Ratio of size of recipient and donor areas in treatment of vitiligo by autologous cultured melanocyte transplantation.

BACKGROUND: Autologous melanocytes can be expanded in vitro, allowing the treatment of large lesions of vitiligo in one session. Theoretically, this procedure could provide a higher donor/recipient size ratio (DR ratio) compared with that in noncultured cell transplantation (with a DR ratio < 1 : 10). However, the exact DR ratio obtained from this procedure has not been reported. OBJECTIVES: To study whether transplantation of cultured pure melanocytes at a high DR ratio is as efficient as that at a low DR ratio. METHODS: One hundred and two patients with vitiligo were treated by transplantation of cultured pure melanocytes and were divided into two groups: a low DR ratio group, including patients with DR ratio ≤ 1 : 10 (mean 1 : 8, 35 cases) and a high DR ratio group with DR ratio > 1 : 10 (mean 1 : 27, 67 cases). The extent of repigmentation between these two groups was compared. RESULTS: There was no significant difference in repigmentation between the low DR ratio group (mean ± SD 77·4 ± 22·5%) and the high DR ratio group (77·6 ± 24·8%). Multiple regression analysis showed that even after adjustment for age, sex, type of vitiligo and transplanted cell density, there was no significant correlation between the extent of repigmentation and the DR ratio, indicating that patients treated with high DR ratio obtained a satisfactory result and showed no difference from the low DR ratio group. CONCLUSIONS: Various surgical procedures for the treatment of vitiligo which involve melanocyte transplantation or skin grafts have different inherent DR ratios. Transplantation of cultured pure melanocytes is an expensive and complicated procedure; however, it provides the highest DR ratio (> 1 : 10 and up to 1 : 60). Surgeons can select one of these methods for the treatment of vitiligo based on their experience and skill, on the size of lesions, and the availability of laboratory support.

Treatment of vitiligo in children and adolescents by autologous cultured pure melanocytes transplantation with comparison of efficacy to results in adults.

BACKGROUND: Transplantation of autologous cultured pure melanocytes is a well-established procedure for the treatment of refractory and stabilized vitiligo. However, there was no report specifically comparing the efficacy with the regard to defined age groups (children-adolescence-adult). OBJECTIVE: We analysed the efficacy of this procedure in the treatment of vitiligo in children and adolescents and compare it with the results in adults treated during the same period and using identical procedures. METHODS: Melanocytes were isolated from the roof of suction blister, cultured and expanded with Hu16 medium in vitro, and transplanted to laser-denuded receipt area. A total of 12 children (8-12 years), 20 adolescents (13-17 years) and 70 adults with vitiligo were treated using this procedure. RESULTS: The patients obtained satisfactory results (repigmentation of 50% or more) results in children, adolescents and adults were 83.3%, 95.0% and 84.0% respectively. The mean extent of repigmentation in children, adolescents and adults was 80.7%, 78.9% and 76.6% respectively. There was no statistical difference in repigmentation among these three groups. After adjusting for all factors (gender, type of vitiligo, period of stability, location of the lesion or transplanted cell density) individually or totally using multiple regression analysis, age still did not correlate to the extent of repigmentation. CONCLUSIONS: The satisfactory results obtained in the treatment of vitiligo in children and adolescents by transplantation of cultured autologous pure melanocytes are comparable with the results in adults. Therefore, this procedure can be considered in refractory and stable vitiligo in children and adolescents, especially in patients with large vitiliginous lesions.

Upregulation of GADD45α in light-damaged retinal pigment epithelial cells.

