Prospective PED-study of intravitreal aflibercept for refractory vascularized pigment epithelium detachment due to age-related macular degeneration: morphologic characteristics of non-responders in optical coherence tomography

Purpose

The aim of this study was to investigate the outcomes of a fixed intravitreal aflibercept regimen in patients with vascular pigment epithelium detachment (vPED) secondary to age-related macular degeneration with refractory subretinal fluid.

Methods

A prospective, interventional case series involved 20 eyes of 20 patients with refractory subretinal fluid and vPED treated with at least three injections of intravitreal anti-VEGF prior to study inclusion. After study inclusion, patients were treated with three injections of intravitreal aflibercept 2 mg/0.05 mL monthly followed by injections every 8 weeks. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) were evaluated at all visits. Fluorescein angiography and indocyanine green angiography were performed at baseline and quarterly. Primary outcomes were effectivity of a fixed treatment as measured in change in BCVA, PED greatest linear diameter (GLD), and PED height from baseline to month 12. In an additional post hoc analysis, vPED patients were differentiated into two groups: (1) vPED lesions that showed persistence of subretinal fluid throughout 1 year of treatment and (2) vPED lesions that showed complete resolution of subretinal fluid at least at one of the monthly performed OCT volume scans. Reflectivity values were determined in the subretinal pigment epithelium (RPE) compartment in OCT scans at baseline, month 6 and 12.

Results

A total of 18 patients completed the study protocol. The mean age was 74.8 ± 10.6 years, and six patients were female. The median BCVA of all patients was 72.0 ± 8.0 EDTRS letters at baseline and 72.5 ± 9.5 EDTRS letters at 12-month follow-up (p = 0.7420). The median PED height in all patients as measured in the OCT images significantly decreased from 372.0 ± 140.0 μm to 149.0 ± 142.0 μm after 12 months of treatment (p = 0.0020). Persistent subretinal fluid was present at every OCT control in six patients (group 1). Twelve patients showed resolution of subretinal fluid at least at one OCT control (group 2). Reflectivity values in the sub-RPE compartment in OCT scans were 41.48 ± 4.48 (group 1) and 42.62 ± 12.34 (group 2) at baseline (p = 0.854) and 65.88 ± 6.74 and 50.87 ± 14.11 at month 12 (p = 0.038).

Conclusions

Intravitreal aflibercept in refractory vPED leads to a significant reduction in PED height and disease activity as well as preservation of BCVA over 1 year. Persistent subretinal fluid was present in PED lesions with high values of reflectivity under the RPE, suggesting both a diffusion barrier and an increasing fibrovascular maturization of the choroidal neovascularization.

Trial registration

ClinicalTrials.gov Identifier: NCT03370380

Impact of integrated multiple image averaging on OCT angiography image quality and quantitative parameters

PURPOSE

Multiple image averaging (MIA) is a new approach to improve OCT angiography (OCTA) imaging. The aim of this work was to analyze the impact of MIA on image quality and quantitative OCTA parameters.

METHODS

Twenty eyes from 20 healthy volunteers (55.65 ± 14.8 years) were prospectively enrolled. Imaging was performed using two commercially available OCTA devices (Canon OCT HS-100, Optovue AngioVue) using a uniform imaging protocol. Each participant had two single scans of the macula (3 × 3mm, Canon and Optovue) as well as five continuous single scan imaging procedures (3 × 3mm each) using the Canon device. Three out of five of these images with highest quality were manually chosen and then automatically processed by the Canon device using MIA. The superficial retinal plexus of the single scans and of MIA images was analyzed with regard to the device' own image quality scores (IQS), peak signal-to-noise ratio (PSNR), the size of the foveolar avascular zone (FAZ), and vessel density (VD). Image acquisition times were recorded. Parameters were compared between the devices and the different imaging protocols.

