Friday, December 31, 2021

Year in Review: 2021


What an eye-opening year 2021 has been for eye care! Despite the ongoing COVID-19 pandemic, research advanced in every area of ocular health and vision care, from basic science to clinical practice. Notable firsts in 2021 included the discovery of a new type of cell in the retina in more than 100 years, the discovery for the first time of DNA in the cytoplasm of cells (and its detrimental interactions with the inflammasome), the preliminary success of CRISPR gene editing for Leber congenital amaurosis in human subjects, the success of using optogenetics to restore partial vision to the blind, implanting a visual prothesis directly onto the human brain, several smart cane prototypes, a plethora of in vitro disease models and therapeutic candidates for the treatment of a variety of eye diseases, advances in various imaging technologies, and much progress in our understanding of the complexity of the visual system. This year also gave us a large gene atlas of eye disorders, an in-depth genetic study of iris cell types, a more nuanced classification system of 25 uveitis subtypes, the identification of 50 new genes contributing to eye color, the identification of 127 genes contributing to glaucoma, a better understanding of the interplay between the eye and the immune system, association studies both linking eye diseases to diverse mental health risks as well as firm evidence of surgical interventions making a positive and significant impact. In the optometric space, this year saw advancements in contact lenses as theranostics, new treatment options for presbyopia, and continued efforts in the delivery of vision care to underserved communities.

C heers to 2022 continuing to shed light on the importance of cutting-edge research to the advancement of knowledge, the improvement of patient care, and the creation of a brighter world.

Thursday, December 30, 2021

Week in Review: Number 47

Vuity: First FDA-Approved Eye Drops for Presbyopia
The U.S. Food and Drug Administration (FDA) recently approved Vuity, a daily eye drop indicated for treatment of presbyopia, or age-related decline in near focus due to decreased ability of the eye's crystalline lens to accommodate. Presbyopia onset usually begins in the mid-40s. Available with a prescription, Vuity is a formulation of 1.25% pilocarpine. A direct-acting cholinergic agonist, pilocarpine acts on the smooth muscle muscarinic receptors of the iris sphincter to constrict the pupils in miosis. Its additional mechanism of action to directly stimulate the longitudinal muscles of the ciliary body is thought to affect the mechanics of the scleral spur to widen the spaces in the trabecular meshwork, thereby increasing aqueous outflow; in this capacity, pilocarpine is sometimes used as a treatment for glaucoma. In the context of pupillary constriction in itself, which decreases the "aperture" of the eye's optical system, the effect is an increase in depth of field and depth of focus, respectively, the range of clear vision in object space in front of the eye and in image space on the "screen" of the retina. (Often mentioned together, these two ranges are dioptrically equivalent.)

The increase in range of clear vision means an increase in near vision without sacrificing distance vision, in emmetropic or corrected-to-emmetropic eyes. In a press release, Allergan, the company marketing the drops, reported that clinical trials of participants 40 to 55 years of age with mild presbyopia showed "a statistically significant proportion of participants treated with VUITY gaining three lines or more in mesopic, high contrast, binocular Distance Corrected Near Visual Acuity (DCNVA), without losing more than 1 line (5 letters) of Corrected Distance Visual Acuity (CDVA) at day 30, hour 3, versus placebo." The effect lasts up to 6 hours. Common sides effects mentioned were headache and eye redness. Because pilocarpine constricts the pupils, thereby reducing the amount of light reaching the retina, consideration should be made for low-light settings, such as driving at night. Vuity does not correct refractive error such as myopia or astigmatism, or ocular pathology. Importantly, Vuity is only FDA-approved for once daily use in each eye, and although caution should be exercised in using the drops to "replace" reading glasses entirely, it is nonetheless a valuable addition to the toolbox of options to increase spectacle independence.

Stem-Cell RPE Model & Two AMD Drug Candidates
Researchers at the National Eye Institute developed a stem cell-based model of the eye's retinal pigmented epithelium (RPE) to test therapies for age-related macular degeneration (AMD). In particular, they used fibroblasts (skin cells) or blood samples from AMD patients to produce induced pluripotent stem cells (iPSC), which were in turn programmed to become RPE cells. Using this iPSC RPE model, the researchers tested genetic contributors to AMD development. For example, they tested the hypothesis that AMD is the result of the inability to regulate the alternate complement pathway once it had become activated, resulting in the formation of anaphylatoxins, a protein that mediates inflammation, among other functions. They exposed 10 iPSC-derived RPE cell lines of different genetic variants to anaphylatoxins from human serum, and subsequently observed that these iPSC-derived RPE cells developed drusen deposits and RPE atrophy, two key characteristics of AMD. Furthermore, cell lines from patients with high-risk variants in the alternate complement pathway had worse disease phenotype compared to cell lines from patients with low-risk variants, allowing the researchers to examine the effects of variations in genotype. Secondly, the scientists used the RPE models to screen more than 1,200 drugs from a pharmacologic library of drugs that had been tested for other conditions, which uncovered two candidate drugs that inhibit RPE atrophy and drusen formation: aminocaproic acid (ACA), a protease inhibitor that blocks the complement pathway outside of cells, and L745, a dopamine receptor antagonist that stops complement-induced inflammation indirectly inside the cell by inhibiting the dopamine pathway. Currently, there are no drugs that stop drusen formation or RPE atrophy in AMD. The scientists hope that the stem cell-based RPE model they developed will be helpful to the research community.

