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Zarnegar A, Valsecchi N, Sadeghi E, Shah S, Tang A, Yagobian S, Iannetta D, Chhablani J. Choroidal imaging biomarkers as predictors of conversion to exudative age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06611-w. [PMID: 39162805 DOI: 10.1007/s00417-024-06611-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/24/2024] [Accepted: 08/07/2024] [Indexed: 08/21/2024] Open
Abstract
PURPOSE Predicting the progression of intermediate AMD (iAMD) to neovascular AMD (nAMD) will help to identify high-risk patients and improve treatment outcomes. The present study assessed whether choroidal OCT biomarkers could predict conversion to nAMD. METHODS This retrospective study included patients with clinically stable iAMD who either converted to nAMD (C group) or did not convert (NC group) during one year of follow-up. OCT parameters included subfoveal choroidal thickness (SFCT), central macular thickness (CMT), Haller vascular thickness (HVT), inner choroidal thickness (ICT), and double-layer sign (DLS). RESULTS Of 116 total eyes, there were 37 in the NC group and 79 in the C group. Baseline SFCT was significantly lower in the C group compared to the NC group (169.0 ± 63.2 μm vs. 218.0 ± 97.8 μm, p = 0.01). Baseline HVT and ICT were lower in the C group (105.2 ± 40.6 μm vs. 121.0 ± 56.6 μm, p = 0.17 and 61.9 ± 35.5 μm vs. 77.5 ± 41.7 μm, p = 0.09). HVT was decreased at all time points in the C group vs NC (p > 0.05). The ICT was reduced in the C group at each time point except at conversion time (p > 0.05). Of all eight eyes who presented DLS at baseline, 100% converted to nAMD (p < 0.001). CONCLUSION Lower SFCT at baseline may signal conversion to nAMD within 12 months.
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Affiliation(s)
- Arman Zarnegar
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nicola Valsecchi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Ophthalmology Unit, Dipartimento Di Scienze Mediche E Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Elham Sadeghi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Stavan Shah
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anthony Tang
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shiva Yagobian
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Danilo Iannetta
- Ophthalmology Unit, Dipartimento Di Scienze Mediche E Chirurgiche, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Basyal D, Lee S, Kim HJ. Antioxidants and Mechanistic Insights for Managing Dry Age-Related Macular Degeneration. Antioxidants (Basel) 2024; 13:568. [PMID: 38790673 PMCID: PMC11117704 DOI: 10.3390/antiox13050568] [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: 03/18/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Age-related macular degeneration (AMD) severely affects central vision due to progressive macular degeneration and its staggering prevalence is rising globally, especially in the elderly population above 55 years. Increased oxidative stress with aging is considered an important contributor to AMD pathogenesis despite multifaceted risk factors including genetic predisposition and environmental agents. Wet AMD can be managed with routine intra-vitreal injection of angiogenesis inhibitors, but no satisfactory medicine has been approved for the successful management of the dry form. The toxic carbonyls due to photo-oxidative degradation of accumulated bisretinoids within lysosomes initiate a series of events including protein adduct formation, impaired autophagy flux, complement activation, and chronic inflammation, which is implicated in dry AMD. Therapy based on antioxidants has been extensively studied for its promising effect in reducing the impact of oxidative stress. This paper reviews the dry AMD pathogenesis, delineates the effectiveness of dietary and nutrition supplements in clinical studies, and explores pre-clinical studies of antioxidant molecules, extracts, and formulations with their mechanistic insights.
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Affiliation(s)
| | | | - Hye Jin Kim
- College of Pharmacy, Keimyung University, Dauge 42601, Republic of Korea
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3
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Fleckenstein M, Schmitz-Valckenberg S, Chakravarthy U. Age-Related Macular Degeneration: A Review. JAMA 2024; 331:147-157. [PMID: 38193957 DOI: 10.1001/jama.2023.26074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Importance Age-related macular degeneration (AMD) affects approximately 20 million people in the US and 196 million people worldwide. AMD is a leading cause of severe vision impairment in older people and is expected to affect approximately 288 million people worldwide by 2040. Observations Older age, genetic factors, and environmental factors, such as cigarette smoking, are associated with development of AMD. AMD occurs when extracellular deposits accumulate in the outer retina, ultimately leading to photoreceptor degeneration and loss of central vision. The late stages of AMD are characterized by outer retinal atrophy, termed geographic atrophy, or neovascularization associated with subretinal and/or intraretinal exudation, termed exudative neovascular AMD. The annual incidence of AMD ranges from 0.3 per 1000 in people who are aged 55 to 59 years to 36.7 per 1000 in people aged 90 years or older. The estimated heritability of late-stage AMD is approximately 71% (95% CI, 18%-88%). Long-term prospective cohort studies show a significantly higher AMD incidence in people who smoke more than 20 cigarettes per day compared with people who never smoked. AMD is diagnosed primarily with clinical examination that includes a special lens that focuses light of the slit lamp through the pupil. Exudative neovascular AMD is best identified using angiography and by optical coherence tomography. Individuals with AMD who take nutritional supplements consisting of high-dose vitamin C, vitamin E, carotenoids, and zinc have a 20% probability to progress to late-stage AMD at 5 years vs a 28% probability for those taking a placebo. In exudative neovascular AMD, 94.6% of patients receiving monthly intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections experience less than a 15-letter visual acuity loss after 12 months compared with 62.2% receiving sham treatment. Conclusions and Relevance The prevalence of AMD is anticipated to increase worldwide to 288 million individuals by 2040. Intravitreally administered anti-VEGF treatment is first-line therapy for exudative neovascular AMD.
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Affiliation(s)
| | - Steffen Schmitz-Valckenberg
- John A. Moran Eye Center, University of Utah Health, Salt Lake City
- Department of Ophthalmology, University of Bonn, Bonn, Germany
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An S, Yu H, Islam MDM, Zhang X, Zhan Y, Olivieri JJ, Ambati J, Yao J, Gelfand BD. Effects of donor-specific microvascular anatomy on hemodynamic perfusion in human choriocapillaris. Sci Rep 2023; 13:22666. [PMID: 38114564 PMCID: PMC10730623 DOI: 10.1038/s41598-023-48631-2] [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: 05/16/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023] Open
Abstract
Evidence from histopathology and clinical imaging suggest that choroidal anatomy and hemodynamic perfusion are among the earliest changes in retinal diseases such as age-related macular degeneration (AMD). However, how inner choroidal anatomy affects hemodynamic perfusion is not well understood. Therefore, we sought to understand the influences of choroidal microvascular architecture on the spatial distribution of hemodynamic parameters in choriocapillaris from human donor eyes using image-based computational hemodynamic (ICH) simulations. We subjected image-based inner choroid reconstructions from eight human donor eyes to ICH simulation using a kinetic-based volumetric lattice Boltzmann method to compute hemodynamic distributions of velocity, pressure, and endothelial shear stress. Here, we demonstrate that anatomic parameters, including arteriolar and venular arrangements and intercapillary pillar density and distribution exert profound influences on inner choroidal hemodynamic characteristics. Reductions in capillary, arteriolar, and venular density not only reduce the overall blood velocity within choriocapillaris, but also substantially increase its spatial heterogeneity. These first-ever findings improve understanding of how choroidal anatomy affects hemodynamics and may contribute to pathogenesis of retinal diseases such as AMD.
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Affiliation(s)
- Senyou An
- State Key Laboratory of Intelligent Construction and Healthy Operation and Maintenance of Deep Underground Engineering, Shenzhen University, Shenzhen, 518060, China
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University, Indianapolis, IN, 46202, USA
| | - Huidan Yu
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University, Indianapolis, IN, 46202, USA.
- Department of Vascular Surgery, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
| | - M D Mahfuzul Islam
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University, Indianapolis, IN, 46202, USA
| | - Xiaoyu Zhang
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University, Indianapolis, IN, 46202, USA
| | - Yuting Zhan
- Department of Mechanical and Energy Engineering, Indiana University-Purdue University, Indianapolis, IN, 46202, USA
- Dyson School of Design Engineering, Imperial College London, London, SW7 2AZ, UK
| | - Joseph J Olivieri
- Center for Advanced Vision Science, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA
- Department of Pathology, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA
| | - Jayakrishna Ambati
- Center for Advanced Vision Science, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA
- Department of Pathology, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA
- Department of Ophthalmology, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA
| | - Jun Yao
- Research Center of Multiphase Flow in Porous Media, China University of Petroleum (East China), Qingdao, 266580, China
| | - Bradley D Gelfand
- Center for Advanced Vision Science, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA.
- Department of Ophthalmology, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA.
- Department of Biomedical Engineering, University of Virginia School of Medicine, Street, Charlottesville, VA, 22908, USA.
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Wang L, Zhang C, Pang L, Wang Y. Integrated network pharmacology and experimental validation to explore the potential pharmacological mechanism of Qihuang Granule and its main ingredients in regulating ferroptosis in AMD. BMC Complement Med Ther 2023; 23:420. [PMID: 37990310 PMCID: PMC10664676 DOI: 10.1186/s12906-023-04205-3] [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: 05/23/2023] [Accepted: 10/07/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Qihuang Granule (QHG) is a traditional prescription that has exhibited potential in safeguarding against age-related maculopathy (AMD). Salvia miltiorrhiza (SM) and Fructus lycii (FL) are the main components of QHG. Ferroptosis, a newly discovered, iron-dependent, regulated cell death pathway, have been implicated in the pathogenesis of AMD. This study delves into the intricate mechanism by which SM/FL and QHG confer protection against AMD by modulating the ferroptosis pathway, employing a combination of network pharmacology and experimental validation. METHODS Bioactive compounds and potential targets of SM and FL were gathered from databases such as TCMSP, GeneCard, OMIM, and FerrDb, along with AMD-related genes and key genes responsible for ferroptosis regulation. Gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis and protein-protein interaction (PPI) network were performed to discover the potential mechanism. The construction of an interaction network involving AMD, ferroptosis, SM/FL potential target genes was facilitated by the STRING database and realized using Cytoscape software. Subsequent validation was accomplished through molecular docking and in vitro cell experiments. RESULTS Noteworthy active compounds including quercetin, tanshinone IIA, luteolin, cryptotanshinone, and hub targets such as HIF-1α, EGFR, IL6, and VEGFA were identified. KEGG enrichment unveiled the HIF-1 signalling pathway as profoundly enriched, and IL6 and VEGF were involved. The molecular docking revealed the significant active compounds with hub genes and quercetin showed good binding to HIF-1α, which is involved in inflammation and angiogenesis. Experimental results verified that both herbs and QHG could regulate key ferroptosis-related targets in the retinal pigment epithelium and inhibit the expression of HIF-1α, VEGFA, and IL-6, subsequently increase cell viability and decrease the ROS content induced by H2O2. CONCLUSION This study demonstrates the molecular mechanism through which SM/FL and QHG protect against AMD and emerges as a plausible mechanism underlying this protection.
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Affiliation(s)
- Lu Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111DaDe Road, Guangzhou, Guangdong, 510120, China
| | - Canyang Zhang
- Department of Ophthalmology, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Long Pang
- Department of Ophthalmology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111DaDe Road, Guangzhou, Guangdong, 510120, China.
| | - Yan Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111DaDe Road, Guangzhou, Guangdong, 510120, China.
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6
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Beraldo DP, Rezende MP, Alexander JG, Polido J, Belfort R, Cabral T. Correlations between subfoveal choroidal thickness, macular thickness, and visual outcome in neovascular age-related macular degeneration using swept source OCT: insights from intravitreal aflibercept treatment. Int J Retina Vitreous 2023; 9:70. [PMID: 37968771 PMCID: PMC10652476 DOI: 10.1186/s40942-023-00506-4] [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: 08/27/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Age-related macular degeneration (AMD) is a leading cause of visual impairment among individuals aged 50 and above, often resulting in irreversible vision loss (1). Currently, antiangiogenic therapy is the primary treatment approach for neovascular AMD (2). The choroid has gained significant attention in recent years due to its involvement in various ocular pathologies (7). The objective of this study was to evaluate visual acuity and correlate pre-treatment variables, such as foveal thickness and choroidal thickness, with post-treatment outcomes. MATERIALS AND METHODS This study was designed as a prospective interventional study to investigate the changes in choroidal and macular thickness in patients with neovascular AMD who received intravitreal aflibercept injections. The study utilized medical records and employed Swept Source Optical Coherence Tomography (OCT-SS) for evaluation. The data was collected from patients treated in Presidente Prudente, Brazil, during a three-month load dose period. RESULTS The best-corrected mean visual acuity significantly improved from 1.0 logarithm of the minimum resolution angle (logMAR) units to 0.55 logMAR after treatment with aflibercept (p < 0.001). Patients undergoing treatment exhibited a significant decrease in average macular thickness from 323 μm to 232 μm (p = 0.001), as well as a reduction in choroidal thickness from 206 μm to 172 μm (p = 0.031), while maintaining intraocular pressure within the normal range (p = 0.719) without significant variation. Statistically significant associations were found between the difference in pre- and post-treatment choroidal thickness and the pretreatment values of macular thickness (p = 0.005) and choroidal thickness (p = 0.013). There was also a statistically significant correlation between the difference in pre- and post-treatment macular thickness and the pretreatment macular thickness value (p < 0.001). CONCLUSION In this study, aflibercept exhibited remarkable effectiveness in reducing macular and choroidal thickness, as evaluated using OCT-SS, and significantly improved visual acuity in patients with neovascular AMD. The assessment of both choroidal and macular changes, as well as their correlations, can provide valuable insights for clinicians, enabling them to make well-informed therapeutic decisions and effectively monitor treatment outcomes. Notably, this study contributes to the existing body of literature as the first to establish a correlation between pretreatment foveal thickness, variation in choroidal thickness, and post-treatment choroidal thickness.
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Affiliation(s)
- Daniel P Beraldo
- Clínica Oftalmo-Retina, Presidente Prudente, SP, Brazil
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04039-032, Brazil
| | - Marcussi P Rezende
- Clínica Oftalmo-Retina, Presidente Prudente, SP, Brazil
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04039-032, Brazil
| | - João G Alexander
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04039-032, Brazil
| | - Júlia Polido
- Department of Specialized Medicine, CCS and Vision Center Unit, Ophthalmology, EBSERH/HUCAM, CCS-UFES-Federal University of Espírito Santo (UFES), Vitória, ES, 29047-105, Brazil
| | - Rubens Belfort
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04039-032, Brazil
| | - Thiago Cabral
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, SP, 04039-032, Brazil.