RESULTS

Average acquisition time was significantly higher for the MIA compared with the single measurements (29.09 ± 10.19 seconds (s) (MIA) vs. 5.56 ± 2.17 s (Canon single scan) vs. 20.28 ± 6.81 s (Optovue) (p < 0.001)). IQS showed no significant differences between the devices and between the recording protocols. PSNR was 12.38 ± 0.20 (Canon single scan), 13.01 ± 0.36 (Canon MIA), and 14.34 ± 0.60 (Optovue) (p < 0.001 between the groups). Mean FAZ area in Canon single scans was 0.29 ± 0.06 mm², 0.27 ± 0.07 mm² using MIA, and 0.27 ± 0.08 mm² using the Optovue device. There was no significant difference between mean FAZ measurements before and after averaging (Canon single scan vs. MIA, p = 0.168). VD of the parafoveal area using MIA was significantly lower compared with both single scans (p < 0.001).

CONCLUSIONS

MIA can improve PSNR, but it also reduces imaging speed and significantly affects VD measurements. Therefore, when comparing OCTA data, the use of uniform imaging protocols is required.

Signal reduction in choriocapillaris and segmentation errors in spectral domain OCT angiography caused by soft drusen

PURPOSE

To analyze signal reduction in choriocapillaris (CC) and segmentation errors in spectral domain optical coherence tomography angiography (OCT-A) caused by soft drusen due to age-related macular degeneration (AMD).

METHODS

Twenty-four eyes of 24 patients underwent multimodal retinal imaging including central 3 × 3mm² OCT-A (AngioVue, Optovue). Three drusen per study eye were randomly chosen and evaluated regarding drusen height, diameter, and accuracy of OCT-A layer segmentation in lesion proximity. Structural en-face OCT CC images were graded qualitatively and quantitatively regarding signal loss underneath the individual drusen area. Those drusen that showed no distinct signal loss in structural en-face OCT CC images were further evaluated in OCT-A. CC decorrelation signal index was measured within a 30-μm OCT-A CC slab in the exact area of drusen affection. Data were compared to healthy age-matched control subjects. Accuracy of layer segmentation, OCT CC data, and OCT-A CC data were correlated to morphological drusen parameters.

RESULTS

Mean drusen height and diameter were 91.57 ± 19.5μm and 315.17 ± 116.7μm. OCT-A layer segmentation of the inner plexiform layer (IPL) was disturbed by more than 50 μm in proximity to 26 drusen (36.1%). In these patients, drusen height was significantly higher compared to those with accurate IPL segmentation (p = 0.0126). Sixty-six out of 72 drusen (91.7%) caused a distinct signal loss in the structural en-face OCT CC image. Drusen height and drusen diameter were significantly higher in this group compared to the six drusen with a sufficient signal (p = 0.0276, p = 0.0025). CC decorrelation signal index measured in the area of these six drusen without OCT signal loss (8.3%) was reduced compared to age-matched healthy controls (73.6 vs. 100.1; p = 0.001).

CONCLUSIONS

Signal attenuation in CC slabs and segmentation errors of the IPL depend on drusen morphology. Both are frequent artifacts in OCT-A imaging in patients with soft drusen and must be considered during image analysis.

Impact of eye-tracking technology on OCT-angiography imaging quality in age-related macular degeneration

OBJECTIVE

To evaluate the impact of eye-tracking (ET) technology on optical coherence tomography angiography (OCT-A) image quality and manifestation of motion artifacts in patients with age-related macular degeneration (AMD).

METHODS

In a prospective trial, multimodal retinal imaging including OCT-A was performed in 30 patients (78.97 ± 9.7 years) affected by different stages of AMD. Central 3 × 3 mm² OCT-A imaging was performed four times consecutively in each patient, twice with active, and twice with inactive ET. Parameters for image evaluation were signal strength index (SSI), variability of foveal vessel density (VD), acquisition time, presence of motion artifacts caused by eye movement (blink lines, displacement) and by software correction of eye movement (quilting, stretch artifacts, vessel doubling). Images were evaluated by two independent readers with subsequent senior reader arbitration for presence of artifacts, and an OCT-A motion artifact score (MAS) was calculated.