Cataract Surgery Does Not Increase Risk of Progression to Advanced AMD
According to the latest analysis of data from the Age-related Eye Disease Study 2 (AREDS2), a 5-year randomized controlled clinical trial, with up to 10 years of follow up, that tested combinations of dietary supplements for their ability to slow progression of age-related macular degeneration (AMD), no association was found between cataract surgery and progression of AMD to an advanced (late) stage, which is defined as presence of geographic atrophy or neovascularization. The analysis involved a subset of 4,553 AREDS2 participants’ eyes that at baseline did not have signs of advanced AMD and had not undergone cataract surgery. Among this group of AREDS2 participants, eyes that later developed cataracts and had cataract surgery were compared with eyes that did not undergo cataract surgery, with analysis of at least two years of follow-up after cataract surgery. Adjustments were made for many potential confounding factors. Senior author of the study explains, "The standard for removing cataracts, called phacoemulsification, where the lens is broken into tiny pieces, causes less trauma and inflammation than older techniques. This could help explain why past studies saw an association between cataract surgery and progression to advanced AMD and we didn’t." In terms of clinical counseling and decision making, she says, "Our results indicate people don’t need to avoid or delay cataract surgery for fear of worsening their AMD."

A Novel Gut-Eye Connection Explored in Uveitis
About 70% of the human immune system is found in our gastrointestinal tract, where it interacts with the gut microbiome. Scientists are beginning to investigate how this ecosystem of gut microorganisms interact with our immune system in the context of eye health, for example, in inflammatory eye diseases such as noninfectious (chronic) uveitis. This novel angle has produced convincing data in animal models. For example, experiments in mice revealed that severity of inflammation from uveitis is partially related to a reduction of regulatory T cells (Tregs) in the gut, which normally function to prevent inflammation. Furthermore, interventions such as giving these mice organic compounds called short-chain fatty acids or oral antibiotics increased the number of Tregs in the gut and improved intestinal permeability and structure, all of which led to decreased eye inflammation. With funding from several awards and grants from the National Institutes of Health, these researchers next plan to dig deeper into the mechanisms that gut microbes use to protect the eye from inflammatory diseases and lay the foundation for new, targeted medications for uveitis. Motivated by the patients she cares for, the lead researcher of this project states, "We’ve hit on something really novel that has the potential to make a difference for people living with uveitis."

Visuals Enhance Attention via Norepinephrine
To catch a child's wandering attention, parents might use a variety of visual cues, e.g., waving their hands, telling the child to "Look at me!" Neuroscientists have uncovered clues as to why using visual stimuli works to engage our attention, reporting that the neurochemical norepinephrine is locally regulated in the visual cortex. Senior author of the study explains, "Before our study, research suggested the possibility of local regulation of norepinephrine release, but it had never been directly demonstrated." A fundamental chemical for optimal neurological performance in general and for attention in particular, reduced levels of norepinephrine result in conditions like attention-deficit/hyperactivity disorder (ADHD), while an excess of norepinephrine release results in states such as post-traumatic stress disorder (PTSD). However, even low-intensity visual stimuli can have an effect to trigger attention-specific norepinephrine signally pathways in the visual cortex. Using a mouse model of the visual cortex and various electrophysiological recordings, the investigators found that "When a person makes a movement, such as turning the head to listen to a parent, and that is combined with visual stimulation, then more norepinephrine is released where visual information is processed." In other words, norepinephrine is locally regulated in cortical areas that process the visual stimuli. Secondly, the researchers found that astrocytes, a type of glial cell in the brain, are sensitive to norepinephrine release, and alter their responses accordingly. They conclude, "Understanding norepinephrine release, its local regulation and the astrocyte response may represent a mechanism by which one could enhance sensory-specific attention."

In Other News
(1) FDA approves Vuity eye drops for presbyopia (Related) (Related) (Related)
(2) FDA approves Varenicline solution nasal spray for DED (Related)
(3) Lenstechs contact lens clinical trials for presbyopia
(4) Protecting the ozone layer to prevent cataracts

Wednesday, December 29, 2021

A Novel Gut-Eye Connection Explored in Uveitis

Article: Pathway to better eye health runs through the gut
Source: Oregon Health & Sciences University
Published: December 21, 2021 

About 70% of the human immune system is found in our gastrointestinal tract, where it interacts with the gut microbiome. Scientists are beginning to investigate how this ecosystem of gut microorganisms interact with our immune system in the context of eye health, for example, in inflammatory eye diseases such as noninfectious (chronic) uveitis. This novel angle has produced convincing data in animal models. For example, experiments in mice revealed that severity of inflammation from uveitis is partially related to a reduction of regulatory T cells (Tregs) in the gut, which normally function to prevent inflammation. Furthermore, interventions such as giving these mice organic compounds called short-chain fatty acids or oral antibiotics increased the number of Tregs in the gut and improved intestinal permeability and structure, all of which led to decreased eye inflammation. With funding from several awards and grants from the National Institutes of Health, these researchers next plan to dig deeper into the mechanisms that gut microbes use to protect the eye from inflammatory diseases and lay the foundation for new, targeted medications for uveitis. Motivated by the patients she cares for, the lead researcher of this project states, "We’ve hit on something really novel that has the potential to make a difference for people living with uveitis."

