1
|
Liu X, Zhou Q, Meng J, Zuo H, Li R, Zhang R, Lu H, Zhang Z, Li H, Zeng S, Tian M, Wang H, Hu K, Li N, Mao L, Hou S. Autophagy-mediated activation of the AIM2 inflammasome enhances M1 polarization of microglia and exacerbates retinal neovascularization. MedComm (Beijing) 2024; 5:e668. [PMID: 39081514 PMCID: PMC11286542 DOI: 10.1002/mco2.668] [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: 02/16/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Retinopathy of prematurity (ROP) is a retinal neovascularization (RNV) disease that is characterized by abnormal blood vessel development in the retina. Importantly, the etiology of ROP remains understudied. We re-analyzed previously published single-cell data and discovered a strong correlation between microglia and RNV diseases, particularly ROP. Subsequently, we found that reactive oxygen species reduced autophagy-dependent protein degradation of absent in melanoma 2 (AIM2) in hypoxic BV2 cells, leading to increased AIM2 protein accumulation. Furthermore, we engineered AIM2 knockout mice and observed that the RNV was significantly reduced compared to wild-type mice. In vitro vascular function assays also demonstrated diminished angiogenic capabilities following AIM2 knockdown in hypoxic BV2 cells. Mechanistically, AIM2 enhanced the M1-type polarization of microglia via the ASC/CASP1/IL-1β pathway, resulting in RNV. Notably, the administration of recombinant protein IL-1β exacerbated angiogenesis, while its inhibition ameliorated the condition. Taken together, our study provides a novel therapeutic target for ROP and offers insight into the interaction between pyroptosis and autophagy.
Collapse
Affiliation(s)
- Xianyang Liu
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of OphthalmologyChongqingChina
| | - Qian Zhou
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of OphthalmologyChongqingChina
| | - Jiayu Meng
- Sichuan Provincial Key Laboratory for Human Disease Gene StudySichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Hangjia Zuo
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of OphthalmologyChongqingChina
| | - Ruonan Li
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of OphthalmologyChongqingChina
| | - Rui Zhang
- Department of OphthalmologyQilu HospitalCheeloo College of MedicineShandong UniversityJinanChina
| | - Huiping Lu
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of OphthalmologyChongqingChina
| | - Zhi Zhang
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of OphthalmologyChongqingChina
| | - Hongshun Li
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of OphthalmologyChongqingChina
| | - Shuhao Zeng
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of OphthalmologyChongqingChina
| | - Meng Tian
- Beijing Institute of OphthalmologyBeijing Tongren Eye CenterBeijing Ophthalmology & Visual Sciences Key LaboratoryBeijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Hong Wang
- Beijing Institute of OphthalmologyBeijing Tongren Eye CenterBeijing Ophthalmology & Visual Sciences Key LaboratoryBeijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Ke Hu
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of OphthalmologyChongqingChina
| | - Na Li
- Department of Laboratory Medicine, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Liming Mao
- Department of ImmunologySchool of MedicineNantong UniversityNantongChina
| | - Shengping Hou
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Beijing Institute of OphthalmologyBeijing Tongren Eye CenterBeijing Ophthalmology & Visual Sciences Key LaboratoryBeijing Tongren HospitalCapital Medical UniversityBeijingChina
| |
Collapse
|
2
|
Modrzejewska M, Zdanowska O, Połubiński P. The Role of HIF-1α in Retinopathy of Prematurity: A Review of Current Literature. J Clin Med 2024; 13:4034. [PMID: 39064074 PMCID: PMC11277540 DOI: 10.3390/jcm13144034] [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: 05/27/2024] [Revised: 07/07/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Hypoxia-inducible factor (HIF) plays a crucial role in regulating oxygen sensing and adaptation at the cellular level, overseeing cellular oxygen homeostasis, erythrocyte production, angiogenesis, and mitochondrial metabolism. The hypoxia-sensitive HIF-1α subunit facilitates tissue adaptation to hypoxic conditions, including the stimulation of proangiogenic factors. Retinopathy of prematurity (ROP) is a proliferative vascular disease of the retina that poses a significant risk to prematurely born children. If untreated, ROP can lead to retinal detachment, severe visual impairment, and even blindness. The pathogenesis of ROP is not fully understood; however, reports suggest that premature birth leads to the exposure of immature ocular tissues to high levels of exogenous oxygen and hyperoxia, which increase the synthesis of reactive oxygen species and inhibit HIF expression. During the ischemic phase, HIF-1α expression is stimulated in the hypoxia-sensitive retina, causing an overproduction of proangiogenic factors and the development of pathological neovascularization. Given the significant role of HIF-1α in the development of ROP, considering it as a potential molecular target for therapeutic strategies appears justified. This review synthesizes information from the last six years (2018-2024) using databases such as PubMed, Google Scholar, and BASE, focusing on the role of HIF-1α in the pathogenesis of ROP and its potential as a target for new therapies.
