Early breakdown of the blood-retinal barrier in diabetes

The blood-retinal barrier plays an important part in the processes of retinal pathophysiology. A new clinical method for the study of the blood-retinal barrier by vitreous fluorophotometry appears to satisfy the necessary requirements in that it is quantitative and shows good reproducibility and high sensitivity. The application of this method to a series of diabetic patients with apparently "normal" fundi revealed the presence of a significant breakdown of the blood-retinal barrier in the early stages of retinal involvement in diabetes. The extent of the breakdown can be measured allowing for comparative and evolutionary evaluations. The disturbance of the blood-retinal barrier, as evidence by vitreous fluorophotometry, appears before microaneurysms or capillary closure can be demonstrated by fluorescein angiography.

Renin, prorenin, and immunoreactive renin in vitreous fluid from eyes with and without diabetic retinopathy

Renin, prorenin, and immunoreactive renin were present in vitreous and subretinal fluid of eyes from subjects with and without diabetic retinopathy. Renin substrate, albumin, transferrin, and immunoglobin G were also found in these ocular fluids. In many samples renin levels were close to the detection limit of the assay. The levels of renin substrate, albumin, transferrin, and immunoglobulin G varied widely among ocular fluid samples, but in each individual sample the levels were, relative to each other, similar to those in plasma. In contrast, the prorenin level in ocular fluid was up to 100 times higher than expected on the basis of the plasma protein content of ocular fluid. Moreover, there was little difference in prorenin concentrations between samples with low and high plasma protein contents. Prorenin, relative to albumin and other plasma proteins, was higher in vitreous fluid from eyes with proliferative diabetic retinopathy complicated by traction retinal detachment than in eyes of nondiabetic subjects with spontaneous retinal detachment. It appears that prorenin (and possibly renin) in ocular fluid is controlled by an active and specific process, possibly local synthesis within the eye. In view of the vascular actions of angiotensin II, an intraocular renin-angiotensin system may play a role in diabetic retinopathy.

Basic fibroblast growth factor levels in the vitreous of patients with proliferative diabetic retinopathy

A two-site enzyme-linked immunosorbent assay was used to quantitate levels of basic fibroblast growth factor in the vitreous from 36 patients undergoing vitrectomy for a variety of retinal conditions, including proliferative diabetic retinopathy, macular pucker, and retinal detachment with and without proliferative vitreoretinopathy. Basic fibroblast growth factor levels ranged from undetectable to 52 ng/mL. In patients with proliferative diabetic retinopathy, basic fibroblast growth factor levels were greater than or equal to 30 ng/mL in 8 of 17 specimens. Of the 8 patients with elevated basic fibroblast growth factor levels, 6 had evidence of active proliferative disease (ie, neovascularization of the disc or iris), whereas in the patients who had undetectable levels only 2 of 9 had evidence of neovascularization of disc and none had neovascularization of the iris. In the rhegmatogenous retinal detachment group, 2 of 10 eyes had elevated basic fibroblast growth factor levels, while none in the macular pucker group had elevated levels. Our study documents increased levels of basic fibroblast growth factor in vitreous specimens from patients with proliferative diabetic retinopathy, particularly those with active proliferative retinopathy. The role of basic fibroblast growth factor in the pathogenesis of various retinal disease entities is discussed.

Lipid peroxidation in cataract of the human

Lipid peroxidation was investigated as one of the possible mechanisms of cataractogenesis in the human. Malondialdehyde (MDA), a major breakdown product of lipid peroxides, was significantly higher in cataractous lenses as compared to that in normal lenses. 2-Thiobarbituric acid-reactive material, isolated from cortical cataracts and purified by Sephadex G-10 column chromatography, was identified as MDA. In cataractous lenses the enzymic defenses against reactive species of O2 were impaired as evidenced by the significant decrease in activities of superoxide dismutase, catalase and glutathione peroxidase. Hydrogen peroxide in aqueous humor and vitreous humor of human eyes associated with cataract was increased 2-3 fold. It is possible that carbonyl groups of MDA could interact with primary amino groups of proteins and phospholipids of lenticular plasmalemmae by a cross-linking reaction forming Schiff-base conjugates and these mechanisms might be involved in the pathogenesis of cataract.

