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Chu L, Wang C, Zhou H. Inflammation mechanism and anti-inflammatory therapy of dry eye. Front Med (Lausanne) 2024; 11:1307682. [PMID: 38420354 PMCID: PMC10899709 DOI: 10.3389/fmed.2024.1307682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/14/2024] [Indexed: 03/02/2024] Open
Abstract
Dry eye is a widespread chronic inflammatory disease that causes fatigue, tingling, burning, and other symptoms. Dry eye is attributed to rheumatic diseases, diabetes, hormone disorders, and contact lenses, which activate inflammatory pathways: mitogen-activated protein kinases (MAPK) and nuclear factor-B (NF-κB), promote macrophage inflammatory cell and T cell activation, and inflammation factors. Clinicians use a combination of anti-inflammatory drugs to manage different symptoms of dry eye; some of these anti-inflammatory drugs are being developed. This review introduces the dry eye inflammation mechanisms and the involved inflammatory factors. We also elucidate the anti-inflammatory drug mechanism and the detection limits.
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Affiliation(s)
- Liyuan Chu
- Department of Ophthalmology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Caiming Wang
- Department of Ophthalmology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Hongyan Zhou
- Department of Ophthalmology, China-Japan Union Hospital of Jilin University, Changchun, China
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Liu YT, Lin CW, Sun CC, Shao SC, Chen NN. Bilateral keratitis associated with afatinib therapy. Taiwan J Ophthalmol 2024; 14:121-124. [PMID: 38654991 PMCID: PMC11034688 DOI: 10.4103/tjo.tjo-d-24-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/21/2024] [Indexed: 04/26/2024] Open
Abstract
This case discussed a significant ocular side effect, bilateral keratitis, which could be induced by afatinib, an irreversible epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). We explored the disease progression of a 52-year-old, stage IV nasopharyngeal carcinoma male patient, who was under afatinib treatment and had experienced progressive bilateral eye dryness and tenderness on increasing afatinib from 40 mg every other day to 40 mg daily. Clinical examination noted bilateral visual acuity reduction, diffuse superficial punctate keratopathy in the right eye, and a central epithelial defect in the left eye. Seidel test results were negative for both eyes, with no corneal infiltration, lagophthalmos, anterior chamber cell precipitation, or retinal lesion. Symptoms subsequently resolved after reducing the frequency of afatinib used, along with intensive ocular hydration. In summary, this case highlighted afatinib's potential link to bilateral keratitis, and early afatinib dose adjustment with supportive medication could significantly reverse the condition.
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Affiliation(s)
- Ya-Tung Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chen-Wei Lin
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Nan-Ni Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Chiayi, Taiwan
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Yang C, Li Y, Liu Y, Xu Z, Li W, Cao W, Jin K, Liu Y. Protection of Barrier Function in Cultured Human Corneal Epithelial Cells by Semaphorin 4D. Curr Eye Res 2023; 48:894-903. [PMID: 37395011 DOI: 10.1080/02713683.2023.2232572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/23/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Corneal epithelial barrier function is important to maintain corneal homeostasis and is impaired by inflammation. We aimed to investigate the localization of semaphorin 4D (Sema4D) in the cornea, and its effects on the barrier function of cultured corneal epithelial cells. METHODS The expressions of semaphorin4 D and its receptor in the murine cornea were examined by immunoblot, immunofluorescent staining and confocal microscopy observations. Human corneal epithelial (HCE) cells stimulated by TNF-α or IL-1β were cultured with or without Sema4D. Cell viability was examined by CCK8, cell migration was evaluated by scratch wound assay, and barrier function was assessed by transepithelial electrical resistance (TEER) and Dextran-FITC permeability assay. The expression of tight junction proteins in HCE cells was examined by immunoblot, immunofluorescent staining and qRT-PCR. RESULTS We demonstrated that the protein of Sema4D and its receptor, plexin-B1, was expressed in murine cornea. Sema4D induced an increase in the TEER and a decrease in the permeability of HCE cells. It also induced the expression of tight junction protein ZO-1, occludin and claudin-1 in HCE cells. Furthermore, under stimulation of TNF-α or IL-1β, Sema4D treatment could inhibit the decreased TEER and the elevated permeability of HCE cells. CONCLUSIONS Sema4D is located distinctly in corneal epithelial cells and promoted their barrier function by increasing the expression of tight junction proteins. Sema4D may act as a preventive for maintaining corneal epithelial barrier function during ocular inflammation.
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Affiliation(s)
- Chengcheng Yang
- Department of Ophthalmology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, P.R. China
| | - Yunzepeng Li
- Department of Ophthalmology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, P.R. China
| | - Ye Liu
- Department of Pathology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, P.R. China
| | - Zhenghua Xu
- Department of Ophthalmology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, P.R. China
| | - Wei Li
- Department of Pathology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, P.R. China
| | - Wanwei Cao
- Department of Pathology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, P.R. China
| | - Kai Jin
- Department of Ophthalmology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, P.R. China
| | - Yang Liu
- Department of Ophthalmology, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, P.R. China
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Huang R, Su C, Fang L, Lu J, Chen J, Ding Y. Dry eye syndrome: comprehensive etiologies and recent clinical trials. Int Ophthalmol 2022; 42:3253-3272. [PMID: 35678897 PMCID: PMC9178318 DOI: 10.1007/s10792-022-02320-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 04/18/2022] [Indexed: 12/07/2023]
Abstract
Dry eye syndrome (DES) is multifactorial and likely to be a cause of concern more so than ever given the rapid pace of modernization, which is directly associated with many of the extrinsic causative factors. Additionally, recent studies have also postulated novel etiologies that may provide the basis for alternative treatment methods clinically. Such insights are especially important given that current approaches to tackle DES remains suboptimal. This review will primarily cover a comprehensive list of causes that lead to DES, summarize all the upcoming and ongoing clinical trials that focuses on treating this disease as well as discuss future potential treatments that can improve inclusivity.
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Affiliation(s)
- Ruojing Huang
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Huangpu Avenue West 613, Tianhe District, Guangzhou, 510630, China
| | - Caiying Su
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Huangpu Avenue West 613, Tianhe District, Guangzhou, 510630, China
| | - Lvjie Fang
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Huangpu Avenue West 613, Tianhe District, Guangzhou, 510630, China
| | - Jiaqi Lu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Huangpu Avenue West 613, Tianhe District, Guangzhou, 510630, China
| | - Jiansu Chen
- Institute of Ophthalmology, Medical College, Jinan University, Huangpu Avenue West 601, Tianhe District, Guangzhou, 510632, China.
| | - Yong Ding
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Huangpu Avenue West 613, Tianhe District, Guangzhou, 510630, China.
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5
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Rodriguez-Garcia A, Babayan-Sosa A, Ramirez-Miranda A, Santa Cruz-Valdes C, Hernandez-Quintela E, Hernandez-Camarena JC, Ramos-Betancourt N, Velasco-Ramos R, Ruiz-Lozano RE. A Practical Approach to Severity Classification and Treatment of Dry Eye Disease: A Proposal from the Mexican Dry Eye Disease Expert Panel. Clin Ophthalmol 2022; 16:1331-1355. [PMID: 35520107 PMCID: PMC9061212 DOI: 10.2147/opth.s351898] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Dry eye disease (DED) has a higher prevalence than many important systemic disorders like cardiovascular disease and diabetes mellitus, representing a significant quality of life burden for the affected patients. It is a common reason for consultation in general eye clinics worldwide. Nowadays, the diagnostic and therapeutic approach at the high corneal and ocular surface specialty level should be reserved for cases of severe and chronic dry eye disease associated with systemic autoimmune diseases or complicated corneal and ocular surface pathologies. In such cases, the diagnostic and therapeutic approach is often complex, elaborate, time-consuming, and costly due to the use of extensive dry eye questionnaires, noninvasive electronic diagnostic equipment, and clinical laboratory and ancillary tests. However, other eye care specialists attend a fair amount of DED cases; therefore, its diagnosis, classification, and management should be simple, practical, achievable, and effective. Considering that many patients attending non-specialized dry eye clinics would benefit from better ophthalmological attention, we decided to elaborate a practical DED classification system based on disease severity to help clinicians discriminate cases needing referral to subspecialty clinics from those they could attend. Additionally, we propose a systematic management approach and general management considerations to improve patients' therapeutic outcomes according to disease severity.
