Accelerating Medicines Partnership® Schizophrenia (AMP® SCZ): Rationale and Study Design of the Largest Global Prospective Cohort Study of Clinical High Risk for Psychosis

This article describes the rationale, aims, and methodology of the Accelerating Medicines Partnership® Schizophrenia (AMP® SCZ). This is the largest international collaboration to date that will develop algorithms to predict trajectories and outcomes of individuals at clinical high risk (CHR) for psychosis and to advance the development and use of novel pharmacological interventions for CHR individuals. We present a description of the participating research networks and the data processing analysis and coordination center, their processes for data harmonization across 43 sites from 13 participating countries (recruitment across North America, Australia, Europe, Asia, and South America), data flow and quality assessment processes, data analyses, and the transfer of data to the National Institute of Mental Health (NIMH) Data Archive (NDA) for use by the research community. In an expected sample of approximately 2000 CHR individuals and 640 matched healthy controls, AMP SCZ will collect clinical, environmental, and cognitive data along with multimodal biomarkers, including neuroimaging, electrophysiology, fluid biospecimens, speech and facial expression samples, novel measures derived from digital health technologies including smartphone-based daily surveys, and passive sensing as well as actigraphy. The study will investigate a range of clinical outcomes over a 2-year period, including transition to psychosis, remission or persistence of CHR status, attenuated positive symptoms, persistent negative symptoms, mood and anxiety symptoms, and psychosocial functioning. The global reach of AMP SCZ and its harmonized innovative methods promise to catalyze the development of new treatments to address critical unmet clinical and public health needs in CHR individuals.

Abstract 4029: JIN-A04, highly effective tyrosine kinase inhibitor targeting HER2 exon 20 insertion mutations in NSCLC

Introduction: Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for about 85% of lung cancer patients. 2% - 4% of patients with NSCLC harbor human epidermal growth factor receptor 2 gene (HER2) mutations, being the 90 % of them exon 20 insertions. The most common HER2 mutations in NSCLC are exon 20 mutation A775_G776insYVMA (YVMA) mutation in the kinase domain. Currently, treatment options for this subset of patients are limited. JIN-A04 is an orally available tyrosine kinase inhibitor (TKI) targeting HER2 exon20 insertion mutations and has the potential to be a best-in-class drug candidate to address this unmet clinical need.

Method: The inhibitory activity of JIN-A04 was evaluated by cell viability assay in both Ba/F3 cell lines expressed HER2 YVMA and HER2 P780_Y781insGSP (GSP) mutations. Also, Ba/F3 HER2 wild-type (WT) and normal cell lines for HUVEC (endothelial cells) and BEAS-2B (human bronchial epithelial cells) were used to assess cellular activity. In addition, to confirm mechanism action, western blotting analysis was performed on Ba/F3 YVMA and Ba/F3 GSP cell lines.

Results: In cell viability assay, JIN-A04 strongly inhibited cellular activity against Ba/F3 cell lines engineering to express the mutants HER2 YVMA (IC50 = 11.1 nM) and GSP (IC50 = 1.4 nM). It was superior to Mobocertinib (IC50 = 27.1 nM for YVMA and IC50 = 3.3 nM for GSP) and comparable with Poziotinib (IC50 = 3.4 nM for YVMA and IC50 = 0.4 nM for GSP). In normal cell lines, JIN-A04 did not inhibit the activity of HUVEC (IC50 = &gt 1000 nM) and BEAS-2B (IC50 = &gt 1000 nM) cell lines, largely sparing HER2 WT activity (IC50 = &gt 1000 nM). In protein expression analysis, JIN-A04 was effectively inhibited in all signaling pathway of p-EGFR, p-AKT, p-ERK1/2, and p-S6 on Ba/F3 YVMA and Ba/F3 GSP cell lines at a low dose level.

Conclusion: JIN-A04 is highly potent against HER2 exon 20 insertion mutations including YVMA and GSP, while largely sparing HER2 WT activity. Also, JIN-A04 demonstrated effective HER2 pathway inhibition. Based on these robust activities for HER2 exon 20 insertion, JIN-A04 is expected to provide a potent therapeutic opportunity for NSCLC patients with HER2 exon20 insertion mutations.

