CXCL16 exacerbates Pseudomonas aeruginosa keratitis by promoting neutrophil activation.

Pseudomonas aeruginosa (PA) keratitis is a major cause of blindness characterized by corneal inflammation. In a murine model of PA keratitis, we assessed the detrimental effects of CXC chemokine ligand 16 (CXCL16). Quantitative PCR (qPCR), western blotting (WB) and immunofluorescence were used to measure the expression and localization of CXCL16 and its receptor, CXC chemokine receptor 6 (CXCR6). Clinical scores, plate counting, and hematoxylin-eosin staining were used to assess infection severity and its exacerbation by CXCL16. Immunofluorescence, myeloperoxidase assays, and flow cytometry were used to detect neutrophil activity and colocalization with CXCR6. WB and immunofluorescence were used to measure levels of reactive oxygen species (ROS) and matrix metalloproteinases (MMPs). These methods also were used to measure the activation of downstream NF-κB signaling and its positive feedback on CXCL16 expression. ELISA, flow cytometry, and qPCR were used to measure the expression of CXCL2 and T helper 17 (Th17) cell-related genes. CXCL16 and CXCR6 expression was increased in infected corneas. Topical application of CXCL16 exacerbated keratitis by increasing corneal bacterial load and promoting neutrophil infiltration, whereas neutralizing antibody against CXCL16 had the opposite effect. CXCL16 also increased ROS and MMP levels. This neutrophil activation may be caused by its positive feedback with the NF-κB pathway and the upregulation of CXCL2 and Th17 cell related-genes. These data suggest that CXCL16 is an attractive therapeutic target for PA keratitis.

Protective effects of resolvin D1 in Pseudomonas aeruginosa keratitis.

PURPOSE: Here, we explored the protective effects of resolvin D1 (RvD1) in Pseudomonas aeruginosa (PA) keratitis. METHODS: C57BL/6 (B6) mice were used as an animal model of PA keratitis. Plate counting and clinical scores were used to assess the severity of the infection and the therapeutic effects of RvD1 in the model. Myeloperoxidase assay was used to detect neutrophil infiltration and activity. Quantitative PCR (qPCR) was used to examine the expression of proflammatory and anti-inflammatory mediators. Immunofluorescence staining and qPCR were performed to identify macrophage polarization. RESULTS: RvD1 treatment alleviated PA keratitis severity by decreasing corneal bacterial load and inhibiting neutrophil infiltration in the mouse model. Furthermore, RvD1 treatment decreased mRNA levels of TNF-α, IFN-γ, IL-1ß, CXCL1, and S100A8/9 while increasing those of IL-1RA, IL-10, and TGF-ß1. RvD1 treatment also reduced the aggregation of M1 macrophages and increased that of M2 macrophages. RvD1 provided an auxiliary effect in gatifloxacin-treated mice with PA keratitis. CONCLUSION: Based on these findings, RvD1 may improve the prognosis of PA keratitis by inhibiting neutrophil recruitment and activity, dampening the inflammatory response, and promoting M2 macrophage polarization. Thus, RvD1 may be a potential complementary therapy for PA keratitis.

Abnormal Functional Connectivity Density in Patients with Dysthyroid Optic Neuropathy.

OBJECTIVE: Functional connectivity density (FCD) mapping was used to investigate abnormalities and factors related to brain functional connectivity in cortical regions of patients with dysthyroid optic neuropathy (DON) and to analyze the pathogenesis of DON further. METHODS: Patients diagnosed with thyroid-associated opthalmology (TAO) in the Eye Hospital were enrolled. All patients underwent comprehensive eye examinations and best-corrected visual acuity, visual field (VF) test. MRI data collection and analysis were completed in the 2nd Affiliated Hospital of Wenzhou Medical University. The patients were divided into 2 groups: the DON group, with an average VF, mean deviation (MD) of both eyes < -5 dB, and the non-DON group (nDON group), with an average VF MD of both eyes ≥ -2 dB. RESULTS: A total of 30 TAO patients (14 men, 16 women) with complete data who met the experimental requirements were enrolled. The average age was 48.79 (40-57) years. There were 16 patients in the DON group and 14 patients in the nDON group. No significant differences in age, gender, education level, and the maximum horizontal diameter of either medial rectus muscle were found between the 2 groups. The difference of brain FCD between the 2 groups showed significant abnormal connectivity in the right orbital gyri of the frontal lobe (Frontal_Inf_Orb_R) and the left precuneus in the DON group compared with the nDON group. As demonstrated by decreased FCD values in the right inferior frontal gyrus/orbital part, the relevant brain regions were the left middle temporal gyrus, left precuneus, left middle frontal gyrus, right postcentral gyrus, and brain gyri (excluding the supramarginal gyrus and angular gyrus) below the left parietal bone. The FCD associated with the left precuneus was increased, and the relevant brain areas were the left middle temporal gyrus, right cuneus, superior occipital gyrus, and right fusiform gyrus. A significant correlation was identified between the MD of the binocular VF and brain FCD. CONCLUSION: The abnormal FCD in the cortex of DON patients suggests that a central nervous system mechanism may be related to the pathogenesis of the DON.

