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Modrzejewska M, Cyrankiewicz J, Zdanowska O, Bosy-Gąsior W. Isolated Depo-Medrol Administration under Tenon's Capsule for Post-COVID-19 Uveitis in a Child: A Case Report and Literature Review. J Clin Med 2024; 13:1341. [PMID: 38592169 PMCID: PMC10932394 DOI: 10.3390/jcm13051341] [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: 01/23/2024] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 04/10/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) can manifest with ocular symptoms. These symptoms can be divided into isolated events attributed to COVID-19, and those occurring in multisystem inflammatory syndrome in children (MIS-C), a newly diagnosed disease entity associated with COVID-19 infection. Currently, the literature lacks specific guidelines and treatment regimens for COVID-19 ocular symptoms, especially in children. The authors present the case of a 14-and-a-half-year-old boy with bilateral uveitis of the anterior and posterior segments along with vasculitis and optic neuritis associated with SARS-CoV-2 infection. The authors also perform an up-to-date review of all available publications on the treatment of post-COVID-19 uveitis in children described in the literature between 2020 and 2023. In the case described by the authors, the treatment involved a Depo-Medrol 40 mg/mL injection uder the Tenon capsule, with two subconjunctival injections of epinephrine, topical steroid therapy and non-steroidal anti-inflammatory drugs: dexamethasone 0.1%; diclofenac eye drops. In addition, acetylsalicylic acid (150 mg) and pentoxifylline (100 mg, orally) were administered throughout the course of the disease as well as up to 12 months after its termination, until a complete improvement in visual acuity and the withdrawal of ocular lesions were achieved. It can be assumed that this type of treatment is far more beneficial for pediatric patients, with an effect comparable to systemic steroid administration with a preserved improvement in retinal-vascular circulation, without exposing the child to systemic post-steroid complications.
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Affiliation(s)
- Monika Modrzejewska
- Second Chair and Department of Ophthalmology, Pomeranian Medical University in Szczecin, Al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| | | | - Oliwia Zdanowska
- Szpital Uniwersytecki im. Karola Marcinkowskiego w Zielonej Górze, 65-046 Zielona Góra, Poland
| | - Wiktoria Bosy-Gąsior
- Scientific Association of Students 2nd Department of Ophthalmology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
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2
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Guadarrama-Escobar OR, Valdés-Alvarez CA, Constantino-Gonzalez KS, Serrano-Castañeda P, Peña-Juárez MC, Morales-Florido MI, Salgado-Machuca M, Rodríguez-Pérez B, Rodriguez-Cruz IM, Vargas-Estrada D, Mercado-Márquez C, Vázquez-Durán A, Méndez-Albores A, Anguíano-Almazán E, Escobar-Chavez JJ. Design and Characterization of Ocular Inserts Loaded with Dexamethasone for the Treatment of Inflammatory Ophthalmic Disease. Pharmaceutics 2024; 16:294. [PMID: 38399348 PMCID: PMC10892931 DOI: 10.3390/pharmaceutics16020294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
The short precorneal residence time of ophthalmic drops is associated with their low absorption; therefore, the development of ocular inserts capable of prolonging and controlling the ophthalmic release of drugs is an interesting option in the design and development of these drugs. A surface response design was developed, specifically the Central Composite Design (CCD), to produce ophthalmic films loaded with Dexamethasone (DEX) by the solvent evaporation method having experimental levels of different concentrations of previously selected polymers (PVP K-30 and Eudragit RS100.). Once optimization of the formulation was obtained, the in vivo test was continued. The optimal formulation obtained a thickness of 0.265 ± 0.095 mm, pH of 7.11 ± 0.04, tensile strength of 15.50 ± 3.94 gF, humidity (%) of 22.54 ± 1.7, mucoadhesion strength of 16.89 ± 3.46 gF, chemical content (%) of 98.19 ± 1.124, release of (%) 13,510.71, and swelling of 0.0403 ± 0.023 g; furthermore, in the in vivo testing the number and residence time of PMN cells were lower compared to the Ophthalmic Drops. The present study confirms the potential use of polymeric systems using PVPK30 and ERS100 as a new strategy of controlled release of ophthalmic drugs by controlling and prolonging the release of DEX at the affected site by decreasing the systemic effects of the drug.
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Affiliation(s)
- Omar Rodrigo Guadarrama-Escobar
- Unidad de Investigacion Multidisciplinaria L-12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán-Teoloyucan, Km 2.5 San Sebastian Xhala, Cuautitlán Izcalli 54714, Mexico; (O.R.G.-E.); (C.A.V.-A.); (K.S.C.-G.); (P.S.-C.); (M.C.P.-J.); (M.I.M.-F.); (M.S.-M.); (E.A.-A.)
| | - Cassandra Araceli Valdés-Alvarez
- Unidad de Investigacion Multidisciplinaria L-12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán-Teoloyucan, Km 2.5 San Sebastian Xhala, Cuautitlán Izcalli 54714, Mexico; (O.R.G.-E.); (C.A.V.-A.); (K.S.C.-G.); (P.S.-C.); (M.C.P.-J.); (M.I.M.-F.); (M.S.-M.); (E.A.-A.)
| | - Karla Stella Constantino-Gonzalez
- Unidad de Investigacion Multidisciplinaria L-12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán-Teoloyucan, Km 2.5 San Sebastian Xhala, Cuautitlán Izcalli 54714, Mexico; (O.R.G.-E.); (C.A.V.-A.); (K.S.C.-G.); (P.S.-C.); (M.C.P.-J.); (M.I.M.-F.); (M.S.-M.); (E.A.-A.)
| | - Pablo Serrano-Castañeda
- Unidad de Investigacion Multidisciplinaria L-12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán-Teoloyucan, Km 2.5 San Sebastian Xhala, Cuautitlán Izcalli 54714, Mexico; (O.R.G.-E.); (C.A.V.-A.); (K.S.C.-G.); (P.S.-C.); (M.C.P.-J.); (M.I.M.-F.); (M.S.-M.); (E.A.-A.)
| | - Ma. Concepción Peña-Juárez
- Unidad de Investigacion Multidisciplinaria L-12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán-Teoloyucan, Km 2.5 San Sebastian Xhala, Cuautitlán Izcalli 54714, Mexico; (O.R.G.-E.); (C.A.V.-A.); (K.S.C.-G.); (P.S.-C.); (M.C.P.-J.); (M.I.M.-F.); (M.S.-M.); (E.A.-A.)
| | - Miriam Isabel Morales-Florido
- Unidad de Investigacion Multidisciplinaria L-12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán-Teoloyucan, Km 2.5 San Sebastian Xhala, Cuautitlán Izcalli 54714, Mexico; (O.R.G.-E.); (C.A.V.-A.); (K.S.C.-G.); (P.S.-C.); (M.C.P.-J.); (M.I.M.-F.); (M.S.-M.); (E.A.-A.)
- Laboratorio de Farmacia Molecular y Liberación Controlada, Departamento de Sistemas Biológicos, Universidad Autónoma Metropolitana, Xochimilco 04960, Mexico
| | - Mariana Salgado-Machuca
- Unidad de Investigacion Multidisciplinaria L-12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán-Teoloyucan, Km 2.5 San Sebastian Xhala, Cuautitlán Izcalli 54714, Mexico; (O.R.G.-E.); (C.A.V.-A.); (K.S.C.-G.); (P.S.-C.); (M.C.P.-J.); (M.I.M.-F.); (M.S.-M.); (E.A.-A.)
| | - Betsabe Rodríguez-Pérez
- Unidad de Investigación Multidisciplinaria L-6 (Laboratorio de Servicios de Análisis de Propóleos), Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán Izcalli 54714, Mexico;
| | - Isabel Marlen Rodriguez-Cruz
- Unidad de Enseñanza e Investigación, Hospital Regional de Alta Especialidad de Zumpango, Carretera Zumpango-Jilotzingo # 400, Barrio de Santiago, 2a Sección, Zumpango 55600, Mexico;
| | - Dinorah Vargas-Estrada
- Departamento de Fisiología y Farmacología, Facultad de Medicina Veterinaria, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico;
| | - Crisóforo Mercado-Márquez
- Unidad de Aislamiento y Bioterio, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán Izcalli 54714, Mexico;
| | - Alma Vázquez-Durán
- Unidad de Investigación Multidisciplinaria L14 (Ciencia y Tecnología de los Materiales), Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán Izcalli 54714, Mexico; (A.V.-D.); (A.M.-A.)
| | - Abraham Méndez-Albores
- Unidad de Investigación Multidisciplinaria L14 (Ciencia y Tecnología de los Materiales), Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán Izcalli 54714, Mexico; (A.V.-D.); (A.M.-A.)
| | - Ericka Anguíano-Almazán
- Unidad de Investigacion Multidisciplinaria L-12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán-Teoloyucan, Km 2.5 San Sebastian Xhala, Cuautitlán Izcalli 54714, Mexico; (O.R.G.-E.); (C.A.V.-A.); (K.S.C.-G.); (P.S.-C.); (M.C.P.-J.); (M.I.M.-F.); (M.S.-M.); (E.A.-A.)
| | - José Juan Escobar-Chavez
- Unidad de Investigacion Multidisciplinaria L-12, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México, Cuautitlán-Teoloyucan, Km 2.5 San Sebastian Xhala, Cuautitlán Izcalli 54714, Mexico; (O.R.G.-E.); (C.A.V.-A.); (K.S.C.-G.); (P.S.-C.); (M.C.P.-J.); (M.I.M.-F.); (M.S.-M.); (E.A.-A.)
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Pockar S, Leal I, Chhabra R, Jones NP, Steeples LR. Intravitreal Fluocinolone 0.19mg Implant in the Management of Chronic Non-Infectious Uveitis: 12-Month Outcomes from a Single Tertiary Centre. Ocul Immunol Inflamm 2023; 31:1572-1578. [PMID: 34124978 DOI: 10.1080/09273948.2021.1922707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
AIM To present efficacy and safety of 0.19 mg fluocinolone acetonide insert (FAi) to treat chronic noninfectious uveitis (NIU) in a single referral center. METHODS A retrospective observational clinical study of 11 eyes with NIU complicated by chronic cystoid macular edema (CMO). RESULTS The main indication for treatment was chronic CMO in all 11 eyes. The mean central retinal thickness (CRT) at baseline was 435 μm ± 176, improving to 296 μm ± 67 at 12 months. Raised intraocular pressure (IOP) was the commonest adverse event. An IOP >21 mmHg was observed in three eyes, and >30 mmHg in one eye, managed with topical therapy. The mean best corrected visual acuity (BCVA) was stable at 12 months. There were no observed recurrences of uveitis. Two eyes received adjunctive treatment for worsening CRT. CONCLUSIONS Our results suggest FAi is an effective maintenance treatment for NIU with favorable functional and anatomical outcomes.
