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Zhu Y, Salowe R, Chow C, Li S, Bastani O, O'Brien JM. Advancing Glaucoma Care: Integrating Artificial Intelligence in Diagnosis, Management, and Progression Detection. Bioengineering (Basel) 2024; 11:122. [PMID: 38391608 PMCID: PMC10886285 DOI: 10.3390/bioengineering11020122] [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: 12/04/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Glaucoma, the leading cause of irreversible blindness worldwide, comprises a group of progressive optic neuropathies requiring early detection and lifelong treatment to preserve vision. Artificial intelligence (AI) technologies are now demonstrating transformative potential across the spectrum of clinical glaucoma care. This review summarizes current capabilities, future outlooks, and practical translation considerations. For enhanced screening, algorithms analyzing retinal photographs and machine learning models synthesizing risk factors can identify high-risk patients needing diagnostic workup and close follow-up. To augment definitive diagnosis, deep learning techniques detect characteristic glaucomatous patterns by interpreting results from optical coherence tomography, visual field testing, fundus photography, and other ocular imaging. AI-powered platforms also enable continuous monitoring, with algorithms that analyze longitudinal data alerting physicians about rapid disease progression. By integrating predictive analytics with patient-specific parameters, AI can also guide precision medicine for individualized glaucoma treatment selections. Advances in robotic surgery and computer-based guidance demonstrate AI's potential to improve surgical outcomes and surgical training. Beyond the clinic, AI chatbots and reminder systems could provide patient education and counseling to promote medication adherence. However, thoughtful approaches to clinical integration, usability, diversity, and ethical implications remain critical to successfully implementing these emerging technologies. This review highlights AI's vast capabilities to transform glaucoma care while summarizing key achievements, future prospects, and practical considerations to progress from bench to bedside.
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Affiliation(s)
- Yan Zhu
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rebecca Salowe
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Caven Chow
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Shuo Li
- Department of Computer & Information Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Osbert Bastani
- Department of Computer & Information Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joan M O'Brien
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
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Mamidipaka A, Di Rosa I, Lee R, Zhu Y, Chen Y, Salowe R, Addis V, Sankar P, Daniel E, Ying GS, O’Brien JM. Factors Associated with Large Cup-to-Disc Ratio and Blindness in the Primary Open-Angle African American Glaucoma Genetics (POAAGG) Study. Genes (Basel) 2023; 14:1809. [PMID: 37761949 PMCID: PMC10530848 DOI: 10.3390/genes14091809] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND/AIMS Primary open-angle glaucoma (POAG) disproportionately affects individuals of African ancestry. In these patients' eyes, a large cup-to-disc ratio (LCDR > 0.90) suggests greater retinal ganglion cell loss, though these patients often display varied visual ability. This study investigated the prevalence and risk factors associated with LCDR in African ancestry individuals with POAG and explored the differences between blind (>20/200) and not blind (≤20/200) LCDR eyes. METHODS A case-control methodology was used to investigate the demographic, optic disc, and genetic risk factors of subjects in the Primary Open-Angle African American Glaucoma Genetics Study. Risk factors were analyzed using univariable and multivariable logistic regression models with inter-eye correlation adjusted using generalized estimating equations. RESULTS Out of 5605 eyes with POAG, 1440 eyes (25.7%) had LCDR. In the multivariable analysis, LCDR was associated with previous glaucoma surgery (OR = 1.72), increased intraocular pressure (OR = 1.04), decreased mean deviation (OR = 1.08), increased pattern standard deviation (OR = 1.06), thinner retinal nerve fiber layer (OR = 1.05), nasalization of vessels (OR = 2.67), bayonetting of vessels (OR = 1.98), visible pores in the lamina cribrosa (OR = 1.68), and a bean-shaped cup (OR = 2.11). Of LCDR eyes, 30.1% were classified as blind (≤20/200). In the multivariable analysis, the statistically significant risk factors of blindness in LCDR eyes were previous glaucoma surgery (OR = 1.72), increased intraocular pressure (OR = 1.05), decreased mean deviation (OR = 1.04), and decreased pattern standard deviation (OR = 0.90). CONCLUSIONS These findings underscore the importance of close monitoring of intraocular pressure and visual function in African ancestry POAG patients, particularly those with LCDR, to preserve visual function.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Joan M. O’Brien
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.M.); (I.D.R.); (R.L.); (Y.Z.); (Y.C.); (R.S.); (V.A.); (P.S.); (E.D.); (G.-S.Y.)
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Kuang G, Halimitabrizi M, Edziah AA, Salowe R, O’Brien JM. The potential for mitochondrial therapeutics in the treatment of primary open-angle glaucoma: a review. Front Physiol 2023; 14:1184060. [PMID: 37601627 PMCID: PMC10433652 DOI: 10.3389/fphys.2023.1184060] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Glaucoma, an age-related neurodegenerative disease, is characterized by the death of retinal ganglion cells (RGCs) and the corresponding loss of visual fields. This disease is the leading cause of irreversible blindness worldwide, making early diagnosis and effective treatment paramount. The pathophysiology of primary open-angle glaucoma (POAG), the most common form of the disease, remains poorly understood. Current available treatments, which target elevated intraocular pressure (IOP), are not effective at slowing disease progression in approximately 30% of patients. There is a great need to identify and study treatment options that target other disease mechanisms and aid in neuroprotection for POAG. Increasingly, the role of mitochondrial injury in the development of POAG has become an emphasized area of research interest. Disruption in the function of mitochondria has been linked to problems with neurodevelopment and systemic diseases. Recent studies have shown an association between RGC death and damage to the cells' mitochondria. In particular, oxidative stress and disrupted oxidative phosphorylation dynamics have been linked to increased susceptibility of RGC mitochondria to secondary mechanical injury. Several mitochondria-targeted treatments for POAG have been suggested, including physical exercise, diet and nutrition, antioxidant supplementation, stem cell therapy, hypoxia exposure, gene therapy, mitochondrial transplantation, and light therapy. Studies have shown that mitochondrial therapeutics may have the potential to slow the progression of POAG by protecting against mitochondrial decline associated with age, genetic susceptibility, and other pathology. Further, these therapeutics may potentially target already present neuronal damage and symptom manifestations. In this review, the authors outline potential mitochondria-targeted treatment strategies and discuss their utility for use in POAG.