Mesenchymal stem cell-derived exosomes protect trabecular meshwork from oxidative stress.

This study aims to investigate the beneficial effects of exosomes derived from bone marrow mesenchymal stem cells (BMSCs) on trabecular meshwork cells under oxidative stress and predict candidate genes associated with this process. Trabecular meshwork cells were pretreated with BMSC-derived exosomes for 24 h, and exposed to 0.1 mM H2O2 for 6 h. Survival rate of trabecular meshwork cells was measured with CCK-8 assay. Production of intracellular reactive oxygen species (iROS) was measured using a flow cytometer. RT-PCR and ELISA were used to detect mRNA and protein levels of inflammatory cytokines and matrix metalloproteinases (MMPs). Sequencing of RNA and miRNA for trabecular meshwork cells from Exo and control groups was performed on BGISEQ500 platform. Phenotypically, pretreatment of BMSC-derived exosomes improves survival rate of trabecular meshwork cells exposed to H2O2, reduces production of iROS, and inhibits expression of inflammatory cytokines, whereas increases expression of MMPs. There were 23 miRNAs, 307 lncRNAs, and 367 mRNAs differentially expressed between Exo and control groups. Exosomes derived from BMSCs may protect trabecular meshwork cells from oxidative stress. Candidate genes responsible for beneficial effects, such as DIO2 and HMOX1, were predicted.

Clinical characteristics, rates of blindness, and geographic features of PACD in China.

OBJECTIVE: To analyze the rates of blindness with the demographics and clinical characteristics of patients with primary angle-closure disease (PACD) to provide a comprehensive epidemiologic reference in China. METHODS: A retrospective analysis was conducted in the Chinese Glaucoma Study Consortium database, which is a national multicenter glaucoma research alliance of 111 hospitals participating between December 21, 2015 and September 9, 2018. The diagnosis of PACD was made by qualified physicians through examination. Comparison of sex, age, family history, subtypes of PACD, and blindness were analyzed. RESULTS: A total of 5762 glaucoma patients were included, of which 4588 (79.6%) had PACD. Of PACD patients, 72.1% were female with the sex ratio (F/M) of 2.6, and the average age of patients was 63.8±9.3 years with the majority between 60 and 70 years. Additionally, 30% of these patients had low vision in one eye, 8.8% had low vision in both eyes, 1.7% had blindness in one eye, and 0.3% had blindness in both eyes. There were statistical differences with regards to age between male and female patients with PACD, with male patients being older on average. Primary angle-closure glaucoma was more commonly diagnosed in males (60%) compared to females (35.9%), whereas acute primary angle closure (APAC) was more commonly diagnosed in females (54.3%) compared to males (37.7%). The visual acuity in APAC patients was lower and the rate of low vision and blindness was higher than other subtypes. CONCLUSION: PACD was the major type of glaucoma in Chinese hospitals. There were more female patients with PACD, mostly between 60 and 70 years old, with higher rates of APAC in women. APAC resulted in the worst visual outcomes of all PACD subtypes.

Level-Set Method for Image Analysis of Schlemm's Canal and Trabecular Meshwork.

Purpose: To evaluate different segmentation methods in analyzing Schlemm's canal (SC) and the trabecular meshwork (TM) in ultrasound biomicroscopy (UBM) images. Methods: Twenty-six healthy volunteers were recruited. The intraocular pressure (IOP) was measured while study subjects blew a trumpet. Images were obtained at different IOPs by 50-MHz UBM. ImageJ software and three segmentation methods-K-means, fuzzy C-means, and level set-were applied to segment the UBM images. The quantitative analysis of the TM-SC region was based on the segmentation results. The relative error and the interclass correlation coefficient (ICC) were used to quantify the accuracy and the repeatability of measurements. Pearson correlation analysis was conducted to evaluate the associations between the IOP and the TM and SC geometric measurements. Results: A total of 104 UBM images were obtained. Among them, 84 were adequately clear to be segmented. The level-set method results had a higher similarity to ImageJ results than the other two methods. The ICC values of the level-set method were 0.97, 0.95, 0.9, and 0.57, respectively. Pearson correlation coefficients for the IOP to the SC area, SC perimeter, SC length, and TM width were -0.91, -0.72, -0.66, and -0.61 (P < 0.0001), respectively. Conclusions: The level-set method showed better accuracy than the other two methods. Compared with manual methods, it can achieve similar precision, better repeatability, and greater efficiency. Therefore, the level-set method can be used for reliable UBM image segmentation. Translational Relevance: The level-set method can be used to analyze TM and SC region in UBM images semiautomatically.