To better understand the molecular mechanisms responsible for light-induced damage in retinal pigmented epithelial (RPE) cells, we developed an automated device to recapitulate intense light exposure. When compared with human fibroblasts, ARPE-19 cells that had been exposed to blue-rich light-emitting diode-light of 10 000 Lux at 37 °C for 9 h displayed dramatic cellular apoptosis. Collectively, gene expression profiling and qPCR demonstrated that growth arrest and DNA damage-45α (GADD45α) expression was markedly upregulated. Transient knockdown of GADD45α partially attenuated light-damage-induced apoptosis in ARPE-19 cells, whereas GADD45α overexpression dramatically increased it. These results demonstrate the critical function of GADD45α in light-induced RPE cellular apoptosis. Quantitative reverse transcription-PCR and western blotting revealed that the upregulation of GADD45α was under direct control of p53. Moreover, treatment with Ly294002, an inhibitor of AKT phosphorylation, further promoted GADD45α gene transcription in both non-light and light-damaged ARPE-19 cells. Treatment also exacerbated RPE cellular apoptosis after light exposure, confirming that inhibition of Akt phosphorylation increases GADD45α expression. Collectively, our findings reveal that light irrigation induces human RPE cellular apoptosis through upregulation of GADD45α expression mediated through both the p53 and phosphatidylinositol 3-kinase-AKT signaling pathways. These results provide new insights into human retinal diseases elicited by light damage and open a new avenue for disease prevention and treatment.

The identification and differential expression of calcium-binding proteins associated with ocular melanoma.

Calcium-binding proteins may endow tumor cells with properties related to their malignancy and metastatic phenotype. Chromatographic procedures and amino acid sequence analysis were used in this study to identify seven calcium-binding proteins, annexin VI, cap g, annexin V, calmodulin, S100A11, S100B and S100A6, associated with uveal melanoma, the primary ocular tumor of adults. This series of calcium-binding proteins was identified in both primary tumors and cell lines of uveal melanoma. Several of the proteins were shown by immunochemical methods to be differentially expressed between normal uveal melanocytes and malignant melanomas of the uvea. In addition, the expression of S100A6 may correlate with the malignant properties of the tumor.

Studies of human uveal melanocytes in vitro: growth regulation of cultured human uveal melanocytes.

PURPOSE: The authors studied the growth requirements and growth regulation of cultured human adult uveal melanocytes (UM). METHODS: The effect of various mitogens and growth factors on the growth of UM were tested separately or combined on cultured UM in multiwell plates. RESULTS: Basic fibroblast growth factor (bFGF) and 12-O-tetradecanoyl-phorbol-13-acetate (TPA) stimulate the growth of UM. Without these agents, the UM did not grow or survive. A cyclic adenosine monophosphate (cAMP) stimulator, such as isobutylmethylxanthine or cholera toxin, stimulated growth in the presence of bFGF. Fetal bovine serum (FBS) is also required for growth. In its absence, UM did not grow, even in the presence of bFGF and cAMP stimulators. Other substances, such as epidermal growth factor, acidic FGF, nerve growth factor, and platelet-derived growth factor had no stimulating effects on the growth of UM. CONCLUSIONS: Three classes of agents are required for the growth of UM in vitro: bFGF or TPA, a cAMP stimulator, and FBS. Adult human UM cultured in medium containing all these agents grew well and could be passaged for many generations.

The combined effect of brain-derived neurotrophic factor and a free radical scavenger in experimental glaucoma.

UNLABELLED: PURPOSE. Brain-derived neurotrophic factor (BDNF) had a limited effect on the survival of retinal ganglion cells (RGCs) in rats' eyes with elevated intraocular pressure (IOP). The combined treatment of BDNF and a nonspecific free radical scavenger N-tert-butyl-(2-sulfophenyal)-nitrone (S-PBN) was investigated on the RGCs in hypertensive eyes of rats. METHODS: Adult Wistar rats were separated into five groups: BDNF (0.5 microg) + S-PBN; BDNF (1. 0 microg) + S-PBN; BDNF (1.0 microg); S-PBN; and phosphate-buffered saline. Right eyes served as normal controls (n = 10). RGCs were labeled with 5% Fluoro Gold; injected into the superior colliculus. Three days after intratectal injection, the episcleral veins of the left eyes were cauterized. Intravitreal injection of BDNF was performed on days 5, 13, 21, and 29 after IOP elevation. S-PBN was injected intraperitoneally (100 mg/kg body wt) every 12 hours starting 30 minutes after cauterization. RESULTS: The survival of RGCs using BDNF treatment alone in moderately hypertensive eyes and systemic administration of S-PBN alone did not significantly rescue the RGCs. However, the combination of BDNF and S-PBN increased the survival of RGCs to 90.1%. CONCLUSIONS: Trophic factors and antioxidants have synergistic effects on rescuing RGCs from death in eyes with elevated IOP. Further studies of different combined treatment therapies may provide avenues to save RGCs from death in eyes with elevated IOP.

