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Valencia-Nieto L, Pinto-Fraga J, Blanco-Vázquez M, Fernández I, López-Miguel A, García-Vázquez C, González-García MJ, Enríquez-de-Salamanca A, Calonge M. Short-Term Efficacy of Ophthalmic Cyclosporine: A 0.1% Cationic Emulsion in Dry Eye Patients Assessed Under Controlled Environment. Ophthalmol Ther 2024; 13:1197-1210. [PMID: 38446281 DOI: 10.1007/s40123-024-00906-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION To evaluate the short-term efficacy of cyclosporine A (CsA)-0.1% cationic emulsion (CE) in patients with dry eye disease (DED) and mitigation of the inflammatory flares triggered by desiccating stress environments. METHODS A single-center non-randomized clinical trial was performed at a tertiary care setting. Twenty patients with DED treated with CsA 0.1% CE were exposed to a normal controlled environment (NCE) (23 °C, 50% relative humidity) and an adverse controlled environment (ACE) (23 °C, 10% relative humidity, 0.43 m/s localized airflow) during baseline and the 1- and 3-month visits. Patients underwent the following evaluations: conjunctival hyperemia and staining, corneal fluorescein staining (CFS) using the Oxford and Cornea and Contact Lens Research Unit (CCLRU) scale, meibomian gland (MG) secretion quality, Dry Eye Questionnaire-5, Symptom Assessment in Dry Eye (SANDE II), and Change in Dry Eye Symptoms Questionnaire. Multivariate models were adjusted for statistical analysis. RESULTS Nineteen women and one man (mean age, 58.9 ± 12.3 years) completed the study. All symptom questionnaires, CFS, conjunctival hyperemia and staining, and MG secretion quality improved (p ≤ 0.003) with 1 month of treatment; improvements were maintained after 3 months (p ≤ 0.02), except for SANDE II (p ≥ 0.07). The CFS worsening (total CCLRU) after baseline ACE exposure (from 8.6 to 10.1) was higher, although not significant (p = 0.64), compared with 1 month (from 5.4 to 5.8) and 3 months (from 5.0 to 5.9) after treatment. CONCLUSION Topical CsA-0.1% CE improved DED signs and symptoms after 1 month of treatment under controlled environmental conditions. Future studies should confirm the benefit of CsA-0.1% CE in desiccating stress environments. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT04492878.
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Affiliation(s)
- Laura Valencia-Nieto
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
| | - José Pinto-Fraga
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
| | - Marta Blanco-Vázquez
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
| | - Itziar Fernández
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Alberto López-Miguel
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain.
| | - Carmen García-Vázquez
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
| | - María J González-García
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Amalia Enríquez-de-Salamanca
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Margarita Calonge
- Instituto de Oftalmobiología Aplicada (IOBA), University of Valladolid, Campus Universitario Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
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Domínguez-López A, Blanco-Vázquez M, Calderón-García AÁ, García-Vázquez C, González-García MJ, Calonge M, Enríquez-de-Salamanca A. Analysis of the mucosal chemokines CCL28, CXCL14, and CXCL17 in dry eye disease: An in vitro and clinical investigation. Exp Eye Res 2024; 241:109854. [PMID: 38453037 DOI: 10.1016/j.exer.2024.109854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/21/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
Mucosal chemokines have antimicrobial properties and play an important role in mucosal immunity. However, little is known about their expression on the ocular surface. This study aimed to analyze the expression of the mucosal chemokines CCL28, CXCL14 and CXCL17 in corneal and conjunctival epithelial cells under in vitro dry eye (DE) conditions, and in conjunctival samples from healthy subjects and DE patients. Human corneal epithelial cells (HCE) and immortalized human conjunctival epithelial cells (IM-HConEpiC) were incubated under hyperosmolar (400-500 mOsM) or inflammatory (TNF-α 25 ng/mL) conditions for 6 h and 24 h to measure CCL28, CXCL14, and CXCL17 gene expression by RT-PCR and their secretion by immunobead-based analysis (CCL28, CXCL14) and ELISA (CXCL17). Additionally, twenty-seven DE patients and 13 healthy subjects were included in this study. DE-related questionnaires (OSDI, mSIDEQ and NRS) evaluated symptomatology. Ocular surface integrity was assessed using vital staining. Tactile sensitivity was measured with Cochet-Bonnet esthesiometer, and mechanic and thermal (heat and cold) sensitivity using Belmonte's non-contact esthesiometer. Subbasal nerve plexus and dendritic cell density were analyzed by in vivo confocal microscopy. Conjunctival cells from participants were collected by impression cytology to measure mucosal chemokines gene expression by RT-PCR. Our results showed that HCE and IM-HConEpiC cells increased CCL28, CXCL14, and CXCL17 secretion under hyperosmolar conditions. The gene expression of CCL28 was significantly upregulated in conjunctival samples from DE patients. CCL28 expression correlated positively with symptomatology, corneal staining, heat sensitivity threshold, and dendritic cell density. CXCL14 expression correlated positively with age, ocular pain, conjunctival staining, tactile sensitivity, and image reflectivity. CXCL17 expression correlated positively with corneal staining. These results suggest that corneal and conjunctival epithelial cells could be a source of CCL28, CXCL14, and CXCL17 on the ocular surface and that CCL28 might be involved in DE pathogenesis.
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Affiliation(s)
| | - Marta Blanco-Vázquez
- Institute of Applied Ophthalmobiology (IOBA), Universidad de Valladolid, Valladolid, Spain
| | | | - Carmen García-Vázquez
- Institute of Applied Ophthalmobiology (IOBA), Universidad de Valladolid, Valladolid, Spain
| | - María J González-García
- Institute of Applied Ophthalmobiology (IOBA), Universidad de Valladolid, Valladolid, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Carlos III National Institute of Health, Spain
| | - Margarita Calonge
- Institute of Applied Ophthalmobiology (IOBA), Universidad de Valladolid, Valladolid, Spain; OculoFacial Pain Unit, Institute of Applied Ophthalmobiology (IOBA), Universidad de Valladolid, Valladolid, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Carlos III National Institute of Health, Spain
| | - Amalia Enríquez-de-Salamanca
- Institute of Applied Ophthalmobiology (IOBA), Universidad de Valladolid, Valladolid, Spain; OculoFacial Pain Unit, Institute of Applied Ophthalmobiology (IOBA), Universidad de Valladolid, Valladolid, Spain; Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Carlos III National Institute of Health, Spain.
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Stern ME, Theofilopoulos AN, Steven P, Niederkorn JY, Fox R, Calonge M, Scheid C, Pflugfelder SC. Immunologic basis for development of keratoconjunctivitis sicca in systemic autoimmune diseases: Role of innate immune sensors. Ocul Surf 2024; 32:130-138. [PMID: 38395195 DOI: 10.1016/j.jtos.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 02/25/2024]
Abstract
The literature is filled with citations reporting an increased incidence of chronic dry eye disease, also known as keratoconjunctivitis sicca, in patients with systemic autoimmune diseases such as rheumatoid arthritis, Sjögren's Syndrome, systemic sclerosis and lupus. As the most environmentally exposed mucosal surface of the body, the conjunctiva constantly responds to environmental challenges which are typically self limited, but when persistent and unresolved may provoke pathogenic innate and adaptive immune reactions. Our understanding of the pathophysiological mechanisms by which systemic autoimmune diseases cause dry eye inducing ocular surface inflammation continues to evolve. Conjunctival immune tone responds to self or foreign danger signals (including desiccating stress) on the ocular surface with an initial non-specific innate inflammatory response. If unchecked, this can lead to activation of dendritic cells that present antigen and prime T and B cells resulting in an adaptive immune reaction. These reactions generally resolve, but dysfunctional, hyper-responsive immune cells found in systemic autoimmune diseases that are recruited to the ocular surface can amplify inflammatory stress responses in the ocular surface and glandular tissues and result in autoimmune reactions that disrupt tear stability and lead to chronic dry eye disease. We here propose that unique features of the ocular surface immune system and the impact of systemic immune dysregulation in autoimmune diseases, can predispose to development of dry eye disease, and exacerbate severity of existing dry eye.
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Affiliation(s)
- Michael E Stern
- University of Cologne, Department of Ophthalmology, Cologne, Germany; IOBA, Department of Ophthalmology, University of Valladolid, Valladolid, Spain.
| | | | - Philipp Steven
- University of Cologne, Department of Ophthalmology, Cologne, Germany; University of Cologne, Department of Internal Medicine - 1, Cologne, Germany
| | - Jerry Y Niederkorn
- Southwestern School of Medicine, Department of Ophthalmology, Dallas, TX, USA
| | - Robert Fox
- Scripps Hospital, Department of Rheumatology, La Jolla, CA, USA
| | - Margarita Calonge
- IOBA, Department of Ophthalmology, University of Valladolid, Valladolid, Spain
| | - Christof Scheid
- University of Cologne, Department of Internal Medicine - 1, Cologne, Germany
| | - Stephen C Pflugfelder
- Ocular Surface Center, Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
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Pérez I, Galindo S, López-Miguel A, Nieto-Miguel T, de la Mata A, López-Paniagua M, Alberca M, Herreras JM, Calonge M. In Vivo Confocal Microscopy in Limbal Stem Cell Deficiency After Mesenchymal Stem Cell Transplantation: A Sub-analysis from a Phase I-II Clinical Trial. Ophthalmol Ther 2023; 12:3251-3262. [PMID: 37773479 PMCID: PMC10640524 DOI: 10.1007/s40123-023-00809-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/31/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION The aim of this work is to evaluate the effect of mesenchymal stem cell transplantation (MSCT) and cultivated limbal epithelial transplantation (CLET) therapies on the limbus of patients suffering from limbal stem cell deficiency (LSCD). METHODS A sub-analysis of a phase I-II randomized, controlled, and double-masked clinical trial was performed to assess the changes in the anatomical structures of the limbus. In vivo confocal microscopy (IVCM) analysis was carried out in LSCD eyes before and 12 months after allogeneic MSCT or CLET. Epithelial phenotype of the central cornea, as well as the presence of transition zones and palisades of Vogt in the limbus, were assessed using Wilcoxon test. RESULTS Twenty-three LSCD (14 MSCT and nine CLET) eyes were included. The epithelial phenotype of the central cornea improved significantly (p < 0.001) from 15 (eight MSCT, seven CLET) and eight (six MSCT, two CLET) LSCD eyes showing conjunctival and mixed phenotypes, respectively, to eight (five MSCT, three CLET), five (two MSCT, three CLET), and ten (seven MSCT, three CLET) eyes showing conjunctival, mixed, and corneal phenotypes, respectively. Transition areas and palisades of Vogt were observed in at least one quadrant in nine (five MSCT, four CLET) and 16 (nine MSCT, seven CLET), and in four (two MSCT, two CLET) and six (three MSCT, three CLET) LSCD eyes before and after surgery, respectively. Changes in the transition zones and palisades were solely significant (p = 0.046) for the nasal and inferior quadrants, respectively. CONCLUSIONS MSCT and CLET improved the central corneal epithelial phenotype despite only minor changes in the anatomical structures of the limbus, as detected by IVCM technology. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT01562002.
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Affiliation(s)
- Inmaculada Pérez
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Campus Miguel Delibes, Paseo Belén, 17, 47011, Valladolid, Spain
| | - Sara Galindo
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Campus Miguel Delibes, Paseo Belén, 17, 47011, Valladolid, Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
- Department of Cell Biology, Genetics, Histology and Pharmacology, Universidad de Valladolid, Valladolid, Spain
| | - Alberto López-Miguel
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Campus Miguel Delibes, Paseo Belén, 17, 47011, Valladolid, Spain.
- Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain.
| | - Teresa Nieto-Miguel
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Campus Miguel Delibes, Paseo Belén, 17, 47011, Valladolid, Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
- Department of Cell Biology, Genetics, Histology and Pharmacology, Universidad de Valladolid, Valladolid, Spain
| | - Ana de la Mata
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Campus Miguel Delibes, Paseo Belén, 17, 47011, Valladolid, Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
| | - Marina López-Paniagua
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Campus Miguel Delibes, Paseo Belén, 17, 47011, Valladolid, Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
- Department of Cell Biology, Genetics, Histology and Pharmacology, Universidad de Valladolid, Valladolid, Spain
- Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, Valladolid, Spain
| | - Mercedes Alberca
- IBGM (Institute of Molecular Biology and Genetics) and University Scientific Park, Universidad de Valladolid, Valladolid, Spain
| | - José M Herreras
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Campus Miguel Delibes, Paseo Belén, 17, 47011, Valladolid, Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
- Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Margarita Calonge
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Campus Miguel Delibes, Paseo Belén, 17, 47011, Valladolid, Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
- Departamento de Cirugía, Oftalmología, Otorrinolaringología y Fisioterapia, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
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Cartes C, Segovia C, Calonge M, Figueiredo FC. International survey on dry eye diagnosis by experts. Heliyon 2023; 9:e16995. [PMID: 37484334 PMCID: PMC10361019 DOI: 10.1016/j.heliyon.2023.e16995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/12/2023] [Accepted: 06/02/2023] [Indexed: 07/25/2023] Open
Abstract
Purpose To evaluate patterns and opinion from international experts with respect to dry eye disease (DED) diagnosis in clinical practice. Methods An online survey was distributed to worldwide DED experts. The use of diagnosis tests was evaluated including: symptoms questionnaires, functional tests, tear stability, tear volume, tear composition, surface damage and inflammation, and eyelid assessment. After the subjective importance of symptoms, tear break up time (TBUT), non-invasive TBUT, Schirmer's test, tear meniscus height, tear osmolarity, tear metalloproteinase 9, blepharitis assessment and non-contact meibography was evaluated according to likert scale. Results The survey was sent to 109 experts, and 77 completed the questionnaire (rate of response = 70.6%). Most of the participants were from North America (27%) and Europe (40%). A majority of respondents (73%) diagnose DED using clinical signs and symptoms, but not fulfilling a specific criteria. Seventy-six participants (98.7%) use symptoms questionnaires. All participants evaluate damage to ocular surface, and fluorescein staining is the most frequent method used (92%). Also, all the respondents perform meibomian gland and blepharitis assessment. On the other hand, only 69.8% evaluate tear composition, being osmolarity the most common test used (66.2%). Regarding to the importance of tests, TBUT (p = 0.002) and Schirmer's (p = 0.021) were found to be more important to experts from Europe than North America. No differences were found in any other test (p > 0.05). Conclusions This survey offers updated and day-to-day diagnostic clinical practice by DED worldwide experts. The results highlight the importance of symptoms and clinical signs, but not necessarily following a strict criteria.
