Kaplan-Meier survival analyses were retrospectively performed. Anatomical failure was defined as regraft or graft permanently cloudy at any time during follow-up. Functional failure was defined as the final best-corrected visual acuity (BCVA) <20/400. RESULTS Thirty-one eyes of 31 patients (19 men), with a mean age of 52±18 years (range 15-81 years) were studied during a mean follow-up of 11.3 years (from 13 months to 48 years). At 12 months postoperatively, all the recipient eyes showed a transparent cornea, but 23% showed functional failure. At the final followup, 16 recipient eyes (52%) showed anatomical and functional success. Twenty-three eyes (74%) showed a clear cornea and 68% reached a better BCVA when compared with preoperative measurements. Nevertheless, 13/31 eyes (42%) displayed functional failure. The accumulative probabilities for anatomical success were 100%, 72% and 48% and 77%, 59% and 29% for functional success at 1, 10 and 40 years, respectively. The most common risk factor for failure was progression of previous glaucoma in 50% of the anatomical failures and in 77% of the functional failures. CONCLUSIONS Autokeratoplasty could be a successful long-term option in patients having one eye with a clear cornea but with irreversible visual dysfunction and the contralateral eye having favourable visual potential limited only by a completely opacified cornea. Progression of previous glaucoma was the most important risk factor for long-term cornea decompensation and visual functional failure in the sample.
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Affiliation(s)
| | - Gemma Julio
- Centro De Oftalmología Barraquer, Barcelona, Spain
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18
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Neelam S, Niederkorn JY. Corneal Nerve Ablation Abolishes Ocular Immune Privilege by Downregulating CD103 on T Regulatory Cells. Invest Ophthalmol Vis Sci 2020; 61:25. [PMID: 32305043 PMCID: PMC7401639 DOI: 10.1167/iovs.61.4.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/28/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Severing corneal nerves during orthotopic corneal transplantation elicits the elaboration of the neuropeptide substance P (SP), which induces the generation of CD11c+ contrasuppressor (CS) cells. CS cells disable T regulatory cells (Tregs) that are induced when antigens enter the anterior chamber (AC), either by direct injection or by orthotopic corneal transplantation. This study examined the crucial cell surface molecules on Tregs that are adversely affected by CS cells that are generated by severing corneal nerves. Methods CS cells were induced by producing shallow 2.0-mm circular incisions in the corneal epithelium in BALB/c mice. CD8+ Tregs were generated by injecting ovalbumin into the AC. The effects of CS cells and SP on the expression and function of two cell surface molecules (CD103 and the receptor of interferon-γ) that are crucial for the induction and function of CD8+ Tregs were analyzed. Results SP converted CD11c+, but not CD11c- , dendritic cells (DCs) to CS cells. Severing corneal nerves resulted in a 66% reduction in the expression of CD103 on CD8+ AC-associated immune deviation (ACAID) Tregs, and a 50% reduction in the interferon-γ receptor (IFN-γR). These effects could be mimicked in vitro by coculturing CS cells with CD8+ ACAID Tregs. Conclusions The elaboration of SP in response to corneal nerve ablation converts CD11c+ DCs to CS cells. CS cells disable CD8+ ACAID Tregs by downregulating two crucial cell surface molecules, CD103 and IFN-γR, by an SP-dependent pathway. Blocking this pathway may provide a means of restoring ocular immune privilege in corneas subjected to corneal nerve injury.
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Affiliation(s)
- Sudha Neelam
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Jerry Y. Niederkorn
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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19
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Vanathi M, Shukla R, Balakrishnan P, Dwivedi R, Gupta N, Tandon R. Evaluation of thrombospondin-1 gene polymorphisms in corneal allograft rejection in Asian Indian patients. Indian J Ophthalmol 2020; 68:565-572. [PMID: 32174570 PMCID: PMC7210848 DOI: 10.4103/ijo.ijo_552_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: To evaluate the frequency and the association of Thrombospondin 1 (THBS1) gene single nucleotide polymorphisms (SNPs) in Asian Indian patients with optical full thickness corneal grafting surgery. Methods: Prospective case–control analysis of optical penetrating keratoplasty patients with and without immune rejection and controls for genotyping of 3 THBS1 gene SNPs (rs1478604 A>G; rs2228261 C>T; rs2228262 A>G) by Amplification Refractory Mutation System-Polymerase Chain Reaction (ARMS PCR). Results: Among 58 patients [45 with immune allograft rejection (DNA isolation was possible in 38 samples) and 13 without immune corneal allograft rejection] and 65 controls, allele frequencies observed for rs1478604 (A>G) are A: 69.7% and 72.6%, G: 30.2% and 27.3%; for rs2228261 (C>T) are T: 70.2% and 62.3%, C: 29.7% and 37.6%; and for rs2228262 (A>G) A: 97.4% and 98.4%; G 2.5% and 1.5% respectively. Genotype frequencies were rs1478604 (A>G) AA: 57.8% and 59.3%, AG 23.6% and 26.5%; GG 18.4% and 14%; for rs2228261 (C>T) TT: 40.5% and 33.8%, TC: 59% and 56.9%, CC: 0% and 9.2%; for rs2228262 (A>G) AA: 94.8% and 96.8%, AG: 5.1% and 3.1% in rejection and controls respectively. The allele and genotype frequency for the 3 described THSB1 SNPs did not show any difference between the corneal graft immune rejection patients and controls. Conclusion: Asian Indian population evaluated for THBS1 gene SNPs by ARMS PCR genotyping in Asian Indian population did not show any genetic association to immune rejection occurrence in our study.
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Affiliation(s)
- Murugesan Vanathi
- Cornea, Ocular Surface, Cataract and Refractive Services, Dr R P Centre for Ophthalmic Sciences, New Delhi, India
| | - Rashmi Shukla
- Department of Pediatric Genetics, All India Institute of Medical Sciences, New Delhi, India
| | - Prahlad Balakrishnan
- Department of Pediatric Genetics, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Dwivedi
- Cornea, Ocular Surface, Cataract and Refractive Services, Dr R P Centre for Ophthalmic Sciences, New Delhi, India
| | - Noopur Gupta
- Cornea, Ocular Surface, Cataract and Refractive Services, Dr R P Centre for Ophthalmic Sciences, New Delhi, India
| | - Radhika Tandon
- Cornea, Ocular Surface, Cataract and Refractive Services, Dr R P Centre for Ophthalmic Sciences, New Delhi, India
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20
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Riau AK, Liu YC, Yam GH, Mehta JS. Stromal keratophakia: Corneal inlay implantation. Prog Retin Eye Res 2020; 75:100780. [DOI: 10.1016/j.preteyeres.2019.100780] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/28/2019] [Accepted: 09/02/2019] [Indexed: 12/31/2022]
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21
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Niederkorn JY. The Eye Sees Eye to Eye With the Immune System: The 2019 Proctor Lecture. Invest Ophthalmol Vis Sci 2019; 60:4489-4495. [PMID: 31661549 PMCID: PMC6819053 DOI: 10.1167/iovs.19-28632] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Jerry Y. Niederkorn
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
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22
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Salabarria AC, Braun G, Heykants M, Koch M, Reuten R, Mahabir E, Cursiefen C, Bock F. Local VEGF-A blockade modulates the microenvironment of the corneal graft bed. Am J Transplant 2019; 19:2446-2456. [PMID: 30821887 DOI: 10.1111/ajt.15331] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/14/2019] [Accepted: 02/16/2019] [Indexed: 01/25/2023]
Abstract
The microenvironment plays an important role in several immunological processes. Vascular endothelial growth factor-A (VEGF-A) not only regulates angiogenesis, but is known as a modulator of the immune microenvironment. Modulating the site of transplantation might be beneficial for subsequent transplant survival. In this study, we therefore analyzed the effect that a local blockade of VEGF-A in the inflamed cornea as the graft receiving tissue has on the immune system. We used the murine model of suture-induced neovascularization and subsequent high-risk corneal transplantation, which is an optimal model for local drug application. Mice were treated with VEGFR1/R2 trap prior to transplantation. We analyzed corneal gene expression, as well as protein levels in the cornea and serum on the day of transplantation, 2 and 8 weeks later. Local VEGF depletion prior to transplantation increases the expression of pro-inflammatory as well as immune regulatory cytokines only in the corneal microenvironment, but not in the serum. Furthermore, local VEGFR1/R2 trap treatment significantly inhibits the infiltration of CD11c+ dendritic cells into the cornea. Subsequent increased corneal transplantation success was accompanied by a local upregulation of Foxp3 gene expression. This study demonstrates that locally restricted VEGF depletion increases transplantation success by modulating the receiving corneal microenvironment and inducing tolerogenic mechanisms.