My rating of this study:

Lin P. "Intestinal T cells and microbiota as therapeutic targets in autoimmune uveitis."
NIH RePORTER. 1R01EY032882-01

Tuesday, December 28, 2021

Visuals Enhance Attention via Norepinephrine

Article: Visuals increase attention. Now science explains why.
Source: University of Texas Health
Published: December 17, 2021 

The overlap of two staining markers that demonstrate
specific expression in noradrenergic neurons in V1

To catch a child's wandering attention, parents might use a variety of visual cues, e.g., waving their hands, telling the child to "Look at me!" Neuroscientists have uncovered clues as to why using visual stimuli works to engage our attention, reporting that the neurochemical norepinephrine is locally regulated in the visual cortex. Senior author of the study explains, "Before our study, research suggested the possibility of local regulation of norepinephrine release, but it had never been directly demonstrated." A fundamental chemical for optimal neurological performance in general and for attention in particular, reduced levels of norepinephrine result in conditions like attention-deficit/hyperactivity disorder (ADHD), while an excess of norepinephrine release results in states such as post-traumatic stress disorder (PTSD). However, even low-intensity visual stimuli can have an effect to trigger attention-specific norepinephrine signally pathways in the visual cortex. Using a mouse model of the visual cortex and various electrophysiological recordings, the investigators found that "When a person makes a movement, such as turning the head to listen to a parent, and that is combined with visual stimulation, then more norepinephrine is released where visual information is processed." In other words, norepinephrine is locally regulated in cortical areas that process the visual stimuli. Secondly, the researchers found that astrocytes, a type of glial cell in the brain, are sensitive to norepinephrine release, and alter their responses accordingly. They conclude, "Understanding norepinephrine release, its local regulation and the astrocyte response may represent a mechanism by which one could enhance sensory-specific attention."

My rating of this study:

Gray SR, Ye L, Ye JY, et al. "Noradrenergic terminal short-term potentiation enables modality-selective integration of sensory input and vigilance state." Science Advances.  7(50). 17 December 2021. https://doi.org/10.1126/sciadv.abk1378 

Monday, December 27, 2021

Stem-Cell RPE Model & Two AMD Drug Candidates

Article: NIH researchers identify potential AMD drugs with stem-cell based research tool
Source: National Eye Institute
Published: December 15, 2021 

L-745 and ACA (second and third columns) restore epithelial phenotype
in complement competent human serum (CC-HS)-treated CFH(Y/Y)-iRPE
and CFH(H/H)-iRPE (low- and high-risk AMD alleles, respectively)
compared to vehicle (fourth column)

Researchers at the National Eye Institute developed a stem cell-based model of the eye's retinal pigmented epithelium (RPE) to test therapies for age-related macular degeneration (AMD). In particular, they used fibroblasts (skin cells) or blood samples from AMD patients to produce induced pluripotent stem cells (iPSC), which were in turn programmed to become RPE cells. Using this iPSC RPE model, the researchers tested genetic contributors to AMD development. For example, they tested the hypothesis that AMD is the result of the inability to regulate the alternate complement pathway once it had become activated, resulting in the formation of anaphylatoxins, a protein that mediates inflammation, among other functions. They exposed 10 iPSC-derived RPE cell lines of different genetic variants to anaphylatoxins from human serum, and subsequently observed that these iPSC-derived RPE cells developed drusen deposits and RPE atrophy, two key characteristics of AMD. Furthermore, cell lines from patients with high-risk variants in the alternate complement pathway had worse disease phenotype compared to cell lines from patients with low-risk variants, allowing the researchers to examine the effects of variations in genotype. Secondly, the scientists used the RPE models to screen more than 1,200 drugs from a pharmacologic library of drugs that had been tested for other conditions, which uncovered two candidate drugs that inhibit RPE atrophy and drusen formation: aminocaproic acid (ACA), a protease inhibitor that blocks the complement pathway outside of cells, and L745, a dopamine receptor antagonist that stops complement-induced inflammation indirectly inside the cell by inhibiting the dopamine pathway. Currently, there are no drugs that stop drusen formation or RPE atrophy in AMD. The scientists hope that the stem cell-based RPE model they developed will be helpful to the research community.

My rating of this study:

Sharma R, George A, Nimmagadda M, et al. "Epithelial phenotype restoring drugs suppress macular degeneration phenotypes in an iPSC model." Nature Communications.  12:7293. 15 December 2021. https://doi.org/10.1038/s41467-021-27488-x 

Sunday, December 26, 2021

AREDS2 Cohort Analysis: Cataract Surgery Does Not Increase Risk of Progression to Advanced AMD

Article: Cataract surgery does not cause disease progression in people with AMD 
Source: National Eye Institute
Published: December 15, 2021 

According to the latest analysis of data from the Age-related Eye Disease Study 2 (AREDS2), a 5-year randomized controlled clinical trial, with up to 10 years of follow up, that tested combinations of dietary supplements for their ability to slow progression of age-related macular degeneration (AMD), no association was found between cataract surgery and progression of AMD to an advanced (late) stage, which is defined as presence of geographic atrophy or neovascularization. The analysis involved a subset of 4,553 AREDS2 participants’ eyes that at baseline did not have signs of advanced AMD and had not undergone cataract surgery. Among this group of AREDS2 participants, eyes that later developed cataracts and had cataract surgery were compared with eyes that did not undergo cataract surgery, with analysis of at least two years of follow-up after cataract surgery. Adjustments were made for many potential confounding factors. Senior author of the study explains, "The standard for removing cataracts, called phacoemulsification, where the lens is broken into tiny pieces, causes less trauma and inflammation than older techniques. This could help explain why past studies saw an association between cataract surgery and progression to advanced AMD and we didn’t." In terms of clinical counseling and decision making, she says, "Our results indicate people don’t need to avoid or delay cataract surgery for fear of worsening their AMD."