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Affiliation(s)
- Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Cornea and External Disease Service, Monterrey, Mexico
| | - Alejandro Babayan-Sosa
- Cornea and Refractive Surgery Service, Fundación Hospital Nuestra Señora de la Luz, I. A. P, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Arturo Ramirez-Miranda
- Cornea and Refractive Surgery Service, Instituto de Oftalmología Conde de Valenciana, I.A.P, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Concepcion Santa Cruz-Valdes
- Cornea and Refractive Surgery Service, Instituto de Oftalmología Conde de Valenciana, I.A.P, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | | | - Julio C Hernandez-Camarena
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Cornea and External Disease Service, Monterrey, Mexico
| | | | - Regina Velasco-Ramos
- Cornea and Refractive Surgery Service, Fundación Hospital Nuestra Señora de la Luz, I. A. P, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Raul E Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Cornea and External Disease Service, Monterrey, Mexico
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Correlations between clinical parameters of dry eye disease and serologic profiles in Sjögren's syndrome. Graefes Arch Clin Exp Ophthalmol 2022; 260:2925-2932. [PMID: 35460362 DOI: 10.1007/s00417-022-05671-0] [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: 09/14/2021] [Revised: 03/25/2022] [Accepted: 04/08/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To investigate the difference in clinical parameters of dry eye disease (DED) according to the presence of serum anti-La antibodies and evaluate the correlations of autoantibody titers with DED parameters in patients with primary Sjögren's syndrome (pSS). METHODS Sixty-two patients diagnosed with pSS according to the 2016 ACR-EULAR classification criteria were classified into two groups depending on the presence of anti-La antibodies: group 1 (anti-Ro positive alone, n = 31) and group 2 (both anti-Ro and anti-La positive, n = 31). DED parameters (conjunctival and corneal ocular staining score (OSS), tear film break-up time (TBUT), Schirmer I test, lipid layer thickness (LLT), meiboscore, and ocular surface disease index), serum autoantibodies (anti-Ro, anti-La, rheumatoid factor (RF), and antinuclear antibody) and focus score were assessed. RESULTS The DED parameters were not significantly different between the two groups (P > 0.05). The anti-Ro titers, RF-positive rate, and the focus score were significantly higher in group 2 than in group 1 (P = 0.001, P = 0.049, P = 0.001, respectively). The anti-Ro titers had a significant positive correlation with conjunctival OSS (r = 0.273, P = 0.033) and the focus score had a positive correlation with LLT and meiboscore (r = - 0.358, P = 0.072; r = 0.379, P = 0.056). CONCLUSION In this study, anti-Ro titers significantly correlated with conjunctival staining score, whereas anti-La did not statistically correlated with clinical DED parameters in SS. Meanwhile, anti-Ro titers and focus score were significantly higher in patients positive for both anti-Ro and anti-La, which suggests that examining anti-La with anti-Ro would be helpful in predicting clinical severities of SS patients.
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Ling J, Chan BCL, Tsang MSM, Gao X, Leung PC, Lam CWK, Hu JM, Wong CK. Current Advances in Mechanisms and Treatment of Dry Eye Disease: Toward Anti-inflammatory and Immunomodulatory Therapy and Traditional Chinese Medicine. Front Med (Lausanne) 2022; 8:815075. [PMID: 35111787 PMCID: PMC8801439 DOI: 10.3389/fmed.2021.815075] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/27/2021] [Indexed: 12/19/2022] Open
Abstract
Dry eye is currently one of the most common ocular surface disease. It can lead to ocular discomfort and even cause visual impairment, which greatly affects the work and quality of life of patients. With the increasing incidence of dry eye disease (DED) in recent years, the disease is receiving more and more attention, and has become one of the hot research fields in ophthalmology research. Recently, with the in-depth research on the etiology, pathogenesis and treatment of DED, it has been shown that defects in immune regulation is one of the main pathological mechanisms of DED. Since the non-specific and specific immune response of the ocular surface are jointly regulated, a variety of immune cells and inflammatory factors are involved in the development of DED. The conventional treatment of DED is the application of artificial tears for lubricating the ocular surface. However, for moderate-to-severe DED, treatment with anti-inflammatory drugs is necessary. In this review, the immunomodulatory mechanisms of DED and the latest research progress of its related treatments including Chinese medicine will be discussed.
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Affiliation(s)
- Jiawei Ling
- Institute of Chinese Medicine and State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants, The Chinese University of Hong Kong, Hong Kong, China
| | - Ben Chung-Lap Chan
- Institute of Chinese Medicine and State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants, The Chinese University of Hong Kong, Hong Kong, China
| | - Miranda Sin-Man Tsang
- Institute of Chinese Medicine and State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants, The Chinese University of Hong Kong, Hong Kong, China
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Xun Gao
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Ping Chung Leung
- Institute of Chinese Medicine and State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants, The Chinese University of Hong Kong, Hong Kong, China
| | - Christopher Wai-Kei Lam
- Faculty of Medicine and State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau, Macau SAR, China
| | - Jiang-Miao Hu
- State Key Laboratory of Phytochemistry and Plant Resources in West China, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming, China
| | - Chun Kwok Wong
- Institute of Chinese Medicine and State Key Laboratory of Research on Bioactivities and Clinical Applications of Medicinal Plants, The Chinese University of Hong Kong, Hong Kong, China
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Li Dak Sum Yip Yio Chin R & D Centre for Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Cui D, Mathews P, Li G, VanCourt S, Akpek E. Outcomes of Sjögren's versus non-Sjögren's related dry eye in a longitudinal, tertiary clinic-based sample. PLoS One 2021; 16:e0261241. [PMID: 34919587 PMCID: PMC8682907 DOI: 10.1371/journal.pone.0261241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/25/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess the long-term treatment outcomes of dry eye in patients with and without underlying primary Sjögren’s syndrome (SS). Design Retrospective longitudinal cohort. Methods SS and non-SS dry eye patients with clinic visits for a minimum of 5 consecutive years at a tertiary, dedicated dry eye clinic were included. Electronic health records were reviewed to collect data regarding demographics, objective dry eye parameters, treatments utilized at baseline and final visit, and corneal complications observed during follow-up. Results Two hundred and two patients (101 SS and 101 randomly selected non-SS), with a mean follow-up of 7.1 years were included. At baseline, mean conjunctival lissamine green staining score was 2.9 and mean corneal fluorescein staining score was 2.0. At last visit, notable improvement in staining score for cornea (–1.1, P < .001) and conjunctiva (–1.8, P < .001) was seen equally in both dry eye groups. Most patients (88.1%) had an escalation of treatment by the final visit, with similar rates in both groups (P = .51). Half (48.9%) of the patients had no conjunctival staining, and a third (34.4%) had no corneal staining at their last visit. Twenty (9.9%) patients experienced a vision-threatening corneal complication, including ulcers and melt, with no difference in occurrences between the groups (P = .64). Conclusions The majority of patients in this longitudinal, tertiary clinic-based sample demonstrated improvement in their ocular surface staining score by the final visit with escalation in treatment. Treatments used, improvement achieved, and corneal complication rates leading to loss of vision were similar in both SS and non-SS dry eye groups.
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Affiliation(s)
- David Cui
- Ocular Surface Disease and Dry Eye Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Priya Mathews
- Ocular Surface Disease and Dry Eye Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Gavin Li
- Ocular Surface Disease and Dry Eye Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Shanna VanCourt
- Ocular Surface Disease and Dry Eye Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Esen Akpek
- Ocular Surface Disease and Dry Eye Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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Rahman MM, Kim DH, Park CK, Kim YH. Experimental Models, Induction Protocols, and Measured Parameters in Dry Eye Disease: Focusing on Practical Implications for Experimental Research. Int J Mol Sci 2021; 22:12102. [PMID: 34830010 PMCID: PMC8622350 DOI: 10.3390/ijms222212102] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 12/20/2022] Open
Abstract
Dry eye disease (DED) is one of the major ophthalmological healthcare challenges worldwide. DED is a multifactorial disease characterized by a loss of homeostasis of the tear film, and its main pathogenesis is chronic ocular surface inflammation related with various cellular and molecular signaling cascades. The animal model is a reliable and effective tool for understanding the various pathological mechanisms and molecular cascades in DED. Considerable experimental research has focused on developing new strategies for the prevention and treatment of DED. Several experimental models of DED have been developed, and different animal species such as rats, mice, rabbits, dogs, and primates have been used for these models. Although the basic mechanisms of DED in animals are nearly identical to those in humans, proper knowledge about the induction of animal models is necessary to obtain better and more reliable results. Various experimental models (in vitro and in vivo DED models) were briefly discussed in this review, along with pathologic features, analytical approaches, and common measurements, which will help investigators to use the appropriate cell lines, animal, methods, and evaluation parameters depending on their study design.
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Affiliation(s)
- Md Mahbubur Rahman
- Gachon Pain Center and Department of Physiology, Gachon University College of Medicine, Incheon 21999, Korea
| | - Dong Hyun Kim
- Gil Medical Center, Department of Ophthalmology, Gachon University College of Medicine, Incheon 21565, Korea
| | - Chul-Kyu Park
- Gachon Pain Center and Department of Physiology, Gachon University College of Medicine, Incheon 21999, Korea
| | - Yong Ho Kim
- Gachon Pain Center and Department of Physiology, Gachon University College of Medicine, Incheon 21999, Korea
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Protective effects of low-molecular-weight components of adipose stem cell-derived conditioned medium on dry eye syndrome in mice. Sci Rep 2021; 11:21874. [PMID: 34750552 PMCID: PMC8575953 DOI: 10.1038/s41598-021-01503-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/29/2021] [Indexed: 11/08/2022] Open
Abstract
The present study demonstrated the protective effects of low-molecular-weight adipose-derived stem cell-conditioned medium (LADSC-CM) in a mouse model of dry eye syndrome. Mice subjected to desiccating stress and benzalkonium chloride had decreased tear secretion, impaired corneal epithelial tight junction with microvilli, and decreased conjunctival goblet cells. Topical application of adipose-derived stem cell-conditioned medium (ADSC-CM) stimulated lacrimal tear secretion, preserved tight junction and microvilli of the corneal epithelium, and increased the density of goblet cells and MUC16 expression in the conjunctiva. The low-molecular-weight fractions (< 10 kDa and < 3 kDa) of ADSC-CM (LADSC-CM) provided better protections than the > 10 kDa or > 3 kDa fractions of ADSC-CM. In the in vitro study, desiccation for 10 min or hyperosmolarity (490 osmols) for 24 h caused decreased viability of human corneal epithelial cells, which were reversed by LADSC-CM. The active ingredients in the LADSC-CM were lipophobic and stable after heating and lyophilization. Our study demonstrated that LADSC-CM had beneficial effects on experimental dry eye. It is worthy of further exploration for the active ingredient(s) and the mechanism.
