Alterations of Tear Mediators in Patients with Keratoconus after Corneal Crosslinking Associate with Corneal Changes

Keratoconus (KC) is the most common primary corneal ectatic disease which has considerable importance in public health. Corneal collagen crosslinking (CXL) is a procedure to mitigate progression of KC and reduce demand for corneal transplantation. Although studies have proven the efficacy of CXL regarding corneal shape, none have investigated the effects of CXL on tear biomarkers which are useful tools to understand molecular mechanisms behind CXL. Our purpose was to determine the effect of CXL on tear mediators in patients with KC and analyze associations with corneal changes. Tear samples were collected pre-CXL from 26 eyes of 23 patients and during a 12-month follow-up. The mediators’ concentration was measured by Cytometric Bead Array technology. Corneal topography parameters measured by Scheimpflug Camera included: Thinnest-corneal-thickness (ThCT), keratometry values (K1, K2), Radii-Minimum (Rmin), Keratoconus-Index (KI), Center-KI (CKI), Index-of-Height Asymmetry (IHA) and Index-of-Surface Variance (ISV). At baseline, KI was correlated negatively with chemokine (C-C motif) ligand 5 (CCL5) (p=0.015) and matrix metalloproteinase (MMP)-13 (p=0.007). At day 4, interleukin (IL)-6 and IL-8 increased, while IL-13, IL-17A, interferon (IFN)-γ, CCL5, MMP-13, epidermal growth factor (EGF), nerve growth factor (NGF) and plasminogen activator inhibitor (PAI-1) decreased significantly compared to pre-CXL concentrations (p≤0.02). At 6 months tissue plasminogen activator (t-PA) increased (p=0.02), while at 12 months Rmin increased (p≤0.004), and IL-6 and CXCL8 (p=0.005 and p=0.047) as well as K1, ISV and KI decreased. After 6 months CKI and ISV showed significant associations with IL-17A; CKI with IL-13 and ThCT with IL-13 (p≤0.02), while at 12 months there were reverse associations between ThCT and IL-6, IL-13, INFγ, CCL5 and PAI-1 (p≤0.02). Alterations of mediators in tear fluid after CXL associate with topographic changes highlight the fact that many mediators are involved in the complex mechanisms after CXL. Further studies on biomarkers to investigate the efficacy of CXL are needed.     

兔泪腺摘除后的泪液分泌及其角膜上皮的形态学改变

目的观察摘除泪腺后,兔泪液S1T值、角膜荧光素染色和虎红染色的变化及其角膜上皮超微结构的变化,评估兔干眼症模型的建立。方法摘除兔泪腺和Harder氏腺,比较泪腺摘除前后S1T、角膜荧光素染色和虎红染色分值的变化,并在透射电镜下观察角膜上皮形态学的变化。结果泪腺摘除后平均S1T值(15.88±6.29mm/5min)低于摘除前的平均S1T值(20.25±5.52mm/5min),差别有统计学意义(P=0.0062)。平均角膜荧光素染色和虎红评分(分别为8.22±1.99和7.67±0.87)明显高于摘除前(分别为0.22±0.44和0.67±0.5),差别有统计学意义(两组均P<0.0001)。以上3个检查指标的变化说明摘除泪腺后出现水液性泪液分泌缺乏,导致角膜上皮点状剥脱,干燥及坏死。在形态学上泪腺摘除前后的角膜上皮也发生了明显的改变,透射电镜检查发现液化的表层上皮细胞,表层细胞膜破裂。以上的改变均符合干眼症的特征。结论摘除兔泪腺和Harder氏腺后兔泪液分泌减少,角膜上皮坏死,能有效形成泪液缺乏型干眼模型。     

Mediators of ocular angiogenesis

Angiogenesis is the formation of new blood vessels from pre-existing vasculature. Pathologic angiogenesis in the eye can lead to severe visual impairment. In our review, we discuss the roles of both pro-angiogenic and anti-angiogenic molecular players in corneal angiogenesis, proliferative diabetic retinopathy, exudative macular degeneration and retinopathy of prematurity, highlighting novel targets that have emerged over the past decade.     