RESULTS

Eight patients had early and eight patients had intermediate stages of AMD. Four patients had an atrophic late stage and ten patients an exudative stage of the disease. SSI was 53.55 with inactive and 57.18 with active ET (p = 0.0005). Coefficients of variability of VD between the first and second measurement were 8.9% with inactive and 5.7% with active ET. Mean image acquisition time was 15.97 s (active ET: 22.88 s, p < 0.001). Presence of motion artifacts was significantly higher with inactive ET (mean MAS 3.27 vs. 1.93; p < 0.0001). MAS correlated with AMD disease stage [p = 0.0031 (inactive ET) and p < 0.0001 (active ET)] and with SSI (p = 0.0072 and p = 0.0006).

CONCLUSIONS

In patients with AMD, active ET technology offers an improved image quality in OCT-A imaging regarding presence of motion artifacts at the expense of higher acquisition time.

[Use of nanoparticles in ophthalomology]

Nanotechnology, the manufacture and use of structures and implements of around a few 100 nm in size, is becoming a key technology of the twenty-first century. An important element for the manufacture of nanoparticles is gold. Gold nanoparticles can be custom made and chemically modified in their size and form. Initial investigations have shown that they are physiologically non-hazardous. A potential application is in neovascular age-related macular degeneration. Gold nanoparticles of suitable dimensions introduced into newly forming blood vessels can be targeted and heated which selectively destroys these blood vessels. This principle has already been demonstrated in cultivated endothelial cells.

[Chances and risks of anti-VEGF therapy]

Vascular endothelial growth factor (VEGF) plays a pivotal role in angiogenesis. Through regulation of haemodynamics, haematopoesis and the immune system, endocrinology and reparative processes, inhibition of VEGF can cause multiple adverse events. Previous data suggest that--even after intravitreal injection--systemic exposure might occur, thus bearing the risk of manifestation of side effects. Experience with intravenous administration of the antibody bevacizumab (Avastin) pointed to the potential consequences of a pan-VEGF blockade. The change of haemodynamic parameters implies a potential influence on the patient's morbidity. Studies already conducted during the approval process do not provide sufficient statistical power when evaluating whether systemic events significantly differ between the treatment and control groups. Retinal perfusion showed an altered vascular tone (change in vessel diameter) following anti-VEGF treatment. Physiological fenestration of the choroicapillaris is significantly reduced. Possible effects on the local oxygen supply in ischaemic tissue have to be considered. In contrast to destructive treatment modalities (laser, cryo), VEGF inhibitors promise the prompt and efficient response of retinal neovascularisation and the preservation of a better function (visual fields). The maturation of growing vessels (pericytes) and the secondary formation of membranes are limiting factors with regard to the time-point at which anti-VEGF therapy is most effective. A diligent use of the available drugs has to take into account which types of exudative retinopathy are showing no or only very limited response to the treatment.

Immunohistochemical localisation of intravitreally injected bevacizumab in the anterior chamber angle, iris and ciliary body of the primate eye

AIMS

To locate bevacizumab in the tissues related to neovascularisation in the anterior segment within 1-14 days after intravitreal injection in the primate eye.

METHODS

Four cynomolgus monkeys received an intravitreal injection of 1.25 mg bevacizumab. Control eyes remained untreated. The eyes were enucleated on day 1, 4 and 14 for immunohistochemistry, using donkey anti-human Cy3-IgG.

RESULTS

Immunoreactivity for bevacizumab was found in the blood vessels walls of the iris, anterior chamber angle and ciliary body. In the iris and chamber angle, immunoreactivity was most prominent on day 1 after injection and diminished until day 14. In the ciliary body, staining was most intense on day 4 and remained prominent until day 14. Immunoreactivity was also present in certain vessel lumens, especially in the ciliary body and the iris on day 4 and 14.

CONCLUSION

Bevacizumab penetrates quickly into the iris, anterior chamber angle and ciliary body after intravitreal injection in the primate eye and accumulates particularly in blood-vessel walls. The highest concentration of bevacizumab in these tissues is present on day 1-4, the iris and anterior chamber angle being penetrated slightly earlier than the ciliary body. Our findings support the clinically observed rapid effect in the treatment of iris neovascularisation.