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Affiliation(s)
- Sasa Pockar
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Inês Leal
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ramandeep Chhabra
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Nicholas P Jones
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Laura R Steeples
- Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
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4
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Harrell CR, Djonov V, Antonijevic A, Volarevic V. NLRP3 Inflammasome as a Potentially New Therapeutic Target of Mesenchymal Stem Cells and Their Exosomes in the Treatment of Inflammatory Eye Diseases. Cells 2023; 12:2327. [PMID: 37759549 PMCID: PMC10529394 DOI: 10.3390/cells12182327] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
Due to their potent immunoregulatory and angio-modulatory properties, mesenchymal stem cells (MSCs) and their exosomes (MSC-Exos) have emerged as potential game-changers in regenerative ophthalmology, particularly for the personalized treatment of inflammatory diseases. MSCs suppress detrimental immune responses in the eyes and alleviate ongoing inflammation in ocular tissues by modulating the phenotype and function of all immune cells that play pathogenic roles in the development and progression of inflammatory eye diseases. MSC-Exos, due to their nano-sized dimension and lipid envelope, easily bypass all barriers in the eyes and deliver MSC-sourced bioactive compounds directly to target cells. Although MSCs and their exosomes offer a novel approach to treating immune cell-driven eye diseases, further research is needed to optimize their therapeutic efficacy. A significant number of experimental studies is currently focused on the delineation of intracellular targets, which crucially contribute to the immunosuppressive and anti-inflammatory effects of MSCs and MSC-Exos. The activation of NLRP3 inflammasome induces programmed cell death of epithelial cells, induces the generation of inflammatory phenotypes in eye-infiltrated immune cells, and enhances the expression of adhesion molecules on ECs facilitating the recruitment of circulating leukocytes in injured and inflamed eyes. In this review article, we summarize current knowledge about signaling pathways that are responsible for NLRP3 inflammasome-driven intraocular inflammation and we emphasize molecular mechanisms that regulate MSC-based modulation of NLRP3-driven signaling in eye-infiltrated immune cells, providing evidence that NLRP3 inflammasome should be considered a potentially new therapeutic target for MSCs and MSC-Exo-based treatment of inflammatory eye diseases.
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Affiliation(s)
- Carl Randall Harrell
- Regenerative Processing Plant, LLC, 34176 US Highway 19 N, Palm Harbor, FL 34684, USA;
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland;
| | - Ana Antonijevic
- Center for Harm Reduction of Biological and Chemical Hazards, Faculty of Medical Sciences, University of Kragujevac, 69 Svetozar Markovic Street, 34000 Kragujevac, Serbia;
| | - Vladislav Volarevic
- Center for Harm Reduction of Biological and Chemical Hazards, Faculty of Medical Sciences, University of Kragujevac, 69 Svetozar Markovic Street, 34000 Kragujevac, Serbia;
- Department of Genetics and Department of Microbiology and Immunology, Faculty of Medical Sciences, University of Kragujevac, 69 Svetozar Markovic Street, 34000 Kragujevac, Serbia
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5
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Sammut Bartolo N, Vella Szijj J, Ferrito V, Serracino-Inglott A. HPLC-UV Method Development and Validation to Monitor Difluprednate Synthesis. J Chromatogr Sci 2023; 61:322-328. [PMID: 36625195 DOI: 10.1093/chromsci/bmac108] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 11/07/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023]
Abstract
During the synthesis of active pharmaceutical ingredients (APIs) there is a need for the development and validation of a simple and rapid high performance liquid chromatography (HPLC) method for the determination and quantification of the synthesized product and related by-products. An HPLC method gives a better understanding of how a synthesis is proceeding. A rapid and easy to use HPLC-UV (ultraviolet) method for the determination of difluprednate and monitoring of impurities generated during synthesis was developed and validated. A Shimadzu VP Series HPLC equipped with a LabSolutions software and UV detector set at 240 nm was used for analysis. The mobile phase consisted of phosphate buffer (pH 6) and acetonitrile 50:50 (v/v) and was eluted at a flow rate of 1.2 mL/min. Separation took place on a reversed-phase Kinetex C18 column (150 × 4.60 mm; 5 μm i.d.). Column temperature was set at 40°C. The developed method was found to have good linearity and acceptable accuracy and precision. The developed method may be effectively applied to determine products and by-products formed during synthetic reactions of steroids and to calculate the yield of the products obtained during each step of the synthesis.
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Affiliation(s)
| | | | - Victor Ferrito
- Department of Pharmacy, University of Malta, Msida MSD 2080, Malta
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6
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Usta Sofu G, Erzurumlu Y, Karaca U, Candan IA, Savran M, Asci H, Hasseyid N. Melatonin receptor agonist ramelteon alleviates experimental acute ocular inflammation via HIF-1Α/VEGF/E-NOS signaling. Eur J Ophthalmol 2022; 33:11206721221123878. [PMID: 36062605 DOI: 10.1177/11206721221123878] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Ramelteon (RML) is a potent, selective agonist of the high-affinity melatonin receptor 1 and 2 receptors. In addition, RML is known to have antioxidant and anti-inflammatory effects. In this study, we aimed to investigate the effects of RML on HIF-1α, VEGF and e-NOS signaling pathway in a rat model of endotoxin-induced uveitis (EIU). METHODS Twenty-eight Wistar albino rats were divided into 4 groups as controls, lypopolysaccharide (LPS) group (5 mg/kg i.p.), LPS + RML group (5 mg/kg i.p and 8 mg/kg orally, respectively) and RML group (8 mg/kg orally). EIU was induced by a single intraperitoneal LPS injection. Histopathological and genetical analyses were performed. RESULTS In histopathological analysis, LPS caused mild anterior uveitis characterized by increased surface area of iris leaflets and ciliary body due to edema, mild to moderate congestion, and inflammatory infiltrate 6 h following the injection. The pathological findings were reduced by RML. Higher inflammation levels seen in LPS group were significantly reduced in LPS + RML group. Also, HIF-1 α, eNOS and VEGF expressions increased in LPS and decreased in LPS + RML group. CONCLUSION RML treatment reversed the changes in the HIF-1α /eNOS/ VEGF signaling pathway in LPS-induced uveitis in rats, preventing the progression of the damage and showed positive effects.
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Affiliation(s)
- Gulsah Usta Sofu
- Department of Ophthalmology, Faculty of Medicine, 52994Suleyman Demirel University, Isparta, Turkey
| | - Yalcın Erzurumlu
- Department of Biochemistry, Faculty of Pharmacy, 52994Suleyman Demirel University, Isparta, Turkey
| | - Umut Karaca
- Department of Ophthalmology, Faculty of Medicine, 52994Suleyman Demirel University, Isparta, Turkey
| | - Ibrahim Aydın Candan
- Department of Histology and Embryology, Faculty of Medicine, 450199Alaaddin Keykubat University, Alanya, Turkey
| | - Mehtap Savran
- Department of Pharmacology, Faculty of Medicine, 52994Suleyman Demirel University, Isparta, Turkey
| | - Halil Asci
- Department of Pharmacology, Faculty of Medicine, 52994Suleyman Demirel University, Isparta, Turkey
| | - Nursel Hasseyid
- Department of Pharmacology, Faculty of Medicine, 52994Suleyman Demirel University, Isparta, Turkey
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7
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The Use of Sustained Release Intravitreal Steroid Implants in Non-Infectious Uveitis Affecting the Posterior Segment of the Eye. Ophthalmol Ther 2022; 11:479-487. [PMID: 35092605 PMCID: PMC8800436 DOI: 10.1007/s40123-022-00456-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/07/2022] [Indexed: 11/02/2022] Open
Abstract
The treatment of non-infectious uveitis affecting the posterior segment of the eye has been revolutionized by the development of sustained-release corticosteroid implants over the past decade. Their use is now supported by healthcare systems that have licensed and commissioned them on the basis of the high-quality randomised controlled trials that formed part of their development and which have informed clinicians as to their benefits and risks. In particular, they have provided an alternative mode of treatment for patients who do not wish to be systemically immunosuppressed, or in whom such immunosuppression is less desirable, such as those with unilateral disease or those with concurrent illnesses such as diabetes mellitus, renal disease or osteoporosis that are negatively impacted by systemic corticosteroids or other immunosuppressive agents. In this article, we review the evidence for the use of the major licensed corticosteroid implants and assess the advantages and disadvantages of each.
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8
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McHarg M, Young L, Kesav N, Yakin M, Sen HN, Kodati S. Practice patterns regarding regional corticosteroid treatment in noninfectious Uveitis: a survey study. J Ophthalmic Inflamm Infect 2022; 12:3. [PMID: 34982279 PMCID: PMC8727651 DOI: 10.1186/s12348-021-00281-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Regional corticosteroid therapy for noninfectious uveitis is well-established but usage patterns have not been studied extensively. This study aims to assess practice patterns of retina and uveitis specialists regarding their preferences on the use of local corticosteroid therapy. Methods A 13-question survey was developed regarding the practice patterns of regional corticosteroid use in specific situations and populations. The survey was distributed to both the American Uveitis Society and Macula Society. Results Responses from 87 ophthalmologists were analyzed. The two most commonly used drugs were the dexamethasone intravitreal implant (Ozurdex®) and posterior sub-tenon’s triamcinolone (also known as posterior sub-Tenon’s Kenalog, or PSTK). Regional corticosteroids were used more frequently as first-line treatment in more than half of posterior uveitis cases when compared to anterior uveitis (39.1–46.0% vs 10.3%, respectively). Respondents were more willing to use regional corticosteroids in more than half of unilateral uveitis cases than in bilateral cases (54.7% vs 18.6%, respectively). A majority of respondents (67.1%) stated that they would avoid using regional corticosteroids in patients under 8 years old. Conclusions Our results demonstrate more frequent regional corticosteroid use in posterior segment uveitis, unilateral cases, and avoidance in younger pediatric patients. Overall, the variability in these responses highlights the need for guidelines regarding regional corticosteroid use. Supplementary Information The online version contains supplementary material available at 10.1186/s12348-021-00281-z.
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Affiliation(s)
- Matthew McHarg
- National Eye Institute, National Institutes of Health, 10 Center Dr, 10/10N109, Bethesda, MD, 20892, USA.,George Washington University School of Medicine, Washington, DC, 20052, USA
| | - LeAnne Young
- National Eye Institute, National Institutes of Health, 10 Center Dr, 10/10N109, Bethesda, MD, 20892, USA.,Cleveland Clinic Lerner College of Medicine, Cleveland, OH, 44195, USA
| | - Natasha Kesav
- National Eye Institute, National Institutes of Health, 10 Center Dr, 10/10N109, Bethesda, MD, 20892, USA.,University Hospitals Eye Institute, Cleveland, OH, 44106, USA
| | - Mehmet Yakin
- National Eye Institute, National Institutes of Health, 10 Center Dr, 10/10N109, Bethesda, MD, 20892, USA
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, 10 Center Dr, 10/10N109, Bethesda, MD, 20892, USA
| | - Shilpa Kodati
- National Eye Institute, National Institutes of Health, 10 Center Dr, 10/10N109, Bethesda, MD, 20892, USA.