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Affiliation(s)
| | - Gabriele Braun
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - Malte Heykants
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Manuel Koch
- Institute for Dental Research and Oral Musculoskeletal Biology and Center for Biochemistry, University of Cologne, Cologne, Germany
| | - Raphael Reuten
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Esther Mahabir
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Felix Bock
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
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23
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Hori J, Yamaguchi T, Keino H, Hamrah P, Maruyama K. Immune privilege in corneal transplantation. Prog Retin Eye Res 2019; 72:100758. [PMID: 31014973 DOI: 10.1016/j.preteyeres.2019.04.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 12/13/2022]
Abstract
Corneal transplantation is the most successful solid organ transplantation performed in humans. The extraordinary success of orthotopic corneal allografts, in both humans and experimental animals, is related to the phenomenon of "immune privilege". Inflammation is self-regulated to preserve ocular functions because the eye has immune privilege. At present, three major mechanisms are considered to provide immune privilege in corneal transplantation: 1) anatomical, cellular, and molecular barriers in the cornea; 2) tolerance related to anterior chamber-associated immune deviation and regulatory T cells; and 3) an immunosuppressive intraocular microenvironment. This review describes the mechanisms of immune privilege that have been elucidated from animal models of ocular inflammation, especially those involving corneal transplantation, and its relevance for the clinic. An update on molecular, cellular, and neural interactions in local and systemic immune regulation is provided. Therapeutic strategies for restoring immune privilege are also discussed.
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Affiliation(s)
- Junko Hori
- Department of Ophthalmology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan; Department of Ophthalmology, Nippon Medical School, Tama-Nagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo, 206-8512, Japan.
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba, 272-8513, Japan; Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Keino
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Pedram Hamrah
- Center for Translational Ocular Immunology, Tufts Medical Center, Tufts University School of Medicine, Tufts University, 800 Washington St, Boston, MA, 02111, USA; Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Tufts University, 800 Washington St, Boston, MA, 02111, USA
| | - Kazuichi Maruyama
- Department of Innovative Visual Science, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Wang H, Zhao Q, Luo D, Yin Y, Li T, Zhao M. Resolvin E1 Inhibits Corneal Allograft Rejection in High-Risk Corneal Transplantation. Invest Ophthalmol Vis Sci 2019; 59:3911-3919. [PMID: 30073362 DOI: 10.1167/iovs.18-24562] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the effects of Resolvin E1 (RvE1) on corneal allograft rejection in a high -risk corneal allograft transplantation model. Methods High-risk corneal beds were created via placement of intrastromal sutures in the corneas of BALB/c mice for 2 weeks. Allogeneic corneal transplantation was performed by transplanting corneas of C57BL/6 mice onto BALB/c hosts. RvE1 or normal saline (control) was subconjunctivally injected. Allograft survival was observed by slit lamp biomicroscope, and inflammatory cell infiltration was detected by hematoxylin and eosin and immunohistochemistry. The percentage of Th1, Th17, and Treg cells in draining lymph nodes (DLNs) were evaluated by flow cytometric analysis. The levels of Th1, Th2, and Th17-associated cytokines in the grafts were measured by cytometric bead array and real-time PCR. Results RvE1 treatment significantly improved allograft survival compared to the control group. After RvE1 treatment, the infiltration of neutrophils and CD4+ T (Th1/Th17) cells were decreased in corneal grafts, and the percentage of Th1/Th17 cells in DLNs were reduced. In addition, RvE1 treatment significantly reduced the mRNA expression of proinflammatory cytokines in the graft including IL-1α, IL-1β, TNF-α, IL-2, IL-6, IFN-γ, IL-17A, IL-17F, IL-21, and IL-22 as well as the protein level of the proinflammatory cytokines, including IL-2, TNF, IL-6, IFN-γ, and IL-17. However, RvE1 treatment did not alter the percentage of Treg cells in DLNs and the expression of IL-4, IL-5, and IL-10. Conclusions RvE1 treatment improves allogeneic corneal graft survival in a high-risk corneal transplantation model via inhibiting the Th1/Th17-related inflammation.
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Affiliation(s)
- Han Wang
- Department of Ophthalmology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Qingqing Zhao
- Department of Ophthalmology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Luo
- Department of Ophthalmology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Yizhou Yin
- Department of Ophthalmology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Ting Li
- Department of Ophthalmology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, China
| | - Min Zhao
- Department of Ophthalmology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing, China
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Jiang L, Liu T, Xie L, Ouyang C, Ji J, Huang T. AICAR prolongs corneal allograft survival via the AMPK-mTOR signaling pathway in mice. Biomed Pharmacother 2019; 113:108558. [PMID: 30856534 DOI: 10.1016/j.biopha.2019.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/06/2019] [Accepted: 01/06/2019] [Indexed: 12/11/2022] Open
Abstract
Immune rejection is a critical complication that results in the graft failure after corneal transplantation. Thus, there remains a need for new therapies for allograft rejection. AICAR (aminoimidazole-4-carboxamide ribonucleoside) is an, as adenosine monophosphate-activated protein kinase (AMPK) activator and a purine nucleoside with a wide range of metabolic effects, including activation of AMPK. More recently, it was reported that it is possible to inhibiting organs rejection and prolong the graft survival time in various models of organ transplantation. In this study, we systematically evaluated the efficacy of AICAR as a treatment modality for inhibiting allograft rejection in a mouse model of corneal transplantation. We found that AICAR significantly suppressed the opacity, edema, and vascularization of the graft, resulting in prolonged corneal allograft survival. AICAR treatment also significantly decreased central corneal thickness. Moreover, the AICAR-treated group showed decreased expression of IB4 and VEGF as compared to the control group. In addition, the mRNA expression of T helper 1 cytokines (IL-2, INF-γ, and TNF-α) was suppressed, and the expression of T helper 2 cytokines (IL-4, IL-5, and IL-13) was elevated by AICAR. Furthermore, the western blotting results revealed that AICAR stimulated AMPK activation and inhibited angiogenesis and inflammation possibly by subsequently suppressing mTOR phosphorylation. By contrast, the AMPK inhibitor Compound C (also called dorsomorphin) had the opposite effect. Our results showed that Compound C blocked AMPK-mTOR signaling and promoted the angiogenesis and inflammation, thus compromising the graft survival. These results suggest that AICAR may be a potential option for inhibiting the corneal graft rejection and for prolonging the graft survival.
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Affiliation(s)
- Li Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, PR China
| | - Tingting Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, PR China
| | - Lijie Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, PR China
| | - Chen Ouyang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, PR China
| | - Jianping Ji
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, PR China
| | - Ting Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, PR China.