Collapse
Affiliation(s)
- Monika Modrzejewska
- 2nd Department of Ophthalmology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Oliwia Zdanowska
- K. Marcinkowski University Hospital in Zielona Góra, 65-046 Zielona Góra, Poland
| | - Piotr Połubiński
- Scientific Association of Students, 2nd Department of Ophthalmology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| |
Collapse
|
3
|
Çuhacı AB, Efe YS, Güneş T. The effect of music on pain, comfort, and physiological parameters during premature retinopathy examination. J Pediatr Nurs 2024; 78:149-157. [PMID: 38943838 DOI: 10.1016/j.pedn.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 05/29/2024] [Accepted: 06/16/2024] [Indexed: 07/01/2024]
Abstract
AIM To determine the effect of music applied during the ROP examination on pain, comfort, and physiological parameters in preterm infants. METHODS The sample of this prospective randomized controlled double-blind experimental study consisted of 28 preterm infants who were examined for ROP of a tertiary hospital in the Neonatal Unit. Data were collected with a Questionnaire, Physiological Parameters Observation Form (PPOF), Revised-Premature Infant Pain Profile (PIPP-R), and Premature Infant Comfort Scale (PICS). RESULTS The results revealed that the crying times of the infants in the experimental group were shorter than the infants in the control group. The preterm infants in the experimental group had statistically lower PIPP-R scores during and after the procedure than the PIPP-R scores of the infants in the control group (p < 0.001) and the music applied to the preterm infants resulted in a mean decrease of 3.857 in the post-procedure and pre-procedure PIPP-R scores (p < 0.05). While there was no statistical difference between the pre-procedure and pre-procedural PICS scores of the preterm infants in the experimental and control groups (p = 0.599; p = 117), the post-procedure PICS values of the preterm infants in the experimental group were found to be lower than those of the control group (p < 0.001). It was found that the music applied to preterm infants during the ROP examination resulted in a mean decrease of 1.286 in PICS scores after the procedure and before the procedure (p < 0.05). CONCLUSION It was determined that the music listened to during the ROP examination decreased the PIPP-R pain scores of preterm infants, had a positive effect on the PICS scores after the procedure, but did not affect the physiological parameters positively. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05263973.
Collapse
Affiliation(s)
| | - Yağmur Sezer Efe
- Department of Pediatric Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Türkiye.
| | - Tamer Güneş
- Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Türkiye.
| |
Collapse
|
4
|
Tu Y, Luo Y, Zhao Q, Zeng Y, Leng K, Zhu M. Role of macrophage in ocular neovascularization. Heliyon 2024; 10:e30840. [PMID: 38770313 PMCID: PMC11103465 DOI: 10.1016/j.heliyon.2024.e30840] [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: 09/30/2023] [Revised: 04/10/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024] Open
Abstract
Ocular neovascularization is the leading cause of blindness in clinical settings. Pathological angiogenesis of the eye can be divided into corneal neovascularization (CoNV), retinal neovascularization (RNV, including diabetic retinopathy and retinopathy of prematurity), and choroidal neovascularization (CNV) based on the anatomical location of abnormal neovascularization. Although anti-Vascular endothelial growth factor (VEGF) agents have wide-ranging clinical applications and are an effective treatment for neovascular eye disease, many deficiencies in this treatment strategy remain. Recently, emerging evidence has demonstrated that macrophages are vital during the process of physiological and pathological angiogenesis. Monocyte-macrophage lineage is diverse and plastic, they can shift between different activation modes and have different functions. Due to the obvious regulatory effect of macrophages on inflammation and angiogenesis, macrophages have been increasingly studied in the field of ophthalmology. Here, we detail how macrophage activated and the role of different subtypes of macrophages in the pathogenesis of ocular neovascularization. The complexity of macrophages has recently taken center stage owing to their subset diversity and tightly regulated molecular and metabolic phenotypes. In this review, we reveal the functional and phenotypic characterization of macrophage subsets associated with ocular neovascularization, more in-depth research is needed to explore the specific mechanisms by which macrophages regulate angiogenesis as well as macrophage polarization. Targeted regulation of macrophage differentiation based on their phenotype and function could be an effective approach to treat and manage ocular neovascularization in the future.