Studies of human uveal melanocytes in vitro: isolation, purification and cultivation of human uveal melanocytes.

PURPOSE: To develop the methods for isolation and cultivation of human uveal melanocytes (UM) from adult donor eyes. METHODS: After removal of the pigment epithelium, the uvea was pretreated in trypsin solution at 4 degrees C overnight, incubated at 37 degrees C with trypsin for 1 hr, then incubated with collagenase for 3 hr. Released cells were collected each hour during the incubation and cultured with F12 medium supplemented with fetal bovine serum, basic fibroblast growth factor, isobutylmethylxanthine and cholera toxin. Contaminant cells were eliminated by adding a selective cytotoxic agent, geneticin, when necessary. RESULTS: These methods provide pure melanocyte cultures with high cell yields, good viability, and rapid growth rates. UM isolated and maintained using these methods can be passaged 23 times for a period of 7 mo for more than 35 population doublings. This is comparable to results obtained with cultured neonatal dermal melanocytes and exceeds results obtained with adult dermal melanocytes cultured in media supplemented with phorbol ester, isobutylmethylxanthine, and cholera toxin. CONCLUSION: A method for isolation and cultivation of UM has been developed that yields satisfactory results. Cultured UM may be useful in in vitro studies of UM physiology and may allow development of in vitro models of the pathogenesis of uveal malignant melanoma.

Isolation and cultivation of human iris pigment epithelium.

There have been very few attempts to isolate and culture human iris pigment epithelium (IPE). Earlier efforts that used whole iris explant methods did not achieve pure cultures of IPE. We have developed methods for separating the IPE from the iris stroma of post-mortem eyes that avoid contamination by other cell types. Three different isolation methods were studied: direct dissection, enzyme digestion, and enzyme-assisted microdissection. The latter method yielded the best results. After treatment with enzyme solution, the IPE was easily separated from the stroma under the stereomicroscope and subsequently cultured with supplemented F12 medium. With this method, approximately 2.3 x 10(5) cells were isolated from each iris with an average viability of 90.2%. IPE cells isolated from 19 of 24 eyes grew to confluence in primary culture. The IPE could be maintained in pure culture for many generations over several months with up to 20 population doublings. Cultured IPE demonstrated cytokeratin and S-100 protein by immunocytochemistry. Some of these cells also displayed desmin, indicating origin from the anterior IPE. Cultured IPE cells retained most of the characteristics of IPE in vivo, such as apical/basal polarization, microvilli, and many cell junctions. Gradual dilution of pigment occurred in the dividing IPE cells, suggesting an inability to produce melanin in vitro. A subpopulation of the IPE cells contained myofilaments by electron microscopy, also indicating a anterior IPE origin. This method provides a source for large numbers of human IPE cells and could be useful in studies of the biology of IPE and the role of IPE in pathogenesis of several eye diseases, most notably exfoliation syndrome and its associated glaucomas.

Melanogenesis by human uveal melanocytes in vitro.

PURPOSE: To study melanogenesis by cultured human uveal melanocytes, and the relationship between melanin production by uveal melanocytes in vitro with the degree of iris pigmentation in vivo. METHODS: Melanin content, melanin production, and tyrosinase activity of cultured uveal melanocytes derived from eyes of various iris color were measured at different stages of cultivation. RESULTS: Cultured uveal melanocytes maintained a constant level of melanin content, expressed tyrosinase activity, and produced measurable amounts of melanin in vitro. Melanosomes in different stages were seen ultrastructurally. Melanin production correlated directly with the degree of iris pigmentation of the eyes from which the uveal melanocytes were isolated. Tyrosinase activity of cultured uveal melanocytes from black versus white donors was significantly different, but, among white donors, there was no correlation with iris pigmentation or with melanin production in vitro. CONCLUSION: Cultured uveal melanocytes can produce melanin in vitro. Cultured uveal melanocytes isolated from eyes of different iris color maintained their inherent capacity for melanogenesis. Therefore, cultured uveal melanocytes are an excellent model system for studying melanogenesis in uveal melanocytes in vitro.

Genetic aspects of retinitis pigmentosa in China.