My rating of this study:

Bhandari S, Vitale S, Agrón E, et al. "Cataract Surgery and the Risk of Developing Late Age-Related Macular Degeneration: The Age-Related Eye Disease Study 2 Report Number 27." Ophthalmology.  15 November 2021. https://doi.org/10.1016/j.ophtha.2021.11.014 

Friday, December 24, 2021

Vuity: First FDA-Approved Eye Drops for Presbyopia

Article: U.S. Food and Drug Administration Approves VUITY
Source: Allergan / Abbvie
Published: October 29, 2021
Article: The First FDA-Approved Eye Drops to Treat Blurry Vision Are Now Available in The US Source: ScienceAlert
Published: December 15, 2021

Vuity: Pilocarpine HCL 1.25% ophthalmic solution
The U.S. Food and Drug Administration (FDA) recently approved Vuity, a daily eye drop indicated for treatment of presbyopia, or age-related decline in near focus due to decreased ability of the eye's crystalline lens to accommodate. Presbyopia onset usually begins in the mid-40s. Available with a prescription, Vuity is a formulation of 1.25% pilocarpine. A direct-acting cholinergic agonist, pilocarpine acts on the smooth muscle muscarinic receptors of the iris sphincter to constrict the pupils in miosis. Its additional mechanism of action to directly stimulate the longitudinal muscles of the ciliary body is thought to affect the mechanics of the scleral spur to widen the spaces in the trabecular meshwork, thereby increasing aqueous outflow; in this capacity, pilocarpine is sometimes used as a treatment for glaucoma. In the context of pupillary constriction in itself, which decreases the "aperture" of the eye's optical system, the effect is an increase in depth of field and depth of focus, respectively, the range of clear vision in object space in front of the eye and in image space on the "screen" of the retina. (Often mentioned together, these two ranges are dioptrically equivalent.)

The increase in range of clear vision means an increase in near vision without sacrificing distance vision, in emmetropic or corrected-to-emmetropic eyes. In a press release, Allergan, the company marketing the drops, reported that clinical trials of participants 40 to 55 years of age with mild presbyopia showed "a statistically significant proportion of participants treated with VUITY gaining three lines or more in mesopic, high contrast, binocular Distance Corrected Near Visual Acuity (DCNVA), without losing more than 1 line (5 letters) of Corrected Distance Visual Acuity (CDVA) at day 30, hour 3, versus placebo." The effect lasts up to 6 hours. Common sides effects mentioned were headache and eye redness. Because pilocarpine constricts the pupils, thereby reducing the amount of light reaching the retina, consideration should be made for low-light settings, such as driving at night. Vuity does not correct refractive error such as myopia or astigmatism, or ocular pathology. Importantly, Vuity is only FDA-approved for once daily use in each eye, and although caution should be exercised in using the drops to "replace" reading glasses entirely, it is nonetheless a valuable addition to the toolbox of options to increase spectacle independence.

My rating of this story:

Thursday, December 23, 2021

Week in Review: Number 46

Immune Cell Presence on the Crystalline Lens in Uveitis
Despite being susceptible to a range of potential threats—whether they come from pathogens, chemicals, radiation, or general oxidative damage—it is surprising that ocular tissues such as the cornea, crystalline lens, and retina are thought to be immune privileged, that is, lacking immune cells. So how do these critical tissues protect themselves? Closer investigation by researchers in previous work revealed, for example, that mice engineered to lack a key protein for crystalline lens formation showed immune cells trying to fix the resulting malformed lens. Other researchers observed immune cells in the cornea after damage to the lens, and vice versa immune cells arriving at the lens surface, acting like sentinels to protect this tissue after damage to the cornea (the external ocular surface). In a new study, researchers at Thomas Jefferson University show that immune cells respond to the lens not only after acute eye injury but also in chronic inflammation. Using high-resolution microscopy and a mouse model of uveitis, or inflammation to the middle layer of the eye, the researchers studied the role of immune cells in relation to cataracts associated with uveitis. 

Unlike the sentinels seen after ocular surface injury, the researchers report, "In this case, it was like a battering ram. There were dozens of immune cells, and different types of them, including T-cells and macrophages. It’s clearly a robust immune response and could reflect in part that inflammation in uveitis is so severe." Similarly, it was previously thought that the lens capsule surrounding the lens protects it from the increase in immune cells that populate the aqueous and vitreous chambers during active uveitis. However, high-resolution confocal z-stacks and scanning electron microscopy revealed that immune cells were actually integrated into the lens capsule, increasing not only in number but also in depth (invasion) as the uveitis progressed. Moreover, the immune cells were observed to be able to penetrate the thick lens capsule, infiltrate into and embedding themselves in the lens tissue. Although most of the cells were gone as the uveitis began to resolve, some of these immune cells remained integrated into the lens capsule and lens tissue. Underscoring the complexity of the presence of immune cells in the eye, a topic that has thus far been understudied, the senior author of the study explains, "Till now, the mechanisms for damage that happen in this region of the eye after uveitis have been poorly understood. For the first time, we’ve been able to provide evidence that immune cells could be driving this damage, particularly to the lens.”