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9
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José-Vieira R, Ferreira A, Menéres P, Sousa-Pinto B, Figueira L. Efficacy and safety of intravitreal and periocular injection of corticosteroids in non-infectious uveitis: a systematic review. Surv Ophthalmol 2021; 67:991-1013. [PMID: 34896190 DOI: 10.1016/j.survophthal.2021.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
Uveitis is among the leading causes of visual loss in the working age population. In non-infectious uveitis, corticosteroids are the first line therapy. We sought to review systematically the evidence regarding the regional corticosteroid delivery modalities in the treatment of non-infectious uveitis. A five-database search (Pubmed, ISI Web of Science, Cochrane, ClinicalTrials.gov, and Scopus) was performed from inception to February, 2021. Nineteen studies with a total of 1935 eyes of 1753 patients were selected from 8922 abstracts retrieved by the initial search. The most frequently compared regimens were intravitreal triamcinolone acetonide injection and orbital floor triamcinolone acetonide injection (2 studies), intravitreal triamcinolone acetonide injection and posterior sub-Tenon triamcinolone acetonide injection (2 studies), and posterior sub-Tenon triamcinolone acetonide injection with the intravitreal dexamethasone implant (2 studies). Our results show that the intravitreal injection of corticosteroids is more effective, but is associated with more adverse events, than periocular injection. Some evidence supports the use of subconjunctival triamcinolone acetonide over intravitreal/periocular triamcinolone acetonide. Moreover, the overall results of 0.59 mg dosage of the intravitreal fluocinolone acetonide implant were superior to those from the 2.1 mg dose. The evidence, however, is not robust and further studies with standardized outcomes are warranted.
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Affiliation(s)
- Rafael José-Vieira
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, Porto, Portugal; RISE-Health Research Network, Porto, Portuga.
| | - André Ferreira
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal; Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Menéres
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal; Department of Ophthalmology, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, Porto, Portugal; RISE-Health Research Network, Porto, Portuga
| | - Luís Figueira
- Department of Ophthalmology, University Hospital Center of S. João, Porto, Portugal; Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; MedInUP-Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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10
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Hoang C, Nguyen AK, Nguyen TQ, Fang W, Han B, Hoang BX, Tran HD. Application of Dimethyl Sulfoxide as a Therapeutic Agent and Drug Vehicle for Eye Diseases. J Ocul Pharmacol Ther 2021; 37:441-451. [PMID: 34314611 DOI: 10.1089/jop.2021.0043] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Dimethyl sulfoxide (DMSO) is an amphipathic molecule widely used as a solvent for water-insoluble substances, cryopreserving, and cell-biological therapies. It has known properties as an inducer of cellular differentiation, a free radical scavenger, and a radioprotectant. In addition, DMSO is used for its various therapeutic and pharmaceutical properties, such as anti-inflammatory, local and systemic analgesic, antibacterial, antifungal, antiviral, and membrane penetration enhancement agents. DMSO treatment can be given orally, intravenously, or topically for a wide range of indications. The administration of DMSO exhibits favorable outcomes in human eye diseases with low to none observed ocular or systemic ocular toxicity. Nevertheless, DMSO is an essential and nonpatentable potential therapeutic agent that remains underexplored and ignored by pharmaceutical developers and ophthalmologists. This current review takes data from experimental and clinical studies that have been published to substantiate the potential therapeutic efficacy of DMSO and stimulate the research of its application in clinical ophthalmology. Given that DMSO is inexpensive, safe, and easily formulated into therapeutic medicinal products and conventional ophthalmological drugs, this compound should be further explored and studied in the treatment of a variety of acute and chronic ocular disorders.
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Affiliation(s)
- Cuong Hoang
- Department of Training and Social Relationship, National Ophthalmological Hospital, Hanoi, Vietnam
| | - Anh Kim Nguyen
- Inventive Medical Foundation, South El Monte, California, USA
| | | | - William Fang
- Western University of Health Sciences, Pomona, California, USA
| | - Bo Han
- Department of Surgery, Keck School of Medicine University of Southern California, Los Angeles, California, USA
| | - Ba X Hoang
- Department of Surgery, Keck School of Medicine University of Southern California, Los Angeles, California, USA
| | - Hau D Tran
- Department of Oncology, National Children Hospital, Hanoi, Vietnam
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11
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Ting DSJ, Ho CS, Deshmukh R, Said DG, Dua HS. Infectious keratitis: an update on epidemiology, causative microorganisms, risk factors, and antimicrobial resistance. Eye (Lond) 2021; 35:1084-1101. [PMID: 33414529 PMCID: PMC8102486 DOI: 10.1038/s41433-020-01339-3] [Citation(s) in RCA: 157] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/22/2020] [Accepted: 11/24/2020] [Indexed: 01/30/2023] Open
Abstract
Corneal opacity is the 5th leading cause of blindness and visual impairment globally, affecting ~6 million of the world population. In addition, it is responsible for 1.5-2.0 million new cases of monocular blindness per year, highlighting an ongoing uncurbed burden on human health. Among all aetiologies such as infection, trauma, inflammation, degeneration and nutritional deficiency, infectious keratitis (IK) represents the leading cause of corneal blindness in both developed and developing countries, with an estimated incidence ranging from 2.5 to 799 per 100,000 population-year. IK can be caused by a wide range of microorganisms, including bacteria, fungi, virus, parasites and polymicrobial infection. Subject to the geographical and temporal variations, bacteria and fungi have been shown to be the most common causative microorganisms for corneal infection. Although viral and Acanthamoeba keratitis are less common, they represent important causes for corneal blindness in the developed countries. Contact lens wear, trauma, ocular surface diseases, lid diseases, and post-ocular surgery have been shown to be the major risk factors for IK. Broad-spectrum topical antimicrobial treatment is the current mainstay of treatment for IK, though its effectiveness is being challenged by the emergence of antimicrobial resistance, including multidrug resistance, in some parts of the world. In this review, we aim to provide an updated review on IK, encompassing the epidemiology, causative microorganisms, major risk factors and the impact of antimicrobial resistance.
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Affiliation(s)
- Darren Shu Jeng Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | | | - Rashmi Deshmukh
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Dalia G Said
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK
| | - Harminder S Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK.
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK.
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12
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Layús BI, Gomez MA, Cazorla SI, Rodriguez AV. Drops of Lactiplantibacillus plantarum CRL 759 culture supernatant attenuates eyes inflammation induced by lipopolysaccharide. Benef Microbes 2021; 12:163-174. [PMID: 33769229 DOI: 10.3920/bm2020.0101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Anti-inflammatory effect of soluble secreted compounds of probiotic bacteria was widely demonstrated as therapy for different inflammatory diseases, but was not investigated in inflammatory eye disorders. The aim of this study was to determine whether Lactiplantibacillus plantarum CRL759 cell-free supernatant reduced inflammatory parameters and clinical signs in ocular inflammations. First, we evaluated the effect of L. plantarum CRL759 supernatant in vitro on human retinal cell line, ARPE-19 cells, stimulated with lipopolysaccharide (LPS). Then, we investigated in vivo its capacity to decrease inflammation by local administration on the eyes of mice with endotoxin induced inflammation. In vitro assays demonstrated that L. plantarum CRL759 supernatant reduced the production of interleukin (IL)-6, IL-8, nitric oxide and thiobarbituric acid reactive substances in LPS-stimulated ARPE-19 cells. Our in vivo data proved that L. plantarum supernatant significantly reduced the clinical score of endotoxin treated mice and diminished levels of tumour necrosis factor alpha, interferon gamma and protein concentration in aqueous humour. Histological examination showed reduction of infiltrating inflammatory cells in the posterior segment of the eyes. As far as we know, this is the first report showing that Lactobacillus spp. supernatant administered as drops reduces some parameters of ocular inflammation. This promising strategy is safe and could alleviate symptoms and signs of ocular inflammation in people that are refractories to the conventional therapies.
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Affiliation(s)
- B I Layús
- CONICET, CERELA, Batalla de Chacabuco 145, 4000 San Miguel de Tucumán, Argentina
| | - M A Gomez
- Hospital Ángel C. Padilla, Juan Bautista Alberdi 550, 4000 San Miguel de Tucumán, Argentina
| | - S I Cazorla
- CONICET, CERELA, Batalla de Chacabuco 145, 4000 San Miguel de Tucumán, Argentina
| | - A V Rodriguez
- CONICET, Cell Signaling Laboratory, Batalla de Chacabuco 145, 4000 San Miguel de Tucumán, Argentina
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13
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Shi M, Ye Y, Zhou J, Qin A, Cheng J, Ren H. Local use of dexamethasone in the treatment of ocular myasthenia gravis. BMC Ophthalmol 2020; 20:432. [PMID: 33115419 PMCID: PMC7594471 DOI: 10.1186/s12886-020-01697-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 10/14/2020] [Indexed: 11/24/2022] Open
Abstract
Background At present, patients with ocular myasthenia gravis (OMG) are typically treated with systemic drugs. We investigated the use of dexamethasone injected in the peribulbar region or extraocular muscle to treat patients with OMG. Methods Patients with OMG were given dexamethasone via peribulbar injection or direct injection into the main paralyzed extraocular muscles, once a week, for 4–6 weeks. The severity of diplopia, blepharoptosis, eye position, and eye movement were evaluated before and after treatment. The duration of follow-up time was ≥6 months. Results Among the 14 patients with OMG who received this treatment, mean age was 38.7 ± 29.7 years. After treatment, symptoms were relieved in 12 patients (85.7%), 1 patient (7.1%) had partial response to treatment, and 1 patient (7.1%) had no response. Two patients (14.2%) experienced symptom recurrence during the follow-up period. Conclusions Dexamethasone peribulbar or extraocular muscle injection is effective in the treatment of patients with OMG and may replace systemic drug therapy. Trial registration Chinese Clinical Trial Registry, ChiCTR2000038863, October 7, 2020.Retrospectively registered. Supplementary information The online version contains supplementary material available at 10.1186/s12886-020-01697-2.