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11
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Kate A, Basu S. Systemic Immunosuppression in Cornea and Ocular Surface Disorders: A Ready Reckoner for Ophthalmologists. Semin Ophthalmol 2021; 37:330-344. [PMID: 34423717 DOI: 10.1080/08820538.2021.1966059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: Many diseases of the cornea and ocular surface are manifestations of an underlying autoimmune process and require systemic immunosuppression for their management. These cases often present to a general ophthalmologist before being referred to an ocular immunologist or rheumatologist. However, the patients do need to be followed by the ophthalmologist to assess disease progression or for management of ocular co-morbidities and for taking care of ocular complications of the disease. Undeniably, there is a certain hesitance to promptly initiate them on systemic therapy because the literature regarding the indications, dosages, and side effects of this group of drugs is vast and dispersed.The aim of this review is to provide a source of ready reference for the general ophthalmologist as well as trainees and residents, on systemic immunosuppression for corneal and ocular surface disease. Methods: This review included 153 studies which were published as randomized controlled trials, systematic reviews, or as nonrandomized comparative studies (cohort or case-control series) on the topic of systemic immunosuppression in cornea and ocular surface disorders.Results: This review provides a concise summary of both the types of drugs and the common indications where they would be indicated, along with treatment and monitoring algorithms for each specific disease condition. The most used group of drugs are corticosteroids, which have significant side effects, particularly when administered systemically or for longer periods of time. To overcome this, steroid-sparing immunosuppressants are recommended. The four main classes of immunosuppressants used today are antimetabolites, T-cell inhibitors, alkylating agents and biologic agents. This review details the use of these drugs in ocular surface inflammation, including the dosing schedule, side effects and monitoring in allergic conjunctivitis, mucous membrane pemphigoid, peripheral ulcerative keratitis, immunological rejection against corneal allografts, anterior scleritis and aqueous deficiency dry eyes. Conclusions: This review provides an uncluttered and wholesome understanding of systemic immunosuppression in cornea and ocular surface diseases, with the hope that this will serve as a ready reckoner and help bridge the gap between ophthalmology and rheumatology for the betterment of our patients.
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Affiliation(s)
- Anahita Kate
- The Cornea Institute, KVC Campus, LV Prasad Eye Institute, Vijayawada, India
| | - Sayan Basu
- The Cornea Institute, KAR Campus, LV Prasad Eye Institute, Hyderabad, India.,Prof. Brien Holden Eye Research Centre (BHERC), LV Prasad Eye Institute, Hyderabad, India
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12
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Ashena Z, Dashputra R, Nanavaty MA. Autoimmune Dry Eye without Significant Ocular Surface Co-Morbidities and Mental Health. Vision (Basel) 2020; 4:vision4040043. [PMID: 33050472 PMCID: PMC7711510 DOI: 10.3390/vision4040043] [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: 08/30/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/21/2022] Open
Abstract
Dry eye symptoms can negatively affect the psychological, physical, and social functioning, which can potentially impair the health-related quality of life. This review evaluated the association between autoimmune related dry eye in the absence of significant ocular surface co-morbidities and mental health. This review found a significantly higher prevalence of mental health disorders (such as depression and anxiety) in systemic lupus erythematous, rheumatoid arthritis, systemic sclerosis, Behcet’s disease, and primary Sjogren’s syndrome patients when compared to the general population. Moreover, patients with depression and anxiety interpret ocular sensations differently than healthy controls and the perception of dry eye symptoms can be influenced by their mood. Somatization is common in depression, and this could influence the perception of ocular discomfort. Anti-depressants and anxiolytics with their potential side effects on the tear film status may also contribute or aggravate the dry eye symptoms in these patients. Although ophthalmologists manage the dry eye disease, as per standardized algorithms, they should be mindful of different ocular sensation interpretation and coexistent mental health issues in a large number of this patient group and initiate a multidisciplinary management plan in certain cases. While rheumatologists look after their autoimmune condition, it may be worth liaising with GP and/or psychiatrist colleagues in order to address their neuropathic type pain and mental health co-morbidities.
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Affiliation(s)
- Zahra Ashena
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BF, UK; (Z.A.); (R.D.)
| | - Radhika Dashputra
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BF, UK; (Z.A.); (R.D.)
| | - Mayank A. Nanavaty
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BF, UK; (Z.A.); (R.D.)
- Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK
- Correspondence: ; Tel.: +44-127-360-6126
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Bastola P, Song L, Gilger BC, Hirsch ML. Adeno-Associated Virus Mediated Gene Therapy for Corneal Diseases. Pharmaceutics 2020; 12:pharmaceutics12080767. [PMID: 32823625 PMCID: PMC7464341 DOI: 10.3390/pharmaceutics12080767] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 12/14/2022] Open
Abstract
According to the World Health Organization, corneal diseases are the fourth leading cause of blindness worldwide accounting for 5.1% of all ocular deficiencies. Current therapies for corneal diseases, which include eye drops, oral medications, corrective surgeries, and corneal transplantation are largely inadequate, have undesirable side effects including blindness, and can require life-long applications. Adeno-associated virus (AAV) mediated gene therapy is an optimistic strategy that involves the delivery of genetic material to target human diseases through gene augmentation, gene deletion, and/or gene editing. With two therapies already approved by the United States Food and Drug Administration and 200 ongoing clinical trials, recombinant AAV (rAAV) has emerged as the in vivo viral vector-of-choice to deliver genetic material to target human diseases. Likewise, the relative ease of applications through targeted delivery and its compartmental nature makes the cornea an enticing tissue for AAV mediated gene therapy applications. This current review seeks to summarize the development of AAV gene therapy, highlight preclinical efficacy studies, and discuss potential applications and challenges of this technology for targeting corneal diseases.
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Affiliation(s)
- Prabhakar Bastola
- Ophthalmology, University of North Carolina, Chapel Hill, NC 27599, USA; (P.B.); (L.S.); (B.C.G.)
- Gene Therapy Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Liujiang Song
- Ophthalmology, University of North Carolina, Chapel Hill, NC 27599, USA; (P.B.); (L.S.); (B.C.G.)
- Gene Therapy Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Brian C. Gilger
- Ophthalmology, University of North Carolina, Chapel Hill, NC 27599, USA; (P.B.); (L.S.); (B.C.G.)
- Clinical Sciences, North Carolina State University, Raleigh, NC 27695, USA
| | - Matthew L. Hirsch
- Ophthalmology, University of North Carolina, Chapel Hill, NC 27599, USA; (P.B.); (L.S.); (B.C.G.)
- Gene Therapy Center, University of North Carolina, Chapel Hill, NC 27599, USA
- Correspondence: ; Tel.: +1-919-966-0696
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Kim SJ, Park B, Huh HW, Na YG, Kim M, Han M, Lee H, Pham TMA, Lee HK, Lee JY, Kim CS, Baek JS, Cho CW. Achyranthis radix Extract-Loaded Eye Drop Formulation Development and Novel Evaluation Method for Dry Eye Treatment. Pharmaceutics 2020; 12:pharmaceutics12020165. [PMID: 32079194 PMCID: PMC7076473 DOI: 10.3390/pharmaceutics12020165] [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: 12/18/2019] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 12/11/2022] Open
Abstract
Recently, Achyranthis radix extract has been studied as a therapeutic agent for dry eye disease that occurs from fine dust. The aim of this study was the development of Achyranthis radix extract-loaded eye drop formulations using lubricants, generally used for artificial tear eye drops. Ecdysterone was used as a marker compound for Achyranthis radix extract and 1% Achyranthis radix extract solution contained 14.37 ± 0.04 μg/mL of ecdysterone. Before formulation studies, a new method was performed to evaluate pigmentation, which might be caused by eye drops of herbal extract. A comparative study of the water retention ability of each formulation and ability to prevent the death of conjunctival epithelial cells in dry conditions was conducted. Moreover, treatment of Achyranthis radix extract (USL) eye drop formulation exhibited a significant inhibitory effect on inflammation in a concentration-dependent manner. The long-term and accelerated stability tests showed that lubricants could contribute to the stability of herbal extracts in solution. In conclusion, hyaluronic acid showed a good effect on the development of eye drop formulation using Achyranthis radix extracts for treating dry eye disease.