SINE RNA Receptor DDX17 Mediates Lupus & AMD
Jayakrishna Ambati, MD, has been a prolific researcher, publishing three papers this year regarding his discoveries connecting atrophic macular degeneration (AMD) with cytoplasmic cDNA and its activation of the inflammasome. His fourth paper this year presents another finding linking triggers of the inflammasome with another disease: lupus. Ambati remarks, "It appears that the new inflammatory pathway we identified could be therapeutically targeted for many chronic diseases." The inflammasome, or pairs of inflammasomes, responsible in this case is the NLRC4-NLRP3 inflammasome. Each are individually large multi-protein complexes that play an important role in protecting the body from pathogens. However, in noninfectious, chronic inflammatory diseases such as lupus and macular degeneration, the researchers found that the NLRC4 inflammasome includes the NLRP3 inflammasome, and is instead independent of NLR family apoptosis inhibitory proteins (NAIPs) that are classically required for NLRC4 inflammasome assembly after bacterial infection. In the "sterile" environment of chronic diseases, that is, in the absence of pathogenic etiologies, researchers wondered what triggers the formation of inflammasomes.

The new research uncovered that the NLRC4-NLRP3 inflammasome is triggered by short interspersed nuclear element RNAs (SINE RNAs), mobile genetic elements known as retrotransposons that make up more than 10% of our genome and is transcribed in response to cellular stresses. SINE RNAs were found to be elevated in both lupus and AMD, among other diseases in previous work. Notably, using human cells transfected with SINE RNA, the research team identified a receptor called DEAD-box helicase 17 (DDX17). When DDX17 was unavailable, there was less interaction between the NLRC4 and NLRP3 proteins in SINE RNA-transfected cells, suggesting that DDX17 is an essential mediator in sterile activation of the NLRC4 inflammasome by SINE RNAs. The finding that DDX17 is colocalized with SINE RNA in the cytoplasm is confirmed in white blood cells isolated from people with active lupus. Additionally, subretinal injection of SINE RNAs in a mouse model of atrophic macular degeneration led to retinal pigmented epithelium (RPE) degeneration in wildtype mice but not in mice engineered with genetic loss of Nlrc4  or Ddx17, demonstrating that the NLRC4 inflammasome and its receptor DDX17 are both necessary to trigger the retinal disease. The finding that there are two inflammasomes involved, both of which are necessary to form an active NLRC4 inflammasome when the complex is triggered by SINE RNAs, also informs therapeutic strategies for both the NLRC4 and NLRP3 inflammasomes. Ambati further comments, “[N]ow that we know what is the sensor—at least a sensor—of SINE retrotransposons, that opens up a whole new intersection between RNA biology and immunology.”

Metformin Explored as a Treatment for L-ORD
Late-onset retinal degeneration (L-ORD) is a rare genetic disorder of autosomal dominant inheritance. Specifically, L-ORD is caused by a missense substitution in the gene that encodes the protein CTRP5, leading to choroidal neovascularization and deposits of apolipoprotein E (which is involved in lipid metabolism within the retina), and retinal pigmented epithelium (RPE) atrophy (which contain an abundance of fatty acids and lipids). Symptoms begin with nyctalopia, progressing to central vision loss by the sixth decade. Scientists at the National Eye Institute are studying the disease by developing a "disease-in-a-dish" model from induced pluripotent stem cells (iPSCs) to make RPE cells from skin fibroblasts; the fibroblast samples were collected from two siblings with L-ORD (L-ORD-iRPE) and compared with two unaffected siblings who lacked the disease-causing mutation. The L-ORD-iRPE were observed to be dysmorphic (deformed), also showing deposits of apolipoprotein E near the tissue and abnormal secretions of vascular endothelial growth factor (VEGF); these cells also had reduced secretions of both normal and mutant CTRP5 proteins.

Computer modeling of the proteins showed that
mutant CTRP5 was less likely to bind with cell receptors that regulate lipid metabolism, in turn leading to chronic activation of AMP-activated protein kinase (AMPK), a key regulator of energy homeostasis and lipid metabolism, such as of apolipoprotein E. One of the researchers explains, "AMPK in the RPE itself is a key regulator of the conversion of DHA [docosahexaenoic acid] into protective mediators [against oxidative damage and mutations]." Chemically inhibited AMPK in the L-ORD-iRPE cells led to fewer apolipoprotein E deposits and less abnormal secretion of VEGF. Finally, the researchers tested two therapies on the L-ORD-iRPE cells: a gene augmentation of normal CTRP5, and modulation of AMPK with anti-diabetes drug metformin. Both strategies prevented signs of L-ORD in the RPE model. Senior author of the study states, "Importantly, we now have two potential strategies to disrupt the L-ORD disease process. While gene therapy may be years away, metformin is a drug that’s long been used to treat diabetes." Although L-ORD is a rare genetic disease, it shares some characteristics with the much more common age-related macular degeneration (AMD). The researchers hope that studying this model, and the effect of metformin, will benefit diseases caused by RPE changes.

Association Study Shows Link between AMD Genetic Risk Factors and Thinner Retinal Layers
Age-related macular degeneration (AMD) is a leading cause visual impairment and loss in Western countries, and especially among individuals 55 years of age and older. Researchers in the U.K. looked at medical records from the U.K. Biobank, which includes retinal scans and genetic data from over 30,000 patients. In particular, they compared the latest data of 34 known genetic risk factors of AMD (which together comprise 46% of the disease's genetic variance) with macular thickness, as measured with spectral-domain optical coherence tomography (SD-OCT). The authors report, "Our analysis has interestingly shown that, in the presence of high genetic risk for AMD, there is a significant decrease in the thickness of both the ISOS-RPE and the RPE-BM which may suggest that premature RPE thinning could be a major contributory factor." The inner-segment outer segment-retinal pigment epithelium (ISOS-RPE) thickness measurement, is of particular interest in that it represents the photoreceptor outer segments where light transduction takes place. The researchers conclude, "Our study highlights the premorbid influence of AMD genetic risk variants on macular thickness and may provide mechanistic insight into the pathophysiology of this debilitating disease." Because these structural changes occur prior to onset of disease symptoms or overt clinical signs, they could provide an early assessment of disease risk to guide healthy habits.