Insulin-like growth factors in vitreous. Studies in control and diabetic subjects with neovascularization

Vitreous and serum were obtained at the time of vitrectomy from 23 diabetic subjects with proliferative retinopathy and from 8 nondiabetic subjects. The mean concentration of IGF-I in vitreous from diabetic patients with neovascularization was 6.3 +/- 0.93 versus 2.7 +/- 0.96 ng/ml. Chi-square and rank analysis indicated that higher concentrations of IGF-I occurred in diabetic vitreous (P less than 0.01 by both analyses). IGF-II concentrations in vitreous of control and diabetic subjects were not significantly different. A positive correlation existed between the concentrations of IGF-I and IGF-II in vitreous and their concentrations in serum in diabetic subjects, but not in control subjects. When vitreous concentrations of IGF-I were calculated for diabetic subjects studied previously with rapid acceleration of retinal disease, these concentrations varied from 20 to 30 ng/ml. The concentrations of IGF-I in the vitreous of most diabetic subjects with severe neovascularization are thus in the range known to stimulate cellular differentiation and growth in several systems. Whether they do so in the eye, and thus contribute to the development of retinopathy, remains to be determined.

Death from self-induced water intoxication among patients with schizophrenic disorders

Review of 60 consecutive records of patients who died before the age of 53 years in a state mental hospital revealed that 27 of those patients (45%) had a schizophrenic disorder. Of those 27 patients, five (18.5%) died of the complications of self-induced water intoxication and schizophrenic disorders (SIWIS). Clinical, laboratory, and autopsy features of those five SIWIS patients and of an additional five SIWIS cases obtained from the literature include psychosis, polydipsia, polyuria, severe hyposthenuria (specific gravity 1.003 or less), hyponatremia, seizures, coma, and cerebral and visceral edema. SIWIS characteristically develops during Arieti's third or "preterminal" stage (5 to 15 years after onset of psychosis) of schizophrenic disorders and it must be included in the differential diagnosis of unexplained death among psychiatric patients. As there are no pathognomonic SIWIS tissue changes, the pathologist must carefully integrate clinical, laboratory, and autopsy findings to arrive at the proper diagnosis. When premortem findings of polydipsia and hyponatremia are not available, evidence of antecedent severe hyposthenuria and postmortem vitreous humor hyponatremia of less than 120 mEq/1 are strongly supportive of the diagnosis of death due to SIWIS.

References for determining the time of death by potassium in vitreous humor

The different statements concerning the slope and intercept of the regression line and the 95% limits of confidence are the reason that potassium in vitreous humor is not used (at least in Germany) as an aid in estimating the time of death. The relationship between the concentration of potassium and the time of death is mainly influenced by antemortem electrolyte imbalances caused by disease and/or duration of terminal episode. The influence of terminal episode is best identified by its duration (Adelson et al., J. Forensic Sci., 8 (1963) 503-514). In order to have a method suitable for every case and to be as precise as possible we looked therefore for parameters in vitreous humor which were stable postmortem and indicating antemortem electrolyte imbalance. Urea is such a parameter, being stable postmortem (Coe, Am. J. Clin. Pathol, 51 (1969) 741-750) and useful as a marker of antemortem electrolyte imbalance. Our investigations on potassium in vitreous humor, including sudden and hospital deaths after chronic lingering disease, revealed 95% limits of confidence of +/- 34 h up to 120 h postmortem. Reviewing only cases with urea less than 100 mg/dl the 95% limits of confidence could be reduced to +/- 22 h. Considering the duration of terminal episode (less than 6 h) the precision was +/- 20 h. In this way our modified procedure is suitable for every case with the resulting precision of estimation being determined only by the duration of the terminal episode and urea concentration.