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Affiliation(s)
- Sung-Jin Kim
- College of Pharmacy and Institute of Drug Research & Development, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Korea; (S.-J.K.); (H.W.H.); (Y.-G.N.); (M.K.); (M.H.); (H.L.); (T.M.A.P.); (H.-K.L.); (J.-Y.L.)
| | - Bongkyun Park
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea; (B.P.); (C.-S.K.)
| | - Hyun Wook Huh
- College of Pharmacy and Institute of Drug Research & Development, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Korea; (S.-J.K.); (H.W.H.); (Y.-G.N.); (M.K.); (M.H.); (H.L.); (T.M.A.P.); (H.-K.L.); (J.-Y.L.)
| | - Young-Guk Na
- College of Pharmacy and Institute of Drug Research & Development, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Korea; (S.-J.K.); (H.W.H.); (Y.-G.N.); (M.K.); (M.H.); (H.L.); (T.M.A.P.); (H.-K.L.); (J.-Y.L.)
| | - Minki Kim
- College of Pharmacy and Institute of Drug Research & Development, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Korea; (S.-J.K.); (H.W.H.); (Y.-G.N.); (M.K.); (M.H.); (H.L.); (T.M.A.P.); (H.-K.L.); (J.-Y.L.)
| | - Mingu Han
- College of Pharmacy and Institute of Drug Research & Development, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Korea; (S.-J.K.); (H.W.H.); (Y.-G.N.); (M.K.); (M.H.); (H.L.); (T.M.A.P.); (H.-K.L.); (J.-Y.L.)
| | - Hyunmin Lee
- College of Pharmacy and Institute of Drug Research & Development, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Korea; (S.-J.K.); (H.W.H.); (Y.-G.N.); (M.K.); (M.H.); (H.L.); (T.M.A.P.); (H.-K.L.); (J.-Y.L.)
| | - Thi Mai Anh Pham
- College of Pharmacy and Institute of Drug Research & Development, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Korea; (S.-J.K.); (H.W.H.); (Y.-G.N.); (M.K.); (M.H.); (H.L.); (T.M.A.P.); (H.-K.L.); (J.-Y.L.)
| | - Hong-Ki Lee
- College of Pharmacy and Institute of Drug Research & Development, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Korea; (S.-J.K.); (H.W.H.); (Y.-G.N.); (M.K.); (M.H.); (H.L.); (T.M.A.P.); (H.-K.L.); (J.-Y.L.)
| | - Jae-Young Lee
- College of Pharmacy and Institute of Drug Research & Development, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Korea; (S.-J.K.); (H.W.H.); (Y.-G.N.); (M.K.); (M.H.); (H.L.); (T.M.A.P.); (H.-K.L.); (J.-Y.L.)
| | - Chan-Sik Kim
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea; (B.P.); (C.-S.K.)
- Korean Convergence Medicine, University of Science and Technology (UST), Daejeon 34054, Korea
| | - Jong-Suep Baek
- Department of Herbal Medicine Resource, Kangwon National University, 346 Hwangjo-gil, Dogye-eup, Samcheok-si, Gangwon-do 25949, Korea;
| | - Cheong-Weon Cho
- College of Pharmacy and Institute of Drug Research & Development, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Korea; (S.-J.K.); (H.W.H.); (Y.-G.N.); (M.K.); (M.H.); (H.L.); (T.M.A.P.); (H.-K.L.); (J.-Y.L.)
- Correspondence: ; Tel.: +82-42-821-5934
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Singla S, Sarkar L, Joshi M. Comparison of topical cyclosporine alone and topical loteprednol with cyclosporine in moderate dry eye in Indian population: A prospective study. Taiwan J Ophthalmol 2019; 9:173-178. [PMID: 31572654 PMCID: PMC6759554 DOI: 10.4103/tjo.tjo_15_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 08/31/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE: The purpose of this study is to compare the efficacy of topical cyclosporine (Cs) 0.05% alone and topical Cs 0.05% with loteprednol 0.5% in patients with moderate dry eye. STUDY DESIGN: This was a comparative, prospective, interventional study. PATIENTS AND METHODS: A total of 140 patients diagnosed with moderate dry eyes were randomly divided into two groups. Group A patients received treatment with topical loteprednol 0.5% started as QID dosage for 2 weeks and tapered to BID dosage over the next 6 weeks, topical Cs 0.05% BID and artificial tears. Group B patients received treatment with topical Cs 0.05% BID and artificial tears. All patients were followed over a period of 6 months with ocular surface disease index (OSDI) questionnaire, tear film break up time (TBUT), corneal fluorescein, and lissamine green staining scores. RESULTS: There was a significant difference in the symptoms and signs of dry eye in the group receiving combination of loteprednol 0.5% and Cs 0.05% as compared to the group receiving Cs alone evident by greater reduction in OSDI score, corneal staining, and improvement in TBUT and Schirmer's test values over a follow-up of 6 months. CONCLUSION: Combination therapy with topical loteprednol and Cs is significantly better than topical Cs alone on alleviating symptoms and signs in moderate dry eye patients.
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Affiliation(s)
- Shaveta Singla
- Department of Ophthalmology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Lopamudra Sarkar
- Department of Ophthalmology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Mukesh Joshi
- Department of Ophthalmology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Kuo YK, Lin IC, Chien LN, Lin TY, How YT, Chen KH, Dusting GJ, Tseng CL. Dry Eye Disease: A Review of Epidemiology in Taiwan, and its Clinical Treatment and Merits. J Clin Med 2019; 8:E1227. [PMID: 31443274 PMCID: PMC6722537 DOI: 10.3390/jcm8081227] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 12/11/2022] Open
Abstract
Dry eye disease (DED) has become common on a global scale in recent years. There is a wide prevalence of DED in different countries based on various ethnicities and environment. DED is a multifactorial ocular disorder. In addition to advanced age and gender, such factors as living at high altitude, smoking, pterygium, prolonged use of consumer electronics or overingesting of caffeine or multivitamins are considered to be the major risk factors of DED. We report the DED epidemiology in Taiwan firstly in this article. According to the pathophysiological factors and changes inthe composition of the tear film in DED, it can be categorized into several subtypes, including lipid anomaly dry eye, aqueous tear deficiency, allergic and toxic dry eye among others. Each subtype has its own cause and disease management; therefore, it is important for ophthalmologists to identify the type through literature review and investigation. The management of DED, relies not only on traditional medications such as artificial tears, gels and ointments, but also newer treatment options such as acupuncture, SYL1001, and nanomedicine therapy. We also conducted a comprehensive literature review including common subtypes and treatment of DED. Clearly, more clinical trials are needed to assess the efficacy and safety of the various treatments and common subtypes of DED.
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Affiliation(s)
- Yu-Kai Kuo
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - I-Chan Lin
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, , Taipei Medical University, Taipei 11031, Taiwan
- Health and Clinical Data Research Center, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
| | - Tzu-Yu Lin
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Ying-Ting How
- Graduate Institute of Biomedical Materials & Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan
| | - Ko-Hua Chen
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Gregory J Dusting
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, East Melbourne, VIC 3002, Australia
| | - Ching-Li Tseng
- Graduate Institute of Biomedical Materials & Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan.
- Institute of International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan.
- Research Center of Biomedical Device, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan.
- International PhD Program in Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
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Kessal K, Liang H, Rabut G, Daull P, Garrigue JS, Docquier M, Melik Parsadaniantz S, Baudouin C, Brignole-Baudouin F. Conjunctival Inflammatory Gene Expression Profiling in Dry Eye Disease: Correlations With HLA-DRA and HLA-DRB1. Front Immunol 2018; 9:2271. [PMID: 30374345 PMCID: PMC6196257 DOI: 10.3389/fimmu.2018.02271] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/12/2018] [Indexed: 01/24/2023] Open
Abstract
Purpose: In several multicenter clinical trials, HLA-DR was found to be a potential biomarker of dry eye disease (DED)'s severity and prognosis. Given the fact that HLA-DR receptor is a heterodimer consisting in an alpha and a beta chain, we intended to investigate the correlation of inflammatory targets with the corresponding transcripts, HLA-DRA and HLA-DRB1, to characterize specific targets closely related to HLA-DR expressed in conjunctival cells from patients suffering from DED of various etiologies. Methods: A prospective study was conducted in 88 patients with different forms of DED. Ocular symptom scores, ocular-staining grades, tear breakup time (TBUT) and Schirmer test were evaluated. Superficial conjunctival cells were collected by impression cytology and total RNAs were extracted for analyses using the new NanoString® nCounter technology based on an inflammatory human code set containing 249 inflammatory genes. Results: Two hundred transcripts were reliably detected in conjunctival specimens at various levels ranging from 1 to 222,546 RNA copies. Overall, from the 88 samples, 21 target genes showed a highly significant correlation (R > 0.8) with HLA-DRA and HLA-DRB1, HLA-DRA and B1 presenting the highest correlation (R = 0.9). These selected targets belonged to eight family groups, namely interferon and interferon-stimulated genes, tumor necrosis factor superfamily and related factors, Toll-like receptors and related factors, complement system factors, chemokines/cytokines, the RIPK enzyme family, and transduction signals such as the STAT and MAPK families. Conclusions: We have identified a profile of 21 transcripts correlated with HLA-DR expression, suggesting closely regulated signaling pathways and possible direct or indirect interactions between them. The NanoString® nCounter technology in conjunctival imprints could constitute a reliable tool in the future for wider screening of inflammatory biomarkers in DED, usable in very small samples. Broader combinations of biomarkers associated with HLA-DR could be analyzed to develop new diagnostic approaches, identify tighter pathophysiological gene signatures and personalize DED therapies more efficiently.