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26
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Majumdar S, Wang X, Sommerfeld SD, Chae JJ, Athanasopoulou EN, Shores LS, Duan X, Amzel LM, Stellacci F, Schein O, Guo Q, Singh A, Elisseeff JH. Cyclodextrin Modulated Type I Collagen Self-Assembly to Engineer Biomimetic Cornea Implants. ADVANCED FUNCTIONAL MATERIALS 2018; 28:1804076. [PMID: 34531709 PMCID: PMC8442673 DOI: 10.1002/adfm.201804076] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Indexed: 05/24/2023]
Abstract
Collagen-rich tissues in the cornea exhibit unique and highly organized extracellular matrix ultrastructures, which contribute to its high load-bearing capacity and light transmittance. Corneal collagen fibrils are controlled during development by small leucine-rich proteoglycans (SLRPs) that regulate the fibril diameter and spacing in order to achieve the unique optical transparency. Cyclodextrins (CDs) of varying size and chemical functionality for their ability to regulate collagen assembly during vitrification process are screened in order to create biosynthetic materials that mimic the native cornea structure. Addition of βCD to collagen vitrigels produces materials with aligned fibers and lamellae similar to native cornea, resulting in mechanically robust and transparent materials. Biochemistry analysis revealed that CD interacts with hydrophobic amino acids in collagen to influence assembly and fibril organization. To translate the self-assembled collagen materials for cornea reconstruction, custom molds for gelation and vitrification are engineered to create βCD/Col implants with curvature matching that of the cornea. Acellular βCD/Col materials are implanted in a rabbit partial keratoplasty model with interrupted sutures. The implants demonstrate tissue integration and support re-epithelialization. Therefore, the addition of CD molecules regulates collagen self-assembly and provides a simple process to engineer corneal mimetic substitutes with advanced structural and functional properties.
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Affiliation(s)
- Shoumyo Majumdar
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Xiaokun Wang
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Sven D Sommerfeld
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Jemin Jeremy Chae
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Evangelia-Nefeli Athanasopoulou
- Supramolecular Nanomaterials and Interfaces Laboratory, École Polytechnique Fédérale de Lausanne, Lausanne 1015, Switzerland
| | - Lucas S Shores
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | | | - L Mario Amzel
- Department of Biophysics and Biophysical Chemistry, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Francesco Stellacci
- Supramolecular Nanomaterials and Interfaces Laboratory, École Polytechnique Fédérale de Lausanne, Lausanne 1015, Switzerland
| | - Oliver Schein
- Wilmer Eye Institute, Johns Hopkins School of Medicine Baltimore, MD 21231, USA
| | - Qiongyu Guo
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Anirudha Singh
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Jennifer H Elisseeff
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD 21231, USA
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27
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Ang M, Baskaran M, Werkmeister RM, Chua J, Schmidl D, Aranha dos Santos V, Garhöfer G, Mehta JS, Schmetterer L. Anterior segment optical coherence tomography. Prog Retin Eye Res 2018; 66:132-156. [DOI: 10.1016/j.preteyeres.2018.04.002] [Citation(s) in RCA: 216] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/20/2018] [Accepted: 04/04/2018] [Indexed: 02/03/2023]
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28
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Stanzel TP, Devarajan K, Lwin NC, Yam GH, Schmetterer L, Mehta JS, Ang M. Comparison of Optical Coherence Tomography Angiography to Indocyanine Green Angiography and Slit Lamp Photography for Corneal Vascularization in an Animal Model. Sci Rep 2018; 8:11493. [PMID: 30065317 PMCID: PMC6068177 DOI: 10.1038/s41598-018-29752-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 06/26/2018] [Indexed: 11/09/2022] Open
Abstract
Corneal neovascularization (CoNV) could be treated by novel anti-angiogenic therapies, though reliable and objective imaging tools to evaluate corneal vasculature and treatment efficacy is still lacking. Optical coherence tomography angiography (OCTA) -currently designed as a retinal vascular imaging system- has been recently adapted for anterior-segment and showed good potential for successful imaging of CoNV. However, further development requires an animal model where parameters can be studied more carefully with histological comparison. Our study evaluated the OCTA in suture-induced CoNV in a rabbit model compared to indocyanine green angiography (ICGA) and slit-lamp photography (SLP). Overall vessel density measurements from OCTA showed good correlation with ICGA (0.957) and SLP (0.992). Vessels density by OCTA was higher than ICGA and SLP (mean = 20.77 ± 9.8%, 15.71 ± 6.28% and 17.55 ± 8.36%, respectively, P < 0.05). OCTA was able to depict CoNV similarly to SLP and ICGA, though it could better detect small vessels. Moreover, the depth and growth of vessels could be assessed using en-face and serial-scans. This study validated the OCTA in a rabbit model as a useful imaging tool for translational studies on CoNV. This may contribute to further studies on OCTA for anterior-segment including serial evaluation of emerging anti-angiogenic therapies.
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Affiliation(s)
- Tisha P Stanzel
- Singapore Eye Research Institute, 169856, Singapore, Singapore
| | - Kavya Devarajan
- Singapore Eye Research Institute, 169856, Singapore, Singapore
| | - Nyein C Lwin
- Singapore Eye Research Institute, 169856, Singapore, Singapore
| | - Gary H Yam
- Singapore Eye Research Institute, 169856, Singapore, Singapore
- Eye-ACP, Duke-NUS Graduate Medical School, 169857, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, 169856, Singapore, Singapore
- Eye-ACP, Duke-NUS Graduate Medical School, 169857, Singapore, Singapore
- Nanyang Technological University, 639798, Singapore, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, 1090, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090, Vienna, Austria
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, 169856, Singapore, Singapore
- Eye-ACP, Duke-NUS Graduate Medical School, 169857, Singapore, Singapore
- Nanyang Technological University, 639798, Singapore, Singapore
- Singapore National Eye Center, 168751, Singapore, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, 169856, Singapore, Singapore.
- Eye-ACP, Duke-NUS Graduate Medical School, 169857, Singapore, Singapore.
- Singapore National Eye Center, 168751, Singapore, Singapore.
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29
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Immune Privilege and Eye-Derived T-Regulatory Cells. J Immunol Res 2018; 2018:1679197. [PMID: 29888291 PMCID: PMC5985108 DOI: 10.1155/2018/1679197] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/18/2018] [Indexed: 02/08/2023] Open
Abstract
Certain cellular components of the eye, such as neural retina, are unable to regenerate and replicate after destructive inflammation. Ocular immune privilege provides the eye with immune protection against intraocular inflammation in order to minimize the risk to vision integrity. The eye and immune system use strategies to maintain the ocular immune privilege by regulating the innate and adaptive immune response, which includes immunological ignorance, peripheral tolerance to eye-derived antigens, and intraocular immunosuppressive microenvironment. In this review, we summarize current knowledge regarding the molecular mechanism responsible for the development and maintenance of ocular immune privilege via regulatory T cells (Tregs), which are generated by the anterior chamber-associated immune deviation (ACAID), and ocular resident cells including corneal endothelial (CE) cells, ocular pigment epithelial (PE) cells, and aqueous humor. Furthermore, we examined the therapeutic potential of Tregs generated by RPE cells that express transforming growth factor beta (TGF-β), cytotoxic T lymphocyte-associated antigen-2 alpha (CTLA-2α), and retinoic acid for autoimmune uveoretinitis and evaluated a new strategy using human RPE-induced Tregs for clinical application in inflammatory ocular disease. We believe that a better understanding of the ocular immune privilege associated with Tregs might offer a new approach with regard to therapeutic interventions for ocular autoimmunity.