- Department of Specialized Medicine, CCS and Vision Center Unit, Ophthalmology, EBSERH/HUCAM, CCS-UFES-Federal University of Espírito Santo (UFES), Vitória, ES, 29047-105, Brazil.
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7
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Zeng J, Wang Y, Zhu M, Wu M, Zhou Y, Wang Q, Xu Y, Lin F, Wang J, Li Y, Liang S, Wang Z, Xie L, Liu X. Neutrophil extracellular traps boost laser-induced mouse choroidal neovascularization through the activation of the choroidal endothelial cell TLR4/HIF-1α pathway. FEBS J 2023; 290:5395-5410. [PMID: 37552110 DOI: 10.1111/febs.16928] [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: 09/09/2022] [Revised: 05/24/2023] [Accepted: 08/07/2023] [Indexed: 08/09/2023]
Abstract
Choroidal neovascularization (CNV) is characterized by the infiltration of immune cells, particularly neutrophils. Neutrophil extracellular trap (NET) facilitates the angiogenesis of pulmonary endothelial cells via activating Toll-like receptor 4 (TLR4). TLR4 promotes the expression of transcription factor hypoxia inducible factor-1α (HIF-1α), which promotes inflammation and angiogenesis via the up-regulation of metalloproteinase-9 (MMP-9) and interleukin-1β (IL-1β). In the present study, we aimed to identify the formation of NET and its role in CNV. Our results showed that NET levels were increased in a mouse laser-induced CNV model via oxidative stress, whereas the inhibition of NET alleviated CNV. In vitro, NET activated the TLR4/HIF-1α pathway in human choroidal endothelial cells (HCECs). Additionally, NET increased the transcription and expression of MMP-9 and IL-1β in HCECs via activating the TLR4/HIF-1α pathway. Meanwhile, NET promoted the inflammatory response accompanied by the proliferation, migration and tube formation of HCECs in a MMP-9- and IL-1β-dependent manner. In conclusion, NET was up-regulated in CNV and promoted the formation of CNV via activating the TLR4/HIF-1α pathway in choroidal endothelial cells. Our data uncovered the novel role of NET in promoting the formation of CNV. The underlying mechanism of NET could be targeted to delay the process of CNV.
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Affiliation(s)
- Jia Zeng
- Department of Pathogen Biology, Medical College, Nantong University, China
| | - Ying Wang
- Department of Ophthalmology, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, China
| | - Manhui Zhu
- Department of Pathology, Lixiang Eye Hospital of Soochow University, Suzhou, China
| | - Min Wu
- Department of Pathogen Biology, Medical College, Nantong University, China
| | - Yamei Zhou
- Department of Pathogen Biology, Medical College, Nantong University, China
| | - Qiaoyun Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yiqian Xu
- Department of Ophthalmology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Fei Lin
- Medical College, Nantong University, China
| | - Jiaqi Wang
- Medical College, Nantong University, China
| | - Yuxuan Li
- Medical College, Nantong University, China
| | | | - Ziyu Wang
- Medical College, Nantong University, China
| | - Laiqing Xie
- Department of Ophthalmology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaojuan Liu
- Department of Pathogen Biology, Medical College, Nantong University, China
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8
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Benavente-Perez A. Evidence of vascular involvement in myopia: a review. Front Med (Lausanne) 2023; 10:1112996. [PMID: 37275358 PMCID: PMC10232763 DOI: 10.3389/fmed.2023.1112996] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/02/2023] [Indexed: 06/07/2023] Open
Abstract
The benign public perception of myopia (nearsightedness) as a visual inconvenience masks the severity of its sight-threatening consequences. Myopia is a significant risk factor for posterior pole conditions such as maculopathy, choroidal neovascularization and glaucoma, all of which have a vascular component. These associations strongly suggest that myopic eyes might experience vascular alterations prior to the development of complications. Myopic eyes are out of focus because they are larger in size, which in turn affects their overall structure and function, including those of the vascular beds. By reviewing the vascular changes that characterize myopia, this review aims to provide an understanding of the gross, cellular and molecular alterations identified at the structural and functional levels with the goal to provide an understanding of the latest evidence in the field of experimental and clinical myopia vascular research. From the evidence presented, we hypothesize that the interaction between excessive myopic eye growth and vascular alterations are tipping-points for the development of sight-threatening changes.
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9
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Liu P, Lavine JA, Fawzi A, Quaggin SE, Thomson BR. Angiopoietin-1 Is Required for Vortex Vein and Choriocapillaris Development in Mice. Arterioscler Thromb Vasc Biol 2022; 42:1413-1427. [PMID: 36172864 PMCID: PMC9613622 DOI: 10.1161/atvbaha.122.318151] [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: 03/22/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The choroidal vasculature, including the choriocapillaris and vortex veins, is essential for providing nutrients to the metabolically demanding photoreceptors and retinal pigment epithelium. Choroidal vascular dysfunction leads to vision loss and is associated with age-related macular degeneration and the poorly understood pachychoroid diseases including central serous chorioretinopathy and polypoidal choroidal vasculopathy that are characterized by formation of dilated pachyvessels throughout the choroid. METHODS Using neural crest-specific Angpt1 knockout mice, we show that Angiopoietin 1, a ligand of the endothelial receptor TEK (also known as Tie2) is essential for choriocapillaris development and vortex vein patterning. RESULTS Lacking choroidal ANGPT1, neural crest-specific Angpt1 knockout eyes exhibited marked choriocapillaris attenuation and 50% reduction in number of vortex veins, with only 2 vortex veins present in the majority of eyes. Shortly after birth, dilated choroidal vessels resembling human pachyvessels were observed extending from the remaining vortex veins and displacing the choriocapillaris, leading to retinal pigment epithelium dysfunction and subretinal neovascularization similar to that seen in pachychoroid disease. CONCLUSIONS Together, these findings identify a new role for ANGPT1 in ocular vascular development and demonstrate a clear link between vortex vein dysfunction, pachyvessel formation, and disease.
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Affiliation(s)
- Pan Liu
- Section of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago IL, USA
- Feinberg Cardiovascular and Renal Research Inst. Chicago, IL, USA
| | - Jeremy A. Lavine
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amani Fawzi
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Susan E Quaggin
- Section of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago IL, USA
- Feinberg Cardiovascular and Renal Research Inst. Chicago, IL, USA
| | - Benjamin R. Thomson
- Feinberg Cardiovascular and Renal Research Inst. Chicago, IL, USA
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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10
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Choroidal Vasculature Changes in Age-Related Macular Degeneration: From a Molecular to a Clinical Perspective. Int J Mol Sci 2022; 23:ijms231912010. [PMID: 36233311 PMCID: PMC9570412 DOI: 10.3390/ijms231912010] [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: 07/20/2022] [Revised: 08/26/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022] Open
Abstract
The contribution of choroidal vasculature to the pathogenesis of age-related macular degeneration (AMD) has been long debated. The present narrative review aims to discuss the primary molecular and choroidal structural changes occurring with aging and AMD with a brief overview of the principal multimodal imaging modalities and techniques that enable the optimal in vivo visualization of choroidal modifications. The molecular aspects that target the choroid in AMD mainly involve human leukocyte antigen (HLA) expression, complement dysregulation, leukocyte interaction at Bruch’s membrane, and mast cell infiltration of the choroid. A mechanistic link between high-risk genetic loci for AMD and mast cell recruitment has also been recently demonstrated. Recent advances in multimodal imaging allow more detailed visualization of choroidal structure, identifying alterations that may expand our comprehension of aging and AMD development.
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11
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Wei X, Roy R, Saurabh K, Sen P, Bhende M, Shelke K, Finocchio L, Sodi A, Virgili G, Invernizzi A, Salvetti AP, Mishra C, Agrawal R. Optical Coherence Tomography-Based Choroidal Structural Analysis and Vascularity Index in Best Vitelliform Macular Dystrophy. Ophthalmol Ther 2022; 11:2141-2152. [DOI: 10.1007/s40123-022-00567-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022] Open
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12
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Fehér J, Élő Á, István L, Nagy ZZ, Radák Z, Scuderi G, Artico M, Kovács I. Microbiota mitochondria disorders as hubs for early age-related macular degeneration. GeroScience 2022; 44:2623-2653. [PMID: 35978068 PMCID: PMC9385247 DOI: 10.1007/s11357-022-00620-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/01/2022] [Indexed: 01/07/2023] Open
Abstract
Age-related macular degeneration (AMD) is a progressive neurodegenerative disease affecting the central area (macula lutea) of the retina. Research on the pathogenic mechanism of AMD showed complex cellular contribution governed by such risk factors as aging, genetic predisposition, diet, and lifestyle. Recent studies suggested that microbiota is a transducer and a modifier of risk factors for neurodegenerative diseases, and mitochondria may be one of the intracellular targets of microbial signaling molecules. This review explores studies supporting a new concept on the contribution of microbiota-mitochondria disorders to AMD. We discuss metabolic, vascular, immune, and neuronal mechanism in AMD as well as key alterations of photoreceptor cells, retinal pigment epithelium (RPE), Bruch's membrane, choriocapillaris endothelial, immune, and neuronal cells. Special attention was paid to alterations of mitochondria contact sites (MCSs), an organelle network of mitochondria, endoplasmic reticulum, lipid droplets (LDs), and peroxisomes being documented based on our own electron microscopic findings from surgically removed human eyes. Morphometry of Bruch's membrane lipids and proteoglycans has also been performed in early AMD and aged controls. Microbial metabolites (short-chain fatty acids, polyphenols, and secondary bile acids) and microbial compounds (lipopolysaccharide, peptidoglycan, and bacterial DNA)-now called postbiotics-in addition to local effects on resident microbiota and mucous membrane, regulate systemic metabolic, vascular, immune, and neuronal mechanisms in normal conditions and in various common diseases. We also discuss their antioxidant, anti-inflammatory, and metabolic effects as well as experimental and clinical observations on regulating the main processes of photoreceptor renewal, mitophagy, and autophagy in early AMD. These findings support an emerging concept that microbiota-mitochondria disorders may be a crucial pathogenic mechanism of early AMD; and similarly, to other age-related neurodegenerative diseases, new treatment approaches should be targeted at these disorders.
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Affiliation(s)
- János Fehér
- PRIMAVERA Program, Nutripharma Hungaria Ltd., Budapest, Hungary
| | - Ágnes Élő
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lilla István
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Zoltán Zsolt Nagy
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Zsolt Radák
- grid.472475.70000 0000 9243 1481Research Institute of Sport Science, University of Physical Education, Budapest, Hungary
| | - Gianluca Scuderi
- grid.7841.aOphthalmology Unit, NESMOS Department, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Marco Artico
- grid.417007.5Department of Sensory Organs, “Sapienza” University of Rome, Roma, Italy
| | - Illés Kovács
- grid.11804.3c0000 0001 0942 9821Department of Ophthalmology, Semmelweis University, Budapest, Hungary ,grid.5386.8000000041936877XDepartment of Ophthalmology, Weill Cornell Medical College, New York City, NY USA
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Kim KL, Joo K, Park SJ, Park KH, Woo SJ. Progression from intermediate to neovascular age-related macular degeneration according to drusen subtypes: Bundang AMD cohort study report 3. Acta Ophthalmol 2022; 100:e710-e718. [PMID: 34390191 DOI: 10.1111/aos.14960] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/01/2021] [Accepted: 06/17/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE To investigate the ophthalmic risk factors related to neovascular change and the subtype-wise incidence of progression from intermediate to neovascular age-related macular degeneration (AMD). METHODS In this retrospective cohort study, 632 eyes with intermediate AMD from 418 patients (older than 50 years) were enrolled. The systemic factors and ophthalmic factors were statistically analysed with respect to neovascular change. RESULTS The 5-year cumulative incidence of progression to neovascular AMD (nAMD) from intermediate AMD was 17.8% and 17.0% in eyes with soft drusen and pachydrusen (p = 0.316). Older age (p = 0.025), preexisting nAMD in the fellow eye (p < 0.001), and reticular pseudodrusen (RPD; p = 0.007) were associated with the risk of progression to nAMD. In reference to soft drusen, pachydrusen was associated with progression to polypoidal choroidal vasculopathy (PCV; p < 0.001) and not to typical nAMD (p = 0.064). CONCLUSIONS The ophthalmic risk factors related to the progression of nAMD from intermediate AMD were found to be preexisting nAMD in the fellow eye and RPD. Pachydrusen showed a similar incidence of neovascular change with soft drusen, and was associated with the progression to PCV but not to typical nAMD.
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Affiliation(s)
- Kyoung Lae Kim
- Department of Ophthalmology Seoul National University College of Medicine Seoul National University Bundang Hospital Seongnam Korea
- Department of Ophthalmology Gangwon National University College of Medicine Gangwon National University Hospital Chuncheon Korea
| | - Kwangsic Joo
- Department of Ophthalmology Seoul National University College of Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - Sang Jun Park
- Department of Ophthalmology Seoul National University College of Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - Kyu Hyung Park
- Department of Ophthalmology Seoul National University College of Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - Se Joon Woo
- Department of Ophthalmology Seoul National University College of Medicine Seoul National University Bundang Hospital Seongnam Korea
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Rosenfeld PJ, Trivizki O, Gregori G, Wang RK. An Update on the Hemodynamic Model of Age-Related Macular Degeneration. Am J Ophthalmol 2022; 235:291-299. [PMID: 34509436 DOI: 10.1016/j.ajo.2021.08.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/22/2021] [Accepted: 08/30/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To provide an update on the hemodynamic model of age-related macular degeneration (AMD). DESIGN Evidence-based perspective. METHODS Review of the literature and experience of the authors. RESULTS Choroidal hemodynamics are not the primary cause of AMD as proposed by Ephraim Friedman in 1997. However, evidence is accumulating to suggest that choroidal perfusion is an important environmental influence that contributes to our understanding of disease progression in this complex genetic disorder. Although early and intermediate AMD seem to be influenced to a large extent by the underlying genetics, the asymmetry of disease progression to the later stages of AMD cannot be explained by genetics alone. The progression of disease and the asymmetry of this progression seem to correlate with abnormalities in choroidal perfusion that can be documented by optical coherence tomography. These perfusion abnormalities in the setting of a thickened Bruch's membrane are thought to exacerbate the impaired nutritional exchange between the retinal pigment epithelium and the choriocapillaris. We propose that the genetic susceptibility to develop AMD combined with age-related changes in macular choroidal hemodynamics, such as increasing choriocapillaris perfusion deficits and decreasing choroidal vascular densities, play an important role in disease progression and may help to explain the asymmetry between eyes, particularly in the later stages of AMD. CONCLUSIONS This updated hemodynamic model of AMD focuses on disease progression and highlights the importance of age-related changes in the choroidal circulation as a major environmental influence on disease severity in eyes that are genetically susceptible to develop AMD.