Collapse
Affiliation(s)
- Yuanyuan Tu
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yalu Luo
- Suzhou Medical College, Soochow University, Suzhou, China
| | - Qingliang Zhao
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yanfeng Zeng
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Kai Leng
- Department of Medical Informatics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Manhui Zhu
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Suzhou, Jiangsu, China
| |
Collapse
|
5
|
Peng N, Zheng M, Song B, Jiao R, Wang W. Transcription Factor EGR1 Facilitates Neovascularization in Mice with Retinopathy of Prematurity by Regulating the miR-182-5p/EFNA5 Axis. Biochem Genet 2024; 62:1070-1086. [PMID: 37530910 DOI: 10.1007/s10528-023-10433-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/15/2023] [Indexed: 08/03/2023]
Abstract
Neovascularization is the hallmark of retinopathy of prematurity (ROP). Early growth response 1 (EGR1) has been reported as an angiogenic factor. This study was conducted to probe the regulatory mechanism of EGR1 in neovascularization in ROP model mice. The ROP mouse model was established, followed by determination of EGR1 expression and assessment of neovascularization [vascular endothelial growth factor-A (VEGF-A) and pigment epithelium-derived factor (PEDF)]. Retinal vascular endothelial cells were cultured and treated with hypoxia, followed by the tube formation assay. The state of oxygen induction was assessed by real-time quantitative polymerase chain reaction (RT-qPCR) and Western blot assay to determine hypoxia-inducible factor 1-alpha (HIF-1A). The levels of microRNA (miRNA)-182-5p and ephrin-A5 (EFNA5) in tissues and cells were determined by RT-qPCR. Chromatin immunoprecipitation and dual-luciferase assay were used to validate gene interaction. EGR1 and EFNA5 were upregulated in the retina of ROP mice while miR-182-5p was downregulated. EGR1 knockdown decreased VEGF-A and HIF-1A expression and increased PEDF expression in the retina of ROP mice. In vitro, EGR1 knockdown also reduced neovascularization. EGR1 binding to the miR-182-5p promoter inhibited miR-182-5p transcription and further promoted EFNA5 transcription. miR-182-5p downregulation or EFNA5 overexpression averted the inhibition of neovascularization caused by EGR1 downregulation. Overall, EGR1 bound to the miR-182-5p promoter to inhibit miR-182-5p transcription and further promoted EFNA5 transcription, thus promoting retinal neovascularization in ROP mice.
Collapse
Affiliation(s)
- Ningning Peng
- Department of Neonatology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, No. 15 Jiefang Road, Fancheng District, Xiangyang City, 441000, Hubei Province, China
| | - Mei Zheng
- Department of Neonatology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, No. 15 Jiefang Road, Fancheng District, Xiangyang City, 441000, Hubei Province, China
| | - Bei Song
- Department of Neonatology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, No. 15 Jiefang Road, Fancheng District, Xiangyang City, 441000, Hubei Province, China
| | - Rong Jiao
- Department of Neonatology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, No. 15 Jiefang Road, Fancheng District, Xiangyang City, 441000, Hubei Province, China.
| | - Wenxiang Wang
- Department of Neonatology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, No. 15 Jiefang Road, Fancheng District, Xiangyang City, 441000, Hubei Province, China.
| |
Collapse
|
6
|
Protsyk O, García Serrano JL. Mechanical Ventilation, Retinal Avascularity and Rate of Vascularisation: A Triad of Predictors for Retinopathy of Prematurity Treatment. J Pers Med 2024; 14:379. [PMID: 38673006 PMCID: PMC11050857 DOI: 10.3390/jpm14040379] [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: 02/21/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
AIM The temporal avascular area of the retina and the duration of mechanical ventilation (DMV) may predict the need to treat retinopathy of prematurity (ROP). This study considers whether the rate of retinal vascularisation and related risk factors should be included in a predictive model of the need for ROP treatment. METHODS This single-centre, observational retrospective case-control study was conducted on 276 preterm infants included in an ROP screening programme. All had undergone at least three examinations of the fundus. The main outcome measures considered were DMV (in days of treatment), the temporal avascular area (in disc diameters, DD) and the rate of temporal retinal vascularisation (DD/week). RESULTS The multivariate logistic model that best explains ROP treatment (R2 = 63.1%) has three significant risk factors: each additional day of mechanical ventilation (OR, 1.05 [95% CI, 1.02-1.09]; p = 0.001); each additional DD of temporal avascular area (OR, 2.2 [95% CI, 1.7-2.9]; p < 0.001) and a vascularisation rate <0.5 DD/week (OR, 19.0 [95% CI, 6.5-55.5]; p < 0.001). Two tables are presented for calculating the expected need for ROP treatment according to these three risk factors. CONCLUSIONS A greater DMV, a broad avascular area of the temporal retina at the first binocular screening and slow retinal vascularisation strongly predict the need for ROP treatment. The predictive model we describe must be validated externally in other centres.
