Efficacy of intravitreal bevacizumab for polypoidal choroidal vasculopathy

AIMS

The aim of the study was to assess the short-term efficacy of intravitreal injections of bevacizumab for polypoidal choroidal vasculopathy (PCV).

METHODS

Intravitreal bevacizumab (1 mg) was injected into 11 eyes of 11 patients with PCV in this retrospective, interventional case series. The main outcome measure was the change in the polypoidal vessels on indocyanine green angiography (IA) 3 months after injection. The foveal height determined by optical coherence tomography and the best-corrected visual acuity (BCVA) also were evaluated before and after treatment.

RESULTS

At baseline, subretinal fluid was observed in five eyes and a pigment epithelial detachment in eight eyes. The foveal height 1 month after injection decreased significantly (p = 0.023), but at 3 months, no significant decrease was observed, although an additional injection was administrated in five of 11 eyes. The IA at 3 months showed resolution of polyps in one eye but residual or enlarged lesions in the other ten eyes. The BCVA did not improve significantly, although the subjects had relatively good BCVA at baseline (mean 0.45).

CONCLUSION

Intravitreal injection of bevacizumab may reduce the fluid from PCV but seems to be ineffective for diminishing its choroidal vascular changes.

Intravitreal injection of bevacizumab for choroidal neovascularisation associated with pathological myopia

AIM

To assess the efficacy and safety of an intravitreal injection of bevacizumab (Avastin(R)) for myopic choroidal neovascularisation (mCNV).

METHODS

Intravitreal bevacizumab (1 mg) was injected into eight eyes of eight patients with mCNV in this non-randomised, interventional case series. The best-corrected visual acuity (BCVA) was measured and the optical coherence tomography (OCT) and fluorescein angiography findings were examined before and after treatment. The minimum follow-up time was 3 months.

RESULTS

The mean BCVA was 0.26 before treatment and 0.51 at the last visit (p = 0.009). The BCVA improved to two or more lines in six eyes (75%) and remained the same in two eyes (25%). Leakage from the mCNV on fluorescein angiography decreased in seven eyes (87.5%). The choroidal neovascularisation area on fluorescein angiography (p = 0.049) and the foveal thickness on OCT images decreased significantly (p = 0.027) after the treatment. No major complications developed.

CONCLUSION

Intravitreal injection of bevacizumab seems to be an effective and safe treatment for mCNV.

Induced HMGA1a expression causes aberrant splicing of Presenilin-2 pre-mRNA in sporadic Alzheimer's disease

The aberrant splicing isoform (PS2V), generated by exon 5 skipping of the Presenilin-2 (PS2) gene transcript, is a diagnostic feature of sporadic Alzheimer's disease (AD). We found PS2V is hypoxia-inducible in human neuroblastoma SK-N-SH cells. We purified a responsible trans-acting factor based on its binding to an exon 5 fragment. The factor was identified as the high mobility group A1a protein (HMGA1a; formerly HMG-I). HMGA1a bound to a specific sequence on exon 5, located upstream of the 5' splice site. HMGA1a expression was induced by hypoxia and the protein was accumulated in the nuclear speckles with the endogenous splicing factor SC35. Overexpression of HMGA1a generated PS2V, but PS2V was repressed by cotransfection with the U1 snRNP 70K protein that has a strong affinity to HMGA1a. HMGA1a could interfere with U1 snRNP binding to the 5' splice site and caused exon 5 skipping. HMGA1a levels were significantly increased in the brain tissue from sporadic AD patients. We propose a novel mechanism of sporadic AD that involves HMGA1a-induced aberrant splicing of PS2 pre-mRNA in the absence of any mutations.

Activation of caspase-12, an endoplastic reticulum (ER) resident caspase, through tumor necrosis factor receptor-associated factor 2-dependent mechanism in response to the ER stress