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Affiliation(s)
- Grace Kuang
- Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Genetics in Complex Diseases, University of Pennsylvania, Philadelphia, PA, United States
| | - Mina Halimitabrizi
- Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Genetics in Complex Diseases, University of Pennsylvania, Philadelphia, PA, United States
| | - Amy-Ann Edziah
- Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Genetics in Complex Diseases, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Salowe
- Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Genetics in Complex Diseases, University of Pennsylvania, Philadelphia, PA, United States
| | - Joan M. O’Brien
- Perelman School of Medicine, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Center for Genetics in Complex Diseases, University of Pennsylvania, Philadelphia, PA, United States
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Daniel E, Gao J, Maguire MG, Ying GS, Gudiseva HV, Salowe R, Addis V, Sankar PS, Lee R, Smith EJ, O'Brien J. Prevalence and factors associated with optic disc grey crescent in the Primary Open-Angle African Ancestry Glaucoma Genetics (POAAGG) Study. BMJ Open Ophthalmol 2023. [PMCID: PMC9930554 DOI: 10.1136/bmjophth-2022-001183] [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] [Indexed: 02/16/2023] Open
Abstract
AimTo investigate the prevalence and factors associated with optic disc grey crescent (GC) in African Americans with glaucoma.MethodsStereo optic disc image features from subjects with glaucoma in the Primary Open-Angle African Ancestry Glaucoma Genetics Study were evaluated independently by non-physician graders and discrepancies adjudicated by an ophthalmologist. Risk factors for GC were evaluated by logistic regression models with intereye correlation accounted for by generalised estimating equations. Adjusted ORs (aORs) were generated.ResultsGC was present in 227 (15%) of 1491 glaucoma cases, with 57 (3.82%) bilateral and 170 (11.4%) unilateral. In multivariable analysis, factors associated with GC were younger age (aOR 1.27, 95% CI 1.11 to 1.43 for every decade younger in age, p=0.001), diabetes (aOR 1.46, 95% CI 1.09 to 1.96, p=0.01), optic disc tilt (aOR 1.84, 95% CI 1.36 to 2.48, p<0.0001), a sloping retinal region adjacent to the outer disc margin (aOR 2.37, 95% CI 1.74 to 3.32, p<0.0001) and beta peripapillary atrophy (aOR 2.32, 95% CI 1.60 to 3.37, p<0.0001). Subjects with GC had a lower mean (SD) value of the ancestral component q0 than those without GC (0.22 (0.15) vs 0.27 (0.20), p=0.001), consistent with higher degrees of African ancestry.ConclusionsMore than 1 in 10 glaucoma cases with African ancestry have GC, occurring more frequently in younger subjects, higher degrees of African ancestry and diabetes. GC was associated with several ocular features, including optic disc tilt and beta peripapillary atrophy. These associations should be considered when evaluating black patients with primary open-angle glaucoma.
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Affiliation(s)
- Ebenezer Daniel
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jinpeng Gao
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maureen G Maguire
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gui-shuang Ying
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Harini V Gudiseva
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca Salowe
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria Addis
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Prithvi S Sankar
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roy Lee
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eli J Smith
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joan O'Brien
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kuang G, Salowe R, O’Brien J. Genetic Factors Implicated in the Investigation of Possible Connections between Alzheimer's Disease and Primary Open Angle Glaucoma. Genes (Basel) 2023; 14:338. [PMID: 36833265 PMCID: PMC9957421 DOI: 10.3390/genes14020338] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Both Alzheimer's disease (AD) and primary open angle glaucoma (POAG) are diseases of primary global neurodegeneration with complex pathophysiologies. Throughout the published literature, researchers have highlighted similarities associated with various aspects of both diseases. In light of the increasing number of findings reporting resemblance between the two neurodegenerative processes, scientists have grown interested in possible underlying connections between AD and POAG. In the search for explanations to fundamental mechanisms, a multitude of genes have been studied in each condition, with overlap in the genes of interest between AD and POAG. Greater understanding of genetic factors can drive the research process of identifying relationships and elucidating common pathways of disease. These connections can then be utilized to advance research as well as to generate new clinical applications. Notably, AD and glaucoma are currently diseases with irreversible consequences that often lack effective therapies. An established genetic connection between AD and POAG would serve as the basis for development of gene or pathway targeted strategies relevant to both diseases. Such a clinical application could be of immense benefit to researchers, clinicians, and patients alike. This paper aims to summarize the genetic associations between AD and POAG, describe common underlying mechanisms, discuss potential areas of application, and organize the findings in a review.
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Affiliation(s)
| | | | - Joan O’Brien
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Kikut A, Sanyal M, Vaughn M, Ridley-Merriweather KE, Head K, Salowe R, Lomax-Reese S, Lewis M, Ross AG, Cui QN, Addis V, Sankar PS, Miller-Ellis E, O’Brien JM. Learning from Black/African American Participants: Applying the Integrated Behavioral Model to Assess Recruitment Strategies for a Glaucoma Genetic Study. Health Commun 2022; 37:515-524. [PMID: 33345602 PMCID: PMC8213868 DOI: 10.1080/10410236.2020.1853897] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The underrepresentation of African American (AA) participants in medical research perpetuates racial health disparities in the United States. Open-ended phone interviews were conducted with 50 AA adults from Philadelphia who had previously participated in a genetic study of glaucoma that included complimentary ophthalmic screenings. Recruitment for the genetic study was done in partnership with a Black-owned radio station. Thematic analysis of interview transcripts, guided by the integrated behavior model (IBM), identified self-reported motivations for participating in this care-focused and community-promoted research program. Findings revealed that decisions to enroll were influenced by strong instrumental attitudes regarding learning more about personal health and contributing to future care options for others. Notable normative influences that factored into participants' decisions to enroll in the study included hearing about the study from a respected community media outlet, friends, and family. About one-third of respondents discussed past and current racial discrimination in medical research as an important sociocultural frame within which they thought about participation, suggesting that experiential attitudes play a continuing role in AA's decisions to enroll in medical research studies. Medical researchers seeking to recruit AA participants should collaborate with community partners, combine enrollment opportunities with access to health services, and emphasize the potential for new research to mitigate racial inequalities.