Citation Format: Mi Ra Yu, Mi Ran Yun, Jii Bum Lee, Ji Yun Lee, So Won Aum, Su Jin Choi, Ju Yeon Park, Seung Yeon Oh, Eun Ji Lee, Krishna Babu Duggirala, Kwangho Lee, Min Hee Hong, Sun Min Lim, Anna Jo, Ethan Seah, Choonok Kim, Byoung Chul Cho. JIN-A04, highly effective tyrosine kinase inhibitor targeting HER2 exon 20 insertion mutations in NSCLC. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4029.

Development and evaluation of photon-counting Cd0.875Zn0.125Te0.98Se0.02 detector for measuring bone mineral density

Cadmium zinc telluride (CZT) has been actively researched and developed by researchers in various fields. In medical applications, especially photon-counting, CZT enables improved image quality, multi-material decomposition, and improved dose efficiency. Moreover, band gap engineering and selenium addition on CZT improved electrical, spectroscopic and structural properties, thereby supporting performance of CZT as a photon-counting detector. In this study, it is shown that Cd_0.875Zn_0.125Te_0.98Se_0.02 (CZTS) shows sufficient performance without loss of detection efficiency. We carried out a study involving the application of this CZTS on calculating bone mineral density (BMD) values, because this application has a novelty of new material for BMD sensor which follows the CdTe- or CdZnTe- based BMD detector. Anatomical images from different energy bins contained different information of attenuation although the images were taken in the same region at the same time. Moreover, calculated BMD values had a proper tendency depending on the amount of bone in that region. The final BMD value was 1.1972 g/cm², which is close to the real value of 1.2 g/cm². The introduction with a bone filter and a smaller pixel size will improve the accuracy and precision of photon-counting CZTS detectors for measuring BMD values. However, in this study the CZTS showed the feasibility that a photon-counting CZTS detector can help the measurement of BMD values and the diagnosis of osteoporosis.

Effectiveness of Switching to Long-acting Injectable Aripiprazole in Patients with Recent-onset and Chronic Schizophrenia

Objective

This study investigated the effectiveness of switching to once-monthly long-acting injectable (LAI) aripiprazole from other second-generation antipsychotics including LAI paliperidone palmitate in both recent-onset and chronic schizophrenia patients.

Methods

This was a 24-week prospective, open-label, flexible dose-switching study in patients with schizophrenia. Scores on the Positive and Negative Syndrome Scale (PANSS), Personal and Social Performance (PSP) scale, Clinical Global Impression (CGI), Subjective Well-being Under Neuroleptics-Short Form (SWN-K), and a computerized emotional recognition test (ERT) were evaluated. Subjects were divided into two groups (recent onset and chronic) based on 5 years' duration of the illness.

Results

Among the 82 patients participating, 67 (81.7%) completed the 24-week study. The discontinuation rate after switching to LAI aripiprazole did not differ according to clinical characteristics including type of previous antipsychotics. Scores on the PANSS, PSP, SWN-K, CGI, and ERT were significantly improved after a switch to LAI aripiprazole without exacerbation of metabolic parameters and bodyweight. The improvements in the PANSS, PSP, and CGI scores were significantly greater in patients with recent-onset than in those with chronic schizophrenia; the improvement in metabolic parameters was significantly greater in the latter group.

Conclusion

High rates of successful switching to LAI aripiprazole from other antipsychotics suggest its good tolerability and effectiveness. Improvements in psychopathology and social functioning were more evident in patients with recent- onset schizophrenia, and improvements in metabolic abnormalities were more prominent in patients with chronic schizophrenia.

Effects of Dietary Habits on General and Abdominal Obesity in Community-dwelling Patients with Schizophrenia

Objective

To investigate the effects of dietary habits on general and abdominal obesity in community-dwelling patients with schizophrenia spectrum disorder according to sex.

Methods

A total of 270 patients with schizophrenia spectrum disorder registered at mental health welfare centers and rehabilitation facilities were recruited. General obesity was defined as a body mass index ≥ 30 kg/m², and abdominal obesity was defined as a waist circumstance ≥ 90 cm in men and ≥ 85 cm in women. Dietary habits were evaluated using dietary guidelines published by the Korean Ministry of Health and Welfare. Demographic and clinical characteristics along with dietary habits and information related to obesity were collected. Factors related to obesity were evaluated separately by sex.