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Affiliation(s)
- Cristian Cartes
- Unidad Oftalmología, Departamento de Especialidades, Facultad de Medicina, Universidad de la Frontera, Temuco, Chile
- Centro de la Visión, Red Centro Oftalmológico Laser, Santiago, Chile
| | - Christian Segovia
- Departamento de Tecnología Médica, Facultad de Ciencias de la Salud. Universidad Católica del Maule, Talca, Chile
| | - Margarita Calonge
- OBA (Institute of Applied Ophthalmobiology), CIBER-BBN, University of Valladolid, 47011, Valladolid, Spain
| | - Francisco C. Figueiredo
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Bioscience Institute, Newcastle University, Newcastle upon Tyne, UK
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de los Santos C, Pastor JC, Calonge M. Mercury intoxication and ophthalmic involvement: An update review. Front Toxicol 2023; 5:1148357. [PMID: 37063600 PMCID: PMC10102333 DOI: 10.3389/ftox.2023.1148357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
Human intoxication after mercury exposure is a rare condition that can cause severe damage to the central nervous, respiratory, cardiovascular, renal, gastrointestinal, skin, and visual systems and represents a major public health concern. Ophthalmic involvement includes impaired function of the extraocular muscles and the eyelids, as well as structural changes in the ocular surface, lens, retina, and optic nerve causing a potential irreversible damage to the visual system. Although, there are many pathways for poisoning depending on the mercury form, it has been suggested that tissue distribution does not differ in experimental animals when administered as mercury vapor, organic mercury, or inorganic mercury. Additionally, visual function alterations regarding central visual acuity, color discrimination, contrast sensitivity, visual field and electroretinogram responses have also been described widely. Nevertheless, there is still controversy about whether visual manifestations occur secondary to brain damage or as a direct affectation, and which ocular structure is primarily affected. Despite the use of some imaging techniques such as in vivo confocal microscopy of the cornea, optical coherence tomography (OCT) of the retina and optic nerve, and functional tests such as electroretinography has helped to solve in part this debate, further studies incorporating other imaging modalities such as autofluorescence, OCT angiography or adaptive optics retinal imaging are needed. This review aims to summarize the published structural and functional alterations found in the visual system of patients suffering from mercury intoxication.
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Affiliation(s)
- Cristian de los Santos
- Institute of Applied Ophthalmobiology (IOBA), Universidad de Valladolid, Valladolid, Spain
- *Correspondence: Cristian de los Santos,
| | - J. Carlos Pastor
- Institute of Applied Ophthalmobiology (IOBA), Universidad de Valladolid, Valladolid, Spain
- Centro en Red de Medicina Regenerativa y Terapia Celular. Junta de Castilla y León, Valladolid, Spain
| | - Margarita Calonge
- Institute of Applied Ophthalmobiology (IOBA), Universidad de Valladolid, Valladolid, Spain
- Centro en Red de Medicina Regenerativa y Terapia Celular. Junta de Castilla y León, Valladolid, Spain
- CIBER-BBN, Carlos III National Institute of Health, Madrid, Spain
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Calonge M, Sahyoun M, Baillif S, Gain P, Paw E, Mearza A, Cochener B. Sodium hyaluronate 0.30% ocular gel versus sodium hyaluronate 0.18% eye drop in the treatment of moderate to severe dry eye disease. Eur J Ophthalmol 2023; 33:188-195. [PMID: 35450456 PMCID: PMC9834324 DOI: 10.1177/11206721221096321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE Compare 0.30% sodium hyaluronate (0.30%HA) ocular gel with 0.18%HA eye drops in terms of improvement of ocular signs and symptoms, in patients with moderate to severe dry eye disease (DED). METHODS This was a multicentric, randomized, investigator-masked, non-inferiority, comparative study conducted over 84 days. Three visits were scheduled, testing fluorescein corneal and conjunctival staining (Oxford and Van Bijsterveld scores), tear film break-up time (TBUT), Schirmer test, DED symptoms, 5-Item-Dry-Eye-Questionnaire (5-DEQ), patient and investigator satisfaction and frequency of instillation. RESULTS At Day 35 (D35) and Day 84 (D84), both groups (n = 35 each) had a significant improvement in corneal staining (p < 0.001) with no inter-group difference. Van Bijsterveld score improved earlier (D35) for 0.30%HA suggesting a faster effect on conjunctival epithelium healing. There was no difference between the two concentrations in terms of TBUT or Schirmer improvements; however, the Schirmer test increase was only significant for 0.30%HA at D35 (p = 0.040). At D35 and D84, both groups showed similar improvements of DED symptoms and DEQ-5 score. Furthermore, treatment satisfaction was similar for the 2 formulations suggesting that daily use of 0.30%HA do not cause gel-related blurred vision disturbances. Frequency of instillation was similar for both groups. CONCLUSION Our study demonstrates the non-inferiority of 0.30%HA gel compared to 0.18%HA solution in patients with moderate to severe DED. Because of its gel formulation and higher HA concentration providing prolonged comfort without causing visual disturbances, 0.30%HA gel might be adapted for bedtime use or during the day in more severe conditions.
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Affiliation(s)
- Margarita Calonge
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain,CIBER-BBN (Biomedical Research Networking Center Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Spain
| | - Marwan Sahyoun
- Horus Pharma, Saint-Laurent-du-Var, France,Marwan Sahyoun, 148 avenue Georges Guynemer, 06700 Saint-Laurent-du-Var, France.
| | | | | | - Ewa Paw
- Eurofins Dermscan Poland Sp. z o. o., Gdańsk, Poland
| | - Ali Mearza
- Imperial College Healthcare NHS Trust, London, UK,Ophthalmic Consultants of London, London, UK
| | - Béatrice Cochener
- Department of Ophthalmology, University Hospital Morvan, Brest, France
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Keel S, Lingham G, Misra N, Block S, Bourne R, Calonge M, Cheng CY, Friedman DS, Furtado JM, Khanna R, Mariotti S, Mathenge W, Matoto E, Müeller A, Rabiu M, Rasengane T, Resnikoff S, Wormald R, Yasmin S, Zhao J, Evans JR, Cieza A, Chan VF, Chen Y, Chinnery H, Dodson S, Downie L, Gordon I, Ghadiri N, Govender Poonsamy P, Han X, Hui F, Jackson ML, Lawrenson J, Ning Lee C, McGuinness M, Murray C, Newsham D, van Nispen R, Prictor M, Puri L, Ramke J, Reekie I, Safi S, Scheetz J, Shen S, Silveira S, Thakur S, Virgili G, Yong AC, Zhang J, Ziaei M, Ali MA, AlObaida IA, AlShamlan FT, Alsulaiman SM, Amissah-Arthur KN, Ang M, Azad R, Bell K, Bharadwaj SR, Booysen DJ, Branchevski S, Bosch V, Brossard-Barbosa N, Chen Y, Craig JP, Dada T, Dichoso CA, Duerksen R, Ebri A, Erdmann I, Freddo T, Flanagan J, Gammoh Y, Gupta N, Hendicott P, Husni MA, Jonathan Jackson A, Jadoon MZ, Januleviciene I, Jeeva I, Jimenez MSS, Kocur I, Kreis A, Kyei S, Lan W, Loy MJV, Marmamula S, Minto LH, Muhit M, Nsubuga NH, Ogundipe A, Okonkwo ON, Olawoye OO, Ouertani AM, Ovenseri-Ogbomo G, Özkan SB, Patel B, Paula JS, Rahi JS, Ravilla RD, Senanayake NS, Sil AK, Solebo AL, Sousa RARC, Tennant MTS, van Staden DB, Wazir JF, Webber AL, Yorston D, Zin A, Faal HB, Keeffe J, McGrath CE. Toward Universal Eye Health Coverage-Key Outcomes of the World Health Organization Package of Eye Care Interventions: A Systematic Review. JAMA Ophthalmol 2022; 140:1229-1238. [PMID: 36394836 DOI: 10.1001/jamaophthalmol.2022.4716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Importance Despite persistent inequalities in access to eye care services globally, guidance on a set of recommended, evidence-based eye care interventions to support country health care planning has not been available. To overcome this barrier, the World Health Organization (WHO) Package of Eye Care Interventions (PECI) has been developed. Objective To describe the key outcomes of the PECI development. Evidence Review A standardized stepwise approach that included the following stages: (1) selection of priority eye conditions by an expert panel after reviewing epidemiological evidence and health facility data; (2) identification of interventions and related evidence for the selected eye conditions from a systematic review of clinical practice guidelines (CPGs); stage 2 included a systematic literature search, screening of title and abstracts (excluding articles that were not relevant CPGs), full-text review to assess disclosure of conflicts of interest and affiliations, quality appraisal, and data extraction; (3) expert review of the evidence extracted in stage 2, identification of missed interventions, and agreement on the inclusion of essential interventions suitable for implementation in low- and middle-income resource settings; and (4) peer review. Findings Fifteen priority eye conditions were chosen. The literature search identified 3601 articles. Of these, 469 passed title and abstract screening, 151 passed full-text screening, 98 passed quality appraisal, and 87 were selected for data extraction. Little evidence (≤1 CPG identified) was available for pterygium, keratoconus, congenital eyelid disorders, vision rehabilitation, myopic macular degeneration, ptosis, entropion, and ectropion. In stage 3, domain-specific expert groups voted to include 135 interventions (57%) of a potential 235 interventions collated from stage 2. After synthesis across all interventions and eye conditions, 64 interventions (13 health promotion and education, 6 screening and prevention, 38 treatment, and 7 rehabilitation) were included in the PECI. Conclusions and Relevance This systematic review of CPGs for priority eye conditions, followed by an expert consensus procedure, identified 64 essential, evidence-based, eye care interventions that are required to achieve universal eye health coverage. The review identified some important gaps, including a paucity of high-quality, English-language CPGs, for several eye diseases and a dearth of evidence-based recommendations on eye health promotion and prevention within existing CPGs.