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Affiliation(s)
- Ava Kikut
- Annenberg School for Communication, University of
Pennsylvania, Philadelphia, PA, USA
| | - Mohima Sanyal
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
| | - Marquis Vaughn
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
| | | | - Katharine Head
- Department of Communication Studies, Indiana
University–Purdue University Indianapolis, IN, USA
| | - Rebecca Salowe
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Ahmara G. Ross
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
| | - Qi N. Cui
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria Addis
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
| | - Prithvi S. Sankar
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
| | - Eydie Miller-Ellis
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
| | - Joan M. O’Brien
- Scheie Eye Institute, Department of Ophthalmology,
University of Pennsylvania, Philadelphia, PA, USA
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Addis V, Chan L, Chen J, Goodyear K, Pistilli M, Salowe R, Lee R, Sankar P, Miller-Ellis E, Cui QN, Maguire MG, O’Brien J. Evaluation of the Cirrus High-Definition OCT Normative Database Probability Codes in a Black American Population. Ophthalmol Glaucoma 2022; 5:110-118. [PMID: 34033949 PMCID: PMC8608902 DOI: 10.1016/j.ogla.2021.05.002] [Citation(s) in RCA: 1] [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] [Received: 11/24/2020] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Race-adjusted interpretation of data from Cirrus high-definition OCT (HD-OCT) devices is not standard practice. The aim of this study is to evaluate differences in peripapillary retinal nerve fiber layer (RNFL) thickness between healthy Black Americans and the Cirrus HD-OCT normative database. DESIGN This is a cross-sectional observational study using control patients recruited from the greater Philadelphia, Pennsylvania, area. PARTICIPANTS A total of 466 eyes were included in this study. Subjects were retrospectively identified from the control cohort of the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study. METHODS Using an age-stratified or linear regression method, we reclassified white-green-yellow-red color probability codes for RNFL thicknesses by quadrant. MAIN OUTCOME MEASURES The distribution of reclassified color codes was compared with the expected 5%-90%-4%-1% percentiles and to the original color codes by the Cirrus machine. RESULTS Average RNFL thickness in the POAAGG control cohort was thinner than in the Cirrus normative database in all except the nasal quadrant. The original color codes of the POAAGG cohort did not fall into the expected distributions, with more RNFL measurements assigned as white and red codes than expected (9.5% and 1.7%) and fewer measurements assigned as green and yellow codes than expected (85.3% and 3.5%) (P < 0.001). Compared with the original Cirrus machine, reclassification using linear regression produced color codes closest to the expected distributions (P = 0.09). The proportion of abnormal results shifted closer to the expected 5% in the nasal (1.3%, P < 0.001 vs. 3.0%, P = 0.048) and temporal (8.2%, P = 0.002 vs. 3.6%, P = 0.18) quadrants. CONCLUSIONS Results further establish the presence of structural differences in the RNFL of Black American patients. Color code reclassification suggests that the existing Cirrus database may not be accurately evaluating glaucomatous nerves in patients of African descent. This study addresses an unmet need to assess Cirrus HD-OCT color probability codes in a Black American population.
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Affiliation(s)
- Victoria Addis
- Scheie Eye Institute, University of Pennsylvania,
Philadelphia, PA, USA
| | - Lilian Chan
- Scheie Eye Institute, University of Pennsylvania,
Philadelphia, PA, USA
| | - Judy Chen
- Scheie Eye Institute, University of Pennsylvania,
Philadelphia, PA, USA
| | - Kendall Goodyear
- Scheie Eye Institute, University of Pennsylvania,
Philadelphia, PA, USA
| | - Maxwell Pistilli
- Scheie Eye Institute, University of Pennsylvania,
Philadelphia, PA, USA
| | - Rebecca Salowe
- Scheie Eye Institute, University of Pennsylvania,
Philadelphia, PA, USA
| | - Roy Lee
- Scheie Eye Institute, University of Pennsylvania,
Philadelphia, PA, USA
| | - Prithvi Sankar
- Scheie Eye Institute, University of Pennsylvania,
Philadelphia, PA, USA
| | | | - Qi N. Cui
- Scheie Eye Institute, University of Pennsylvania,
Philadelphia, PA, USA
| | | | - Joan O’Brien
- Scheie Eye Institute, University of Pennsylvania,
Philadelphia, PA, USA.,Corresponding Author: Scheie Eye Institute,
51 N. 39th Street, Philadelphia, PA 19104, USA,
(; phone: 215-662-8657; fax:
215-662-9676)
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Zenebe-Gete S, Salowe R, O'Brien JM. Benefits of Cohort Studies in a Consortia-Dominated Landscape. Front Genet 2021; 12:801653. [PMID: 34950194 PMCID: PMC8688987 DOI: 10.3389/fgene.2021.801653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/15/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Selam Zenebe-Gete
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Salowe
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, United States
| | - Joan M O'Brien
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, United States
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Addis V, Chen M, Zorger R, Salowe R, Daniel E, Lee R, Pistilli M, Gao J, Maguire MG, Chan L, Gudiseva HV, Zenebe-Gete S, Merriam S, Smith EJ, Martin R, Parker Ostroff C, Gee JC, Cui QN, Miller-Ellis E, O’Brien JM, Sankar PS. A Precise Method to Evaluate 360 Degree Measures of Optic Cup and Disc Morphology in an African American Cohort and Its Genetic Applications. Genes (Basel) 2021; 12:genes12121961. [PMID: 34946910 PMCID: PMC8701339 DOI: 10.3390/genes12121961] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Vertical cup-to-disc ratio (CDR) is an important measure for evaluating damage to the optic nerve head (ONH) in glaucoma patients. However, this measure often does not fully capture the irregular cupping observed in glaucomatous nerves. We developed and evaluated a method to measure cup-to-disc ratio (CDR) at all 360 degrees of the ONH. (2) Methods: Non-physician graders from the Scheie Reading Center outlined the cup and disc on digital stereo color disc images from African American patients enrolled in the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study. After converting the resultant coordinates into polar representation, the CDR at each 360-degree location of the ONH was obtained. We compared grader VCDR values with clinical VCDR values, using Spearman correlation analysis, and validated significant genetic associations with clinical VCDR, using grader VCDR values. (3) Results: Graders delineated outlines of the cup contour and disc boundaries twice in each of 1815 stereo disc images. For both cases and controls, the mean CDR was highest at the horizontal bisector, particularly in the temporal region, as compared to other degree locations. There was a good correlation between grader CDR at the vertical bisector and clinical VCDR (Spearman Correlation OD: r = 0.78 [95% CI: 0.76–0.79]). An SNP in the MPDZ gene, associated with clinical VCDR in a prior genome-wide association study, showed a significant association with grader VCDR (p = 0.01) and grader CDR area ratio (p = 0.02). (4) Conclusions: The CDR of both glaucomatous and non-glaucomatous eyes varies by degree location, with the highest measurements in the temporal region of the eye. This method can be useful for capturing innate eccentric ONH morphology, tracking disease progression, and identifying genetic associations.
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Affiliation(s)
- Victoria Addis
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
| | - Min Chen
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.C.); (J.C.G.)
| | - Richard Zorger
- Penn Vision Research Center, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Rebecca Salowe
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
| | - Ebenezer Daniel
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
| | - Roy Lee
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
| | - Maxwell Pistilli
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
| | - Jinpeng Gao
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
| | - Maureen G. Maguire
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
| | - Lilian Chan
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
| | - Harini V. Gudiseva
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
| | - Selam Zenebe-Gete
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
| | - Sayaka Merriam
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
| | - Eli J. Smith
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
| | - Revell Martin
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
| | - Candace Parker Ostroff
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
| | - James C. Gee
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA; (M.C.); (J.C.G.)
| | - Qi N. Cui
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
| | - Eydie Miller-Ellis
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
| | - Joan M. O’Brien
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
- Correspondence: Joan.O’; Tel.: +1-215-662-8657; Fax: +1-215-662-9676
| | - Prithvi S. Sankar
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.A.); (R.S.); (E.D.); (R.L.); (M.P.); (J.G.); (M.G.M.); (L.C.); (H.V.G.); (S.Z.-G.); (S.M.); (E.J.S.); (R.M.); (C.P.O.); (Q.N.C.); (E.M.-E.); (P.S.S.)