Collapse
Affiliation(s)
- Olena Protsyk
- Department of Ophthalmology, Jaen University Hospital, Av. del Ejército Español 10, 23007 Jaén, Spain;
| | - José Luis García Serrano
- Department of Surgery and Related Specialities, University of Granada, 18012 Granada, Spain
- Ophthalmology Service, Hospital Clínico San Cecilio, 18016 Granada, Spain
| |
Collapse
|
7
|
Osipova NA, Panova AY, Efremov AM, Lozinskaya NA, Beznos OV, Katargina LA. Melatonin and its bioisosteres as potential therapeutic agents for the treatment of retinopathy of prematurity. Chem Biol Drug Des 2024; 103:e14504. [PMID: 38480485 DOI: 10.1111/cbdd.14504] [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: 11/14/2023] [Revised: 02/06/2024] [Accepted: 03/04/2024] [Indexed: 03/27/2024]
Abstract
We conducted a study on the impact of intraperitoneal injections of melatonin and its three bioisosteres (compounds 1-3) on the development of oxygen-induced retinopathy in newborn rats during a 21-day experiment. It was demonstrated that melatonin and its analogues 1-3 effectively reduce the total protein concentration in the vitreous body of rat pups, decrease concentration of VEGF-A, and lower the level of oxidative stress (as indicated by normalization of antioxidant activity in the vitreous body). Melatonin and its analogues 1-3 equally normalize the level of VEGF-A. Analogues 1 and 2 even exceed melatonin in their ability to reduce protein influx into the vitreous body. However, analogue 2 had no effect on antioxidant activity, while analogues 1 and 3 caused a significant increase in this parameter, with analogue 3 even slightly exceeding melatonin. Thus, it can be concluded that analogues 1-3 are comparable to melatonin and can be utilized as potential therapeutic agents for the treatment of retinopathy of prematurity.
Collapse
Affiliation(s)
- N A Osipova
- Helmholtz National Medical Center of Eye Diseases, Moscow, Russia
| | - A Y Panova
- Helmholtz National Medical Center of Eye Diseases, Moscow, Russia
| | - A M Efremov
- Department of Chemistry, Lomonosov Moscow State University, Moscow, Russia
| | - N A Lozinskaya
- Department of Chemistry, Lomonosov Moscow State University, Moscow, Russia
| | - O V Beznos
- Helmholtz National Medical Center of Eye Diseases, Moscow, Russia
| | - L A Katargina
- Helmholtz National Medical Center of Eye Diseases, Moscow, Russia
| |
Collapse
|
8
|
García H, Villasis-Keever MA, Zavala-Vargas G, Bravo-Ortiz JC, Pérez-Méndez A, Escamilla-Núñez A. Global Prevalence and Severity of Retinopathy of Prematurity over the Last Four Decades (1985-2021): A Systematic Review and Meta-Analysis. Arch Med Res 2024; 55:102967. [PMID: 38364488 DOI: 10.1016/j.arcmed.2024.102967] [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: 07/06/2023] [Revised: 12/01/2023] [Accepted: 01/31/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a vasoproliferative disease of the retina that occurs in premature infants. The prevalence of ROP reported so far is inconsistent. AIM To conduct a systematic review to describe the trend of ROP prevalence between 1985 and 2021, and to determine the influence of countries' economic conditions on ROP prevalence. METHODS We searched PubMed, Embase, and Google Scholar for studies published between January 1985 and December 2021 using the following MeSH terms: "retinopathy of prematurity", "ROP", "incidence", and "prevalence". Two independent reviewers examined the articles to select studies that met the selection criteria and performed data extraction and study quality assessment. For the meta-analysis, the pooled prevalence was calculated using a random-effects model and R software. RESULTS Of 5,250 titles and abstracts, 139 original studies met the inclusion criteria; a total of 121,618 premature infants were included in these studies. The pooled prevalence of ROP was 31.9% (95% confidence interval [CI] 29.0-34.8) and that of severe ROP was 7.5% (6.5-8.7). In general, no significant differences in prevalence were found over the four decades; however, we found a higher prevalence in premature infants ≤28 weeks of gestational age. In addition, the highest ROP prevalence was found in lower-middle-income countries with high mortality rates. In contrast, the highest severe ROP prevalence was found in high-income countries. CONCLUSION ROP remains a common cause of morbidity in premature infants worldwide. Therefore, it seems necessary to maintain early identification strategies for patients at higher risk, particularly in low- and middle-income countries.