When accumulation of a malfolded protein in the endoplastic reticulum (ER) is induced by various adverse conditions, such as hypoxia, glucose starvation, and perturbation of calcium homeostasis, cells respond to the stress by increasing transcription of genes encoding ER molecular chaperones, a process known as unfolded protein response. The signaling is initiated by IRE1s, ER stress sensors. Alternatively, excessive stress to the ER results in apoptosis. Caspase-12 is known to be essential for this ER stress-induced apoptosis. In this study, we analyzed the detailed regulatory mechanisms of IRE1s during ER stress. We identified c-Jun N-terminal inhibitory kinase (JIK) as a binding partner of IRE1alpha, and JIK was seen to modulate IRE1alpha-TRAF2 (tumor necrosis factor receptor-associated factor 2) complex formation and the resultant alteration to c-Jun N-terminal kinase signaling from IRE1s in response to ER stress. We also demonstrated that TRAF2 interacts with procaspase-12 and promotes the clustering of procaspase-12 and its activation by cleavage in response to ER stress. These results indicate that TRAF2 plays crucial roles not only in the signaling of the c-Jun N-terminal kinase pathway but also in activation of caspase-12 to transduce signals from IRE1s. Thus, we provide a missing link in the ER stress-induced apoptosis-signaling pathway, one which connects the stress sensor molecule IRE1 and the activation of caspase-12.

Characterization of mouse Ire1 alpha: cloning, mRNA localization in the brain and functional analysis in a neural cell line

In yeast, an endoplasmic reticulum (ER)-associated protein, Ire1p, is believed to initiate the unfolded protein response (UPR), that is responsible for protein folding in the ER under stressed conditions. Two mammalian homologs of Ire1p have been identified, Ire1 alpha and Ire1 beta. We have previously reported that familial Alzheimer's disease linked presenilin-1 variants downregulate the signaling pathway of the UPR by affecting the phosphorylation of Ire1 alpha. In the present study, we cloned the mouse homolog of Ire1 alpha for generating genetically modified mice. Ire1 alpha was ubiquitously expressed in all mouse tissues examined, and was expressed preferentially in neuronal cells in mouse brain. This led us to investigate the effects of the downregulation of the UPR on the survival of neuronal cells under conditions of ER stress. Morphological and biochemical studies using a dominant-negative form of mouse Ire1 alpha have revealed that cell death caused by ER stress can be attributed to apoptosis, and that the downregulation of the UPR enhances the apoptotic process in the mouse neuroblastoma cell line, Neuro2a. Our results indicate that genetically modified mice such as transgenic mice with a dominant-negative form of Ire1 alpha might provide further understanding of the pathogenic mechanisms of Alzheimer's disease and other neurodegenerative disorders.

Molecular cloning of a novel membrane glycoprotein, pal, specifically expressed in photoreceptor cells of the retina and containing leucine-rich repeat

We have isolated a novel retina-specific gene in a screen for genes of which expression is not apparent neonatally in rat retina but is abundant postnatally on day 14 (P14). This gene, named Pal, encodes a putative type I transmembrane protein containing five leucine-rich repeats (LRRs), a single C2-type Ig-like domain, and a single fibronectin type III domain and is considered to be a new member of the LRR and Ig superfamily. No expression of Pal was found in rat retina at P1, but it was detected at P7 and markedly increased with subsequent development. These expression patterns of Pal appeared to be correlated with the development of the photoreceptor outer segments, because in the adult rat retina it was specifically localized in these segments. Ultrastructually, Pal immunoreactivity was distributed diffusely on the disk membrane in the lamellar regions. On the basis of its structural features and localization pattern, Pal may act as a receptor for a certain trophic factor or for an adhesion molecule participating in morphogenesis. The human homolog of Pal was mapped to chromosome 10q23.2-23.3 using fluorescence in situ hybridization.

Regulatory mechanisms of TRAF2-mediated signal transduction by Bcl10, a MALT lymphoma-associated protein

To elucidate the function of Bcl10, recently cloned as an apoptosis-associated gene mutated in MALT lymphoma, we identified its binding partner TRAF2, which mediates signaling via tumor necrosis factor receptors. In mammalian cells, low levels of Bcl10 expression promoted the binding of TRAF2 and c-IAPs. Conversely, excessive expression inhibited complex formation. Overexpressed Bcl10 reduced c-Jun N-terminal kinase activation and induced nuclear factor kappaB activation downstream of TRAF2. To determine whether overexpression of Bcl10 could perturb the regulation of apoptosis in vivo, we generated Bcl10 transgenic mice. In these transgenic mice, atrophy of the thymus and spleen was observed at postnatal stages. The morphological changes in these tissues were caused by acceleration of apoptosis in T cells and B cells. The phenotype of Bcl10 transgenic mice was similar to that of TRAF2-deficient mice reported previously, indicating that excessive expression of Bcl10 might deplete the TRAF2 function. In contrast, in the other organs such as the brain, where Bcl10 was expressed at high levels, no apoptosis was detected. The altered sensitivities to overexpressed Bcl10 may have been due to differences in signal responses to Bcl10 among cell types. Thus, Bcl10 was suggested to play crucial roles in the modulation of apoptosis associated with TRAF2.

