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

Levels of Trace Elements in the Lens, Aqueous Humour, and Plasma of Cataractous Patients-A Narrative Review

Cataracts are one of the most common causes of effective vision loss. Although most cases of cataracts are related to the ageing process, identifying modifiable risk factors can prevent their onset or progression. Many studies have suggested that micro and macroelement levels, not only in blood serum but also in the lens and aqueous humour, may affect the risk of the occurrence and severity of cataracts. This systematic review aims to summarise existing scientific reports concerning the importance of trace elements in cataractogenesis. Many authors have pointed out elevated or decreased levels of particular elements in distinct ocular compartments. However, it is not known if these alterations directly affect the increased risk of cataract occurrence. Further studies are needed to show whether changes in the levels of these elements are correlated with cataract severity and type. Such information would be useful for determining specific recommendations for micronutrient supplementation in preventing cataractogenesis.

Salt, Hypertension, and the Lens

BACKGROUND

Salt is important in the pathogenesis of hypertension (HT). Salt-sensitive hypertension (SSH) accounts for about half of all HT cases. In SSH, sodium/potassium adenosine triphosphatase (Na⁺/K⁺-ATPase) activity is impaired. Impaired Na⁺/K⁺-ATPase activity in the lens epithelium results in cortical opacities in the peripheral equator of the lens. We investigated the sensitivity of cortical lens opacities in detecting SSH.

METHODS

The study included 191 SSH and 159 non-SSH, salt-resistant HT (SRH) patients (350 HT patients total), aged 40-80 years. One hundred twenty-four sex- and age-matched patients without a HT diagnosis made up the control group. Daily salt intake of all groups was calculated from 24-hr urinary Na excretion. SSH was diagnosed when the difference in mean arterial blood pressure values obtained during high- and low-Na diets was ≥10%. Non-SSH, SRH was diagnosed when the difference was <10%.Two researchers examined the presence of cortical lens opacities biomicroscopically using the diffuse, direct, Scheimpflug, and retroillumination from fundus methods.

RESULTS

Total lens opacity was predictive of SSH among all cases (P < 0.001), with a sensitivity and specificity of 75.4% [95% confidence interval (CI): 68.6-81.3] and 83.6% (95% CI: 77.0-89.0), respectively. Its positive and negative predictive values were 84.7% (95% CI: 79.4-88.8) and 73.9% (95% CI: 68.6-78.5), respectively.

CONCLUSIONS

Lens opacities can be used as a finding that can be easily observed in the detection of SSH and excess salt intake.

Expression, regulation and function of Na,K-ATPase in the lens

Na,K-ATPase is responsible for maintaining the correct concentrations of sodium and potassium in lens cells. Na,K-ATPase activity is different in the two cell types that make up the lens, epithelial cells and fibers; specific activity in the epithelium is higher than in fibers. In some parts of the fiber mass Na,K-ATPase activity is barely detectable. There is a large body of evidence that suggests Na,K-ATPase-mediated ion transport by the epithelium contributes significantly to the regulation of ionic composition in the entire lens. In some species different Na,K-ATPase isoforms are present in epithelium and fibers but in general, fibers and epithelium express a similar amount of Na,K-ATPase protein. Turnover of Na,K-ATPase by protein synthesis may contribute to preservation of high Na,K-ATPase activity in the epithelium. In ageing lens fibers, oxidation, and glycation may decrease Na,K-ATPase activity. Na,K-ATPase activity in lens fibers and epithelium also may be subject to regulation as the result of protein tyrosine phosphorylation. Moreover, activation of G protein-coupled receptors by agonists such as endothelin-1 elicits changes of Na,K-ATPase activity. The asymmetrical distribution of Na,K-ATPase activity in the epithelium and fibers may contribute to ionic currents that flow in and around the lens. Studies on human cataract and experimental cataract in animals reveal changes of Na,K-ATPase activity but no clear pattern is evident. However, there is a convincing link between abnormal elevation of lens sodium and the opacification of the lens cortex that occurs in age-related human cataract.