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30
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Zhong W, Montana M, Santosa SM, Isjwara ID, Huang YH, Han KY, O'Neil C, Wang A, Cortina MS, de la Cruz J, Zhou Q, Rosenblatt MI, Chang JH, Azar DT. Angiogenesis and lymphangiogenesis in corneal transplantation-A review. Surv Ophthalmol 2017; 63:453-479. [PMID: 29287709 DOI: 10.1016/j.survophthal.2017.12.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/12/2017] [Accepted: 12/18/2017] [Indexed: 12/13/2022]
Abstract
Corneal transplantation has been proven effective for returning the gift of sight to those affected by corneal disorders such as opacity, injury, and infections that are a leading cause of blindness. Immune privilege plays an important role in the success of corneal transplantation procedures; however, immune rejection reactions do occur, and they, in conjunction with a shortage of corneal donor tissue, continue to pose major challenges. Corneal immune privilege is important to the success of corneal transplantation and closely related to the avascular nature of the cornea. Corneal avascularity may be disrupted by the processes of angiogenesis and lymphangiogenesis, and for this reason, these phenomena have been a focus of research in recent years. Through this research, therapies addressing certain rejection reactions related to angiogenesis have been developed and implemented. Corneal donor tissue shortages also have been addressed by the development of new materials to replace the human donor cornea. These advancements, along with other improvements in the corneal transplantation procedure, have contributed to an improved success rate for corneal transplantation. We summarize recent developments and improvements in corneal transplantation, including the current understanding of angiogenesis mechanisms, the anti-angiogenic and anti-lymphangiogenic factors identified to date, and the new materials being used. Additionally, we discuss future directions for research in corneal transplantation.
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Affiliation(s)
- Wei Zhong
- Department of Ophthalmology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, P.R. China; Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mario Montana
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Samuel M Santosa
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Irene D Isjwara
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Yu-Hui Huang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kyu-Yeon Han
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Christopher O'Neil
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ashley Wang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria Soledad Cortina
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jose de la Cruz
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Qiang Zhou
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mark I Rosenblatt
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jin-Hong Chang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
| | - Dimitri T Azar
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
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Cho YK, Shin EY, Uehara H, Ambati BK. Effect of sorafenib in a murine high risk penetrating keratoplasty model. Int J Ophthalmol 2017; 10:834-839. [PMID: 28730071 DOI: 10.18240/ijo.2017.06.02] [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: 11/12/2016] [Accepted: 03/25/2017] [Indexed: 01/26/2023] Open
Abstract
AIM To evaluate the effect of sorafenib in murine high risk keratoplasty model. METHODS Graft survival, corneal neovascularization, and corneal lymphangiogenesis were compared among the sorafenib, dexamethasone, dimethyl sulfoxide (DMSO), and phosphate buffered saline (PBS) groups following subconjunctival injection in mice that underwent high risk penetrating keratoplasty (HRPK). Real-time polymerase chain reaction was performed to quantify the expression of inflammatory cytokines and vascular endothelial growth factor (VEGF)-A, VEGF-C, vascular endothelial growth factor receptor (VEGFR)-2, VEGFR-3. RESULTS The two-month graft survival rate for HRPK was 42.86% in sorafenib group, 37.50% in dexamethasone group, 0 in DMSO group, and 0 in PBS group. Sorafenib significantly increased graft survival compared to the DMSO and PBS group (P<0.05). The sorafenib didn't show significant effect in decreasing neovascularization compared with dexamethsone, DMSO, and PBS group. The sorafenib showed less total lymphangiogenesis than the dexamethasone, DMSO, and PBS group (P=0.011, P<0.001, P<0.001, respectively). The sorafenib group showed reduced expression of VEGF-C, tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, VEGFR-2 and VEGFR-3 compared with DMSO group and PBS group (all P<0.05). The sorafenib group didn't show difference in the expression of VEGF-A compared with DMSO, neither with PBS. The sorafenib group showed reduced expression of VEGFR-3 compared with dexamethasone (P=0.051). CONCLUSION The subconjunctivally administered sorafenib shows significant anti-lymphangiogenic effect, resulting in increased transplant survival in a murine high risk keratoplasty model. We suggest that a close linkage between decreased VEGF-C/VEGFR-2 and -3 signaling and increased corneal graft survival by sorafenib seems to exist.
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Affiliation(s)
- Yang Kyung Cho
- Department of Ophthalmology, St.Vincent's Hospital, College of Medicine, the Catholic University of Korea, Suwon, Gyeonggi-Do 16247, Korea
| | - Eun Young Shin
- Research Institute of Medical Science, St.Vincent's Hospital, College of Medicine, the Catholic University of Korea, Suwon, Gyeonggi-Do 16247, Korea
| | - Hironori Uehara
- Department of Ophthalmology, University of Utah, School of Medicine, Salt Lake City, Utah 84132, USA
| | - Balamurali K Ambati
- Department of Ophthalmology, University of Utah, School of Medicine, Salt Lake City, Utah 84132, USA
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32
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Wound-Healing Studies in Cornea and Skin: Parallels, Differences and Opportunities. Int J Mol Sci 2017; 18:ijms18061257. [PMID: 28604651 PMCID: PMC5486079 DOI: 10.3390/ijms18061257] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/24/2017] [Accepted: 05/31/2017] [Indexed: 02/06/2023] Open
Abstract
The cornea and the skin are both organs that provide the outer barrier of the body. Both tissues have developed intrinsic mechanisms that protect the organism from a wide range of external threats, but at the same time also enable rapid restoration of tissue integrity and organ-specific function. The easy accessibility makes the skin an attractive model system to study tissue damage and repair. Findings from skin research have contributed to unravelling novel fundamental principles in regenerative biology and the repair of other epithelial-mesenchymal tissues, such as the cornea. Following barrier disruption, the influx of inflammatory cells, myofibroblast differentiation, extracellular matrix synthesis and scar formation present parallel repair mechanisms in cornea and skin wound healing. Yet, capillary sprouting, while pivotal in proper skin wound healing, is a process that is rather associated with pathological repair of the cornea. Understanding the parallels and differences of the cellular and molecular networks that coordinate the wound healing response in skin and cornea are likely of mutual importance for both organs with regard to the development of regenerative therapies and understanding of the disease pathologies that affect epithelial-mesenchymal interactions. Here, we review the principal events in corneal wound healing and the mechanisms to restore corneal transparency and barrier function. We also refer to skin repair mechanisms and their potential implications for regenerative processes in the cornea.
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33
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Effector and Regulatory T Cell Trafficking in Corneal Allograft Rejection. Mediators Inflamm 2017; 2017:8670280. [PMID: 28539707 PMCID: PMC5429952 DOI: 10.1155/2017/8670280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/26/2017] [Indexed: 01/08/2023] Open
Abstract
Corneal transplantation is among the most prevalent and successful forms of solid tissue transplantation in humans. Failure of corneal allograft is mainly due to immune-mediated destruction of the graft, a complex and highly coordinated process that involves elaborate interactions between cells of innate and adaptive immunity. The migration of immune cells to regional lymphoid tissues and to the site of graft plays a central role in the immunopathogenesis of graft rejection. Intricate interactions between adhesion molecules and their counter receptors on immune cells in conjunction with tissue-specific chemokines guide the trafficking of these cells to the draining lymph nodes and ultimately to the site of graft. In this review, we discuss the cascade of chemokines and adhesion molecules that mediate the trafficking of effector and regulatory T cells during corneal allograft rejection.