Results

Dietary habits differed according to sex, in that scores for healthy eating habits were lower in men than in women. In men, the prevalences of general and abdominal obesity were 17.0% and 37.3%, respectively. In women, the prevalences of general and abdominal obesity were 23.1% and 38.5%, respectively. Regression analysis showed that the scores of regular eating habits were negatively associated with general and abdominal obesity in men, and the scores of healthy eating habits were negatively associated with general and abdominal obesity in women.

Conclusion

Among patients with schizophrenia, regular eating habits might reduce the risk of obesity in men, and healthy eating habits might reduce the risk of obesity in women. Nutrition education should be provided to community- dwelling patients with schizophrenia to prevent obesity in this population.

Extru-seq: a method for predicting genome-wide Cas9 off-target sites with advantages of both cell-based and in vitro approaches

We present a novel genome-wide off-target prediction method named Extru-seq and compare it with cell-based (GUIDE-seq), in vitro (Digenome-seq), and in silico methods using promiscuous guide RNAs with large numbers of valid off-target sites. Extru-seq demonstrates a high validation rate and retention of information about the intracellular environment, both beneficial characteristics of cell-based methods. Extru-seq also shows a low miss rate and could easily be performed in clinically relevant cell types with little optimization, which are major positive features of the in vitro methods. In summary, Extru-seq shows beneficial features of cell-based and in vitro methods.

TAPE-seq is a cell-based method for predicting genome-wide off-target effects of prime editor

Prime editors (PEs) are powerful tools that widen the possibilities for sequence modifications during genome editing. Although methods based on the analysis of Cas9 nuclease or nickase activity have been used to predict genome-wide off-target activities of PEs, no tool that directly uses PEs for this purpose has been reported yet. In this study, we present a cell-based assay, named TAgmentation of Prime Editor sequencing (TAPE-seq), that provides genome-wide off-target candidates for PEs. TAPE-seq analyses are successfully performed using many different versions of PEs. The TAPE-seq predictions are compared with results from two other off-site prediction methods, Cas9 nuclease-based GUIDE-seq and Cas9 nickase-based Digenome-seq (nDigenome-seq). TAPE-seq shows a lower miss rate, and a higher area under the receiver operating characteristic curve compared to the other methods. TAPE-seq also identified valid off-target sites that were missed by the other methods.

The effects of patient personality traits and family cohesion on the treatment delay for patients with first-episode schizophrenia spectrum disorder

AIM

The duration of untreated psychosis (DUP) is an important prognostic indicator of schizophrenia. We explored the effects of patient personality and family relationships on delayed schizophrenia treatment.

METHODS

We prospectively included data from 169 patients diagnosed with first-episode schizophrenia. Personality traits were investigated using the Big Five Inventory (BFI-10) and family relationship was assessed employing the Family Adaptability and Cohesion Evaluation Scale-III (FACES-III). We explored patient clinical characteristics using the Positive and Negative Syndrome Scale (PANSS) and the Social and Occupational Functioning Scale (SOFAS). The DUP was defined as the time between the first appearance of psychotic symptoms and commencement of adequate antipsychotic treatment. Subjects were divided into two groups by the 3-month median DUP cutoff.

RESULTS

The average and median DUPs were 12 and 3 months, respectively. A longer DUP was associated with older age, a higher PANSS score, and a lower SOFAS score. The frequency of suicide attempts tended to be higher in the delayed treatment group (P = .055). The delayed treatment group scored significantly higher in conscientiousness factor of the BFI-10 and scored significantly lower family cohesion and adaptability factors of the FACES-III. Logistic regression showed that a longer DUP was significantly associated with higher-level conscientiousness on the BFI-10 and poorer family cohesion on the FACES-III.

CONCLUSION

Treatment delay was associated with reduced family cohesion and higher patient conscientiousness, suggesting that the family plays a crucial role in terms of patient access to mental health services when early psychotic symptoms appear.

