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van Setten GB. Ocular Surface Allostasis-When Homeostasis Is Lost: Challenging Coping Potential, Stress Tolerance, and Resilience. Biomolecules 2023; 13:1246. [PMID: 37627311 PMCID: PMC10452761 DOI: 10.3390/biom13081246] [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: 04/05/2023] [Revised: 07/20/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
The loss of ocular surface (OS) homeostasis characterizes the onset of dry eye disease. Resilience defines the ability to withstand this threat, reflecting the ability of the ocular surface to cope with and bounce back after challenging events. The coping capacity of the OS defines the ability to successfully manage cellular stress. Cellular stress, which is central to the outcome of the pathophysiology of dry eye disease, is characterized by intensity, continuity, and receptivity, which lead to the loss of homeostasis, resulting in a phase of autocatalytic dysregulation, an event that is not well-defined. To better define this event, here, we present a model providing a potential approach when homeostasis is challenged and the coping capacities have reached their limits, resulting in the stage of heterostasis, in which the dysregulated cellular stress mechanisms take over, leading to dry eye disease. The main feature of the proposed model is the concept that, prior to the initiation of the events leading to cellular stress, there is a period of intense activation of all available coping mechanisms preventing the imminent dysregulation of ocular surface homeostasis. When the remaining coping mechanisms and resilience potential have been maximally exploited and have, finally, been exceeded, there will be a transition to manifest disease with all the well-known signs and symptoms, with a shift to allostasis, reflecting the establishment of another state of balance. The intention of this review was to show that it is possibly the phase of heterostasis preceding the establishment of allostasis that offers a better chance for therapeutic intervention and optimized recovery. Once allostasis has been established, as a new steady-state of balance at a higher level of constant cell stress and inflammation, treatment may be far more difficult, and the potential for reversal is drastically decreased. Homeostasis, once lost, can possibly not be fully recovered. The processes established during heterostasis and allostasis require different approaches and treatments for their control, indicating that the current treatment options for homeostasis need to be adapted to a more-demanding situation. The loss of homeostasis necessarily implies the establishment of a new balance; here, we refer to such a state as allostasis.
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Affiliation(s)
- Gysbert-Botho van Setten
- St. Eriks Eye Hospital, 171 04 Solna, Sweden;
- Lab of DOHF and Wound Healing, Division of Eye and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Eugeniavägen 12/Level 6, 171 04 Solna, Sweden
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Beck R, Stachs O, Koschmieder A, Mueller-Lierheim WGK, Peschel S, van Setten GB. Hyaluronic Acid as an Alternative to Autologous Human Serum Eye Drops: Initial Clinical Results with High-Molecular-Weight Hyaluronic Acid Eye Drops. Case Rep Ophthalmol 2019; 10:244-255. [PMID: 31692577 PMCID: PMC6760367 DOI: 10.1159/000501712] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/11/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction Autologous serum eye drops (ASED) are used in the treatment of most severe stages of dry eye. Once introduced, it is currently considered impossible to return to other lubricating eye drops or other commercially available therapeutic regimen. Materials and Methods In a randomized study, non-preserved high-molecular-weight hyaluronic acid eye drops were offered as an alternative to 11 patients using autologous serum treatment for at least 3 months. The control group (n = 5) continued their treatment with ASED. The verum group (n = 6) used very-high-molecular-weight hyaluronic eye drops (Comfort Shield®) instead of the ASED. Results From four of initially six patients in the verum group that finished the study, 2 (50%) preferred to stay with the very-high-molecular-weight hyaluronic acid eye drops beyond the trial period, the other two returned to the earlier therapy with ASED. The control group continued their treatment as before and finished the study after 8 weeks. Conclusion For the first time, artificial eye drops, i.e., high-molecular-weight hyaluronic acid eye drops, offered an acceptable alternative to ASED. Some patients perceived these drops as even better than the patient's own serum. This is the first evidence that optimization of the molecular structure of hyaluronic acid can be used to create eye drops that are perceived to be better than other tested tear substitutes and even patients' own serum. This offers a new treatment perspective for patients with very severe dry eye disease.