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10
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Meer E, Qin VL, Gudiseva HV, McGeehan B, Salowe R, Pistilli M, He J, Daniel E, Ying GS, Chavali VRM, O’Brien JM. LMX1B Locus Associated with Low-Risk Baseline Glaucomatous Features in the POAAGG Study. Genes (Basel) 2021; 12:1252. [PMID: 34440426 PMCID: PMC8394298 DOI: 10.3390/genes12081252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 01/11/2023] Open
Abstract
Primary open-angle glaucoma (POAG) is the leading cause of irreversible blindness worldwide and has been associated with multiple genetic risk factors. The LMX1B gene is a genetic susceptibility factor for POAG, and several single-nucleotide polymorphisms (SNPs) were shown to be associated with POAG in our own prior Primary Open-Angle African American Glaucoma Genetics (POAAGG) study genome-wide association study (GWAS). This study evaluated the association of the LMX1B locus with baseline optic disc and clinical phenotypic characteristics of glaucoma patients from our African American cohort. Compared to the GG genotype in SNP rs187699205, the GC genotype in this SNP was found to be significantly associated with a smaller cup-to-disc ratio (CDR) and increased (better) visual field mean deviation (MD) in glaucoma cases. None of the glaucoma cases with the GC genotype had disc hemorrhages, disc notching, or beanpot disc appearance. In conclusion, glaucoma phenotypes differed significantly by LMX1B variant in African American patients with POAG, and a SNP variant was associated with certain disease features considered lower risk.
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Affiliation(s)
- Elana Meer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Vivian L. Qin
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Harini V. Gudiseva
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Brendan McGeehan
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Rebecca Salowe
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Maxwell Pistilli
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Jie He
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Ebenezer Daniel
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Gui Shang Ying
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Venkata R. M. Chavali
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
| | - Joan M. O’Brien
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; (V.L.Q.); (H.V.G.); (B.M.); (R.S.); (M.P.); (J.H.); (E.D.); (G.S.Y.); (V.R.M.C.)
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11
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Cole BS, Gudiseva HV, Pistilli M, Salowe R, McHugh CP, Zody MC, Chavali VRM, Ying GS, Moore JH, O'Brien JM. The Role of Genetic Ancestry as a Risk Factor for Primary Open-angle Glaucoma in African Americans. Invest Ophthalmol Vis Sci 2021; 62:28. [PMID: 33605984 PMCID: PMC7900887 DOI: 10.1167/iovs.62.2.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/27/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose POAG is the leading cause of irreversible blindness in African Americans. In this study, we quantitatively assess the association of autosomal ancestry with POAG risk in a large cohort of self-identified African Americans. Methods Subjects recruited to the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study were classified as glaucoma cases or controls by fellowship-trained glaucoma specialists. POAAGG subjects were genotyped using the MEGA Ex array (discovery cohort, n = 3830; replication cohort, n = 2135). Population structure was interrogated using principal component analysis in the context of the 1000 Genomes Project superpopulations. Results The majority of POAAGG samples lie on an axis between African and European superpopulations, with great variation in admixture. Cases had a significantly lower mean value of the ancestral component q0 than controls for both cohorts (P = 6.14-4; P = 3-6), consistent with higher degree of African ancestry. Among POAG cases, higher African ancestry was also associated with thinner central corneal thickness (P = 2-4). Admixture mapping showed that local genetic ancestry was not a significant risk factor for POAG. A polygenic risk score, comprised of 23 glaucoma-associated single nucleotide polymorphisms from the NHGRI-EBI genome-wide association study catalog, was significant in both cohorts (P < 0.001), suggesting that both known POAG single nucleotide polymorphisms and an omnigenic ancestry effect influence POAG risk. Conclusions In sum, the POAAGG study population is very admixed, with a higher degree of African ancestry associated with an increased POAG risk. Further analyses should consider social and environmental factors as possible confounding factors for disease predisposition.
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Affiliation(s)
- Brian S. Cole
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Harini V. Gudiseva
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Maxwell Pistilli
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Rebecca Salowe
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | | | - Michael C. Zody
- New York Genome Center, New York City, New York, United States
| | - Venkata R. M. Chavali
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Gui Shuang Ying
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Jason H. Moore
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Joan M. O'Brien
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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12
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Salowe R, O’Brien JM. The Collaborative Ocular Melanoma Study Randomized Trial of Iodine 125 Brachytherapy for Choroidal Melanoma. Ophthalmology 2020; 127:S146-S147. [DOI: 10.1016/j.ophtha.2019.09.047] [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: 09/06/2019] [Revised: 09/30/2019] [Accepted: 09/30/2019] [Indexed: 11/16/2022] Open
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13
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Kikut A, Vaughn M, Salowe R, Sanyal M, Merriam S, Lee R, Becker E, Lomax-Reese S, Lewis M, Ryan R, Ross A, Cui QN, Addis V, Sankar PS, Miller-Ellis E, Cannuscio C, O'Brien J. Evaluation of a multimedia marketing campaign to engage African American patients in glaucoma screening. Prev Med Rep 2020; 17:101057. [PMID: 32025476 PMCID: PMC6997297 DOI: 10.1016/j.pmedr.2020.101057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/03/2019] [Revised: 12/23/2019] [Accepted: 01/21/2020] [Indexed: 12/21/2022] Open
Abstract
Our objective was to determine which messaging approaches from a marketing campaign were most effective in recruiting African American individuals to a glaucoma screening and research study. We conducted a multimedia marketing campaign in Philadelphia from 01/31/2018 to 06/30/2018. Messaging approaches included radio advertisements and interviews (conducted in partnership with a local radio station with a large African American listener base), print materials, event tables, and online postings. Participants received free glaucoma screenings and the opportunity to enroll in our glaucoma genetics study. These screenings allowed individuals with glaucoma to receive a full examination and treatment plan with a glaucoma specialist, as well as to contribute to future efforts to identify genetic variants underlying this disease. We compared inquiry, enrollment, and cost yield for each messaging approach. Our campaign resulted in 154 unique inquiries, with 98 patients receiving glaucoma screenings (64%) and 60 patients enrolling in our study (39%). Commercials on WURD radio yielded the highest number of inquiries (62%) and enrollments (62%), but at relatively high cost ($814/enrolled patient). The most inexpensive approach that yielded more than five enrollments was postcards ($429/enrolled patient). Our campaign suggests that high-frequency commercials and postcards distributed at targeted healthcare locations are particularly effective and affordable options for connecting with the African American community. Our findings can help to inform recruitment efforts for other understudied diseases in minority populations.