Comparative evaluation of MCP gene in worldwide strains of Megalocytivirus (Iridoviridae family) for early diagnostic marker

Members of the Iridoviridae family have been considered as aetiological agents of iridovirus diseases, causing fish mortalities and economic losses all over the world. Virus identification based on candidate gene sequencing is faster, more accurate and more reliable than other traditional phenotype methodologies. Iridoviridae viruses are covered by a protein shell (capsid) encoded by the important candidate gene, major capsid protein (MCP). In this study, we investigated the potential of the MCP gene for use in the diagnosis and identification of infections caused Megalocytivirus of the Iridoviridae family. We selected data of 66 Iridoviridae family isolates (53 strains of Megalocytivirus, eight strains of iridoviruses and five strains of Ranavirus) infecting various species of fish distributed all over the world. A total of 53 strains of Megalocytivirus were used for designing the complete primer sets for identifying the most hypervariable region of the MCP gene. Further, our in silico analysis of 102 sequences of related and unrelated viruses reconfirms that primer sets could identify strains more specifically and offers a useful and fast alternative for routine clinical laboratory testing. Our findings suggest that phenotype observation along with diagnosis using universal primer sets can help detect infection or carriers at an early stage.

Down-regulation of p21-activated serine/threonine kinase 1 is involved in loss of mesencephalic dopamine neurons

BACKGROUND

Although the roles of p21-activated serine/threonine kinase 1 (PAK1) have been reported in some neurodegenerative diseases, details regarding neurodegeneration are still limited. Hence, we tried to determine the role of PAK1 and molecular mechanisms of neuronal death involved in neurodegeneration.

RESULTS

Expression of a dominant-negative form of PAK1 (PAK1(H83,86L, K229R), PAK1-DN) decreased the cell viability and increased cell death induced by oxidative stress. Indeed, oxidative stress decreased the phosphorylation of PAK1 in neuroblastoma cells, cultured dopamine (DA) neurons, or rat midbrains. PAK1-DN reduced the level of Bcl-2 protein, through an ubiquitin/proteasome-dependent mechanism. The level of Bcl-2 may be regulated by PAK1-ERK signaling and/or PAK1, directly. Conversely, expression of an active form of PAK1 (PAK1(T423E), PAK1-CA) could recover both loss of DA neurons in the substantia nigra (SN) and behavioral defects in a 6-OHDA-induced hemiparkinsonian rat model.

CONCLUSIONS

Our data suggest that the oxidative stress-induced down-regulation of PAK1 activity could be involved in the loss of mesencephalic DA neurons through modulation of neuronal death, suggesting a novel role of PAK1 as a molecular determinant and mechanisms in the pathogenesis of Parkinson's disease.

BNIP3 is essential for mitochondrial bioenergetics during adipocyte remodelling in mice

AIMS/HYPOTHESIS

Adipose tissue is a highly versatile system in which mitochondria in adipocytes undergo significant changes during active tissue remodelling. BCL2/adenovirus E1B 19 kDa protein-interacting protein 3 (BNIP3) is a mitochondrial protein and a known mitochondrial quality regulator. In this study, we investigated the role of BNIP3 in adipocytes, specifically under conditions of peroxisome proliferator-activated receptor-γ (PPARγ)-induced adipose tissue remodelling.

METHODS

The expression of BNIP3 was evaluated in 3T3-L1 adipocytes in vitro, C57BL/6 mice fed a high-fat diet and db/db mice in vivo. Mitochondrial bioenergetics was investigated in BNIP3-knockdown adipocytes after rosiglitazone treatment. A putative peroxisome proliferator hormone responsive element (PPRE) was characterised by promoter assay and electrophoretic mobility shift assay (EMSA).

RESULTS

The protein BNIP3 was more abundant in brown adipose tissue than white adipose tissue. Furthermore, BNIP3 expression was upregulated by 3T3-L1 pre-adipocyte differentiation, starvation and rosiglitazone treatment. Conversely, BNIP3 expression in adipocytes decreased under various conditions associated with insulin resistance. This downregulation of BNIP3 was restored by rosiglitazone treatment. Knockdown of BNIP3 in adipocytes inhibited rosiglitazone-induced mitochondrial biogenesis and function, partially mediated by the 5' AMP-activated protein kinase (AMPK)-peroxisome proliferator-activated receptor γ, co-activator 1 α (PGC1α) signalling pathway. Rosiglitazone treatment increased the transcription level of Bnip3 in the reporter assay and the presence of the PPRE site in the Bnip3 promoter was demonstrated by EMSA.