GAA compound heterozygous mutations associated with autophagic impairment cause cerebral infarction in Pompe disease.

Clinical manifestations of the late-onset adult Pompe disease (glycogen storage disease type II) are heterogeneous. To identify genetic defects of a special patient population with cerebrovascular involvement as the main symptom, we performed whole-genome sequencing (WGS) analysis on a consanguineous Chinese family of total eight members including two Pompe siblings both had cerebral infarction. Two novel compound heterozygous variants were found in GAA gene: c.2238G>C in exon 16 and c.1388_1406del19 in exon 9 in the two patients. We verified the function of the two mutations in leading to defects in GAA protein expression and enzyme activity that are associated with autophagic impairment. We further performed a gut microbiome metagenomics analysis, found that the child's gut microbiome metagenome is very similar to his mother. Our finding enriches the gene mutation spectrum of Pompe disease, and identified the association of the two new mutations with autophagy impairment. Our data also indicates that gut microbiome could be shared within Pompe patient and cohabiting family members, and the abnormal microbiome may affect the blood biochemical index. Our study also highlights the importance of deep DNA sequencing in potential clinical applications.

An Experimental Study of Femto-Laser in Assisting Xenograft Acellular Cornea Matrix Lens Transplantation.

BACKGROUND The aim of this study was to evaluate the feasibility of using a femto-laser in assisting xenograft cornea matrix lens transplantation in correcting ametropia, along with evaluating the effectiveness and predictability of this procedure. MATERIAL AND METHODS A corneal matrix pouch was prepared on the right eyes on 8 healthy New Zealand rabbits by a femto-laser that was also employed to perform small incision lenticule extraction (SMILE) on 8 bovine cornea matrix lenses (+6D). A lens was treated acellular and implanted into a right rabbit cornea matrix pouch. Surface inflammation was observed at 1, 2, 4, 8, 12, and 24 weeks after surgery. Anterior ocular segment optical coherence tomography (OCT), corneal topography, retinoscopy, and cornea endothelial cell enumeration were performed. RESULTS All the surgeries were successfully performed without any complications. The hyperopia condition of the rabbit eyes transformed into myopia status at an early stage and gradually developed hyperopia. Diopter at 24 weeks after surgery was 1/3 of that before surgery. Central corneal thickness stabilized at 4 weeks after surgery. Anterior segment OCT showed a clear lens edge at early post-operative stage, and blurred edge at 24 weeks later, indicating gradual fusion with the rabbit corneal matrix. CONCLUSIONS Femto-laser assisted xenograft corneal matrix lens transplantation is safe and effective in correcting ametropia, with satisfactory predictability, thus providing novel choice for correcting ametropia.

Retinal vessels change in primary angle-closure glaucoma: the Handan Eye Study.

Glaucoma is the second leading cause of blindness worldwide. To examine the relationship between angle closure and the retinal vessel diameter in Chinese adults, we conducted Handan Eye Study (HES), a large population-based cross-sectional study, which enrolled 6830 participants >30 year-old living in 13 randomly selected villages of Yongnian County. After adjusting for age, gender, spherical equivalent (SE), diabetes, and hypertension, the mean central retinal artery equivalent (CRAE, µm) was 127.1 ± 7.0 and 145.6 ± 4.4 in primary open-angle glaucoma (POAG) and primary angle closure glaucoma (PACG), respectively; narrower than that in normal control (156.1 ± 0.4), primary angle-closure suspect (PACS) (156.3 ± 1.1) or primary angle closure (PAC) (156.0 ± 3.4) (P = 0.001). The mean central retinal vein equivalent (CRVE, µm) was 229.0 ± 5.9 and 215.8 ± 9.5 in POAG and PACG, respectively; narrower than that in normal control (238.3 ± 0.5), PACS (241.2 ± 1.4) or PAC (242.2 ± 4.6) (P = 0.001). There was no significant difference in the mean CRAE or CRVE between PACG and POAG. Compared to the normal control (0.66), the mean arterio-venous ratio (AVR) was smaller in POAG (0.64) and PACG (0.59), whereas larger in PACS (0.65) and PAC (0.67) (P = 0.003). To conclude, PACG and POAG individuals have narrower retinal arteries and veins.