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Affiliation(s)
- Minghua Shi
- Department of Strabismus and Pediatric Ophthalmology, Wuhan Aier Eye Hospital (Hanyang), Wuhan, 430020, China.
| | - Yingjia Ye
- Department of Strabismus and Pediatric Ophthalmology, Wuhan Aier Eye Hospital (Hanyang), Wuhan, 430020, China
| | - Junping Zhou
- Department of Strabismus and Pediatric Ophthalmology, Wuhan Aier Eye Hospital (Hanyang), Wuhan, 430020, China
| | - Aijiao Qin
- Department of Strabismus and Pediatric Ophthalmology, Wuhan Aier Eye Hospital (Hanyang), Wuhan, 430020, China
| | - Jing Cheng
- Department of Strabismus and Pediatric Ophthalmology, Wuhan Aier Eye Hospital (Hanyang), Wuhan, 430020, China
| | - Hongxing Ren
- Department of Strabismus and Pediatric Ophthalmology, Wuhan Aier Eye Hospital (Hanyang), Wuhan, 430020, China
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Lipski DA, Foucart V, Dewispelaere R, Caspers LE, Defrance M, Bruyns C, Willermain F. Retinal endothelial cell phenotypic modifications during experimental autoimmune uveitis: a transcriptomic approach. BMC Ophthalmol 2020; 20:106. [PMID: 32183784 PMCID: PMC7076950 DOI: 10.1186/s12886-020-1333-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/03/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Blood-retinal barrier cells are known to exhibit a massive phenotypic change during experimental autoimmune uveitis (EAU) development. In an attempt to investigate the mechanisms of blood-retinal barrier (BRB) breakdown at a global level, we studied the gene regulation of total retinal cells and retinal endothelial cells during non-infectious uveitis. METHODS Retinal endothelial cells were isolated by flow cytometry either in Tie2-GFP mice (CD31+ CD45- GFP+ cells), or in wild type C57BL/6 mice (CD31+ CD45- endoglin+ cells). EAU was induced in C57BL/6 mice by adoptive transfer of IRBP1-20-specific T cells. Total retinal cells and retinal endothelial cells from naïve and EAU mice were sorted and their gene expression compared by RNA-Seq. Protein expression of selected genes was validated by immunofluorescence on retinal wholemounts and cryosections and by flow cytometry. RESULTS Retinal endothelial cell sorting in wild type C57BL/6 mice was validated by comparative transcriptome analysis with retinal endothelial cells sorted from Tie2-GFP mice, which express GFP under the control of the endothelial-specific receptor tyrosine kinase promoter Tie2. RNA-Seq analysis of total retinal cells mainly brought to light upregulation of genes involved in antigen presentation and T cell activation during EAU. Specific transcriptome analysis of retinal endothelial cells allowed us to identify 82 genes modulated in retinal endothelial cells during EAU development. Protein expression of 5 of those genes (serpina3n, lcn2, ackr1, lrg1 and lamc3) was validated at the level of inner BRB cells. CONCLUSION Those data not only confirm the involvement of known pathogenic molecules but further provide a list of new candidate genes and pathways possibly implicated in inner BRB breakdown during non-infectious posterior uveitis.
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Affiliation(s)
- Deborah A. Lipski
- Ophthalmology Group, IRIBHM (Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire), Université Libre de Bruxelles (ULB), Erasme Campus, Building C, Room C6.117, 808 Route de Lennik, 1070 Brussels, Belgium
- Ophthalmology Department of Erasme Hospital, Université Libre de Bruxelles (ULB), 808 Route de Lennik, 1070 Brussels, Belgium
| | - Vincent Foucart
- Ophthalmology Group, IRIBHM (Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire), Université Libre de Bruxelles (ULB), Erasme Campus, Building C, Room C6.117, 808 Route de Lennik, 1070 Brussels, Belgium
- Ophthalmology Department of CHU Saint-Pierre, 322 Rue Haute, 1000 Brussels, Belgium
- Ophthalmology Department of CHU Brugmann, 4 Place Van Gehuchten, 1020 Brussels, Belgium
| | - Rémi Dewispelaere
- Ophthalmology Group, IRIBHM (Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire), Université Libre de Bruxelles (ULB), Erasme Campus, Building C, Room C6.117, 808 Route de Lennik, 1070 Brussels, Belgium
- Ophthalmology Department of CHU Saint-Pierre, 322 Rue Haute, 1000 Brussels, Belgium
| | - Laure E. Caspers
- Ophthalmology Department of CHU Saint-Pierre, 322 Rue Haute, 1000 Brussels, Belgium
| | - Matthieu Defrance
- Interuniversity Institute of Bioinformatics in Brussels, Université Libre de Bruxelles - Vrije Universiteit Brussel, La Plaine Campus, BC building, 6th floor, CP 263, Triomflaan, 1050 Brussels, Belgium
| | - Catherine Bruyns
- Ophthalmology Group, IRIBHM (Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire), Université Libre de Bruxelles (ULB), Erasme Campus, Building C, Room C6.117, 808 Route de Lennik, 1070 Brussels, Belgium
| | - François Willermain
- Ophthalmology Group, IRIBHM (Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire), Université Libre de Bruxelles (ULB), Erasme Campus, Building C, Room C6.117, 808 Route de Lennik, 1070 Brussels, Belgium
- Ophthalmology Department of CHU Saint-Pierre, 322 Rue Haute, 1000 Brussels, Belgium
- Ophthalmology Department of CHU Brugmann, 4 Place Van Gehuchten, 1020 Brussels, Belgium
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15
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Karatsai E, Robson AG, Taylor SRJ. Outcomes Associated With Sustained-Release Intraocular Fluocinolone Implants in a Case of Melanoma-Associated Retinopathy Treated Without Systemic Immunosuppression. JAMA Ophthalmol 2020; 137:564-567. [PMID: 30896772 DOI: 10.1001/jamaophthalmol.2019.0284] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Melanoma-associated retinopathy (MAR) is a paraneoplastic syndrome in which antiretinal antibodies crossreact with retinal ON-bipolar cells, resulting in night blindness and progressive visual field loss. Current therapeutic options include cytoreductive surgery in combination with immunoglobulin, corticosteroids, or plasmapheresis, but their effectiveness is limited and may be contraindicated, given the possible protective role of circulating autoantibodies against metastatic spread. We report 3-year follow-up of the first case (to our knowledge) of MAR treated with intravitreal long-acting steroid implants. Objective To report on a patient with MAR who was treated with intravitreal fluocinolone acetonide implants in the absence of systemic immunosuppression. Design, Setting, and Participants This is a 3-year follow-up of a 73-year-old woman with a history of surgical excision of a malignant melanoma of the left pinna who presented with visual symptoms of shimmering and nyctalopia. Fundus examination, fundus autofluorescence, and optical coherence tomography were normal, with no evidence of cystoid macular edema. Automated perimetry showed a reduction in visual field and full-field electroretinography (ERG) demonstrated findings consistent with generalized ON-bipolar cell dysfunction, typical of MAR. The patient was treated with bilateral fluocinolone acetonide intravitreal implants. Main Outcomes and Measures Visual acuity, visual field, and electroretinography testing for 3 years after treatment. Results Visual fields improved in this 73-year-old patient from 20/30 (Snellen measured as 6/9) OD and 20/16 (6/5) OS at baseline to 20/20 OU within 1 week of treatment. Detailed electroretinography monitoring indicated characteristic abnormalities that partly resolved after treatment, consistent with improved inner retinal ON-bipolar cell function. Bilateral cataracts developed approximately 2 years after injection; cataract surgery was performed uneventfully. At 3 years posttreatment, the patient remained visually stable and in systemic disease remission, with best-corrected visual acuity remaining at 20/20 OU. Conclusions and Relevance We report what is, to our knowledge, the first case of MAR treated with intravitreal slow-release corticosteroid implants, which shows improvements in visual symptoms, visual fields, and retinal function. Sustained-release intraocular steroid implants may offer an effective and safe alternative to systemic immunosuppression in MAR, although results from 1 case should be generalized with abundant caution.
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Affiliation(s)
| | - Anthony G Robson
- Moorfields Eye Hospital, London, United Kingdom.,University College London Institute of Ophthalmology, London, United Kingdom
| | - Simon R J Taylor
- Royal Surrey County Hospital, Guildford, United Kingdom.,University of Surrey, Guildford, United Kingdom
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16
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Garweg JG. [Pharmacological treatment strategies and surgical options for uveitis]. Ophthalmologe 2019; 116:942-950. [PMID: 30796601 DOI: 10.1007/s00347-019-0870-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Modern treatment of uveitis aims at a complete control of inflammatory activity, preservation of visual function and the prevention of secondary organ damage as a consequence of the underlying inflammatory disease and its treatment. OBJECTIVE This article gives an update about the strategies of pharmacological and surgical options for uveitis. MATERIAL AND METHODS The outcomes reported here are based on a PubMed search using the terms <"uveitis" AND "therapy"> and <"uveitis" AND "surgery" OR "surgical treatment">. All prospective studies and case series with more than 20 cases as well as review articles from the last 5 years along with cited cross-references were evaluated. RESULTS Local and systemic corticosteroids form the foundation of treatment after exclusion of an infectious etiology. If uveitis activity is not controlled within 6 weeks or if the daily corticosteroid dosage is unacceptably high, a treatment escalation using immunomodulatory drugs is required. If a complete control of inflammatory activity is not achieved, in a third phase treatment is supplemented by antibody-based treatment or cytokines, so-called biologics, with the aim of complete long-term freedom from disease without local or systemic steroid treatment. This target is achieved in 65-80% and guarantees long-term functional stability and anatomical integrity. Early treatment escalation in cases of persisting or recurrent activity as a rule prevents new secondary organ damage. Surgical options are utilized for diagnostic purposes, the administration of intravitreal drugs and for treatment of secondary complications. CONCLUSION Just like the majority of immunological diseases, uveitis is a chronic disease requiring long-term and possibly lifelong treatment and remission (absence of inflammation without treatment) is achieved in only <20%. Surgical interventions can be performed with a good prognosis, if the optic nerve head and macula are not involved. They have a substantially lower complication rate when freedom from symptoms exists preoperatively for at least 3 months.
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Affiliation(s)
- Justus G Garweg
- Berner Augenklinik am Lindenhofspital, Affiliation: Klinik und Poliklinik für Augenheilkunde, Inselspital, Universität Bern, Bremgartenstr 119, 3012, Bern, Schweiz. .,Swiss Eye Institute, Rotkreuz, Schweiz.
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17
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Safety and efficacy of tacrolimus-coated silicone plates as an alternative to mitomycin C in a rabbit model of conjunctival fibrosis. PLoS One 2019; 14:e0219194. [PMID: 31276522 PMCID: PMC6611608 DOI: 10.1371/journal.pone.0219194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 06/18/2019] [Indexed: 12/05/2022] Open
Abstract
Purpose To find safer and more effective drugs than mitomycin C to prevent conjunctival fibrosis in a rabbit model. Methods Twenty-four rabbits were involved and randomly divided into four groups. Limbus-based peritomy was performed at the superior cornea, and normal saline (NS group), mitomycin C (MMC group), SR (SR group), or TC (TC group)-coated silicone plate was inserted at the sub-Tenon’s space in each group. Conjunctival congestion was evaluated at 1 and 4 weeks postoperatively. At 4 weeks, the numbers of inflammatory cells, fibroblasts, myofibroblasts, blood vessels, and goblet cells were counted in the conjunctiva and Tenon’s capsule around the silicone plate. Results At 4 weeks, conjunctival congestion was significantly less than that observed at 1 week in the SR and TC groups (p < 0.05), whereas the number of myofibroblasts was significantly lower in the MMC and TC groups (p < 0.05). The conjunctiva was significantly less congested in the TC group versus the other groups at 1 week and 4 weeks (p < 0.05). The TC group had the lowest number of inflammatory cells and MMC group had the lowest number of goblet cells among all groups (p < 0.05). Conclusions The TC-coated silicone plate was more effective in inhibiting inflammation and fibrosis versus the MMC-coated silicone plate and was associated with fewer adverse effects in the rabbit model.
