In vitro production of steroid cataract in bovine lens. Part II: measurement of sodium-potassium adenosine triphosphatase activity

Topical use of rapamycin in herpetic stromal keratitis

PURPOSE

To evaluate and compare the efficacy of rapamycin used topically in a mouse model of herpetic stromal keratitis.

METHODS

The corneas were infected with herpes simplex virus type-1 strain KOS. Animals were divided into: control (CG), rapamycin (RAPA), cyclosporine (CsA), and dexamethasone (DEXA). The evolution of the disease was assessed clinically and histologically.

RESULTS

On day 10 postinfection (pi), the RAPA group showed only a significantly lower angiogenic development than the CG. On day 14 pi, the treated groups had significantly lower scores for angiogenesis and necrosis than the CG. Also, on day 14 pi, the RAPA and DEXA groups showed significantly lower histopathological scores compared to the CG.

CONCLUSIONS

The topical application of 0.05% rapamycin showed greater efficacy than 0.5% cyclosporine and similar efficacy to 0.1% dexamethasone to minimize the immuno-inflammatory process. Also, rapamycin showed early inhibition of the formation of new vessels.

Cell adhesion molecule expression in human lens epithelial cells after corticosteroid exposure

Aim:

The aim of the study was to investigate changes in cell adhesion molecule expression in human lens epithelial cells (HLEC) subjected to glucocorticoids.

Methods:

Human lens epithelial cells were exposed to different concentrations of dexamethasone for 24 hours. Cell adhesion molecule expression was studied by western blot and immunohistochemistry of vimentin, N-cadherin, E-cadherin, α-catenin, β-catenin and γ-catenin. Expression of the glucocorticoid receptor (GR) was also studied. Cell morphology was examined by transmission electron microscopy (TEM).

Result:

Expression of N-cadherin, α-catenin, β-catenin and GR was significantly decreased in dexamethasone exposed cells as compared to unexposed cells. No significant change in γ-catenin was present. Visualization of adhesion molecules, N-cadherin and α-catenin, by immunohistochemistry showed decreased antigen reactivity in dexamethasone exposed as compared to the unexposed cells. However, no change was seen for β-catenin and γ-catenin. E-cadherin was not detectable using western blot or immunohistochemistry.

TEM showed multilayering of cells, vacuole formation and appearance of electron-dense multivesicular bodies in HLEC exposed to 0, 0.1, 1, 10 and 100 αM dexamethasone.

Conclusion:

Glucocorticoids affect several adhesion molecules in lens epithelial cells, something that may contribute to the pathogenesis of posterior subcapsular opacification.

Inhibition of glucocorticoid-induced changes of Na(+), K(+)-ATPase in rat lens by a glucocorticoid receptor antagonist RU486

Cataract formation can be induced by prolonged use of glucocorticoids. The underlying mechanism is not fully understood yet. The presence of the functional glucocorticoid receptor (GR) in human and rat lens epithelial cells suggests that glucocorticoids target lens epithelial cells directly and specifically. Na(+), K(+)-ATPase has long been recognized for its role in regulating electrolyte concentration in the lens, contributing to lens transparency. We previously reported that the inactivation of Na(+), K(+)-ATPase induced by a glucocorticoid in rat lens. Therefore, the question is whether the changes of Na(+), K(+)-ATPase can be induced through the specific GR activation in glucocorticoid-induced cataract formation. Clear rat lenses were cultured in vitro and were treated with or without dexamethasone (Dex) or RU486 (a GR antagonist). The lenses were cultured for 7 days and photographed daily to record the development of opacity. The activity of Na(+), K(+)-ATPase was determined by using spectrophotometric analysis. The mRNA and protein level expressions of Na(+), K(+)-ATPase α1 were examined by reverse transcription polymerase chain reaction (RT-PCR), Western blot and immunohistochemistry analysis, respectively. Our findings are presented in this study and show that mist-like opacity of the lens was observed as early as 5 days after incubation with dexamethasone. The opacity was more obvious at day 7 in the Dex group. The lenses of the untreated group and the RU486+Dex group remained transparent throughout the incubation. The activity of Na(+), K(+)-ATPase in the Dex-treated group decreased in a time-dependent manner. There was no significant loss of enzyme activity in either the control or the RU486+Dex group throughout the incubation period. Both the protein and mRNA expression levels of Na(+), K(+)-ATPase α1 in the capsule-epithelium of lenses decreased in the Dex-treated group. The GR antagonist RU486 inhibited the decrease of the expression of Na(+), K(+)-ATPase α1 induced by Dex. All of the above results suggested that the GR-mediated reduction of Na(+), K(+)-ATPase may contribute to the formation of steroid-induced cataract. Intervention in this pathway maybe helpful to avoid glucocorticoids-cataract formation.