Implantable visual prostheses

Visual impairment and blindness is primarily caused by optic neuropathies like injuries and glaucomas, as well as retinopathies like agerelated macular degeneration (MD), systemic diseases like diabetes, hypertonia and hereditary retinitis pigmentosa (RP). These pathological conditions may affect retinal photoreceptors, or retinal pigment epithelium, or particular subsets of retinal neurons, and in particular retinal ganglion cells (RGCs). The RGCs which connect the retina with the brain are unique cells with extremely long axons bridging the distance from the retina to visual relays within the thalamus and midbrain, being therefore vulnerable to heterogeneous pathological conditions along this pathway. When becoming mature, RGCs loose the ability to divide and to regenerate their accidentally or experimentally injured axons. Consequently, any loss of RGCs is irreversible and results to loss of visual function. The advent of micro- and nanotechnology, and the construction of artificial implants prompted to create visual prostheses which aimed at compensating for the loss of visual function in particular cases. The purpose of the present contribution is to review the considerable engineering expertise that is essential to fabricate current visual prostheses in connection with their functional features and applicability to the animal and human eye. In this chapter, 1) Retinal and cortical implants are introduced, with particular emphasis given to the requirements they have to fulfil in order to replace very complex functions like vision. 2) Advanced work on material research is presented both from the technological and from the biocompatibility aspect as prerequisites of any perspectives for implantation. 3) Ultimately, experimental studies are presented showing the shaping of implants, the procedures of testing their biocompatibility and essential modifications to improve the interfaces between technical devices and the biological environment. The review ends by pointing to future perspectives in the rapidly accelerating process of visual prosthetics and in the increasing hope that restoration of the visual system becomes reality.

Role of a neuronal small non-messenger RNA: behavioural alterations in BC1 RNA-deleted mice

BC1 RNA is a small non-messenger RNA common in dendritic microdomains of neurons in rodents. In order to investigate its possible role in learning and behaviour, we compared controls and knockout mice from three independent founder lines established from separate embryonic stem cells. Mutant mice were healthy with normal brain morphology and appeared to have no neurological deficits. A series of tests for exploration and spatial memory was carried out in three different laboratories. The tests were chosen as to ensure that different aspects of spatial memory and exploration could be separated and that possible effects of confounding variables could be minimised. Exploration was studied in a barrier test, in an open-field test, and in an elevated plus-maze test. Spatial memory was investigated in a Barnes maze and in a Morris water maze (memory for a single location), in a multiple T-maze and in a complex alley maze (route learning), and in a radial maze (working memory). In addition to these laboratory tasks, exploratory behaviour and spatial memory were assessed under semi-naturalistic conditions in a large outdoor pen. The combined results indicate that BC1 RNA-deficient animals show behavioural changes best interpreted in terms of reduced exploration and increased anxiety. In contrast, spatial memory was not affected. In the outdoor pen, the survival rates of BC1-depleted mice were lower than in controls. Thus, we conclude that the neuron-specific non-messenger BC1 RNA contributes to the aptive modulation of behaviour.

[Neuroprotection and regeneration after traumatic lesion of the optic nerve]

BACKGROUND

After a traumatic lesion of the optic nerve, retinal ganglion cells (RGC) undergo massive degeneration by apoptosis, which leads to loss of vision in the affected eye. Like other neurones in the central nervous system, RGC are not able to regenerate their damaged axons spontaneously. We used special surgical methods and pharmacological measures to achieve enhanced survival and regeneration of damaged RGC.

MATERIALS AND METHODS

Studies were performed using the model of RGC degeneration induced by severing the optic nerve of adult rats. RGC were loaded with a fluorescent dye, and several drugs were applied intravitreally. The effects were evaluated after two weeks by counting the surviving RGC. For regeneration studies, an autologous peripheral nerve graft was sutured to the stump of the cut optic nerve, or the ends of the cut optic nerve were re-sutured. Recovery of RGC function was assessed by VEP measurements.