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18
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Barnes AC, Lowder CY, Bessette AP, Baynes K, Srivastava SK. Treatment of Acute Zonal Occult Outer Retinopathy With Intravitreal Steroids. Ophthalmic Surg Lasers Imaging Retina 2019; 49:504-509. [PMID: 30021037 DOI: 10.3928/23258160-20180628-06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/04/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To report on the use of intravitreal steroids in the management of acute zonal occult outer retinopathy (AZOOR), a rare disorder affecting the outer retina. PATIENTS AND METHODS Retrospective case series of nine eyes of five patients with AZOOR who received intravitreal triamcinolone acetonide (IVTA), dexamethasone intravitreal implant, and/or fluocinolone acetonide implant. Treatment response was determined by reported symptoms and multimodal imaging findings. Patients were observed for at least 1 year following intravitreal steroid treatment (range: 14 months to 63 months). RESULTS Seven eyes received IVTA, six eyes received the dexamethasone intravitreal implant, and one eye received the fluocinolone acetonide implant. All patients experienced disease stability or improvement based on symptomatic response and multimodal imaging findings after intravitreal steroids. One eye developed central serous retinopathy, and another eye a choroidal neovascular membrane. Five of nine eyes experienced ocular hypertension. All phakic eyes developed cataracts. CONCLUSION Intravitreal steroids effectively achieved disease stability in patients with AZOOR. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:504-509.].
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Teja S, Sawatzky L, Wiens T, Maberley D, Ma P. Ozurdex for refractory macular edema secondary to diabetes, vein occlusion, uveitis and pseudophakia. Can J Ophthalmol 2019; 54:540-547. [PMID: 31564342 DOI: 10.1016/j.jcjo.2018.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the functional and morphological effects of the intravitreal dexamethasone implant (Ozurdex, Allergan) on patients with macular edema secondary to retinal vein occlusion (RVO), diabetic retinopathy (DME), posterior noninfectious uveitis (NIU), or pseudophakic Irvine-Gass syndrome (IGS). METHODS 144 charts were retrospectively reviewed; 100 eyes met inclusion criteria for analysis: at least one intravitreal dexamethasone implant injection, refractory to antivascular endothelial growth factor, and had ≥6 months of follow-up postinsertion. The primary outcome was the efficacy of the dexamethasone implant in reducing macular edema as measured by reduction in central retinal thickness (CRT). Secondary outcomes included visual acuity (VA), duration of treatment efficacy (measured by time to next treatment), and safety. The Wilcoxon signed-rank test was used to compare values from baseline, and Kaplan-Meier survival curves were used to analyze time to retreatment. RESULTS There were 28 patients with RVO, 30 with DME, 24 with posterior NIU, and 18 with IGS. VA improved from baseline to month 6 in all groups, but was not statistically significant. CRT improved in all 4 groups, and was statistically significant for DME (p = 0.008) and NIU (p = 0.05). At 3 months, 34 patients (41.5%) required retreatment; by month 6, 46 patients (56.1%) required retreatment. There was a large variation between the groups in number of patients requiring intraocular pressure (IOP)-lowering medications. Two patients needed IOP-lowering surgery. One patient developed endophthalmitis. CONCLUSION The use of intravitreal dexamethasone implants in patients with refractory retinal diseases is well tolerated and results in consistently improved anatomic outcomes, but the positive anatomic outcomes are not necessarily correlated to improvements in visual function. Patients who are treated earlier in the disease process will had better outcomes. This patient population were refractory to treatment and, therefore, have less-predictable functional outcomes.
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Affiliation(s)
- Salina Teja
- Department of Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, B.C..
| | - Lauren Sawatzky
- Department of Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, B.C
| | - Theresa Wiens
- Department of Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, B.C
| | - David Maberley
- Department of Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, B.C
| | - Patrick Ma
- Department of Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, B.C
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20
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Leal I, Rodrigues FB, Sousa DC, Romão VC, Duarte GS, Carreño E, Dick AD, Marques-Neves C, Costa J, Fonseca JE. Efficacy and safety of intravitreal anti-tumour necrosis factor drugs in adults with non-infectious uveitis - a systematic review. Acta Ophthalmol 2018; 96:e665-e675. [PMID: 29577629 DOI: 10.1111/aos.13699] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 12/09/2017] [Indexed: 12/29/2022]
Abstract
Anti-tumour necrosis factor (TNF) drugs have been extensively used in non-infectious uveitis (NIU), when corticosteroids or conventional immunosuppressive drugs cannot adequately control inflammation or intolerable side-effects occur. However, systemic anti-TNF therapies are also associated with a myriad of side-effects. Therefore, intravitreal administration of anti-TNF biologics has been employed to minimize patient morbidity and systemic adverse effects, while maintaining therapeutic effectivity. We undertook a systematic review to determine evidence of efficacy and safety of intravitreal administration of anti-TNF drugs in adults with NIU. We conducted this systematic review according to the PRISMA guidelines. The protocol was registered with PROSPERO (CRD42016041946). We searched CENTRAL, MEDLINE and EMBASE, from inception to April 2017, as well as clinical trial registries and grey literature. The qualitative analysis included all studies of adult patients with a diagnosis of NIU and who received intravitreal anti-TNF drugs with a 4-week minimum follow-up. A total of 4840 references were considered for title and abstract screening. Seven full texts were screened, and five studies were considered for analysis. All studies were open-label, single-centre, prospective, non-randomized, interventional case series with a follow-up between 4 and 26 weeks, employing either adalimumab in two studies and infliximab in three. Three studies showed a treatment effect of anti-TNF intravitreal injections, while one study revealed short-term improvement and one study revealed no efficacy of anti-TNF intravitreal therapy. None of the studies reported ocular adverse effects but only two studies included electrophysiological assessment in the safety analysis and no study assessed systemic human anti-drug antibodies. The available evidence is not sufficiently robust to conclude about the clinical effectivity of intravitreal anti-TNF in NIU and so no recommendation can be made. In conclusion, intravitreal injection of anti-TNF antibodies remains a possible treatment option to be explored through robust clinical investigation.
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Affiliation(s)
- Inês Leal
- Department of Ophthalmology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisboa Portugal
- Department of Ophthalmology; Faculdade de Medicina; Universidade de Lisboa; Lisboa Portugal
- Centro de Estudos das Ciências da Visão; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Filipe B Rodrigues
- Laboratory of Clinical Pharmacology and Therapeutics; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Clinical Pharmacology Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Huntington's Disease Centre; University College London; London UK
| | - David Cordeiro Sousa
- Department of Ophthalmology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisboa Portugal
- Department of Ophthalmology; Faculdade de Medicina; Universidade de Lisboa; Lisboa Portugal
- Centro de Estudos das Ciências da Visão; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Vasco C Romão
- Department of Rheumatology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisbon Portugal
- Rheumatology Research Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Gonçalo S Duarte
- Laboratory of Clinical Pharmacology and Therapeutics; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Clinical Pharmacology Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Ester Carreño
- Clinical Research Unit; Bristol Eye Hospital NHS Foundation Trust; Bristol UK
| | - Andrew D Dick
- Clinical Research Unit; Bristol Eye Hospital NHS Foundation Trust; Bristol UK
- School of Clinical Sciences; Faculty of Medicine and Dentistry; University of Bristol; Bristol UK
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology; London UK
| | - Carlos Marques-Neves
- Department of Ophthalmology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisboa Portugal
- Department of Ophthalmology; Faculdade de Medicina; Universidade de Lisboa; Lisboa Portugal
- Centro de Estudos das Ciências da Visão; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Clinical Pharmacology Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Evidence Based Medicine Centre; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
- Portuguese Collaborating Centre of the Cochrane Iberoamerican Network; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - João Eurico Fonseca
- Department of Rheumatology; Hospital de Santa Maria-CHLN; Lisbon Academic Medical Centre; Lisbon Portugal
- Rheumatology Research Unit; Instituto de Medicina Molecular; Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
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Abstract
Background Sarcoidosis constitutes one of the leading causes of ocular inflammation. Chronic ocular sarcoidosis can affect any segment of the eye and its adnexa, producing a wide range of clinical manifestations and severity. If left untreated, permanent visual impairment or even blindness may ensue. Treatment approaches vary from topical therapy to systemic agents that induce immunosuppression to different levels according to disease severity. Objective To review the published literature on the management options for chronic ocular sarcoidosis and provide a comprehensive list of available treatment strategies, including the newer biologics. Summary Ocular disease remains a challenging aspect of sarcoidosis and may even be the presenting sign of the disease. Prompt and effective therapy may reverse visual damage and prevent permanent loss of vision. Because of the complexity of the disease, a multidisciplinary approach is often required, with a view to addressing both the ocular and other systemic manifestations of sarcoidosis. Recent data suggest that achieving overall optimal systemic control is of paramount importance in controlling eye inflammation as well. Cytotoxic immunosuppressive agents for refractory chronic ocular disease, as well as biologic anti-TNFα therapies, have advanced the management of chronic disease and should be considered corticosteroid-sparing strategies before the onset of significant steroid-induced morbidity.
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Affiliation(s)
- Artemis Matsou
- Second Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Greece
| | - Konstantinos T Tsaousis
- Ophthalmology Department, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
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22
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Green tea extract attenuates LPS-induced retinal inflammation in rats. Sci Rep 2018; 8:429. [PMID: 29323215 PMCID: PMC5765135 DOI: 10.1038/s41598-017-18888-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/19/2017] [Indexed: 01/05/2023] Open
Abstract
Inflammation is in a wide spectrum of retinal diseases, causing irreversible blindness and visual impairment. We have previously demonstrated that Green Tea Extract (GTE) is a potent anti-inflammatory agent for anterior uveitis. Here we investigated the anti-inflammatory effect of GTE on lipopolysaccharides (LPS)-induced retinal inflammation in rats and explored the underlying mechanism. Adult rats were injected with LPS and GTE was administered intra-gastrically at 2, 8, 26 and 32 hours post-injection. Staining of whole-mount retina showed that the number of activated microglia cells was significantly increased at 48 hours post-injection, which was suppressed after GTE treatment in a dose-dependent manner. Activation of astrocytes and Müller glia in the retina was also suppressed after GTE treatment. Meanwhile, GTE reduced the expression of pro-inflammatory cytokines including IL-1β, TNF-α and IL-6 in retina and vitreous humor. These anti-inflammatory effects were associated with a reduced phosphorylation of STAT3 and NF-κB in the retina. Furthermore, the surface receptor of EGCG, 67LR, was localized on the neurons and glia in the retina. These findings demonstrate that GTE is an effective agent in suppressing LPS-induced retinal inflammation, probably through its potent anti-oxidative property and a receptor-mediated action on transcription factors that regulate production of pro-inflammatory cytokines.