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Affiliation(s)
- Ava Kikut
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Marquis Vaughn
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Salowe
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Mohima Sanyal
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Sayaka Merriam
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Roy Lee
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Becker
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Ahmara Ross
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Qi N. Cui
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria Addis
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Prithvi S. Sankar
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Carolyn Cannuscio
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joan O'Brien
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
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Parikh R, O'Keefe L, Salowe R, Mccoskey M, Pan W, Sankar P, Miller-Ellis E, Addis V, Lehman A, Maguire M, O'Brien J. Factors associated with participation by African Americans in a study of the genetics of glaucoma. Ethn Health 2019; 24:694-704. [PMID: 28669230 PMCID: PMC5748378 DOI: 10.1080/13557858.2017.1346189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 06/14/2017] [Indexed: 06/07/2023]
Abstract
Objective: African Americans have been historically underrepresented in research studies. Our aim was to evaluate factors influencing enrollment in the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study. Design: Patients approached to enroll in the POAAGG study were asked to complete a 15-item survey addressing demographic characteristics, knowledge of genetics and glaucoma, and opinions on human research. Survey responses were compared between subjects who enrolled (Enrollers) and did not enroll (Decliners) in the POAAGG study. Results: Enrollers (N = 190) were 3.7 years younger (P = 0.007) and had similar gender, education, and income level to Decliners (N = 117). Knowledge about genetics and glaucoma was similar between groups. Enrollers were more comfortable providing DNA for research studies (93.1% vs 54.1%; P < 0.001) and more likely to have participated in prior studies (P = 0.003) and consider participating in future studies (P < 0.001). Among Decliners, lack of time was the primary reason given for not enrolling. Conclusion: To increase participation of African Americans in genetic research studies, efforts should be made to raise comfort with DNA donation.
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Affiliation(s)
- Rupin Parikh
- a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA
| | - Laura O'Keefe
- a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA
| | - Rebecca Salowe
- a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA
| | - Makayla Mccoskey
- a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA
| | - Wei Pan
- a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA
| | - Prithvi Sankar
- a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA
| | - Eydie Miller-Ellis
- a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA
| | - Victoria Addis
- a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA
| | - Amanda Lehman
- a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA
| | - Maureen Maguire
- a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA
| | - Joan O'Brien
- a Scheie Eye Institute , University of Pennsylvania , Philadelphia , PA , USA
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15
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McCoskey M, Addis V, Goodyear K, Sankar PS, Ying GS, Yu Y, Salowe R, Cui QN, Miller-Ellis E, Maguire M, O Apos Brien JM. Association between Primary Open-Angle Glaucoma and Cognitive Impairment as Measured by the Montreal Cognitive Assessment. NEURODEGENER DIS 2019; 18:315-322. [PMID: 30893703 DOI: 10.1159/000496233] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 07/12/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is currently unclear whether primary open-angle glaucoma (POAG) affects neurological functions outside of vision, such as cognition. OBJECTIVE This study examined the association between POAG and cognitive impairment in African Americans. METHODS Masked interviewers administered the Montreal Cognitive Assessment (MoCA) to patients enrolled in the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study at the Scheie Eye Institute. Cases were further assessed for retinal nerve fiber layer (RNFL) thickness and visual field (VF) loss. Univariate and multivariate linear regression analyses were performed to compare mean MoCA score between cases and controls and to assess the association between POAG severity and MoCA score. RESULTS A total of 137 patients completed the MoCA, including 70 cases and 67 controls. The mean age ± SD was 68.7 ± 11.2 years for cases and 65.7 ± 10.4 years for controls (p = 0.11). The mean MoCA total score (out of 30 points) was 20.3 among POAG cases and 21.3 among controls (mean difference = -1.03, 95% confidence interval, CI = -2.54 to 0.48, p = 0.18). After adjusting for age, gender, education level, diabetes, hypertension, and smoking status, the mean difference in the MoCA total score between cases and controls was -0.64 (95% CI = -1.72 to 0.45, p = 0.25). Among cases, more VF loss was associated with lower total MoCA score for mean deviation (adjusted linear trend p = 0.02) and VF index (adjusted linear trend p = 0.03). There was no significant association between average RNFL thickness and total MoCA score. CONCLUSIONS POAG cases and controls had similar neurocognitive function as measured by the MoCA. Among POAG cases, worse VF loss was associated with lower MoCA. Future studies are needed to further elucidate the clinical effect of neuropathy in POAG.
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Affiliation(s)
- Makayla McCoskey
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria Addis
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kendall Goodyear
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Prithvi S Sankar
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gui-Shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yinxi Yu
- Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca Salowe
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Qi N Cui
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eydie Miller-Ellis
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maureen Maguire
- Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joan M O Apos Brien
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
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16
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Gudiseva HV, Pistilli M, Salowe R, Singh LN, Collins DW, Cole B, He J, Merriam S, Khachataryan N, Henderer J, Addis V, Cui QN, Sankar PS, Miller-Ellis E, Chavali VRM, Ying GS, Wallace D, O'Brien JM. The association of mitochondrial DNA haplogroups with POAG in African Americans. Exp Eye Res 2019; 181:85-89. [PMID: 30653964 DOI: 10.1016/j.exer.2019.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/13/2018] [Revised: 01/08/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
Mitochondrial dysfunction has been implicated in the pathogenesis of primary open-angle glaucoma (POAG). However, the potential significance of mitochondrial DNA (mtDNA) haplogroups to POAG has not been evaluated in the overaffected African American population. To investigate the association of mtDNA haplogroups with POAG and its phenotypic characteristics, genotyping data from 4081 African American subjects (1919 cases and 2162 controls) was analyzed using 1293 positions on mtDNA. The overall frequency of mtDNA haplogroups in the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study cohort was 37% L3, 29% L2, 21% L1, 4% L0, and 10% non-African haplogroups (non-L). When all haplogroups (L0, L1, L2, and non-L) were compared against theL3 reference group, after adjusting by age and principal component of ancestry, the non-L3 haplogroups showed higher risk of POAG (OR-1.19, p = 0.02), with a particularly strong association among males (OR = 1.41, p = 0.003). More specifically the non-L group was associated with higher POAG risk than the L3 haplogroup (OR = 1.77, p = 0.007, Bonferroni adjusted p = 0.027) and to the L3e (n = 256, OR = 1.92, p = 0.007, Bonferroni adjusted p = 0.029). No significant association was found when genders were analyzed together or in female only analysis. There were no significant differences in various POAG endophenotypes across mtDNA haplogroups. This study expands our knowledge of mitochondrial genetics and mtDNA haplogroup associations in African American POAG. Further work is needed to better understand the functional role of mtDNA polymorphisms and their interactions with nuclear genes that affect POAG.