RESULTS

The number of RGC surviving an axotomy increased significantly after intravitreal injections of aurintricarboxylic acid, cortisol, a caspase inhibitor, brimonidine or microglia-targeted substances. Regeneration of cut axons was enhanced by aurintricarboxylic acid or cortisol. In addition, considerable neuroprotective and regenerative effects including partial restoration of VEP were induced by lens injury, which results in a gradual release of crystallins into the vitreous, or by intravitreal injection of purified crystallins.

CONCLUSION

The loss of vision after an optic nerve trauma can be reduced in this animal model by suitable neuroprotective measures, which raises hope for the treatment of patients.

Lens-injury-stimulated axonal regeneration throughout the optic pathway of adult rats

Axonal regrowth and restoration of visual function were studied in adult rats. The optic nerve was completely cut behind the eye. The proximal and distal nerve stumps were realigned and the meninges sutured back together. During the same surgical procedure, the lens was lesioned in order to induce secondary cellular cascades, which are known to strongly support the survival of retinal ganglion cells (RGCs) and to promote axonal regeneration. The anatomical and topographic restoration of the visual pathway was assessed neuroanatomically with the aid of anterograde and retrograde tracing using fluorescent dyes. It appeared that the axons formed growth cones at the junction of the suture soon after injury, before glial cells and extracellular matrix proteins were able to cause local scar formation. Growth cones first entered the distal optic nerve stump 3 days after injury, grew through it to reach the optic chiasm approximately 3 weeks after the lesion was made, and terminated within the retinoreceptive layers of the superior colliculus 5 weeks after lesioning. Quantification of the retrogradely labeled cell bodies within the regenerating retina revealed that up to 30% of the RGCs, which includes all major cell types, were capable of regenerating their axons along the entire visual pathway. To assess whether topography was restored, double-labeling experiments were performed, revealing only crude topographic restoration during the initial stages of regeneration. However, visual-evoked potentials could be recorded, indicating that synaptic transmission in higher visual areas was relatively intact. The data show, in principle, that cut axons can regenerate over long distances within the white matter of a central nerve like the adult optic nerve, spanning over 11 mm to the chiasm and between 12 and 15 mm to the thalamus and midbrain. The findings suggest, for the first time, that lentogenic stimulation of RGCs is sufficient to induce the formation of growth cones that can override inhibitors at the site of injury, grow through the white matter of the optic nerve, pass through the optic chiasm, and make synaptic connections within the brain.

Exposure to a solar eclipse causes neuronal death in the retina

BACKGROUND

A solar eclipse was observed in Europe on 11 August 1999. Several individuals suffered from transient or persisting retinal damage, caused by gazing at the eclipse without adequate eye protection. Retinal damage is the most serious hazard of exposure to light. but the mechanisms by which this type of exposure produces retinal damage and its cellular correlates are not yet established. We used an animal model to monitor the mechanisms of retinal damage following excessive light exposure, and in particular to study whether observation of the eclipse induces death of retinal cells.

METHODS

In the geographic area where the experiment was conducted, a partial (90%) solar eclipse was observed. Experimental albino rats were exposed to these eclipse conditions, and control rats were exposed to normal sunlight. Another group of control animals was exposed to the same conditions, but was provided with protective light filters of the type recommended for human use. The DNA fragmentation in retinal sections of the various groups was analysed by terminal deoxynucleotidyl-transferase-mediated dUTP nick-end labelling. This analysis revealed that exposure to both normal sunlight and to the eclipse resulted in neuronal apoptosis. Immunohistochemical techniques were used to evaluate possible glial-vascular alterations.

RESULTS

Dying cells could first be detected 24 h after exposure, the largest number of which were found 6 days later in the photoreceptor layer. Control levels were attained 14 days after the exposure. Retinal ganglion cells underwent apoptosis in both groups (normal sunlight and eclipse exposure), whereas in the neuroglial cells there was an up-regulation of the intermediate filament content. The number of dying cells in both groups was greater in animals whose pupils had been dilated pharmacologically during exposure. On the other hand, the protective filters were effective in preserving the rat retinal cells from apoptosis.

CONCLUSIONS

These results show, for the first time, that the cellular correlates of solar retinopathy are neuronal apoptosis accompanied by glio-vascular responses. Cellular apoptosis is an irreversible process, which could manifest itself as permanent visual impairment. The activation of non-neuronal cells, such as glial and endothelial cells, could be responsible for the more transient clinical symptoms.