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Affiliation(s)
- Stuart Keel
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Gareth Lingham
- Centre for Eye Research Ireland, Technological University Dublin, Dublin, Ireland.,Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Australia
| | - Neha Misra
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | - Rupert Bourne
- Cambridge University Hospitals, Cambridge, United Kingdom.,Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Margarita Calonge
- Institute of Applied OphthalmoBiology, Universidad de Valladolid, Valladolid, Spain.,CIBER-BBN (Biomedical Research Networking Center Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
| | - Ching-Yu Cheng
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | - João M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Rohit Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
| | - Silvio Mariotti
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | | | - Andreas Müeller
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Mansur Rabiu
- Noor Dubai Foundation, Dubai Health Authority, Dubai, United Arab Emirates
| | - Tuwani Rasengane
- Department of Optometry, University of the Free State, Bloemfontein, South Africa.,Universitas Hospital, Bloemfontein, South Africa
| | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Brien Holden Vision Institute, Sydney, Australia.,Organisation pour la Prévention de la Cécité, Paris, France
| | - Richard Wormald
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom.,Cochrane Eyes and Vision, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Jialiang Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Eye Research Center Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Cochrane Eyes and Vision, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Alarcos Cieza
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | - Ving Fai Chan
- for the Package of Eye Care Interventions Development Group
| | - Yanxian Chen
- for the Package of Eye Care Interventions Development Group
| | - Holly Chinnery
- for the Package of Eye Care Interventions Development Group
| | - Sarity Dodson
- for the Package of Eye Care Interventions Development Group
| | - Laura Downie
- for the Package of Eye Care Interventions Development Group
| | - Iris Gordon
- for the Package of Eye Care Interventions Development Group
| | - Nima Ghadiri
- for the Package of Eye Care Interventions Development Group
| | | | - Xiaotong Han
- for the Package of Eye Care Interventions Development Group
| | - Flora Hui
- for the Package of Eye Care Interventions Development Group
| | | | - John Lawrenson
- for the Package of Eye Care Interventions Development Group
| | - Chan Ning Lee
- for the Package of Eye Care Interventions Development Group
| | | | - Craig Murray
- for the Package of Eye Care Interventions Development Group
| | - David Newsham
- for the Package of Eye Care Interventions Development Group
| | | | - Megan Prictor
- for the Package of Eye Care Interventions Development Group
| | - Lila Puri
- for the Package of Eye Care Interventions Development Group
| | | | - Ian Reekie
- for the Package of Eye Care Interventions Development Group
| | - Sare Safi
- for the Package of Eye Care Interventions Development Group
| | - Jane Scheetz
- for the Package of Eye Care Interventions Development Group
| | - Sunny Shen
- for the Package of Eye Care Interventions Development Group
| | - Sue Silveira
- for the Package of Eye Care Interventions Development Group
| | - Sahil Thakur
- for the Package of Eye Care Interventions Development Group
| | - Gianni Virgili
- for the Package of Eye Care Interventions Development Group
| | - Ai Chee Yong
- for the Package of Eye Care Interventions Development Group
| | - Justine Zhang
- for the Package of Eye Care Interventions Development Group
| | - Mohammed Ziaei
- for the Package of Eye Care Interventions Development Group
| | | | | | | | | | | | - Marcus Ang
- for the Package of Eye Care Interventions Development Group
| | | | - Kristin Bell
- for the Package of Eye Care Interventions Development Group
| | | | - Dirk J Booysen
- for the Package of Eye Care Interventions Development Group
| | | | - Vanessa Bosch
- for the Package of Eye Care Interventions Development Group
| | | | - Yi Chen
- for the Package of Eye Care Interventions Development Group
| | | | - Tanuj Dada
- for the Package of Eye Care Interventions Development Group
| | | | | | - Anne Ebri
- for the Package of Eye Care Interventions Development Group
| | - Irmela Erdmann
- for the Package of Eye Care Interventions Development Group
| | - Thomas Freddo
- for the Package of Eye Care Interventions Development Group
| | - John Flanagan
- for the Package of Eye Care Interventions Development Group
| | - Yazan Gammoh
- for the Package of Eye Care Interventions Development Group
| | - Neeru Gupta
- for the Package of Eye Care Interventions Development Group
| | | | | | | | | | | | - Irfan Jeeva
- for the Package of Eye Care Interventions Development Group
| | | | - Ivo Kocur
- for the Package of Eye Care Interventions Development Group
| | - Andreas Kreis
- for the Package of Eye Care Interventions Development Group
| | - Samuel Kyei
- for the Package of Eye Care Interventions Development Group
| | - Weizhong Lan
- for the Package of Eye Care Interventions Development Group
| | | | | | | | - Mohammad Muhit
- for the Package of Eye Care Interventions Development Group
| | | | | | | | | | | | | | - Seyhan B Özkan
- for the Package of Eye Care Interventions Development Group
| | - Bina Patel
- for the Package of Eye Care Interventions Development Group
| | - Jayter S Paula
- for the Package of Eye Care Interventions Development Group
| | - Jugnoo S Rahi
- for the Package of Eye Care Interventions Development Group
| | | | | | - Asim Kumar Sil
- for the Package of Eye Care Interventions Development Group
| | | | - Raúl ARC Sousa
- for the Package of Eye Care Interventions Development Group
| | | | | | | | - Ann L Webber
- for the Package of Eye Care Interventions Development Group
| | - David Yorston
- for the Package of Eye Care Interventions Development Group
| | - Andrea Zin
- for the Package of Eye Care Interventions Development Group
| | - Hannah B Faal
- for the Package of Eye Care Interventions Development Group
| | - Jill Keeffe
- for the Package of Eye Care Interventions Development Group
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Calonge M. Amniotic membrane as a substrate and delivery vehicle for stem cells. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.15592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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10
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Calonge M. Mesenchimal stem cells for ocular surface disease. Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.15558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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11
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Vázquez A, Martínez-Plaza E, Fernández I, Sobas EM, González-García MJ, Enríquez-de-Salamanca A, Ortega E, López-Miguel A, Calonge M. Phenotypic characterization of patients developing chronic dry eye and pain after refractive surgery: A cross-sectional study. Ocul Surf 2022; 26:63-74. [DOI: 10.1016/j.jtos.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 10/16/2022]
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12
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Cano-Suárez MT, Reinoso R, Martín MC, Calonge M, Vallelado AI, Fernández I, Corell A. Epithelial component and intraepithelial lymphocytes of conjunctiva-associated lymphoid tissue in healthy children. Histol Histopathol 2021; 36:1273-1283. [PMID: 34698365 DOI: 10.14670/hh-18-385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Conjunctiva-associated lymphoid tissue (CALT) plays a key role in protecting the eye surface by initiating and regulating immune responses. The aim of this study was to investigate in healthy children the proportion of intraepithelial lymphocytes (IELs), the degree of viability and/or apoptosis and cell proliferation in three different topographic areas of the conjunctiva. Superior tarsal, superior bulbar, and inferior tarsal-bulbarfornix conjunctival cells were collected by brush cytology (BC) from 24 healthy paediatric subjects (13 boys and 11 girls, mean age 6±2 years) who were to undergo strabismus correction surgery under general anaesthesia. Subsequently, these cells were analysed phenotypically and functionally by flow cytometry (FC). Flow cytometry analysis showed that not all the cells obtained by BC were of the epithelial lineage, but that there was a population of CD45+ cells (IELs) regularly present in the conjunctiva of healthy children. These IELs were mostly T-lymphocytes (CD3+) and B-lymphocytes (CD19+), with higher levels of T-lymphocytes (CD3+) in the upper areas than in the inferior tarsal-bulbar-fornix, where the highest levels of B-lymphocytes (CD19+) were found. In the apoptosis assay, two groups of cell populations were differentiated by cell size and complexity (cytoplasmic granularity), with more complex cells predominating in the upper areas of the conjunctiva and less complex cells being more abundant in the inferior tarsal-bulbar-fornix. Finally, the proliferative capacity of the conjunctival epithelium was significantly higher in the upper tarsal zone than in the rest of the zones analysed. These results suggest that the epithelial component and the IELs of CALT are also regularly present in the conjunctiva of the healthy child, varying in phenotype, viability and cell proliferation according to the different conjunctival regions analysed, which could lead us to believe that each conjunctival zone plays a different, specific role in the regulation of the immune response at the ocular level.
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Affiliation(s)
- Magnolia T Cano-Suárez
- Ocular Surface Group, IOBA (Institute for Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain
| | - Roberto Reinoso
- Ocular Surface Group, IOBA (Institute for Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain.,CIBER-BBN (Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine), Spain
| | - M Carmen Martín
- Ocular Surface Group, IOBA (Institute for Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain.,Centro de Hemoterapia y Hemodonación de Castilla y León (Hemotherapy and Hemodonation Centre, CHEMCYL), Valladolid, Spain
| | - Margarita Calonge
- Ocular Surface Group, IOBA (Institute for Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain.,CIBER-BBN (Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine), Spain
| | - Ana I Vallelado
- Ocular Surface Group, IOBA (Institute for Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain
| | - Itziar Fernández
- Ocular Surface Group, IOBA (Institute for Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain.,CIBER-BBN (Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine), Spain
| | - Alfredo Corell
- Ocular Surface Group, IOBA (Institute for Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain.,CIBER-BBN (Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine), Spain.,Department of Immunology, University of Valladolid, Valladolid, Spain
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13
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Cañadas P, Lantigua Y, Enríquez-de-Salamanca A, Fernandez I, Pastor-Idoate S, Sobas EM, Dueñas-Laita A, Pérez-Castrillón JL, Pastor Jimeno JC, Calonge M. Ocular Surface Pathology in Patients Suffering from Mercury Intoxication. Diagnostics (Basel) 2021; 11:diagnostics11081326. [PMID: 34441261 PMCID: PMC8391177 DOI: 10.3390/diagnostics11081326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose: To report the ocular surface pathology of patients suffering from acute/subacute mercury vapor intoxication. Design: Cross-sectional study. Participants: Male workers intoxicated with inorganic mercury referred for ophthalmic involvement and healthy control subjects. Methods: The following tests were performed: dry eye (DE)-related symptoms indicated by the ocular surface disease (OSDI) index questionnaire; tear osmolarity; analysis of 23 tear cytokine concentrations and principal component and hierarchical agglomerative cluster analyses; tear break-up time (T-BUT); corneal fluorescein and conjunctival lissamine green staining; tear production by Schirmer and tear lysozyme tests; mechanical and thermal corneal sensitivity (non-contact esthesiometry); and corneal nerve analysis and dendritic cell density by in vivo confocal microscopy (IVCM). Results: Twenty-two out of 29 evaluated patients entered the study. Most had DE-related symptoms (OSDI values > 12), that were severe in 63.6% of them. Tear osmolarity was elevated (>308 mOsms/L) in 83.4% of patients (mean 336.23 (28.71) mOsm/L). Corneal and conjunctival staining were unremarkable. T-BUT was low (<7 s) in 22.7% of patients. Schirmer test and tear lysozyme concentration were low in 13.6% and 27.3% of cases, respectively. Corneal esthesiometry showed patient mechanical (mean 147.81 (53.36) mL/min) and thermal thresholds to heat (+2.35 (+1.10) °C) and cold (−2.57 (−1.24) °C) to be significantly higher than controls. Corneal IVCM revealed lower values for nerve density (6.4 (2.94) n/mm2), nerve branching density (2 (2.50) n/mm2), and dendritic cell density (9.1 (8.84) n/mm2) in patients. Tear levels of IL-12p70, IL-6, RANTES, and VEGF were increased, whereas EGF and IP-10/CXCL10 were decreased compared to controls. Based on cytokine levels, two clusters of patients were identified. Compared to Cluster 1, Cluster 2 patients had significantly increased tear levels of 18 cytokines, decreased tear lysozyme, lower nerve branching density, fewer dendritic cells, and higher urine mercury levels. Conclusions: Patients suffering from systemic mercury intoxication showed symptoms and signs of ocular surface pathology, mainly by targeting the trigeminal nerve, as shown by alterations in corneal sensitivity and sub-basal nerve morphology.
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Affiliation(s)
- Pilar Cañadas
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, 47011 Valladolid, Spain; (Y.L.); (A.E.-d.-S.); (I.F.); (S.P.-I.); (E.M.S.); (J.C.P.J.); (M.C.)
- Correspondence: ; Tel.: +34-(98)-3184763
| | - Yrbani Lantigua
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, 47011 Valladolid, Spain; (Y.L.); (A.E.-d.-S.); (I.F.); (S.P.-I.); (E.M.S.); (J.C.P.J.); (M.C.)
| | - Amalia Enríquez-de-Salamanca
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, 47011 Valladolid, Spain; (Y.L.); (A.E.-d.-S.); (I.F.); (S.P.-I.); (E.M.S.); (J.C.P.J.); (M.C.)
- CIBER-BBN (Biomedical Research Networking Center Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, 28029 Madrid, Spain
| | - Itziar Fernandez
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, 47011 Valladolid, Spain; (Y.L.); (A.E.-d.-S.); (I.F.); (S.P.-I.); (E.M.S.); (J.C.P.J.); (M.C.)
- CIBER-BBN (Biomedical Research Networking Center Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, 28029 Madrid, Spain
| | - Salvador Pastor-Idoate
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, 47011 Valladolid, Spain; (Y.L.); (A.E.-d.-S.); (I.F.); (S.P.-I.); (E.M.S.); (J.C.P.J.); (M.C.)
| | - Eva M. Sobas
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, 47011 Valladolid, Spain; (Y.L.); (A.E.-d.-S.); (I.F.); (S.P.-I.); (E.M.S.); (J.C.P.J.); (M.C.)
| | - Antonio Dueñas-Laita
- Department of Toxicology, Medical School, University of Valladolid, 47003 Valladolid, Spain;
| | | | - Jose C. Pastor Jimeno
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, 47011 Valladolid, Spain; (Y.L.); (A.E.-d.-S.); (I.F.); (S.P.-I.); (E.M.S.); (J.C.P.J.); (M.C.)
| | - Margarita Calonge
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, 47011 Valladolid, Spain; (Y.L.); (A.E.-d.-S.); (I.F.); (S.P.-I.); (E.M.S.); (J.C.P.J.); (M.C.)
- CIBER-BBN (Biomedical Research Networking Center Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, 28029 Madrid, Spain
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Galindo S, de la Mata A, López-Paniagua M, Herreras JM, Pérez I, Calonge M, Nieto-Miguel T. Subconjunctival injection of mesenchymal stem cells for corneal failure due to limbal stem cell deficiency: state of the art. Stem Cell Res Ther 2021; 12:60. [PMID: 33441175 PMCID: PMC7805216 DOI: 10.1186/s13287-020-02129-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/28/2020] [Indexed: 12/13/2022] Open
Abstract
Mesenchymal stem cells (MSCs) have unique and beneficial properties and are currently used to treat a broad variety of diseases. These properties include the potential for differentiation into other cell types, secretion of different trophic factors that promote a regenerative microenvironment, anti-inflammatory actions, selective migration to damaged tissues, and non-immunogenicity. MSCs are effective for the treatment of ocular surface diseases such as dry eye, corneal burns, and limbal stem cell deficiency (LSCD), both in experimental models and in humans. LSCD is a pathological condition in which damage occurs to the limbal epithelial stem cells, or their niche, that are responsible for the continuous regeneration of the corneal epithelium. If LSCD is extensive and/or severe, it usually causes corneal epithelial defects, ulceration, and conjunctival overgrowth of the cornea. These changes can result in neovascularization and corneal opacity, severe inflammation, pain, and visual loss. The effectiveness of MSCs to reduce corneal opacity, neovascularization, and inflammation has been widely studied in different experimental models of LSCD and in some clinical trials; however, the methodological disparity used in the different studies makes it hard to compare outcomes among them. In this regard, the MSC route of administration used to treat LSCD and other ocular surface diseases is an important factor. It should be efficient, minimally invasive, and safe. So far, intravenous and intraperitoneal injections, topical administration, and MSC transplantation using carrier substrata like amniotic membrane (AM), fibrin, or synthetic biopolymers have been the most commonly used administration routes in experimental models. However, systemic administration carries the risk of potential side effects and transplantation requires surgical procedures that could complicate the process. Alternatively, subconjunctival injection is a minimally invasive and straightforward technique frequently used in ophthalmology. It enables performance of local treatments using high cell doses. In this review, we provide an overview of the current status of MSC administration by subconjunctival injection, analyzing the convenience, safety, and efficacy for treatment of corneal failure due to LSCD in different experimental models. We also provide a summary of the clinical trials that have been completed, are in progress, or being planned.