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Affiliation(s)
- Ria Beck
- University Eye Hospital, Rostock, Germany
| | | | | | | | | | - Gysbert-Botho van Setten
- St Eriks Eye Hospital, Karolinska Institutet, Stockholm, Sweden.,Institute of Wound Research and Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
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Balasubramanian SA, Pye DC, Willcox MDP. Levels of lactoferrin, secretory IgA and serum albumin in the tear film of people with keratoconus. Exp Eye Res 2012; 96:132-7. [DOI: 10.1016/j.exer.2011.12.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 12/05/2011] [Accepted: 12/10/2011] [Indexed: 12/27/2022]
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Biomedical soft contact-lens sensor for in situ ocular biomonitoring of tear contents. Biomed Microdevices 2011; 13:603-11. [PMID: 21475940 DOI: 10.1007/s10544-011-9530-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A soft contact-lens biosensor (SCL-biosensor) for novel non-invasive biomonitoring of tear fluids was fabricated and tested. Wearing a biosensor on eye enabled the in situ monitoring of tear contents. The biosensor has an enzyme immobilized electrode on the surface of a polydimethyl siloxane (PDMS) contact lens. The SCL-biosensor was fabricated using microfabrication techniques for functional polymers (PDMS and 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer). In investigation of in vitro characterization, the SCL-biosensor showed excellent relationship between the output current and glucose concentration from 0.03 to 5.0 mmol·L(-1), with a correlation coefficient of 0.994. The calibration range covered the reported tear glucose concentrations (0.14 mmol·L(-1)). Based on the result, ocular biomonitoring with the SCL-biosensor was carried out. The SCL-biosensor well worked both in the static state and the dynamic state. The tear glucose level of rabbit was estimated to 0.12 mmol·L(-1) at first and then the tear turnover was successfully calculated to be 29.6 ± 8.42% min(-1). The result indicated that SCL-biosensor is useful for advanced biomonitoring on eye.
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van Setten GB, Tervo T, Tervo K, Tarkkanen A. Epidermal growth factor (EGF) in ocular fluids: presence, origin and therapeutical considerations. Acta Ophthalmol 2009:54-9. [PMID: 1322012 DOI: 10.1111/j.1755-3768.1992.tb02169.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- G B van Setten
- Department of Ophthalmology, Helsinki University Central Hospital, Finland
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Dartt DA. Dysfunctional neural regulation of lacrimal gland secretion and its role in the pathogenesis of dry eye syndromes. Ocul Surf 2007; 2:76-91. [PMID: 17216081 DOI: 10.1016/s1542-0124(12)70146-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Tears are a complex fluid consisting of three layers, each of which is secreted by a different set of tissues or glands. The aqueous portion of the tear film is produced predominantly by the lacrimal gland. Dry eye syndromes are diseases in which the amount and composition of tears are altered, which can lead to ocular surface damage. There are many causes for dry eye syndromes. One such cause is the alteration in the functions of nerves innervating the lacrimal gland and the ocular surface. The autoimmune disease Sjogren syndrome can deleteriously affect the innervation of the lacrimal gland. Damage to the sensory nerves in the ocular surface, specifically the cornea, as a result of refractive surgery and normal aging, prevents the normal reflex arc to the lacrimal gland. Both defects can result in decreased tear secretion and dry eye syndromes. This review will discuss the current information regarding neurally-stimulated protein, water, and electrolyte secretion from the lacrimal gland and delineate how nerve dysfunction resulting from a variety of causes decreases secretion from this gland.
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Affiliation(s)
- Darlene A Dartt
- Schepens Eye Research Institute, and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Klenkler B, Sheardown H, Jones L. Growth Factors in the Tear Film: Role in Tissue Maintenance, Wound Healing, and Ocular Pathology. Ocul Surf 2007; 5:228-39. [PMID: 17660896 DOI: 10.1016/s1542-0124(12)70613-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Numerous biologically active growth factors are secreted by the lacrimal gland and distributed via the tears over the ocular surface, where they affect cellular proliferation, migration, differentiation, and survival. The role of growth factors and their receptors in maintenance of tissue homeostasis and wound healing continues to be elucidated, and the effect of growth factor imbalances in ocular surface diseases is just beginning to be understood. For instance, in eyes with ocular surface diseases, including conjunctivitis, corneal erosion, keratitis, and corneal ulcers, epidermal growth factor release rates have been shown to be significantly lower than in normal eyes during reflex tearing. Future research into the mechanisms of dry eye disease will focus on reasons for decreased tear and growth factor production in the neuronal reflex loop or the acinar lacrimal gland cells. Animal models to test therapeutic approaches must be developed.
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Affiliation(s)
- Bettina Klenkler
- Department of Chemical Engineering, McMaster University, Hamilton, ON, Canada
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Ohashi Y, Dogru M, Tsubota K. Laboratory findings in tear fluid analysis. Clin Chim Acta 2006; 369:17-28. [PMID: 16516878 DOI: 10.1016/j.cca.2005.12.035] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Revised: 12/29/2005] [Accepted: 12/30/2005] [Indexed: 11/24/2022]
Abstract
The tear film, composed of the lipid, aqueous and mucin layers, has many functions including defending the ocular surface. The tear film covering the ocular surface presents a mechanical and antimicrobial barrier and ensures an optical refractive surface. The lipid component originates from the meibomian glands of the tarsus and forms the superficial layer of the tear film. The aqueous component contains electrolytes, water, and a large variety of proteins, peptides and glycoproteins, and is primarily secreted by the lacrimal gland. Mucins are glycoproteins expressed by epithelial tissues of mucous surfaces. They protect tissues by functioning as antioxidants, providing lubrication, and inhibiting bacterial adherence. Quantitatively and qualitatively, its composition must be maintained within the fairly narrow limits to maintain a healthy and functional visual system. Abnormalities of the tear film, affecting the constituents or the volume, can rapidly result in serious dysfunction of the eyelids and conjunctiva and ultimately affect the transparency of the cornea. Many ocular surface tests have been developed for the clinical diagnosis of dry eye syndromes. This paper provides an overview on laboratory methods for the analysis of the tear film. Understanding the components of the tear film will aid in the treatment of dry eye syndromes and the ocular surface diseases.