Oxidative damage to mouse lens in culture. Protective effect of pyruvate

Studies have been conducted to examine the feasibility of preventing oxyradical-dependent oxidative stress to mouse lens in culture, using pyruvate as an antioxidant. The extent of oxidative damage to the tissue was assessed by measurement of the status of Na(+)-K(+) ATPase dependent active transport of rubidium 86Rb(+). The tissue levels of adenosine triphosphate (ATP), glutathione (GSH), malonaldehyde (MDA) and catalase were also determined. While the measurement of 86Rb(+) uptake provides an assessment of the integrity of the primary active transport system, measurement of the other components reflects the status of intracellular oxidative stress. ATP measurement also reflected on the overall status of metabolic integrity. Incubation of the lens with xanthine (XA)/xanthine oxidase (XO) system had an adverse effect on all these parameters. Incorporation of pyruvate was strikingly protective. The protective effect of pyruvate is apparently due to its ability to scavenge ROS generated in the medium with the possibility of its action on tissue metabolism as well. The findings are hence considered useful for further studies on the prevention of oxidative stress to tissues by exogenous supplementation with pyruvate, specially the human lens where the biochemistry of its antioxidant mechanisms is similar to the mouse lens, contrary to the rat lens.

Changes in the energy metabolism of cultured lens epithelial cells in comparison with the fresh lens

Energy metabolism of bovine cultured lens epithelial cells (CLEC) was compared to that of fresh bovine lens. CLEC contained high levels of ATP (44 nmol mg protein-1) and creatine phosphate (13 nmol mg protein-1). An ATP/ADP ratio of ten and a creatine phosphate/creatine ratio of two indicated the cells were in a well-energized state. ATP concentration in fresh epithelium was comparable to that of CLEC; however in the anterior cortex it was tenfold lower. In contrast to fresh lenses, CLEC were able to oxidize glucose, lactate and palmitic acid. Lactate was oxidized at the highest rate. In CLEC, 42% of the ATP generated by catabolizing glucose resulted from oxidative phosphorylation. Glucose (5 mM) was degraded to lactate and CO2 at a 2:1 ratio. The hexose monophosphate pathway accounted for two thirds of the CO2 produced. In the fresh whole bovine lens palmitate was not oxidized and lactate was oxidized to a lesser degree than in CLEC. Only one-tenth of the ATP generated by glucose catabolism in the fresh whole lens was derived from oxidative phosphorylation. This was also the case for a preparation of fresh epithelium, maintained in air and 100% oxygen, demonstrating that the preferential glycolytic catabolism of glucose in lens is not caused by limited oxygen diffusion. In the fresh bovine lens the epithelium accounted for one third of the glucose catabolism of the whole lens, even though it had only about 0.1% of its protein mass. In fresh human lenses, conversion of glucose into lactate was even more pronounced--the lactate/CO2 ratio was 73:1.(ABSTRACT TRUNCATED AT 250 WORDS)

Nucleotide levels in human lens: regional distribution in different forms of senile cataract

Sensitive high-performance liquid chromatography methods were employed to assess regional distribution of adenine, guanosine and uridine nucleotides in clear and cataractous human eye lenses. According to slit-lamp examination, three forms of senile cataract were distinguished: (1) supranuclear or deep cortical cataract (typical senile cataract), (2) primary nuclear cataract (cataracta brunescens) and (3) subcapsular cortical cataract associated either with a supranuclear (3a) or a secondary nuclear cataract (3b). Except for AMP, which was highest in the nuclear fraction, all other nucleotides (ATP, ADP, GTP, and UTP) were predominantly located in the anterior cortex (plus epithelium) of clear as well as cataractous lenses, that is, ATP levels in the nucleus amounted to 20% of those found in the anterior cortex (plus epithelium); ATP levels in the posterior cortex were about 60% of those in the anterior cortex (plus epithelium). Significant differences in the absolute regional nucleotide level existed between the different forms of cataract. Highest ATP levels were found in the anterior cortex (plus epithelium) of clear lenses and deep or supranuclear cortical cataract. The ATP level was slightly diminished in primary nuclear cataract and in supranuclear cortical cataract when associated with an early subcapsular cortical cataract. ATP levels were depressed to less than 30% in the anterior cortex (plus epithelium) of lenses with a subcapsular cortical cataract when associated with either an early secondary nuclear or a mature cataract. Furthermore, the ATP/ADP ratio was decreased in this form of senile cataract. The decrease in lens nucleotide level did not correlate with increased age. These data suggest that decreases in regional ATP level are a secondary event and do not appear to be causally involved in the genesis of the 'cataracta senilis'.