Collapse
Affiliation(s)
- Heladia García
- Research Unit in Analysis and Synthesis of Evidence, Pediatrics Hospital, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
| | - Miguel Angel Villasis-Keever
- Research Unit in Analysis and Synthesis of Evidence, Pediatrics Hospital, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Georgina Zavala-Vargas
- Research Unit in Analysis and Synthesis of Evidence, Pediatrics Hospital, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Juan Carlos Bravo-Ortiz
- Pediatric Ophthalmology Service, Pediatrics Hospital, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Ayari Pérez-Méndez
- Research Unit in Analysis and Synthesis of Evidence, Pediatrics Hospital, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Alberto Escamilla-Núñez
- Research Unit in Analysis and Synthesis of Evidence, Pediatrics Hospital, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| |
Collapse
|
9
|
Tăbăcaru G, Moldovanu S, Răducan E, Barbu M. A Robust Machine Learning Model for Diabetic Retinopathy Classification. J Imaging 2023; 10:8. [PMID: 38248993 PMCID: PMC10816944 DOI: 10.3390/jimaging10010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/24/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024] Open
Abstract
Ensemble learning is a process that belongs to the artificial intelligence (AI) field. It helps to choose a robust machine learning (ML) model, usually used for data classification. AI has a large connection with image processing and feature classification, and it can also be successfully applied to analyzing fundus eye images. Diabetic retinopathy (DR) is a disease that can cause vision loss and blindness, which, from an imaging point of view, can be shown when screening the eyes. Image processing tools can analyze and extract the features from fundus eye images, and these corroborate with ML classifiers that can perform their classification among different disease classes. The outcomes integrated into automated diagnostic systems can be a real success for physicians and patients. In this study, in the form image processing area, the manipulation of the contrast with the gamma correction parameter was applied because DR affects the blood vessels, and the structure of the eyes becomes disorderly. Therefore, the analysis of the texture with two types of entropies was necessary. Shannon and fuzzy entropies and contrast manipulation led to ten original features used in the classification process. The machine learning library PyCaret performs complex tasks, and the empirical process shows that of the fifteen classifiers, the gradient boosting classifier (GBC) provides the best results. Indeed, the proposed model can classify the DR degrees as normal or severe, achieving an accuracy of 0.929, an F1 score of 0.902, and an area under the curve (AUC) of 0.941. The validation of the selected model with a bootstrap statistical technique was performed. The novelty of the study consists of the extraction of features from preprocessed fundus eye images, their classification, and the manipulation of the contrast in a controlled way.
Collapse
Affiliation(s)
- Gigi Tăbăcaru
- Department of Automatic Control and Electrical Engineering, Faculty of Automation, Computers, Electrical, Engineering and Electronics, “Dunarea de Jos” University of Galati, 800008 Galați, Romania; (G.T.); (E.R.); (M.B.)
| | - Simona Moldovanu
- Computer Science and Information Technology, Faculty of Automation, Computers, Electrical Engineering and Electronics, “Dunarea de Jos” University of Galati, 800210 Galati, Romania
- The Modelling & Simulation Laboratory, Dunarea de Jos University of Galati, 47 Domneasca Str., 800008 Galati, Romania
| | - Elena Răducan
- Department of Automatic Control and Electrical Engineering, Faculty of Automation, Computers, Electrical, Engineering and Electronics, “Dunarea de Jos” University of Galati, 800008 Galați, Romania; (G.T.); (E.R.); (M.B.)
| | - Marian Barbu
- Department of Automatic Control and Electrical Engineering, Faculty of Automation, Computers, Electrical, Engineering and Electronics, “Dunarea de Jos” University of Galati, 800008 Galați, Romania; (G.T.); (E.R.); (M.B.)