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Affiliation(s)
- Sara Galindo
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Edificio IOBA, Campus Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain.,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain.,Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, Valladolid, Spain
| | - Ana de la Mata
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Edificio IOBA, Campus Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain. .,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain. .,Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, Valladolid, Spain.
| | - Marina López-Paniagua
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Edificio IOBA, Campus Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain.,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain.,Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, Valladolid, Spain
| | - Jose M Herreras
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Edificio IOBA, Campus Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain.,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain.,Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, Valladolid, Spain
| | - Inmaculada Pérez
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Edificio IOBA, Campus Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain.,Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, Valladolid, Spain
| | - Margarita Calonge
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Edificio IOBA, Campus Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain.,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain.,Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, Valladolid, Spain
| | - Teresa Nieto-Miguel
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Edificio IOBA, Campus Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain. .,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain. .,Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, Valladolid, Spain.
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15
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Fernández I, López-Miguel A, Martín-Montañez V, Enríquez-de-Salamanca A, Calonge M, González-Méijome JM, González-García MJ. Inflammatory status predicts contact lens discomfort under adverse environmental conditions. Ocul Surf 2020; 18:829-840. [PMID: 32814157 DOI: 10.1016/j.jtos.2020.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 07/15/2020] [Accepted: 07/25/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To characterize and predict the clinical and tear molecular response of contact lens (CL) wearers exposed to a controlled adverse desiccating environment (CADE). METHODS Objective and subjective variables and tear cytokine levels were evaluated of monthly silicone hydrogel CL wearers pre- and post-90 min of CADE exposure. Unsupervised hierarchical agglomerative clustering based on relative change from baseline values was used to identify response profiles (clusters). A multiple logistic regression model was used to identify cluster membership predictors. RESULTS Forty-seven CL wearers were divided into 3 clusters having similar age (mean: 27.7 ± 7.7 years) and sex distribution. All of them showed a significant (p ≤ 0.05) increase in limbal hyperemia and staining after CADE exposure. Additionally, Cluster-1 (n = 22, 46.8%) membership was characterized by a significant (p ≤ 0.05) higher worsening of corneal and limbal staining, increased CL wear symptoms, and reduced epidermal-growth-factor and increased interleukin (IL)-4 and IL-6 tear levels. Cluster-2 (n = 22, 46.8%) showed no changes (p > 0.05) in symptoms after CADE; however, their IL-12p70, monocyte-chemoattractant-protein-1 and regulated-on-activation, normal-T-cell-expressed-and-secreted (RANTES) post-exposure tear levels significantly (p ≤ 0.05) increased. Finally, Cluster-3 (n = 3, 6.4%) mainly showed significant higher blink rate (78.1 ± 21.7) during CADE. Corneal staining and tear IL-12p70 levels were identified as Cluster-1 membership predictors. CONCLUSIONS Most of silicone hydrogel CL wearers exposed to CADE showed a worsening of the ocular surface integrity and an upregulated tear inflammatory status. However, only half of them reported worsening of CL wear symptoms. These CL wearers were detected based on corneal integrity and tear inflammatory status. These findings can help reduce CL wear discontinuation and drop out.
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Affiliation(s)
- Itziar Fernández
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain; IOBA (Instituto de Oftalmobiología Aplicada), Universidad de Valladolid, Valladolid, Spain
| | - Alberto López-Miguel
- IOBA (Instituto de Oftalmobiología Aplicada), Universidad de Valladolid, Valladolid, Spain; Red Temática de Investigación Collaborative en Oftalmología (OftaRed), Instituto de Salud Carlos III, Madrid, Spain.
| | | | - Amalia Enríquez-de-Salamanca
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain; IOBA (Instituto de Oftalmobiología Aplicada), Universidad de Valladolid, Valladolid, Spain
| | - Margarita Calonge
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain; IOBA (Instituto de Oftalmobiología Aplicada), Universidad de Valladolid, Valladolid, Spain
| | - José M González-Méijome
- Clinical and Experimental Optometry Research Laboratory, Center of Physics, University of Minho, Braga, Portugal
| | - María J González-García
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain; IOBA (Instituto de Oftalmobiología Aplicada), Universidad de Valladolid, Valladolid, Spain
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16
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Keel S, Evans JR, Block S, Bourne R, Calonge M, Cheng CY, Friedman DS, Furtado JM, Khanna RC, Mathenge W, Mariotti S, Matoto E, Müller A, Rabiu MM, Rasengane T, Zhao J, Wormald R, Cieza A. Strengthening the integration of eye care into the health system: methodology for the development of the WHO package of eye care interventions. BMJ Open Ophthalmol 2020; 5:e000533. [PMID: 32821853 PMCID: PMC7418692 DOI: 10.1136/bmjophth-2020-000533] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/23/2020] [Accepted: 07/08/2020] [Indexed: 02/06/2023] Open
Abstract
Objective To describe the rational for, and the methods that will be employed to develop, the WHO package of eye care interventions (PECI). Methods and analysis The development of the package will be conducted in four steps: (1) selection of eye conditions (for which interventions will be included in the package) based on epidemiological data on the causes of vision impairment and blindness, prevalence estimates of eye conditions and health facility data; (2) identification of interventions and related evidence for the selected eye conditions from clinical practice guidelines and high-quality systematic reviews by a technical working group; (3) expert agreement on the inclusion of eye care interventions in the package and the description of resources required for the provision of the selected interventions; and (4) peer review. The project will be led by the WHO Vision Programme in collaboration with Cochrane Eyes and Vision. A Technical Advisory Group, comprised of public health and clinical experts in the field, will provide technical input throughout all stages of development. Results After considering the feedback of Technical Advisory Group members and reviewing-related evidence, a final list of eye conditions for which interventions will be included in the package has been collated. Conclusion The PECI will support Ministries of Health in prioritising, planning, budgeting and integrating eye care interventions into health systems. It is anticipated that the PECI will be available for use in 2021.
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Affiliation(s)
- Stuart Keel
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sandra Block
- Illinois College of Optometry, Chicago, United States
| | - Rupert Bourne
- Cambridge University Hospitals, Cambridge, United Kingdom
- Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Margarita Calonge
- Institute of Applied OphthalmoBiology, University of Valladolid and CIBER-BBN (Biomedical Research Networking Center Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
| | - Ching-Yu Cheng
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard University, Boston, United States
| | - João M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | | | - Silvio Mariotti
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | - Andreas Müller
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - M Mansur Rabiu
- Noor Dubai Foundation, Dubai Health Authority, Dubai, United Arab Emirates
| | - Tuwani Rasengane
- Department of Optometry, University of the Free State and Universitas Hospital, Bloemfontein, South Africa
| | - Jialang Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Eye Research Center Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Richard Wormald
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- UCL Institute of Ophthalmology, London, United Kingdom
| | - Alarcos Cieza
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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17
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López-de la Rosa A, González-García MJ, Calonge M, Enríquez-de-Salamanca A. Tear Inflammatory Molecules in Contact Lens Wearers: A Literature Review. Curr Med Chem 2020; 27:523-548. [DOI: 10.2174/0929867326666190409152921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/14/2019] [Accepted: 03/22/2019] [Indexed: 01/20/2023]
Abstract
Background:
Numerous studies have analysed the effect of using different Contact
Lenses (CLs) or care solutions, and suffering discomfort or diseases associated with CL wear
on the inflammatory mediator release into the tears.
Objective:
To summarize the published data on tear inflammatory molecules related to CL use.
Methods:
A PubMed-NCBI search has been conducted and those publications which carried
out original investigations including the analysis of tear inflammatory mediators in CL wearers
were selected.
Results:
Forty-three articles, from 1990 to 2019, have been included. Wearing hydrogel CLs,
rigid gas permeable CLs, and special designs for irregular corneas in keratoconus patients (CLs
with keratoconic design, hybrid CLs, piggyback fit, and scleral CLs) have been reported to alter
the concentration of several molecules in tears. Moreover, there seems to be an effect of the
wearing time and schedule, CL materials and designs, and care solutions used. Regarding CL
discomfort, its relation with inflammatory mediators is not clear. However, some diseases associated
to CL wear, such as giant papillary conjunctivitis, CL induced acute red eye, CL induced
peripheral ulcer, and acanthamoeba keratitis have been related to the release of certain inflammatory
mediators, which may serve as potential biomarkers.
Conclusion:
There is evidence suggesting that different aspects of CL wear alter the inflammatory
mediator profile in tears, which may indicate an inflammatory state of the lacrimal functional
unit. However, more studies need to be carried out to better understand how this inflammatory
process works and its repercussion on the different aspects of CL wear.
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Affiliation(s)
| | | | - Margarita Calonge
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain
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18
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González-García MJ, Murillo GM, Pinto-Fraga J, García N, Fernández I, Maldonado MJ, Calonge M, Enríquez-de-Salamanca A. Clinical and tear cytokine profiles after advanced surface ablation refractive surgery: A six-month follow-up. Exp Eye Res 2020; 193:107976. [PMID: 32081669 DOI: 10.1016/j.exer.2020.107976] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 12/14/2022]
Abstract
Neuropathic dry eye is one of the most frequently seen complications after corneal refractive surgery, however, its incidence decreases in a significant manner along the first six months postoperative, reaching between 10 and 45% incidence. However, little is known on the inflammatory status of the ocular surface during this recovery process. We aim to analyze the clinical and tear molecule concentration changes along six months after advanced surface ablation for myopia correction, in a prospective study including 18 eyes of 18 subjects who bilaterally underwent advanced surface ablation corneal refractive surgery. Clinical variables (uncorrected distance visual acuity, symptoms, conjunctival hyperemia, tear osmolarity, tear stability, corneal fluorescein staining, conjunctival lissamine staining, Schirmer test, and corneal esthesiometry) and a panel of 23 pro and anti-inflammatory cytokines/chemokines concentration in tears preoperatively and at 1, 3 and 6 months postoperatively were evaluated. We found that uncorrected distance visual acuity improved significantly from baseline at 1-month visit, symptoms improved and tear osmolarity decreased significantly from baseline at 3-month visit and there was a decrease in mechanical corneal threshold between 1-month and 3- and 6-month visits. Regarding tear molecules, IL-4, IL-5, IL-6, IL-13, IL-17A, and IFN-γ tear levels were significantly increased at all the three visits, compared to preoperative levels at V0; IL-2 and VEGF were also significantly increased at 1-month and 6-month visits, but not at 3-month visit, whereas IL-9 IL-10 and IL-12 were only significantly increased at 6-month visit. Although we found that there is a recovery in clinical variables at 6 months postoperatively (i.e. neuropathic dry eye was not developed in the sample), ocular surface homeostasis is not completely restored, as it can be seen by the changes in concentration of some pro and anti-inflammatory molecules measured in tears.
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Affiliation(s)
- María J González-García
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Campus Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain; CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Valladolid, Spain.
| | - Giovanna M Murillo
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Campus Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
| | - José Pinto-Fraga
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Campus Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
| | - Noelia García
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Campus Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
| | - Itziar Fernández
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Campus Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain; CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Valladolid, Spain
| | - Miguel J Maldonado
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Campus Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain
| | - Margarita Calonge
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Campus Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain; CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Valladolid, Spain
| | - Amalia Enríquez-de-Salamanca
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Campus Miguel Delibes, Paseo de Belén 17, 47011, Valladolid, Spain; CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Valladolid, Spain
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19
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López-Paniagua M, Nieto-Miguel T, Galindo S, García-Posadas L, de la Mata A, Corrales RM, Calonge M, Diebold Y. Optimization of Human Limbal Stem Cell Culture by Replating a Single Limbal Explant. Methods Mol Biol 2020; 2145:39-49. [PMID: 32542599 DOI: 10.1007/978-1-0716-0599-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cultured limbal epithelial stem cell transplantation is a clinical procedure used to regenerate the corneal epithelium in patients with limbal stem cell deficiency. The protocols used to expand limbal epithelial cells in vitro need to be optimized, since the scarcity of human ocular tissue donors is limiting the potential use of this procedure. Here, we describe a method to consecutively expand a single human limbal explant. With this method it is possible to obtain up to three limbal epithelial primary cultures from the same explant, thus increasing the efficiency of the in vitro cell culture.
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Affiliation(s)
- Marina López-Paniagua
- Grupo de Superficie Ocular, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN). Instituto de Salud Carlos III, Madrid, Spain
- Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, , Valladolid, Spain
| | - Teresa Nieto-Miguel
- Grupo de Superficie Ocular, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN). Instituto de Salud Carlos III, Madrid, Spain
| | - Sara Galindo
- Grupo de Superficie Ocular, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN). Instituto de Salud Carlos III, Madrid, Spain
| | - Laura García-Posadas
- Grupo de Superficie Ocular, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
| | - Ana de la Mata
- Grupo de Superficie Ocular, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN). Instituto de Salud Carlos III, Madrid, Spain
- Centro en Red de Medicina Regenerativa y Terapia Celular de Castilla y León, , Valladolid, Spain
| | - Rosa M Corrales
- Grupo de Superficie Ocular, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN). Instituto de Salud Carlos III, Madrid, Spain
| | - Margarita Calonge
- Grupo de Superficie Ocular, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN). Instituto de Salud Carlos III, Madrid, Spain
| | - Yolanda Diebold
- Grupo de Superficie Ocular, Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain.
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN). Instituto de Salud Carlos III, Madrid, Spain.