Changes in mRNA of protein inhibitor of neuronal nitric oxide synthase following facial nerve transection

Protein inhibitor of neuronal nitric oxide synthase (PIN) is reported as the protein inhibiting neuronal nitric oxide synthase (nNOS) activity by preventing dimerization of nNOS. It was also reported that PIN inhibits the activity of all nitric oxide synthase (NOS) isozymes. We examined the effects of facial nerve transection on PIN mRNA and NOS expression by in situ hybridization for PIN mRNA and nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) staining. PIN mRNA was initially expressed and transiently increased from 3 to 5 days and returned to the basal level at 7 days after axotomy in the motoneurons of the facial nucleus. NADPH-d-positive motoneurons were found from 7 days post-operation in the facial nucleus. These results suggest that PIN may interact with NOS from 7 days post-operation.

Presenilin-1 mutations downregulate the signalling pathway of the unfolded-protein response

Missense mutations in the human presenilin-1 (PS1) gene, which is found on chromosome 14, cause early-onset familial Alzheimer's disease (FAD). FAD-linked PS1 variants alter proteolytic processing of the amyloid precursor protein and cause an increase in vulnerability to apoptosis induced by various cell stresses. However, the mechanisms responsible for these phenomena are not clear. Here we report that mutations in PS1 affect the unfolded-protein response (UPR), which responds to the increased amount of unfolded proteins that accumulate in the endoplasmic reticulum (ER) under conditions that cause ER stress. PS1 mutations also lead to decreased expression of GRP78/Bip, a molecular chaperone, present in the ER, that can enable protein folding. Interestingly, GRP78 levels are reduced in the brains of Alzheimer's disease patients. The downregulation of UPR signalling by PS1 mutations is caused by disturbed function of IRE1, which is the proximal sensor of conditions in the ER lumen. Overexpression of GRP78 in neuroblastoma cells bearing PS1 mutants almost completely restores resistance to ER stress to the level of cells expressing wild-type PS1. These results show that mutations in PS1 may increase vulnerability to ER stress by altering the UPR signalling pathway.

IPP isomerase, an enzyme of mevalonate pathway, is preferentially expressed in postnatal cortical neurons and induced after nerve transection

To understand the molecular mechanisms underlying the developmental processes of the cerebral cortex, we screened genes whose mRNA expression was up-regulated in neonatal in the rat cortex to a greater extent than in adult by differential display and obtained five genes. Among these genes, we focused on pyrophosphate (isopentenyl diphosphate, dimethylallyl diphosphate: IPP) isomerase gene, the product of which is known as an enzyme of the mevalonate pathway. Rat IPP isomerase was recently cloned and the gene expression was shown to be dependent on the activation of the mevalonate pathway. Its expression and roles in the brain, however, have not been investigated hitherto. In the present study, Northern blots and in situ hybridization analysis showed that at embryonic stage weak signals for IPP mRNA were diffusely detected in the CNS, and the signal in the cortex became intense at postnatal day 1 and maximized in almost all neurons of all layers at postnatal day 7 with a subsequent reduction. At 8 weeks, the expression of IPP isomerase mRNA in neurons decreased, while it was detected in the oligodendrocytes in the regions containing abundant nerve fibers. These findings suggested that IPP isomerase contributes to postnatal neuronal maturation and myelination. We also demonstrated that IPP isomerase mRNA is induced after nerve axotomy, which suggests a relationship between neuronal regeneration and IPP isomerase. Taken together, these results suggest that elevation of IPP isomerase mRNA levels in neurons contributes to construction of nerve fibers both during the postnatal period in the cortex and their regeneration.