Perforated microelectrode arrays implanted in the regenerating adult central nervous system

Adult mammalian optic nerve axons are able to regenerate, when provided with the permissive environment of an autologous peripheral nerve graft, which is usually the sciatic nerve. This study demonstrates the ability of adult rat optic nerve axons to regenerate through the preformed perforations of a polyimide electrode carrier implanted at the interface between the proximal stump of the cut optic nerve and the stump of the peripheral nerve piece used for grafting. Evidence that retinal ganglion cells regenerated their axons through the perforated electrode carrier was obtained by retrograde labeling with a fluorescent dye deposited into the sciatic nerve graft beyond the nerve-carrier-nerve junction. The number of regenerating cells could be enhanced by injecting neuroprotective drugs like aurintricarboxylic acid and cortisol intravitreally. A second line of evidence was obtained by immunohistochemical staining with antibodies to neurofilament. Third, electrical activity of the regenerating nerves was recorded after stimulating the retina with a flash of light. The results suggest that a regenerating central nerve tract may serve as an experimental model to implant artificial microdevices to monitor the physiological and topographical properties of neurites passing through the device or to stimulate them, thus interfering with their potential to grow. This study reports for the first time that the optic nerve has unique properties, which aids in the realization of these goals.

Glioanatomy assessed by cell-cell interactions and phagocytotic labelling

In the last three decades of research in neuroscience, fluorescent probes have gone from technical tools in the studies of physicochemical reactions, to being versatile tools in developmental neurobiology, neuroanatomy, angiography, neuromorphology, connectivity, cell death and even photodynamic therapy. Fluorescent dyes belong to heterogeneous groups of substances, but the feature to emit light of a certain wavelength depends on the energy status of the corresponding chemical bond. Therefore, light emission can range from the blue to the infrared spectrum, thus allowing multiple stains of the same cell, or event. The heterogeneity in their structure allows application of some fluorescent dyes for anterograde long-tract labelling, whereas others can be used for retrograde tracing. Lipophilic dyes are suitable for intramembraneous diffusion along cell membranes post-mortem, whereas hydrophilic stains seem more suitable for genealogic cell studies over several cell divisions. In the same time, less attention has been paid by most researchers to the use of fluorescent dyes to monitor neuroglial interactions and glioanatomy in the healthy and diseased brain. Studies of cell-cell-interactions during apoptosis can now be carried out with sequestration and subsequent phagocytosis of intracellular dyes. The present review focuses on recent developments that include the use of fluorescent probes. These probes make it possible to transneuronally assess functions of glial cells during programmed cell death, or induced degeneration. The high variety of available dyes, and their particular accumulation within subcellular compartments, is promising to shed light on some glial cell geometry and functions. The lessons obtained from the vast number of studies in neurons are of increasing importance for cells too, as their functions are not directly accessible. In short, some glial-glial and neuroglial negotiations will be analysed in near future by developing new, or by modifying existing fluorescent probes.

Restoration of the retinofugal pathway

In a relatively short period of time covering the last 2 decades, regeneration of retinofugal axons has become one of most prominent experimental models in restorative neurobiology. There is now a significant knowledge both on the mechanisms governing retinal ganglion cell responses to transection of the optic nerve, and the subsequent cell-cell interactions accumulating in death of the neurons. In addition, retinofugal axons served as an excellent model to examine whether, and to conclude that these axons have remarkable abilities for re-growth. This last issue was of invaluable importance, because axons could regenerate in vivo, into peripheral nerve grafts, and last but not least within the white matter of the cut optic nerve. As it stands to date, the extremely complex aspects of axonal regeneration will probably be understood within the retinofugal pathway. Final elucidation of this delicate system will essentially lead to some revision of our knowledge concerning neurotraumatology and CNS-repair.