CONCLUSIONS/INTERPRETATION

The protein BNIP3 contributes to the improvement of mitochondrial bioenergetics that occurs on exposure to rosiglitazone. It may be a novel therapeutic target for restoring mitochondrial dysfunction under insulin-resistant conditions.

Effect of γ-cyclodextrin as a lyoprotectant for freeze-dried actinidin

Actinidin (ATD) is a cysteine protease found in kiwifruit. It is used to tenderize meat and to enhance the digestion of proteins in the small intestine. However, ATD is unstable during freeze-drying, which alters its bioactivity. It is well known that sugars have the ability to protect proteins from the stress of freeze-drying. In this study, we investigated the protective effect of various saccharides on the stability of ATD during freeze-drying. The ATD activities of the samples containing γ-cyclodextrin (CyD) showed only a small decrease, and compared with trehalose and sucrose, γ-CyD was a more effective stabilizer for ATD. Secondary structural changes in freeze-dried ATD were observed by circular dichroism spectroscopy and compared with the changes in stabilized samples. There was a close relationship between the α-helix content and the stabilization. The sugars stabilized the protein by suppressing the changes in the α-helix. Fourier transform infrared spectroscopy measurement showed that the amide I band of ATD with γ-CyD was shifted to a lower wavenumber compared with other sugars. Therefore, stronger hydrogen bonds may be formed between ATD and γ-CyD than between ATD and other sugars. The suppression of changes in the protein secondary structure accompanying the formation of hydrogen bonding between the protein and the sugar also contributed to the protective effect of the sugars.

Activity-dependent synaptic localization of processing bodies and their role in dendritic structural plasticity

In neurons, transport of a subset of mRNAs to subcellular regions and their translation has a role in synaptic plasticity. Recent studies have suggested a control mechanism of this local translation through mRNA compartmentalization or degradation. Here we report that processing bodies (P-bodies), which are involved in mRNA degradation or storage, are transported to dendrites by conventional kinesin (KIF5A) as a motor protein. Neuronal activation induced by depolarization increased the colocalization of P-bodies with PSD-95 in dendrites. This neuronal activity increased the release of Nd1 and Arp2 mRNA from the P-bodies and, consequently, reversed the decrease of F-actin (induced by overexpression of Dcp1a) in the dendrites. Our data suggest that the activity-induced redistribution of P-bodies and mRNA release from P-bodies might have a role in synaptic structural plasticity by altering levels of mRNAs that are involved in the dynamics of the actin cytoskeleton in dendrites.

Endothelial progenitor cell cotransplantation enhances islet engraftment by rapid revascularization

Impaired revascularization of transplanted islets is a critical problem that leads to progressive islet loss. Since endothelial progenitor cells (EPCs) are known to aid neovascularization, we aimed to enhance islet engraftment by cotransplanting EPCs with islets. Porcine islets, with (islet-EPC group) or without (islet-only group) human cord blood-derived EPCs, were transplanted into diabetic nude mice. The islet-EPC group reached euglycemia by ∼11 days posttransplantation, whereas the islet-only group did not. Also, the islet-EPC group had a higher serum porcine insulin level than the islet-only group. Islets from the islet-EPC group were more rapidly revascularized at the early period of transplantation without increment of final capillary density at the fully revascularized graft. Enhanced revascularization rate in the islet-EPC group was mainly attributed to stimulating vascular endothelial growth factor-A production from the graft. The rapid revascularization by EPC cotransplantation led to better graft perfusion and recovery from hypoxia. EPC cotransplantation was also associated with greater β-cell proliferation, probably by more basement membrane production and hepatocyte growth factor secretion. In conclusion, cotransplantation of EPCs and islets induces better islet engraftment by enhancing the rate of graft revascularization. These findings might provide a directly applicable tool to enhance the efficacy of islet transplantation in clinical practice.