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Affiliation(s)
- Philip J Rosenfeld
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (P.J.P., O.T., G.G.), Miami, Florida, USA.
| | - Omer Trivizki
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (P.J.P., O.T., G.G.), Miami, Florida, USA; Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv University (O.T.), Tel Aviv, Israel and the Department of Bioengineering (R.K.W.) and Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Giovanni Gregori
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (P.J.P., O.T., G.G.), Miami, Florida, USA
| | - Ruikang K Wang
- Department of Ophthalmology (R.K.W.), University of Washington, Seattle, Washington, USA
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15
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Lylyk I, Bleise C, Lylyk PN, Perez N, Lundquist J, Scrivano E, Francone AA, Charles M, Zompa T, Lylyk P. Ophthalmic artery angioplasty for age-related macular degeneration. J Neurointerv Surg 2022; 14:968-972. [PMID: 34987072 PMCID: PMC9484375 DOI: 10.1136/neurintsurg-2021-018222] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/10/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is considerable overlap of contributors to cardiovascular disease and the development of age-related macular degeneration (AMD). Compromised ocular microcirculation due to aging and vascular disease contribute to retinal dysfunction and vision loss. Decreased choroidal perfusion is evident in eyes with dry AMD and is thought to play a role in retinal pigment epithelial dysfunction, the rate of development of geographic atrophy, and the development of neovascularization. The aim of the study was to demonstrate that AMD is correlated with a compromised blood flow in the ocular pathway and show OA angioplasty as a potential treatment of late-stage AMD. METHODS Based on the potential for the ophthalmic artery (OA) to be an anatomical target for the treatment of AMD as outlined above, five patients were found to be eligible for compassionate use treatment, presenting clinically significant late-stage AMD with profound vision loss in one or both eyes, and are included in this retrospective study. RESULTS OA narrowing, or significant calcium burden at the ophthalmic segment of the internal carotid artery compromising the origin of the OA was confirmed in all cases. Subsequent OA cannulation was achieved in all patients with some difficulty. Subjective patient reports indicated that all patients perceived a benefit following the procedure; however, improved postoperative visual acuity did not confirm that perceived benefit for one of the patients. CONCLUSIONS Feasibility and safety of the OA angioplasty were demonstrated, and a benefit perceived in five patients with profound vision loss and a desire to achieve improved quality of life. A clinical trial with controlled schedule, imaging, and methodologies is needed to confirm these results.
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Affiliation(s)
- Ivan Lylyk
- Department of Interventional Neuroradiology, Instituto Medico ENERI, Buenos Aires, Argentina
| | - Carlos Bleise
- Department of Interventional Neuroradiology, Instituto Medico ENERI, Buenos Aires, Argentina
| | - Pedro N Lylyk
- Department of Interventional Neuroradiology, Instituto Medico ENERI, Buenos Aires, Argentina
| | - Nicolas Perez
- Department of Neuroradiology, Instituto Medico ENERI, Buenos Aires, Argentina
| | - Javier Lundquist
- Department of Interventional Neuroradiology, Instituto Medico ENERI, Buenos Aires, Argentina
| | - Esteban Scrivano
- Department of Interventional Neuroradiology, Instituto Medico ENERI, Buenos Aires, Argentina
| | - Anibal A Francone
- Department of Ophthalmology, Centro Oftalmológico Dr Daniel Charles S.A, Buenos Aires, Argentina
| | - Martin Charles
- Department of Ophthalmology, Centro Oftalmológico Dr Daniel Charles S.A, Buenos Aires, Argentina
| | - Tamara Zompa
- Department of Ophthalmology, Centro Oftalmológico Dr Daniel Charles S.A, Buenos Aires, Argentina
| | - Pedro Lylyk
- Department of Interventional Neuroradiology, Instituto Medico ENERI, Buenos Aires, Argentina
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Altunel O, Ozsaygili C. Assessment of choriocapillaris/Sattler and Haller layer changes after intravitreal injection in eyes with neovascular age-related macular degeneration: aflibercept vs ranibizumab. Jpn J Ophthalmol 2022; 66:159-166. [PMID: 34982296 DOI: 10.1007/s10384-021-00894-w] [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: 06/18/2021] [Accepted: 12/02/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the changes in choriocapillaris (CC)/Sattler and Haller layer thicknesses in eyes with neovascular age-related macular degeneration (nAMD) after aflibercept or ranibizumab injections. STUDY DESIGN Retrospective. METHODS A total of 70 eyes of 70 patients with treatment-naïve exudative nAMD were treated with 3 consecutive injections of aflibercept (IVA) or ranibizumab (IVR). CC/Sattler and Haller layer thicknesses were measured at the nasal and temporal regions 1000 µm from the center of the fovea by enhanced-depth imaging optical coherence tomography at baseline and after the 3 monthly intravitreal injections. In addition, the hyperfluorescence region (HF) was measured as the largest horizontal diameter of the hyperfluorescence area on the early-middle phase fluorescein angiographic images at baseline and after the 3 loading doses. RESULTS After the 3 consecutive injections, the mean reductions in the nasal/temporal CC/Sattler layer thicknesses in the IVR and IVA groups were - 10.1 ± 2.3/ - 8.5 ± 1.8 and - 25.2 ± 15.2/ - 19.4 ± 12.8 μm, respectively. Also, the mean reductions in the nasal/temporal Haller layer thicknesses in the IVR and IVA groups were - 6.5 ± 3.6/ - 7.2 ± 7.9 and - 9.5 ± 8.0/ - 7.0 ± 6.2 μm, respectively. The changes in the CC/Sattler layer thicknesses of the IVA group were greater than those of the IVR group (P < .001); however, the changes in the Haller layer thickness were similar between the groups (P > .05). The mean decrease in the HF size of the IVA group was greater than that of the IVR group (P < .001). CONCLUSIONS Aflibercept treatment has a more pronounced effect on the CC/Sattler layer. Such results may indicate that aflibercept treatment influences choroidal neovascularization, possibly by reducing the capillary permeability associated with active neovascularization in the CC layer.
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Affiliation(s)
- Orhan Altunel
- Department of Ophthalmology, Kutahya Health Sciences University, School of Medicine, Kutahya, Turkey.
| | - Cemal Ozsaygili
- Department of Ophthalmology, Kayseri City Education and Research Hospital, Kayseri, Turkey
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Wang T, Xia J, Yuan M, Wu X, Zhu Y, Chen C, Bergunder SJ, Liu Z, Chen W, Huang K, Lin H. Hypertension affects the treatment of wet age-related macular degeneration. Acta Ophthalmol 2021; 99:871-876. [PMID: 33787087 PMCID: PMC9544391 DOI: 10.1111/aos.14791] [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] [Received: 04/19/2020] [Revised: 10/16/2020] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
Purpose Due to population ageing as well as the high prevalence of hypertension and age‐related macular degeneration (AMD) in elderly individuals, and the relationship between hypertension and AMD is unclear. Our research aimed to investigate the association between hypertension, wet AMD (wAMD) and the treatment strategy of wAMD patients affected by hypertension. Methods Data of wAMD patients at Zhongshan Ophthalmic Center, Sun Yat‐sen University, between 1 January 2002 and 30 June 2019, were extracted from the electronic healthcare information system. wAMD patients were divided into subgroups by hypertension status, age, sex, the need for vitrectomy surgery and the number of anti‐VEGF drug intravitreal injections that these were divided in 1–3 vs. >3 (available time from 1 January 2012 to 30 June 2019). Results A total of 3096 wAMD patients (41.7% female, 58.3% male) with an age range of 50–96 years (68.7 (SD 9.42) years) were included. wAMD was significantly associated with hypertension (p < 0.001). After adjustment for sex and age, Cox regression model showed a significant association between hypertension in wAMD patients and the number of injections (RR = 1.31, 95% CI: 1.13–1.50, p < 0.001). There was no significant association between hypertension and the need for vitrectomy (p = 0.82). Conclusions wet AMD was associated with hypertension status, and after the regular series of three injections, wAMD patients with hypertension were more likely to receive anti‐VEGF drug intravitreal injections than those without hypertension. These results may facilitate prospective research on the prevention of wAMD and contribute to the management of wAMD patients.
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Affiliation(s)
- Ting Wang
- State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Sun Yat‐sen University Guangzhou China
| | - Jun Xia
- Key Laboratory of Machine Intelligence and Advanced Computing Sun Yat‐sen University Guangzhou China
| | - Meng Yuan
- State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Sun Yat‐sen University Guangzhou China
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Sun Yat‐sen University Guangzhou China
| | - Yi Zhu
- Department of Molecular and Cellular Pharmacology University of Miami Miller School of Medicine Miami FL USA
| | - Chuan Chen
- Sylvester Comprehensive Cancer Center University of Miami Miller School of Medicine Miami FL USA
| | - Sean J. Bergunder
- Jihua laboratory R&D Center for Ophthalmic Cutting‐Edge Technology and Medical Devices Foshan Guangdong China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Sun Yat‐sen University Guangzhou China
| | - Wenben Chen
- State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Sun Yat‐sen University Guangzhou China
| | - Kai Huang
- Key Laboratory of Machine Intelligence and Advanced Computing Sun Yat‐sen University Guangzhou China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Sun Yat‐sen University Guangzhou China
- Center for Precision Medicine Sun Yat‐sen University Guangzhou China
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Hibert M, Chen Y, Ohringer N, Feuer W, Waheed N, Heier J, Calhoun M, Rosenfeld P, Polimeni J. Altered Blood Flow in the Ophthalmic and Internal Carotid Arteries in Patients with Age-Related Macular Degeneration Measured Using Noncontrast MR Angiography at 7T. AJNR Am J Neuroradiol 2021; 42:1653-1660. [PMID: 34210664 PMCID: PMC8423057 DOI: 10.3174/ajnr.a7187] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Age-related macular degeneration is associated with reduced perfusion of the eye; however, the role of altered blood flow in the upstream ophthalmic or internal carotid arteries is unclear. We used ultra-high-field MR imaging to investigate whether the diameter of and blood flow in the ophthalmic artery and/or the ICA are altered in age-related macular degeneration and whether any blood flow changes are associated with disease progression. MATERIALS AND METHODS Twenty-four patients with age-related macular degeneration and 13 similarly-aged healthy controls participated. TOF and high-resolution dynamic 2D phase-contrast MRA (0.26 × 0.26 × 2mm3, 100-ms effective sampling rate) was acquired at 7T. Vessel diameters were calculated from cross-sectional areas in phase-contrast acquisitions. Blood flow time-series were measured across the cardiac cycle. RESULTS The ophthalmic artery vessel diameter was found to be significantly smaller in patients with age-related macular degeneration than in controls. Volumetric flow through the ophthalmic artery was significantly lower in patients with late age-related macular degeneration, with a significant trend of decreasing volumetric ophthalmic artery flow rates with increasing disease severity. The resistance index was significantly greater in patients with age-related macular degeneration than in controls in the ophthalmic artery. Flow velocity through the ophthalmic artery and ICA was significantly higher in patients with age-related macular degeneration. Ophthalmic artery blood flow as a percentage of ipsilateral ICA blood flow was nearly double in controls than in patients with age-related macular degeneration. CONCLUSIONS These findings support the hypothesis that vascular changes upstream to the eye are associated with the severity of age-related macular degeneration. Additional investigation into the potential causality of this relationship and whether treatments that improve ocular circulation slow disease progression is warranted.
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Affiliation(s)
- M.L. Hibert
- From the Athinoula A. Martinos Center for Biomedical Imaging (M.L.H., Y.I.C., N. O., J.R.P.), Massachusetts General Hospital, Charlestown, Massachusetts
| | - Y.I. Chen
- From the Athinoula A. Martinos Center for Biomedical Imaging (M.L.H., Y.I.C., N. O., J.R.P.), Massachusetts General Hospital, Charlestown, Massachusetts,Department of Radiology (Y.I.C., J.R.P.), Harvard Medical School, Boston, Massachusetts
| | - N. Ohringer
- From the Athinoula A. Martinos Center for Biomedical Imaging (M.L.H., Y.I.C., N. O., J.R.P.), Massachusetts General Hospital, Charlestown, Massachusetts
| | - W.J. Feuer
- Department of Ophthalmology (W.J.F., P.J.R.), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - N.K. Waheed
- New England Eye Center (N.K.W.), Tufts Medical Center, Boston, Massachusetts
| | - J.S. Heier
- Ophthalmic Consultants of Boston (J.S.H.), Boston, Massachusetts
| | | | - P.J. Rosenfeld
- Department of Ophthalmology (W.J.F., P.J.R.), Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - J.R. Polimeni
- From the Athinoula A. Martinos Center for Biomedical Imaging (M.L.H., Y.I.C., N. O., J.R.P.), Massachusetts General Hospital, Charlestown, Massachusetts,Department of Radiology (Y.I.C., J.R.P.), Harvard Medical School, Boston, Massachusetts,Harvard-Massachusetts Institute of Technology Division of Health Sciences and Technology (J.R.P.), Massachusetts Institute of Technology, Cambridge, Massachusetts
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The impact of vascular risk factors on the thickness and volume of the choroid in AMD patients. Sci Rep 2021; 11:15106. [PMID: 34302055 PMCID: PMC8302717 DOI: 10.1038/s41598-021-94676-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/29/2021] [Indexed: 11/08/2022] Open
Abstract
Disturbances in choroidal microcirculation may lead to the onset and progression of age-related macular degeneration (AMD). We aimed to assess changes in the choroidal volume and thickness in the macular region in AMD eyes and to investigate whether coexisting vascular risk factors alter choroidal status. We enrolled 354 AMD patients (175 dry, 179 wet AMD) and 121 healthy controls. All participants underwent a complete ophthalmologic examination and assessment of choroidal thickness and volume. A multivariate analysis adjusted for age, sex, and smoking status revealed that wet AMD was an independent factor associated with higher average thickness of the central ring area (ATC) and average volume of the central ring area (AVC) and lower choroidal vascularity index (CVI) compared to controls (β = + 0.18, p = 0.0007, β = + 0.18, p = 0.0008, respectively) and to dry AMD (β = + 0.17, p = 0.00003 for both ATC and AVC and β = - 0.30 p < 0.0001 for CVI). ATC, AVC and average volume (AV) were lower in AMD patients with hypertension and ischaemic heart disease (IHD). The duration of hypertension was inversely correlated with ATC, AVC and AV (Rs = - 0.13, p < 0.05; Rs = - 0.12; p < 0.05, Rs = - 0.12; p < 0.05, respectively) while IHD duration negatively correlated with AV (Rs = - 0.15, p < 0.05). No such associations were observed in the control group. Our findings show that the choroidal vascular system in eyes with AMD is much more susceptible to damage in the presence than in the absence of systemic vascular disease.