We analyzed 151 pedigrees (209 cases) of retinitis pigmentosa in Shanghai, China. Of the 209 cases, the proportion of autosomal recessive (AR), autosomal dominant (AD), X-linked recessive (XR), and simplex cases is 33.1, 11, 7.7, and 48.3% respectively. The average age of onset was 24.7 years in the AD type, 22.9 years in the AR and five years in the XR type. The average refractive errors were -1.88 D in the AD type, -2.37 D in the AR type, and -5.72 D in the XR type. In addition, 24,100 persons were screened and six cases of retinitis pigmentosa were found. The gene frequencies of the AR (including simplex cases), AD, and XR types as calculated from the disease prevalence were 0.0142267, 0.0000137, and 0.0000384, respectively. The gene frequency of the AR type as calculated from the frequency of consanguinity (15.9%) was 0.00389, which is much less than that calculated from the prevalence. The probable explanation is that the AR type of retinitis pigmentosa really consists of several different disease entities, with each entity representing a separate gene mutation. The number of different mutations within the AR group is estimated to lie between 11 and 41.

Isolation and culture of iris pigment epithelium from iridectomy specimens of eyes with and without exfoliation syndrome.

OBJECTIVE: To culture iris pigment epithelium (IPE) from surgical iridectomy specimens of eyes with and without exfoliation syndrome. METHODS: The IPE was treated to obtain a single cell suspension. Cells were cultured in Ham F12 nutrient mixture, which was supplemented with 30% fetal bovine serum, 50-micrograms/mL [corrected] gentamicin, and 2-mmol/L glutamine. After confluence, the cells were detached using a 0.125% trypsin-0.01% edetic acid solution, resuspended, diluted, and subcultured. The IPE from primary cultures and subcultures was studied by transmission electron microscopy. Immunocytochemical staining was performed. RESULTS: In the primary cultures of IPE from patients with exfoliation syndrome, curved, cross-banded, fine fibrils (diameter, 10-15 nm; periodicity, 10-14 nm) were found on the cell surface. Thicker fibrils (diameter, 24-48 nm; periodicity, 24-36 nm) were found external to the fine fibrils. Subcultures contained mainly fine fibrils. The IPE cells stained positively with anticytokeratin, S100 protein, and vimentin antibodies. CONCLUSION: Iris pigment epithelium can be successfully cultured from eyes with exfoliation syndrome. Studying the production of exfoliation material in vitro should provide information about the pathogenesis of exfoliation syndrome and about the nature of the exfoliation material. The cultivation of normal IPE from surgical specimens provides a source for the study of the growth regulation and pharmacophysiology of IPE in vitro.

Patterns of retinal ganglion cell survival after brain-derived neurotrophic factor administration in hypertensive eyes of rats.

We investigated the effect of brain-derived neurotrophic factor (BDNF) on retinal ganglion cell (RGC) survival after intraocular pressure (IOP) elevation at various time intervals. In adult Wistar rats, RGCs were labeled with 5% Fluorogold. Animals with 1.8-2.5-fold increase in IOP after cauterization of three episcleral vessels, were divided into three BDNF groups and three vehicle control groups, each receiving one, two or three injections. The RGC survival percentage on RGCs of the first, second and third injections were 93.9% (n = 7), 91.3% (n = 7), 82.7% (n = 5), respectively in BDNF groups; 91.6% (n = 6), 84.1% (n = 6) and 73.5% (n = 5), respectively in vehicle controls. The second and third injections of BDNF showed statistically significant survival effects. These findings demonstrated that BDNF has partial neuroprotection on RGCs in whole retina and enhances RGC survival in moderately chronic hypertensive eyes.

Photophysical studies of A2-E, putative precursor of lipofuscin, in human retinal pigment epithelial cells.