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23
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Zhu S, Xu X, Liu K, Gu Q, Wei F, Jin H. Peptide GC31 inhibits chemokines and ICAM-1 expression in corneal fibroblasts exposed to LPS or poly(I:C) by blocking the NF-κB and MAPK pathways. Exp Eye Res 2017; 164:109-117. [PMID: 28778400 DOI: 10.1016/j.exer.2017.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 07/10/2017] [Accepted: 07/28/2017] [Indexed: 02/06/2023]
Abstract
In keratitis, keratocytes play a vital role by releasing inflammatory cytokines and expressing intercellular cell adhesion molecule-1(ICAM-1). GC31 is a peptide derived from thrombomodulin, an endogenous protein with potential anti-inflammation properties. We evaluated the protective effect of GC31 in LPS- or poly(I:C)-induced corneal fibroblasts. Cultured keratocytes were treated with either LPS or poly(I:C); The mRNA and protein expressions of IL-6, IL-8, MCP-1, and IFN-γ were determined by real-time RT-PCR and ELISA. The expression level of ICAM-1 was estimated by real-time RT-PCR, immunofluorescence, and western blot. The underlying pathways were investigated by detecting NF-κB p65 translocation and phosphorylation of IκBα, p65, p38, JNK, and ERK. The MTS assay was used to measure cell viability of keratocytes after GC31 incubation. The elevation of IL-6, IL-8, MCP-1, and IFN-γ expression induced by LPS or poly(I:C) was significantly inhibited by GC31 in a dose-dependent manner at both mRNA and protein levels. GC31 also reduced the expression of ICAM-1 in keratocytes after LPS or poly(I:C) stimulation. LPS or poly(I:C) induced p65 translocation and phosphorylation of IκBα, p65, p38, and JNK were suppressed by GC31.GC31 is not only an effective inhibitor of LPS-induced inflammatory response, but it also inhibits poly(I:C)-induced release of inflammatory cytokines and ICAM-1 expression by blocking the NF-κB and MAPK (p38 and JNK) pathways. This suggested that GC31 may exert a protective effect in attenuating corneal inflammation by suppressing the immune response of the fibroblasts.
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Affiliation(s)
- Shaopin Zhu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, No. 100, Haining Road, Shanghai, People's Republic of China; Shanghai Key Laboratory of Fundus Disease, No. 100, Haining Road, Shanghai, People's Republic of China
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, No. 100, Haining Road, Shanghai, People's Republic of China; Shanghai Key Laboratory of Fundus Disease, No. 100, Haining Road, Shanghai, People's Republic of China
| | - Kun Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, No. 100, Haining Road, Shanghai, People's Republic of China; Shanghai Key Laboratory of Fundus Disease, No. 100, Haining Road, Shanghai, People's Republic of China
| | - Qing Gu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, No. 100, Haining Road, Shanghai, People's Republic of China; Shanghai Key Laboratory of Fundus Disease, No. 100, Haining Road, Shanghai, People's Republic of China
| | - Fang Wei
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, No. 100, Haining Road, Shanghai, People's Republic of China; Shanghai Key Laboratory of Fundus Disease, No. 100, Haining Road, Shanghai, People's Republic of China
| | - Huiyi Jin
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, No. 100, Haining Road, Shanghai, People's Republic of China; Shanghai Key Laboratory of Fundus Disease, No. 100, Haining Road, Shanghai, People's Republic of China.
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Bai L, Shao H, Wang H, Zhang Z, Su C, Dong L, Yu B, Chen X, Li X, Zhang X. Effects of Mesenchymal Stem Cell-Derived Exosomes on Experimental Autoimmune Uveitis. Sci Rep 2017; 7:4323. [PMID: 28659587 PMCID: PMC5489510 DOI: 10.1038/s41598-017-04559-y] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 05/17/2017] [Indexed: 12/20/2022] Open
Abstract
We previously demonstrated that mesenchymal stem cells (MSCs) ameliorated experimental autoimmune uveoretinitis (EAU) in rats. Recently, MSC-derived exosomes (MSC-Exo) were thought to carry functions of MSCs. In this study, we tested the effect of local administration of human MSC-Exo on established EAU in the same species. Rats with EAU induced by immunization with interphotoreceptor retinol-binding protein 1177–1191 peptide were treated by periocular injections of increasing doses of MSC-Exo starting at the disease onset for 7 consecutive days. The in vitro effects of MSC-Exo on immune cell migration and responder T cell proliferation were examined by chemotactic assays and lymphocyte proliferation assays, respectively. We found that MSC-Exo greatly reduced the intensity of ongoing EAU as their parent cells by reducing the infiltration of T cell subsets, and other inflammatory cells, in the eyes. Furthermore, the chemoattractive effects of CCL2 and CCL21 on inflammatory cells were inhibited by MSC-Exo. However, no inhibitory effect of MSC-Exo on IRBP-specific T cell proliferation was observed. These results suggest that MSC-Exo effectively ameliorate EAU by inhibiting the migration of inflammatory cells, indicating a potential novel therapy of MSC-Exo for uveitis.
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Affiliation(s)
- Lingling Bai
- Tianjin Medical University Eye Hospital, Eye Institute &School of Optometry and Ophthalmology, Tianjin, 300384, P.R. China
| | - Hui Shao
- Department of Ophthalmology and Visual Sciences, Kentucky Lions Eye Center, University of Louisville, Louisville, KY, 40202, USA
| | - Hongxing Wang
- Department of Ophthalmology, Chuiyangliu Hospital, Beijing, China
| | - Zhihui Zhang
- Tianjin Medical University Eye Hospital, Eye Institute &School of Optometry and Ophthalmology, Tianjin, 300384, P.R. China
| | - Chang Su
- Tianjin Medical University Eye Hospital, Eye Institute &School of Optometry and Ophthalmology, Tianjin, 300384, P.R. China
| | - Lijie Dong
- Tianjin Medical University Eye Hospital, Eye Institute &School of Optometry and Ophthalmology, Tianjin, 300384, P.R. China
| | - Bo Yu
- Tianjin Medical University Eye Hospital, Eye Institute &School of Optometry and Ophthalmology, Tianjin, 300384, P.R. China
| | - Xiteng Chen
- Tianjin Medical University Eye Hospital, Eye Institute &School of Optometry and Ophthalmology, Tianjin, 300384, P.R. China
| | - Xiaorong Li
- Tianjin Medical University Eye Hospital, Eye Institute &School of Optometry and Ophthalmology, Tianjin, 300384, P.R. China.
| | - Xiaomin Zhang
- Tianjin Medical University Eye Hospital, Eye Institute &School of Optometry and Ophthalmology, Tianjin, 300384, P.R. China.
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25
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Frère A, Caspers L, Makhoul D, Judice L, Postelmans L, Janssens X, Lefebvre P, Mélot C, Willermain F. Single Dexamethasone Intravitreal Implant in the Treatment of Noninfectious Uveitis. J Ocul Pharmacol Ther 2017; 33:290-297. [DOI: 10.1089/jop.2016.0139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Ariane Frère
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
- Department of Ophthalmology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Laure Caspers
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Dorine Makhoul
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
- Department of Ophthalmology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Lia Judice
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
- Department of Ophthalmology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Laurence Postelmans
- Department of Ophthalmology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Xavier Janssens
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Lefebvre
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Christian Mélot
- Department of Emergency, Erasme Academic Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - François Willermain
- Department of Ophthalmology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
- Department of Ophthalmology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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26
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Zhu S, Xu X, Wang L, Su L, Gu Q, Wei F, Liu K. Inhibitory effect of a novel peptide, H-RN, on keratitis induced by LPS or poly(I:C) in vitro and in vivo via suppressing NF-κB and MAPK activation. J Transl Med 2017; 15:20. [PMID: 28125988 PMCID: PMC5270222 DOI: 10.1186/s12967-017-1121-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/06/2017] [Indexed: 12/22/2022] Open
Abstract
Background Keratitis is a common cause of blindness. Current anti-inflammatory drugs used in keratitis have profound side effects. Small peptides derived from endogenous proteins potentially display both desired efficiency and safety. We identified an 11-amino-acid peptide, H-RN, from hepatocyte growth factor (HGF), an endogenous protein with anti-inflammatory properties. We evaluated the effects of H-RN in keratitis in vitro and in vivo. Methods In vitro, corneal fibroblasts were stimulated with LPS or poly(I:C), surrogates for bacteria and viruses. Inflammatory cytokines, intercellular cell adhesion molecule-1 (ICAM-1), translocation of NF-κB p65, activation of IκBα, NF-κB, and MAPKs were detected. In vivo, keratitis in rats was induced by LPS. Clinical, histological observation, and quantification of cytokines in the cornea were conducted. H-RN safety was measured by cell viability, clinical, histological, and microstructural observations. Results H-RN inhibited IL-6, monocyte chemotactic protein-1(MCP-1), Interferon- γ(IFN-γ), and ICAM-1 expression triggered by LPS or poly(I:C), alleviated the clinical manifestation and reduced the clinical score in keratitis in vivo. The histological disorder and proinflammatory cytokines of the cornea were also reduced. The translocation of NF-κB and phosphorylation of IκBα, NF-κB, p38, JNK, and ERK were significantly inhibited by H-RN. No sign of toxicity was observed. Conclusions H-RN effectively attenuated keratitis in vivo and in vitro induced by LPS or poly(I:C) through blocking NF-κB and MAPK signaling pathways. It may be a promising and safe agent in treating keratitis.
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Affiliation(s)
- Shaopin Zhu
- Department of Ophthalmology, School of Medicine, Shanghai First People's Hospital, Shanghai Jiao Tong University, No. 100, Haining Road, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Fundus Disease, No. 100, Haining Road, Shanghai, People's Republic of China
| | - Xun Xu
- Department of Ophthalmology, School of Medicine, Shanghai First People's Hospital, Shanghai Jiao Tong University, No. 100, Haining Road, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Fundus Disease, No. 100, Haining Road, Shanghai, People's Republic of China
| | - Lili Wang
- Department of Ophthalmology, School of Medicine, Shanghai First People's Hospital, Shanghai Jiao Tong University, No. 100, Haining Road, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Fundus Disease, No. 100, Haining Road, Shanghai, People's Republic of China
| | - Li Su
- Department of Ophthalmology, School of Medicine, Shanghai First People's Hospital, Shanghai Jiao Tong University, No. 100, Haining Road, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Fundus Disease, No. 100, Haining Road, Shanghai, People's Republic of China
| | - Qing Gu
- Department of Ophthalmology, School of Medicine, Shanghai First People's Hospital, Shanghai Jiao Tong University, No. 100, Haining Road, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Fundus Disease, No. 100, Haining Road, Shanghai, People's Republic of China
| | - Fang Wei
- Department of Ophthalmology, School of Medicine, Shanghai First People's Hospital, Shanghai Jiao Tong University, No. 100, Haining Road, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Fundus Disease, No. 100, Haining Road, Shanghai, People's Republic of China
| | - Kun Liu
- Department of Ophthalmology, School of Medicine, Shanghai First People's Hospital, Shanghai Jiao Tong University, No. 100, Haining Road, Shanghai, People's Republic of China. .,Shanghai Key Laboratory of Fundus Disease, No. 100, Haining Road, Shanghai, People's Republic of China.