Advances in pharmacological strategies for the prevention of cataract development

Cataractous-opacification of the lens is one of the leading causes of blindness in India. The situation can be managed by surgical removal of the cataractous lens. Various pharmacological strategies have been proposed for the prevention and treatment of cataract. Information on possible benefits of putative anticataract agents comes from a variety of approaches, ranging from laboratory experiments, both in vitro and in vivo, to epidemiological studies in patients. This review deals with the various mechanisms, and possible pharmacological interventions for the prevention of cataract. The article also reviews research on potential anticataractous agents, including aldose reductase inhibitors, glutathione boosters, antiglycating agents, vitamins and various drugs from indigenous sources.

In vitro production of sterioid cataract in bovine lens. Part I: measurement of optical changes

Fresh calf lenses were incubated in nutritive media, to which was added ouabain and dexamethasone phosphate at concentrations of 1 X 10(-4) M. At the end of a three day incubation period, cortical opacification developed in the control series of lenses as well as those lenses incubated in both ouabain and dexamethasone phosphate. Using a light transmission device which quantitates lens opacification, it was noted that dexamethasone produced a level of cortical opacification significantly greater than that of the control series. Ouabain produced a level of cortical opacification statistically identical to that produced by the dexamethasone. It is suggested that the aforementioned light transmission device is an accurate and reproducible method of quantitating cataractous opacification.

What causes steroid cataracts? A review of steroid-induced posterior subcapsular cataracts

Prolonged use of glucocorticoids is a significant risk factor for the development of posterior subcapsular cataract. This places restrictions on the use of glucocorticoids in the treatment of systemic and/or ocular inflammatory conditions as well as in organ transplantation. The mechanisms responsible for the opacification are unknown and no effective treatment, other than surgical removal of the lens, is available. Difficulties in establishing suitable in vivo or in vitro models have limited research in this area. Nevertheless, several mechanisms, based on observations with other types of cataracts, have been proposed. In this review, these mechanisms are evaluated in light of the evidence available. A novel mechanism is also proposed, in which steroids do not directly act on the lens but rather affect the balance of ocular cytokines and growth factors.

Characterization of membrane steroid binding protein mRNA and protein in lens epithelial cells

Epithelial cells of the ocular lens contain a 28 kDa membrane protein which is proposed to mediate high affinity binding of steroid hormones and rapid non-genomic actions of steroid hormones. It has been named membrane steroid binding protein (MSBP). Our purpose was to further characterize this protein from cultured bovine lens epithelial cells (BLEC) and compare it to similar forms of the protein present in other species and tissues. The size of the protein's mRNA was examined by Northern blot analysis using a digoxigenin-labelled antisense riboprobe. The sequence of the mRNA was obtained by RT-PCR amplification of poly A+ RNA recovered from cultured BLEC. PCR amplification was conducted using three sets of nested sense and antisense primers, one set at a time. The amino acid sequence of the lens protein was deduced from the revealed cDNA sequence. The hydropathy of the protein was examined by Kyte-Doolittle plots. The sequence of the lens protein's cDNA (about 1.7 kb total) described an open reading frame of 582 residues which coded for a protein of 194 amino acids. The presence of a C-terminal isoprenylation motif suggested by earlier work was not found in the coding region. The deduced amino acid sequence of the lens protein was extremely similar to those of other species and tissues, being 95-98% homologous with that of the other members. All of the MSBPs apparently contain a single membrane spanning domain in the amino terminal. The highly conserved nature of this protein implies a useful function to the cell. We speculate that the protein is a receptor which mediates rapid actions of steroids on lens epithelial cells, such as calcium mobilization, and that the protein plays a role in the mechanism of steroid induced cataracts.

Is there a glucocorticoid receptor in the bovine lens?