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Affiliation(s)
- Harini V Gudiseva
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Maxwell Pistilli
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Salowe
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Larry N Singh
- Center for Mitochondrial and Epigenomic Medicine, Children's Hospital of Philadelphia and Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David W Collins
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Brian Cole
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jie He
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Sayaka Merriam
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jeffrey Henderer
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Victoria Addis
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Qi N Cui
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Prithvi S Sankar
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Gui-Shuang Ying
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas Wallace
- Center for Mitochondrial and Epigenomic Medicine, Children's Hospital of Philadelphia and Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joan M O'Brien
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA. joan.o'
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17
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Addis V, Oyeniran E, Daniel E, Salowe R, Zorger R, Lee R, Pistilli M, Maguire M, Cui Q, Miller-Ellis E, O'Brien JM, Sankar PS. Non-physician grader reliability in measuring morphological features of the optic nerve head in stereo digital images. Eye (Lond) 2019; 33:838-844. [PMID: 30635643 DOI: 10.1038/s41433-018-0332-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/09/2018] [Accepted: 12/14/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To introduce a new method of grading optic nerve stereo disc photographs and evaluate reproducibility of assessments by non-physician graders in a reading center. METHODS Three non-physician graders, experienced in grading features of the retina but not the optic nerve head (ONH), were trained by glaucoma specialists to assess digital stereo color images of the ONH. These graders assessed a total of 2554 digital stereo disc images from glaucoma cases and controls participating in the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study by outlining the optic cup and disc. Inter-grader reproducibility of area, height, and width measurements was analyzed. RESULTS Among all images, the intraclass correlation (95% confidence interval) was 0.90 (0.89, 0.90) for the cup area using only color cues; 0.92 (0.91, 0.92) for the cup area using contour and vascular cues; and 0.99 (0.99, 0.99) for the optic disc area. The intraclass correlation for cup-to-disc ratio (CDR) was 0.61 (0.58, 0.63), as determined by the ratio of optic cup area to optic disc area (using contour and vascular cues). The CDR difference by graders for area was ≤ 0.1 in 65% of images using color/vascular cues and ≤0.1 in 71% of images using color cues. CONCLUSIONS After adequate training, non-physician graders were able to measure the optic nerve CDR with high inter-grader reliability.
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Affiliation(s)
- Victoria Addis
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Enny Oyeniran
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Ebenezer Daniel
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Salowe
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard Zorger
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Roy Lee
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Maxwell Pistilli
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Maureen Maguire
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Qi Cui
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Joan M O'Brien
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA. joan.o'
| | - Prithvi S Sankar
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
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Sankar PS, O'Keefe L, Choi D, Salowe R, Miller-Ellis E, Lehman A, Addis V, Ramakrishnan M, Natesh V, Whitehead G, Khachatryan N, O'Brien J. The SCHEIE Visual Field Grading System. ACTA ACUST UNITED AC 2017; 8. [PMID: 28932621 PMCID: PMC5602567 DOI: 10.4172/2155-9570.1000651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/09/2022]
Abstract
OBJECTIVE No method of grading visual field (VF) defects has been widely accepted throughout the glaucoma community. The SCHEIE (Systematic Classification of Humphrey visual fields-Easy Interpretation and Evaluation) grading system for glaucomatous visual fields was created to convey qualitative and quantitative information regarding visual field defects in an objective, reproducible, and easily applicable manner for research purposes. METHODS The SCHEIE grading system is composed of a qualitative and quantitative score. The qualitative score consists of designation in one or more of the following categories: normal, central scotoma, paracentral scotoma, paracentral crescent, temporal quadrant, nasal quadrant, peripheral arcuate defect, expansive arcuate, or altitudinal defect. The quantitative component incorporates the Humphrey visual field index (VFI), location of visual defects for superior and inferior hemifields, and blind spot involvement. Accuracy and speed at grading using the qualitative and quantitative components was calculated for non-physician graders. RESULTS Graders had a median accuracy of 96.67% for their qualitative scores and a median accuracy of 98.75% for their quantitative scores. Graders took a mean of 56 seconds per visual field to assign a qualitative score and 20 seconds per visual field to assign a quantitative score. CONCLUSION The SCHEIE grading system is a reproducible tool that combines qualitative and quantitative measurements to grade glaucomatous visual field defects. The system aims to standardize clinical staging and to make specific visual field defects more easily identifiable. Specific patterns of visual field loss may also be associated with genetic variants in future genetic analysis.
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Affiliation(s)
- Prithvi S Sankar
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura O'Keefe
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Choi
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca Salowe
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eydie Miller-Ellis
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amanda Lehman
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria Addis
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meera Ramakrishnan
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vikas Natesh
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gideon Whitehead
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Naira Khachatryan
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joan O'Brien
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Salowe R, O'Keefe L, Merriam S, Lee R, Khachatryan N, Sankar P, Miller-Ellis E, Lehman A, Addis V, Murphy W, Henderer J, Maguire M, O'Brien J. Cost and yield considerations when expanding recruitment for genetic studies: the primary open-angle African American glaucoma genetics study. BMC Med Res Methodol 2017; 17:101. [PMID: 28705151 PMCID: PMC5512952 DOI: 10.1186/s12874-017-0374-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 02/02/2017] [Accepted: 06/26/2017] [Indexed: 01/03/2023] Open
Abstract
Background African Americans have been historically under-represented in genetic studies. More research is needed on effective recruitment strategies for this population, especially on approaches that supplement traditional clinic enrollment. This study evaluates the cost and efficacy of four supplemental recruitment methods employed by the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study. Methods After enrolling 2304 patients from University of Pennsylvania ophthalmology clinics, the POAAGG study implemented four new recruitment methods to supplement clinic enrollment. These methods included: 1) outreach in the local community, 2) in-house screening of community members (“in-reach”), 3) expansion to two external sites, and 4) sampling of the Penn Medicine Biobank. The cost per subject was calculated for each method and enrollment among cases, controls, and suspects was reported. Results The biobank offered the lowest cost ($5/subject) and highest enrollment yield (n = 2073) of the four methods, but provided very few glaucoma cases (n = 31). External sites provided 88% of cases recruited from the four methods (n = 388; $85/subject), but case enrollment at these sites declined over the next 9 months as the pool of eligible subjects was depleted. Outreach and in-reach screenings of community members were very high cost for low return on enrollment ($569/subject for 102 subjects and $606/subject for 45 subjects, respectively). Conclusions The biobank offered the most cost-effective method for control enrollment, while expansion to external sites was necessary to recruit richly phenotyped cases. These recruitment methods helped the POAAGG study to exceed enrollment of the discovery cohort (n = 5500) 6 months in advance of the predicated deadline and could be adopted by other large genetic studies seeking to supplement clinic enrollment.