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Affiliation(s)
- Yoshiki Ohashi
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku Tokyo 160-8582, Japan
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Abstract
Dry eye syndrome (DES) refers to a spectrum of ocular surface diseases with diverse and frequently multiple aetiologies. The common feature of the various manifestations of DES is an abnormal tear film. Tear film abnormalities associated with DES are tear deficiency, owing to insufficient supply or excessive loss, and anomalous tear composition. These categorizations are artificial, as in reality both often coexist. DES disrupts the homeostasis of the tear film with its adjacent structures, and adversely affects its ability to perform essential functions such as supporting the ocular surface epithelium and preventing microbial invasion. In addition, whatever the initial trigger, moderate and severe DES is characterized by ocular surface inflammation, which in turn becomes the cause and consequence of cell damage, creating a self-perpetuating cycle of deterioration. Progress has been made in our understanding of the aetiology and pathogenesis of DES, and these advances have encouraged a proliferation of therapeutic options. This article aims to amalgamate prevailing ideas of DES development, and to assist in that, relevant aspects of the structure, function, and production of the tear film are reviewed. Additionally, a synopsis of therapeutic strategies for DES is presented, detailing treatments currently available, and those in development.
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Affiliation(s)
- Michael E Johnson
- School of Optometry and Vision Sciences, Cardiff University, King Edward VII Avenue, Cardiff CF10 3NB, UK.
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Esquenazi S. Five-year Follow-up of Laser in situ Keratomileusis for Hyperopia Using the Technolas Keracor 117C Excimer Laser. J Refract Surg 2004; 20:356-63. [PMID: 15307398 DOI: 10.3928/1081-597x-20040701-09] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate safety, predictability, efficiency, and long-term stability of laser in situ keratomileusis (LASIK) for spherical hyperopia. METHODS This study was a retrospective 5-year analysis of 67 patients (125 eyes) who had LASIK for spherical hyperopia; preoperative mean manifest spherical equivalent refraction was +3.84+/-1.13 D (range +1.00 to +6.50 D) and mean astigmatism was 0.37+/-0.27 D (range 0 to 1.00 D). Preoperative spherical equivalent refraction for the low hyperopia group was +1.00 to +2.75 D; medium hyperopia group, +3.00 to +4.25 D, and high hyperopia group, +4.50 to +6.50 D. All surgeries were performed using the scanning Chiron Technolas Keracor 117C excimer laser. Uncorrected and best spectacle-corrected visual acuity, predictability, long-term stability of refraction, and complications were analyzed. RESULTS At 5 years after hyperopic LASIK, mean spherical equivalent refraction for the low hyperopia group was +0.48D+/-0.79 D; medium hyperopia group, +1.52+/-1.45 D; high hyperopia group C, +3.39+/-1.98 D. The percentage of eyes with a spherical equivalent refraction within +/-0.50 D of emmetropia for the low hyperopia group was 63% (37 eyes); medium hyperopia group, 42% (20 eyes); high hyperopia group, 22% (4 eyes). Eyes with chronic dry eye symptoms had a mean difference in spherical equivalent refraction from target refraction of +1.43 D compared with +0.84 D for eyes without dry eye symptoms. Five eyes (4%) lost 2 lines of BSCVA at 5 years. CONCLUSION LASIK was safe, effective, and stable for primary hyperopia between +1.00 and +3.00 D. Higher amounts of hyperopia had poor long-term stability, especially eyes with more than +4.25 D. Chronic dry eye symptoms were associated with regression over time.
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Affiliation(s)
- Salomon Esquenazi
- Department of Ophthalmology and Neuroscience Center for Excellence, LSU Health Science Center New Orleans, LA 70115, USA.
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Ohashi Y, Ishida R, Kojima T, Goto E, Matsumoto Y, Watanabe K, Ishida N, Nakata K, Takeuchi T, Tsubota K. Abnormal protein profiles in tears with dry eye syndrome. Am J Ophthalmol 2003; 136:291-9. [PMID: 12888052 DOI: 10.1016/s0002-9394(03)00203-4] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To verify the hypothesis that protein concentrations, such as lactoferrin, epidermal growth factor (EGF), and aquaporin 5 (AQP5), in tears are abnormal in patients with dry eye. DESIGN Prospective case-control study. METHODS One hundred three dry eye patients were divided into three groups: dry eye not associated with the Sjögren syndrome (non-SS; n = 71), Sjögren syndrome (SS; n = 23), and Stevens-Johnson syndrome (SJS; n = 9). Sixteen normal control subjects were also checked. The concentrations of lactoerrin, EGF, and AQP5 were measured by enzyme-linked immunosorbent assay. RESULTS The concentration of lactoferrin was significantly decreased in tears of non-SS (P =.0001), SS (P =.00005), and SJS (P =.0006) patients compared with control subjects. The concentration of EGF was significantly decreased in non-SS (P =.0005), SS (P =.00002), and SJS (P =.0001) patients compared with control subjects. The concentration of AQP5 was significantly increased in tears of only SS patients (P =.01) compared with control subjects and increased in tears of only SS patients compared with non-SS patients (P =.007). CONCLUSIONS The decrease in both lactoferrin and EGF was found not only in SS patients but also in non-SS patients, indicating that tear components in dry eyes differ in their quantity and quality. Quantification of AQP5 increased only in SS patients, suggesting that AQP5 protein leaks into the tears when acinar cells of the lacrimal gland are damaged by lymphocytic infiltration.