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20
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Fernández I, López-Miguel A, Enríquez-de-Salamanca A, Tesón M, Stern ME, González-García MJ, Calonge M. Response profiles to a controlled adverse desiccating environment based on clinical and tear molecule changes. Ocul Surf 2019; 17:502-515. [DOI: 10.1016/j.jtos.2019.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/14/2019] [Accepted: 03/26/2019] [Indexed: 12/18/2022]
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21
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Calonge M, Pérez I, Galindo S, Nieto-Miguel T, López-Paniagua M, Fernández I, Alberca M, García-Sancho J, Sánchez A, Herreras JM. A proof-of-concept clinical trial using mesenchymal stem cells for the treatment of corneal epithelial stem cell deficiency. Transl Res 2019; 206:18-40. [PMID: 30578758 DOI: 10.1016/j.trsl.2018.11.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/18/2018] [Accepted: 11/18/2018] [Indexed: 01/02/2023]
Abstract
Ocular stem cell transplantation derived from either autologous or allogeneic donor corneoscleral junction is a functional cell therapy to manage extensive and/or severe limbal stem cell deficiencies that lead to corneal epithelial failure. Mesenchymal stem cells have been properly tested in animal models of this ophthalmic pathology, but never in human eyes despite their potential advantages. We conducted a 6- to 12-month proof-of-concept, randomized, and double-masked pilot trial to test whether allogeneic bone marrow-derived mesenchymal stem cell transplantation (MSCT], n = 17) was as safe and as equally efficient as allogeneic cultivated limbal epithelial transplantation (CLET), (n = 11) to improve corneal epithelial damage due to limbal stem cell deficiency. Primary endpoints demanded combination of symptoms, signs, and the objective improvement of the epithelial phenotype in central cornea by in vivo confocal microscopy. This proof-of-concept trial showed that MSCT was as safe and efficacious as CLET. Global success at 6-12 months was 72.7%-77.8% for CLET cases and 76.5%-85.7% for MSCT cases (not significant differences). Central corneal epithelial phenotype improved in 71.4% and 66.7% of MSCT and CLET cases, respectively at 12 months (P = 1.000). There were no adverse events related to cell products. This trial suggests first evidence that MSCT facilitated improvement of a diseased corneal epithelium due to lack of its stem cells as efficiently as CLET. Consequently, not only CLET but also MSCT deserves more preclinical investigational resources before the favorable results of this proof-of-concept trial could be transformed into the larger numbers of the multicenter trials that would provide stronger evidence. (ClinicalTrials.gov number, NCT01562002.).
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Affiliation(s)
- Margarita Calonge
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain; CIBER-BBN (Biomedical Research Networking Centre in Bioengineering, Biomaterials, and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain.
| | - Inmaculada Pérez
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain.
| | - Sara Galindo
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain; CIBER-BBN (Biomedical Research Networking Centre in Bioengineering, Biomaterials, and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain.
| | - Teresa Nieto-Miguel
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain; CIBER-BBN (Biomedical Research Networking Centre in Bioengineering, Biomaterials, and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain.
| | - Marina López-Paniagua
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain; CIBER-BBN (Biomedical Research Networking Centre in Bioengineering, Biomaterials, and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain.
| | - Itziar Fernández
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain; CIBER-BBN (Biomedical Research Networking Centre in Bioengineering, Biomaterials, and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain.
| | - Mercedes Alberca
- IBGM (Institute of Molecular Biology and Genetics), University of Valladolid and National Research Council (CSIC), and University Scientific Park, Valladolid, Spain.
| | - Javier García-Sancho
- IBGM (Institute of Molecular Biology and Genetics), University of Valladolid and National Research Council (CSIC), and University Scientific Park, Valladolid, Spain.
| | - Ana Sánchez
- IBGM (Institute of Molecular Biology and Genetics), University of Valladolid and National Research Council (CSIC), and University Scientific Park, Valladolid, Spain.
| | - José M Herreras
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain; CIBER-BBN (Biomedical Research Networking Centre in Bioengineering, Biomaterials, and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain.
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22
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Labetoulle M, Baudouin C, Calonge M, Merayo‐Lloves J, Boboridis KG, Akova YA, Aragona P, Geerling G, Messmer EM, Benítez‐del‐Castillo J. Role of corneal nerves in ocular surface homeostasis and disease. Acta Ophthalmol 2019; 97:137-145. [PMID: 30225941 DOI: 10.1111/aos.13844] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/14/2018] [Indexed: 12/11/2022]
Abstract
Corneal nerves are key components of the physiological system that controls ocular surface homeostasis. The cornea is primarily innervated by the ophthalmic branch of the trigeminal nerves (cranial nerve V), which distend bilaterally from the pons. The nasociliary branch (afferent) of the ophthalmic nerve is sensory for cornea, eyelid and conjunctiva. These nerve fibres play a role in sensing temperature, chemical and mechanical stimuli, and pain, whereas, branches of the facial nerve (cranial nerve VII) contain motor nerves that control blinking and autonomic (sympathetic and a paucity of parasympathetic) fibres that stimulate tear production and secretion via feedback loops between the ocular surface, lacrimal glands and brain. Disruption of these nerves with interruption of neural feedback loops between the ocular surface and lacrimal glands can lead to corneal diseases such as dry eye disease (DED) and neurotrophic keratopathy (NK). Inversely, hypersensitivity of the nerve fibres and/or dysregulation of pain-controlling nervous centres may lead to neuropathic pain. Recently, medications that specifically target regeneration of corneal nerves have started to become available - and considering the high prevalence of diseases associated with corneal nerve dysfunction, these agents promise to fulfil a hitherto important unmet need. In this review, we explore the physiology of corneal nerves, the pathology of corneal nerve diseases and how these relate to neuropathic pain, NK and DED. We also discuss what novel treatments may be useful against diseases involving corneal nerves.
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Affiliation(s)
- Marc Labetoulle
- Ophthalmology South Paris University Hospital‐APHP Le Kremlin‐Bicêtre France
| | - Christophe Baudouin
- Quinze‐Vingts National Ophthalmology Hospital Paris France
- INSERM UMRS968 CNRS UMR7210 Paris 6 Vision Institute UPMC University Paris France
- University of Versailles Saint‐Quentin en Yvelines Versaille France
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23
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Abengózar-Vela A, Schaumburg CS, Stern ME, Calonge M, Enríquez-de-Salamanca A, González-García MJ. Topical Quercetin and Resveratrol Protect the Ocular Surface in Experimental Dry Eye Disease. Ocul Immunol Inflamm 2018; 27:1023-1032. [PMID: 30096001 DOI: 10.1080/09273948.2018.1497664] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Purpose: To determine the anti-inflammatory effect of quercetin (QCT), resveratrol (RES), and their combination in a dry eye disease (DED) model. Methods: 0.01% QCT, 0.1% RES, 0.01% QCT + 0.1% RES (QCT + RES) or vehicle were topically applied in a desiccating stress (DS) mice model. CD4+ T cells isolated from DS-exposed mice were transferred to athymic recipient mice. Corneal fluorescein staining, tear production, and tear cytokine levels were evaluated in DS-exposed mice, and conjunctival CD4+ T cell infiltration was evaluated in recipient mice. Results: QCT (p < 0.001) and QCT + RES (p < 0.05) reduced corneal staining in DS-exposed mice. IL-1α tear concentration was reduced by QCT, RES, and QCT + RES (p < 0.05, 0.01 and 0.01, respectively) compared to DS + vehicle mice. CD4+ T cells increased in recipients of DS-exposed mice (p < 0.05) and were lower in recipients of QCT- and RES-treated mice (p < 0.05). Conclusion: The anti-inflammatory effect of QCT, RES, and QCT + RES on DED-experimental model suggests that their topical application could be used for DED treatment.
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Affiliation(s)
| | - Chris S Schaumburg
- Biological Sciences, Inflammation Research Program, Allergan, Inc ., Irvine , CA , USA
| | - Michael E Stern
- Biological Sciences, Inflammation Research Program, Allergan, Inc ., Irvine , CA , USA
| | - Margarita Calonge
- IOBA, University of Valladolid , Valladolid , Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN) , Valladolid , Spain
| | - Amalia Enríquez-de-Salamanca
- IOBA, University of Valladolid , Valladolid , Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN) , Valladolid , Spain
| | - María Jesús González-García
- IOBA, University of Valladolid , Valladolid , Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN) , Valladolid , Spain
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Calonge M, Labetoulle M, Messmer EM, Shah S, Akova YA, Boboridis KG, Merayo-Lloves J, Aragona P, Benítez-Del-Castillo J, Geerling G, Rolando M, Baudouin C. Controlled Adverse Environment Chambers in Dry Eye Research. Curr Eye Res 2018; 43:445-450. [PMID: 29336696 DOI: 10.1080/02713683.2017.1420197] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Dry eye disease (DED) is a common condition with signs and symptoms that vary depending on a wide range of environmental factors to which people are exposed in their daily lives. Factors such as variable temperature, airflow velocity, relative humidity, seasonality, and pollutants can alter the rate of tear film evaporation, improving or exacerbating symptoms of DED. Results from currently available clinical tests do not always correlate well with patient-reported symptoms, and the continually changing environment and variability in DED symptoms present challenges for the design and conduct of clinical trials. Controlled adverse environment chambers allow standardization of temperature, humidity, and airflow and may minimize potential confounding factors in clinical investigations. Their use can promote accurate study of the pathophysiology of DED, discovery of disease biomarkers, and assessment of the effect of various therapeutic approaches on patients' symptoms. Controlled adverse environment chambers have been used to simulate indoor surroundings such as airplane cabins and to test their effects on contact lens wearers. This review summarizes how these chambers may be useful for the development, approval, and differentiation of potential new treatments for DED.
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Affiliation(s)
- Margarita Calonge
- a Instituto Oftalmobiologia Aplicada (IOBA), University of Valladolid , Valladolid , Spain.,b CIBER-BBN , Valladolid , Spain
| | - Marc Labetoulle
- c Department of Ophthalmology , Bicêtre University Hospital , Le Kremlin-Bicêtre , France
| | - Elisabeth M Messmer
- d Department of Ophthalmology , Ludwig Maximilian University , Munich , Germany
| | - Sunil Shah
- e Birmingham and Midland Eye Centre , Birmingham City Hospital , Birmingham , UK
| | - Yonca A Akova
- f Department of Ophthalmology , Bayindir Hospital , Ankara , Turkey
| | - Kostas G Boboridis
- g Oculoplastic and Ocular Surface Disease , Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Jesús Merayo-Lloves
- h Instituto Universitario Fernández-Vega, University of Oviedo , Oviedo , Spain
| | - Pasquale Aragona
- i Department of Biomedical Sciences, University of Messina , Messina , Italy
| | | | - Gerd Geerling
- k Department of Ophthalmology , University Hospital , Düsseldorf , Germany
| | - Maurizio Rolando
- l Department of Neuroscience, Ophthalmology and Genetics , University of Genoa , Genoa , Italy
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Nättinen J, Jylhä A, Aapola U, Enríquez-de-Salamanca A, Pinto-Fraga J, López-Miguel A, González-García MJ, Stern ME, Calonge M, Zhou L, Nykter M, Uusitalo H, Beuerman R. Topical fluorometholone treatment and desiccating stress change inflammatory protein expression in tears. Ocul Surf 2018; 16:84-92. [DOI: 10.1016/j.jtos.2017.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/07/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
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López-De La Rosa A, Arroyo-Del Arroyo C, Cañadas P, López-Miguel A, Calonge M, Enríquez-De-Salamanca A, González-García MJ. Are Contact Lens Discomfort or Soft Contact Lens Material Properties Associated with Alterations in the Corneal Sub-Basal Nerve Plexus? Curr Eye Res 2017; 43:487-492. [DOI: 10.1080/02713683.2017.1420804] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Alberto López-De La Rosa
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), University of Valladolid, Valladolid, Spain
- Departamento de Física Teórica, Atómica y Óptica, University of Valladolid, Valladolid, Spain
| | - Cristina Arroyo-Del Arroyo
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), University of Valladolid, Valladolid, Spain
- Departamento de Física Teórica, Atómica y Óptica, University of Valladolid, Valladolid, Spain
| | - Pilar Cañadas
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), University of Valladolid, Valladolid, Spain
- Departamento de Física Teórica, Atómica y Óptica, University of Valladolid, Valladolid, Spain
| | - Alberto López-Miguel
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), University of Valladolid, Valladolid, Spain
| | - Margarita Calonge
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), University of Valladolid, Valladolid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Amalia Enríquez-De-Salamanca
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), University of Valladolid, Valladolid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - María J González-García
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), University of Valladolid, Valladolid, Spain
- Departamento de Física Teórica, Atómica y Óptica, University of Valladolid, Valladolid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
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Cocho L, Fernández I, Calonge M, Sainz de la Maza M, Rovira M, Stern ME, Garcia-Vazquez C, Enríquez-de-Salamanca A. Prehematopoietic Stem Cell Transplantation Tear Cytokines as Potential Susceptibility Biomarkers for Ocular Chronic Graft-Versus-Host Disease. ACTA ACUST UNITED AC 2017; 58:4836-4846. [DOI: 10.1167/iovs.17-21670] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Lidia Cocho
- Institute of Applied OphthalmoBiology (IOBA), University of Valladolid, Valladolid, Spain
| | - Itziar Fernández
- Institute of Applied OphthalmoBiology (IOBA), University of Valladolid, Valladolid, Spain 2Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Carlos III National Institute of Health, Spain
| | - Margarita Calonge
- Institute of Applied OphthalmoBiology (IOBA), University of Valladolid, Valladolid, Spain 2Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Carlos III National Institute of Health, Spain
| | | | - Montserrat Rovira
- Clinical Institute of Hematologic and Oncological Diseases (ICMHO), Barcelona Clinic Hospital, Barcelona, Spain
| | - Michael E. Stern
- Baylor College of Medicine, Department of Ophthalmology, Houston, Texas, United States 6ImmunEyez, LLC, Mission Viejo, California, United States
| | - Carmen Garcia-Vazquez
- Institute of Applied OphthalmoBiology (IOBA), University of Valladolid, Valladolid, Spain
| | - Amalia Enríquez-de-Salamanca
- Institute of Applied OphthalmoBiology (IOBA), University of Valladolid, Valladolid, Spain 2Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Carlos III National Institute of Health, Spain
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Galindo S, Herreras JM, López-Paniagua M, Rey E, de la Mata A, Plata-Cordero M, Calonge M, Nieto-Miguel T. Therapeutic Effect of Human Adipose Tissue-Derived Mesenchymal Stem Cells in Experimental Corneal Failure Due to Limbal Stem Cell Niche Damage. Stem Cells 2017; 35:2160-2174. [DOI: 10.1002/stem.2672] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 04/18/2017] [Accepted: 06/17/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Sara Galindo
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid; Valladolid Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health; Spain
| | - José M. Herreras
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid; Valladolid Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health; Spain
| | - Marina López-Paniagua
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid; Valladolid Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health; Spain
| | - Esther Rey
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid; Valladolid Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health; Spain
| | - Ana de la Mata
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid; Valladolid Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health; Spain
| | - María Plata-Cordero
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid; Valladolid Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health; Spain
| | - Margarita Calonge
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid; Valladolid Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health; Spain
| | - Teresa Nieto-Miguel
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid; Valladolid Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health; Spain
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Carreño E, Portero A, Herreras JM, García-Vázquez C, Whitcup SM, Stern ME, Calonge M, Enríquez-de-Salamanca A. Cytokine and chemokine tear levels in patients with uveitis. Acta Ophthalmol 2017; 95:e405-e414. [PMID: 27873479 DOI: 10.1111/aos.13292] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/13/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine whether the levels of cytokines and chemokines in tears differ in uveitis patients and healthy subjects. METHODS Ninety-two uveitis patients (mean age 46.4 years) and 157 control healthy subjects (mean age 49.5 years) were recruited. Subjects with ocular surface diseases such as dry eye were excluded from the study. Using multiplex bead-based assays, tears (4 μl) were analysed for the concentration of interleukin (IL)-1β, IL-1RA, IL-2, IL-6, IL-7, IL-8/CXCL8, IL-10, IL-12p70, IL-15, IL-17A, IL-23, epidermal growth factor (EGF), fractalkine/CX3CL1, interferon-γ, IP-10/CXCL10, monocyte chemo-attractant protein (MCP)-1/CCL2, tumour necrosis factor-α, vascular endothelial growth factor (VEGF), transforming growth factor (TGF)-β1, TGF-β2 and TGF-β3. Tear molecule levels were compared between the groups and among the different forms of uveitis and disease severity. RESULTS Epidermal growth factor, IL-1RA, IL-7, IL-8/CXCL8, IP-10/CXCL10, MCP-1/CCL2, TGF-β2 and VEGF were detected in more than 75% of the samples in both groups. Statistically significant differences in percentage of detection between control and patient groups were found for IL-23, IL-1β, IL-15, EGF, fractalkine/CX3CL1 and MCP-1/CCL2. The concentrations of IL-1RA, IL-8/CXCL8, fractalkine/CX3CL1, IP-10/CXCL10, VEGF and TGF-β2 in uveitis tear samples were elevated compared to controls (p < 0.05). Significant differences in tear levels of those molecules and also EGF were also present depending on the anatomic classification of uveitis. CONCLUSION There were significant differences in the levels of several cytokines and chemokines in tears of patients with uveitis compared with healthy subjects. These results can help understand the underlying pathophysiology of the uveitis and could potentially aid in diagnosis.