Aurintricarboxylic acid promotes survival and regeneration of axotomised retinal ganglion cells in vivo

Aurintricarboxylic acid (ATA) has been used as an anti-apoptotic drug to counteract ischemic or cytotoxic injury to neurons. We investigated whether ATA has a neuroprotective effect on axotomized, adult retinal ganglion cells (RGC) as a model for traumatic neuronal cell death. A solution of ATA was injected into the vitreous body of rat eyes whose optic nerves had been cut. In controls, 14% of RGC survived 14 days after axotomy, whereas 44% of RGC survived after a single injection of ATA solution, and 59% survived when the injection was repeated after 7 days. A single injection of ATA 1 day after axotomy rescued 58% of RGC. However, injection of ATA 4 days after axotomy did not influence the survival of RGC, indicating that crucial, irreversible cascades of death are initiated prior to this point in time. The TUNEL technique was used to visualise apoptotic ganglion cells and revealed that 4 days after axotomy their number was significantly less in retinas whose optic nerves were axotomized and treated with ATA, than those of controls. As a consequence of neuroprotection, more RGC were recruited to regenerate into a peripheral nerve graft used to replace the cut optic nerve. In this paradigm, ATA-treated RGC extended significantly more axons within the graft than control RGC. This number could be increased by a second injection of ATA 7 days after axotomy. These data show that ATA is not only able to delay post-traumatic neuronal death but also enhances the extent of axonal regeneration in vivo.

NO production during neuronal cell death can be directly assessed by a chemical reaction in vivo

The role of nitric oxide (NO) as a putative mediator of neuronal death can be understood best if NO is detected directly. For this purpose, we developed a new sensitive method that for the first time directly captures released NO during neurodegeneration in vivo and at the cellular site of its generation. The non-fluorescent substance 1,2-diaminoanthraquinone (DAA) was injected into the eyes of rats whose optic nerve was injured to induce retrograde degeneration of the ganglion cells. The reaction product of DAA with NO is a triazole with red fluorescence. The two major NO producing cell populations in the retina are capillary endothelial cells and microglial cells. The methodology of NO assessment is convenient and applicable to numerous living systems both in vivo and in vitro.

Modification of glassy carbon surfaces with synthetic laminin-derived peptides for nerve cell attachment and neurite growth

Interactions between cultured nerve cells and surfaces are of importance for the implantation of biocompatible electrode materials such as glassy carbon (GC). Since implants serve as recording sensors in prosthetic neuroscience, we investigated whether coating electrodes with certain laminin derivatives containing the peptide sequences SIKVAV, CDPGYIGSR, PDSGR, YFQRYLI, and RNIAEIIKDA influences neuronal adhesion and neurite outgrowth in vitro. The coating of GC was performed by electrochemical polymerization and, for comparison, by adsorption or covalent coupling. Electrochemical polymerization is suitable for the coupling of peptides to GC, as shown by amino acid analysis and sequencing. Embryonic chicken retinal ganglion cells and brain cells (days E7 or E17) were used for both attachment and growth studies. Surfaces made by electrochemical polymerization of peptides were more efficient than those made by adsorption or covalent coupling of peptides. Synthetic cyclic peptide derivatives of CDPGYIGSR and 18-mer SIKVAV were found to be more efficient than the linear peptides. Competitive effects that resulted in a decreased cell attachment could be found upon application of soluble peptides. Nevertheless, irrespective of the method of coating, peptides were less efficient compared with the whole laminin molecule, as expected from its multiple adhesion sites. When small GC pins were implanted into the brain of E17 chicken after coating with the 18-mer SIKVAV peptide, nerve cell attachment was observed in vivo. The results suggest that chronically implantable materials may exert a higher neurocompatibility when coated with synthetic peptides.