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Yamamoto T, Kanda A, Kase S, Ishida S. Hypoxia Induces Galectin-1 Expression Via Autoinduction of Placental Growth Factor in Retinal Pigment Epithelium Cells. Invest Ophthalmol Vis Sci 2021; 62:22. [PMID: 33599733 PMCID: PMC7900883 DOI: 10.1167/iovs.62.2.22] [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: 11/24/2022] Open
Abstract
Purpose Galectin-1/LGALS1, a β-galactoside-binding protein, contributes to angiogenesis and fibrosis in various ocular diseases. Hypoxia-dependent and -independent pathways upregulate galectin-1/LGALS1 expression in Müller glial cells. Here, we present novel findings on the galectin-1/LGALS1 regulatory system in human retinal pigment epithelium (RPE) cells, the major cellular participant in the pathogenesis of neovascular age-related macular degeneration (nAMD). Methods Human RPE cells were used to evaluate changes in gene and protein expression with real-time quantitative PCR and immunoblot analyses, respectively. The promoter and enhancer regions of LGALS1 were analyzed by reporter assay and chromatin immunoprecipitation. Immunofluorescence analysis of nAMD patient specimens was used to confirm the in vitro findings. Results Hypoxia induced galectin-1/LGALS1 expression via binding of hypoxia-inducible factor 1α (HIF-1α) to hypoxia-responsive elements in the LGALS1 promoter region. Blockade of vascular endothelial growth factor receptor 1 (VEGFR1) partially decreased hypoxia-induced galectin-1/LGALS1 expression. Among several VEGFR1 ligands induced by hypoxia, placental growth factor (PlGF)/PGF alone upregulated galectin-1/LGALS1 expression via phosphorylation of activator protein 1 (AP-1) subunits following AKT and p38 mitogen-activated protein kinase (MAPK) activation. An AP-1 site in the LGALS1 enhancer region was required for PlGF-induced galectin-1/LGALS1 expression in RPE cells. PlGF application upregulated PGF expression via extracellular signal-regulated kinase 1 and 2, AKT, and p38 MAPK pathways. nAMD patient specimens demonstrated co-localization of galectin-1 with HIF-1α, PlGF, and VEGFR1 in RPE cells. Conclusions Our present findings implicate the significance of hypoxia as a key inducer of galectin-1/LGALS1 in RPE cells and the autoinduction of hypoxia-induced PlGF as a vicious cycle amplifying the pathogenesis of nAMD.
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Affiliation(s)
- Taku Yamamoto
- Laboratory of Ocular Cell Biology and Visual Science, Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Atsuhiro Kanda
- Laboratory of Ocular Cell Biology and Visual Science, Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Satoru Kase
- Laboratory of Ocular Cell Biology and Visual Science, Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Susumu Ishida
- Laboratory of Ocular Cell Biology and Visual Science, Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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ASSOCIATION OF TREATMENT RESPONSE WITH QUANTITATIVE CHANGES IN CHOROIDAL NEOVASCULARIZATION AND CHOROIDAL VESSEL IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2021; 40:1704-1718. [PMID: 31725526 DOI: 10.1097/iae.0000000000002678] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the association between treatment response and quantitative morphological changes in choroidal neovascularization and outer choroidal vessels using optical coherence tomography angiography (OCTA) and en face OCT in neovascular age-related macular degeneration (nAMD). METHODS We retrospectively analyzed 75 eyes of typical nAMD patients and 53 polypoidal choroidal vasculopathy eyes of 124 patients with OCTA performed at least 6 months after initial antivascular endothelial growth factor treatment. Quantitative parameters, including vessel area, vessel diameter, branch vessel length, fractal dimension, and lacunarity were analyzed based on en face images of the choroidal neovascularization and choroidal vessel in Haller's layer. Parameters associated with loss of logarithm of the minimum angle of resolution visual acuity with the basis of 0.3 and the treatment interval (good vs. poor responder based on 12 weeks) were analyzed. Analyses were conducted for "before OCTA" (initial visit to OCTA) and "after OCTA" (OCTA to 6 months post-OCTA). RESULTS In typical nAMD, visual acuity loss before OCTA was associated with a higher SD of choroidal neovascularization diameter and lower choroidal fractal dimension. Visual acuity loss after OCTA in typical nAMD was associated with higher lacunarity of the choroid. Poor responders before OCTA were not associated with any factor. Poor responders after OCTA were associated with a lower SD of outer choroidal vessel diameter in typical nAMD. In polypoidal choroidal vasculopathy, no factor was associated with clinical outcomes in either period. CONCLUSION Quantitative analyses of choroidal neovascularization on OCTA and choroidal vessels on en face OCT provide information about treatment response, including changes in visual acuity and treatment interval, in nAMD.
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Li C, Fitzgerald MEC, Del Mar N, Wang H, Haughey C, Honig MG, Reiner A. Role of the superior salivatory nucleus in parasympathetic control of choroidal blood flow and in maintenance of retinal health. Exp Eye Res 2021; 206:108541. [PMID: 33736985 PMCID: PMC8087653 DOI: 10.1016/j.exer.2021.108541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/16/2021] [Accepted: 03/09/2021] [Indexed: 01/24/2023]
Abstract
The vasodilatory pterygopalatine ganglion (PPG) innervation of the choroid is under the control of preganglionic input from the superior salivatory nucleus (SSN), the parasympathetic portion of the facial motor nucleus. We sought to confirm that choroidal SSN drives a choroid-wide vasodilation and determine if such control is important for retinal health. To the former end, we found, using transscleral laser Doppler flowmetry, that electrical activation of choroidal SSN significantly increased choroidal blood flow (ChBF), at a variety of choroidal sites that included more posterior as well as more anterior ones. We further found that the increases in ChBF were significantly reduced by inhibition of neuronal nitric oxide synthase (nNOS), thus implicating nitrergic PPG terminals in the SSN-elicited ChBF increases. To evaluate the role of parasympathetic control of ChBF in maintaining retinal health, some rats received unilateral lesions of SSN, and were evaluated functionally and histologically. In eyes ipsilateral to choroidal SSN destruction, we found that the flash-evoked scotopic electroretinogram a-wave and b-wave peak amplitudes were both significantly reduced by 10 weeks post lesion. Choroidal baroregulation was evaluated in some of these rats, and found to be impaired in the low systemic arterial blood pressure (ABP) range where vasodilation normally serves to maintain stable ChBF. In retina ipsilateral to SSN destruction, the abundance of Müller cell processes immunolabeled for glial fibrillary acidic protein (GFAP) and GFAP message were significantly upregulated. Our studies indicate that the SSN-PPG circuit mediates parasympathetic vasodilation of choroid, which appears to contribute to ChBF baroregulation during low ABP. Our results further indicate that impairment in this adaptive mechanism results in retinal dysfunction and pathology within months of the ChBF disturbance, indicating its importance for retinal health.
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Affiliation(s)
- Chunyan Li
- Department of Anatomy and Neurobiology, USA
| | - Malinda E C Fitzgerald
- Department of Anatomy and Neurobiology, USA; Department of Ophthalmology, University of Tennessee, 855 Monroe Ave, Memphis, TN, 38163, USA; Department of Biology, Christian Brothers University, Memphis, TN, 38104, USA
| | | | | | | | | | - Anton Reiner
- Department of Anatomy and Neurobiology, USA; Department of Ophthalmology, University of Tennessee, 855 Monroe Ave, Memphis, TN, 38163, USA.
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23
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MULTIMODAL IMAGING OF FOCAL CHOROIDAL EXCAVATION COMPLICATED BY CHOROIDAL NEOVASCULARIZATION IN A PATIENT WITH ANGIOID STREAKS AND PSEUDOXANTHOMA ELASTICUM. Retin Cases Brief Rep 2021; 15:155-162. [PMID: 29965887 DOI: 10.1097/icb.0000000000000759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe a case of focal choroidal excavation (FCE) complicated with Type-2 choroidal neovascularization (CNV) in a patient with angioid streaks secondary to pseudoxanthoma elasticum before and after treatment with bevacizumab. METHODS Fundus photography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography (SD-OCT) and SD-OCT angiography were performed in a 60-year-old white woman with angioid streaks and bilateral FCE. Spectral domain OCT images were taken before and after three-monthly intravitreal injections of bevacizumab. Histopathological analysis of the dermis established the diagnosis of pseudoxanthoma elasticum. RESULTS Multimodal imaging revealed bilateral FCE and CNV. Spectral domain OCT diagnosed bilateral FCE and Type-1 and Type-2 CNV in the right eye, and irregular vascular network, along macular streak, in both eyes, which were not observed on fluorescein neither on indocyanine green angiography, but only on SD-OCT angiography. Patient presented good anatomical and functional response to intravitreal injections of bevacizumab. CONCLUSION Focal choroidal excavation is a rare condition detected mainly by SD-OCT, which may be associated with angioid streaks secondary to pseudoxanthoma elasticum and complicated by CNV. Multimodal imaging is important for diagnosis and follow-up of such patients, even in the absence of signs of CNV, and anatomical and functional response to anti-vascular endothelial growth factor therapy is good.
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24
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Edwards M, Lutty GA. Bruch's Membrane and the Choroid in Age-Related Macular Degeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1256:89-119. [PMID: 33847999 DOI: 10.1007/978-3-030-66014-7_4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A healthy choroidal vasculature is necessary to support the retinal pigment epithelium (RPE) and photoreceptors, because there is a mutualistic symbiotic relationship between the components of the photoreceptor/retinal pigment epithelium (RPE)/Bruch's membrane (BrMb)/choriocapillaris (CC) complex. This relationship is compromised in age-related macular degeneration (AMD) by the dysfunction or death of the choroidal vasculature. This chapter will provide a basic description of the human Bruch's membrane and choroidal anatomy and physiology and how they change in AMD.The choriocapillaris is the lobular, fenestrated capillary system of choroid. It lies immediately posterior to the pentalaminar Bruch's membrane (BrMb). The blood supply for this system is the intermediate blood vessels of Sattler's layer and the large blood vessels in Haller's layer.In geographic atrophy (GA), an advanced form of dry AMD, large confluent drusen form on BrMb, and hyperpigmentation (presumably dysfunction in RPE) appears to be the initial insult. The resorption of these drusen and loss of RPE (hypopigmentation) can be predictive for progression of GA. The death and dysfunction of CC and photoreceptors appear to be secondary events to loss in RPE. The loss of choroidal vasculature may be the initial insult in neovascular AMD (nAMD). We have observed a loss of CC with an intact RPE monolayer in nAMD, by making RPE hypoxic. These hypoxic cells then produce angiogenic substances like vascular endothelial growth factor (VEGF), which stimulate growth of new vessels from CC, resulting in choroidal neovascularization (CNV). Reduction in blood supply to the CC, often stenosis of intermediate and large blood vessels, is associated with CC loss.The polymorphisms in the complement system components are associated with AMD. In addition, the environment of the CC, basement membrane and intercapillary septa, is a proinflammatory milieu with accumulation of proinflammatory molecules like CRP and complement components during AMD. In this toxic milieu, CC die or become dysfunctional even early in AMD. The loss of CC might be a stimulus for drusen formation since the disposal system for retinal debris and exocytosed material from RPE would be limited. Ultimately, the photoreceptors die of lack of nutrients, leakage of serum components from the neovascularization, and scar formation.Therefore, the mutualistic symbiotic relationship of the photoreceptor/RPE/BrMb/CC complex is lost in both forms of AMD. Loss of this functionally integrated relationship results in death and dysfunction of all of the components in the complex.
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Affiliation(s)
- Malia Edwards
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Gerard A Lutty
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, USA.
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25
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Nita M, Grzybowski A. Interplay between reactive oxygen species and autophagy in the course of age-related macular degeneration. EXCLI JOURNAL 2020; 19:1353-1371. [PMID: 33192217 PMCID: PMC7658465 DOI: 10.17179/excli2020-2915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 12/11/2022]
Abstract
Pathological biomolecules such as lipofuscin, methylglyoxal-modified proteins (the major precursors of advanced glycationend products), misfolding protein deposits and dysfunctional mitochondria are source of oxidative stress and act as strong autophagic stimulators in age-related macular degeneration. Disturbed autophagy accelerates progression of the disease, since it leads to retinal cells' death and activates inflammation by the interplay with the NLRP3 inflammasome complex. Vascular dysfunction and hypoxia, as well as circulating autoantibodies against autophagy regulators (anti-S100A9, anti-ANXA5, and anti-HSPA8, A9 and B4) compromise an autophagy-mediated mechanism as well. Metformin, the autophagic stimulator, may act as a senostatic drug to inhibit the senescent phenotype in the age-related macular degeneration. PGC-1α , Sirt1 and AMPK represent new therapeutic targets for interventions in this disease.