Corneal dystrophies

The term corneal dystrophy embraces a heterogenous group of bilateral genetically determined non-inflammatory corneal diseases that are restricted to the cornea. The designation is imprecise but remains in vogue because of its clinical value. Clinically, the corneal dystrophies can be divided into three groups based on the sole or predominant anatomical location of the abnormalities. Some affect primarily the corneal epithelium and its basement membrane or Bowman layer and the superficial corneal stroma (anterior corneal dystrophies), the corneal stroma (stromal corneal dystrophies), or Descemet membrane and the corneal endothelium (posterior corneal dystrophies). Most corneal dystrophies have no systemic manifestations and present with variable shaped corneal opacities in a clear or cloudy cornea and they affect visual acuity to different degrees. Corneal dystrophies may have a simple autosomal dominant, autosomal recessive or X-linked recessive Mendelian mode of inheritance. Different corneal dystrophies are caused by mutations in the CHST6, KRT3, KRT12, PIP5K3, SLC4A11, TACSTD2, TGFBI, and UBIAD1 genes. Knowledge about the responsible genetic mutations responsible for these disorders has led to a better understanding of their basic defect and to molecular tests for their precise diagnosis. Genes for other corneal dystrophies have been mapped to specific chromosomal loci, but have not yet been identified. As clinical manifestations widely vary with the different entities, corneal dystrophies should be suspected when corneal transparency is lost or corneal opacities occur spontaneously, particularly in both corneas, and especially in the presence of a positive family history or in the offspring of consanguineous parents. Main differential diagnoses include various causes of monoclonal gammopathy, lecithin-cholesterol-acyltransferase deficiency, Fabry disease, cystinosis, tyrosine transaminase deficiency, systemic lysosomal storage diseases (mucopolysaccharidoses, lipidoses, mucolipidoses), and several skin diseases (X-linked ichthyosis, keratosis follicularis spinolosa decalvans). The management of the corneal dystrophies varies with the specific disease. Some are treated medically or with methods that excise or ablate the abnormal corneal tissue, such as deep lamellar endothelial keratoplasty (DLEK) and phototherapeutic keratectomy (PTK). Other less debilitating or asymptomatic dystrophies do not warrant treatment. The prognosis varies from minimal effect on the vision to corneal blindness, with marked phenotypic variability.     

Duplex Tear Film Evaporation Analysis

Tear film thinning, hyperosmolarity, and breakup can cause irritation and damage to the human eye, and these form an area of active investigation for dry eye syndrome research. Recent research demonstrates that deficiencies in the lipid layer may cause locally increased evaporation, inducing conditions for breakup. In this paper, we explore the conditions for tear film breakup by considering a model for tear film dynamics with two mobile fluid layers, the aqueous and lipid layers. In addition, we include the effects of osmosis, evaporation as modified by the lipid, and the polar portion of the lipid layer. We solve the system numerically for reasonable parameter values and initial conditions and analyze how shifts in these cause changes to the system’s dynamics.     