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Affiliation(s)
- Ester Carreño
- IOBA (Institute of Applied OphthalmoBiology); University of Valladolid; Valladolid Spain
| | - Alejandro Portero
- IOBA (Institute of Applied OphthalmoBiology); University of Valladolid; Valladolid Spain
| | - José M. Herreras
- IOBA (Institute of Applied OphthalmoBiology); University of Valladolid; Valladolid Spain
- University Clinic Hospital; Valladolid Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine); Valladolid Spain
| | - Carmen García-Vázquez
- IOBA (Institute of Applied OphthalmoBiology); University of Valladolid; Valladolid Spain
| | | | | | - Margarita Calonge
- IOBA (Institute of Applied OphthalmoBiology); University of Valladolid; Valladolid Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine); Valladolid Spain
| | - Amalia Enríquez-de-Salamanca
- IOBA (Institute of Applied OphthalmoBiology); University of Valladolid; Valladolid Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine); Valladolid Spain
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López-de la Rosa A, Martín-Montañez V, López-Miguel A, Fernández I, Calonge M, González-Méijome JM, González-García MJ. Ocular response to environmental variations in contact lens wearers. Ophthalmic Physiol Opt 2017; 37:60-70. [PMID: 28030882 DOI: 10.1111/opo.12338] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/15/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the influence of different indoor environments simulated in an environmental chamber on soft contact lens (CL) wearers. METHODS Fifty-four CL wearers were grouped based on their symptoms while wearing their CLs. Subjects were fitted with two different CL types, conventional hydrogel (Omafilcon A) and silicone hydrogel (comfilcon A), and exposed to two controlled indoor environmental conditions, standard [50% relative humidity (RH), 23°C, 930 mb of atmospheric pressure] and adverse (in-flight air cabin environment: 5% RH, localised air flow, 23°C, 750 mb atmospheric pressure), for 90 min in an environmental chamber, making a total of four visits. Symptoms, tear osmolarity, pre-lens tear breakup time (PLBUT), phenol red thread test, visual acuity, bulbar and limbal hyperaemia, corneal and limbal staining, and CL dehydration were assessed using repeated measures analysis of variance. A linear mixed model was used to analyse the effect of environment, CL type, discomfort-based grouping, and time on blink rate. RESULTS Environment was found to significantly (p ≤ 0.018) affect limbal and bulbar hyperaemia, PLBUT, tear osmolarity, and CL dehydration. Likewise, CL type significantly (p ≤ 0.04) affected nasal and total corneal staining, limbal conjunctival staining, CL dehydration, comfort, and blurred vision. The environment, CL type, and time had significant effects (p ≤ 0.0001) on the blink rate. CONCLUSIONS Ocular surface integrity and blink rate in CL wearers depend on the environment CL users are exposed to, as well as on the soft CL type that they are wearing. Tight control of environmental conditions can contribute to a better understanding of CL-related discomfort.
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Affiliation(s)
| | | | | | - Itziar Fernández
- Ocular Surface Group, IOBA, University of Valladolid, Valladolid, Spain.,Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Margarita Calonge
- Ocular Surface Group, IOBA, University of Valladolid, Valladolid, Spain.,Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - José M González-Méijome
- Clinical and Experimental Optometry Research Laboratory, Center of Physics, University of Minho, Braga, Portugal
| | - María J González-García
- Ocular Surface Group, IOBA, University of Valladolid, Valladolid, Spain.,Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
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Urzua CA, Lantigua Y, Abuauad S, Liberman P, Berger O, Sabat P, Velasquez V, Castiglione E, Calonge M. Clinical Features and Prognostic Factors in Presumed Ocular Tuberculosis. Curr Eye Res 2017; 42:1029-1034. [PMID: 28157425 DOI: 10.1080/02713683.2016.1266663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To characterize the clinical features in patients with presumed ocular tuberculosis (TB) and determine prognostic factors of visual outcomes and complications in this disease. MATERIAL AND METHODS Retrospective case series of 35 patients (29 females, 6 males) with presumed ocular TB from referral centers in Chile and Spain between 2002 and 2012. Medical records were reviewed, and data regarding clinical features, complications, best-corrected visual acuity (BCVA), duration of disease, extraocular manifestations, and therapy were retrieved. Prognostic factors for low vision (BCVA 20/50 or less), legal blindness (BCVA 20/200 or less), and complications (cataract, glaucoma, and macular lesion) were evaluated. To calculate correlations, we used Spearman's rank correlation test. To determine clinical predictors, we used the binary logistic regression test. RESULTS Anterior and non-granulomatous uveitis was the most common types of inflammation. Only 2 (5.7%) patients had respiratory symptoms, and 6 (17.1%) patients had an abnormal chest X-ray at diagnosis. All patients received combined antitubercular therapy with a mean duration of 6.9 ± 2.3 months. A longer duration of symptoms at diagnosis was associated with both low vision and legal blindness. Older patients had a higher risk of legal blindness. A longer duration of symptoms as well as anterior inflammation demonstrated an increased risk for cataract formation. The duration of the symptoms and baseline BCVA had a positive correlation with the final BCVA. Prognostic factors of macular lesions were not found. CONCLUSIONS The diagnosis of ocular TB can be difficult due to the lack of extraocular manifestations and the broad spectrum of ocular features. A longer duration of symptoms at diagnosis was associated with poorer visual outcomes and cataracts. Therefore, efforts should be made to avoid a delay in the diagnosis of ocular TB and to identify prognostic factors for visual outcomes and complications.
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Affiliation(s)
- Cristhian A Urzua
- a Uveitis Department , Hospital del Salvador , Santiago , Chile.,b Ophthalmology Department , University of Chile , Santiago , Chile
| | - Yrbani Lantigua
- c IOBA (Institute of Applied Ophthalmobiology), University of Valladolid , Valladolid , Spain
| | - Sergio Abuauad
- b Ophthalmology Department , University of Chile , Santiago , Chile
| | - Paulina Liberman
- d Ophthalmology Department , Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Osvaldo Berger
- d Ophthalmology Department , Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Pablo Sabat
- a Uveitis Department , Hospital del Salvador , Santiago , Chile.,b Ophthalmology Department , University of Chile , Santiago , Chile
| | - Victor Velasquez
- a Uveitis Department , Hospital del Salvador , Santiago , Chile.,b Ophthalmology Department , University of Chile , Santiago , Chile
| | - Enzo Castiglione
- b Ophthalmology Department , University of Chile , Santiago , Chile
| | - Margarita Calonge
- c IOBA (Institute of Applied Ophthalmobiology), University of Valladolid , Valladolid , Spain.,e Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN) , Valladolid , Spain
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Calonge M, Pinto-Fraga J, González-García MJ, Enríquez-de-Salamanca A, López-de la Rosa A, Fernández I, López-Miguel A. Effects of the External Environment on Dry Eye Disease. Int Ophthalmol Clin 2017; 57:23-40. [PMID: 28282312 DOI: 10.1097/iio.0000000000000168] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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López-Paniagua M, Nieto-Miguel T, de la Mata A, Galindo S, Herreras JM, Corrales RM, Calonge M. Successful Consecutive Expansion of Limbal Explants Using a Biosafe Culture Medium under Feeder Layer-Free Conditions. Curr Eye Res 2016; 42:685-695. [PMID: 27911610 DOI: 10.1080/02713683.2016.1250278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Transplantation of in vitro cultured limbal epithelial stem cells (LESCs) is a treatment widely used for LESC deficiency. However, the number of limbal tissue donors is limited, and protocols for LESC cultivation often include compounds and/or feeder layers that can induce side effects and/or increase the cost of the culture procedure. We investigated the feasibility of obtaining more than one limbal primary culture (LPC) from the same biopsy using a culture medium in which several potentially harmful compounds were replaced at the same time by biosafe supplements, allowing the LESC cultivation without feeder layers. MATERIALS AND METHODS We established feeder layer-free LPCs with three culture media: (1) a modified supplemental hormonal epithelial medium, containing potential harmful components (cholera toxin, dimethylsulfoxide, and fetal bovine serum [FBS]), (2) IOBA-FBS, a medium with FBS but with no other harmful supplements, and (3) IOBA-HS, similar to IOBA-FBS but with human serum instead of FBS. Additionally, the same limbal explant was consecutively cultured with IOBA-HS producing three cultures. LPCs were characterized by real-time reverse transcription polymerase chain reaction and/or immunofluorescence. RESULTS LPCs cultured with the three media under feeder layer-free conditions showed cuboidal cells and no significant differences in the percentage of positive cells for limbal (ABCG2, p63, and K14) and corneal (K3, K12) proteins. Except for ABCG2, the relative mRNA expression of the LESC markers was significantly higher when IOBA-FBS or IOBA-HS was used. LPC1 showed characteristics similar to LPC0, while LPC2 cell morphology became elongated and the expression of some LESC markers was diminished. CONCLUSION IOBA-HS enables the culturing of up to two biosafe homologous LPCs from one limbal tissue under feeder layer-free conditions. The routine use of this culture medium could improve both the biosafety and the number of available LPCs for potential clinical transplantation, as well as decrease the expense of the culture procedure.