Regulators of Adult Visual Cortex Plasticity in Mice
Learning and recovery from injuries depend on the brain's plasticity. This plasticity between neuronal connections relies heavily on the network of macromolecules in between and surrounding the nerve cells, known as the extracellular matrix (ECM). As the brain becomes more mature, the stability of the ECM increases, providing a scaffold for the existing arrangements and synaptic circuits of nerve cells. New experiences require that this extracellular matrix be loosened in order for new connections to form. Similarly, when the brain experiences an injury such as a stroke, it needs to reorganize itself and form new connections. This balance between stability and plasticity is regulated by the proteolytic activity of enzymes such as matrix metalloproteinases (MMPs), which "digest" the ECM in order to "loosen" it. Researchers in Germany studying the visual cortex of mice showed that blocking the matrix metalloproteinases MMP2 and MMP9 can have opposing effects depending on whether the brain is sick, such as after stroke, or healthy. In the primary visual cortex of healthy mice, blocking MMP2 and MMP9 led to decreased ocular dominance plasticity. In mice studied immediately after a stroke, inhibition of MMP2 and MMP9 (which spike for a short time after a stroke) rescued neuronal plasticity that had been compromised by the stroke, that is, the MMPs had a therapeutic effect. The researchers point out that the intentional inhibition of the metaloproteinases immediately after inducing an experimental stroke was in order to simulate treatment. The authors argue that these findings show that levels of MMPs must be precise and optimal in the brain, as both too low or too high an amount can prevent neuronal plasticity.

In Other News
(1) Vision's effect on the development of hearing investigated
(2) Candy-like models to make STEM accessible to students with visual impairment
(3) Visual behavior and autism prediction in infants

Wednesday, December 22, 2021

Regulators of Adult Visual Cortex Plasticity in Mice

Article: Learning and protecting itself: how the brain adapts
Source: University of Göttingen (Germany)
Published: December 10, 2021 

Neurons in the mouse visual cortex enwrapped by ECM molecules (red)
Learning and recovery from injuries depend on the brain's plasticity. This plasticity between neuronal connections relies heavily on the network of macromolecules in between and surrounding the nerve cells, known as the extracellular matrix (ECM). As the brain becomes more mature, the stability of the ECM increases, providing a scaffold for the existing arrangements and synaptic circuits of nerve cells. New experiences require that this extracellular matrix be loosened in order for new connections to form. Similarly, when the brain experiences an injury such as a stroke, it needs to reorganize itself and form new connections. This balance between stability and plasticity is regulated by the proteolytic activity of enzymes such as matrix metalloproteinases (MMPs), which "digest" the ECM in order to "loosen" it. Researchers in Germany studying the visual cortex of mice showed that blocking the matrix metalloproteinases MMP2 and MMP9 can have opposing effects depending on whether the brain is sick, such as after stroke, or healthy. In the primary visual cortex of healthy mice, blocking MMP2 and MMP9 led to decreased ocular dominance plasticity. In mice studied immediately after a stroke, inhibition of MMP2 and MMP9 (which spike for a short time after a stroke) rescued neuronal plasticity that had been compromised by the stroke, that is, the MMPs had a therapeutic effect. The researchers point out that the intentional inhibition of the metaloproteinases immediately after inducing an experimental stroke was in order to simulate treatment. The authors argue that these findings show that levels of MMPs must be precise and optimal in the brain, as both too low or too high an amount can prevent neuronal plasticity.

My rating of this study:

Akol I, Kalogeraki E, Pielecka-Fortuna J, et al. "MMP2 and MMP9 Activity Is Crucial for Adult Visual Cortex Plasticity in Healthy and Stroke-Affected Mice." Journal of Neuroscience.  JN-RM-0902-21. 11 November 2021. https://doi.org/10.1523/JNEUROSCI.0902-21.2021  

Tuesday, December 21, 2021

Metformin Explored as a Treatment for L-ORD

Article: NIH study traces molecular link from gene to late-onset retinal degeneration
Source: National Eye Institute
Published: December 9, 2021 
Article: LSU Health Contributes to Research Suggesting Late-Onset Retinal Degeneration Mechanism & Potential Rx
Source: Louisiana State University
Published: December 9, 2021

Metformin counteracts the increased susceptibility to dedifferentiation in L-ORD-iRPE



Late-onset retinal degeneration (L-ORD) is a rare genetic disorder of autosomal dominant inheritance. Specifically, L-ORD is caused by a missense substitution in the gene that encodes the protein CTRP5, leading to choroidal neovascularization and deposits of apolipoprotein E (which is involved in lipid metabolism within the retina), and retinal pigmented epithelium (RPE) atrophy (which contain an abundance of fatty acids and lipids). Symptoms begin with nyctalopia, progressing to central vision loss by the sixth decade. Scientists at the National Eye Institute are studying the disease by developing a "disease-in-a-dish" model from induced pluripotent stem cells (iPSCs) to make RPE cells from skin fibroblasts; the fibroblast samples were collected from two siblings with L-ORD (L-ORD-iRPE) and compared with two unaffected siblings who lacked the disease-causing mutation. The L-ORD-iRPE were observed to be dysmorphic (deformed), also showing deposits of apolipoprotein E near the tissue and abnormal secretions of vascular endothelial growth factor (VEGF); these cells also had reduced secretions of both normal and mutant CTRP5 proteins.