Implantable bioelectric interfaces for lost nerve functions

Neuronal cells are unique within the organism. In addition to forming long-distance connections with other nerve cells and non-neuronal targets, they lose the ability to regenerate their neurites and to divide during maturation. Consequently, external violations like trauma or disease frequently lead to their disappearance and replacement by non-neuronal, and thus not properly functioning cells. The advent of microtechnology and construction of artificial implants prompted to create particular devices for specialised regions of the nervous system, in order to compensate for the loss of function. The scope of the present work is to review the current devices in connection with their applicability and functional perspectives. (1) Successful implants like the cochlea implant and peripherally implantable stimulators are discussed. (2) Less developed and not yet applicable devices like retinal or cortical implants are introduced, with particular emphasis given to the reasons for their failure to replace very complex functions like vision. (3) Material research is presented both from the technological aspect and from their biocompatibility as prerequisite of any implantation. (4) Finally, basic studies are presented, which deal with methods of shaping the implants, procedures of testing biocompatibility and modification of improving the interfaces between a technical device and the biological environment. The review ends by pointing to future perspectives in neuroimplantation and restoration of interrupted neuronal pathways.

Regenerating ganglion cell axons in the adult rat establish retinofugal topography and restore visual function

The mechanisms of neuronal network response to axotomy are poorly understood. In one of the favoured models used to study the fate of injured neurons in the adult rat visual system, appreciable numbers of retinal neurons survive optic nerve injury under conditions of microglia-targeted neuroprotection. Rescued neurons can regenerate their axons and become target-dependently stabilised after reconnection with their natural visual centres by means of a peripheral nerve graft, which, in addition to guidance, actively supports axonal growth. The mechanisms that control regenerative axonal growth and resynaptogenesis include coordinated cell-cell interactions between growing neurites and target cells in order to establish a meaningful reconnectivity. Here the function of the regenerating visual circuitry was first studied by monitoring the ability of animals to discriminate spatial patterns, and second by recording visual evoked cortical potentials (VEPs) in the same animals. These functions were correlated with neuroanatomical studies of the retinotopic organisation of regenerating axons. To achieve these goals, adult rats were behaviourally trained in a Y-maze to discriminate between vertical and horizontal stripes. Both optic nerves were transected, and the regenerating axons of one optic nerve were guided into the area of optic tract with a peripheral nerve graft according to the protocols of neuroprotection and simultaneous grafting, in order to enable large numbers of axons to reinnervate the major visual targets in the midbrain and thalamus. Postoperative testing of the animals showed a marked improvement of visual perception and behaviour. The VEPs of the same animals were measurable indicating a restoration of the visual circuitry including the ascending corticopedal connections. Neuroanatomical assessment of the fibre topography within the graft and the area of termination revealed a rough topographic organisation that may account for restoration of the function. These results suggest that interrupted central pathways can be functionally reconnected by providing a neuroprotective environment in combination with peripheral nerve grafts to bypass lesions.

A 'mixed' self-assembled monolayer for an impedimetric immunosensor

A synthetic peptide with the amino acid sequence 135-154 of the capsid protein VP1 of the foot-and-mouth-disease virus was modified with omega-hydroxyundecanethiol and applied together with non-derivatised omega-hydroxyundecanethiol for consecutive adsorption onto gold electrodes according to self-assembling procedures. The binding of a specific antibody to prepared recognition layers could be monitored by measurement of impedance or capacitance. In order to avoid non-specific effects, all measurements were performed in the presence of BSA. The complex between the antigenic peptide and the antibody was split by applying 6 M urea solution. The gold electrodes were mounted into an optimised flow-through system in order to perform capacitance-time measurements. The immobilised peptide can be recognised repeatedly by specific antibodies.

Interface analysis in biosensor design

In a survey, the analytical tools to characterise and optimise properties and stabilities of interfaces in thin film biosensors are discussed. After an introduction to microscopic and spectroscopic techniques and different transducers, case studies are presented. They concern bioaffinity sensors with particular emphasis on biomimetic recognition structures, catalytic sensors, transmembrane sensors, cell sensors, and the ambitious goal of addressing individual biomolecular function units.

[Application of dipeptidylpeptidase IV in formation of the peptide bond]

According to the increasing importance of enzyme catalysed peptide synthesis the capability of the protease dipeptidyl peptidase IV is shown to form the peptide bond. To our best knowledge, it's the first time that has been used successfully proline as one of the amino acids. The formation of the peptide bond is kinetically controlled. Free amino acids have been used as nucleophiles. The reaction media contain 50 vol.-% glycerol. A first approach to a kinetic treatment is shown.