Up-regulation of dendritic Kv4.2 mRNA by activation of the NMDA receptor

The localization of Kv4.2 mRNAs in dendritic regions suggests that Kv4.2 channels, which originate from on-site protein synthesis in the dendrites, might play a role in synaptic function. In this study, we determined the molecular mechanisms of dendritic transport of Kv4.2 mRNA. Three hours of incubation following a brief depolarization resulted in significant increases in Kv4.2 mRNA levels in both cell bodies and dendrites. The increase in the mRNA in the dendrites was mediated by transcription- and translation-independent mechanisms. In order to further clarify the molecular mechanism of dendritic transport of Kv4.2 mRNA, we used the GFP-MS2 reporting system. Consistent with the in situ data, depolarization resulted in significant increases in dendritic levels of Kv4.2 mRNA at the maximal length at which Kv4.2 mRNA could be detected. These increases were mediated in a synaptic NMDA receptor- and Ca(2+)-dependent fashion. Collectively, these results indicate that Kv4.2 mRNA levels are regulated in response to synaptic activity, and this phenomenon may be the mechanism underlying the homeostasis of Kv4.2 protein on dendritic surfaces.

Dendritic localization and a cis-acting dendritic targeting element of Kv4.2 mRNA

Kv4.2, a pore-forming α-subunit of voltage-gated A-type potassium channels, is expressed abundantly in the soma and dendrites of hippocampal neurons, and is responsible for somatodendritic I(A) current. Recent studies have suggested that changes in the surface levels of Kv4.2 potassium channels might be relevant to synaptic plasticity. Although the function and expression of Kv4.2 protein have been extensively studied, the dendritic localization of Kv4.2 mRNA is not well described. In this study, Kv4.2 mRNAs were shown to be localized in the dendrites near postsynaptic regions. The dendritic transport of Kv4.2 mRNAs were mediated by microtubule- based movement. The 500 nucleotides of specific regions within the 3'-untranslated region of Kv4.2 mRNA were found to be necessary and sufficient for its dendritic localization. Collectively, these results suggest that the dendritic localization of Kv4.2 mRNAs might regulate the dendritic surface level of Kv4.2 channels and synaptic plasticity.

Antitumor effect of carboplatin combined with radiation on tumors in mice

The antitumor effect of cis-diammine-1, 1-cyclobutane dicarboxylate platinum(II) (CBDCA, Carboplatin) and radiation on Ehrlich ascites tumors was evaluated in CD-1 mice. A single dose of CBDCA was combined with a single dose of radiation. The antitumor effect was evaluated by tumor volume. Inhibition of tumor growth by the combination of CBDCA and radiation was greater than by CBDCA and radiation alone. The most effective condition was the simultaneous combination of CBDCA with radiation. Further, we examined the radiation influence on the concentration of platinum in tumor tissue. We found that when CBDCA was administered after irradiation, the concentration of platinum in tumor tissue decreased proportionally with time.

Enhancement of antitumor effects of new analogue of platinum, cis-diammine (glycolato) platinum (254-S) combined with hyperthermia in vivo

Cis-diammine (glycolato) platinum (254-S) is a second generation platinum complex with reduced nephrotoxicity. In this study the antitumor effect of 254-S combined with hyperthermia in vivo in mice was studied. On the 6th day after inoculation of the Ehrlich ascites tumour cells, 254-S (15mg/kg) was administered intraperitoneally (i.p.) and hyperthermia was induced by using a circulating water bath at 42.5 degrees C for 45 min. The antitumour effect was evaluated by relative tumour volume. Furthermore, platinum concentration in tumour tissue was determined by using atomic absorption spectrophotometry. The most effective condition was found to be the combination of 254-S with hyperthermia. A significantly higher concentration of platinum in the tumour tissue was observed when treatment with 254-S was combined with hyperthermia, than with treatment using 254-S alone. Our study suggested that the accumulation of 254-S in the tumour tissue, and its retention at a high concentration within the tumour tissue long term was one of the reasons for the enhancement of antitumour effect of 254-S treatment when combined with hyperthermia.

The role of orbital wall morphological properties and their supporting structures in the etiology of "blow-out" fractures

The stiffness and strength of the orbital walls are proportionally dependent on the anatomical structures which support and strengthen these walls from the opposite side. The medial wall is therefore strong due to the support of ethmoid cells. The floor is stronger the less surface there is and the more supported it is by trabeculae of the maxillar sinus. The strength of the upper and lateral walls are proportional to their thickness. The orbital floor is on the average the weakest, followed by the medial and upper walls. The lateral wall is the stiffest and the most rigid. Computed tomography (CT) has improved structural analysis of the orbital contents and orbital walls enabling the visualisation of superficial and deep soft tissues and bone structures.