Prolonged glucocorticoid therapy is a risk factor for cataract development. The mechanism remains unknown. If cataract results from the direct effect of steroids on lens function, a glucocorticoid receptor is required. In order to determine whether such a receptor was present in the bovine lens, metabolic and steroid binding experiments were undertaken. Cultured bovine lens epithelial cells were exposed to 10(- 4)and 10(-8) M dexamethasone or prednisolone and the uptake and incorporation of(14)C leucine,(14)C glucose and(3)H thymidine, examined. Neither glucocorticoid affected cell protein synthesis or glucose uptake. Both dexamethasone concentrations and the lower concentration of prednisolone had no effect on thymidine uptake or incorporation, however, the 10(-4) M prednisolone exposure reduced these by 15 +/- 5%. This regulation is thought to be due to membrane fluidity changes and not the action of the glucocorticoid receptor. As the glucocorticoid receptor is very heat labile in vitro, the effects of increasing temperature on dexamethasone binding by proteins from lens epithelium, lens nucleus and liver were examined. At 0 degree C, lens epithelial extract bound nine-fold more dexamethasone than liver extract. After exposure to 37 degrees C, liver binding decreased by 66% whereas that for lens epithelium increased by 18%. For both lens extracts, steroid binding increased with temperature up to 50 degrees C. Scatchard analysis of the steroid binding kinetics showed there to be no high affinity sites in lens epithelial extract, with the binding best described as a non-specific partitioning event. Western blotting with a specific glucocorticoid receptor antibody revealed protein bands of approximately 94 and 79 kDa in liver, which is known to contain significant levels of receptor. No immunoreactivity was observed for lens epithelial extract. Therefore, within the limits of detection, these results suggest the bovine lens does not contain a glucocorticoid receptor. This raises questions about the validity of receptor-mediated mechanisms proposed for cataract development.

Steroid adduct formation with lens crystallins

BACKGROUND: Development of steroid cataract is a likely outcome following prolonged exposure to glucocorticoids. It has been suggested that formation of steroid-protein adducts is a key event in this lens opacification. In order to explore this possibility, we have monitored the reaction of bovine lens proteins with glucocorticoids and examined the effects of adduct formation on their structures. METHODS: Bovine lens proteins were incubated with high (10(-4) M) and low (10(-8) M) concentrations of dexamethasone or prednisolone for up to 56 days at 37 degrees Celsius. Changes in molecular size and solubility of the crystallins and their polypeptide subunits were examined using gel permeation chromatography and SDS gel electrophoresis. Conformational changes were assessed with the aid of tryptophan fluorescence spectroscopy and oxidation was monitored by measuring protein sulphydryl content. RESULTS: Covalent incorporation of glucocorticoids was observed for all crystallins with relative reactivities for alpha-: beta-: gamma-crystallin of 20: 5: 1. The maximum incorporated was one steroid molecule per 40 to 50 subunits of alpha-crystallin. The proportions and sizes of the soluble crystallins and their subunits were unchanged. Protein sulphydryl contents decreased by eight to 10 per cent more than controls but no intermolecular disulphide bonds were detected. There were no alterations in tryptophan microenvironments. CONCLUSIONS: Steroids form adducts with lens proteins, in particular alpha-crystallin, but it appears unlikely that this reaction is responsible for steroid cataract formation.

The relationship between cataract, cell swelling and volume regulation

The cause of cataracts is not known. Data from epidemiological and case-control studies have suggested various risk factors, among them; sunlight, diabetes, diarrhoea, oxidative stress, smoking and alcohol. Many reports in the literature suggest that the hydrated state of the lens is linked to cataract and recently direct evidence has emerged linking lens swelling to cataract. This review attempts to collate the various strands of evidence relating the hydrated state of the lens in cataract and to construct a common pathway for cataractogenesis. This common pathway involves lens swelling, membrane permeabilization, vacuole and cleft formation, disturbance to the intracellular environment, protein aggregation/modification and light scatter. This hypothesis gives rise to some testable predictions amongst which is that under certain conditions the lens axial diameter will increase raising the possibility that pre-cataractous changes could be detected (e.g., by ultrasound) and, with appropriate action, the cataract could be prevented or delayed. There are encouraging signs from animal studies that certain types of lens opacification can be delayed or prevented, lending credibility to the objective of cataract prevention in humans. Even a delay in the onset of cataract would have a huge global impact. The incidence of cataract correlates with poverty, poor diet and poor hygiene and the vast majority of cataract is found in developing countries. Economic factors and a lack of cataract surgeons in these countries mean that surgery is not the long-term answer. Prevention is the only realistic global approach. This review concludes that detection of pre-cataractous changes and cataract prevention are achievable objectives and funds should be directed towards their realization.