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Affiliation(s)
- Rebecca Salowe
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura O'Keefe
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Sayaka Merriam
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Roy Lee
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Naira Khachatryan
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Prithvi Sankar
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Amanda Lehman
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria Addis
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jeffrey Henderer
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Maureen Maguire
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Joan O'Brien
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA. joan.o'
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Saxena V, Kim M, Keah NM, Neuwirth AL, Stoeckl BD, Bickard K, Restle DJ, Salowe R, Wang MY, Steinberg DR, Mauck RL. Anatomic Mesenchymal Stem Cell-Based Engineered Cartilage Constructs for Biologic Total Joint Replacement. Tissue Eng Part A 2016; 22:386-95. [PMID: 26871863 DOI: 10.1089/ten.tea.2015.0384] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Cartilage has a poor healing response, and few viable options exist for repair of extensive damage. Hyaluronic acid (HA) hydrogels seeded with mesenchymal stem cells (MSCs) polymerized through UV crosslinking can generate functional tissue, but this crosslinking is not compatible with indirect rapid prototyping utilizing opaque anatomic molds. Methacrylate-modified polymers can also be chemically crosslinked in a cytocompatible manner using ammonium persulfate (APS) and N,N,N',N'-tetramethylethylenediamine (TEMED). The objectives of this study were to (1) compare APS/TEMED crosslinking with UV crosslinking in terms of functional maturation of MSC-seeded HA hydrogels; (2) generate an anatomic mold of a complex joint surface through rapid prototyping; and (3) grow anatomic MSC-seeded HA hydrogel constructs using this alternative crosslinking method. Juvenile bovine MSCs were suspended in methacrylated HA (MeHA) and crosslinked either through UV polymerization or chemically with APS/TEMED to generate cylindrical constructs. Minipig porcine femoral heads were imaged using microCT, and anatomic negative molds were generated by three-dimensional printing using fused deposition modeling. Molded HA constructs were produced using the APS/TEMED method. All constructs were cultured for up to 12 weeks in a chemically defined medium supplemented with TGF-β3 and characterized by mechanical testing, biochemical assays, and histologic analysis. Both UV- and APS/TEMED-polymerized constructs showed increasing mechanical properties and robust proteoglycan and collagen deposition over time. At 12 weeks, APS/TEMED-polymerized constructs had higher equilibrium and dynamic moduli than UV-polymerized constructs, with no differences in proteoglycan or collagen content. Molded HA constructs retained their hemispherical shape in culture and demonstrated increasing mechanical properties and proteoglycan and collagen deposition, especially at the edges compared to the center of these larger constructs. Immunohistochemistry showed abundant collagen type II staining and little collagen type I staining. APS/TEMED crosslinking can be used to produce MSC-seeded HA-based neocartilage and can be used in combination with rapid prototyping techniques to generate anatomic MSC-seeded HA constructs for use in filling large and anatomically complex chondral defects or for biologic joint replacement.
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Affiliation(s)
- Vishal Saxena
- 1 McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,2 Translational Musculoskeletal Research Center, Philadelphia Veterans Affairs Medical Center , Philadelphia, Pennsylvania
| | - Minwook Kim
- 1 McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,2 Translational Musculoskeletal Research Center, Philadelphia Veterans Affairs Medical Center , Philadelphia, Pennsylvania.,3 Department of Bioengineering, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Niobra M Keah
- 1 McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,2 Translational Musculoskeletal Research Center, Philadelphia Veterans Affairs Medical Center , Philadelphia, Pennsylvania
| | - Alexander L Neuwirth
- 1 McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,2 Translational Musculoskeletal Research Center, Philadelphia Veterans Affairs Medical Center , Philadelphia, Pennsylvania
| | - Brendan D Stoeckl
- 1 McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,2 Translational Musculoskeletal Research Center, Philadelphia Veterans Affairs Medical Center , Philadelphia, Pennsylvania
| | - Kevin Bickard
- 1 McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,3 Department of Bioengineering, University of Pennsylvania , Philadelphia, Pennsylvania
| | - David J Restle
- 1 McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,3 Department of Bioengineering, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Rebecca Salowe
- 1 McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,3 Department of Bioengineering, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Margaret Ye Wang
- 1 McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,3 Department of Bioengineering, University of Pennsylvania , Philadelphia, Pennsylvania
| | - David R Steinberg
- 1 McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,2 Translational Musculoskeletal Research Center, Philadelphia Veterans Affairs Medical Center , Philadelphia, Pennsylvania
| | - Robert L Mauck
- 1 McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania.,2 Translational Musculoskeletal Research Center, Philadelphia Veterans Affairs Medical Center , Philadelphia, Pennsylvania.,3 Department of Bioengineering, University of Pennsylvania , Philadelphia, Pennsylvania
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Gudiseva HV, Hansen M, Gutierrez L, Collins DW, He J, Verkuil LD, Danford ID, Sagaser A, Bowman AS, Salowe R, Sankar PS, Miller-Ellis E, Lehman A, O'Brien JM. Saliva DNA quality and genotyping efficiency in a predominantly elderly population. BMC Med Genomics 2016; 9:17. [PMID: 27052975 PMCID: PMC4823890 DOI: 10.1186/s12920-016-0172-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 07/29/2015] [Accepted: 02/24/2016] [Indexed: 11/24/2022] Open
Abstract
Background The question of whether DNA obtained from saliva is an acceptable alternative to DNA from blood is a topic of considerable interest for large genetics studies. We compared the yields, quality and performance of DNAs from saliva and blood from a mostly elderly study population. Methods Two thousand nine hundred ten DNAs from primarily elderly subjects (mean age ± standard deviation (SD): 65 ± 12 years), collected for the Primary Open-Angle African-American Glaucoma Genetics (POAAGG) study, were evaluated by fluorometry and/or spectroscopy. These included 566 DNAs from blood and 2344 from saliva. Subsets of these were evaluated by Sanger sequencing (n = 1555), and by microarray SNP genotyping (n = 94) on an Illumina OmniExpress bead chip platform. Results The mean age of subjects was 65, and 68 % were female in both the blood and saliva groups. The mean ± SD of DNA yield per ml of requested specimen was significantly higher for saliva (17.6 ± 17.8 μg/ml) than blood (13.2 ± 8.5 μg/ml), but the mean ± SD of total DNA yield obtained per saliva specimen (35 ± 36 μg from 2 ml maximum specimen volume) was approximately three-fold lower than from blood (106 ± 68 μg from 8 ml maximum specimen volume). The average genotyping call rates were >99 % for 43 of 44 saliva DNAs and >99 % for 50 of 50 for blood DNAs. For 22 of 23 paired blood and saliva samples from the same individuals, the average genotyping concordance rate was 99.996 %. High quality PCR Sanger sequencing was obtained from ≥ 98 % of blood (n = 297) and saliva (n = 1258) DNAs. DNA concentrations ≥10 ng/μl, corresponding to total yields ≥ 2 μg, were obtained for 94 % of the saliva specimens (n = 2344). Conclusions In spite of inferior purity, the performance of saliva DNAs for microarray genotyping was excellent. Our results agree with other studies concluding that saliva collection is a viable alternative to blood. The potential to boost study enrollments and reduce subject discomfort is not necessarily offset by a reduction in genotyping efficiency. Saliva DNAs performed comparably to blood DNAs for PCR Sanger sequencing. Electronic supplementary material The online version of this article (doi:10.1186/s12920-016-0172-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Harini V Gudiseva