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Affiliation(s)
- Karima Kessal
- Sorbonne Université, UPMC Univ Paris 06, INSERM, CNRS, Institut de la Vision, Paris, France.,Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DGOS CIC 1423, Paris, France
| | - Hong Liang
- Sorbonne Université, UPMC Univ Paris 06, INSERM, CNRS, Institut de la Vision, Paris, France.,Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DGOS CIC 1423, Paris, France
| | - Ghislaine Rabut
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DGOS CIC 1423, Paris, France
| | | | | | - Mylene Docquier
- iGE3 Genomics Platform University of Geneva, Geneva, Switzerland
| | | | - Christophe Baudouin
- Sorbonne Université, UPMC Univ Paris 06, INSERM, CNRS, Institut de la Vision, Paris, France.,Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, Paris, France.,Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DGOS CIC 1423, Paris, France.,Department of Ophthalmology, Ambroise Paré Hospital, APHP, University of Versailles Saint-Quentin en Yvelines, Boulogne-Billancourt, France
| | - Françoise Brignole-Baudouin
- Sorbonne Université, UPMC Univ Paris 06, INSERM, CNRS, Institut de la Vision, Paris, France.,Quinze-Vingts National Ophthalmology Hospital, DHU Sight Restore, INSERM-DGOS CIC 1423, Paris, France.,Sorbonne Paris Cité Université Paris Descartes, Faculté de Pharmacie de Paris, Paris, France
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18
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Coursey TG, Wassel RA, Quiambao AB, Farjo RA. Once-Daily Cyclosporine-A-MiDROPS for Treatment of Dry Eye Disease. Transl Vis Sci Technol 2018; 7:24. [PMID: 30323997 PMCID: PMC6181191 DOI: 10.1167/tvst.7.5.24] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/06/2018] [Indexed: 12/15/2022] Open
Abstract
Purpose To determine if a Microemulsion Drug Ocular Penetration System (MiDROPS) formulation of cyclosporine A (CsA) delivers more drug and is more efficacious for treatment of dry eye disease (DED) than the current clinical formulation. Methods Tissue distribution of CsA was quantified by liquid chromatography with tandem mass spectrometry (LC-MS/MS). To assess tolerability, CsA-MiDROPS (0.1%) was applied to the eyes of rabbits twice per day for 14 days and assessed using ophthalmoscopic examinations. Mice were exposed to desiccating stress for 10 days and received daily topical instillation of the vehicle or test agent. Cornea staining was done to quantify corneal permeability. Histologic quantification of goblet cell (GC) density and CD4+ T-cell infiltration in the conjunctiva was performed. Results Ophthalmic distribution studies indicate significantly increased drug concentration with CsA-MiDROPS compared with Restasis. CsA-MiDROPS is well tolerated with little toxicity in a 2-week tolerability study. In the DED model, both 0.05% and 0.1% CsA-MiDROPS conferred a significant effect and were more effective than Restasis for treating experimental DED when dosed twice per day. As compared with Restasis dosed twice per day, 0.1% CsA-MiDROPS dosed once per day demonstrated superiority. Conclusions CsA-MiDROPS showed superior drug delivery and efficacy compared with other clinical formulations. As this product is simple to produce and needs to be only applied once daily, the clinical development of CsA-MiDROPS will help to reduce societal and patient burdens by lowering drug costs and accelerating/improving the activity of CsA. Translational Relevance MiDROPS has broad application concerning the ophthalmic development of lipophilic small molecule therapeutics.
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Bhattacharya S, García-Posadas L, Hodges RR, Makarenkova HP, Masli S, Dartt DA. Alteration in nerves and neurotransmitter stimulation of lacrimal gland secretion in the TSP-1 -/- mouse model of aqueous deficiency dry eye. Mucosal Immunol 2018; 11:1138-1148. [PMID: 29445135 PMCID: PMC6030454 DOI: 10.1038/s41385-018-0002-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 02/04/2023]
Abstract
The purpose of this study is to determine neural, vascular, protein secretion, and cellular signaling changes with disease progression in lacrimal glands of the thrombospondin-1-/- (TSP-1-/-) mouse model of dry eye compared to C57BL/6 wild-type (WT) mice. Neural innervation was reduced in TSP-1-/- lacrimal glands compared to WT controls, whereas the number of blood vessels was increased. Intracellular Ca2+ stores and the amount of lysosomes, mitochondria, and secretory granules, but not the endoplasmic reticulum, were reduced in TSP-1-/- compared to WT acini at 12 weeks of age. Ex vivo high KCl-evoked secretion was decreased in TSP-1-/- compared to WT lacrimal gland tissue pieces. The α1D-adrenergic agonist-stimulated response was increased in TSP-1-/- at 4 and 24 weeks but decreased at 12 weeks, and the ATP and MeSATP-stimulated peak [Ca2+]i responses were decreased at 24 weeks. These changes were observed prior to the appearance of mononuclear infiltrates. We conclude that in the lacrimal gland the absence of TSP-1: injures peripheral nerves; blocks efferent nerve activation; decreases protein secretion; and alters intracellular Ca2+ stores. Through these effects the absence of TSP-1 leads to disruption of ocular surface homeostasis and development of dry eye.
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Affiliation(s)
- Sumit Bhattacharya
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Laura García-Posadas
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Robin R Hodges
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Helen P Makarenkova
- Molecular Medicine Department, The Scripps Research Institute, La Jolla, CA, USA
| | - Sharmila Masli
- Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA
| | - Darlene A Dartt
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
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Subconjunctival dendrimer-drug therapy for the treatment of dry eye in a rabbit model of induced autoimmune dacryoadenitis. Ocul Surf 2018; 16:415-423. [PMID: 29777869 DOI: 10.1016/j.jtos.2018.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/12/2018] [Accepted: 05/15/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate the efficacy of a single subconjunctival injection of dendrimer-dexamethasone conjugate in a rabbit model of induced autoimmune dacryoadenitis (AID). METHODS Dendrimer biodistribution after subconjunctival injection in AID animals was evaluated using Cy5-labelled dendrimer (D-Cy5) and confocal microscopy. Diseased animals were treated with free dexamethasone (Free-Dex), dendrimer-dexamethasone (D-Dex), or saline via a single subconjunctival injection. The efficacy was evaluated using various clinical evaluations, such as Schirmer's test, tear breakup time (TBUT), and fluorescein and rose Bengal staining. Histopathology was evaluated by H&E staining and immunostaining. Levels of inflammatory cytokines and aquaporin proteins in the LGs were determined by real-time PCR. RESULTS Subconjunctivally administered dendrimers selectively localized in the inflamed LGs, and were taken up by the infiltrating cells. At two weeks post single dose-treatment, the D-Dex group showed improved clinical evaluations. No significant changes were observed in other groups. H&E staining demonstrated less inflammatory cell infiltration and fewer atrophic acini in D-Dex group, compared to those treated with saline or Free-Dex. Immunohistochemistry demonstrated that the intensity of CD-18 (+) and RTLA (+) was weaker in LGs in the D-Dex group than in other treatment groups. Pro-inflammatory gene expression levels of MMP9, IL6, IL8, and TNFα were significantly decreased in the D-Dex group compared to the Free-Dex and saline group. CONCLUSIONS The dendrimer exhibits pathology-dependent biodistribution in the inflamed LGs. Subconjunctivally administered D-Dex suppressed LG inflammation, leading to partial recovery of LG function with clinical improvement in induced AID. Sjögren's patients may benefit from this targeted nanomedicine approach.
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21
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Jiang D, Liu X, Hu J. Topical administration of Esculetin as a potential therapy for experimental dry eye syndrome. Eye (Lond) 2017; 31:1724-1732. [PMID: 28643798 PMCID: PMC5733282 DOI: 10.1038/eye.2017.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 04/27/2017] [Indexed: 01/16/2023] Open
Abstract
PurposeIn this study, we investigated the therapeutic effects of topical Esculetin for dry eye rabbits through the ocular tests, inflammatory factor levels and specific phosphorylated protein expressions of ERK1/2 singnal pathway.Patients and methodsThirty-two healthy adult male New Zealand white rabbits were chosen for the study. DES models were established after removing of the main lacrimal gland, Harderian gland and nictitating membrane in the left eyes and randomly divided into group DES control, group CsA, group Esculetin and group Esculetin combined with CsA (C&E), meanwhile the right eyes served as group Normal control. Schirmer's I tests, fluorescein scores, goblet cell densities, inflammatory cytokines IL-1α,IL-1β,TNF-αlevels were observed by slit-lamp microscope, conjunctival impression cytology and ELISA essay at week 0, 1, 2, 4, 8. Phosphorylated-ERK1/2 expressions were detected in Western blot analysis at week 8.ResultsAfter induction of DES, aqueous tear production and goblet cell density were decreased, FL score was much higher in group DES control throughout the study (P<0.05). Both topical Esculetin and Esculetin combing CsA increased the SIT values (10±1 mm, 14±3 mm, P<0.05) and goblet cell densities (77±12/HP, 92±12/HP, P<0.05), decreased FL scores (7.48±0.33, 5.09±0.24, P<0.05) at week 8. Alternations of IL-1α,IL-1β,TNF-αlevels had similar trend. In Western blot analysis, downregulations of p-ERK1/2 were observed in therapy groups when compared with group DES control and the most decreasing was found in group C&E (P<0.05).ConclusionTopical Esculetin improved DES symptoms, downregulated the inflammatory cytokine expressions, suppressed the ERK1/2 pathway and enhanced the therapeutic effect of CsA.