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Affiliation(s)
- Malgorzata Nita
- Domestic and Specialized Medicine Centre "Dilmed" Katowice, Poland
| | - Andrzej Grzybowski
- Department of Ophthalmolgy, Medical Faculty, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Poznań, Poland
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26
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Wang SV, Kulldorff M, Poor S, Rice DS, Banks A, Li N, Lii J, Gagne JJ. Screening Medications for Association with Progression to Wet Age-Related Macular Degeneration. Ophthalmology 2020; 128:248-255. [PMID: 32777229 DOI: 10.1016/j.ophtha.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE There is an urgent need for treatments that prevent or delay development to advanced age-related macular degeneration (AMD). Drugs already on the market for other conditions could affect progression to neovascular AMD (nAMD). If identified, these drugs could provide insights for drug development targets. The objective of this study was to use a novel data mining method that can simultaneously evaluate thousands of correlated hypotheses, while adjusting for multiple testing, to screen for associations between drugs and delayed progression to nAMD. DESIGN We applied a nested case-control study to administrative insurance claims data to identify cases with nAMD and risk-set sampled controls that were 1:4 variable ratio matched on age, gender, and recent healthcare use. PARTICIPANTS The study population included cases with nAMD and risk set matched controls. METHODS We used a tree-based scanning method to evaluate associations between hierarchical classifications of drugs that patients were exposed to within 6 months, 7 to 24 months, or ever before their index date. The index date was the date of first nAMD diagnosis in cases. Risk-set sampled controls were assigned the same index date as the case to which they were matched. The study was implemented using Medicare data from New Jersey and Pennsylvania, and national data from IBM MarketScan Research Database. We set an a priori threshold for statistical alerting at P ≤ 0.01 and focused on associations with large magnitude (relative risks ≥ 2.0). MAIN OUTCOME MEASURES Progression to nAMD. RESULTS Of approximately 4000 generic drugs and drug classes evaluated, the method detected 19 distinct drug exposures with statistically significant, large relative risks indicating that cases were less frequently exposed than controls. These included (1) drugs with prior evidence for a causal relationship (e.g., megestrol); (2) drugs without prior evidence for a causal relationship, but potentially worth further exploration (e.g., donepezil, epoetin alfa); (3) drugs with alternative biologic explanations for the association (e.g., sevelamer); and (4) drugs that may have resulted in statistical alerts due to their correlation with drugs that alerted for other reasons. CONCLUSIONS This exploratory drug-screening study identified several potential targets for follow-up studies to further evaluate and determine if they may prevent or delay progression to advanced AMD.
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Affiliation(s)
- Shirley V Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Martin Kulldorff
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Stephen Poor
- Ophthalmology, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Dennis S Rice
- Ophthalmology, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Angela Banks
- Ophthalmology, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Ning Li
- Ophthalmology, Novartis Institutes for Biomedical Research, Cambridge, Massachusetts
| | - Joyce Lii
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joshua J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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27
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Calzetti G, Mora P, Favilla S, Ottonelli G, Devincenzi G, Carta A, Tedesco S, Mursch-Edlmayr A, Garhöfer G, Gandolfi S, Schmetterer L. Assessment of Choroidal Neovascularization Perfusion: A Pilot Study With Laser Speckle Flowgraphy. Transl Vis Sci Technol 2020; 9:9. [PMID: 32821481 PMCID: PMC7401962 DOI: 10.1167/tvst.9.5.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/03/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose The purpose of this study was to quantify perfusion in the area of choroidal neovascularization (CNV) using laser speckle flowgraphy (LSFG) before and after intravitreal anti-vascular endothelial growth factor (VEGF) injection. Methods Retrospective case series. Fifteen eyes of 15 patients with treatment-naïve CNV due to age-related macular degeneration (AMD) and with available LSFG images were included. The main outcome was the mean blur rate (MBR) quantified as a measure of perfusion within the CNV area observed on indocyanine green angiography. Twelve patients had available longitudinal data until one month after the injection, used to evaluate changes in perfusion, central macular thickness (CMT), visual acuity, and ocular perfusion pressure. Reproducibility of LSFG measurements was investigated at each time point from two images taken within five minutes. Results Intraclass correlation coefficients for LSFG measurements were higher than 0.8 indicating excellent reproducibility. There was a significant decrease in perfusion after one week (-26.4 ± 14.4%; P = 0.027), whereas, after one month, perfusion was no longer significantly different from baseline (P = 0.121). CMT showed a progressive decrease over the follow-up period. Changes in perfusion were strongly correlated with changes in CMT after one week, but not thereafter. Conclusions This pilot study suggests a method to select a region in the CNV area to quantify perfusion using LSFG. MBR could represent a parameter possibly related to regrowth of the CNV after anti-VEGF treatment. Large-scale studies are needed to assess the usefulness of LSFG in defining re-treatment criteria for neovascular AMD. Translational Relevance LSFG technology to quantify perfusion could provide useful biomarkers for therapeutic management of CNV.
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Affiliation(s)
| | - Paolo Mora
- Ophthalmology Unit, University Hospital of Parma, Parma, Italy
| | | | | | | | - Arturo Carta
- Ophthalmology Unit, University Hospital of Parma, Parma, Italy
| | | | - Anna Mursch-Edlmayr
- Department of Ophthalmology, Kepler University Clinic, Johannes Kepler University, Linz, Austria
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Singapore Eye Research Institute, Singapore.,Nanyang Technological University, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Institute of Ophthalmology, Basel, Switzerland
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28
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Lutty GA, McLeod DS, Bhutto IA, Edwards MM, Seddon JM. Choriocapillaris dropout in early age-related macular degeneration. Exp Eye Res 2020; 192:107939. [PMID: 31987759 DOI: 10.1016/j.exer.2020.107939] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/30/2019] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
Loss of choriocapillaris (CC) in advanced age-related macular degeneration (AMD) is well documented but changes in early AMD have not been quantified. Postmortem eyes from donors with clinically documented early AMD were examined in choroidal whole mounts to determine the area, pattern, and severity of CC loss. Choroids from postmortem human eyes without AMD (n = 7; mean age = 86.1) and from eyes with a Grade 2 clinical classification of early AMD (n = 7; mean age = 87) were immunolabeled with Ulex europaeus agglutinin (UEA) lectin-FITC to stain blood vessels. Whole mounts were imaged using confocal microscopy and image analysis was performed to determine the area of vascular changes and density of vasculature (percent vascular area, %VA). All areas evaluated had a complete RPE monolayer upon gross examination. In age-matched control eyes, the CC had broad lumens and a homogenous pattern of freely interconnecting capillaries. The mean %VA ± standard deviation in submacula of control subjects was 78.1 ± 3.25%. In eyes with early AMD, there was a significant decrease in mean %VA to 60.1 ± 10.4% (p < 0.0001). The paramacular %VA was not significantly different in eyes with or without AMD. The area of submacular choroid affected by CC dropout was 0.04 ± 0.09 mm2 in control eyes. In eyes with early AMD, the mean area affected by CC dropout was significantly increased (10.4 ± 6.1 mm2; p < 0.001). In some cases, incipient neovascular buds were observed at the border of regions with CC dropout in early AMD choroids. In conclusion, UEA lectin-labeled choroidal whole mounts from donors with clinically documented early AMD has provided a unique opportunity to examine regional changes in vascular pathology associated with choriocapillaris. The study demonstrated attenuation of submacular CC in early AMD subjects but no vascular pathology was observed outside the submacular region. While the affected area in some eyes was quite extensive histologically, these changes may not be detectable clinically using standard in vivo imaging.
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Affiliation(s)
- Gerard A Lutty
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, 21287, USA.
| | - D Scott McLeod
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, 21287, USA
| | - Imran A Bhutto
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, 21287, USA
| | - Malia M Edwards
- Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, 21287, USA
| | - Johanna M Seddon
- Department of Ophthalmology and Visual Sciences, University of Massachusetts Medical School, Worchester, MA, USA.
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29
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Lipecz A, Miller L, Kovacs I, Czakó C, Csipo T, Baffi J, Csiszar A, Tarantini S, Ungvari Z, Yabluchanskiy A, Conley S. Microvascular contributions to age-related macular degeneration (AMD): from mechanisms of choriocapillaris aging to novel interventions. GeroScience 2019; 41:813-845. [PMID: 31797238 PMCID: PMC6925092 DOI: 10.1007/s11357-019-00138-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 12/13/2022] Open
Abstract
Aging of the microcirculatory network plays a central role in the pathogenesis of a wide range of age-related diseases, from heart failure to Alzheimer's disease. In the eye, changes in the choroid and choroidal microcirculation (choriocapillaris) also occur with age, and these changes can play a critical role in the pathogenesis of age-related macular degeneration (AMD). In order to develop novel treatments for amelioration of choriocapillaris aging and prevention of AMD, it is essential to understand the cellular and functional changes that occur in the choroid and choriocapillaris during aging. In this review, recent advances in in vivo analysis of choroidal structure and function in AMD patients and patients at risk for AMD are discussed. The pathophysiological roles of fundamental cellular and molecular mechanisms of aging including oxidative stress, mitochondrial dysfunction, and impaired resistance to molecular stressors in the choriocapillaris are also considered in terms of their contribution to the pathogenesis of AMD. The pathogenic roles of cardiovascular risk factors that exacerbate microvascular aging processes, such as smoking, hypertension, and obesity as they relate to AMD and choroid and choriocapillaris changes in patients with these cardiovascular risk factors, are also discussed. Finally, future directions and opportunities to develop novel interventions to prevent/delay AMD by targeting fundamental cellular and molecular aging processes are presented.
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Affiliation(s)
- Agnes Lipecz
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Ophthalmology, Josa Andras Hospital, Nyiregyhaza, Hungary
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lauren Miller
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd. BMSB553, Oklahoma City, OK, 73104, USA
| | - Illes Kovacs
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Department of Ophthalmology, Weill Cornell Medical College, New York City, NY, USA
| | - Cecília Czakó
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Tamas Csipo
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Baffi
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Anna Csiszar
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, University of Szeged, Szeged, Hungary
| | - Stefano Tarantini
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, University of Szeged, Szeged, Hungary
| | - Zoltan Ungvari
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- International Training Program in Geroscience, Theoretical Medicine Doctoral School, University of Szeged, Szeged, Hungary
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Translational Geroscience Laboratory, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shannon Conley
- Vascular Cognitive Impairment and Neurodegeneration Program, Center for Geroscience and Healthy Brain Aging/Reynolds Oklahoma Center on Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 940 Stanton L. Young Blvd. BMSB553, Oklahoma City, OK, 73104, USA.
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30
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Ji Cho M, Yoon SJ, Kim W, Park J, Lee J, Park JG, Cho YL, Hun Kim J, Jang H, Park YJ, Lee SH, Min JK. Oxidative stress-mediated TXNIP loss causes RPE dysfunction. Exp Mol Med 2019; 51:1-13. [PMID: 31615975 PMCID: PMC6802648 DOI: 10.1038/s12276-019-0327-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/12/2019] [Accepted: 08/23/2019] [Indexed: 01/08/2023] Open
Abstract
The disruption of the retinal pigment epithelium (RPE), for example, through oxidative damage, is a common factor underlying age-related macular degeneration (AMD). Aberrant autophagy also contributes to AMD pathology, as autophagy maintains RPE homeostasis to ensure blood–retinal barrier (BRB) integrity and protect photoreceptors. Thioredoxin-interacting protein (TXNIP) promotes cellular oxidative stress by inhibiting thioredoxin reducing capacity and is in turn inversely regulated by reactive oxygen species levels; however, its role in oxidative stress-induced RPE cell dysfunction and the mechanistic link between TXNIP and autophagy are largely unknown. Here, we observed that TXNIP expression was rapidly downregulated in RPE cells under oxidative stress and that RPE cell proliferation was decreased. TXNIP knockdown demonstrated that the suppression of proliferation resulted from TXNIP depletion-induced autophagic flux, causing increased p53 activation via nuclear localization, which in turn enhanced AMPK phosphorylation and activation. Moreover, TXNIP downregulation further negatively impacted BRB integrity by disrupting RPE cell tight junctions and enhancing cell motility by phosphorylating, and thereby activating, Src kinase. Finally, we also revealed that TXNIP knockdown upregulated HIF-1α, leading to the enhanced secretion of VEGF from RPE cells and the stimulation of angiogenesis in cocultured human retinal microvascular endothelial cells. This suggests that the exposure of RPE cells to sustained oxidative stress may promote choroidal neovascularization, another AMD pathology. Together, these findings reveal three distinct mechanisms by which TXNIP downregulation disrupts RPE cell function and thereby exacerbates AMD pathogenesis. Accordingly, reinforcing or restoring BRB integrity by targeting TXNIP may serve as an effective therapeutic strategy for preventing or attenuating photoreceptor damage in AMD. A protein found in retinal cells promotes the development of age-related macular degeneration and may provide a therapeutic target. Sight loss through macular degeneration is triggered by disruption to the retinal pigment epithelium (RPE), a layer of cells that carries nutrients to the eye. RPE cells can be disrupted under oxidative stress conditions, but how this influences macular degeneration is unclear. Jeong-Ki Min and Sang-Hyun Lee at the Korea Research Institute of Bioscience and Biotechnology in Daejeon, South Korea, and co-workers found that oxidative stress reduces levels of the thioredoxin-interacting protein (TXNIP) in human RPE cell cultures. This interrupts cellular communication and disturbs the balance between cell proliferation and cell recycling. It also increases the levels of proteins that promote excess blood vessel formation, a key process contributing to macular degeneration.
