Ocular fluid dynamics response to topical RU486, a steroid blocker

Experimental research on the relationship between the stiffness and the expressions of fibronectin proteins and adaptor proteins of rat trabecular meshwork cells

Background

Trabecular meshwork (TM) plays an important role in maintaining normal intraocular pressure (IOP). Studies have shown that glaucomatous TM tissues are stiffer than those of normal tissue. The high expression of fibronectin protein (FN) and adaptor protein (LNK) may be related to high resistance to aqueous humor outflow as well as high IOP. Our concern is what factors lead to the variation of the stiffness of trabecular tissue/cells.

Methods

Atomic force microscope (AFM) and Western blot (WB) analysis were applied to test TM cells of rats cultured with different concentrations of dexamethasone (DEX) and mifepristone (MIF). Rat TM cells were randomly divided into 7 groups, marked as D1, D2, D3 and M1, M2 M3 for different concentrations of DEX and MIF, respectively, and C for blank control.

Results

The elastic modulus of the treated cells were 2.67 ± 0.914 KPa, 2.92 ± 0.986 KPa, 4.52 ± 1.22 KPa for D1, D2, D3, 2.06 ± 0.745 KPa, 1.23 ± 0.462 KPa, 0.467 ± 0.275 KPa for M1, M2, M3, and 2.43 ± 0.713 KPa for C group, respectively. Expressions of FN and LNK increase (decrease) with the increase of the concentrations of DEX (MIF).

Discussion

We focus on the relationship between the stiffness and the expressions of FN and LNK of rat TM cells. We analyzed the correlation between cell stiffness and FN, LNK expression, discussed the relationship between cell stiffness and aqueous humor outflow resistance.

Conclusions

The changes of TM cell stiffness and the expressions of FN and LNK are positively correlated.

Effects of topical corticosteroid administration on intraocular pressure in normal and glaucomatous cats

OBJECTIVE

The objective of this study was to determine the effect of topical corticosteroid (CCS) therapy on intraocular pressure (IOP) in normal cats and cats with primary feline congenital glaucoma (FCG).

ANIMALS STUDIED

Five normal and 11 FCG cats were studied in two cohorts.

PROCEDURES

IOP was measured by a single, masked observer, once daily, 3-5 days/week throughout the course of CCS treatment and for up to 11 days after treatment discontinuation. One eye per cat was randomly assigned for treatment twice daily with CCS; balanced salt solution (BSS) applied to the contralateral eye served as a control. Differences between eyes and between weeks of the study period were calculated for each cat. A positive response to CCS was defined as a consistent >15% or >25% higher IOP in the treated relative to control eye in normal and FCG cats, respectively.

RESULTS

A total of 8 of 11 FCG cats responded to topical CCS after 1-5 weeks of treatment with an increase in IOP relative to the untreated eye (maximum IOP discrepancy of 56 mmHg). Two of five normal cats responded to topical CCS with an appreciable, but clinically unimportant increase in IOP in the treated eye (maximum IOP discrepancy of 6.4 mmHg).

CONCLUSIONS

Our data indicate that the incidence of steroid-induced IOP elevation in cats is lower than that of previously published feline studies. Cats with preexisting compromise in aqueous humor outflow may show a greater, clinically relevant response to topical CCS than normal cats.

Treatment of glaucoma with 3 alpha, 5 beta-tetrahydrocortisol: a new therapeutic modality

The effectiveness of 3 alpha, 5 beta-tetrahydrocortisol (3 alpha, 5 beta-THF), a metabolite of cortisol, in lowering intraocular pressure (IOP) in rabbits made ocular hypertensive with glucocorticoids suggested its use in patients with Primary Open Angle Glaucoma (POAG). Patients with well-documented POAG were treated with a 1% suspension of 3 alpha, 5 beta-THF administered to one eye four times daily for up to six weeks. Eight out of nine patients experienced an appreciable decrease in IOP in the treated eye (average decrease 4.9 mm Hg). There was no conjunctival irritation, corneal pathology, visual field changes, alteration in liver or renal function tests or blood count during the treatment period. The present study demonstrates that 3 alpha, 5 beta-THF, a naturally occurring steroid metabolite, is effective in lowering IOP in patients with POAG. Antiglucocorticoids may represent a new therapeutic modality for the management of POAG.

Interaction between progesterone and mifepristone on intraocular pressure in rabbits

The interaction between a topically administered progesterone, medrysone, and a steroid antagonist, mifepristone, on rabbit intraocular pressure (IOP) has been determined. Medrysone alone increased IOP significantly above parallel controls over the first three weeks; this increase was not sustained. When medrysone and mifepristone were given simultaneously the IOP increased initially, but then fell after two weeks to control levels. When mifepristone was added 14 days after medrysone, the IOP was again reduced to, or below, control levels by mifepristone. The use of mifepristone alone reduced IOP relative to controls and the further addition of medrysone at 14 days had no effect on IOP. It appears that mifepristone is an effective antagonist against progesterone effects on IOP.

Distribution of a steroid antagonist in the eye following topical administration

The distribution of a steroid antagonist, RU486, that is known to reduce rabbit intraocular pressure has been examined in the eye. On an equal tissue weight basis, the corneal epithelium is the site of maximal absorption followed by conjunctival tissues (bulbar and palpebral) and the rest of the cornea. Aqueous humor concentrations of drug vary between 5 X 10(-6) and 5 X 10(-8) at 1 and 24 hours, respectively: these concentrations have been shown by others to inhibit dexamethasone binding to rat thymocytes, and are sufficient to act as an antagonist at steroid receptors in the eye. Multiple drop administration for 10 days (3 drops per day) revealed no accumulation in the treated eye, but did show the presence of drug in the untreated contralateral eye that could explain the contralateral pharmacological effect seen on intraocular pressure after several days of treatment.

Subconjunctival suspension of RU486 lowers intraocular pressure in normal rabbits

RU486 is both a progesterone blocker and a corticosteroid blocker (peripheral). Subconjunctival injections of 0.2 ml of a 1% suspension of RU486 powder (2 mg) were given twice weekly to one eye chosen at random of 12 rabbits. The fellow eye received the same volume, 0.2 ml, of vehicle (normal saline) only. Ocular tension was measured twice daily for six days per week by an Alcon pneumatonograph, the tonometrist(s) being unaware of which eyes were treated and which untreated. A small but significant reduction in intraocular pressure, about 0.7 mmHg, occurred in treated eyes. No intereye difference in the ocular hypertensive response to intraperitoneal injections of distilled water (50 ml/kg) was found. Clinical trials are planned in which a larger fall is expected because the trabecular meshwork in patients with open-angle glaucoma or ocular hypertension is presumably more affected by (normal) tissue levels of corticosteroid.