With age, human retinal pigment epithelial cells accumulate lipofuscin that can absorb photons in the visible range leading to light-induced damage and impaired vision. A putative precursor of lipofuscin, 2-[2,6-dimethyl-8-(2,6,6-trimethyl-1-cyclohexen-1-yl)-1E,3E, 5E,7E- octatetraenyl]-1-(2-hydroxyethyl)-4-[4-methyl-6-(2,6,6-trimethyl-1 - cyclohexen-1-yl)-1E,3E,5E-hexatrienyl]-pyridinium (A2-E), has recently been isolated and characterized from aged human retinal pigment epithelial cells. We have found that A2-E inhibits the growth of human retinal pigment epithelial cells at concentrations greater than 1 microM. Time-resolved fluorescence measurements of 1 microM A2-E in solution, performed under 413 nm excitation, showed that fluorescence wave forms integrated across the spectrum (450-600 nm) were best-fitted with three decay times in the nanosecond and subnanosecond time scale: 6.6, 1.9 and 0.33 ns. Untreated retinal pigment epithelial cells were characterized by three fluorescence lifetimes: 6.3, 1.7 and 0.35 ns. In retinal pigment epithelial cells treated with 1 microM A2-E, the fluorescence decay was significantly faster, with the marked presence (approximately equal to 30%) of a fourth short lifetime (0.12 ns). These fluorescence decay times for A2-E bound to human retinal pigment epithelial cells are similar to those of lipofuscin granules isolated from aged human retinal pigment epithelial cells. This similarity supports the hypothesis that A2-E is a precursor of lipofuscin and suggests that A2-E may play a role in the overall light damage associated with age-related retinal diseases.

Melatonin inhibits growth of cultured human uveal melanoma cells.

The effects of melatonin on the growth of human uveal melanoma cells were studied in vitro. Three continuous uveal melanoma cell lines were tested. Cells were plated into multi-well plates. After 24 h, melatonin was added to the medium at concentrations from 0.001 to 1000 nM. Cells were collected and counted after 5 days and compared with the controls. Melatonin inhibited the growth of melanoma cells in a dose-dependent manner (0.1-10 nM) with a mean inhibition rate of 50%. The uptake of bromodeoxyuridine (BrdU) by the melanoma cells was also measured. Melatonin inhibited the uptake of BrdU of melanoma cells at concentrations of 0.1-10 nM with a mean inhibition rate of 40%. These results indicate that melatonin may offer a new treatment for metastatic uveal melanoma.

Effects of melatonin, its precursors and derivatives on the growth of cultured human uveal melanoma cells.

The effects of melatonin, its precursors and derivatives on the growth of cultured human uveal melanoma cells were studied. The melanoma cells were plated into 24-well plates. Melatonin, its 6-hydroxy or 6-chloro derivative, serotonin, tryptophan or kynurenine was added to the medium in concentrations of 0.001 to 1000 nM. After 5 days the cells were detached, counted, and compared with the controls. Melatonin inhibited the growth of uveal melanoma cell lines in a dose-dependent manner (0.1-10 nM). This growth inhibition occurred at concentrations of melatonin (2 nM) found in human aqueous humour. The melatonin derivatives also inhibited the growth of uveal melanoma cells; 6-chloromelatonin was more potent than melatonin and 6-hydroxymelatonin was the least active (6-chloromelatonin > melatonin > 6-hydroxymelatonin). The precursors of melatonin (tryptophan and serotonin) and the abnormal metabolite of tryptophan (kynurenine) did not inhibit the growth of the melanoma cells, indicating that changes to the metabolic processes of melatonin may play a role in the pathogenesis of uveal melanoma.

Hepatocyte growth factor is increased in the aqueous humor of glaucomatous eyes.

PURPOSE: To assess the concentrations of hepatocyte growth factor (HGF) in the aqueous humor of eyes with glaucoma compared with control eyes with cataract only. METHODS: Concentrations of HGF were measured in aqueous humor aspirates taken during anterior segment surgery from 84 patients, of whom 72 had glaucoma (38 cases of primary open-angle glaucoma, 17 angle-closure glaucoma, and 17 exfoliative glaucoma) and 12 had cataract only, using a sandwich enzyme-linked immunosorbent assay kit. RESULTS: Hepatocyte growth factor was detected in all samples. The concentration in eyes with cataract only was 563.3 +/- 178.8 pg/mL (mean +/- standard deviation), which was significantly lower than that in eyes with glaucoma (967.1 +/- 514.7 pg/mL, P < 0.01). Eyes with exfoliative glaucoma had significantly higher HGF concentrations (1,425.5 +/- 586.7 pg/mL) than did eyes with primary open-angle glaucoma (855.0 +/- 341.5 pg/mL) and angle-closure glaucoma (759.4 +/- 511.4 pg/mL) (P < 0.01). There was no effect of age, sex, or history of medical, laser, or surgical treatment on the aqueous humor HGF concentration (P > 0.05). Aqueous humor and plasma HGF concentrations were measured and compared in 28 patients. The aqueous humor HGF concentration (908 +/- 586.2 pg/mL) was significantly higher (P < 0.01) than the plasma concentration (521.3 +/- 183.1 pg/mL). No significant correlation could be found between aqueous humor and plasma HGF concentrations. CONCLUSIONS: The relatively high concentration of HGF in human aqueous humor suggests that HGF may play an important role in ocular physiology and disease. The higher concentration in patients with glaucoma may indicate a response to injury.