| |
Collapse
|
10
|
Glaser K, Härtel C, Dammann O, Herting E, Andres O, Speer CP, Göpel W, Stahl A. Erythrocyte transfusions are associated with retinopathy of prematurity in extremely low gestational age newborns. Acta Paediatr 2023; 112:2507-2515. [PMID: 37667535 DOI: 10.1111/apa.16965] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/20/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023]
Abstract
AIM Retinopathy of prematurity (ROP) is a major morbidity in preterm infants causing visual impairment including blindness. Prevention and timely treatment are critical. We investigated the potential role of red blood cell (RBC) transfusions as risk factor for ROP development. METHODS Retrospective cohort study of data from 68 tertiary level neonatal intensive care units in Germany. Preterm infants born at 22 + 0 to 28 + 6 weeks of gestation between January 2009 and December 2021 were enrolled. RESULTS We included n = 12 565 infants. Prevalence of any ROP was 49.2% with most infants being diagnosed with stage 1 (21.5%) and 2 disease (17.2%). ROP stage 3 was present in 10.2%, stage 4 in 0.3%, and ROP requiring treatment in 6.6%. Infants with ROP had significantly more frequently a history of RBC transfusions. Adjusting for confounders, RBC transfusions were associated with increased odds of ROP (OR 1.4, p < 0.001), ROP progression (OR 2.1, p < 0.01) and ROP requiring treatment (OR 3.6, p < 0.001). Restrictive transfusion approaches correlated with decreased (OR 0.7, p < 0.001), liberal regimes with increased odds (OR 1.2, p = 0.001). CONCLUSION The present study confirmed an association of RBC transfusions and ROP. Our findings emphasise the need for anaemia prevention and critical re-evaluation of transfusion practices in preterm infants.
Collapse
Affiliation(s)
- Kirsten Glaser
- Division of Neonatology, Department of Women's and Children's Health, University of Leipzig Medical Center, Leipzig, Germany
| | - Christoph Härtel
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - Olaf Dammann
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Egbert Herting
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Oliver Andres
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - Christian P Speer
- Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany
| | - Wolfgang Göpel
- Department of Pediatrics, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Andreas Stahl
- Department of Ophthalmology, University Medicine Greifswald, Greifswald, Germany
| |
Collapse
|
11
|
Deliyanti D, Suphapimol V, Ang P, Tang X, Jayasimhan A, Wilkinson-Berka JL. Early Depletion of Neutrophils Reduces Retinal Inflammation and Neovascularization in Mice with Oxygen-Induced Retinopathy. Int J Mol Sci 2023; 24:15680. [PMID: 37958664 PMCID: PMC10648252 DOI: 10.3390/ijms242115680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/22/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Retinal inflammation is a central feature of ocular neovascular diseases such as diabetic retinopathy and retinopathy of prematurity, but the contribution of neutrophils to this process is not fully understood. We studied oxygen-induced retinopathy (OIR) which develops in two phases, featuring hyperoxia-induced retinal vaso-obliteration in phase I, followed by retinal neovascularization in phase II. As neutrophils are acute responders to tissue damage, we evaluated whether neutrophil depletion with an anti-Ly6G mAb administered in phase I OIR influenced retinal inflammation and vascular injury. Neutrophils were measured in blood and spleen via flow cytometry, and myeloperoxidase, an indicator of neutrophil activity, was evaluated in the retina using Western blotting. Retinal vasculopathy was assessed by quantitating vaso-obliteration, neovascularization, vascular leakage, and VEGF levels. The inflammatory factors, TNF, MCP-1, and ICAM-1 were measured in retina. In the OIR controls, neutrophils were increased in the blood and spleen in phase I but not phase II OIR. In OIR, the anti-Ly6G mAb reduced neutrophils in the blood and spleen, and myeloperoxidase, inflammation, and vasculopathy in the retina. Our findings revealed that the early rise in neutrophils in OIR primes the retina for an inflammatory and angiogenic response that promotes severe damage to the retinal vasculature.
Collapse
Affiliation(s)
| | | | | | | | | | - Jennifer L. Wilkinson-Berka
- Department of Anatomy and Physiology, School of Biomedical Sciences, University of Melbourne, Parkville, VIC 3010, Australia; (D.D.); (V.S.); (P.A.); (X.T.); (A.J.)
| |
Collapse
|
12
|
Abstract
Retinopathy of prematurity (ROP) is a complex disease involving development of the neural retina, ocular circulations, and other organ systems of the premature infant. The external stresses of the ex utero environment also influence the pathophysiology of ROP through interactions among retinal neural, vascular, and glial cells. There is variability among individual infants and presentations of the disease throughout the world, making ROP challenging to study. The methods used include representative animal models, cell culture, and clinical studies. This article describes the impact of maternal-fetal interactions; stresses that the preterm infant experiences; and biologic pathways of interest, including growth factor effects and cell-cell interactions, on the complex pathophysiology of ROP phenotypes in developed and emerging countries.