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Affiliation(s)
- Marina López-Paniagua
- a IOBA (Institute of Applied Ophthalmobiology) , University of Valladolid , Valladolid , Spain.,b CIBER-BBN (Networking Research Center on Bioengineering, Biomaterials, and Nanomedicine) , Valladolid , Spain
| | - Teresa Nieto-Miguel
- a IOBA (Institute of Applied Ophthalmobiology) , University of Valladolid , Valladolid , Spain.,b CIBER-BBN (Networking Research Center on Bioengineering, Biomaterials, and Nanomedicine) , Valladolid , Spain
| | - Ana de la Mata
- a IOBA (Institute of Applied Ophthalmobiology) , University of Valladolid , Valladolid , Spain.,b CIBER-BBN (Networking Research Center on Bioengineering, Biomaterials, and Nanomedicine) , Valladolid , Spain
| | - Sara Galindo
- a IOBA (Institute of Applied Ophthalmobiology) , University of Valladolid , Valladolid , Spain.,b CIBER-BBN (Networking Research Center on Bioengineering, Biomaterials, and Nanomedicine) , Valladolid , Spain
| | - José M Herreras
- a IOBA (Institute of Applied Ophthalmobiology) , University of Valladolid , Valladolid , Spain.,b CIBER-BBN (Networking Research Center on Bioengineering, Biomaterials, and Nanomedicine) , Valladolid , Spain
| | - Rosa M Corrales
- a IOBA (Institute of Applied Ophthalmobiology) , University of Valladolid , Valladolid , Spain.,b CIBER-BBN (Networking Research Center on Bioengineering, Biomaterials, and Nanomedicine) , Valladolid , Spain
| | - Margarita Calonge
- a IOBA (Institute of Applied Ophthalmobiology) , University of Valladolid , Valladolid , Spain.,b CIBER-BBN (Networking Research Center on Bioengineering, Biomaterials, and Nanomedicine) , Valladolid , Spain
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Calonge M, Herreras J, Stern M. Inflammation the good and the bad. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Martín-Montañez V, Enríquez-de-Salamanca A, López-de la Rosa A, López-Miguel A, Fernández I, Calonge M, González-Méijome JM, González-García MJ. Effect of Environmental Conditions on the Concentration of Tear Inflammatory Mediators During Contact Lens Wear. Cornea 2016; 35:1192-8. [DOI: 10.1097/ico.0000000000000960] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cocho L, Fernández I, Calonge M, Martínez V, González-García MJ, Caballero D, López-Corral L, García-Vázquez C, Vázquez L, Stern ME, Enríquez-de-Salamanca A. Biomarkers in Ocular Chronic Graft Versus Host Disease: Tear Cytokine- and Chemokine-Based Predictive Model. Invest Ophthalmol Vis Sci 2016; 57:746-58. [PMID: 26927568 DOI: 10.1167/iovs.15-18615] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To develop a tear molecule level-based predictive model based on a panel of tear cytokines and their correlation with clinical features in ocular chronic graft versus host disease (cGVHD). METHODS Twenty-two ocular cGVHD patients and 21 healthy subjects were evaluated in a controlled environmental research laboratory (CERLab). Clinical parameters were recorded, and tears were collected. Levels of 15 molecules (epidermal growth factor [EGF], IL receptor antagonist [IL-1Ra], IL-1β, IL-2, IL-6, IL-8/CXCL8, IL-10, IL-12p70, IL-17A, interferon inducible protein [IP]-10/CXCL10, IFN-γ, VEGF, TNF-α, eotaxin 1, and regulated on activation normal T cell expressed and secreted [RANTES]) were measured by multiplex-bead assay and correlated with clinical parameters. Logistic regression was used to develop a predictive model. Leave-one-out cross-validation was applied. Classification capacity was evaluated in a cohort of individuals with dry eye (DE) of other etiologies different from GVHD. RESULTS Epidermal growth factor and IP-10/CXCL10 levels were significantly decreased in ocular cGVHD, positively correlating with tear production and stability and negatively correlating with symptoms, hyperemia, and vital staining. Interleukin-1Ra, IL-8/CXCL8, and IL-10 were significantly increased in ocular cGVHD, and the first two correlated positively with symptoms, hyperemia, and ocular surface integrity while negatively correlating with tear production and stability. Predictive models were generated, and the best panel was based on IL-8/CXCL8 and IP-10/CXCL10 tear levels along with age and sex, with an area under the receiving operating curve of 0.9004, sensitivity of 86.36%, and specificity of 95.24%. CONCLUSIONS A predictive model based on tear levels of IL-8/CXCL8 and IP-10/CXCL10 resulted in optimal sensitivity and specificity. These results add further knowledge to the search for potential biomarkers in this devastating ocular inflammatory disease.
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Affiliation(s)
- Lidia Cocho
- Institute of Applied OphthalmoBiology (IOBA), University of Valladolid, Valladolid, Spain
| | - Itziar Fernández
- Institute of Applied OphthalmoBiology (IOBA), University of Valladolid, Valladolid, Spain 2Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Margarita Calonge
- Institute of Applied OphthalmoBiology (IOBA), University of Valladolid, Valladolid, Spain 2Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Verónica Martínez
- Institute of Applied OphthalmoBiology (IOBA), University of Valladolid, Valladolid, Spain
| | - María J González-García
- Institute of Applied OphthalmoBiology (IOBA), University of Valladolid, Valladolid, Spain 2Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Dolores Caballero
- Hematology Service, University Hospital, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Lucía López-Corral
- Hematology Service, University Hospital, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Carmen García-Vázquez
- Institute of Applied OphthalmoBiology (IOBA), University of Valladolid, Valladolid, Spain
| | - Lourdes Vázquez
- Hematology Service, University Hospital, Instituto de Investigación Biomédica de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | | | - Amalia Enríquez-de-Salamanca
- Institute of Applied OphthalmoBiology (IOBA), University of Valladolid, Valladolid, Spain 2Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
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López-Paniagua M, Nieto-Miguel T, de la Mata A, Dziasko M, Galindo S, Rey E, Herreras JM, Corrales RM, Daniels JT, Calonge M. Comparison of functional limbal epithelial stem cell isolation methods. Exp Eye Res 2016; 146:83-94. [DOI: 10.1016/j.exer.2015.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/05/2015] [Accepted: 12/07/2015] [Indexed: 12/15/2022]
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Priegue M, Vila A, Lucas A, Calonge M, Parrilla A. DI-078 Economic impact evaluation of oseltamivir adjustment criteria in renal impairment. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Cocho L, Fernández I, Calonge M, Martínez V, González-García MJ, Caballero D, López-Corral L, García-Vázquez C, Vázquez L, Stern ME, Enríquez-de-Salamanca A. Gene Expression-Based Predictive Models of Graft Versus Host Disease-Associated Dry Eye. Invest Ophthalmol Vis Sci 2015. [PMID: 26200497 DOI: 10.1167/iovs.15-16736] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To develop a predictive model based on inflammatory gene mRNA expression in conjunctival cells of graft versus host disease (GvHD)-associated dry eye (DE) patients, as well as to find meaningful correlations between gene signals and clinical signs. METHODS Twenty GvHD-DE patients and 14 healthy controls were recruited. Patients discontinued medications for 1 week before examination. Dry eye-related symptoms and signs were recorded, and conjunctival epithelial cells were collected by impression cytology after spending 20 minutes under standard conditions within a Controlled Environmental Research Laboratory. Gene expression of inflammatory molecules was determined by polymerase chain reaction, and the results were correlated with clinical signs. Shrinkage discriminant analysis, support vector machine, and k-nearest neighbor classifier methods were used to develop predictive models that were validated considering accuracy, calibration, and discriminant capability. RESULTS Out of the 84 genes analyzed, 34 showed significant differences in expression. IL-6, IL-9, CCL24, CCL18, IL-10, IFN-γ, and CCL2 were highly increased (>6-fold); 26 genes were moderately upregulated (2- to 6-fold), whereas EGFR was downregulated (2.63 fold) in GvHD-DE samples. A panel based on EGFR, IL-6, IL-9, and NAMPT had an area under the receiver operating characteristic curve of 0.994, a sensitivity of 100%, and a specificity of 92.9%. EGFR expression correlated negatively with ocular surface damage markers, while IL-6, IL-9, and NAMPT correlated positively with these tests. CONCLUSIONS EGFR, IL-6, IL-9, and NAMPT have the greatest potential as diagnostic biomarkers, with excellent sensitivity, specificity, and clinical relevance to the ocular surface status of GvHD.
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Affiliation(s)
- Lidia Cocho
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain
| | - Itziar Fernández
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain 2Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain
| | - Margarita Calonge
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain 2Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain
| | - Verónica Martínez
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain
| | - María J González-García
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain 2Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain
| | - Dolores Caballero
- Hematology Service, University Hospital, Instituto Biosanitario de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Lucía López-Corral
- Hematology Service, University Hospital, Instituto Biosanitario de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | - Carmen García-Vázquez
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain
| | - Lourdes Vázquez
- Hematology Service, University Hospital, Instituto Biosanitario de Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | | | - Amalia Enríquez-de-Salamanca
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain 2Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain
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Pinto-Fraga J, López-Miguel A, González-García MJ, Fernández I, López-de-la-Rosa A, Enríquez-de-Salamanca A, Stern ME, Calonge M. Topical Fluorometholone Protects the Ocular Surface of Dry Eye Patients from Desiccating Stress: A Randomized Controlled Clinical Trial. Ophthalmology 2015; 123:141-53. [PMID: 26520171 DOI: 10.1016/j.ophtha.2015.09.029] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/18/2015] [Accepted: 09/18/2015] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To assess the efficacy of topical 0.1% fluorometholone in dry eye disease (DED) patients for ameliorating the worsening of the ocular surface when exposed to adverse environments. DESIGN Single-center, double-masked, randomized, vehicle-controlled clinical trial. PARTICIPANTS Forty-one patients showing moderate to severe DED. METHODS Patients randomly received 1 drop 4 times daily of either topical 0.1% fluorometholone (FML group) or topical polyvinyl alcohol (PA group) for 22 days. Corneal and conjunctival staining, conjunctival hyperemia, tear film breakup time (TBUT), tear osmolarity, and the Symptom Assessment in Dry Eye (SANDE) questionnaire scores were determined at baseline. Variables were reassessed on day 21 before and after undergoing a 2-hour controlled adverse environment exposure and again on day 22. MAIN OUTCOMES MEASURES Percentage of patients showing an increase 1 point or more in corneal staining and a reduction of 2 points or more (0-10 scale) in SANDE score, after the controlled adverse environment exposure and 24 hours later. RESULTS After 21 days of treatment, the FML group showed greater improvements in corneal and conjunctival staining, hyperemia, and TBUT than the PA group (P≤0.03). After the adverse exposure, the percentage of patients having a 1-grade or more increase in corneal staining was significantly (P = 0.03) higher in the PA group (63.1% vs. 23.8%, respectively). Additionally, the FML group showed no significant changes in corneal staining (mean, 0.86; 95% confidence interval [CI], 0.47-1.25; vs. mean, 1.05; 95% CI, 0.59-1.51, for visit 2 and 3, respectively), conjunctival staining (mean, 0.95; 95% CI, 0.54-1.37 vs. mean, 1.19; 95% CI, 0.75-1.63), and hyperemia (mean, 0.71; 95% CI, 0.41-1.02 vs. 1.14; 95% CI, 0.71-1.58) after the exposure, whereas for the PA group, there was significant worsening (P≤0.009) in these variables (corneal staining: mean, 1.95; 95% CI, 1.57-2.33 vs. mean, 2.58; 95% CI, 2.17-2.98; conjunctival staining: mean, 1.68; 95% CI, 1.29-2.08 vs. mean, 2.47; 95% CI, 2.07-2.88; hyperemia: mean, 1.95; 95% CI, 1.63-2.26 vs. mean, 2.84; 95% CI, 2.62-3.07). CONCLUSIONS Three-week topical 0.1% fluorometholone therapy is effective not only in reducing ocular surface signs in DED patients, but also especially in preventing exacerbation caused by exposure to a desiccating stress.
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Affiliation(s)
- José Pinto-Fraga
- Instituto Universitario de Oftalmobiología Aplicada, University of Valladolid, Valladolid, Spain; Biomedical Research Networking Center on Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Alberto López-Miguel
- Instituto Universitario de Oftalmobiología Aplicada, University of Valladolid, Valladolid, Spain; VISIÓN I+D, SL, Valladolid, Spain
| | - María J González-García
- Instituto Universitario de Oftalmobiología Aplicada, University of Valladolid, Valladolid, Spain; Biomedical Research Networking Center on Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Itziar Fernández
- Instituto Universitario de Oftalmobiología Aplicada, University of Valladolid, Valladolid, Spain; Biomedical Research Networking Center on Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | - Alberto López-de-la-Rosa
- Instituto Universitario de Oftalmobiología Aplicada, University of Valladolid, Valladolid, Spain
| | - Amalia Enríquez-de-Salamanca
- Instituto Universitario de Oftalmobiología Aplicada, University of Valladolid, Valladolid, Spain; Biomedical Research Networking Center on Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain
| | | | - Margarita Calonge
- Instituto Universitario de Oftalmobiología Aplicada, University of Valladolid, Valladolid, Spain; Biomedical Research Networking Center on Bioengineering, Biomaterials and Nanomedicine, Zaragoza, Spain.