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Affiliation(s)
- Yoshiki Ohashi
- Department of Ophthalmology, Tokyo Dental College, Ichikawa, Chiba, Japan.
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Albietz JM, Lenton LM, McLennan SG. Effect of Laser in situ Keratomileusis for Hyperopia on Tear Film and Ocular Surface. J Refract Surg 2002; 18:113-23. [PMID: 11934197 DOI: 10.3928/1081-597x-20020301-02] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine the effects of laser in situ keratomileusis (LASIK) for hyperopia on the tear film and ocular surface. METHODS A retrospective 12-month analysis of 88 eyes (88 participants) who had LASIK for hyperopia was performed. Participants were evaluated before and after (2 weeks, 1, 3, 6, and 12 months) surgery for dry eye symptoms (McMonnies Dry Eye Survey primary symptoms), tear film stability (fluorescein break-up time), tear volume (phenol red thread test), ocular surface staining (fluorescein), and conjunctival goblet cell density. RESULTS Chronic dry eye was experienced by 32% of participants; symptoms were significantly associated with female gender, preoperative dry eye symptoms, lower tear film stability after surgery, greater ocular surface staining after surgery, lower tear volume before and after surgery, and lower goblet cell densities after surgery. Regression rate 12 months after surgery was 32% and significantly associated with female gender, chronic dry eye symptoms, lower tear film stability after surgery, greater ocular surface staining before and after surgery, and lower tear volume before and after surgery. CONCLUSIONS Dry eye, particularly in females, is problematic after LASIK for hyperopia and is associated with refractive regression. Current methods for managing the tear film and ocular surface may not control LASIK-induced dry eye, particularly in some females during the first 6 months after surgery.
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Affiliation(s)
- Julie M Albietz
- Queensland University of Technology, Centre for Eye Research, Brisbane, Australia.
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Abstract
PURPOSE To review the advances in the diagnosis, pathogenesis, and management of dry eye disease in the past 25 years. METHODS Literature review. RESULTS The preocular tear film is a hydrated mucus gel that contains soluble antimicrobial proteins and growth factors that protect and support the ocular surface. The final common pathway in dry eye is a perturbation of the integrated ocular surface/lacrimal gland reflex unit. Diagnostic tests evaluating tear composition and clearance appear to show stronger correlation with the severity of ocular irritation symptoms and keratoconjunctivitis sicca (KCS) than the conventional Schirmer tests. KCS is a condition of abnormal differentiation and mucus production by the ocular surface epithelium that results in a poorly lubricated, abnormally permeable ocular surface that has increased susceptibility to environmental insults. Chronic subclinical ocular surface inflammation appears to play a key role in the pathogenesis of KCS. New therapeutic strategies are aimed at reducing the ocular surface inflammation of dry eye disease. CONCLUSIONS There has been a tremendous increase in knowledge regarding dry eye disease in the past 25 years that has resulted in improved diagnostic classification and new targeted therapies.
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Affiliation(s)
- S C Pflugfelder
- Ocular Surface and Tear Center, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, Florida, USA.
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Burling K, Seguin MA, Marsh P, Brinkman K, Madigan J, Thurmond M, Moon-Massat P, Mannis M, Murphy CJ. Effect of topical administration of epidermal growth factor on healing of corneal epithelial defects in horses. Am J Vet Res 2000; 61:1150-5. [PMID: 10976751 DOI: 10.2460/ajvr.2000.61.1150] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED OBJECTIVE-To characterize healing of corneal epithelial defects in horses and to evaluate the ability of epidermal growth factor (EGF) to modulate rate of corneal epithelial healing in horses. SAMPLE POPULATION 20 eyes in 12 adult horses. PROCEDURE Corneal epithelial wounds were created by mechanically debriding the limbus. Corneal healing was recorded for 3 treatment groups: 50 microg of EGF/ml (n = 5 eyes), 5 microg of EGF/ml (7), and PBS solution (8). Corneal healing was recorded once daily after instillation of fluorescein stain by use of photography and calculating the area of the wound, using imaging software. RESULTS After corneal debridement, re-epithelialization was rapid and progressed in a linear fashion for the first 5 to 7 days after surgery in all groups. After that period, rates of healing decreased. A profound increase in the degree of inflammation, neovascularization, melanosis, and scarring was observed in eyes treated with the high dose of EGF (50 microg/ml), but there was not a statistical difference in mean healing time or in mean decrease in radius during the linear phase between the control and either EGF treatment groups. However, for all 8 horses in which both eyes were debrided, the first eye healed significantly faster than the second eye, regardless of treatment. CONCLUSIONS AND CLINICAL RELEVANCE Beneficial effects of topical administration of a high dose of EGF for acceleration of healing of corneal defects in eyes of horses are outweighed by the intensity of the associated inflammatory response.