Computer modeling of the proteins showed that
mutant CTRP5 was less likely to bind with cell receptors that regulate lipid metabolism, in turn leading to chronic activation of AMP-activated protein kinase (AMPK), a key regulator of energy homeostasis and lipid metabolism, such as of apolipoprotein E. One of the researchers explains, "AMPK in the RPE itself is a key regulator of the conversion of DHA [docosahexaenoic acid] into protective mediators [against oxidative damage and mutations]." Chemically inhibited AMPK in the L-ORD-iRPE cells led to fewer apolipoprotein E deposits and less abnormal secretion of VEGF. Finally, the researchers tested two therapies on the L-ORD-iRPE cells: a gene augmentation of normal CTRP5, and modulation of AMPK with anti-diabetes drug metformin. Both strategies prevented signs of L-ORD in the RPE model. Senior author of the study states, "Importantly, we now have two potential strategies to disrupt the L-ORD disease process. While gene therapy may be years away, metformin is a drug that’s long been used to treat diabetes." Although L-ORD is a rare genetic disease, it shares some characteristics with the much more common age-related macular degeneration (AMD). The researchers hope that studying this model, and the effect of metformin, will benefit diseases caused by RPE changes.

My rating of this study:

Miyagishima KJ, Sharma R, Nimmagadda M, et al. "AMPK modulation ameliorates dominant disease phenotypes of CTRP5 variant in retinal degeneration." Communications Biology.  4:1360. 9 December 2021. https://doi.org/10.1038/s42003-021-02872-x 

Monday, December 20, 2021

Association Study Shows Early Link between AMD Genetic Risk Factors and Thinner Retinal Layers

Article: Warning signs of sight loss could be identified before vision deteriorates
Source: University of Southampton (U.K.)
Published: December 9, 2021 

The ISOS-RPE and RPE-BM layers (starred) are both
thinner in individuals with AMD genetic risk factors

Age-related macular degeneration (AMD) is a leading cause visual impairment and loss in Western countries, and especially among individuals 55 years of age and older. Researchers in the U.K. looked at medical records from the U.K. Biobank, which includes retinal scans and genetic data from over 30,000 patients. In particular, they compared the latest data of 34 known genetic risk factors of AMD (which together comprise 46% of the disease's genetic variance) with macular thickness, as measured with spectral-domain optical coherence tomography (SD-OCT). The authors report, "Our analysis has interestingly shown that, in the presence of high genetic risk for AMD, there is a significant decrease in the thickness of both the ISOS-RPE and the RPE-BM which may suggest that premature RPE thinning could be a major contributory factor." The inner-segment outer segment-retinal pigment epithelium (ISOS-RPE) thickness measurement, is of particular interest in that it represents the photoreceptor outer segments where light transduction takes place. The researchers conclude, "Our study highlights the premorbid influence of AMD genetic risk variants on macular thickness and may provide mechanistic insight into the pathophysiology of this debilitating disease." Because these structural changes occur prior to onset of disease symptoms or overt clinical signs, they could provide an early assessment of disease risk to guide healthy habits.

My rating of this study:

Kaye RA, Patasova K, Patel PJ, et al. "Macular thickness varies with age-related macular degeneration genetic risk variants in the UK Biobank cohort." Scientific Reports.  11:23255. 1 December 2021. https://doi.org/10.1038/s41598-021-02631-2 

Sunday, December 19, 2021

Immune Cell Presence on the Crystalline Lens in Uveitis

Article: Reimagining Immunity in the Eye
Source: Thomas Jefferson University
Published: December 8, 2021 

Despite being susceptible to a range of potential threats—whether they come from pathogens, chemicals, radiation, or general oxidative damage—it is surprising that ocular tissues such as the cornea, crystalline lens, and retina are thought to be immune privileged, that is, lacking immune cells. So how do these critical tissues protect themselves? Closer investigation by researchers in previous work revealed, for example, that mice engineered to lack a key protein for crystalline lens formation showed immune cells trying to fix the resulting malformed lens. Other researchers observed immune cells in the cornea after damage to the lens, and vice versa immune cells arriving at the lens surface, acting like sentinels to protect this tissue after damage to the cornea (the external ocular surface). In a new study, researchers at Thomas Jefferson University show that immune cells respond to the lens not only after acute eye injury but also in chronic inflammation. Using high-resolution microscopy and a mouse model of uveitis, or inflammation to the middle layer of the eye, the researchers studied the role of immune cells in relation to cataracts associated with uveitis. 

Immune cells observed at the lens capsule surface (top)
and integrated into the lens capsule (bottom)

Unlike the sentinels seen after ocular surface injury, the researchers report, "In this case, it was like a battering ram. There were dozens of immune cells, and different types of them, including T-cells and macrophages. It’s clearly a robust immune response and could reflect in part that inflammation in uveitis is so severe." Similarly, it was previously thought that the lens capsule surrounding the lens protects it from the increase in immune cells that populate the aqueous and vitreous chambers during active uveitis. However, high-resolution confocal z-stacks and scanning electron microscopy revealed that immune cells were actually integrated into the lens capsule, increasing not only in number but also in depth (invasion) as the uveitis progressed. Moreover, the immune cells were observed to be able to penetrate the thick lens capsule, infiltrate into and embedding themselves in the lens tissue. Although most of the cells were gone as the uveitis began to resolve, some of these immune cells remained integrated into the lens capsule and lens tissue. Underscoring the complexity of the presence of immune cells in the eye, a topic that has thus far been understudied, the senior author of the study explains, "Till now, the mechanisms for damage that happen in this region of the eye after uveitis have been poorly understood. For the first time, we’ve been able to provide evidence that immune cells could be driving this damage, particularly to the lens.”