Toll-like receptor 2 siRNA suppresses corneal inflammation and attenuates Aspergillus fumigatus keratitis in rats.

Toll-like receptors (TLRs) are key components of innate immunity that detect microbial infection and trigger host defense responses. However, they are capable of initiating both protective and damaging immune responses, as exaggerated expression of inflammatory components can have devastating effects on the host. We previously reported that TLR2 in corneal epithelium has an important role in the pathogenesis of fungal keratitis, however, how the corneal inflammation is modulated remains to be elucidated. This study aims to investigate the effect of targeting TLR2 on Aspergillus fumigatus keratitis in rats. The control or TLR2 small interfering RNA (siRNA) was applied sub-conjunctively and topically to the cornea. TLR2 immunostaining was performed to determine the feasibility of TLR2 siRNA delivery. Production of inflammatory cytokines and chemokines were determined by real-time quantitative PCR. Polymorphonuclear leukocyte (PMN) infiltration was assessed by myeloperoxidase activity. It was found that rat corneas treated with TLR2 siRNA showed a significant reduction of TLR2 expression in corneal epithelium. TLR2 siRNA treatment improved the outcome of keratitis, which was characterized by decreased corneal opacity, less corneal perforation, suppressed PMN infiltration, reduced production of inflammatory cytokines and chemokines, and less fungal burden. In conclusion, TLR2 siRNA treatment attenuated A. fumigatus keratitis by suppressing corneal inflammation and preventing fungal invasion, suggesting a novel avenue to control fungal infection and avert damage caused by excessive inflammation.

Expression profiles and function of Toll-like receptors in human corneal epithelia.

BACKGROUND: Toll-like receptors play an important role in the human immune system. This study was conducted to investigate the expression profiles and function of Toll-like receptor (TLR) 1 - 9 in human corneal epithelium. METHODS: The expression of TLR1 - 9 mRNA in 20 human donor corneal epithelia samples abraded during photorefractive keratotomy (PRK) and cultivated telomerase-immortalized human corneal epithelial cells (THCEs) was examined by semi-quantitative reverse-transcriptase polymerase chain reaction (RT-PCR) analysis. Human peripheral blood mononuclear cells (PBMCs) were used as positive controls. The expression of the TLR2 and TLR4 proteins was detected by Western analysis. ELISA was used to detect IL-8 secretion from THCEs challenged with ligands for TLR3 and TLR4 with and without antibody blockade. RESULTS: The expression of TLR1 - 9 at the mRNA level was detected in the epithelia of 20 patients and in THCE. Significant differences among individuals were observed. One patient was found to lack of the expression of TLR3, 4, 6 and 8, whereas another did not express TLR5. The expression of TLR2 and TLR4 protein was detected in human corneal epithelial cells. As THCE cells express TLR1 - 9, cells were challenged with lipopolysaccharides (LPS) and poly I:C to determine whether TLR4 and TLR3 were functional. The results showed that secretion of IL-8 by cells stimulated with LPS and Poly I:C was 7 to 10 fold greater than secretion by unchallenged cells. Blocking TLR4 with an anti-TLR4 antibody significantly inhibited the LPS-induced IL-8 production by THCE (P < 0.05). CONCLUSION: Human corneal epithelial cells express multiple TLRs and are able to recognize LPS and poly I:C. Different expression profiles among individuals suggest that differences in the susceptibilities and sensitivities to bacterial and viral infection in human populations relate to different patterns of TLR expression.

[Aspergillus fumigatus activate human corneal epithelial cells via Toll-like receptor 2 and 4].