Steroid-induced cataract: new perspective from in vitro and lens culture studies

The prevailing view regarding the mechanism of steroid cataract formation holds that glucocorticoids are covalently bound to lens proteins resulting in destabilization of the protein structure allowing further modification (i.e. oxidation) leading to cataract. Alternative hypotheses (e.g. that cataracts result from glucocorticoid receptor mediated effects) have been difficult to test since protein binding does in fact occur for many cataractogenic steroids. A glucocorticoid lacking the typical glucocorticoid hydroxy group at C21 (fluorometholone, FML), other steroids which can bind to proteins but lack glucocorticoid activity, and a glucocorticoid antagonist (RU486) have been utilized to discriminate between these two hypotheses. Purified bovine beta-crystallin incubated with three different 3H-steroids, dexamethasone (Dex), aldosterone or progesterone demonstrated that the C-21 hydroxyl group is not essential for steroid binding. Progesterone (with no C-21 OH) bound to the greatest extent. Pretreatment of the protein with aspirin to acetylate the free protein amino groups blocked this binding, demonstrating the probability of a Schiff base mechanism. Lens culture studies with the same three radiolabeled steroids demonstrated much the same result. Rat lenses cultured for 48 hr-11 days, demonstrated that loss of GSH is an early and significant effect of several glucocorticoids (Dex, prednisolone and FML) but is not seen with other non-glucocorticoid steroids. However, none of the steroids tested consistently produced lenticular opacification (i.e. cataracts) in this in vitro system, nor did they alter rubidium transport. We suggest that a mechanism other than covalent binding of steroids to lens proteins is responsible for glucocorticoid induced cataracts because: (1) non-glucocorticoids were demonstrated to bind lens proteins as well or better than the glucocorticoid Dex and (2) only glucocorticoids, and not other steroids, lowered lens reduced glutathione content which has been demonstrated to be associated with other forms of cataract.

Glucocorticoid-induced cataract of developing chick embryo as a screening model for anticataract agents

In order to develop an effective screening model for anticataract agents, we examined the age dependence of cataract induction by glucocorticoid in developing chick embryos. Hydrocortisone sodium succinate (0.25 mumol) was administered to chick embryos on day 15 (15-day-old) and cataract formation was examined 48 hr later. Administration earlier than on day 13 or later than on day 15 was a little or ineffective. These results indicate that the formation of glucocorticoid-induced cataract in developing chick embryos depends on developing stages. The embryos treated with hydrocortisone sodium succinate on day 15 decreased GSH amount in the lens, approximately 50% of the control in 48hr. However, the embryos treated at other ages, in which cataract was not induced, showed little or no decrease of GSH. The cataract formation in chick embryos appeared to depend on structure of steroid and was due to biological activities of glucocorticoids. Since cataract is easily produced in a reproducible manner with high incidence by glucocorticoid, our chick embryo model will be a valuable model system for screening anticataract agents.

Cataract as a complication of severe microbial keratitis

Complicated cataract results from local ocular disease; we report five cases that followed severe anterior segment infection. Three patients had Pseudomonas keratitis and two Acanthamoeba keratitis. All patients had severe keratitis and iridocyclitis. Mature cataracts developed after a mean of 5.5 months from the onset. Cataract formation with severe keratitis may be attributable to bacterial toxins, iridocyclitis and treatment toxicity. All these factors may cause cataract by interference with lens metabolism. One of our cases had no steroid treatment; the remaining four had between 7.7 and 28.14 mg of topical steroid (256-938 drops of Dexamethasone 0.1%). Cataract formation may result from severe microbial keratitis alone but is probably enhanced by concurrent treatment with high doses of topical steroid. The potential for cataract formation must be considered when managing microbial keratitis with the use of steroids and when planning surgical rehabilitation of the anterior segment.