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Dong X, Hara H, Wang Y, Wang L, Zhang Y, Cooper DK, Dai Y, Pan Z. Initial study of α1,3-galactosyltransferase gene-knockout/CD46 pig full-thickness corneal xenografts in rhesus monkeys. Xenotransplantation 2017; 24. [DOI: 10.1111/xen.12282] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 11/02/2016] [Accepted: 11/14/2016] [Indexed: 01/17/2023]
Affiliation(s)
- Xiaojuan Dong
- Beijing Ophthalmology & Visual Science Key Laboratory; BeijingTongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Hidetaka Hara
- Department of Surgery; Thomas E. Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
| | - Ying Wang
- State Key Laboratory of Reproductive Medicine and Jiangsu Key Laboratory of Xenotransplantation; Nanjing Medical University; Nanjing China
| | - Li Wang
- Beijing Ophthalmology & Visual Science Key Laboratory; BeijingTongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
| | - Yingnan Zhang
- Department of Surgery; Thomas E. Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
| | - David K.C. Cooper
- Department of Surgery; Thomas E. Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
| | - Yifan Dai
- State Key Laboratory of Reproductive Medicine and Jiangsu Key Laboratory of Xenotransplantation; Nanjing Medical University; Nanjing China
| | - Zhiqiang Pan
- Beijing Ophthalmology & Visual Science Key Laboratory; BeijingTongren Eye Center; Beijing Tongren Hospital; Capital Medical University; Beijing China
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35
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Management of high-risk corneal transplantation. Surv Ophthalmol 2016; 62:816-827. [PMID: 28012874 DOI: 10.1016/j.survophthal.2016.12.010] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 12/14/2022]
Abstract
The cornea is the most commonly transplanted tissue in medicine. The main cause of corneal graft failure is allograft rejection. The incidence of graft rejection depends on the presence of high-risk characteristics, most notably corneal neovascularization. Although corneal grafting has high success rates in the absence of these risk factors, high-risk keratoplasty is associated with low success rates because of a high incidence of immune-mediated graft rejection. To improve the survival of high-risk corneal transplantation, various preoperative, intraoperative, and postoperative measures can be considered; however, the key step in the management of these grafts is the long-term use of local and/or systemic immunosuppressive agents. Although a number of immunosuppressive agents have been used for this purpose, the results vary significantly across different studies. This is partly due to the lack of an optimized method for their use, as well as the lack of a precise stratification of the degree of risk in each individual patient. New targeted biologic treatments, as well as tolerance-inducing methods, show promising horizons in the management of high-risk corneal transplantation in near future.
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36
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Kuffova L, Knickelbein JE, Yu T, Medina C, Amescua G, Rowe AM, Hendricks RL, Forrester JV. High-Risk Corneal Graft Rejection in the Setting of Previous Corneal Herpes Simplex Virus (HSV)-1 Infection. Invest Ophthalmol Vis Sci 2016; 57:1578-87. [PMID: 27050878 PMCID: PMC4824377 DOI: 10.1167/iovs.15-17894] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose The “high-risk phenotype” of corneal graft recipients is considered to be related to preexisting vascularization such as that associated with herpes simplex virus-1 (HSV-1) keratitis (HSK). The purpose of this study was to investigate the immunologic mechanisms underlying accelerated corneal graft rejection using a mouse model of HSK. Methods Herpes simplex virus type 1 keratitis was induced in BALB/c mice. Syngeneic and allogeneic (C57BL/6 mice) corneal grafts were performed in mice with HSK at different times after infection. Some grafts were performed on HSV-infected CD4 T cell–deficient BALB/c mice. Clinical, histologic, immunologic, and virus detection studies were performed on samples of cornea, draining lymph node (LN), and trigeminal ganglion (TG) cells. Results Corneal grafts in mice with HSK rejected with higher frequency and more rapid tempo compared with grafts in uninfected mice. In corneas with HSK and vascularization at the time of grafting, both syngeneic and allogeneic corneal grafts failed with similar frequency and tempo. However, in the absence of preexisting inflammation and vascularization, syngeneic grafts were accepted when the grafts were performed at a late time point after HSV infection (42 days), whereas allografts were rejected at this time. In contrast, syngeneic grafts in nonvascularized HSV-infected recipients failed if they were performed within 10 days of HSV infection, an effect that was dependent on CD4 T cells, as demonstrated using CD4 deficient mice. Importantly, a variably sustained but strongly positive anti-HSV T-cell response was detected in allografted HSK recipients with a similar but lesser response in syngeneic hosts. Conclusions A previous HSV-1 corneal infection predisposes donor grafts to a high risk of failure by both innate and adaptive immune mechanisms in which an anti-HSV CD4 T-cell response plays a prominent role.
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Affiliation(s)
- Lucia Kuffova
- Division of Applied Medicine, Section of Immunity, Infection and Inflammation (Ocular Immunology), Institute of Medical Sciences, School of Medicine and Dentistry, Foresterhill, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Jared E Knickelbein
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Tian Yu
- Division of Applied Medicine, Section of Immunity, Infection and Inflammation (Ocular Immunology), Institute of Medical Sciences, School of Medicine and Dentistry, Foresterhill, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Carlos Medina
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Guillermo Amescua
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Alexander M Rowe
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Robert L Hendricks
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States 3Departments of Immunology, Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, Unite
| | - John V Forrester
- Division of Applied Medicine, Section of Immunity, Infection and Inflammation (Ocular Immunology), Institute of Medical Sciences, School of Medicine and Dentistry, Foresterhill, University of Aberdeen, Aberdeen, Scotland, United Kingdom 4Ocular Immunology
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Control of Cross Talk between Angiogenesis and Inflammation by Mesenchymal Stem Cells for the Treatment of Ocular Surface Diseases. Stem Cells Int 2016; 2016:7961816. [PMID: 27110252 PMCID: PMC4823508 DOI: 10.1155/2016/7961816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/29/2016] [Indexed: 12/13/2022] Open
Abstract
Angiogenesis is beneficial in the treatment of ischemic heart disease and peripheral artery disease. However, it facilitates inflammatory cell filtration and inflammation cascade that disrupt the immune and angiogenesis privilege of the avascular cornea, resulting in ocular surface diseases and even vision loss. Although great progress has been achieved, healing of severe ocular surface injury and immunosuppression of corneal transplantation are the most difficult and challenging step in the treatment of ocular surface disorders. Mesenchymal stem cells (MSCs), derived from various adult tissues, are able to differentiate into different cell types such as endothelial cells and fat cells. Although it is still under debate whether MSCs could give rise to functional corneal cells, recent results from different study groups showed that MSCs could improve corneal disease recovery through suppression of inflammation and modulation of immune cells. Thus, MSCs could become a promising tool for ocular surface disorders. In this review, we discussed how angiogenesis and inflammation are orchestrated in the pathogenesis of ocular surface disease. We overviewed and updated the knowledge of MSCs and then summarized the therapeutic potential of MSCs via control of angiogenesis, inflammation, and immune response in the treatment of ocular surface disease.
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He Y, Wang B, Jia B, Guan J, Zeng H, Pan Z. Effects of Adoptive Transferring Different Sources of Myeloid-Derived Suppressor Cells in Mice Corneal Transplant Survival. Transplantation 2016; 99:2102-8. [PMID: 26270448 DOI: 10.1097/tp.0000000000000749] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adoptively transferring different sources of myeloid-derived suppressor cells (MDSCs) may assist in mice corneal transplant survival. METHODS Allogeneic full thickness corneal transplantation (donor C57BL/6 to recipient Balb/c mice) was performed. Naive myeloid cells, inflammation-induced MDSCs (iMDSCs), and tumor-induced MDSCs (tMDSCs) were purified from bone marrow of naive, cecal ligation and puncture, or tumor-bearing Balb/c mice, respectively. The inhibitory abilities of myeloid cells toward CD4(+) T cell proliferation were accessed by in vitro carboxyfluorescein diacetate, succinimidyl ester (CFSE) assays. Myeloid cells were adoptively transferred to corneal recipients by retroorbital injection after corneal transplantation. Corneal grafts were examined and photographed for a period of 45 days. The growth of corneal graft neovascularization was quantitatively measured by image editing software. Histopathology was performed to evaluate corneal graft inflammation. RESULTS The iMDSCs and tMDSCs significantly inhibited T cell proliferation in vitro and significantly prolonged corneal allograft survival in vivo. Strikingly, iMDSC transferring significantly reduced neovascularization that was comparable to transferring of tMDSCs, without additional immunosuppression. However, additional adoptive transfer of MDSCs did not further ameliorate corneal survival in these allogeneic corneal transplantation mice. CONCLUSIONS Inflammation-induced MDSC transfer could reduce corneal neovascularization and prolong corneal allograft survival.