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Affiliation(s)
- D Jiang
- Department of Ophthalmology, Longhua Hosptial, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - X Liu
- Department of Ophthalmology, Longhua Hosptial, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - J Hu
- Department of Ophthalmology, Longhua Hosptial, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Li K, Zhang C, Yang Z, Wang Y, Si H. Evaluation of a novel dry eye model induced by oral administration of finasteride. Mol Med Rep 2017; 16:8763-8770. [PMID: 29039509 PMCID: PMC5779951 DOI: 10.3892/mmr.2017.7754] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 09/19/2017] [Indexed: 12/18/2022] Open
Abstract
Dry eye is a common eye disease, and suitable animal models are indispensable for investigating the pathogenesis and developing treatments for dry eye. The present study was conducted to develop an androgen deficiency dry eye model induced by finasteride, and to evaluate ocular surface status and inflammatory cytokine gene expression in the lacrimal gland using a cytokine antibody array system. The results revealed that the antiandrogenic drug finasteride induced significant tear deficiency, and the histopathology results revealed significant inflammatory cell infiltration in the lacrimal gland. The cytokine antibody array system identified increased B7-2 (also known as cluster of differentiation 86), interleukin (IL)-1β, IL-4, IL-6, IL-10, matrix metalloproteinase-8, Fas ligand, tumor necrosis factor (TNF)-α and metalloproteinase inhibitor 1 levels in the lacrimal gland of the dry eye model. These cytokines were validated as candidate markers through the use of western blot analysis and reverse transcription-quantitative polymerase chain reaction. Both analyses confirmed a significant increase in proinflammatory cytokines, including IL-1β, IL-6 and TNF-α, and anti-inflammatory cytokines, including IL-4 and IL-10. The aforementioned data suggested that inflammation in antiandrogenic models resulted from a balance between inflammatory and anti-inflammatory responses. Thus, direct finasteride administration may produce an applicable model for dry eye mediated by androgen deficiency. In addition, there may be a correlation between sex, steroid deficiency and the inflammatory response. The findings of the present study have provided useful information for the pathogenesis and diagnosis of dry eye mediated by androgen deficiency.
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Affiliation(s)
- Kai Li
- Department of Ophthalmology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Chuanwei Zhang
- Department of Ophthalmology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Zichao Yang
- Department of Ophthalmology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Yuliang Wang
- Department of Ophthalmology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Haipeng Si
- Department of Pathology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
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Long Q, Wang JY, Xu D, Li Y. Comparison of corneal biomechanics in Sjögren's syndrome and non-Sjögren's syndrome dry eyes by Scheimpflug based device. Int J Ophthalmol 2017; 10:711-716. [PMID: 28546925 DOI: 10.18240/ijo.2017.05.08] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/29/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the corneal biomechanics of Sjögren's syndrome (SS) and non-SS dry eyes with Corneal Visualization Scheimpflug Technology (CorVis ST). METHODS Corneal biomechanics and tear film parameters, namely the Schirmer I test value, tear film break-up time (TBUT) and corneal staining score (CSS) were detected in 34 eyes of 34 dry eye patients with SS (SSDE group) and 34 dry eye subjects without SS (NSSDE group) using CorVis ST. The differences of the above parameters between the two groups were examined, and the relationship between corneal biomechanics and tear film parameters were observed. RESULTS The differences in age, sex, intraocular pressure (IOP) and central corneal thickness (CCT) were not significant between the two groups (P>0.05). The tear film parameters had significant differences between the SSDE group and NSSDE group (all P<0.05). Patients in the SSDE group had significantly lower A1-time and HC-time, but higher DA (P=0.01, 0.02, and 0.02, respectively) compared with the NSSDE group. In the SSDE group, DA was negatively correlated with TBUT (rho=-0.38, P=0.03); HC-time was negatively correlated with CSS (rho=-0.43, P=0.02). In the NSSDE group, HC-time was again negatively correlated with CSS (rho=-0.39, P=0.02). CONCLUSION There are differences in corneal biomechanical properties between SSDE and NSSDE. The cornea of SSDE tends to show less "stiffness", as seen by a significantly shorter A1-time and HC-time, but larger DA, compared with the cornea of NSSDE. Biomechanical parameters can be influenced by different tear film parameters in both groups.
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Affiliation(s)
- Qin Long
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jing-Yi Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Dong Xu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Epitropoulos AT, Goslin K, Bedi R, Blackie CA. Meibomian gland dysfunction patients with novel Sjögren's syndrome biomarkers benefit significantly from a single vectored thermal pulsation procedure: a retrospective analysis. Clin Ophthalmol 2017; 11:701-706. [PMID: 28458508 PMCID: PMC5402721 DOI: 10.2147/opth.s119926] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose To measure the effects from a single vectored thermal pulsation treatment of the meibomian glands on dry eye signs and symptoms in patients who tested positively versus negatively for novel Sjögren’s syndrome (SS) biomarkers. Methods The retrospective study included the deidentified data of 102 eyes of 59 patients with dry eye and meibomian gland dysfunction (MGD), who were also tested for novel biomarkers for SS and underwent a single 12-minute LipiFlow thermal pulsation procedure. All patients were already being treated with individualized dry eye therapy but remained symptomatic. Meibomian gland secretion (MGS) scores, Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire scores and tear breakup times (TBUTs) before and 8 weeks after thermal pulsation treatment were analyzed. Results Twenty-three patients tested positive for novel biomarkers of SS and 36 patients tested negative. At baseline, MGS, SPEED and TBUT of both SS-positive and SS-negative patients were equivalent. At 8 weeks’ post-treatment, mean MGS score, SPEED and TBUT were 13.0±7.8, 12.5±6.8 and 9.6±4.6, respectively, in SS-positive patients and 15.9±7.9, 10.0±6.3 and 8.3±4.6, respectively, in SS-negative patients (P<0.001). While the post-treatment MGS was significantly better in SS-negative patients than SS-positive (P=0.021), no significant difference between post-treatment SPEED and TBUT was observed between the two groups (P>0.05). Conclusion LipiFlow treatment in MGD patients who were SS-positive for novel biomarkers of SS demonstrated improvement in signs and symptoms of dry eye. While improvement in MGS scores in SS-negative patients was higher than that observed in SS-positive patients, SPEED and TBUT were equivalent between these two groups.
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Affiliation(s)
- Alice T Epitropoulos
- Ophthalmic Surgeons and Consultants of Ohio, The Eye Center of Columbus.,The Ohio State University Wexner Medical Center, Department of Ophthalmology, Columbus, OH, USA
| | - Krysta Goslin
- The Ohio State University Wexner Medical Center, Department of Ophthalmology, Columbus, OH, USA
| | - Raman Bedi
- Iris Advanced Eye Centre, Chandigarh, India
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25
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Ruan GF, Zheng L, Huang JS, Huang WX, Gong BD, Fang XX, Zhang XY, Tang JP. Effect of mesenchymal stem cells on Sjögren-like mice and the microRNA expression profiles of splenic CD4+ T cells. Exp Ther Med 2017; 13:2828-2838. [PMID: 28587347 PMCID: PMC5450633 DOI: 10.3892/etm.2017.4313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 12/09/2016] [Indexed: 12/11/2022] Open
Abstract
Mesenchymal stem cells (MSCs) serve immuno-regulatory functions and offer a promising novel treatment for certain autoimmune diseases. The present study investigated the therapeutic effect of mice bone marrow (BM)-MSCs on mice with relatively late stage of Sjögren-like disease and the impact of BM-MSCs on the microRNA (miRNA) expression profiles of splenic CD4+ T cells. Female NOD/Ltj mice were randomized into two groups: The disease group (n=8) and the MSC-treated group (n=8). Female ICR mice served as the healthy control group (n=8). The MSC-treated group received an injection of MSCs when they were 26 weeks old. Water intake, blood glucose and salivary flow rate were measured and submandibular glands were resected and stained with hematoxylin and eosin to calculate the focus score. The concentrations of interleukin (IL)-2, IL-6, hepatocyte growth factor, interferon γ, IL-10, prostaglandin E2, transforming growth factor β1 and tumor necrosis factor-α in serum were measured using ELISA. The expression of miRNAs in splenic CD4+ T cells were measured using deep sequencing. The results demonstrated that treatment with BM-MSCs prevented a decline in the salivary flow rate and lymphocyte infiltration in the salivary glands of NOD mice, indicating that MSC-treatment had a therapeutic effect on NOD mice with relatively late stage of Sjögren-like disease. ELISA and deep sequencing results showed that the three groups of mice had different serum concentrations of cytokines/growth factors and different miRNA expression profiles of splenic CD4+ T cells. This implies that the alteration in serum levels of cytokines/growth factors and miRNA expression profiles of splenic CD4+ T cells may explain the therapeutic effect MSCs have on Sjögren's syndrome.