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Affiliation(s)
- K Burling
- Animal Eye Specialists of San Jose, CA 95123, USA
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Abstract
For more than 15 years, the excimer laser has been used as a surgical instrument on the cornea. Photorefractive keratectomy (PRK) followed radial keratotomy as researchers sought a more precise technique. In PRK, precision turned out to depend on surgical technique as well as the wound-healing process, with the 2 factors interdependent. The PRK technique has evolved toward a large diameter, flat ablation curvatures, and an even surface. The role of such factors as cytokines and interleukins has become more clear in the past 10 years. However, understanding the wound-healing process becomes more complicated with increasing know edge. Learning the contributing factors and performing trials with new drugs and antibodies to modulate wound healing have shown positive results on the experimental level. Patient selection based on the concentration of epidermal growth factor in tears may be another way to increase PRK s precision. The PRK technique has taught much about wound healing. For the technique to be competitive, increased precision, particularly in eyes with high myopia, is needed. Two other factors are imperative: controlling postoperative pain and decreasing visual rehabilitation time.
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Affiliation(s)
- P Fagerholm
- St. Eriks Eye Hospital, Karolinska Institutet, Stockholm, Sweden
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Pflugfelder SC, Jones D, Ji Z, Afonso A, Monroy D. Altered cytokine balance in the tear fluid and conjunctiva of patients with Sjögren's syndrome keratoconjunctivitis sicca. Curr Eye Res 1999; 19:201-11. [PMID: 10487957 DOI: 10.1076/ceyr.19.3.201.5309] [Citation(s) in RCA: 425] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To compare epidermal growth factor (EGF) concentration in tear fluid and levels of inflammatory cytokines in the conjunctival epithelium of patients with Sjögren's syndrome keratoconjunctivitis sicca with those of normal controls. METHODS Schirmer 1 tear testing, corneal fluorescein staining and conjunctival impression cytology for quantitation of goblet cell density were performed in ten patients with Sjögren's syndrome-associated keratoconjunctivitis sicca and ten asymptomatic normal controls. ELISA was used to detect the concentration of EGF in tear fluid and interleukin 6 in lysates of conjunctival cytology specimens obtained from all subjects. The levels of RNA transcripts encoding inflammatory cytokines [interleukin 1alpha_(IL-1alpha), interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor alpha_(TNF-alpha), and transforming growth factor beta1 (TGF-beta1)] as well as a housekeeping gene (G3PDH) were evaluated in conjunctival cytology specimens taken from all subjects by semiquantitative competitive reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS Decreased tear fluid EGF concentration was noted in Sjögren's syndrome patients (mean 0.68 +/- 0.59 ng/ml) compared to controls (mean 1.66 +/- 0.45 ng/ml, P = 0.004). Significantly increased levels of IL-1alpha, IL-6, IL-8, TNF-alpha and TGF-beta1 RNA transcripts were found in the conjunctival epithelium of Sjögren's syndrome patients compared to controls (P < 0.05), while the level of G3PDH was similar in both groups. The concentration of IL-6 protein was significantly higher in Sjögren's syndrome conjunctiva samples (P = 0.012). Tear EGF concentration correlated with Schirmer 1 scores (rho 0.767, P < 0.001), corneal fluorescein staining scores (rho -0.562, P = 0.01), conjunctival goblet cell density (rho 0.661, P = 0.001) and the levels of IL-1alpha_and IL-8 RNA in the conjunctival epithelium (rho -0.677 and -0.747, respectively, P = 0.001). Both IL-1alpha_and IL-8 RNA in the conjunctival epithelium increased as Schirmer 1 scores decreased (P </= 0.001). IL-8 RNA level correlated with corneal fluorescein staining (rho 0.690, P = 0.001) and conjunctival goblet cell density (rho -0.767, P < 0.001). A significant decrease in IL-8 RNA level, corresponding to improvement in irritation symptoms and ocular surface disease, was observed in six eyes after two weeks of topical corticosteroid therapy. CONCLUSIONS The balance of cytokines in the tear fluid and conjunctival epithelium is altered in Sjögren's syndrome. The severity of keratoconjunctivitis sicca in this condition increases as tear fluid EGF concentration decreases and levels of inflammatory cytokines in the conjunctival epithelium increase. These findings provide new insight into the pathogenesis of keratoconjunctivitis and provide potential targets for therapy.
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Affiliation(s)
- S C Pflugfelder
- Ocular Surface and Tear Center Bascom Palmer Eye Institute University of Miami School of Medicine Department of Ophthalmology Miami, FL 33136, USA.