OBJECTIVE: To determine Toll-like receptors (TLR) 2 and TLR4 expression in human corneal epithelial tissue and cell line (THCE), and its activation by aspergillus fumigatus (AF) in inflammatory response. METHODS: The expression of TLR2 and TLR4 protein in human corneal epithelial tissue and THCE was detected by Western blot and immunocytochemistry. THCE was challenged with AF mycelium fragment (5 x 10(6)/ml) and supernatant extract agent (equivalent to bovine serum albumin 10 microg/ml). IL-8 and TNF-alpha in THCE supernatant were detected by ELISA at 1, 2, 4 and 8 h post stimulation. The protein of IkappaBalpha in THCE cells was assayed by Western blot at 30 min, 1 h and 2 h after treatment. Antibody blocking test was utilized to evaluate the effect on IL-8 and TNF-alpha expression of THCE by blocking TLR2 and (or) TLR4 before challenge with AF agent. RESULTS: TLR2 and TLR4 protein were expressed in human corneal epithelial tissue and THCE. The IL-8 and TNF-alpha level in THCE supernatant was elevated at 1 h, increased to (64.71 +/- 5.15) pg/ml and (32.46 +/- 3.28) pg/ml (AF mycelium challenge group), (94.94 +/- 11.92) pg/ml and (48.70 +/- 3.32) pg/ml (AF supernatant challenge group) 8 h post-challenged, which was 3.0 times and 2.5 times, 4.5 times and 3.5 times to that of control group respectively (P < 0.01). The activity of IkappaBalpha in THCE cells was decreased to 10.31 +/- 1.30 (gray scale value) and 8.15 +/- 2.37 at 30 min after challenged with AF mycelium or supernatant extract agent compared to 51.57 +/- 5.58 and 49.23 +/- 3.49 of control group (P < 0.01), and was reverted at 2 h. The secretion of IL-8 and TNF-alpha was partly inhibited by blocking TLR2 or TLR4 (P < 0.05), obviously inhibited by blocking TLR2 and TLR4 (50% and 40% compared to that of control group) (P < 0.01) when challenged with AF mycelium. And that was markedly inhibited by blocking TLR4 or blocking TLR2 and TLR4 when challenged with AF supernatant (P < 0.01). The secretion of IL-8 and TNF-alpha was not inhibited by blocking TLR2 when challenged with AF supernatant (P > 0.05). CONCLUSIONS: AF agent may induce human corneal epithelial cells express inflammatory cytokines via TLR-NF-kappaB pathway. TLR2 and TLR4 possibly mediate the recognition to AF mycelium, and TLR4 may dominate the recognition to AF supernatant agent.

[The expression and functionality of Toll-like receptors in human corneal epithelium and tolerated human corneal epithelial cell line].

OBJECTIVE: To investigate the expression and functionality of Toll-like receptors (TLRs) 1 - 9 in human corneal epithelium and cell line THCE (tolerated human corneal epithelial). METHODS: Reverse-transcriptase polymerase chain reaction (RT-PCR) analysis was used to determine the expression of TLR1 - 9 mRNA in the specimens of human corneal epithelial cells from 20 persons, 5 males and 10 females, aged 18 - 25, undergoing photorefractive keratectomy (PRK), and in cultured THCE cells. Human peripheral blood mononuclear cells (PBMCs) were used as positive control. The expression of TLR2 protein and TLR4 protein were detected with Western blotting. KEM-2 fluid containing anti-TLR4 antibody was used to block the THEC cells for 30 minutes, then KEM-2 fluid containing PolyI: C or LPS, ligands for TLR 3 and 4, was used to stimulate the THEC cells, 1, 4, and 8 hours after the concentrations of IL-8 in the supernatant were determined by ELISA. RESULTS: The human corneal epithelial cells strongly expressed TLR1, 2, 3, 5, 6, and 9 mRNA, weakly expressed TLR7 and 8 mRNA, and very weakly expressed TLR4 mRNA. Negative expression of TLR3, 4, 6, and 8 mRNA was seen in 1 case, a female aged 22. Weak expression of TLR5 mRNA was seen in 1 case, a female aged 20. The THCE cells showed the same expression pattern as the healthy human corneal epithelial cells, except for the strong expression of TLR9. The human PBMCs, as positive controls, strongly expressed TLR1 approximately 4 and 8 mRNA, weakly expressed TLR5, 6, and 9 mRNA, and very weakly expressed TLR7 mRNA. The human corneal epithelial cells, cultured THEC cells, and PBMCs all expressed TLR2 and 4 proteins. The concentrations of IL-8 in the supernatant of the culture fluid of THEC cells increased along with the time of stimulation of LPS and Poly: C, ligands for TLR3 and 4, and reached to 297.33 pg/ml and 229.67 pg/ml respectively 8 hours after, 10 times and 7 times those of the control group (both P < 0.05). 30 minutes after the blocking of TLR4 with anti-TLR4 antibody LPS was used to stimulate the THEC, the concentration of IL-8 was 88.54 pg/ml, being 30% that of the un-blocked group (P < 0.05). CONCLUSION: Human corneal epithelium expresses TLR1 approximately 9 at different levels. THCE cell line is an excellent line to study TLRs function.