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Affiliation(s)
- Guang-Feng Ruan
- Department of Rheumatology, Tongji Hospital of Tongji University, Shanghai 200065, P.R. China
| | - Ling Zheng
- Department of Respiratory Medicine, Tongji Hospital of Tongji University, Shanghai 200065, P.R. China
| | - Jia-Shu Huang
- Department of Rheumatology, Tongji Hospital of Tongji University, Shanghai 200065, P.R. China
| | - Wan-Xue Huang
- Department of Rheumatology, Tongji Hospital of Tongji University, Shanghai 200065, P.R. China
| | - Bang-Dong Gong
- Department of Rheumatology, Tongji Hospital of Tongji University, Shanghai 200065, P.R. China
| | - Xing-Xing Fang
- Department of Rheumatology, Tongji Hospital of Tongji University, Shanghai 200065, P.R. China
| | - Xiao-Yu Zhang
- Department of Rheumatology, Tongji Hospital of Tongji University, Shanghai 200065, P.R. China
| | - Jian-Ping Tang
- Department of Rheumatology, Tongji Hospital of Tongji University, Shanghai 200065, P.R. China
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26
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Tissue resident memory T cells in the human conjunctiva and immune signatures in human dry eye disease. Sci Rep 2017; 7:45312. [PMID: 28345628 PMCID: PMC5366884 DOI: 10.1038/srep45312] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/28/2017] [Indexed: 12/14/2022] Open
Abstract
Non-recirculating resident memory (TRM) and recirculating T cells mount vigorous immune responses to both self and foreign antigens in barrier tissues like the skin, lung and gastrointestinal tract. Using impression cytology followed by flow cytometry we identified two TRM subsets and four recirculating T-subsets in the healthy human ocular surface. In dry eye disease, principal component analysis (PCA) revealed two clusters of patients with distinct T-cell signatures. Increased conjunctival central memory and naïve T cells characterized Cluster-1 patients, and increased CD8+ TRMs and CD4+ recirculating memory T cells characterized Cluster-2 patients. Interestingly these T-cell signatures are associated with different clinical features: the first signature correlated with increased ocular redness, and the second with reduced tear break up times. These findings open the door to immune-based characterization of dry eye disease and T-subset specific immunotherapies to suppress T-subsets involved in disease. They may also help with patient stratification during clinical trials of immunomodulators.
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Abstract
PURPOSE/OBJECTIVES To review common tyrosine kinase inhibitors, as well as their ocular side effects and management.
. DATA SOURCES A comprehensive literature search was conducted using CINAHL®, PubMed, and Cochrane databases for articles published since 2004 with the following search terms. DATA SYNTHESIS Tyrosine kinase inhibitors can cause significant eye toxicity.
. CONCLUSIONS Given the prevalence of new tyrosine kinase inhibitor therapies and the complexity of possible pathogenesis of ocular pathology, oncology nurses can appreciate the occurrence of ocular toxicities and the role of nursing in the management of these problems.
. IMPLICATIONS FOR NURSING Knowledge of the risk factors and etiology of ocular toxicity of targeted cancer therapies can guide nursing assessment, enhance patient education, and improve care management. Including a review of eye symptoms and vision issues in nursing assessment can enhance early detection and treatment of ocular toxicity.
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Affiliation(s)
- Mary Elizabeth Davis
- Department of Ambulatory Nursing, Memorial Sloan-Kettering Cancer Center, New York, NY
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28
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Coman IC, Paunescu H, Stamate AC, Cherecheanu AP, Ghita I, Barac C, Vasile D, Tudosescu R, Fulga I. Topical administration of Metamizole and its implications on vascular reactivity in Wistar rats- Experimental research. Rom J Ophthalmol 2017; 61:32-38. [PMID: 29450368 PMCID: PMC5710050 DOI: 10.22336/rjo.2017.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 11/18/2022] Open
Abstract
Aim: The aim of this paper was to describe the possible implications of topical (ocular) administration of Metamizole on vascular reactivity of the iris in Wistar rats. No other study regarding its topical use was found. Methods: Male adult Wistar rats were anaesthetized with Ketamine 100 mg /kg body weight - injected intraperitoneally - while maintaining spontaneous respiration and the blink reflex. After selecting the area of interest (long posterior ciliary artery - LPCA), manual adjustments of the image magnitude, clarity, and brightness were made, and the experiment began. The image recording lasted 10 minutes. Results: Metamizole induced a slight vasoconstriction that started with the initial moment for all the doses used. After the topical administration of Metamizole, we did not observe an increase of the vascular diameter of LPCA in a dose dependent manner. The saline solution used as a negative control did not modify the vessel diameter. Conclusions: Metamizole (dipyrone) is a non-opioid drug, which is commonly used in human and veterinary medicine. It is the most popular first-line analgesic in various populations. In some cases, this agent is still incorrectly classified as a non-steroidal anti-inflammatory drug. The high analgesic efficacy of metamizole, as well as its spasmolytic effect, makes it a very important pharmaceutical agent that could be used in the therapy of various eye disorders in humans and in animals. Abbreviations: COX = Cyclooxygenase; LPCA = Long Posterior Ciliary Artery; PRP = panretinal photocoagulation; PDR = proliferative diabetic retinopathy; Sec = second(s); VSPR = very severe non proliferative diabetic retinopathy.
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Affiliation(s)
- Ioana-Cristina Coman
- Pharmacology and Pharmacotherapy Department, "Carol Davila" University of Medicine and Pharmacy, Faculty of Medicine, Bucharest, Romania
| | - Horia Paunescu
- Pharmacology and Pharmacotherapy Department, "Carol Davila" University of Medicine and Pharmacy, Faculty of Medicine, Bucharest, Romania
| | - Alina Cristina Stamate
- Pharmacology and Pharmacotherapy Department, "Carol Davila" University of Medicine and Pharmacy, Faculty of Medicine, Bucharest, Romania
| | | | - Isabel Ghita
- Pharmacology and Pharmacotherapy Department, "Carol Davila" University of Medicine and Pharmacy, Faculty of Medicine, Bucharest, Romania
| | - Cosmina Barac
- Ophthalmology Department, Emergency University Hospital, Bucharest, Romania
| | - Danut Vasile
- Surgery Department, Emergency University Hospital, Bucharest, Romania
| | - Ruxandra Tudosescu
- Ophthalmology Department, Emergency University Hospital, Bucharest, Romania
| | - Ion Fulga
- Pharmacology and Pharmacotherapy Department, "Carol Davila" University of Medicine and Pharmacy, Faculty of Medicine, Bucharest, Romania
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29
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Chen A, Chen HT, Hwang YH, Chen YT, Hsiao CH, Chen HC. Severity of dry eye syndrome is related to anti-dsDNA autoantibody in systemic lupus erythematosus patients without secondary Sjogren syndrome: A cross-sectional analysis. Medicine (Baltimore) 2016; 95:e4218. [PMID: 27428227 PMCID: PMC4956821 DOI: 10.1097/md.0000000000004218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
There are as many as one-third of the systemic lupus erythematosus (SLE) patients who suffer from dry eye syndrome. To this date, dry eye syndrome in SLE patients is believed to be caused by secondary Sjogren syndrome (sSS). However, there is increasing evidence for possible independency of dry eye syndrome and sSS in patients suffering from autoimmune diseases. The purpose of this retrospective observational case series was to identify SLE patients without sSS who had dry eye syndrome, examine the correlation of different autoantibodies and dry eye severity, and determine the cause of dry eye in these patients.We included 49 consecutive SLE patients with dry eye who visited our dry eye clinic. In order to rule out sSS, these patients were all negative for anti-Sjogren's-syndrome-related antigen A and B (anti-SSA/SSB) and had no oral symptoms. Each patient's lupus activity was determined by serological tests including antidouble-stranded DNA antibody (anti-dsDNA), complement levels (C3, C4), erythrocyte sedimentation rate (ESR), and antinuclear antibody (ANA). Severity of dry eye syndrome was determined by corneal sensation (KSen), superficial punctuate keratopathy (SPK), Schirmer-I test (Schirmer), and tear film break-up time (TBUT). The autoantibodies and the dry eye parameters in each group were tested using the χ test or the Mann-Whitney U test for normally distributed or skewed data, respectively.The anti-dsDNA showed significant correlations with KSen (P < 0.001), SPK (P < 0.001), and Schirmer (P = 0.042) but not TBUT. The C3 showed significant correlations with KSen (P < 0.001), SPK (P < 0.001), and Schirmer (P = 0.014) but not TBUT. No correlations of dry eye parameters were observed between C4, ESR, and ANA.The major finding of this study was that the severity of dry eye syndrome in SLE patients without sSS was strongly correlated with anti-dsDNA and C3 but not with C4, ESR, and ANA.