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Wilson SE, Li Q, Mohan RR, Tervo T, Vesaluoma M, Bennett GL, Schwall R, Tabor K, Kim J, Hargrave S, Cuevas KH. Lacrimal gland growth factors and receptors: lacrimal fibroblastic cells are a source of tear HGF. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1998; 438:625-8. [PMID: 9634946 DOI: 10.1007/978-1-4615-5359-5_88] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- S E Wilson
- Eye Institute, Cleveland Clinic Foundation, Ohio, USA
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Dellaert MM, Casey TA, Wiffen S, Gordon J, Johnson P, Geerards AJ, Rijneveld WJ, Remeijer L, Mulder PG, Beekhuis WH. Influence of topical human epidermal growth factor on postkeratoplasty re-epithelialisation. Br J Ophthalmol 1997; 81:391-5. [PMID: 9227205 PMCID: PMC1722180 DOI: 10.1136/bjo.81.5.391] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM To test the efficacy and safety of recombinant human epidermal growth factor (hEGF) on corneal re-epithelialisation following penetrating keratoplasty. METHODS A prospective, randomised, placebo controlled study was carried out in which patients were matched for diagnosis and received either hEGF ophthalmic solution (30 micrograms/ml or 100 micrograms/ml) or placebo in a double masked fashion. Matched pairs of patients received donor corneas from the same donor and were operated by the same surgeon on the same day. At the end of surgery all donor epithelium was removed mechanically. Patients were examined twice daily and fluorescein stained photographs were taken until the epithelium had closed. The area of the defect was measured by planimetry of the fluorescein stained defect on the photographs. RESULTS There were no significant differences in re-epithelialisation of the donor cornea between the placebo group and the group treated with 30 micrograms/ml hEGF. Time until complete closure was slightly longer with 100 micrograms/ml hEGF compared with 30 micrograms/ml hEGF and with placebo. Mean healing rate of the epithelial defect with 100 micrograms/ml hEGF was significantly slower than in the other groups. CONCLUSION No significant acceleration of corneal re-epithelialisation was demonstrated with the use of recombinant hEGF after penetrating keratoplasty in humans.
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Affiliation(s)
- M M Dellaert
- Cornea Service, Rotterdam Eye Hospital, Rotterdam, The Netherlands
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19
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Pflugfelder SC, Tseng SC, Yoshino K, Monroy D, Felix C, Reis BL. Correlation of goblet cell density and mucosal epithelial membrane mucin expression with rose bengal staining in patients with ocular irritation. Ophthalmology 1997; 104:223-35. [PMID: 9052626 DOI: 10.1016/s0161-6420(97)30330-3] [Citation(s) in RCA: 160] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This study was designed to compare goblet cell densities and mucosal epithelial membrane mucin (MEM) expression in impression cytology specimens obtained from control subjects and patients with one of the following clinically defined diseases: aqueous tear deficiency (ATD) associated with Sjögren syndrome, ATD not associated with Sjögren syndrome, inflammatory Meibomian gland disease associated with rosacea, and Meibomian gland atrophy. These data were correlated with ocular surface rose Bengal staining scores, Schirmer scores, and HLA-DR antigen staining of conjunctival epithelial cells. METHODS Goblet cell density and MEM expression were studied by impression imprints with immunohistochemical staining using an anti-mucosal epithelial membrane mucin antibody in the temporal and inferior bulbar and inferior tarsal conjunctiva of study subjects. RESULTS Goblet cell density adjacent to the temporal limbus was significantly reduced at 3 mm posterior to the temporal limbus in both aqueous tear deficiency groups compared with the other groups and in patients with Sjögren syndrome compared with all other groups. In the inferior tarsus, goblet cell density was significantly reduced in patients with non-Sjögren syndrome ATD as compared with all other groups, except those with inflammatory Meibomian gland disease. Mucosal epithelial membrane mucin expression in the bulbar and tarsal conjunctiva was absent in a greater percentage of patients with Sjögren syndrome compared with all other groups. Total ocular surface rose Bengal staining scores were significantly higher in patients with Sjögren syndrome as compared with all other groups and in patients with non-Sjögren syndrome ATD as compared with control groups. Rose Bengal staining scores and Schirmer I test results (without anesthesia) were inversely correlated with bulbar, but not tarsal, conjunctival goblet cell densities, and with the absence of bulbar conjunctival MEM expression. CONCLUSIONS These results suggest that reduced goblet cell density and mucosal epithelial cell mucin expression could explain increased rose Bengal staining in patients with aqueous tear deficiency. In addition, MEM may be regarded as a marker for normal differentiation of ocular surface epithelia, with its absence signifying the development of squamous metaplasia.