Immunological study of acidic fibroblast growth factor (aFGF) distribution in the eye

During the last ten years, several groups, including the present authors, have detected growth factor activities in various ocular tissues, and the presence of a ubiquitous Eye-Derived Growth Factor (EDGF) has been described. More recently, isolation and characterization of this growth factor activity from the retina led to the identification of two molecules. These molecules were shown to be identical to other growth factors isolated from neuronal and non-neuronal tissues and are now designated as acidic and basic fibroblast growth factor (aFGF, bFGF). The biological function and the reason for the ubiquitous distribution of these factors remain unclear. Understanding may be improved by quantification of this distribution in various tissues during development. In the present study, specific polyclonal antibodies were raised against acidic FGF, aFGF was determined in various ocular tissues by enzyme immunoassay, and the localization of immunoreactive aFGF by immunohistological staining with fluorescent antibodies or with enzyme- or gold-labeled antibodies was studied. In almost all tissues tested aFGF was found; but the retina, cornea, and vitreous body contained the highest levels of aFGF per gram of tissue. In the retina, aFGF was associated primarily with the nerve fiber layer and the inner and outer segments of the photoreceptors, whereas corneal aFGF was detected in the cytoplasma of the basal layer of epithelial cells.

Vitreous potassium as a measure of the postmortem interval: an historical review and critical evaluation

This is an historical review of the articles published in English on the use of vitreous potassium to determine the PMI. External factors which influence the validity of the test are sampling techniques, analytical instrumentation and environmental temperature during the PMI. Internal factors that are recognized at the present time which influence vitreous potassium are the age of the individual, the duration of the terminal episode and the presence or absence of nitrogen retention.

Vitreous aspirates from patients with proliferative vitreoretinopathy stimulate retinal pigment epithelial cell migration

Several studies have focused on retinal pigment epithelial (RPE) cell proliferation as an important event in proliferative vitreoretinopathy (PVR). Little attention has been given to the question of how RPE cells gain access to the vitreous cavity where proliferation occurs. We have recently demonstrated that the serum components fibronectin and platelet-derived growth factor stimulate and direct RPE migration in vitro. In this study, we used this same in vitro technique to examine vitreous aspirates from 13 eyes with PVR, five eyes with macular puckers, and three eyes with uncomplicated retinal detachments for their ability to stimulate RPE migration. We found that aspirates from eyes with PVR stimulated RPE migration to a much greater extent than aspirates from eyes with macular pucker and uncomplicated retinal detachments. The ability to stimulate RPE cell migration correlated with high levels (mean +/- SEM, 178 +/- 67 mg/L) of immunoreactive fibronectin.

The molecular weight of hyaluronate in the aqueous humour and vitreous body of rabbit and cattle eyes

The molecular weight distribution of hyaluronate in the aqueous humour and vitreous body of rabbit and cattle has been determined by gel chromatography. The eluate from the column was monitored by a radioassay, whereby the molecular weight distribution of 15-20 microgram samples could be analysed. Control experiments were carried out with radioactively-labelled hyaluronate added to bovine material to estimate the degradation of the polymer during handling of the ocular fluids. It was shown that in vitro degradation does not appreciably affect the results. The analyses show a considerable polydispersity of the hyaluronate preparations. There is also a marked variation in the degree of polymerization between the two species. Hyaluronate from rabbit vitreous has a weight-average molecular weight (MW) of 2-3 X 10(6) while adult bovine vitreous displays a value of about 5-8 X 10(5). The hyaluronate of bovine vitreous varies with age. In newborn calf, a value of 3 X 10(6) was registered. This value dropped to about 5 X 10(5) in old cattle. The hyaluronate in the aqueous humour of rabbit showed a considerably higher molecular weight than that of the vitreous indicating that part of the hyaluronate in the anterior segment originates elsewhere than the vitreous. The differences between hyaluronate from the aqueous humour of adult cattle and that from the vitreous were more complex. As with the rabbit, a relatively large proportion of hyaluronate in the aqueous humour was of high-molecular weight, but, in contrast, the aqueous humour also contained material which had a lower degree of polymerization than the hyaluronate in the vitreous. The proportion of high-molecular weight material in bovine aqueous humour seemed to be lower in the summer than in the winter.