Tissue culture of adult human retinal ganglion cells.

PURPOSE: We wished to isolate and cultivate adult human retinal ganglion cells (RGC) from donor eyes. METHODS: Small pieces of retina from donor eyes were plated in dishes and cultured with Ham's F12 medium with 10% serum for organ culture. For cell culture, cells were isolated by mechanical or enzymatic dissociation methods and cultured with F12 medium with 10% serum, with or without nerve growth factor (NGF) and/or basic fibroblast growth factor (bFGF). RESULTS: In organ cultures, no neurite outgrowth from the retinal explants was observed. In cell cultures for which mechanical dissociation methods were used, the few cells that could be isolated showed poor viability. Better results were obtained with enzymatic dissociation methods. When cultured with medium supplemented with bFGF, some cells attached, spread, and sent out numerous dendrites, morphologically similar to RGC. These cells stained positively for neurofilaments and Thy-1 and negatively for glial fibrillary acidic protein (GFAP), indicating they were RGC. CONCLUSIONS: Cell cultures of human RGC can be established. This is a potential model system for studying effects of damaging and protective factors on RGC in vitro.

Pulse radiolysis studies of melatonin and chloromelatonin.

The endogenous indole melatonin and the melatonin receptor agonist 6-chloromelatonin block the proliferation of both dermal and uveal melanoma cells by mechanisms that may involve redox reactions. The interactions of hydrated electrons, the azide radical, hydroxyl radicals and superoxide with melatonin and its 6-chloro analogue have been studied using the technique of pulse radiolysis. The reaction rate constants of eaq- and N3 x with these compounds were found to be dependent on substitution at the sixth position. The rate constants for reaction of 6-chloromelatonin and melatonin with solvated electrons are 4.5 x 10(9) M-1 s-1 and 4.2 x 10(8) M-1 s-1, respectively. The reaction rate constants of N3 x with malatonin and chloromelatonin are 9.8 x 10(9) M-1 s-1 and 3.5 x 10(9) M-1 s-1 and 3.5 x 10(9) M-1 s-1, respectively. Melatonin and 6-chloromelatonin react with hydroxyl radicals at near diffusion controlled rates (1.3 x 10(10) M-1 s-1, 8.2 x 10(9) M-1 s-1). Melatonin and 6-chloromelatonin did not react with superoxide radicals and we calculate an upper limit of 1.0 x 10(4) M-1 s-1 for the rate constant for reaction of melatonin and 6-chloromelatonin with superoxide ion.

Transplant of cultured autologous pure melanocytes after laser-abrasion for the treatment of segmental vitiligo.

Segmental vitiligo is a special type of vitiligo with unilateral distribution of lesions and has a stable course. Clinically, many patients with segmental vitiligo have unsatisfactory responses to topical corticosteroid or UV phototherapy. We have developed a technique for the isolation of melanocytes from a small specimen of normally pigmented skin obtained via a suction blister. The melanocytes can be proliferated in culture and then replanted onto laser-abrased vitiliginous areas. We used this procedure to treat 25 patients with segmental vitiligo that were refractory to medical therapy. The repigmented portion of the total treated area amounted to 95-100% in 21 patients and 65 to 94% in 4 patients. The response rate to treatment was 100% in this study. No scarring or other side-effects developed. The results of this study demonstrate that this method is a valuable tool for the treatment of patients with segmental vitiligo.