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Affiliation(s)
- Min Ji Cho
- Biotherapeutics Translational Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 125 Gwahak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea.,Department of Biomolecular Science, KRIBB School of Bioscience, Korea University of Science and Technology (UST), 217 Gajeong-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Sung-Jin Yoon
- Environmental Disease Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 125 Gwahak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Wooil Kim
- Biotherapeutics Translational Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 125 Gwahak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea.,Department of Biomolecular Science, KRIBB School of Bioscience, Korea University of Science and Technology (UST), 217 Gajeong-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Jongjin Park
- Biotherapeutics Translational Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 125 Gwahak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Jangwook Lee
- Biotherapeutics Translational Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 125 Gwahak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Jong-Gil Park
- Biotherapeutics Translational Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 125 Gwahak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Young-Lai Cho
- Metabolic Regulation Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 125 Gwahak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Jeong Hun Kim
- Fight against Angiogenesis-Related Blindness (FARB) Laboratory, Clinical Research Institute, Seoul National University Hospital, 101 Daehak-ro, jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyejin Jang
- Department of Biomolecular Science, KRIBB School of Bioscience, Korea University of Science and Technology (UST), 217 Gajeong-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea.,Environmental Disease Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 125 Gwahak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Young-Jun Park
- Department of Biomolecular Science, KRIBB School of Bioscience, Korea University of Science and Technology (UST), 217 Gajeong-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea.,Environmental Disease Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 125 Gwahak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Sang-Hyun Lee
- Biotherapeutics Translational Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 125 Gwahak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea.
| | - Jeong-Ki Min
- Biotherapeutics Translational Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 125 Gwahak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea. .,Department of Biomolecular Science, KRIBB School of Bioscience, Korea University of Science and Technology (UST), 217 Gajeong-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea.
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Vujosevic S, Toma C, Villani E, Muraca A, Torti E, Florimbi G, Pezzotti M, Nucci P, De Cillà S. Quantitative choriocapillaris evaluation in intermediate age-related macular degeneration by swept-source optical coherence tomography angiography. Acta Ophthalmol 2019; 97:e919-e926. [PMID: 30900822 DOI: 10.1111/aos.14088] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 02/21/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE To investigate choriocapillaris (CC) perfusion, by evaluating flow voids (FV), in eyes with intermediate age-related macular degeneration (iAMD) using swept-source optical coherence tomography angiography (SS-OCT-A). METHODS Patients with bilateral or unilateral iAMD and normal controls underwent SS-OCT and OCT-A examination. Choriocapillaris (CC) FVs were quantitatively assessed on OCT-A images using matlab (version 2017b; MathWorks, Natick, MA, USA), after a preprocessing aimed at compensating for CC attenuation artefacts. Three different thresholds [1 standard deviation (SD), 1.25 SD and 1.5 SD] were applied. Final FV percentage (FV%) was calculated as the ratio between area with absent flow and total scanned area. RESULTS Of 41 patients with iAMD and 16 normal subjects enrolled in the study, 39 eyes (39 patients) with iAMD and all 16 normal eyes (16 control subjects) were included in the final analysis. Mean FV% (1 SD) was 13.45 ± 0.66 in controls, 14.19 ± 1.23 in bilateral iAMD and 14.21 ± 0.99 in unilateral iAMD (p = 0.03, for difference between controls and bilateral iAMD). Mean FV% (1.25 SD) was 6.55 ± 0.65 in controls, 7.33 ± 1.4 in bilateral iAMD and 7.06 ± 1.4 in unilateral iAMD (p = 0.048, for difference between controls and bilateral iAMD). Mean FV% (1.5 SD) was 2.71 ± 0.82 in controls, 2.55 ± 1.12 in bilateral iAMD and 3.25 ± 1.17 in unilateral iAMD (p = 0.038, for difference between bilateral and unilateral iAMD). CONCLUSION A significantly higher FV% was found in patients with iAMD versus controls. A higher trend in FV% was found in unilateral iAMD (with neovascular AMD in the fellow eye) versus bilateral iAMD, when applying the lowest threshold. Further, larger and longitudinal studies are needed to confirm this data.
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Affiliation(s)
- Stela Vujosevic
- Eye Clinic University Hospital Maggiore della Carita’ Novara Italy
| | - Caterina Toma
- Eye Clinic University Hospital Maggiore della Carita’ Novara Italy
| | - Edoardo Villani
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
- Eye Clinic San Giuseppe Hospital Milan Italy
| | - Andrea Muraca
- Eye Clinic University Hospital Maggiore della Carita’ Novara Italy
| | - Emanuele Torti
- Department of Electrical, Computer and Biomedical Engineering University of Pavia Pavia Italy
| | - Giordana Florimbi
- Department of Electrical, Computer and Biomedical Engineering University of Pavia Pavia Italy
| | - Marco Pezzotti
- Eye Clinic University Hospital Maggiore della Carita’ Novara Italy
| | - Paolo Nucci
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
- Eye Clinic San Giuseppe Hospital Milan Italy
| | - Stefano De Cillà
- Eye Clinic University Hospital Maggiore della Carita’ Novara Italy
- Department of Health Sciences University East Piedmont “A.Avogadro” Novara Italy
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Li C, Fitzgerald MEC, Del Mar N, Haughey C, Reiner A. Defective Choroidal Blood Flow Baroregulation and Retinal Dysfunction and Pathology Following Sympathetic Denervation of Choroid. Invest Ophthalmol Vis Sci 2019; 59:5032-5044. [PMID: 30326072 PMCID: PMC6190756 DOI: 10.1167/iovs.18-24954] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose We sought to determine if sympathetic denervation of choroid impairs choroidal blood flow (ChBF) regulation and harms retina. Methods Rats received bilateral superior cervical ganglionectomy (SCGx), which depleted choroid of sympathetic but not parasympathetic innervation. The flash-evoked scotopic ERG and visual acuity were measured 2 to 3 months after SCGx, and vasoconstrictive ChBF baroregulation during high systemic arterial blood pressure (ABP) induced by LNAME was assessed by laser Doppler flowmetry (LDF). Eyes were harvested for histologic evaluation. Results ChBF increased in parallel with ABP in SCGx rats over an ABP range of 90% to 140% of baseline ABP, while in sham rats ChBF remained stable and uncorrelated with ABP. ERG a- and b-wave latencies and amplitudes, and visual acuity were significantly reduced after SCGx. In SCGx retina, Müller cell GFAP immunolabeling was upregulated 2.5-fold, and Iba1+ microglia were increased 3-fold. Dopaminergic amacrine cell fibers in inner plexiform layer were reduced in SCGx rats, and photoreceptors were slightly depleted. Functional deficits and pathology were correlated with impairments in sympathetic regulation of ChBF. Conclusions These studies indicate that sympathetic denervation of choroid impairs ChBF baroregulation during elevated ABP, leading to choroidal overperfusion. This defect in ChBF regulation is associated with impaired retinal function and retinal pathology. As sympathetic ChBF baroregulatory defects have been observed in young individuals with complement factor H (CFH) polymorphisms associated with risk for AMD, our results suggest these defects may harm retina, perhaps contributing to AMD pathogenesis.
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Affiliation(s)
- Chunyan Li
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Malinda E C Fitzgerald
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Department of Ophthalmology, University of Tennessee, Memphis, Tennessee, United States.,Department of Biology, Christian Brothers University, Memphis, Tennessee, United States
| | - Nobel Del Mar
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Corey Haughey
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Department of Biology, Christian Brothers University, Memphis, Tennessee, United States
| | - Anton Reiner
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, Tennessee, United States.,Department of Ophthalmology, University of Tennessee, Memphis, Tennessee, United States
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Chua J, Chin CWL, Tan B, Wong SH, Devarajan K, Le TT, Ang M, Wong TY, Schmetterer L. Impact of systemic vascular risk factors on the choriocapillaris using optical coherence tomography angiography in patients with systemic hypertension. Sci Rep 2019; 9:5819. [PMID: 30967575 PMCID: PMC6456612 DOI: 10.1038/s41598-019-41917-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/20/2019] [Indexed: 12/29/2022] Open
Abstract
We investigated the characteristics of the choriocapillaris flow voids using optical coherence tomography angiography (OCTA) in 85 patients (164 eyes) with hypertension (mean ± SD age, 56 ± 11 years; 45% women; 20% poorly controlled BP; 16% diabetes) who are without ocular diseases and determined possible correlations with systemic vascular risk factors. Data on 24-hour ambulatory blood pressure (BP), serum creatinine, and urine microalbumin/creatinine ratio (MCR) were collected. Estimated glomerular filtration rate (eGFR) was calculated based on CKD-EPI Creatinine Equation. OCTA imaging (6 × 6 mm scans; AngioVue) with quantitative microvascular analysis of the choriocapillaris was performed. Linear regression was used to investigate the association of systemic risk factors with area (percentage), size (pixels) and number of choriocapillaris flow voids. Diabetes (β = 0.33; 95% CI, 0.02 to 0.63) and daytime systolic BP (β = -0.13; 95% CI, -0.24 to -0.02) were associated with areas of flow voids. Age (β = 0.21; 95% CI, 0.06 to 0.36) and daytime diastolic BP (β = -0.18; 95% CI, -0.34 to -0.02) were associated with size of flow voids. Age (β = -21.21; 95% CI, -31.79 to -10.63) and nighttime diastolic BP (β = 13.89; 95% CI, 0.61 to 27.17) were associated with number of flow voids. Kidney parameters were not associated with any features of flow voids. In patients with hypertension, a higher BP appeared to increase blood flow in the choriocapillaris which needs to be considered when using the OCTA to study eye diseases in hypertensives.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Calvin Woon Loong Chin
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Si Han Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Kavya Devarajan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Thu-Thao Le
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. .,Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore. .,Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria. .,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
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Harris A, Siesky B, Huang A, Do T, Mathew S, Frantz R, Gross J, Januleviciene I, Verticchio Vercellin AC. Lutein Complex Supplementation Increases Ocular Blood Flow Biomarkers in Healthy Subjects. INT J VITAM NUTR RES 2019; 89:5-12. [PMID: 30932775 DOI: 10.1024/0300-9831/a000576] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: To investigate the effects of a lutein complex supplementation on ocular blood flow in healthy subjects. Materials and Methods: Sixteen healthy female patients (mean age 36.8 ± 12.1 years) were enrolled in this randomized, placebo-controlled, double-blinded, two-period crossover study. Subjects received daily an oral dose of the lutein with synergistic phytochemicals complex (lutein (10 mg), ascorbic acid (500 mg), tocopherols (364 mg), carnosic acid (2.5 mg), zeaxanthin (2 mg), copper (2 mg), with synergistic effects in reducing pro-inflammatory mediators and cytokines when administered together in combination) and placebo during administration periods. Measurements were taken before and after three-week supplementation periods, with crossover visits separated by a three-week washout period. Data analysis included blood pressure, heart rate, intraocular pressure, visual acuity, contrast sensitivity detection, ocular perfusion pressure, confocal scanning laser Doppler imaging of retinal capillary blood flow, and Doppler imaging of the retrobulbar blood vessels. Results: Lutein complex supplementation produced a statistically significant increase in mean superior retinal capillary blood flow, measured in arbitrary units (60, p = 0.0466) and a decrease in the percentage of avascular area in the superior (-0.029, p = 0.0491) and inferior (-0.023, p = 0.0477) retina, as well as reduced systolic (-4.06, p = 0.0295) and diastolic (-3.69, p = 0.0441) blood pressure measured in mmHg from baseline. Data comparison between the two supplement groups revealed a significant decrease in systemic diastolic blood pressure (change from pre- to post-treatment with lutein supplement (mean (SE)): -3.69 (1.68); change from pre- to post-treatment with placebo: 0.31 (2.57); p = 0.0357) and a significant increase in the peak systolic velocity (measured in cm/sec) in the central retinal artery (change from pre- to post-treatment with lutein supplement: 0.36 (0.19); change from pre- to post-treatment with placebo: -0.33 (0.21); p = 0.0384) with lutein complex supplement; data analyses from the placebo group were all non-significant. Discussion: In healthy participants, oral administration of a lutein phytochemicals complex for three weeks produced increased ocular blood flow biomarkers within retinal vascular beds and reduced diastolic blood pressure compared to placebo.
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Affiliation(s)
- Alon Harris
- 1Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brent Siesky
- 1Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amelia Huang
- 1Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Thai Do
- 1Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sunu Mathew
- 1Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rachel Frantz
- 1Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Josh Gross
- 1Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ingrida Januleviciene
- 2Eye Clinic of Medical Academy of Lithuanian University of Health Sciences, Kaunas, Lithuania
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Vascular Response to Sildenafil Citrate in Aging and Age-Related Macular Degeneration. Sci Rep 2019; 9:5049. [PMID: 30911094 PMCID: PMC6434029 DOI: 10.1038/s41598-019-41509-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/11/2019] [Indexed: 01/21/2023] Open
Abstract
Age-related macular degeneration (AMD) - the leading cause of vision loss in the elderly - share many risks factors as atherosclerosis, which exhibits loss of vascular compliance resulting from aging and oxidative stress. Here, we attempt to explore choroidal and retinal vascular compliance in patients with AMD by evaluating dynamic vascular changes using live ocular imaging following treatment with oral sildenafil citrate, a phosphodiesterase type 5 (PDE5) inhibitor and potent vasodilator. Enhanced-depth imaging optical coherence tomography (EDI-OCT) and OCT angiography (OCT-A) were performed on 46 eyes of 23 subjects, including 15 patients with non-exudative AMD in one eye and exudative AMD in the fellow eye, and 8 age-matched control subjects. Choroidal thickness, choroidal vascularity, and retinal vessel density were measured across the central macula at 1 and 3 hours after a 100 mg oral dose of sildenafil citrate. Baseline choroidal thickness was 172.1 ± 60.0 μm in non-exudative AMD eyes, 196.4 ± 89.8 μm in exudative AMD eyes, and 207.4 ± 77.7 μm in control eyes, with no difference between the 3 groups (P = 0.116). After sildenafil, choroidal thickness increased by 6.0% to 9.0% at 1 and 3 hours in all groups (P = 0.001-0.014). Eyes from older subjects were associated with choroidal thinning at baseline (P = 0.005) and showed less choroidal expansion at 1 hour and 3 hours after sildenafil (P = 0.001) regardless of AMD status (P = 0.666). The choroidal thickening appeared to be primarily attributed to expansion of the stroma rather than luminal component. Retinal vascular density remained unchanged after sildenafil in all 3 groups (P = 0.281-0.587). Together, our studies suggest that vascular response of the choroid to sildenafil decreases with age, but is not affected by the presence of non-exudative or exudative AMD, providing insight into changes in vessel compliance in aging and AMD.