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SUB-TENON TRIAMCINOLONE ACETONIDE INJECTION IN A PREGNANT PATIENT WITH VOGT-KOYANAGI-HARADA DISEASE. Retin Cases Brief Rep 2016; 12:375-378. [PMID: 28033228 DOI: 10.1097/icb.0000000000000510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a case of new-onset Vogt-Koyanagi-Harada disease treated with sub-Tenon injection of triamcinolone acetonide in a 16-week pregnant patient. METHODS Review of clinical records. RESULTS A 33-year-old woman in her 16th week of pregnancy presented with bilateral serous retinal detachments associated with anterior chamber inflammation. Enhanced depth imaging optical coherence topography showed marked choroidal thickening. Headache and tinnitus developed 3 days later. The patient was diagnosed with incomplete Vogt-Koyanagi-Harada disease and treated with bilateral sub-Tenon triamcinolone acetonide injections. Within 2 weeks, the serous retinal detachments completely resolved with decreased choroidal thickness in both eyes. No recurrence of inflammation or choroidal thickening was noted over a follow-up of 13 months. The patient delivered a healthy baby at 41 weeks of pregnancy. CONCLUSION Sub-Tenon triamcinolone acetonide injection may be an effective and safe treatment in pregnant women with new-onset Vogt-Koyanagi-Harada disease.
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Foeldvari I. Ocular Involvement in Juvenile Idiopathic Arthritis: Classification and Treatment. Clin Rev Allergy Immunol 2016; 49:271-7. [PMID: 25081063 DOI: 10.1007/s12016-014-8436-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is one of the most common rheumatic diseases in childhood with a prevalence of 4 in 1,000 children. Anterior uveitis is a well-known threatening comorbid condition of JIA and affects around 10 % of the patients depending on JIA subtype. A large proportion of children with JIA develop uveitis in the first year of disease and 73 to 90 % after 4 years. Uveitis can progress into adulthood and usually occurs as 'white uveitis', while in the JIA related to the enthesitis subtype that is symptomatic. Current studies reinforced the previous observations that early age of JIA onset, oligoarticular subtype and ANA reactivity are the main risk factors for the development of uveitis. Factors associated to worse prognosis are as follows: findings of 1+ or more vitreous cells at presentation and initial visual acuity of 20/200 or worse. The Standardization of Uveitis Nomenclature (SUN) Group took the first step to define outcome measures for uveitis, but it was established for adults. The Multinational Interdisciplinary Working Group for Uveitis in Childhood (MIWGUC) proposed outcome measures for JIA-associated uveitis incorporating the SUN criteria in 2011. The current suggested management recommends to start early a steroid-sparing effective immunomodulatory systemic treatment. Methylprednisolone intravenous pulse therapy, rituximab, tocilizumab and abatacept are promising agents. Because JIA-associated uveitis is a potentially threatening comorbidity, it is important to recognize and treat it early to prevent any visual damage that could impair visual acuity.
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Affiliation(s)
- Ivan Foeldvari
- Hamburger Zentrum für Kinder- und Jugendrheumatologie am Klinikum Eilbek, Dehnhaide 120, 22081, Hamburg, Germany.
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29
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Patel AK, Newcomb CW, Liesegang TL, Pujari SS, Suhler EB, Thorne JE, Foster CS, Jabs DA, Levy-Clarke GA, Nussenblatt RB, Rosenbaum JT, Sen HN, Artornsombudh P, Kothari S, Kempen JH. Risk of Retinal Neovascularization in Cases of Uveitis. Ophthalmology 2016; 123:646-54. [PMID: 26686964 PMCID: PMC4766036 DOI: 10.1016/j.ophtha.2015.10.056] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/24/2015] [Accepted: 10/28/2015] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To evaluate the risk of and risk factors for retinal neovascularization (NV) in cases of uveitis. DESIGN Retrospective cohort study. PARTICIPANTS Patients with uveitis at 4 US academic ocular inflammation subspecialty practices. METHODS Data were ascertained by standardized chart review. Prevalence data analysis used logistic regression. Incidence data analysis used survival analysis with time-updated covariates where appropriate. MAIN OUTCOME MEASURES Prevalence and incidence of NV. RESULTS Among uveitic eyes of 8931 patients presenting for initial evaluation, 106 of 13,810 eyes had NV (prevalence = 0.77%, 95% confidence interval [CI], 0.60-0.90). Eighty-eight more eyes developed NV over 26,465 eye-years (incidence, 0.33%/eye-year; 95% CI, 0.27-0.41). Factors associated with incident NV include age <35 years compared with >35 years (adjusted hazard ratio [aHR], 2.4; 95% CI, 1.5-3.9), current cigarette smoking (aHR, 1.9; 95% CI, 1.1-3.4), and systemic lupus erythematosus (aHR, 3.5, 95% CI, 1.1-11). Recent diagnosis of uveitis was associated with an increased incidence of NV (compared with patients diagnosed >5 years ago, aHR, 2.4 [95% CI, 1.1-5.0] and aHR, 2.6 [95% CI, 1.2-6.0] for diagnosis within <1 year vs. 1-5 years, respectively). Compared with anterior uveitis, intermediate uveitis (aHR, 3.1; 95% CI, 1.5-6.6), posterior uveitis (aHR, 5.2; 95% CI, 2.5-11), and panuveitis (aHR, 4.3; 95% CI, 2.0-9.3) were associated with a similar degree of increased NV incidence. Active (aHR, 2.1, 95% CI, 1.2-3.7) and slightly active (aHR, 2.4, 95% CI, 1.3-4.4) inflammation were associated with an increased incidence of NV compared with inactive inflammation. Neovascularization incidence also was increased with retinal vascular occlusions (aHR, 10, 95% CI, 3.0-33), retinal vascular sheathing (aHR, 2.6, 95% CI, 1.4-4.9), and exudative retinal detachment (aHR, 4.1, 95% CI, 1.3-13). Diabetes mellitus was associated with a somewhat increased incidence of retinal NV (aHR, 2.3, 95% CI, 1.1-4.9), and systemic hypertension (aHR 1.5, 95% CI, 0.89-2.4) was associated with nonsignificantly increased NV incidence. Results were similar in sensitivity analyses excluding the small minority of patients with diabetes mellitus. CONCLUSIONS Retinal NV is a rare complication of uveitis, which occurs more frequently in younger patients, smokers, and those with intermediate/posterior/panuveitis, systemic vasculopathy, retinal vascular disease, or active inflammation. Inflammation and retinal NV likely are linked; additional studies are needed to further elucidate this connection.
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Affiliation(s)
- Apurva K Patel
- Ophthalmology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Retina Northwest P.C., Portland, Oregon
| | - Craig W Newcomb
- Biostatistics and Epidemiology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania
| | - Teresa L Liesegang
- Ophthalmology, Casey Eye Institute-Oregon Health Sciences University, Portland, Oregon
| | - Siddharth S Pujari
- Om Eye Care Hospital, Belgaum, Karnataka, India; Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts
| | - Eric B Suhler
- Ophthalmology, Casey Eye Institute-Oregon Health Sciences University, Portland, Oregon; Portland Veterans Affairs Medical Center, Portland, Oregon
| | - Jennifer E Thorne
- Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Douglas A Jabs
- Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Grace A Levy-Clarke
- Devers Eye Institute, Portland, Oregon; The Tampa Bay Uveitis Center, Safety Harbor, Florida
| | - Robert B Nussenblatt
- Laboratory of Immunology, National Eye Institute/National Institutes of Health, Bethesda, Maryland
| | - James T Rosenbaum
- Ophthalmology, Casey Eye Institute-Oregon Health Sciences University, Portland, Oregon; Internal Medicine, Casey Eye Institute-Oregon Health Sciences University, Portland, Oregon; Devers Eye Institute, Portland, Oregon
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute/National Institutes of Health, Bethesda, Maryland
| | - Pichaporn Artornsombudh
- Ophthalmology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts; Division of Ophthalmology Somdech Phra Pinklao Hospital, Naval Medical Department, Royal Thai Navy, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Srishti Kothari
- Ophthalmology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts
| | - John H Kempen
- Ophthalmology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Biostatistics and Epidemiology, University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania; Ocular Inflammation Service University of Pennsylvania/Scheie Eye Institute, Philadelphia, Pennsylvania.
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PAPep, a small peptide derived from human pancreatitis-associated protein, attenuates corneal inflammation in vivo and in vitro through the IKKα/β/IκBα/NF–κB signaling pathway. Pharmacol Res 2015; 102:113-22. [DOI: 10.1016/j.phrs.2015.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/13/2015] [Indexed: 11/22/2022]
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31
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Lance KD, Good SD, Mendes TS, Ishikiriyama M, Chew P, Estes LS, Yamada K, Mudumba S, Bhisitkul RB, Desai TA. In Vitro and In Vivo Sustained Zero-Order Delivery of Rapamycin (Sirolimus) From a Biodegradable Intraocular Device. Invest Ophthalmol Vis Sci 2015; 56:7331-7. [PMID: 26559479 PMCID: PMC4642602 DOI: 10.1167/iovs.15-17757] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/16/2015] [Indexed: 12/16/2022] Open
Abstract
PURPOSE We created implantable intraocular devices capable of constant and continuous rapamycin release on the scale of months to years. METHODS Polycaprolactone (PCL) thin films were used to encapsulate rapamycin to create implantable and biodegradable intraocular devices. Different film devices were studied by modifying the size, thickness, and porosity of the PCL films. RESULTS In vitro release of rapamycin was observed to be constant (zero-order) through 14 weeks of study. Release rates were tunable by altering PCL film porosity and thickness. In vivo release of rapamycin was observed out through 16 weeks with concentrations in the retina-choroid in the therapeutic range. Rapamycin concentration in the blood was below the lower limit of quantification. The drug remaining in the device was chemically stable in vitro and in vivo, and was sufficient to last for upwards of 2 years of total release. The mechanism of release is related to the dissolution kinetics of crystalline rapamycin. CONCLUSIONS Microporous PCL thin film devices demonstrate good ocular compatibility and the ability to release rapamycin locally to the eye over the course of many weeks.