Characterization of acidic and basic fibroblast growth factors in brain, retina and vitreous chick embryo

We have purified acidic and basic fibroblast growth factors (c-aFGF, c-bFGF) from 11 day-old chick embryo brain, retina and vitreous by heparin-Sepharose chromatography and reverse phase HPLC. The analysis of their biological activity as well as their molecular weight indicates that they were analogous to basic or acidic human and bovine FGF. The ratio of c-aFGF to c-bFGF activity depended of the tissue. In brain c-aFGF represented 66% of the total mitogenic activity retained on the heparin-sepharose column and c-bFGF 34% while retina contained 16% of c-aFGF and 84% of c-bFGF; vitreous 78% of c-aFGF and 22% of c-bFGF. Like human aFGF, Heparin stimulated purified c-aFGF mitogenic activity in the absence of serum but inhibited the activity of the retina acid soluble extract, in the presence of foetal calf serum (FCS). Thus, chick embryo and adult human acidic and basic FGF respectively share the same biochemical properties. Since there are no blood vessels in chick retina or vitreous, their presence in these tissues suggests that angiogenesis is not the only role of these growth factors.

Combined glucose and lactate values in vitreous humour for postmortem diagnosis of diabetes mellitus

The combined glucose and lactate values in vitreous humour were examined in 52 autopsy cases without diabetes and 10 cases with diabetes, and the significance thresholds for the distribution of the combined values were calculated. The use of these values in the diagnosis of antemortem hyperglycaemia, lactic acidosis or hypoglycaemia is discussed.

Intraocular penetration of miconazole in rabbits

Data from this in vivo albino rabbit study suggest that miconazole nitrate may penetrate the ocular compartments better than either natamycin or amphotericin B after intravenous, subconjunctival, or topical administration. The concentrations of miconazole in cornea and in aqueous humor after either topical or subconjunctival administration were very high, and a further threefold increase in the levels was seen if the corneal epithelium had been removed prior to drug therapy. Miconazole was found in the vitreous in some animals after subconjunctival injections of the drug. Intravenous administration produced high concentrations of miconazole in the aqueous humor, which rapidly fell over eight hours. No signs of toxicity or adverse reactions were found in these short-term experiments. Miconazole may be a useful addition in our methods of treating keratomycosis and oculomycosis.

Comparative study of ethanol levels in blood versus bone marrow, vitreous humor, bile and urine

Post-mortem ethanol levels in blood were compared to corresponding levels in rib bone marrow, vitreous humor, urine and bile. In forensic toxicology, a good correlation between blood and a tissue or body fluid is needed to estimate a blood alcohol concentration when blood is unavailable or contaminated. In this study, direct injection and headspace gas-chromatographic techniques were employed to quantitate the ethanol concentrations. Comparable findings by these two techniques showed a reproducibility of results. When the determined bone marrow ethanol levels were corrected for the lipid fraction, a consistent correlation could be established between ethanol levels in blood and bone marrow. The relationship (linearity and ratio range) between ethanol levels in blood and corrected levels in bone marrow was better than that between blood and vitreous humor, bile or urine. This study showed that blood ethanol levels can be predicted by extrapolating the corrected rib bone marrow ethanol level.

Magnesium, potassium, sodium and calcium in post-mortem vitreous humour from humans

Levels of magnesium, potassium, sodium and calcium in post-mortem vitreous humour from human controls, fire fatalities and drowning victims have been determined. The effects of time-related internal changes, external environmental parameters and different causes of death are evaluated. Despite the positive correlation and marked increase of potassium and, to a lesser extent, of magnesium and calcium with the length of the post-mortem interval, individual biological variability severely limits the usefulness of predictions of post-mortem interval based on electrolyte metal data. At best, there is only a 2/3 chance of a prediction being within 12 h of the true value. Vitreous humour metal concentrations are affected by external influences, such as the elevated temperatures of fires which increase the rate of release of intracellular magnesium and potassium. In cases where drowning is suspected, establishment or exclusion of this cause of death is not possible on the basis of vitreous humour electrolyte metal data because of possible post-immersion diffusion across the permeable membrane of the eyeball. It appears, however, that magnesium in salt-water cases and sodium in fresh-water cases are related, albeit erratically, to the length of the immersion period.