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Affiliation(s)
- S C Pflugfelder
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, FL 33136, USA
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Rask R, Jensen PK, Ehlers N. Epithelial healing in the second eye after corneal abrasion. ACTA OPHTHALMOLOGICA SCANDINAVICA 1996; 74:232-4. [PMID: 8828717 DOI: 10.1111/j.1600-0420.1996.tb00082.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Corneal epithelial healing velocity was determined in patients admitted to excimer laser photo refractive keratectomy, by daily video planimetry of the denuded area until complete healing. The epithelial healing process was followed in fellow eyes with regard to intervals between surgery of the two eyes of 1 to 10 weeks. In cases where the fellow eye was treated at one week after the first eye, the lesions healed significantly faster in the second eye as compared to patients with longer delay between the two operations.
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Affiliation(s)
- R Rask
- Department of Ophthalmology, Arhus University Hospital, Denmark
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21
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van Setten GB. Basic fibroblast growth factor in human tear fluid: detection of another growth factor. Graefes Arch Clin Exp Ophthalmol 1996; 234:275-7. [PMID: 8964535 DOI: 10.1007/bf00430422] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Topical application of various growth factors have shown promising experimental data in speeding up corneal wound healing. Similar effects have been reported for another group of proteins, fibroblast growth factors (FGFs). One of them, basic FGF (bFGF), stimulates the proliferation of cells of mesodermal as well as of neuroectodermal origin and is highly angiogenic. The aim of the present study was to investigate the presence of bFGF in human tear fluid. METHODS After establishing an advanced enzyme-linked immunosorbent assay technique, tear fluid was collected from 15 healthy individuals before and after stimulation of reflex tearing. RESULTS In none of the tear fluid samples collected prior to induction of reflex tearing could FGF be detected. Of the 15 samples collected during reflex tearing, six (40%) contained measurable amounts of bFGF. The amount of bFGF appeared to decrease with increasing tear fluid flow, suggesting a dilution effect. CONCLUSION This study gives strong evidence that bFGF, as previously shown for epidermal growth factor and transforming growth factor-alpha, may occur in human tear fluid of healthy individuals after induction of reflex tearing and, in very low concentrations, under normal conditions. Whether bFGF can to be considered a constant component of tear fluid, however, remains to be investigated.
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Affiliation(s)
- G B van Setten
- Karolinska Institutet, S:t Eriks Eye Clinic DOHF Laboratory, Stockholm, Sweden
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22
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Sheardown H, Cheng YL. Tear EGF concentration following corneal epithelial wound creation. J Ocul Pharmacol Ther 1996; 12:239-43. [PMID: 8875329 DOI: 10.1089/jop.1996.12.239] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The effect of corneal epithelial wound creation on epidermal growth factor (EGF) concentration in tears was evaluated in order to better understand the effects of EGF on the wound healing process. The tears of New Zealand white rabbits were sampled by micropipette one day prior to wounding, immediately prior to the creation of a 7.5 mm diameter anterior keratectomy wound, immediately following wound creation, and at 1, 2, 3, 7, and 14 days following wounding. A volume of 50 microL was taken at each sampling time, and all tear samples were assayed for EGF by an enzyme linked immunosorbent assay (ELISA). The results demonstrated that the concentration of EGF in the tear layer rises dramatically immediately following wound creation. The basal measured EGF concentration was approximately 600 pg/mL; immediately following wound creation, this rose to approximately 1600 pg/mL. By 1 day following creation of the wound, the concentration of EGF in the tears had returned to the basal level. A second, marginally significant increase in the tear concentration was noted at 3 days post wounding. The EGF concentration in the tears were not significantly different at any other time. The measured dramatic rise in EGF concentration in the tears in response to the creation of a corneal epithelial wound provides further evidence of the importance of tear EGF in the wound healing process. The concentrations in all cases were on the order of ng/mL, suggesting that the intercellular concentrations in this range result in optimal cell stimulation.
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Affiliation(s)
- H Sheardown
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Ontario, Canada
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23
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24
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Virtanen T, Ylätupa S, Mertaniemi P, Partanen P, Tuunanen T, Tervo T. Tear Fluid Cellular Fibronectin Levels After Photorefractive Keratectomy. J Refract Surg 1995; 11:106-12. [PMID: 7634139 DOI: 10.3928/1081-597x-19950301-10] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Fibronectin is supposed to have an important role in wound healing. The extradomain A-containing cellular fibronectin (EDAcFn) refers to fibronectin, which instead of being a hepatocyte derived component of blood plasma or body fluids, is produced locally. The present study was undertaken to clarify the possible changes in excretion of EDAcFn in tears following excimer laser photorefractive keratectomy (PRK). METHODS An immunoassay was used to determine EDAcFn concentrations in human tear fluid samples of 11 eyes after PRK. Tear fluids were collected with scaled microcapillaries preoperatively as well as 1, 2, and 7 days after PRK. The time used to collect a known volume of tears was registered. This was done to estimate the dilution effect related to the hypersecretion of tears after PRK. RESULTS The mean preoperative tear fluid EDAcFn concentration was 0.28 +/- 0.07 ng/microliter with a wide range (0.05 to 0.63). The tear fluid flow-corrected excretion of EDAcFn was 1.36 +/- 0.35 ng/min (range, 0.145 to 3.50). There was a significant increase in both postoperative tear fluid flow and excretion of EDAcFn on days 1 and 2. The elevation of the mean EDAcFn concentration did not decrease in spite of reflex tearing. The mean excretion of EDAcFn in tears was 28-fold on the first and 17-fold on the second postoperative day. Normal level was reached by day 7. CONCLUSION There is a rapid increase in excretion of EDAcFn in tears following PRK. This seems to last only as long as an epithelial defect persists. The epithelium of all eyes healed in 3 to 4 days in spite of wide interindividual variations in both tear fluid flow and EDAcFn excretion.