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Affiliation(s)
- Yan He
- 1 Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmic and Visual Science Key Laboratory, Beijing, China. 2 Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Eye institute of The Second Xiangya Hospital of Central South University, Changsha, China. 3 Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China. 4 Beijing Key Laboratory of Emerging Infectious Diseases, Beijing, China
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Trufanov SV, Subbot AM, Malozhen SA, Salovarova EP, Krakhmaleva DA. [Risk factors, clinical presentations, prevention, and treatment of corneal graft rejection]. Vestn Oftalmol 2016. [PMID: 28635902 DOI: 10.17116/oftalma20161326108-116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Corneal transplantation is the most common and successful type of allotransplantation surgery. Post-transplant immune response in keratoplasty is less pronounced than that in other transplantation procedures, which is accounted for by anatomical features of the cornea and, also, its low antigenic potential and active immunosuppression. However, the immune privilege of the cornea can be violated by neovascularization, inflammation, or trauma. Patients who require keratoplasty to restore their sight and whose immune privilege is disturbed, fall into a high-risk group and are likely to demonstrate tissue incompatibility and non-transparent engraftment. Two approaches exist as to how graft rejection can be prevented. One of them involves induction of donor-specific tolerance, the other - non-specific suppression of the recipient's immune response. To avoid tissue incompatibility, measures can be taken to restore the immune privilege of the cornea as well as to induce antigen-specific tolerance, which is considered a promising, thought yet experimental, area of modern transplantology. In clinical practice, one pays most attention to improvement of non-specific immune suppression methods based on interfering in the metabolism of immunocompetent cells. Thus, timely prescriptions and proper immunosuppressive tactics with account to possible risk factors determine the outcome in high-risk patients undergoing corneal transplantation surgery.
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Affiliation(s)
- S V Trufanov
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - A M Subbot
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - S A Malozhen
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - E P Salovarova
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
| | - D A Krakhmaleva
- Research Institute of Eye Diseases, 11 A, B, Rossolimo St., Moscow, Russian Federation, 119021
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The roles of sepsis-induced myeloid derived suppressor cells in mice corneal, skin and combined transplantation. Transpl Immunol 2015; 34:8-13. [PMID: 26733333 DOI: 10.1016/j.trim.2015.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/22/2015] [Accepted: 12/22/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE To explore the effects of adoptive transferring sepsis induced myeloid-derived suppressor cells (iMDSCs) in mice corneal, skin, and combined corneal-skin survival. METHODS Allogeneic full-thickness corneal transplantation, fully mismatched skin transplantation, and corneal-skin combined transplantation (donor C57BL/6 to recipient Balb/c mice) were performed. Sepsis-induced infectious-MDSCs (iMDSCs), were purified from bone marrow of cecal ligated and punctured (CLP) Balb/c mice. Recipient-derived iMDSCs were adoptively transferred into different recipient groups by retro-orbital injection after surgeries. Corneal and skin grafts were examined and photographed routinely for a period of 45days. Histopathology was performed to evaluate corneal-graft inflammation. Bone marrow and/or corneal grafts in each group were harvested from executed recipients on postoperative days 15, 25, 35. Corneal cells and bone marrow cells were stained with CD11b-PE and Gr1-FITC, analyzed by FACS. RESULTS iMDSCs were able to significantly prolong allograft survival in both corneal and corneal-skin combined transplant groups. A substantial expansion of MDSCs was observed in recipients' bone marrow, particularly in combined groups at an early stage postoperatively, and accordingly the concentration of MDSCs in corneal grafts increased significantly in adoptive transferred groups. CONCLUSIONS Sepsis-induced MDSCs may suggest a novel cellular therapeutic approach for preventing various types of allograft rejection.
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Yang JF, Walia A, Huang YH, Han KY, Rosenblatt MI, Azar DT, Chang JH. Understanding lymphangiogenesis in knockout models, the cornea, and ocular diseases for the development of therapeutic interventions. Surv Ophthalmol 2015; 61:272-96. [PMID: 26706194 DOI: 10.1016/j.survophthal.2015.12.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 01/05/2023]
Abstract
A major focus of cancer research for several decades has been understand the ability of tumors to induce new blood vessel formation, a process known as angiogenesis. Unfortunately, only limited success has been achieved in the clinical application of angiogenesis inhibitors. We now know that lymphangiogenesis, the growth of lymphatic vessels, likely also plays a major role in tumor progression. Thus, therapeutic strategies targeting lymphangiogenesis or both lymphangiogenesis and angiogenesis may represent promising approaches for treating cancer and other diseases. Importantly, research progress toward understanding lymphangiogenesis is significantly behind that related to angiogenesis. A PubMed search of "angiogenesis" returns nearly 80,000 articles, whereas a search of "lymphangiogenesis" returns 2,635 articles. This stark contrast can be explained by the lack of molecular markers for identifying the invisible lymphatic vasculature that persisted until less than 2 decades ago, combined with the intensity of research interest in angiogenesis during the past half century. Still, significant strides have been made in developing strategies to modulate lymphangiogenesis, largely using ocular disease models. Here we review the current knowledge of lymphangiogenesis in the context of knockout models, ocular diseases, the biology of activators and inhibitors, and the potential for therapeutic interventions targeting this process.
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Affiliation(s)
- Jessica F Yang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Amit Walia
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Yu-hui Huang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kyu-yeon Han
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mark I Rosenblatt
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Dimitri T Azar
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jin-Hong Chang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA.
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Paunicka KJ, Mellon J, Robertson D, Petroll M, Brown JR, Niederkorn JY. Severing corneal nerves in one eye induces sympathetic loss of immune privilege and promotes rejection of future corneal allografts placed in either eye. Am J Transplant 2015; 15:1490-501. [PMID: 25872977 PMCID: PMC4590984 DOI: 10.1111/ajt.13240] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 11/16/2014] [Accepted: 12/06/2014] [Indexed: 01/25/2023]
Abstract
Less than 10% of corneal allografts undergo rejection even though HLA matching is not performed. However, second corneal transplants experience a threefold increase in rejection, which is not due to prior sensitization to histocompatibility antigens shared by the first and second transplants since corneal grafts are selected at random without histocompatibility matching. Using a mouse model of penetrating keratoplasty, we found that 50% of the initial corneal transplants survived, yet 100% of the subsequent corneal allografts (unrelated to the first graft) placed in the opposite eye underwent rejection. The severing of corneal nerves that occurs during surgery induced substance P (SP) secretion in both eyes, which disabled T regulatory cells that are required for allograft survival. Administration of an SP antagonist restored immune privilege and promoted graft survival. Thus, corneal surgery produces a sympathetic response that permanently abolishes immune privilege of subsequent corneal allografts, even those placed in the opposite eye and expressing a completely different array of foreign histocompatibility antigens from the first corneal graft.
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Affiliation(s)
- K J Paunicka
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX
| | - J Mellon
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX
| | - D Robertson
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX
| | - M Petroll
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX
| | - J R Brown
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX
| | - J Y Niederkorn
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX
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Abdelfattah NS, Amgad M, Zayed AA, Salem H, Elkhanany AE, Hussein H, Abd El-Baky N. Clinical correlates of common corneal neovascular diseases: a literature review. Int J Ophthalmol 2015; 8:182-93. [PMID: 25709930 DOI: 10.3980/j.issn.2222-3959.2015.01.32] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 11/19/2014] [Indexed: 12/14/2022] Open
Abstract
A large subset of corneal pathologies involves the formation of new blood and lymph vessels (neovascularization), leading to compromised visual acuity. This article aims to review the clinical causes and presentations of corneal neovascularization (CNV) by examining the mechanisms behind common CNV-related corneal pathologies, with a particular focus on herpes simplex stromal keratitis, contact lenses-induced keratitis and CNV secondary to keratoplasty. Moreover, we reviewed CNV in the context of different types of corneal transplantation and keratoprosthesis, and summarized the most relevant treatments available so far.