Lipid Mediators in the Resolution of Inflammation

Mounting of the acute inflammatory response is crucial for host defense and pivotal to the development of chronic inflammation, fibrosis, or abscess formation versus the protective response and the need of the host tissues to return to homeostasis. Within self-limited acute inflammatory exudates, novel families of lipid mediators are identified, named resolvins (Rv), protectins, and maresins, which actively stimulate cardinal signs of resolution, namely, cessation of leukocytic infiltration, counterregulation of proinflammatory mediators, and the uptake of apoptotic neutrophils and cellular debris. The biosynthesis of these resolution-phase mediators in sensu stricto is initiated during lipid-mediator class switching, in which the classic initiators of acute inflammation, prostaglandins and leukotrienes (LTs), switch to produce specialized proresolving mediators (SPMs). In this work, we review recent evidence on the structure and functional roles of these novel lipid mediators of resolution. Together, these show that leukocyte trafficking and temporal spatial signals govern the resolution of self-limited inflammation and stimulate homeostasis.Resolution of an acute inflammatory response is the ideal outcome of this protective host response with return of the tissue to homeostasis (Majno and Joris 2004; Serhan et al. 2010). Lipid mediators are widely appreciated for their important roles in initiating the leukocyte traffic required in host defense (Cotran et al. 1999). These include the classic eicosanoids, prostaglandins (PGs) and leukotrienes (LTs) (Samuelsson et al. 1987; Samuelsson 2012), that stimulate blood flow changes, edema, and neutrophil influx to tissues (Flower 2006). Novel resolution-phase mediators that possess potent proresolving actions were identified and named resolvins, protectins, and maresins. Further studies established that these three families as well as lipoxins function together with their aspirin-triggered (AT) forms (collectively termed specialized proresolving mediators [SPMs]) and are biosynthesized during active resolution (Serhan 2004; Serhan and Chiang 2013). The complete stereochemistry of each of the main SPMs is established and their potent actions confirmed via total organic synthesis (Serhan and Petasis 2011). Given increased availability of certain SPMs, a body of literature emerged that expands their potent proresolving and anti-inflammatory actions and functions originally identified for the SPMs. In this work, we review and update the roles and actions of the SPMs, focusing on recent results with resolvins, protectins, and maresins, in active resolution mechanisms.Professor Rod Flower of the William Harvey Research Institute, University of London once recited the quotation from Juvenal, a Roman poet, to introduce these new concepts and findings: Quis custodiet ipsos custodes? Who will guard the guards themselves? Hence, this quote is apropos to begin this article focusing on novel chemical mediators of resolution. The guards, the innate immune system phagocytes, certainly require direction (Serhan 2004; Perretti and D''Acquisto 2009) in the form of chemoattractants and chemical signals to appropriately control their function(s) and permit clearance of microbes and cellular debris without tissue injury; the cardinal signs of resolution.     