Collapse
|
13
|
Ingvaldsen SH, Moljord K, Grøtting A, Omland PM, Dammann O, Austeng D, Morken TS. Retinal structure and visual pathway function at school age in children born extremely preterm: a population-based study. BMC Ophthalmol 2023; 23:296. [PMID: 37393251 DOI: 10.1186/s12886-023-03055-4] [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: 03/30/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Children born extremely preterm (gestational age < 28 weeks) show reduced visual function even without any cerebral or ophthalmological neonatal diagnosis. In this study, we aimed to assess the retinal structure with optical coherence tomography (OCT) and visual function with pattern-reversal visual evoked potentials (PR-VEPs) in a geographically defined population-based cohort of school-aged children born extremely preterm. Moreover, we aimed to explore the association between measures of retinal structure and visual pathway function in this cohort. METHODS All children born extremely preterm from 2006-2011 (n = 65) in Central Norway were invited to participate. Thirty-six children (55%) with a median age of 13 years (range = 10-16) were examined with OCT, OCT-angiography (OCT-A), and PR-VEPs. The foveal avascular zone (FAZ) and circularity, central macular vascular density, and flow were measured on OCT-A images. Central retinal thickness, circumpapillary retinal nerve fibre layer (RNFL) and inner plexiform ganglion cell layer (IPGCL) thickness were measured on OCT images. The N70-P100 peak-to-peak amplitude and N70 and P100 latencies were assessed from PR-VEPs. RESULTS Participants displayed abnormal retinal structure and P100 latencies (≥ 2 SD) compared to reference populations. Moreover, there was a negative correlation between P100 latency in large checks and RNFL (r = -.54, p = .003) and IPGCL (r = -.41, p = .003) thickness. The FAZ was smaller (p = .003), macular vascular density (p = .006) and flow were higher (p = .004), and RNFL (p = .006) and IPGCL (p = .014) were thinner in participants with ROP (n = 7). CONCLUSION Children born extremely preterm without preterm brain injury sequelae have signs of persistent immaturity of retinal vasculature and neuroretinal layers. Thinner neuroretinal layers are associated with delayed P100 latency, prompting further exploration of the visual pathway development in preterms.
Collapse
Affiliation(s)
- Sigrid Hegna Ingvaldsen
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway.
- Department of Ophthalmology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Kyrre Moljord
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Ophthalmology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Arnstein Grøtting
- Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Petter Moe Omland
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Olaf Dammann
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Dordi Austeng
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Ophthalmology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tora Sund Morken
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Ophthalmology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
14
|
Hu Z, Xu W, Yang X, Li Y, Ma R, Hei Y, Hu J, Zhang Z, Wang L, Wang Y. SIRT2 inhibition attenuates the vasculopathy and vision impairment via Akt signaling in retinopathy of prematurity. Exp Eye Res 2023:109547. [PMID: 37348672 DOI: 10.1016/j.exer.2023.109547] [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: 02/15/2023] [Revised: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
Despite decades of research, the underlying mechanism of retinopathy of prematurity (ROP) remains unclear. The role of Sirt2, which is involved in both angiogenesis and inflammation, both pivotal in ROP, was investigated in an animal model of ROP known as oxygen-induced retinopathy (OIR). Our study found that Sirt2 was overexpressed and colocalized with microglia in OIR. Furthermore, it demonstrated that the level of Sirt2 was upregulated in hypoxia microglia BV-2 in vitro. Subsequently, our results elucidated that administration of the Sirt2 antagonist AGK2 attenuated the avascular and neovascular area and downregulated the expression of IGF-1. The phosphorylation of Akt and the expression of IGF-1 were upregulated in hypoxia BV-2 and conditional media collected from BV-2 under hypoxia promoted the migration and tube formation of retinal capillary endothelial cells, which were suppressed with AGK2. Notably, our findings are the first to demonstrate the deleterious role of Sirt2 in ROP, as Sirt2 inhibition led to the downregulation of Akt/IGF-1 and ameliorated vasculopathy, ultimately improving visual function. These results suggest that Sirt2 may be a promising therapeutic target for ROP.