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Affiliation(s)
- Kevin D. Lance
- University of California at Berkeley–University of California, San Francisco Bioengineering Graduate Program, San Francisco, California, United States
| | - Samuel D. Good
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
| | - Thaís S. Mendes
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
| | - Mynna Ishikiriyama
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
| | - Patrick Chew
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, United States
| | - Laurel S. Estes
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, United States
| | - Kazuhito Yamada
- Pharmaceutical Development Group, Pharmaceutical Development Center, Santen Pharmaceutical Co., Ltd., Nara, Japan
| | - Sri Mudumba
- Pharmaceutical Development, Santen, Inc., Emeryville, California, United States
| | - Robert B. Bhisitkul
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
| | - Tejal A. Desai
- University of California at Berkeley–University of California, San Francisco Bioengineering Graduate Program, San Francisco, California, United States
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, United States
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Antagonist of GH-releasing hormone receptors alleviates experimental ocular inflammation. Proc Natl Acad Sci U S A 2014; 111:18303-8. [PMID: 25489106 DOI: 10.1073/pnas.1421815112] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Disruptions in immunity and occurrence of inflammation cause many eye diseases. The growth hormone-releasing hormone-growth hormone-insulin-like growth factor-1 (GHRH-GH-IGF1) axis exerts regulatory effects on the immune system. Its involvement in ocular inflammation remains to be investigated. Here we studied this signaling in endotoxin-induced uveitis (EIU) generated by LPS. The increase in GHRH receptor (GHRH-R) protein levels was parallel to the increase in mRNA levels of pituitary-specific transcription factor-1, GHRH-R splice variant 1, GHRH, and GH following LPS insult. Elevation of GHRH-R and GH receptor was localized on the epithelium of the iris and ciliary body, and GHRH-R was confined to the infiltrating macrophages and leukocytes in aqueous humor but not to those in stroma. Treatment with GHRH-R antagonist decreased LPS-stimulated surges of GH and IGF1 in aqueous humor and alleviated inflammation by reducing the infiltration of macrophages and leukocytes and the production of TNF-α, IL-1β, and monocyte chemotactic protein-1. Our results indicate that inflammation in the iris and ciliary body involves the activation of GHRH signaling, which affects the recruitment of immune cells and the production of proinflammatory mediators that contribute to EIU pathogenesis. Moreover, the results suggest that GHRH-R antagonists are potential therapeutic agents for the treatment of acute ocular inflammation.
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Abstract
PURPOSE OF REVIEW Birdshot chorioretinopathy remains incompletely understood, but new insights into its pathogenesis have been reported recently, and treatment and monitoring options have also expanded. Central visual acuity may remain good until the late stages of the disease, but loss of visual field and peripheral retinal function is common. RECENT FINDINGS The underlying pathogenesis of the disease has long been believed to be T-cell driven, but examination of the IL-17 pathway has now further refined the potential underlying mechanism. New imaging techniques, including extended depth imaging of the choroid with optical coherence tomography, have demonstrated promise in detecting disease activity earlier, enabling targeted treatment to be given. Treatment options have expanded with the advent of the biological agents, and these may yet improve outcomes, particularly in refractory patients. SUMMARY Laboratory research continues to investigate the underlying mechanisms of disease, but our understanding remains frustratingly incomplete for a disease with such a clear HLA association. Clinical research is increasingly being driven to improve the phenotyping of affected patients so that those at risk of visual loss can be identified early and treated more aggressively with individually targeted therapies such as the newer biological agents, but how successful this approach will ultimately prove to be remains to be seen.
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Pascual-Camps I, Hernández-Martínez P, Monje-Fernández L, Dolz-Marco R, Gallego-Pinazo R, Wu L, Arévalo JF, Díaz-Llopis M. Update on intravitreal anti-tumor necrosis factor alpha therapies for ocular disorders. J Ophthalmic Inflamm Infect 2014; 4:26. [PMID: 25825604 PMCID: PMC4372686 DOI: 10.1186/s12348-014-0026-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/24/2014] [Indexed: 12/31/2022] Open
Abstract
Tumor necrosis factor alpha (TNF-?) is an important pro-inflammatory cytokine associated with a variety of ocular diseases. The currently available TNF-? inhibitors are etanercept, infliximab, adalimumab, golimumab, and certolizumab. Experimental and clinical studies on the intravitreal use of these agents have been reported with etanercept, infliximab, and adalimumab: etanercept has shown limited efficacy in scarce reports; infliximab has been associated with local safety concerns but appears to benefit certain cases; adalimumab has shown no efficacy in cases of age-related macular degeneration (AMD) or diabetic macular edema (DME), but the combination with bevacizumab may be effective in refractory cases of macular diseases. Further preclinical and clinical studies are warranted in order to be able to obtain a more robust conclusion on the use of intravitreal TNF-? inhibitors.
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Affiliation(s)
- Isabel Pascual-Camps
- Department of Ophthalmology, University and Polytechnic Hospital La Fe, Av. Fernando Abril Martorell, n° 106, Valencia, 46026, Spain
| | - Pablo Hernández-Martínez
- Department of Ophthalmology, University and Polytechnic Hospital La Fe, Av. Fernando Abril Martorell, n° 106, Valencia, 46026, Spain
| | - Laura Monje-Fernández
- Department of Ophthalmology, University Hospital Complex, Alto de Nava s/n, Leon, 24071, Spain
| | - Rosa Dolz-Marco
- Department of Ophthalmology, University and Polytechnic Hospital La Fe, Av. Fernando Abril Martorell, n° 106, Valencia, 46026, Spain
| | - Roberto Gallego-Pinazo
- Department of Ophthalmology, University and Polytechnic Hospital La Fe, Av. Fernando Abril Martorell, n° 106, Valencia, 46026, Spain
| | - Lihteh Wu
- Instituto de Cirugía Ocular, Paseo Colón, San José, PO BOX 3971-1000, Costa Rica
| | - J Fernando Arévalo
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore 21287, MD, USA ; Vitreoretinal Division, King Khaled Eye Specialist Hospital, Al Arubah Rd, Umm AL Hamam AL Gharbi, Riyadh 12329, Saudi Arabia
| | - Manuel Díaz-Llopis
- Faculty of Medicine, University of Valencia, Av Blasco Ibañez, 15, Valencia, 46010, Spain
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Barry RJ, Nguyen QD, Lee RW, Murray PI, Denniston AK. Pharmacotherapy for uveitis: current management and emerging therapy. Clin Ophthalmol 2014; 8:1891-911. [PMID: 25284976 PMCID: PMC4181632 DOI: 10.2147/opth.s47778] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Uveitis, a group of conditions characterized by intraocular inflammation, is a major cause of sight loss in the working population. Most uveitis seen in Western countries is noninfectious and appears to be autoimmune or autoinflammatory in nature, requiring treatment with immunosuppressive and/or anti-inflammatory drugs. In this educational review, we outline the ideal characteristics of drugs for uveitis and review the data to support the use of current and emerging therapies in this context. It is crucial that we continue to develop new therapies for use in uveitis that aim to suppress disease activity, prevent accumulation of damage, and preserve visual function for patients with the minimum possible side effects.
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Affiliation(s)
- Robert J Barry
- Academic Unit of Ophthalmology, Centre for Translational Inflammation, Research, University of Birmingham, UK
| | - Quan Dong Nguyen
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Richard W Lee
- Inflammation and Immunotherapy Theme, National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Philip I Murray
- Academic Unit of Ophthalmology, Centre for Translational Inflammation, Research, University of Birmingham, UK
| | - Alastair K Denniston
- Academic Unit of Ophthalmology, Centre for Translational Inflammation, Research, University of Birmingham, UK ; Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Intralesional Injection of Interferon-α2b in Orbital Eosinophilic Granuloma. Ophthalmic Plast Reconstr Surg 2014; 32:e106-9. [PMID: 25226096 DOI: 10.1097/iop.0000000000000289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Considering the immune system dysfunction in unifocal orbital eosinophilic granuloma; possible complications of surgery, intralesional steroid, and radiotherapy; immunomodulatory and cytoreductive effects of interferon-α2b; and its safety profile in treatment of ocular surface neoplasia, intralesional interferon-α2b was first commenced in treatment of 3 cases (8-, 25-, and 43-year-old men) with biopsy proven orbital eosinophilic granuloma (2007-2014). Three intralesional injections of interferon-α2b (1.5 million units/0.5 ml) were given every other day. Cases 1 and 3 showed a rapid response with no recurrence in 86 and 29 months follow up. Case 2, however, required a second course of injection 2 months after the first one due to a partial response to the first injections with no recurrence at last follow up (57 months). Transient flulike symptom was the only side effect that was observed in Cases 2 and 3.
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Wang L, Xu Y, Yu Q, Sun Q, Xu Y, Gu Q, Xu X. H-RN, a novel antiangiogenic peptide derived from hepatocyte growth factor inhibits inflammation in vitro and in vivo through PI3K/AKT/IKK/NF-κB signal pathway. Biochem Pharmacol 2014; 89:255-65. [DOI: 10.1016/j.bcp.2014.02.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 02/25/2014] [Accepted: 02/27/2014] [Indexed: 12/11/2022]
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Abstract
Birdshot chorioretinopathy is a relatively uncommon subtype of idiopathic posterior uveitis with distinct clinical characteristics and a strong genetic association with the Human Leukocyte Antigen (HLA)-A29 allele. The diagnosis remains clinical and is based on the presence of typical clinical features, including multiple, distinctive, hypopigmented choroidal lesions throughout the fundus. The long-term visual prognosis of this disorder, however, remains guarded – central visual acuity can be preserved until late in the disease and it is not uncommon for patients to receive inadequate immunosuppressive treatment, leading to a poor long-term outcome in which peripheral retinal damage eventually leads to visual deterioration. Birdshot chorioretinopathy has proven a particularly attractive area of study within the field of uveitis, as it is a relatively easily defined disease with an associated human leukocyte antigen haplotype. Despite this, however, the immune mechanisms involved in its pathogenesis remain unclear, and some patients continue to lose retinal function despite therapy with corticosteroids and conventional immunosuppressive agents. Laboratory research continues to investigate the underlying mechanisms of disease, and clinical research is now being driven to improve the phenotyping and monitoring of this condition as, in the era of so-called personalized medicine, it is becoming increasingly important to identify patients at risk of visual loss early so that they can be treated more aggressively with targeted therapies such as the newer biological agents. This approach requires the formation of collaborative groups, as the relative rarity of the condition makes it difficult for one center to accumulate enough patients for worthwhile studies. Nevertheless, results obtained with newer therapies, such as biological agents directed against particular cytokines or cell-surface receptors, demonstrate ever improving control of the inflammation in refractory cases, providing hope that the outlook for visual function in this condition can only improve.
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Affiliation(s)
- Victor Menezo
- Institut Catala de Retina, Barcelona, Spain ; Department of Ophthalmology, Provincial Hospital Consortium Castellon, Castello, Spain
| | - Simon Rj Taylor
- Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK ; Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
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Joshi L, Karydis A, Gemenetzi M, Shao EH, Taylor SRJ. Uveitis as a Result of MAP Kinase Pathway Inhibition. Case Rep Ophthalmol 2013; 4:279-82. [PMID: 24474928 PMCID: PMC3901607 DOI: 10.1159/000357060] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We report the case of a patient treated with dabrafenib and trametinib (mitogen-activated protein kinase pathway inhibitors) for stage 3b cutaneous melanoma who developed bilateral uveitis. Although there have been reports of ocular side effects with this class of drugs, uveitis has not been previously reported to the best of our knowledge. This case indicates the wide range of side effects that can be seen with the newer targeted biological therapies.
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Affiliation(s)
- Lavnish Joshi
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, London, UK
| | - Andreas Karydis
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, London, UK
| | - Maria Gemenetzi
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, London, UK
| | - Emily H Shao
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, London, UK
| | - Simon R J Taylor
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, London, UK ; Faculty of Medicine, Imperial College London, London, UK
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