Mediators of Homologous DNA Pairing

Homologous DNA pairing and strand exchange are at the core of homologous recombination. These reactions are promoted by a DNA-strand-exchange protein assembled into a nucleoprotein filament comprising the DNA-pairing protein, ATP, and single-stranded DNA. The catalytic activity of this molecular machine depends on control of its dynamic instability by accessory factors. Here we discuss proteins known as recombination mediators that facilitate formation and functional activation of the DNA-strand-exchange protein filament. Although the basics of homologous pairing and DNA-strand exchange are highly conserved in evolution, differences in mediator function are required to cope with differences in how single-stranded DNA is packaged by the single-stranded DNA-binding protein in different species, and the biochemical details of how the different DNA-strand-exchange proteins nucleate and extend into a nucleoprotein filament. The set of (potential) mediator proteins has apparently expanded greatly in evolution, raising interesting questions about the need for additional control and coordination of homologous recombination in more complex organisms.Homologous recombination, the exchange of base pairing between homologous DNA molecules, is a central process for life (Morrical 2014). Not only does it create genetic diversity that sustains a population, it is essential at the cellular level for proper replication and maintenance of genomes (Wyman and Kanaar 2006). Given this central role in DNA metabolism, it is not surprising that the core reaction of homologous recombination is highly conserved among all kingdoms of life. The fundamental unit of this reaction is a DNA-strand-exchange protein, a small ATP-binding protein of ∼40 kDa. The DNA-strand-exchange protomers assemble head-to-tail in a right-handed helical filament around single-stranded (ss) DNA. This molecular assembly, programmed by the sequence of the bases of the bound DNA strand, recognizes homology in a double-stranded (ds) partner DNA molecule. Through protein-mediated manipulation of DNA structure and disassembly of protein–protein and protein–DNA interactions, exchange of base-pairing partners is achieved (Wyman 2011; Jasin and Rothstein 2013).It is essential that the DNA-strand-exchange reaction at the core of homologous recombination is regulated such that it is actively applied in specific and changing conditions. Inappropriate DNA rearrangements also need to be avoided where they would be disastrous rather than beneficial. Thus, there need to be tipping points at which the reaction can either be driven forward or reversed, an important feature required to attain quality control (Kanaar et al. 2008). To achieve intricate levels of regulation, reaction choreographers have evolved, which are often referred to as positive or negative recombination mediators or effectors (Daley et al. 2014). Interestingly, although the fundamentals of the DNA-strand-exchange reaction are the same for bacteriophages, bacteria, archaea, and eukaryotes (Maher et al. 2011; White 2011), it appears that the set of proteins that influences homologous recombination has expanded significantly during evolution of more complex life forms (Fig. 1). In this review, we focus on positive recombination mediators of the highly conserved DNA-strand-exchange protein proteins UvsX (bacteriophages), RecA (bacteria), and RAD51 (eukaryotes).Open in a separate windowFigure 1.The figure shows the increasing evolutionary complexity within the group of homologous recombination accessory factors that contribute to the formation and stability of the DNA-strand-exchange protein nucleoprotein filament in the key model organisms. Main homologous recombination steps (resection [Symington 2014], coating with ssDNA-binding protein [S], loading of the DNA-strand-exchange protein [R], and strand invasion) are shown schematically. Phylogenetic relationships between homologous proteins are indicated with solid lines in cases of well-supported orthology or broken lines when the exact evolutionary relationship is uncertain; x indicates no close homolog in a fully sequenced genome. Because phage, bacterial, and archaeal homologous recombination accessory proteins do not show detectably sequence similarity and have likely evolved independently, they are displayed as separate domains. Proteins that most closely meet the “mediator” definition criteria are indicated in bold. ∼ indicates the ability to promote annealing of protein-coated ssDNA, shared by UvsY, RecO, and RAD52, which is a remarkable example of convergent evolution emphasizing the universal usefulness of this biochemical activity.At the core of homologous recombination is a DNA-strand-exchange protein–ATP–ssDNA nucleoprotein filament (Wyman 2011). The positive recombination mediator proteins facilitate formation and functional activation of this molecular machinery. Specifically, in the original definition, recombination mediator proteins are described to facilitate loading DNA-strand-exchange proteins onto ssDNA that is coated by ssDNA-binding proteins (Beernink and Morrical 1999). Mediators influence the competition for ssDNA binding in favor of the filament forming DNA-strand-exchange protein. Mediators also influence the preferential binding of DNA-strand-exchange proteins to ssDNA in favor of the much more abundant dsDNA in cells. Although in biochemical assays the order of addition of protein can be controlled by the experimenter, with variable results for efficiency of assay outcome, in vivo exposed ssDNA will be rapidly and effectively bound by abundant, high-affinity ssDNA-binding proteins (Dickey et al. 2013). These proteins need to be prevented from binding or replaced by the DNA-strand-exchange protein to initiate homologous recombination. However, in part because of the semantic ambiguity of the term and the large number of factors affecting homologous recombination that still lack a clearly established biochemical function, the term mediator is often applied more generally in the literature. We prefer the term “homologous recombination accessory proteins” for this broader class of proteins, and will focus our discussion here on those mediators that fit the original definition when possible. A model for mediator-assisted sequential handover of ssDNA from the ssDNA-binding protein to the DNA-strand-exchange protein gradually emerged from studies of the slimmed down recombination systems, especially phage T4. The properties attributed to mediators include: ssDNA binding, interaction with the ssDNA-binding protein, interaction with the DNA-strand-exchange protein, and “filament stabilization” by affecting ATPase activity of the nucleoprotein filament (Liu et al. 2011a). This last feature, an effect on nucleotide exchange or ATPase activity by the nucleoprotein filament, became the template used to search for candidate mediators in higher organisms. Typically, the potential mediator proteins were then tested for the specific interactions and functions needed to promote DNA-strand-exchange protein filament formation and activation.     