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Affiliation(s)
- Nizar Saleh Abdelfattah
- Doheny Image Reading Center, Doheny Eye Institute, University of California, Los Angeles, 1355 San Pablo Street, Los Angeles, California 90033, USA
| | - Mohamed Amgad
- Faculty of Medicine, Cairo University, Cairo 11956, Egypt
| | - Amira A Zayed
- Department of Surgery, Mayo Clinic, Rochester 55905, MN, USA
| | - Hamdy Salem
- Faculty of Medicine, University of Alexandria, Alexandria 21131, Egypt
| | - Ahmed E Elkhanany
- Department of Medical Oncology, Mayo Clinic, Rochester 55905, MN, USA
| | - Heba Hussein
- Faculty of Oral and Dental Medicine, Cairo University, Cairo 11956, Egypt
| | - Nawal Abd El-Baky
- Antibody Laboratory, Protein Research Department, Genetic Engineering and Biotechnology Research Institute, City for Scientific Research and Technology Applications, Alexandria 21934, Egypt
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Antilymphangiogenic therapy to promote transplant survival and to reduce cancer metastasis: what can we learn from the eye? Semin Cell Dev Biol 2014; 38:117-30. [PMID: 25460541 DOI: 10.1016/j.semcdb.2014.11.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/01/2014] [Accepted: 11/12/2014] [Indexed: 12/22/2022]
Abstract
The lymphatic vasculature is - amongst other tasks - essentially involved in inflammation, (auto)immunity, graft rejection and cancer metastasis. The eye is mainly devoid of lymphatic vessels except for its adnexa, the conjunctiva and the limbus. However, several pathologic conditions can result in the secondary ingrowth of lymphatic vessels into physiologically alymphatic parts of the eye such as the cornea or the inner eye. Therefore, the cornea has served as an excellent in vivo model system to study lymphangiogenesis, and findings from such studies have substantially contributed to the understanding of central principles of lymphangiogenesis also with relevance outside the eye. Grafting experiments at the cornea have been extensively used to analyze the role of lymphangiogenesis in transplant immunology. In this regard, we recently demonstrated the crucial role of lymphatic vessels in mediating corneal allograft rejection and could show that antilymphangiogenic therapy increases graft survival. In the field of cancer research, we recently detected tumor-associated lymphangiogenesis in the most common malignant tumors of the eye, such as conjunctival carcinoma and melanoma, and ciliochoroidal melanoma with extraocular extension. These neolymphatics correlate with an increased risk of local recurrence, metastasis and tumor related death, and may offer potential therapeutic targets for the treatment of these tumors. This review will focus on corneal and tumor-associated ocular lymphangiogenesis. First, we will describe common experimentally used corneal lymphangiogenesis models and will recapitulate recent findings regarding the involvement of lymphatic vessels in corneal diseases and transplant immunology. The second part of this article will summarize findings about the participation of tumor-associated lymphangiogenesis in ocular malignancies and their implications for the development of future therapeutic strategies.
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45
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Choi W, Byun YJ, Jung E, Noh H, Hajrasouliha AR, Sadrai Z, Chang E, Lee JH, Lee HK. Chemokine decoy receptor D6 mimicking trap (D6MT) prevents allosensitization and immune rejection in murine corneal allograft model. J Leukoc Biol 2014; 97:413-24. [PMID: 25395300 DOI: 10.1189/jlb.5a0414-233rr] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Although corneal allotransplantation is performed in the immune-privileged cornea, many grafts are still rejected after transplantation. This study examined the role of chemokine receptor D6 expression in a corneal allograft rejection, investigated the modulation of D6 expression in cells, and determined the effect of D6 on graft survival. Interestingly, D6 was highly expressed in CD45 -: cells and the corneal epithelium of accepted corneal allografts. From the mouse corneal allograft model, TGF-β was found to play a key role in D6 up-regulation, leading to reduced CCL2, CCL5, and CCL3. To modulate D6 chemokine binding, a D6MT was developed and showed effective chemokine trapping through SPR and FACS assays. By treating corneal allografts with D6MT, the allograft survival rate was improved, and (lymph) angiogenesis was reduced. Direct allosensitization and DC LN homing was drastically reduced in the mouse corneal allograft model. These findings suggest that TGF-β is a positive regulator of D6 expression, and it is a potential therapeutic target to enhance the survival of corneal allografts.
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Affiliation(s)
- Wungrak Choi
- *Institute of Vision Research, Department of Ophthalmology, and Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea; Kentucky Lions Eye Center, Department of Ophthalmology, University of Louisville, Louisville, Kentucky, USA; Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, USA; Department of Anatomy and Cell Biology, University of Ulsan College of Medicine, Seoul, Korea; and Myunggok Eye Research Institute, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Yu Jeong Byun
- *Institute of Vision Research, Department of Ophthalmology, and Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea; Kentucky Lions Eye Center, Department of Ophthalmology, University of Louisville, Louisville, Kentucky, USA; Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, USA; Department of Anatomy and Cell Biology, University of Ulsan College of Medicine, Seoul, Korea; and Myunggok Eye Research Institute, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Eunae Jung
- *Institute of Vision Research, Department of Ophthalmology, and Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea; Kentucky Lions Eye Center, Department of Ophthalmology, University of Louisville, Louisville, Kentucky, USA; Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, USA; Department of Anatomy and Cell Biology, University of Ulsan College of Medicine, Seoul, Korea; and Myunggok Eye Research Institute, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Hyemi Noh
- *Institute of Vision Research, Department of Ophthalmology, and Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea; Kentucky Lions Eye Center, Department of Ophthalmology, University of Louisville, Louisville, Kentucky, USA; Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, USA; Department of Anatomy and Cell Biology, University of Ulsan College of Medicine, Seoul, Korea; and Myunggok Eye Research Institute, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Amir R Hajrasouliha
- *Institute of Vision Research, Department of Ophthalmology, and Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea; Kentucky Lions Eye Center, Department of Ophthalmology, University of Louisville, Louisville, Kentucky, USA; Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, USA; Department of Anatomy and Cell Biology, University of Ulsan College of Medicine, Seoul, Korea; and Myunggok Eye Research Institute, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Zahra Sadrai
- *Institute of Vision Research, Department of Ophthalmology, and Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea; Kentucky Lions Eye Center, Department of Ophthalmology, University of Louisville, Louisville, Kentucky, USA; Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, USA; Department of Anatomy and Cell Biology, University of Ulsan College of Medicine, Seoul, Korea; and Myunggok Eye Research Institute, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Eunju Chang
- *Institute of Vision Research, Department of Ophthalmology, and Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea; Kentucky Lions Eye Center, Department of Ophthalmology, University of Louisville, Louisville, Kentucky, USA; Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, USA; Department of Anatomy and Cell Biology, University of Ulsan College of Medicine, Seoul, Korea; and Myunggok Eye Research Institute, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Joon H Lee
- *Institute of Vision Research, Department of Ophthalmology, and Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea; Kentucky Lions Eye Center, Department of Ophthalmology, University of Louisville, Louisville, Kentucky, USA; Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, USA; Department of Anatomy and Cell Biology, University of Ulsan College of Medicine, Seoul, Korea; and Myunggok Eye Research Institute, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Hyung Keun Lee
- *Institute of Vision Research, Department of Ophthalmology, and Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Korea; Kentucky Lions Eye Center, Department of Ophthalmology, University of Louisville, Louisville, Kentucky, USA; Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, USA; Department of Anatomy and Cell Biology, University of Ulsan College of Medicine, Seoul, Korea; and Myunggok Eye Research Institute, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
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Nguyen P, Rue K, Heur M, Yiu SC. Ocular surface rehabilitation: Application of human amniotic membrane in high-risk penetrating keratoplasties. Saudi J Ophthalmol 2014; 28:198-202. [PMID: 25278797 DOI: 10.1016/j.sjopt.2014.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/01/2014] [Accepted: 06/15/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Human amniotic membrane is a versatile tool for management of ocular surface disorders. This study evaluates the effect of cryopreserved human amniotic membrane (hAM) on one-year survival of penetrating keratoplasties (PKP) in high-risk recipients. METHOD This is a retrospective noncomparative cohort study of 58 consecutive eyes undergoing PKP with concurrent placement of a self-retained cryopreserved hAM (PROKERA®) at a tertiary care center from January 2009 to July 2010. RESULTS Mean patient age was 66.7 ± 17.2 years and 30 (54%) were males. 51 eyes were pseudophakic and one aphakic. 27 eyes were glaucomatous; 24 had glaucoma drainage device and 2 had previous endocyclophotocoagulation. 12 patients had PKP for the first time and 46 had repeat PKP (average number of prior PKP = 1.63 ± 1.1, range: 1-5). Risk factors for graft failure included repeat PKP (79.3%), corneal neovascularization (51.7%), preexisting glaucoma (46.6%), and presence of anterior synechiae (37.9%). Both First Transplant and Repeat Transplant groups had similar survival rates until 6 months after transplant (75% vs 74%, odds ratio = 1.06, p = 1.00). At 12 months, First Transplant group showed a better survival rate (67% vs 43%, odds ratio = 2.60, p = 0.20). Eyes with >3 risk factors had a higher graft failure rate (odds ratio = 5.81, p = 0.003). CONCLUSION Survey of the literature suggests that high-risk PKP with concurrent hAM placement demonstrate comparable graft survival. Presence of multiple risk factors is associated with poor survival.