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Calonge M, Gonzalez-Garcia M, Enriquez de Salamanca A, Fernandez I, Pinto-Fraga J, Teson M, Martin-Montanez V, Stern M, Lopez-Miguel A. Environmental factors in ocular surface disease. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Calonge
- IOBA; University of Valladolid; Valladolid Spain
- CIBER-BBN; Carlos III National Institute of Health; Spain
| | - M.J. Gonzalez-Garcia
- IOBA; University of Valladolid; Valladolid Spain
- CIBER-BBN; Carlos III National Institute of Health; Spain
| | - A. Enriquez de Salamanca
- IOBA; University of Valladolid; Valladolid Spain
- CIBER-BBN; Carlos III National Institute of Health; Spain
| | - I. Fernandez
- IOBA; University of Valladolid; Valladolid Spain
- CIBER-BBN; Carlos III National Institute of Health; Spain
| | - J. Pinto-Fraga
- IOBA; University of Valladolid; Valladolid Spain
- CIBER-BBN; Carlos III National Institute of Health; Spain
| | - M. Teson
- IOBA; University of Valladolid; Valladolid Spain
- CIBER-BBN; Carlos III National Institute of Health; Spain
| | - V. Martin-Montanez
- IOBA; University of Valladolid; Valladolid Spain
- CIBER-BBN; Carlos III National Institute of Health; Spain
| | - M.E. Stern
- IOBA; University of Valladolid; Valladolid Spain
- Allergan Biological Sciences; Irvine CA USA
| | - A. Lopez-Miguel
- IOBA; University of Valladolid; Valladolid Spain
- Vision I+D; Valladolid Spain
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Abengózar-Vela A, Calonge M, Stern ME, González-García MJ, Enríquez-De-Salamanca A. Quercetin and Resveratrol Decrease the Inflammatory and Oxidative Responses in Human Ocular Surface Epithelial Cells. Invest Ophthalmol Vis Sci 2015; 56:2709-19. [PMID: 26066604 DOI: 10.1167/iovs.15-16595] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine the anti-inflammatory and antioxidant effects of quercetin (QCT) and/or resveratrol (RES) on human conjunctival (IOBA-NHC) and corneal (HCE) epithelial cell lines. METHODS IOBA-NHC and HCE cells were treated with QCT (0.5-25 μM), RES (0.5-50 μM) and a low-dose mixture of QCT (0.5 μM) and RES (5 μM) (QCT+RES) and stimulated with either TNF-α or ultraviolet (UV)-B radiation. Cytokine production (IL-6, IL-8, IP-10, and VEGF) was analyzed by an immune bead-based array, and intracellular reactive oxygen species (ROS) production was determined by a H2DCF-DA dye assay. RESULTS Stimulation of IOBA-NHC and HCE cells with TNF-α induced an increase of IL-6, IL-8, and IP-10 secretion in both cell lines. Quercetin and RES decreased IL-6 and IP-10 secretion in a dose-dependent manner in both cell lines. Interleukin-8 secretion was also inhibited in a dose-dependent manner by QCT in HCE, but only at 20 and 25 μM QCT and 50 μM RES in IOBA-NHC and at 50 μM RES in HCE. QCT+RES decreased IL-6 and IL-8 secretion (P < 0.01 and P < 0.05, respectively) in IOBA-NHC cells. Ultraviolet-B induced a significant increase of ROS in both cell lines (P < 0.01 and P < 0.001 for IOBA-NHC and HCE cells, respectively), which was significantly decreased in a dose-dependent manner by QCT and RES in HCE cells. Reactive oxygen species production in IOBA-NHC cells was inhibited (P < 0.05) by 50 μM RES. CONCLUSIONS Quercetin and RES have anti-inflammatory and antioxidant effects on IOBA-NHC and HCE cells. These in vitro data suggest that both polyphenols may have a therapeutic potential in the treatment of inflammatory ocular surface diseases.
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Affiliation(s)
- Antonio Abengózar-Vela
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain 2Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain
| | - Margarita Calonge
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain 2Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain
| | - Michael E Stern
- Biological Sciences, Inflammation Research Program, Allergan, Inc., Irvine, California, United States
| | - María Jesús González-García
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain 2Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain
| | - Amalia Enríquez-De-Salamanca
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain 2Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain
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Ramírez BE, Victoria DA, Murillo GM, Herreras JM, Calonge M. In vivo confocal microscopy assessment of the corneoscleral limbal stem cell niche before and after biopsy for cultivated limbal epithelial transplantation to restore corneal epithelium. Histol Histopathol 2014; 30:183-92. [PMID: 25075515 DOI: 10.14670/hh-30.183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Autologous cultivated limbal epithelial transplantation (CLET) is a successful therapy to restore corneal epithelium when limbal epithelial stem cells are damaged unilaterally, which can result in corneal blindness. We used in vivo confocal microscopy (IVCM) to identify the best location in the corneoscleral limbal niche and to harvest autologous epithelial stem cells for CLET. We also ascertained the completeness of limbal structure removal after biopsy and followed the healing process for any evidence of limbal structure reappearance. The 4 meridians of the corneoescleral limbus of 5 healthy donor eyes were scanned clinically and by IVCM before biopsy and 1 week, 1, 3, and 6 months after. IVCM detected palisades of Vogt, the limbal niche hallmark, more efficiently (100%) than clinically (60%), and were consistently better defined at the 12 o'clock meridian, and so this was the site selected for biopsy. The depth of palisades was 80.4±19.8 μm, and of the limbal biopsies was 136.8±19.1 μm, thus assuring that the limbal niche was completely harvested in all cases. Re-epithelialization of the donor site was complete at 1 week. The limbal wound was refilled with fibrovascular tissue, and no limbal-like structures reappeared. The study shows that clinical absence of palisades of Vogt is not necessarily an exclusionary criterion for autologous CLET. IVCM was useful to select the best place for limbal biopsy and identified features not visible clinically. IVCM also confirmed complete removal of limbal tissue by the biopsy. Limbal niche structures did not reappear by 6 months after surgery.
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Affiliation(s)
- Beatriz E Ramírez
- Cell Therapy Unit, IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain.
| | - Darío A Victoria
- Cell Therapy Unit, IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain
| | - Giovana M Murillo
- Cell Therapy Unit, IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain
| | - José M Herreras
- Cell Therapy Unit, IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, and CIBER-BBN (Networking Research Center on Bioengineering, Biomaterials and Nanomedicine, Carlos III National Institute of Health, Valladolid, Spain
| | - Margarita Calonge
- Cell Therapy Unit, IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, and CIBER-BBN (Networking Research Center on Bioengineering, Biomaterials and Nanomedicine, Carlos III National Institute of Health, Valladolid, Spain.
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García-Posadas L, Contreras-Ruiz L, Arranz-Valsero I, López-García A, Calonge M, Diebold Y. CD44 and RHAMM hyaluronan receptors in human ocular surface inflammation. Graefes Arch Clin Exp Ophthalmol 2014; 252:1289-95. [PMID: 24916930 DOI: 10.1007/s00417-014-2686-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 02/27/2014] [Accepted: 05/28/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND CD44 and RHAMM hyaluronan (HA) receptors have been studied in several systemic diseases such as osteoarthritis and cancer. However, not too much is known about their role in ocular surface disorders. The purpose of this research was to determine if CD44 and RHAMM are implicated in human ocular surface inflammation. METHODS Upper tarsal conjunctival epithelial samples from patients with active ocular surface inflammation (n = 17) and healthy controls (n = 14) were recovered by brush cytology. Patients were evaluated by an ophthalmologist and classified in different groups according to the etiology (immune atopic diseases or immune non-atopic diseases) and inflammation intensity (mild/moderate or severe). CD44, RHAMM, and p53 mRNAs were measured using real-time PCR. RESULTS CD44, RHAMM, and p53 mRNAs were detected in all samples. In immune atopic diseases, higher levels of CD44 and RHAMM mRNAs were present, reaching a 300 % increase for RHAMM in severe inflammation (p < 0.001). In contrast, in immune non-atopic diseases, the HA receptors were downregulated. CD44 tended to decrease up to 30 % in severe patients (p = 0.06), and RHAMM decreased 40 % in severe inflammation (p = 0.021). CONCLUSIONS RHAMM may be implicated in severe ocular surface inflammation affecting the upper tarsal conjunctiva.
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Affiliation(s)
- Laura García-Posadas
- Ocular Surface Group, IOBA (Institute for Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain
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López-Miguel A, Tesón M, Martín-Montañez V, Enríquez-de-Salamanca A, Stern ME, Calonge M, González-García MJ. Dry eye exacerbation in patients exposed to desiccating stress under controlled environmental conditions. Am J Ophthalmol 2014; 157:788-798.e2. [PMID: 24412126 DOI: 10.1016/j.ajo.2014.01.001] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 01/03/2014] [Accepted: 01/04/2014] [Indexed: 01/11/2023]
Abstract
PURPOSE To determine if controlled environmental conditions can induce acute exacerbations of signs and symptoms in dry eye and asymptomatic subjects. DESIGN Prospective cross-sectional study. METHODS Nineteen patients with dry eye and 20 asymptomatic controls were exposed to controlled low humidity (5% relative humidity, desiccating environment) for 2 hours in our Controlled Environmental Research Laboratory at the University of Valladolid. The patients completed the Single-Item Score Dry Eye Questionnaire and the following diagnostic tests were performed before and after exposure: tear osmolarity, phenol red thread test, conjunctival hyperemia, fluorescein tear film break-up time, Schirmer test, and ocular surface vital staining. Sixteen molecules in the tears samples were analyzed by multiplex bead analysis. RESULTS After exposure, the patients and controls had a significant (P ≤ .003) increase in corneal staining (from 0.68 ± 0.15 to 1.16 ± 0.14 and from 0.50 ± 0.15 to 1.30 ± 0.19, respectively), significantly decreased (P ≤ .01) fluorescein tear film break-up time values (from 2.78 ± 0.56 seconds to 1.94 ± 0.24 seconds and from 2.81 ± 0.24 seconds to 2.13 ± 0.19 seconds, respectively), and significantly increased (P ≤ .03) matrix metalproteinase 9 tear levels (from 10 054.4 ± 7326.6 pg/mL to 25 744.5 ± 13 212.4 pg/mL and from 10 620.5 ± 4494.3 pg/mL to 16 398.7 ± 5538.3 pg/mL, respectively). In the control group, the epidermal growth factor tear levels decreased significantly (P = .007; from 1872.1 ± 340.7 pg/mL to 1107.1 ± 173.6 pg/mL), and interleukin 6 levels increased significantly (P < .001; from 29.6 ± 5.8 pg/mL to 54.3 ± 8.3 pg/mL) after exposure. CONCLUSIONS Adult patients with mild-to-moderate dry eye and asymptomatic subjects of similar ages can experience acute exacerbation in an environmental chamber that resembles the sudden worsening that patients with dry eye experience daily.
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Benito MJ, González-García MJ, Tesón M, García N, Fernández I, Calonge M, Enríquez-de-Salamanca A. Intra- and inter-day variation of cytokines and chemokines in tears of healthy subjects. Exp Eye Res 2014; 120:43-9. [DOI: 10.1016/j.exer.2013.12.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/27/2013] [Accepted: 12/26/2013] [Indexed: 12/13/2022]
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García N, Tesón M, Enríquez-de-Salamanca A, Mena L, Sacristán A, Fernández I, Calonge M, González-García MJ. Basal values, intra-day and inter-day variations in tear film osmolarity and tear fluorescein clearance. Curr Eye Res 2014; 39:673-9. [DOI: 10.3109/02713683.2013.865757] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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de la Mata A, Nieto-Miguel T, López-Paniagua M, Galindo S, Aguilar MR, García-Fernández L, Gonzalo S, Vázquez B, Román JS, Corrales RM, Calonge M. Chitosan-gelatin biopolymers as carrier substrata for limbal epithelial stem cells. J Mater Sci Mater Med 2013; 24:2819-2829. [PMID: 23892486 DOI: 10.1007/s10856-013-5013-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 07/16/2013] [Indexed: 06/02/2023]
Abstract
The aim of this work was to evaluate semi-synthetic biopolymers based on chitosan (CH) and gelatin (G) as potential in vitro carrier substrata for human limbal epithelial cells (hLECs). To that end, human corneal epithelial cells (HCE) were cultured onto different CH-G membranes. None of the polymers were cytotoxic and cell proliferation was higher when CH was functionalized with G. Expression levels of corneal epithelial markers (K3, K12, E-caherin, desmoplakin, and zonula occludens (ZO)-1) were better maintained in HCE cells grown on CH-G 20:80 membranes than other proportions. Consequently, CH-G 20:80 was chosen for the subsequent expansion of hLECs. Cells derived from limbal explants were successfully expanded on CH-G 20:80 membranes using a culture medium lacking components of non-human animal origin. The expression levels found for corneal (K3 and K12) and limbal epithelial stem cells (K15) specific markers were similar to or higher than those found in limbal cells grown onto the control substratum. Our results demonstrate that CH-G 20:80 membranes are suitable for the expansion and maintenance of stem cells derived from the limbal niche. These results strongly support the use of polymers as alternative substrata for the transplantation of cultivated limbal cells onto the ocular surface.
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Affiliation(s)
- Ana de la Mata
- IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain,
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Gonzalez-Garcia MJ, Montañez VM, Lopez-Miguel A, Calonge M, Meijome JMG. Effect of environmental conditions in contact lens (CL) dehydration and symptoms of CL wearers. Cont Lens Anterior Eye 2013. [DOI: 10.1016/j.clae.2013.08.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martín-Montañez V, López-Miguel A, Arroyo C, Mateo ME, González-Méijome JM, Calonge M, González-García MJ. Influence of environmental factors in thein vitrodehydration of hydrogel and silicone hydrogel contact lenses. J Biomed Mater Res B Appl Biomater 2013; 102:764-71. [DOI: 10.1002/jbm.b.33057] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 09/22/2013] [Accepted: 09/22/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Vicente Martín-Montañez
- Ocular Surface Group; IOBA; Universidad de Valladolid; Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine); Spain
| | - Alberto López-Miguel
- VISIÓN I+D, SL; Valladolid Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine); Spain
| | - Cristina Arroyo
- Ocular Surface Group; IOBA; Universidad de Valladolid; Spain
| | - María E. Mateo
- Ocular Surface Group; IOBA; Universidad de Valladolid; Spain
| | - José M. González-Méijome
- Clinical and Experimental Optometry Research Laboratory; Center of Physics, University of Minho; Braga Portugal
| | - Margarita Calonge
- Ocular Surface Group; IOBA; Universidad de Valladolid; Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine); Spain
| | - María J. González-García
- Ocular Surface Group; IOBA; Universidad de Valladolid; Spain
- CIBER-BBN (Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine); Spain
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