[Long-term results after simple vitrectomy for age-related macular degeneration with vitreous hemorrhage]

We reviewed the cases of 10 eyes with vitreous hemorrhage secondary to submacular hemorrhage associated with age-related macular degeneration, in which vitrectomy was performed without subretinal management. Vitreous hemorrhage occurred within 3 weeks of submacular hemorrhage. After vitrectomy, residual subretinal hemorrhage was rapidly absorbed and choroidal neovascularization was undetectable. After the surgery visual acuity improved over that of submacular hemorrhage in 5 eyes. Mean follow-up was 25 months and final visual acuity was 0.2 or better in 6 eyes (60%). Final visual outcome was highly corelated with the period from subretinal hemorrhage to vitrectomy, the thickness of subfoveal hemorrhage at vitrectomy, position of choroidal neovascularization, and duration of subretinal hemorrhage. Simple virectomy might be effective to stabilize submacular changes and improve visual acuity.

Effects of aging and food restriction on the antioxidant enzyme activity of rat livers

The effects of aging and food restriction on the activities and mRNA levels of antioxidant enzymes in rat livers were examined. Rats were fed ad libitum every day (AL) or ad libitum on every other weekday (FR). At 30 months of age, the catalase and glutathione peroxidase activities were lower, whereas the thiobarbituric acid (TBA) value, an index of lipid peroxidation of the AL rats, was higher than that at younger ages. At 33 months of age, copper/zinc superoxide dismutase (CuZnSOD), catalase, and glutathione peroxidase activities increased, and the TBA value of the FR rats remained unchanged as compared with those at younger ages. Until old age, food restriction gave rather decreasing effects on antioxidant enzyme activities. Furthermore, antioxidant enzyme activities and the TBA values of the FR rats were higher at the end of a fasting period than those at the end of a feeding period.

Effect of copper deficiency on the activity levels of ceruloplasmin and superoxide dismutase in tissues of young and old rats

Six- and 24-month-old rats were fed a copper deficient diet for 10 weeks; the copper content of the diet was one fourteenth that of a control diet. After the 10-week feeding period, the copper contents of the cerebrums, livers, lungs, and serum were decreased by 20-17, 49-47, 48-37, and 84-83%, respectively, while those of hearts and muscles were unchanged or only slightly decreased. There was no difference in the decreases in copper content of tissues between young and old rats. Copper deficiency decreased the activity level of ceruloplasmin in the serum of young and old rats by 95%, and the copper/zinc superoxide dismutase (CuZn-SOD) activity levels of cerebrums, lungs, and livers of young rats by 16, 36, and 34%, respectively, but did not change the CuZn-SOD activity levels of tissues of old rats. Although copper deficiency affected catalase activity, vitamin E concentration, and reduced glutathione concentration in several tissues, no consistent trends were observed. On the basis of the survival time of rats exposed to more than 96% oxygen, it is suggested that a decrease in CuZn-SOD activity due to copper deficiency increases oxygen susceptibility.

Effects of oxygen inhalation on the antioxidant capacity of lungs, livers, and brains in normal and vitamin E-deficient rats at various ages

The effects of oxygen inhalation for 48 h on the antioxidant capacity of lungs, livers, and brains in normal and vitamin E-deficient rats at various ages were examined. The activity levels of catalase, glutathione peroxidase, and superoxide dismutase, and the level of vitamin E in tissue homogenates were assayed as the indices of antioxidant capacity. Oxygen inhalation mostly decreased antioxidant enzyme activity in lungs. In particular, the catalase activity was much decreased. The glutathione peroxidase activity tended to be decreased. The superoxide dismutase activity was decreased in 32-month-old rats. Vitamin E deficiency did not augment oxidative damage due to oxygen inhalation. There appears to be no age effect on the oxygen-induced decrease in the antioxidant enzyme activities of lungs, except the superoxide dismutase activity in very old rats. Oxygen inhalation had some effects on the antioxidant capacity of livers and brains. For example, oxygen inhalation decreased the vitamin E concentration of livers in 32-month-old, normal rats. These results suggest that the antioxidant capacity of lungs is directly damaged by oxygen inhalation and that the antioxidant capacity of livers and brains is indirectly affected through lung damage. Antioxidant capacity may be maintained without large variation during young and middle ages, but its redundancy for emergency use may be diminished in old age.