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Affiliation(s)
- T Virtanen
- Department of Ophthalmology, University of Helsinki, Finland
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25
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van Setten G, Schultz G. Transforming growth factor-alpha is a constant component of human tear fluid. Graefes Arch Clin Exp Ophthalmol 1994; 232:523-6. [PMID: 7959090 DOI: 10.1007/bf00181994] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Growth factors are known as a family of polypeptides with powerful influences on angiogenesis, tumor growth and wound healing. Transforming growth factor-alpha (TGF-alpha) and epidermal growth factor (EGF) are structurally related peptides which bind to the same receptor, EGF-R, and also exert similar effects. EGF is a natural component of human tears, and ocular disease leads to decreased concentrations in tear fluid. Using a sensitive radioimmunoassay we investigated whether TGF-alpha is also to be considered a natural component of tear fluid and in which concentrations it occurs. All of 46 tear fluid samples from 24 volunteers contained TGF-alpha. The mean concentration was 161.4 pg TGF-alpha/ml (SD 11.6 pg). No statistically significant correlation was found between tear fluid flow and TGF-alpha concentration in the sample. However, the concentration of TGF-alpha in tear fluid decreased significantly with increasing total time of tear fluid collection (P = 0.002). TGF-alpha levels in samples collected from males (n = 16) appeared to be higher (mean 247.0 pg/ml, SD 15.3 pg/ml) than in those from females (n = 30; mean 180.0 pg/ml, SD 8.5 pg/ml; P = 0.05). No correlation was found between the age of the individuals and the concentration of TGF-alpha in their tear fluid. The findings show that TGF-alpha is, like EGF, a constant component of human tear fluid. The dependence of TGF-alpha concentration on tear fluid flow and the physiological importance of its presence for corneal integrity and ocular surface physiology, however, require further investigation.
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Affiliation(s)
- G van Setten
- Karolinska Institut, St. Eriks Eye Clinic, Laboratory of Dacryology, Stockholm, Sweden
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Wilson SE. Growth factor and receptor messenger RNA production in human lacrimal gland tissue. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1994; 350:197-204. [PMID: 8030477 DOI: 10.1007/978-1-4615-2417-5_35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- S E Wilson
- Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas 75235
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Kijlstra A, Kuizenga A. Analysis and function of the human tear proteins. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1994; 350:299-308. [PMID: 8030492 DOI: 10.1007/978-1-4615-2417-5_51] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- A Kijlstra
- Graduate School Neurosciences Amsterdam, The Netherlands Ophthalmic Research Institute
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28
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van Setten GB, Schultz GS, Macauley S. Growth factors in human tear fluid and in lacrimal glands. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1994; 350:315-9. [PMID: 8030495 DOI: 10.1007/978-1-4615-2417-5_53] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
EGF has been shown to be a constant component of human tear fluid. Its concentration depends on the actual tear fluid flow, as shown for other proteins secreted by the lacrimal gland. This organ has also been considered to be the origin of tear fluid EGF and immunohistochemical evidence for this hypothesis was found. During corneal disease the concentration of EGF in tear fluid considerably decreases to levels even lower than those found during short time stimulation of reflex tearing. Other members of the EGF family, such as TGF-alpha, have considerable similarity with the EGF molecule and even bind to the same receptor. Currently it is thought that TGF-alpha may be, in certain phases of cell life, even more important in the regulation of cell metabolism than EGF. In the present study we have investigated the presence of TGF-alpha in tear fluid and the lacrimal gland. The initial results presented here, show for the first time that TGF-alpha like EGF, seems to be constant component of human tear fluid and to originate, at least partially, from the lacrimal gland.
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Affiliation(s)
- G B van Setten
- Karolinska Institute, St. Eriks Eye Clinic, Laboratory for Dacryology, Stockholm, Sweden
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Abstract
Wound healing is a complex, long-lasting regulatory sequence that involves expression of a number of genes, which are active during the individual's development. Some of the phenomena differ from normal tissue turnover and growth only quantitatively. This article reviews the current data on corneal wound healing, with particular reference to mesenchymal matrix proteins and their integrin receptors, to growth factors and to proteolytic enzymes. Some inflammatory mediators are also discussed. The theoretical basis for therapeutic interventions is also discussed briefly, in the light of present knowledge.
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Affiliation(s)
- T Tervo
- Department of Ophthalmology, University of Helsinki, Finland
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