- Scheie Eye Institute, University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA, 19104, USA
| | | | | | - David W Collins
- Scheie Eye Institute, University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA, 19104, USA
| | - Jie He
- Scheie Eye Institute, University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA, 19104, USA
| | - Lana D Verkuil
- Scheie Eye Institute, University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA, 19104, USA
| | - Ian D Danford
- Scheie Eye Institute, University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA, 19104, USA
| | - Anna Sagaser
- Scheie Eye Institute, University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA, 19104, USA
| | - Anita S Bowman
- Scheie Eye Institute, University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA, 19104, USA
| | - Rebecca Salowe
- Scheie Eye Institute, University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA, 19104, USA
| | - Prithvi S Sankar
- Scheie Eye Institute, University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA, 19104, USA
| | - Eydie Miller-Ellis
- Scheie Eye Institute, University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA, 19104, USA
| | - Amanda Lehman
- Scheie Eye Institute, University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA, 19104, USA
| | - Joan M O'Brien
- Scheie Eye Institute, University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA, 19104, USA. Joan.O'
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Jacobs IN, Redden RA, Goldberg R, Hast M, Salowe R, Mauck RL, Doolin EJ. Pediatric laryngotracheal reconstruction with tissue-engineered cartilage in a rabbit model. Laryngoscope 2015; 126 Suppl 1:S5-21. [PMID: 26468093 DOI: 10.1002/lary.25676] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 06/10/2015] [Revised: 08/05/2015] [Accepted: 08/21/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVES/HYPOTHESIS To develop an effective rabbit model of in vitro- and in vivo-derived tissue-engineered cartilage for laryngotracheal reconstruction (LTR). STUDY DESIGN 1) Determination of the optimal scaffold 1% hyaluronic acid (HA), 2% HA, and polyglycolic acid (PGA) and in vitro culture time course using a pilot study of 4 by 4-mm in vitro-derived constructs analyzed on a static culture versus zero-gravity bioreactor for 4, 8, and 12 weeks, with determination of compressive modulus and histology as outcome measures. 2) Three-stage survival rabbit experiment utilizing autologous auricular chondrocytes seeded in scaffolds, either 1% HA or PGA. The constructs were cultured for the determined in vitro time period and then cultured in vivo for 12 weeks. Fifteen LTRs were performed using HA cartilage constructs, and one was performed with a PGA construct. All remaining specimens and the final reconstructed larynx underwent mechanical testing, histology, and glycosaminoglycan (GAG) content determination, and then were compared to cricoid control specimens (n = 13) and control LTR using autologous thyroid cartilage (n = 18). METHODS 1) One rabbit underwent an auricular punch biopsy, and its chondrocytes were isolated and expanded and then encapsulated in eight 4 by 4-mm discs of 1% HA, 2% HA, PGA either in rotary bioreactor or static culture for 4, 8, and 12 weeks, respectively, with determination of compressive modulus, GAG content, and histology. 2) Sixteen rabbits underwent ear punch biopsy; chondrocytes were isolated and expanded. The cells were seeded in 13 by 5 by 2.25-mm UV photopolymerized 1% HA (w/w) or calcium alginate encapsulated synthetic PGA (13 × 5 × 2 mm); the constructs were then incubated in vitro for 12 weeks (the optimal time period determined above in paragraph 1) on a shaker. One HA and one PGA construct from each animal was tested mechanically and histologically, and the remaining eight (4 HA and 4 PGA) were implanted in the neck. After 12 weeks in vivo, the most optimal-appearing HA construct was used as a graft for LTR in 15 rabbits and PGA in one rabbit. The seven remaining specimens underwent hematoxylin and eosin, Safranin O, GAG content determination, and flexural modulus testing. At 12 weeks postoperative, the animals were euthanized and underwent endoscopy. The larynges underwent mechanical and histological testing. All animals that died underwent postmortem examination, including gross and microhistological analysis of the reconstructed airway. RESULTS Thirteen of the 15 rabbits that underwent LTR with HA in vitro- and in vivo-derived tissue-engineered cartilage constructs survived. The 1% HA specimens had the highest modulus and GAG after 12 weeks in vitro. The HA constructs became well integrated in the airway, supported respiration for the 12 weeks, and were histologically and mechanically similar to autologous cartilage. CONCLUSIONS The engineering of in vitro- and in vivo-derived cartilage with HA is a novel approach for laryngotracheal reconstruction. The data suggests that the in vitro- and in vivo-derived tissue-engineered approaches may offer a promising alternative to current strategies used in pediatric airway reconstruction, as well as other head and neck applications. LEVEL OF EVIDENCE NA. Laryngoscope, 126:S5-S21, 2016.
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Affiliation(s)
- Ian N Jacobs
- Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Robert A Redden
- Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Rachel Goldberg
- Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Michael Hast
- School of Engineering and Applied Sciences at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Rebecca Salowe
- School of Engineering and Applied Sciences at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Robert L Mauck
- School of Engineering and Applied Sciences at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Edward J Doolin
- Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
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Salowe R, Salinas J, Farbman NH, Mohammed A, Warren JZ, Rhodes A, Brucker A, Regina M, Miller-Ellis E, Sankar PS, Lehman A, O'Brien JM. Primary Open-Angle Glaucoma in Individuals of African Descent: A Review of Risk Factors. ACTA ACUST UNITED AC 2015; 6. [PMID: 26664770 PMCID: PMC4671514 DOI: 10.4172/2155-9570.1000450] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective To identify the major risk factors for primary open-angle glaucoma (POAG) in individuals of African descent. Methods We searched PubMed for relevant articles, with results spanning April 1947 to present. All abstracts were reviewed and, where relevant to POAG and race, articles were catalogued and analyzed. Additional sources were identified through citations in articles returned by our search. Results Numerous potential POAG risk factors were identified and organized into categories by demographics (age, sex, and skin color), lifestyle choices (smoking, alcohol), comorbidities (hypertension, diabetes, and obesity), ophthalmic findings (eye structure, central corneal thickness, corneal hysteresis, elevated intraocular pressure, myopia, cataract, and vascular abnormalities), family history, socioeconomic status, and adherence. Older age, male sex, lower central corneal thickness, decreased corneal hysteresis, elevated intraocular pressure, myopia, vascular abnormalities, and positive family history were definitively associated with increased risk of POAG. Conclusions Individuals at greatest risk for POAG should be screened by an ophthalmologist to allow earlier detection and to slow disease progression. Further studies on the genetics of the disease will provide more insight into underlying pathologic mechanisms and could lead to improved therapeutic interventions. Continued research in urban areas with large populations of blacks is especially needed.
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Affiliation(s)
- Rebecca Salowe
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Salinas
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Neil H Farbman
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Aishat Mohammed
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua Z Warren
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Allison Rhodes
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexander Brucker
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Meredith Regina
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Prithvi S Sankar
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Amanda Lehman
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Joan M O'Brien
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
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