Food restriction suppresses an age-dependent increase in the exhalation rate of pentane from rats: a longitudinal study

Longitudinal age changes in the exhalation rates of ethane and pentane, which are used as the indices of in vivo lipid peroxidation, from rats under ad libitum feeding and food restriction were measured. The exhalation rate of ethane or pentane from old, ad libitum-fed rats is higher than that of the corresponding hydrocarbon from young, ad libitum-fed rats, as reported previously. There is no difference between the exhalation rates of each hydrocarbon from young, ad libitum-fed and food-restricted rats. However, the exhalation rate of pentane from old, food-restricted rats is significantly lower than that from old, ad libitum-fed rats, while the exhalation rate of pentane from old, food-restricted rats tends to be lower than that from old, ad libitum-fed rats. In addition, the exhalation rate of pentane from old, food-restricted rats is equivalent to that from young, ad libitum-fed rats. These results are consistent with the views that in vivo lipid peroxidation in rats is increased during aging, and that the age-dependent increase in in vivo lipid peroxidation is suppressed by food restriction.

Aging retards spin clearance from mouse brain and food restriction prevents its age-dependent retardation

After the nitroxyl radical 3-carbamoyl-2,2,5,5-tetramethyl-1-pyrrolidinyloxyl (carbamoylPROXYL) was intraperitoneally administered to mice, the time courses of changes in the intensity of signals in L-band electron spin resonance spectra from their brains were measured. The spin clearance rate of old, ad libitum-fed mice was lower than that of young, ad libitum-fed mice. The rate of old, food-restricted mice was significantly higher than that of old, ad libitum-fed mice and was comparable to that of young, ad libitum-fed mice. The spin clearance was found to be due to the one-electron reduction of the nitroxyl radical, because a decreased spin intensity of it in serum was restored to the original level by potassium hexacyanoferrate (III) oxidation in vitro. These results suggest that reducing capacity in the cardiovascular system of mice is decreased with advancing age, and that food restriction prevents an age-dependent decrease in the reducing capacity.

Age-related alterations in antioxidant capacity and lipid peroxidation in brain, liver, and lung homogenates of normal and vitamin E-deficient rats

Age-related alterations in both antioxidant capacity and lipid peroxidation in the cerebrum, lung and liver homogenates of normal and vitamin E-deficient rats were investigated. The antioxidant capacity, which includes superoxide dismutase, catalase and glutathione peroxidase activities and vitamin E (alpha-tocopherol) concentration, was relatively stable throughout the lifespan. It was observed, however, that catalase and glutathione peroxidase activities in livers of old rats decreased and that vitamin E concentration in lung and liver increased with age. In vitamin E-deficient animals, catalase activity in liver increased and glutathione peroxidase activity in liver and lung decreased. Lipid peroxidation was monitored by use of three different indices, i.e. the thiobarbituric acid (TBA) value, oxygen absorption and conjugated-diene formation. In the absence of any initiator, neither oxygen absorption into tissue homogenates nor conjugated-diene formation in lipid extracts from the homogenates occurred. The TBA value of each cerebrum homogenate incubated under air or an oxygen atmosphere was larger than that of the corresponding unincubated cerebrum homogenate. From comparison between the TBA value and oxygen absorption, this increase in the TBA value was suggested to be due to some reactions other than lipid peroxidation. Although tissue homogenates examined contained TBA-reacting materials, no lipid peroxidation seems to arise during incubation of them. No age-related alterations in the TBA value and oxygen absorption in rat tissue homogenates were observed. Vitamin E deficiency had no effect on the TBA values of cerebrum and lung homogenates, while it seemed to increase the TBA values of liver homogenates. Vitamin E deficiency had no effect on oxygen absorption in these tissue homogenates. The induction period of initiator-induced conjugated-diene formation in lipid extracts from liver and lung homogenates from normal and vitamin E-deficient rats tended to be extended with age. Vitamin E deficiency decreased the induction period of initiator-induced conjugated-diene formation. As a result, the length of the induction period was found to be proportional to vitamin E concentration in lipid extracts. The overall antioxidant capacity of rat tissues appears to be maintained without large variation during ageing. Decreases in the capacity of some antioxidant factors may be compensated by increases in the capacity of other factors.

Experimental studies on intra-abdominal adhesions

Various intra-abdominal adhesions have been produced in rats and mice.

Those animals given an intra-peritoneal injection of protoporphyrin showed a reduction of adhesion formation.

Its mechanism has been discussed in view of Ellis's concept.

It seems to be appropriate to use PPN for patients who may develop post-operative adhesions.