Intravitreal expansion of perfluorocarbon bubbles

The intraocular expansion of perfluoromethane (CF4), perfluoroethane (C2F6), and perfluoropropane (C3F8) was determined by a direct method for measuring intravitreal gas. A bubble of CF4 was found to expand 1.9 times the volume initially injected; C2F6 expanded 3.3 times; C3F8 expanded four times. The expansion characteristics of the experimental gases were compared with those of sulfur hexafluoride (SF6) and octofluorocyclobutane (C4F8), two gases already in clinical use.

Precision of estimating the time since death by vitreous potassium--comparison of two different equations

The precision of death time estimation by vitreous potassium using two different formulas [1-3] is compared on an independent random sample of 100 cases. The very flat slope in Sturner's equation is the reason for a systematic overestimation of the time since death with much wider 95%-limits of confidence compared to the results using an own equation with a steeper slope of vitreous potassium.

Substrate-bonded hyaluronic acid exhibits a size-dependent stimulation of chondrogenic differentiation of stage 24 limb mesenchymal cells in culture

Extracellular matrix molecules including glycosaminoglycans have been implicated in several differentiative and morphogenetic processes including cell aggregation and migration. Previous reports have shown that plating of stage 24 limb mesenchyme cells onto hyaluronic acid (HA) bonded to the culture substrate causes an increase in the number of cells exhibiting chondrogenesis. This increased chondrogenesis is now shown to be dependent upon the source of the HA. When limb mesenchymal cells are plated onto HA from bovine vitreous humor, human umbilical cord, or large molecular weight HA (Healon), increased chondrogenesis is observed only on the bovine vitreous humor HA. Unsulfated chondroitin, which has a structure and charge density similar to those of HA, is capable of enhancing chondrogenesis, while cells plated onto sulfated glycosaminoglycan substrates are indistinguishable from controls. The evidence in this report suggests that the differentiation response is related to the molecular size of the HA bound to the culture substrate. Healon and human umbilical cord HA are ineffective because their molecular weight is too large, while smaller HA derived from these larger molecules or normally present in bovine vitreous humor preparations stimulates the chondrogenic differentiation of stage 24 limb mesenchymal cells in culture. The most active size class of HA elutes from a Sepharose CL-2B column with a Kav between 0.6 and 0.7 and, thus, has a molecular weight of approximately 200,000-400,000. These observations reinforce the hypothesis that local cues have an informational effect on the differentiation of chick limb mesenchymal cells.

Mammalian eyes and associated tissues contain molecules that are immunologically related to cartilage proteoglycan and link protein

Monospecific antibodies to bovine nasal cartilage proteoglycan monomer and link protein were used to demonstrate that immunologically related molecules are present in the bovine eye and associated tissues. With immunofluorescence microscopy, reactions for both proteoglycan and link protein were observed in the sclera, the anterior uveal tract, and the endoneurium of the optic nerve of the central nervous system. Antibody to bovine nasal cartilage proteoglycan also reacted with some connective tissue sheaths of rectus muscle and the perineurium of the optic nerve of the central nervous system. Antibody to proteoglycan purified from rat brain cross-reacted with bovine nasal cartilage proteoglycan, indicating structural similarities between these proteoglycans. ELISA studies and crossed immunoelectrophoresis demonstrated that purified dermatan sulphate proteoglycans isolated from bovine sclera did not react with these antibodies but that the antibody to cartilage proteoglycan reacted with other molecules extracted from sclera. Two molecular species resembling bovine nasal link protein in size and reactivity with antibody were also demonstrated in scleral extracts: the larger molecule was more common. Antibody to link protein reacted with the media of arterial vessels demonstrating the localization of arterial link protein described earlier. Tissues that were unstained for either molecule included the connective tissue stroma of the iris, retina, vitreous body, cornea, and the remainder of the uveal tract. These observations clearly demonstrate that tissues other than cartilage contain molecules that are immunologically related to cartilage-derived proteoglycans and link proteins.