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Tan B, Chua J, Barathi VA, Baskaran M, Chan A, Lin E, Ang M, Klose G, Schmetterer L. Quantitative analysis of choriocapillaris in non-human primates using swept-source optical coherence tomography angiography (SS-OCTA). BIOMEDICAL OPTICS EXPRESS 2019; 10:356-371. [PMID: 30775105 PMCID: PMC6363185 DOI: 10.1364/boe.10.000356] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 05/12/2023]
Abstract
The choriocapillaris is a unique vascular plexus located posterior to the retinal pigment epithelium. In recent years, there is an increasing interest in the examination of the interrelationship between the choriocapillaris and eye diseases. We used several techniques to study choroidal perfusion, including laser Doppler flowmetry, laser speckle flowgraphy, and optical coherence tomography angiography (OCTA), but with the latter no standardized algorithm for quantitative analysis has been provided. We analyzed different algorithms to quantify flow voids in non-human primates that can be easily implemented into clinical research. In-vivo, high-resolution images of the non-human primate choriocapillaris were acquired with a swept-source OCTA (SS-OCTA) system with 100kHz A-scan/s rate, over regions of 3 × 3 mm2 and 12 × 12 mm2. The areas of non-perfusion, also called flow voids, were segmented with a structural, intensity adjusted, uneven illuminance-compensated algorithm and the new technique was compared to previously published methods. The new algorithm shows improved reproducibility and may have applications in a wide array of eye diseases including age-related macular degeneration (AMD).
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Affiliation(s)
- Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Veluchamy Amutha Barathi
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Anita Chan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Emily Lin
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Moorfield Hospital, London, UK
| | | | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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37
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The Different Facades of Retinal and Choroidal Endothelial Cells in Response to Hypoxia. Int J Mol Sci 2018; 19:ijms19123846. [PMID: 30513885 PMCID: PMC6321100 DOI: 10.3390/ijms19123846] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 02/06/2023] Open
Abstract
Ocular angiogenic diseases, such as proliferative diabetic retinopathy and neovascular age-related macular degeneration, are associated with severe loss of vision. These pathologies originate from different vascular beds, retinal and choroidal microvasculatures, respectively. The activation of endothelial cells (EC) plays pivotal roles in angiogenesis, often triggered by oxygen deficiency. Hypoxia-inducible factors in ECs mediate the transcription of multiple angiogenic genes, including the canonical vascular endothelial growth factors. ECs show notable heterogeneity in function, structure, and disease, therefore the understanding of retinal/choroidal ECs (REC; CEC) biochemical and molecular responses to hypoxia may offer key insights into tissue-specific vascular targeting treatments. The aim of this review is to discuss the differences spanning between REC and CEC, with focus on their response to hypoxia, which could provide innovative and sustainable strategies for site specific targeting of ocular neovascularization.
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Mottet B, Aptel F, Geiser MH, Hera R, Zhou T, Almanjoumi A, Vinh V, Chiquet C. Choroidal blood flow after the first intravitreal ranibizumab injection in neovascular age-related macular degeneration patients. Acta Ophthalmol 2018; 96:e783-e788. [PMID: 30203609 DOI: 10.1111/aos.13763] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 02/15/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE To analyse choroidal blood flow (ChBF) changes after the first intravitreal ranibizumab injection in naïve, age-related macular degeneration (ARMD) patients. METHODS Subfoveal ChBF was assessed by laser Doppler flowmetry (LDF) in newly diagnosed ARMD patients. Both treated and untreated eyes were assessed in each subject at each visit before the first intravitreal ranibizumab injection as well as 24 hr (day 1) and 7 days after (day 7). Central macular thickness (CMT), best-corrected visual acuity (BVCA), systemic haemodynamic parameters and LDF parameters were evaluated at each visit. Nonparametric tests were used to compare data between visits and between treated and untreated eyes. RESULTS Seventeen ARMD patients were included (12 women and five men, 78 ± 8 years old). At day 7 postintravitreal ranibizumab injection, the normalized choroidal blood velocity (ChBVel) change in the treated eye group was significant (-10.2%; p = 0.006). The choroidal blood volume (ChBVol) did not change significantly after intravitreal injection of ranibizumab. There was a trend for a reduction in ChBF at day 7 (-9.1%, p = 0.08). The sensitivity of the experiment was 12% for ChBVel, 16% for ChBVol and 9% for ChBF. CONCLUSION In conclusion, the laser Doppler technique provides feasible and noninvasive measurements of blood flow parameters before and after intravitreal injection of antivascular endothelial growth factor (anti-VEGF) in patients with exudative ARMD. Choroidal blood velocity decreased as early as 7 days after intravitreal ranibizumab injection, suggesting a vasoconstriction effect of anti-VEGF in large choroidal vessels in front of choriocapillaris (the site of LDF measurement).
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Affiliation(s)
- Benjamin Mottet
- Grenoble Alpes University; Grenoble France
- Department of Ophthalmology; University Hospital; CHU Grenoble-Alpes; Grenoble France
| | - Florent Aptel
- Grenoble Alpes University; Grenoble France
- Department of Ophthalmology; University Hospital; CHU Grenoble-Alpes; Grenoble France
- INSERM U1042; Lab Hypoxia and Physiopathology; Grenoble-Alpes University; Grenoble France
| | | | - Ruxandra Hera
- Department of Ophthalmology; University Hospital; CHU Grenoble-Alpes; Grenoble France
| | - Thierry Zhou
- Grenoble Alpes University; Grenoble France
- Department of Ophthalmology; University Hospital; CHU Grenoble-Alpes; Grenoble France
| | - Ahmed Almanjoumi
- Department of Ophthalmology; University Hospital; CHU Grenoble-Alpes; Grenoble France
| | - Viviane Vinh
- Department of Ophthalmology; University Hospital; CHU Grenoble-Alpes; Grenoble France
| | - Christophe Chiquet
- Department of Ophthalmology; University Hospital; CHU Grenoble-Alpes; Grenoble France
- INSERM U1042; Lab Hypoxia and Physiopathology; Grenoble-Alpes University; Grenoble France
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Robinson DG, Margrain TH, Dunn MJ, Bailey C, Binns AM. Low-Level Nighttime Light Therapy for Age-Related Macular Degeneration: A Randomized Clinical Trial. ACTA ACUST UNITED AC 2018; 59:4531-4541. [DOI: 10.1167/iovs.18-24284] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- D. Grant Robinson
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Tom H. Margrain
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Matt J. Dunn
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Clare Bailey
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, United Kingdom
| | - Alison M. Binns
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, United Kingdom
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40
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Wei X, Balne PK, Meissner KE, Barathi VA, Schmetterer L, Agrawal R. Assessment of flow dynamics in retinal and choroidal microcirculation. Surv Ophthalmol 2018; 63:646-664. [DOI: 10.1016/j.survophthal.2018.03.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 01/08/2023]
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41
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Reiner A, Fitzgerald MEC, Del Mar N, Li C. Neural control of choroidal blood flow. Prog Retin Eye Res 2018; 64:96-130. [PMID: 29229444 PMCID: PMC5971129 DOI: 10.1016/j.preteyeres.2017.12.001] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/28/2017] [Accepted: 12/01/2017] [Indexed: 02/07/2023]
Abstract
The choroid is richly innervated by parasympathetic, sympathetic and trigeminal sensory nerve fibers that regulate choroidal blood flow in birds and mammals, and presumably other vertebrate classes as well. The parasympathetic innervation has been shown to vasodilate and increase choroidal blood flow, the sympathetic input has been shown to vasoconstrict and decrease choroidal blood flow, and the sensory input has been shown to both convey pain and thermal information centrally and act locally to vasodilate and increase choroidal blood flow. As the choroid lies behind the retina and cannot respond readily to retinal metabolic signals, its innervation is important for adjustments in flow required by either retinal activity, by fluctuations in the systemic blood pressure driving choroidal perfusion, and possibly by retinal temperature. The former two appear to be mediated by the sympathetic and parasympathetic nervous systems, via central circuits responsive to retinal activity and systemic blood pressure, but adjustments for ocular perfusion pressure also appear to be influenced by local autoregulatory myogenic mechanisms. Adaptive choroidal responses to temperature may be mediated by trigeminal sensory fibers. Impairments in the neural control of choroidal blood flow occur with aging, and various ocular or systemic diseases such as glaucoma, age-related macular degeneration (AMD), hypertension, and diabetes, and may contribute to retinal pathology and dysfunction in these conditions, or in the case of AMD be a precondition. The present manuscript reviews findings in birds and mammals that contribute to the above-summarized understanding of the roles of the autonomic and sensory innervation of the choroid in controlling choroidal blood flow, and in the importance of such regulation for maintaining retinal health.
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Affiliation(s)
- Anton Reiner
- Department of Anatomy & Neurobiology, University of Tennessee, 855 Monroe Ave. Memphis, TN 38163, United States; Department of Ophthalmology, University of Tennessee, 855 Monroe Ave. Memphis, TN 38163, United States.
| | - Malinda E C Fitzgerald
- Department of Anatomy & Neurobiology, University of Tennessee, 855 Monroe Ave. Memphis, TN 38163, United States; Department of Ophthalmology, University of Tennessee, 855 Monroe Ave. Memphis, TN 38163, United States; Department of Biology, Christian Brothers University, Memphis, TN, United States
| | - Nobel Del Mar
- Department of Anatomy & Neurobiology, University of Tennessee, 855 Monroe Ave. Memphis, TN 38163, United States
| | - Chunyan Li
- Department of Anatomy & Neurobiology, University of Tennessee, 855 Monroe Ave. Memphis, TN 38163, United States
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Rodrigo F, Ruiz-Moreno JM, García JB, Torregrosa ME, Segura JV, Piñero DP. Color Doppler imaging of the retrobulbar circulation and plasmatic biomarkers of vascular risk in age-related macular degeneration: A pilot study. Indian J Ophthalmol 2018; 66:89-93. [PMID: 29283130 PMCID: PMC5778590 DOI: 10.4103/ijo.ijo_488_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To evaluate preliminarily and compare the level of plasmatic biomarkers of vascular risk in patients with and without exudative age-related macular degeneration (ARMD) and to relate it to vascular resistance alterations in the ophthalmic artery (OA), central retinal artery (CRA), posterior temporal ciliary artery (PTCA), and posterior nasal ciliary artery (PNCA). METHODS Color Doppler imaging of the OA, CRA, PTCA, and PNCA was performed in 30 eyes of 30 cataract patients (control group) as well as in 30 eyes of 30 patients with naive exudative ARMD (study group), measuring the peak systolic velocity, end-diastolic velocity (EDV), and Pourcelot resistive index (RI). Likewise, in both groups, a blood test was performed to determine the plasmatic levels of homocysteine, C-reactive protein (CRP), B12 vitamin, and folic acid. RESULTS A positive and significant correlation was found between the level of CRP and RI of the OA in the ARMD group (r = 0.498, P = 0.005), with an increased RI in all arteries compared to controls, although differences only reached statistical significance for the PTCA (P = 0.035). Likewise, a significantly lower EDV for the CRA was found in ARMD eyes compared to controls (P = 0.041). In the study group, significantly higher plasmatic levels of homocysteine (P = 0.042) and CRP (P = 0.046) were found. In contrast, no significant differences were found between groups in the levels of folic acid (P = 0.265) and B12 vitamin (P = 0.520). CONCLUSION The decrease of the choroidal perfusion related to hyperhomocysteinemia, and increase in the CRP plasmatic levels may play an etiological role on the exudative ARMD. This should be investigated in future studies with larger samples of patients.
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Affiliation(s)
- Fermin Rodrigo
- Department of Ophthalmology, Marina Baixa Hospital, Villajoyosa, Spain
| | | | | | | | | | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
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Calzetti G, Fondi K, Bata AM, Luft N, Wozniak PA, Witkowska KJ, Bolz M, Popa-Cherecheanu A, Werkmeister RM, Schmidl D, Garhöfer G, Schmetterer L. Assessment of choroidal blood flow using laser speckle flowgraphy. Br J Ophthalmol 2018; 102:1679-1683. [PMID: 29472236 PMCID: PMC6287569 DOI: 10.1136/bjophthalmol-2017-311750] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/15/2018] [Accepted: 02/03/2018] [Indexed: 11/26/2022]
Abstract
Background/aims There is considerable interest in novel techniques to quantify choroidal blood flow (CBF) in humans. In the present study, we investigated a novel technique to measure CBF based on laser speckle flowgraphy (LSFG) in healthy subjects. Methods This study included 31 eyes of 31 healthy, non-smoking subjects aged between 19 and 74 years. A commercial LSFG instrument was used to measure choroidal vessel diameter (CVD) and relative flow volume (RFV) in choroidal vessels that were identified on fundus photos, an approach that was used previously only for retinal vessels. The reproducibility and the effect of isometric exercise on these parameters were investigated. The latter was compared with measurement of subfoveal CBF using laser Doppler flowmetry (LDF). Results Intraclass correlation coefficients for CVD and RFV were higher than 0.8 indicating excellent reproducibility. During isometric exercise, we observed an increase in ocular perfusion pressure of approximately 60% (P<0.001). The increase in RFV and CBF was lower, but also highly significant versus baseline (at minute 6 of isometric exercise: RFV 10.5%±4.2%, CBF 8.3%±3.6%; P<0.001 each) indicating choroidal autoregulation. Conclusion LSFG may be a novel approach to study blood flow in choroidal vessels. Data are reproducible and show good agreement with LDF data. Trial registration number NCT02102880, Results.