Collapse
Affiliation(s)
- Zhicha Hu
- Department of Ophthalmology of the Third Medical Center of PLA General Hospital, PR China
| | - Wenqi Xu
- Department of Ophthalmology of the Third Medical Center of PLA General Hospital, PR China
| | - Xinji Yang
- Department of Ophthalmology of the Third Medical Center of PLA General Hospital, PR China
| | - Yueyue Li
- Department of Ophthalmology of the Third Medical Center of PLA General Hospital, PR China
| | - Rui Ma
- Department of Ophthalmology of the Third Medical Center of PLA General Hospital, PR China
| | - Yan Hei
- Department of Ophthalmology of the Third Medical Center of PLA General Hospital, PR China
| | - Jian Hu
- Department of Ophthalmology of the Third Medical Center of PLA General Hospital, PR China
| | - Zifeng Zhang
- Department of Ophthalmology, Eye Institute of China PLA, Xijing Hospital, the Fourth Military Medical University, PR China.
| | - Liqiang Wang
- Department of Ophthalmology of the Third Medical Center of PLA General Hospital, PR China.
| | - Yusheng Wang
- Department of Ophthalmology, Eye Institute of China PLA, Xijing Hospital, the Fourth Military Medical University, PR China.
| |
Collapse
|
15
|
Hartnett ME. How can the safety of antibody therapy for retinopathy of prematurity be improved? EXPERT REVIEW OF OPHTHALMOLOGY 2023; 18:97-99. [PMID: 37485085 PMCID: PMC10358718 DOI: 10.1080/17469899.2023.2200934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/05/2023] [Indexed: 07/25/2023]
|
16
|
Hematologic Risk Factors for the Development of Retinopathy of Prematurity—A Retrospective Study. CHILDREN 2023; 10:children10030567. [PMID: 36980125 PMCID: PMC10047256 DOI: 10.3390/children10030567] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023]
Abstract
(1) Background: Retinopathy of prematurity (ROP) can cause severe visual impairment or even blindness. We aimed to assess the hematological risk factors that are associated with different stages of ROP in a cohort of preterm newborns, and to compare the clinical characteristics and therapeutic interventions between groups. (2) Methods: This retrospective study included 149 preterm newborns from a tertiary maternity hospital in Romania between January 2018 and December 2018, who were segregated into: Group 1 (with ROP, n = 59 patients), and Group 2 (without ROP, n = 90 patients). The patients that were affected by ROP were subsequently divided into the following subgroups: Subgroup 1 (Stage 1, n = 21), Subgroup 2 (Stage 2, n = 35), and Subgroup 3 (Stage 3, n = 25). The associations were analyzed using multivariate logistic regression and sensitivity analysis. (3) Results: Platelet mass indexes (PMI) that were determined in the first, seventh, and tenth days of life were significantly associated with Stage 1 ROP. PMI determined in the first day of life was also significantly associated with Stage 2 ROP. The sensitivity and specificity of these parameters were modest, ranging from 44 to 57%, and 59 to 63%. (4) Conclusions: PMI has a modest ability to predict the development of ROP.
Collapse
|
17
|
Antenatal and Postnatal Sequelae of Oxidative Stress in Preterm Infants: A Narrative Review Targeting Pathophysiological Mechanisms. Antioxidants (Basel) 2023; 12:antiox12020422. [PMID: 36829980 PMCID: PMC9952227 DOI: 10.3390/antiox12020422] [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: 01/23/2023] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
The detrimental effects of oxidative stress (OS) can start as early as after conception. A growing body of evidence has shown the pivotal role of OS in the development of several pathological conditions during the neonatal period, which have been therefore defined as OS-related neonatal diseases. Due to the physiological immaturity of their antioxidant defenses and to the enhanced antenatal and postnatal exposure to free radicals, preterm infants are particularly susceptible to oxidative damage, and several pathophysiological cascades involved in the development of prematurity-related complications are tightly related to OS. This narrative review aims to provide a detailed overview of the OS-related pathophysiological mechanisms that contribute to the main OS-related diseases during pregnancy and in the early postnatal period in the preterm population. Particularly, focus has been placed on pregnancy disorders typically associated with iatrogenic or spontaneous preterm birth, such as intrauterine growth restriction, pre-eclampsia, gestational diabetes, chorioamnionitis, and on specific postnatal complications for which the role of OS has been largely ascertained (e.g., respiratory distress, bronchopulmonary dysplasia, retinopathy of prematurity, periventricular leukomalacia, necrotizing enterocolitis, neonatal sepsis). Knowledge of the underlying pathophysiological mechanisms may increase awareness on potential strategies aimed at preventing the development of these conditions or at reducing the ensuing clinical burden.
Collapse
|