Tear production in three captive wild herbivores in Israel

The Schirmer tear test (STT) I was performed to evaluate tear production in 12 captive Nubian ibex (Capra ibex nubiana), 10 captive Burchell's zebras (Equus burchelli) and five Arabian oryx (Oryx leucoryx) at the Tel-Aviv Ramat-Gan Zoological Center (Israel). Mean (+/- standard deviation) STT values were 13.2 +/- 5.1 mm/min in the ibex, 23.4 +/- 3.4 mm/min in the zebra and 12.7 +/- 4.8 mm/min in the oryx. There were no significant effects of gender, age, weight, or side of the eye. There were no significant differences in STT values between ibex and oryx, but tear production in both species was significantly lower than in zebras. Knowledge of normal tear production values is important for the differential diagnosis of conjunctivitis and keratitis in these species.     

Porcine VEG Proteins and Tear Prealbumins

Small soluble proteins, belonging to the lipocalin family aresecreted in large amounts by tongue von Ebner's glands and lachrymalglands. In humans, the lingual protein, called VEG, and thelachrymal protein, called tear prealbumin, have shown identicalcDNA sequences. In the pig, we have purified homodimeric proteinswith subunits of 17 kDa, both from von Ebner's glands and fromlachrymal glands. In both cases, the proteins can be resolvedinto two isoforms on a chromatofocusing column. Partial aminoacidsequences and full cDNA sequences have been obtained for themore abundant forms purified from both tissues. The two proteinsappear to be identical, as in humans. The reason why the sameprotein is expressed in different tissues, as well as its physiologicalfunction, still remain to be clarified.     

Corneal microprojections in coleoid cephalopods

The cornea is the first optical element in the path of light entering the eye, playing a role in image formation and protection. Corneas of vertebrate simple camera-type eyes possess microprojections on the outer surface in the form of microridges, microvilli, and microplicae. Corneas of invertebrates, which have simple or compound eyes, or both, may be featureless or may possess microprojections in the form of nipples. It was previously unknown whether cephalopods (invertebrates with camera-type eyes like vertebrates) possess corneal microprojections and, if so, of what form. Using scanning electron microscopy, we examined corneas of a range of cephalopods and discovered nipple-like microprojections in all species. In some species, nipples were like those described on arthropod compound eyes, with a regular hexagonal arrangement and sizes ranging from 75 to 103?nm in diameter. In others, nipples were nodule shaped and irregularly distributed. Although terrestrial invertebrate nipples create an antireflective surface that may play a role in camouflage, no such optical function can be assigned to cephalopod nipples due to refractive index similarities of corneas and water. Their function may be to increase surface-area-to-volume ratio of corneal epithelial cells to increase nutrient, gas, and metabolite exchange, and/or stabilize the corneal mucous layer, as proposed for corneal microprojections of vertebrates.     

Corneal thickness in congenital glaucoma

Central corneal thickness is very important measurement in glaucoma treatment because it influences the eye pressure measurements. A thinner cornea gives us artifactually lower intraocular pressure and a thicker cornea gives higher intraocular pressure reading, so it has to be corrected in both cases. The aim of this study is to compare central corneal thickness between congenital glaucoma patients and normal subjects. Prospective study included 27 patients with congenital glaucoma and 35 patients in control group. First group was subdivided in two subgroups: A--8 earlier operated patients, B--19 patients treated with topic therapy. Patients had no other corneal disorders, history of trauma, corneal surgery and they were not contact lens wearers. Measurements were performed by specular microscope Tomey EM 3000 on central corneas. This study showed that patients with congenital glaucoma have lower central corneal thickness than normal subjects. Also, the study showed that antiglaucomatous operation doesn't influence central corneal thickness. Central corneal thickness need to be a routine part of examination measurements because of need to correct intraocular pressure according to it, but also the thinner corneas values can suggest congenital glaucoma diagnosis beside the other parameters.