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Affiliation(s)
- Pho Nguyen
- Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Kelly Rue
- Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Martin Heur
- Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Samuel C Yiu
- Department of Ophthalmology, The Wilmer Eye Institute, The John Hopkins University, Baltimore, MD, USA
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Abstract
PURPOSE To examine the effects of presurgical corticosteroid treatment for normal-risk penetrating keratoplasty (NRPK), high-risk penetrating keratoplasty (HRPK), and high-risk penetrating keratoplasty plus lensectomy. METHODS We used 3 corneal transplantation models (NRPK, HRPK, and high-risk penetrating keratoplasty plus lensectomy). For each model, we tried to compare the effect of corticosteroid treatment according to different timetables as follows: The first trial began with a corticosteroid injection given 2 weeks before the PK and continued until 4 weeks after the PK (group 1). The second trial started with a corticosteroid injection given on the day of the PK and continued for 4 weeks after the PK (group 2). The third trial started with a corticosteroid injection administered on the day of the PK and continued for 8 weeks after the PK (group 3). After harvesting and immunostaining of corneas, graft survival, neovascularization (NV), and lymphangiogenesis (LY) were compared among the groups. A P value <0.05 was considered as being statistically significant. RESULTS With respect to graft survival, group 1 had improved graft survival compared with that of group 3 in the HRPK model (P = 0.025). In all the 3 PK models, groups 2 and 3 demonstrated a similar graft survival (P > 0.05). With respect to NV and LY, in NRPK, group 1 showed less NV than did group 2 (P < 0.001) and group 3 (P = 0.016). In HRPK, group 1 also demonstrated less NV and LY than did group 3 (P = 0.045 and 0.044, respectively). CONCLUSIONS The initiation time point of the corticosteroid treatment is important for graft survival. Corticosteroid pretreatment is an effective means to increase graft survival for HRPK and to decrease NV and LY for both NRPK and HRPK.
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Yan F, Cai L, Hui Y, chen S, Meng H, Huang Z. Tolerogenic dendritic cells suppress murine corneal allograft rejection by modulating CD28/CTLA-4 expression on regulatory T cells. Cell Biol Int 2014; 38:835-48. [PMID: 24604878 DOI: 10.1002/cbin.10268] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 02/21/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Feng Yan
- Department of Ophthalmology; Jinling Hospital; School of Medicine; Nanjing University; Nanjing 210002 China
- Department of Ophthalmology; Xijing Hospital; The Fourth Military Medical University; Xi'an China
| | - Li Cai
- Department of Ophthalmology; Xijing Hospital; The Fourth Military Medical University; Xi'an China
| | - Yannian Hui
- Department of Ophthalmology; Xijing Hospital; The Fourth Military Medical University; Xi'an China
| | - Suihua chen
- Department of Ophthalmology; Jinling Hospital; School of Medicine; Nanjing University; Nanjing 210002 China
| | - Hao Meng
- Department of Ophthalmology; Xijing Hospital; The Fourth Military Medical University; Xi'an China
- Department of Ophthalmology; NO.313 Hospital; Hulu Dao China
| | - Zhenping Huang
- Department of Ophthalmology; Jinling Hospital; School of Medicine; Nanjing University; Nanjing 210002 China
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50
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Tan X, Zeng H, Jie Y, Zhang Y, Xu Q, Pan Z. CD154 blockade modulates the ratio of Treg to Th1 cells and prolongs the survival of allogeneic corneal grafts in mice. Exp Ther Med 2014; 7:827-834. [PMID: 24660031 PMCID: PMC3961129 DOI: 10.3892/etm.2014.1527] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 11/08/2013] [Indexed: 11/09/2022] Open
Abstract
Administration of anti-CD154 monoclonal antibody (mAb) may prolong the survival of an allograft; however, the associated therapeutic mechanisms remain poorly understood. This study aimed to evaluate the effects of anti-CD154 mAb on T-cell responses in a mouse model of corneal allograft transplantation. BALB/c mice were transplanted with corneal grafts from C57BL/6 mice and treated intraperitoneally with 250 μg anti-CD154 mAb or isotype IgG on days 0, 3 and 6 post surgery. The transparency of the corneal grafts was evaluated for potential rejection signs by slit-lamp biomicroscopy and histopathology. The percentages of CD4+ T, Tim-3+CD4+ T helper (Th) 1 and CD4+CD25+Foxp3+ regulatory T cells (Tregs) in the spleen, ipsilateral draining lymph nodes and corneal grafts, and the frequency of splenic IFN-γ+ and IL-10+ expression in CD4+ T cells were determined by flow cytometry. Moreover, the ratio of Tregs to Th1 cells was calculated and the suppressive activity of splenic Tregs was measured. Anti-CD154 neutralization significantly prolonged the survival of the corneal allograft (P=0.0012) and reduced the numbers of inflammatory infiltrates in the corneal graft. In the spleen and lymph nodes, anti-CD154 treatment reduced the frequency of CD4+ T cells, Tregs and particularly Th1 cells. In the corneal allografts, anti-CD154 treatment downregulated graft-infiltrated CD4+ T cells and Th1 cells, but increased graft-infiltrated Tregs. Furthermore, anti-CD154 treatment increased the frequency of splenic IL-10+CD4+ T cells and decreased the concentration of splenic IFN-γ+CD4+ T cells. As a result, the ratio of Tregs to Th1 cells in the anti-CD154-treated recipients increased. Anti-CD154 treatment did not enhance the suppressive activity of Tregs in the recipients. The results indicate that the therapeutic effects of anti-CD154 mAb on prolonging the survival of the corneal allograft may be associated with an increased ratio of Tregs to Th1 cells in mice.
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Affiliation(s)
- Xiaobo Tan
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China ; Department of Ophthalmology, the Affiliated Hospital of Chengde Medical College, Chengde, Hebei 067000, P.R. China
| | - Hui Zeng
- Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100730, P.R. China
| | - Ying Jie
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China
| | - Yingnan Zhang
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China
| | - Qing Xu
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China
| | - Zhiqiang Pan
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China
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