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Affiliation(s)
- Giacomo Calzetti
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Department of Ophthalmology, University of Parma, Parma, Italy
| | - Klemens Fondi
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Ahmed M Bata
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Nikolaus Luft
- Department of Ophthalmology, Kepler University Hospital, Linz, Austria.,Center for Refractive Therapy, University Eye Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Piotr A Wozniak
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | | | - Matthias Bolz
- Department of Ophthalmology, Kepler University Hospital, Linz, Austria
| | - Alina Popa-Cherecheanu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Ophthalmology, Emergency University Hospital, Bucharest, Romania
| | - René M Werkmeister
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Singapore Eye Research Institute, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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Nørgaard MF, Grauslund J. Automated Screening for Diabetic Retinopathy - A Systematic Review. Ophthalmic Res 2018; 60:9-17. [PMID: 29339646 DOI: 10.1159/000486284] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/12/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE Worldwide ophthalmologists are challenged by the rapid rise in the prevalence of diabetes. Diabetic retinopathy (DR) is the most common complication in diabetes, and possible consequences range from mild visual impairment to blindness. Repetitive screening for DR is cost-effective, but it is also a costly and strenuous affair. Several studies have examined the application of automated image analysis to solve this problem. Large populations are needed to assess the efficacy of such programs, and a standardized and rigorous methodology is important to give an indication of system performance in actual clinical settings. METHODS In a systematic review, we aimed to identify studies with methodology and design that are similar or replicate actual screening scenarios. A total of 1,231 publications were identified through PubMed, Cochrane Library, and Embase searches. Three manual search strategies were carried out to identify publications missed in the primary search. Four levels of screening identified 7 studies applicable for inclusion. RESULTS Seven studies were included. The detection of DR had high sensitivities (87.0-95.2%) but lower specificities (49.6-68.8%). False-negative results were related to mild DR with a low risk of progression within 1 year. Several studies reported missed cases of diabetic macular edema. A meta-analysis was not conducted as studies were not suitable for direct comparison or statistical analysis. CONCLUSION The study demonstrates that despite limited specificity, automated retinal image analysis may potentially be valuable in different DR screening scenarios with a relatively high sensitivity and a substantial workload reduction.
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Affiliation(s)
- Mads Fonager Nørgaard
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Research Unit of Ophthalmology, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Research Unit of Ophthalmology, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Wei X, Ting DSW, Ng WY, Khandelwal N, Agrawal R, Cheung CMG. CHOROIDAL VASCULARITY INDEX: A Novel Optical Coherence Tomography Based Parameter in Patients With Exudative Age-Related Macular Degeneration. Retina 2018; 37:1120-1125. [PMID: 27632714 DOI: 10.1097/iae.0000000000001312] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To evaluate choroidal structural changes in exudative age-related macular degeneration (AMD) using choroidal vascularity index computed from image binarization on spectral domain optical coherence tomography with enhanced depth imaging. METHODS This prospective case series included 42 consecutive patients with unilateral exudative AMD. Choroidal images were segmented into luminal area and stromal area. Choroidal vascularity index was defined as the ratio of luminal area to total choroid area. Mean choroidal vascularity index and mean choroidal thickness between study and fellow eyes of the same patient with dry AMD were compared using Student's t-test. RESULTS There was a significantly lower choroidal vascularity index in eyes with exudative AMD (60.14 ± 4.55 vs. 62.75 ± 4.82, P < 0.01). Luminal area (P < 0.01) was decreased in eyes with exudative AMD but there was no significant difference in total choroid area (P = 0.05) and choroidal thickness (P = 0.93) between study and fellow eyes. CONCLUSION Eyes with exudative AMD demonstrated reduced choroidal vascularity index but insignificant differences in choroidal thickness compared with their fellow eyes. Choroidal vascularity index may be a potential noninvasive tool for studying structural changes in choroid and monitoring choroidal disease in exudative AMD.
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Affiliation(s)
- Xin Wei
- *National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore; †Singapore Eye Research Institute, Singapore, Singapore; and ‡Singapore National Eye Centre, Singapore, Singapore
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Human stem cell-derived retinal epithelial cells activate complement via collectin 11 in response to stress. Sci Rep 2017; 7:14625. [PMID: 29116192 PMCID: PMC5677091 DOI: 10.1038/s41598-017-15212-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/24/2017] [Indexed: 01/07/2023] Open
Abstract
Age-related macular degeneration (AMD) is a major cause of blindness and is associated with complement dysregulation. The disease is a potential target for stem cell therapy but success is likely to be limited by the inflammatory response. We investigated the innate immune properties of human induced-pluripotent stem cell (iPSC)-derived RPE cells, particularly with regard to the complement pathway. We focused on collectin-11 (CL-11), a pattern recognition molecule that can trigger complement activation in renal epithelial tissue. We found evidence of constitutive and hypoxia-induced expression of CL-11 in iPS-RPE cells, and in the extracellular fluid. Complement activation on the cell surface occurred in conjunction with CL-11 binding. CL-11 has been shown to activate inflammatory responses through recognition of L-fucose, which we confirmed by showing that fucosidase-treated cells, largely, failed to activate complement. The presence of CL-11 in healthy murine and human retinal tissues confirmed the biological relevance of CL-11. Our data describe a new trigger mechanism of complement activation that could be important in disease pathogenesis and therapeutic interventions.
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Kaya F. Change in choroidal thickness after intravitreal injection for treatment of neovascular age-related macular degeneration: Ranibizumab versus aflibercept. J Fr Ophtalmol 2017; 40:832-838. [PMID: 29113742 DOI: 10.1016/j.jfo.2017.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 04/10/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the changes in subfoveal choroidal thickness after intravitreal ranibizumab or aflibercept injections for neovascular age-related macular degeneration (nAMD). METHODS In this retrospective study, 28 eyes with nAMD treated with 3 consecutive monthly injections of ranibizumab (IVR) and 24 eyes with nAMD treated with 3 consecutive monthly injections of aflibercept (IVA) between September 2012 and June 2016 were reviewed. The follow-up time was 6 months. Changes in two groups' best-corrected visual acuity (BCVA) and subfoveal choroidal thickness by using enhanced depth imaging optical coherence tomography at 1st, 3rd and 6th months were recorded and compared. RESULTS Choroidal thickness decreased significantly in eyes treated with IVR (P=0.015, 0.01 and 0.01, respectively) or IVA (P=0.001, 0.001 and ˂0.001, respectively) at 1, 3 and 6 months examination but IVA treated eyes presented a significantly further reduction in choroidal thickness when compared with ranibizumab (P=0.03, 0,04 and 0.03, respectively). There was no significant difference between aflibercept and ranibizumab group when change in BCVA from baseline compared at 1, 3 and 6th months (P=0.54, 0.06 and 0.37, respectively). There was no correlation between change in choroidal thickness and the BCVA outcomes in either group. CONCLUSIONS Subfoveal choroidal thickness decreased significantly after both of IVR and IVA injections in patients with nAMD. In conclusion, intravitreal injections of ranibizumab or aflibercept affect not only neovascular lesion but also the underlying choroid.
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Affiliation(s)
- F Kaya
- Service d'ophtalmologie, hôpital de Nisa, 34196 Istanbul, Turkey; Clinique universitaire d'ophtalmologie, faculté de médecine, université d'Istanbul Medipol, 34196 Istanbul, Turkey.
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48
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Koh LHL, Agrawal R, Khandelwal N, Sai Charan L, Chhablani J. Choroidal vascular changes in age-related macular degeneration. Acta Ophthalmol 2017; 95:e597-e601. [PMID: 28391615 DOI: 10.1111/aos.13399] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 12/19/2016] [Indexed: 01/21/2023]
Abstract
PURPOSE To assess the choroidal vascular changes using choroidal vascularity index (CVI) in patients with age-related macular degeneration (AMD) compared to controls. METHODS Enhanced depth imaging (EDI) optical coherence tomography (OCT) scans of 64 patients with unilateral or bilateral AMD were obtained. Images with a poorly demarcated choroidal-scleral interface (CSI) were excluded from the analysis. Foveal scans of 63 AMD eyes and 35 'normal fellow' eyes were analysed. Images of 30 eyes from 18 age-matched healthy subjects were included as controls. Choroidal vascularity index (CVI) was derived from binarization of EDI OCT images, using fiji software. RESULTS The mean age was 56.50 ± 5.50 years for AMD patients and 52.25 ± 6.75 years for controls. All patients were treatment naïve. Subfoveal choroidal thickness (SFCT) in AMD, 'normal fellow' eyes and controls was 314.02 ± 78.80 μm, 300.88 ± 53.85 μm and 278.5 ± 65.31 μm, respectively. Choroidal vascularity index (CVI) in AMD, 'normal fellow' eyes and controls was 64.04 ± 2.43%, 64.66 ± 2.25% and 66.07 ± 1.72%, respectively. Choroidal vascularity index (CVI) of both AMD and 'normal fellow' eyes was significantly lower compared to controls (p < 0.0001 and p = 0.007). The SFCT of AMD eye was not found to be significantly different from 'normal fellow eyes' (p = 0.45). CONCLUSION There was no statistical difference in SFCT, but CVI was significantly lower in patients with AMD. Choroidal vascularity index (CVI) was also lower in 'normal fellow' AMD eyes as compared to controls. This suggests possible reduction in choroidal vascularity in eyes with AMD and also to a certain extent in the 'normal fellow' eyes without phenotypical manifestations and may suggest underlying choroidal morphological change leading to wet AMD.
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Affiliation(s)
- Lilian Hui Li Koh
- National Healthcare Group Eye Institute; Tan Tock Seng Hospital; Singapore Singapore
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute; Tan Tock Seng Hospital; Singapore Singapore
| | - Neha Khandelwal
- National Healthcare Group Eye Institute; Tan Tock Seng Hospital; Singapore Singapore
| | - Labishetty Sai Charan
- National Healthcare Group Eye Institute; Tan Tock Seng Hospital; Singapore Singapore
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Nakajima E, Hammond KB, Hirata M, Shearer TR, Azuma M. Contribution of Calpain and Caspases to Cell Death in Cultured Monkey RPE Cells. Invest Ophthalmol Vis Sci 2017; 58:5412-5420. [PMID: 29053764 PMCID: PMC6110128 DOI: 10.1167/iovs.17-22325] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose AMD is the leading cause of human vision loss after 65 years of age. Several mechanisms have been proposed: (1) age-related failure of the choroidal vasculature leads to loss of RPE; (2) RPE dysfunctions due to accumulation of phagocytized, but unreleased A2E (N-retinylidene-N-retinylethanolamine); (3) zinc deficiency activation of calpain and caspase proteases, leading to cell death. The purpose of the present study is to compare activation of calpain and caspase in monkey RPE cells cultured under hypoxia or with A2E. Methods Monkey primary RPE cells were cultured under hypoxic conditions in a Gaspak pouch or cultured with synthetic A2E. Immunoblotting was used to detect activation of calpain and caspase. Calpain inhibitor, SNJ-1945, and pan-caspase inhibitor, z-VAD-fmk, were used to confirm activation of the proteases. Results (1) Hypoxia and A2E each decreased viability of RPE cells in a time-dependent manner. (2) Incubation under hypoxia alone induced activation of calpain, but not caspases. SNJ-1945 inhibited calpain activation, but z-VAD-fmk did not. (3) Incubation with A2E alone induced activation of calpain, caspase-9, and caspase-3. SNJ-1945 inhibited calpain activation. z-VAD-fmk inhibited caspase activation, suggesting no interaction between calpain and caspases. Conclusions Hypoxia activated the calpain pathway, while A2E activated both calpain and caspase pathways in monkey RPE cells. Such knowledge may be utilized in the treatment of AMD if inhibitor drugs against calpain and/or caspase are used to prevent RPE dysfunction caused by hypoxia or A2E.
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Affiliation(s)
- Emi Nakajima
- Senju Laboratory of Ocular Sciences, Senju Pharmaceutical Corporation Limited, Portland, Oregon, United States.,Department of Integrative Biosciences, Oregon Health & Science University, Portland, Oregon, United States
| | - Katherine B Hammond
- Senju Laboratory of Ocular Sciences, Senju Pharmaceutical Corporation Limited, Portland, Oregon, United States.,Department of Integrative Biosciences, Oregon Health & Science University, Portland, Oregon, United States
| | - Masayuki Hirata
- Senju Laboratory of Ocular Sciences, Senju Pharmaceutical Corporation Limited, Portland, Oregon, United States.,Department of Integrative Biosciences, Oregon Health & Science University, Portland, Oregon, United States
| | - Thomas R Shearer
- Department of Integrative Biosciences, Oregon Health & Science University, Portland, Oregon, United States
| | - Mitsuyoshi Azuma
- Senju Laboratory of Ocular Sciences, Senju Pharmaceutical Corporation Limited, Portland, Oregon, United States.,Department of Integrative Biosciences, Oregon Health & Science University, Portland, Oregon, United States
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Park JH, Kim M, Oh JH. Effects of bevacizumab on endoplasmic reticulum stress in hypoxic retinal pigment epithelial cells. PLoS One 2017; 12:e0179048. [PMID: 28591217 PMCID: PMC5462411 DOI: 10.1371/journal.pone.0179048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 05/23/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the effects of bevacizumab on endoplasmic reticulum (ER) stress in human retinal pigment epithelial (RPE) cells cultured under hypoxic conditions. Methods RPE cells (ARPE–19) were cultured under hypoxic conditions (1% O2) with or without bevacizumab (0.3125 mg/mL) for 24 and 48 h. Cell viability was measured by a PrestoBlue assay. The expression of vascular endothelial growth factor (VEGF), binding protein/glucose-regulated protein 78 (BiP/GRP78), and C/EBP homologous protein-10 (CHOP) mRNA was measured by quantitative real-time polymerase chain reaction (qRT-PCR). BiP/GRP78 and CHOP protein levels in the cells were assessed by western blot. VEGF protein in the media was quantified by enzyme-linked immunosorbent assay (ELISA). Results Under hypoxic conditions, cell viability decreased and mRNA and protein levels of VEGF, BiP/GRP78, and CHOP increased compared to those under normoxic conditions. Bevacizumab improved cell viability and reduced the expression of VEGF mRNA under hypoxic conditions. Bevacizumab also reduced the expression of both mRNA and protein of two ER stress indicators, BiP/GRP78 and CHOP, under hypoxic conditions. Conclusions Bevacizumab mitigated ER stress in human RPE cells cultured under hypoxic conditions. This effect may be involved in the improved cell viability and reduction of VEGF expression after bevacizumab treatment of hypoxic RPE cells in vitro. However, the effects of bevacizumab on RPE cells under experimental conditions are unlikely to be clinically equivalent to those in the human eye.
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Affiliation(s)
- Joo-Hee Park
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Moosang Kim
- Department of Ophthalmology, School of Medicine, Kangwon National University, Chuncheon, South Korea
| | - Jong-Hyun Oh
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, South Korea
- * E-mail:
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