The human lens epithelium; morphological and ultrastructural changes associated with steroid therapy

A distinct disturbance to the structure of the lens epithelium was observed in cataract patients receiving steroid medication. Of those cataract patients receiving steroids, 83% exhibited a reticulated pattern of intercellular clefts compared to 5% in the control group. The reticulated pattern was shown to be due to the presence of gaps between the lateral borders of the epithelial cells by electron microscopy. A significant correlation between steroid therapy and epithelial disruption was demonstrated. The significance of such epithelial disruption to cataract formation is discussed.

Corticosteroid-induced cataracts

The association linking corticosteroid therapy with the development of posterior subcapsular cataracts has been well documented. These drugs are widely used therapeutically, principally to capitalize on their ability to inhibit inflammatory responses. The literature on corticosteroid-induced posterior subcapsular cataracts is reviewed here. Data from the previously published series and individual lens susceptibility to corticoids do not allow the establishment of a direct factor relating cataract formation to corticosteroid dose and the duration of therapy; however, significant progress has been made in elucidating the mechanism by which corticoids bring about the development of these opacities. Exploration into the development of these lesions has shed light on the similarities these opacities share with other cataracts, especially with regard to location and pathogenesis.

Glucocorticoid-lens protein adducts in experimentally induced steroid cataracts

The injection of glucocorticoids into the vitreous chamber of the rabbit eye results in the development of posterior subcapsular opacities. These lesions appear to be similar in morphology to human steroid-induced cataracts. Electron microscopic analysis revealed fiber cell separation, vacuolization, and changes within the matrix of the crystallins. Opacification could only be produced by glucocorticoids possessing a reactive C-20,21 hydroxylcarbonyl function, supporting the hypothesis that glucocorticoid addition products are involved in the induction of these lesions. The occurrence of glucocorticoid-lens proteins adducts was confirmed by tritium incorporation and by radioimmunoassay of protein hydrolysates obtained from these lenses.

Effect of corticosteroids on electrolyte transport of the isolated human and rabbit lens

In the isolated human lens, short circuit current was inhibited by pharmacological concentrations of 6-methylprednisolone and opacities occurred in the posterior subcapsular region in some lenses. The effect was seen only when the anterior (epithelial) surface of the lens was exposed. There was an increase of the short circuit current in the rabbit lens by 6-methyl-prednisolone and the lenses remained clear. Methylprednisolone effects were seen in spite of Na-K-ATPase inhibition by ouabain. Aldosterone had no effect on the translenticular potential difference, short circuit current and transparency. The data are discussed with respect to corticosteroid receptors in the lens epithelium and to the pathogenesis of steroid-associated cataract in man.

Preventive effect of ascorbic acid against glucocorticoid-induced cataract formation of developing chick embryos

Glucocorticoid administration to developing chick embryos is known to promote cataract formation with a decreasing level of glutathione in the lens. To gain further understanding of this process, the level of ascorbic acid, a biological antioxidant, in the lenses was measured during the course of glucocorticoid treatment. When 0.25 mumol of hydrocortisone hemisuccinate sodium (HC) were administered to 15-day-old chick embryos, the level of ascorbic acid in the lens began to decline after 30 hr and became around 40% of the control value at 48 hr after HC treatment. At this time about 90% of the lenses showed opacity in the nuclear region. However, the level of ascorbic acid in the cataractous lens recovered to the control level at 96 hr, a time when the lens has recovered from cataract formation. A triple application of ascorbic acid (20 mumol/egg) at 3, 10 and 20 hr after HC treatment significantly prevented lens opacification. The administration of ascorbic acid prevented the decline of ascorbic acid content and partially that of glutathione content in the lens caused by HC.

Human senile cataract and Na-K ATP'ase activity in the anterior lens structures with special reference to anterior capsular/subcapsular opacity

Location and in vitro determination of Na-K ATP'ase activity in the anterior structures of individual human lenses with senile cataract are reported, with special reference to anterior capsular/subcapsular opacity (ACSCO). Histochemically, ATP'ase reaction products were found exclusively in the epithelium. Even totally opaque lenses showed strong positive reactions. Biochemically, increasing ratios of Na+/K+ concentrations in the assay medium resulted in an increase in enzyme activity to a limited degree, whereafter the activity remained stable. We cannot decide whether the Na-K ATP'ase activity of the anterior lens structures is unchanged in relation to ACSCO as indicated by our figures. For there are methodological problems, although our analytical error, expressed as the variation coefficient for slaughterhouse pig lenses, seems to be one of the lowest so far reported in the literature on interindividual, non-pooled material.