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Affiliation(s)
- Alexander Chen
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
| | - Hung-Ta Chen
- Department of Internal Medicine, Taipei City Hospital-Heping Branch
| | - Yih-Hsiou Hwang
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
| | - Yi-Tsun Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei
| | - Ching-Hsi Hsiao
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
| | - Hung-Chi Chen
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
- Correspondence: Hung-Chi Chen, Department of Ophthalmology, Chang Gung Memorial Hospital, Guishan District, Taoyuan, Taiwan (e-mail: )
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30
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Fea AM, Aragno V, Testa V, Machetta F, Parisi S, D'Antico S, Spinetta R, Fusaro E, Grignolo FM. The Effect of Autologous Platelet Lysate Eye Drops: An In Vivo Confocal Microscopy Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8406832. [PMID: 27200376 PMCID: PMC4854989 DOI: 10.1155/2016/8406832] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/07/2016] [Accepted: 03/29/2016] [Indexed: 01/22/2023]
Abstract
Purpose. To determine the effectiveness of autologous platelet lysate (APL) eye drops in patients with primary Sjögren syndrome (SS) dry eye, refractory to standard therapy, in comparison with patients treated with artificial tears. We focused on the effect of APL on cornea morphology with the in vivo confocal microscopy (IVCM). Methods. Patients were assigned to two groups: group A used autologous platelet lysate QID, and group B used preservative-free artificial tears QID, for 90 days. Ophthalmological assessments included ocular surface disease index (OSDI), best corrected visual acuity (BCVA), Schirmer test, fluorescein score, and breakup time (BUT). A subgroup of patients in group A underwent IVCM: corneal basal epithelium, subbasal nerves, Langerhans cells, anterior stroma activated keratocytes, and reflectivity were evaluated. Results. 60 eyes of 30 patients were enrolled; in group A (n = 20 patients) mean OSDI, fluorescein score, and BUT showed significant improvement compared with group B (n = 10 patients). The IVCM showed a significant increase in basal epithelium cells density and subbasal nerve plexus density and number and a decrease in Langerhans cells density (p < 0.05). Conclusion. APL was found effective in the treatment of SS dry eye. IVCM seems to be a useful tool to visualize cornea morphologic modifications.
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Affiliation(s)
- Antonio M. Fea
- Department of Clinical Sciences, Ophthalmology Institute, University of Turin, 10122 Turin, Italy
| | - Vittoria Aragno
- Department of Clinical Sciences, Ophthalmology Institute, University of Turin, 10122 Turin, Italy
| | - Valeria Testa
- Department of Clinical Sciences, Ophthalmology Institute, University of Turin, 10122 Turin, Italy
| | - Federica Machetta
- Department of Clinical Sciences, Ophthalmology Institute, University of Turin, 10122 Turin, Italy
| | - Simone Parisi
- Rheumatology Department, AOU Città della Salute e della Scienza di Torino, 10134 Turin, Italy
| | - Sergio D'Antico
- Blood Bank, AOU Città della Salute e della Scienza di Torino, 10134 Turin, Italy
| | - Roberta Spinetta
- Department of Clinical Sciences, Ophthalmology Institute, University of Turin, 10122 Turin, Italy
| | - Enrico Fusaro
- Rheumatology Department, AOU Città della Salute e della Scienza di Torino, 10134 Turin, Italy
| | - Federico M. Grignolo
- Department of Clinical Sciences, Ophthalmology Institute, University of Turin, 10122 Turin, Italy
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31
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Coursey TG, Tukler Henriksson J, Barbosa FL, de Paiva CS, Pflugfelder SC. Interferon-γ-Induced Unfolded Protein Response in Conjunctival Goblet Cells as a Cause of Mucin Deficiency in Sjögren Syndrome. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 186:1547-58. [PMID: 27085137 DOI: 10.1016/j.ajpath.2016.02.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 01/19/2016] [Accepted: 02/01/2016] [Indexed: 12/21/2022]
Abstract
Goblet cells (GCs) are specialized secretory cells that produce mucins and a variety of other proteins. Significant conjunctival GC loss occurs in both experimental dry eye models and patients with keratoconjunctivitis sicca due to the induction of interferon (IFN)-γ. With the use of a primary murine culture model, we found that GCs are highly sensitive to IFN-γ with significantly reduced proliferation and altered structure with low concentrations. GC cultures treated with IFN-γ have increased gene expression of Muc2 and Muc5AC but do not express these mucin glycoproteins. We hypothesized that IFN-γ induces endoplasmic reticulum stress and the unfolded protein response (UPR) in GCs. Cultures treated with IFN-γ increased expression of UPR-associated genes and proteins. Increased GRP78 and sXBP1 expression was found in experimental dry eye and Sjögren syndrome models and was GC specific. Increased GRP78 was also found in the conjunctiva of patients with Sjögren syndrome at the gene and protein levels. Treatment with dexamethasone inhibited expression of UPR-associated genes and increased mucin production. These results indicate that induction of UPR by IFN-γ is an important cause of GC-associated mucin deficiency observed in aqueous-deficient dry eye. Therapies to block the effects of IFN-γ on the metabolically active endoplasmic reticulum in these cells might enhance synthesis and secretion of the protective GC mucins on the ocular surface.
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Affiliation(s)
- Terry G Coursey
- Ocular Surface Center, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Johanna Tukler Henriksson
- Ocular Surface Center, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Flavia L Barbosa
- Ocular Surface Center, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Cintia S de Paiva
- Ocular Surface Center, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Stephen C Pflugfelder
- Ocular Surface Center, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.
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32
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Min JH, Lee CH, Ji YW, Yeo A, Noh H, Song I, Kim EK, Lee HK. Activation of Dll4/Notch Signaling and Hypoxia-Inducible Factor-1 Alpha Facilitates Lymphangiogenesis in Lacrimal Glands in Dry Eye. PLoS One 2016; 11:e0147846. [PMID: 26828208 PMCID: PMC4734677 DOI: 10.1371/journal.pone.0147846] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 01/08/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE By using hypoxia-inducible factor-1 alpha conditional knockout (HIF-1α CKO) mice and a dry eye (DE) mouse model, we aimed to determine the role played by delta-like ligand 4 (Dll4)/Notch signaling and HIF-1α in the lymphangiogenesis of lacrimal glands (LGs). METHODS C57BL/6 mice were housed in a controlled-environment chamber for DE induction. During DE induction, the expression level of Dll4/Notch signaling and lymphangiogenesis in LGs was measured by quantitative RT-PCR, immunoblot, and immunofluorescence staining. Next, lymphangiogenesis was measured after Dll4/Notch signal inhibition by anti-Dll4 antibody or γ-secretase inhibitor. Using HIF-1α CKO mice, the expression of Dll4/Notch signaling and lymphangiogenesis in LGs of DE-induced HIF-1α CKO mice were assessed. Additionally, the infiltration of CD45+ cells in LGs was assessed by immunohistochemical (IHC) staining and flow cytometry for each condition. RESULTS DE significantly upregulated Dll4/Notch and lymphangiogenesis in LGs. Inhibition of Dll4/Notch significantly suppressed lymphangiogenesis in LGs. Compared to wild-type (WT) mice, DE induced HIF-1α CKO mice showed markedly low levels of Dll4/Notch and lymphangiogenesis. Inhibition of lymphangiogenesis by Dll4/Notch suppression resulted in increased CD45+ cell infiltration in LGs. Likewise, CD45+ cells infiltrated more in the LGs of HIF-1α CKO DE mice than in non-DE HIF-1α CKO mice. CONCLUSIONS Dll4/Notch signaling and HIF-1α are closely related to lymphangiogenesis in DE-induced LGs. Lymphangiogenesis stimulated by Dll4/Notch and HIF-1α may play a role in protecting LGs from DE-induced inflammation by aiding the clearance of immune cells from LGs.
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Affiliation(s)
- Ji Hwan Min
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Hee Lee
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Woo Ji
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Areum Yeo
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyemi Noh
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Insil Song
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Kweon Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Keun Lee
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
- Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Human Serum Eye Drops in Eye Alterations: An Insight and a Critical Analysis. J Ophthalmol 2015; 2015:396410. [PMID: 26504592 PMCID: PMC4609447 DOI: 10.1155/2015/396410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/07/2015] [Indexed: 12/13/2022] Open
Abstract
Human serum contains a physiological plethora of bioactive elements naturally released by activated platelets which might have a significant effect on the regeneration of corneal layers by stimulating the cell growth. This mechanism supported the use of human serum eye drops in some ocular diseases associated with dystrophic changes and alterations of the tear film, such as persistent corneal epithelial defects and dry eye syndrome. We focused our effort on potential benefits and limitations of the use of human serum eye drops when conventional therapies failed. We reviewed the recent literature by reporting published studies from 2010 to 2014. Despite the limited evaluated study populations, most of the clinical studies have confirmed that serum eye drop therapy is effective in corneal healing by reducing ocular symptom, particularly during the short-term follow-up. In addition, three recent published studies have shown the efficacy of the serum eye drop therapy in comparison to traditional ones in intractable patients. Besides, reported ongoing clinical studies confirmed the open debate regarding the use of biologic tools for cornea regeneration. Results from these studies might open novel challenges and perspectives in the therapy of such refractory patients.
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