My rating of this study:

DeDreu J, Pal-Ghosh S, Mattapallil MJ, et al. "Uveitis-mediated immune cell invasion through the extracellular matrix of the lens capsule." The FASEB Journal.  4:1360. 7 December 2021. https://doi.org/10.1096/fj.202101098R

Saturday, December 18, 2021

SINE RNA Receptor DDX17 Mediates Lupus & AMD

Article: Link Found Between Lupus, Macular Degeneration 
Source: University of Virginia Medicine
Published: December 7, 2021
Article: Retrotransposon RNA Triggers NLRC4 Inflammasome Formation
Source: The Scientist
Published: December 10, 2021

Jayakrishna Ambati, MD, has been a prolific researcher, publishing three papers this year regarding his discoveries connecting atrophic macular degeneration (AMD) with cytoplasmic cDNA and its activation of the inflammasome. His fourth paper this year presents another finding linking triggers of the inflammasome with another disease: lupus. Ambati remarks, "It appears that the new inflammatory pathway we identified could be therapeutically targeted for many chronic diseases." The inflammasome, or pairs of inflammasomes, responsible in this case is the NLRC4-NLRP3 inflammasome. Each are individually large multi-protein complexes that play an important role in protecting the body from pathogens. However, in noninfectious, chronic inflammatory diseases such as lupus and macular degeneration, the researchers found that the NLRC4 inflammasome includes the NLRP3 inflammasome, and is instead independent of NLR family apoptosis inhibitory proteins (NAIPs) that are classically required for NLRC4 inflammasome assembly after bacterial infection. In the "sterile" environment of chronic diseases, that is, in the absence of pathogenic etiologies, researchers wondered what triggers the formation of inflammasomes.

Subretinal injection of SINE RNAs in a mouse model of AMD led to RPE degeneration
in wildtype mice (left), but not in mice engineered with genetic loss of Nlrc4 (middle) or Ddx17 (right)













The new research uncovered that the NLRC4-NLRP3 inflammasome is triggered by short interspersed nuclear element RNAs (SINE RNAs), mobile genetic elements known as retrotransposons that make up more than 10% of our genome and is transcribed in response to cellular stresses. SINE RNAs were found to be elevated in both lupus and AMD, among other diseases in previous work. Notably, using human cells transfected with SINE RNA, the research team identified a receptor called DEAD-box helicase 17 (DDX17). When DDX17 was unavailable, there was less interaction between the NLRC4 and NLRP3 proteins in SINE RNA-transfected cells, suggesting that DDX17 is an essential mediator in sterile activation of the NLRC4 inflammasome by SINE RNAs. The finding that DDX17 is colocalized with SINE RNA in the cytoplasm is confirmed in white blood cells isolated from people with active lupus. Additionally, subretinal injection of SINE RNAs in a mouse model of atrophic macular degeneration led to retinal pigmented epithelium (RPE) degeneration in wildtype mice but not in mice engineered with genetic loss of Nlrc4  or Ddx17, demonstrating that the NLRC4 inflammasome and its receptor DDX17 are both necessary to trigger the retinal disease. The finding that there are two inflammasomes involved, both of which are necessary to form an active NLRC4 inflammasome when the complex is triggered by SINE RNAs, also informs therapeutic strategies for both the NLRC4 and NLRP3 inflammasomes. Ambati further comments, “[N]ow that we know what is the sensor—at least a sensor—of SINE retrotransposons, that opens up a whole new intersection between RNA biology and immunology.”

My rating of this study:

Wang S, Narendran S, Hirahara S, et al. "DDX17 is an essential mediator of sterile NLRC4 inflammasome activation by retrotransposon RNAs." Science Immunology.  6:66. 3 December 2021. https://doi.org/10.1126/sciimmunol.abi4493

Friday, December 17, 2021

Week in Review: Number 45

Interview: From Neurons to Artificial Visual Systems, with a Dash of Inspired Science Outreach
The brain's visual system is central to our perception and interpretation of the world we see. Yet, how it gathers and integrates visual information into a cohesive whole still remains largely a mystery. Harvard Medicine News  interviewed Carlos Ponce, M.D., Ph.D., assistant professor of neurobiology at HMS, about his interest in the visual system and how he uses this information to build better computational models. Ponce explains that his research is focused on the brain's ventral stream, or parts of the visual system that analyze and categorize shapes, whether they be faces, objects, scenes, etc. He uses macaque monkeys as animal models, since they are an experimental model with brains most similar to humans. Using images as stimuli and electrophysiology recordings, Ponce studies how the responses of neurons approximate our visual perception. As he explains, "The pictures represent a hypothesis, and the neural response is an evaluation of that." However, images that are selected by human minds cannot fully capture the range of variability and nuance in visual stimuli that the brain encounters in the world; the images we select as input are limited by our imaginations and biases. This is where advances in computational modeling come in handy. The models not only learn from the input of millions of pictures, but can also generate entirely new images.

In an earlier paper from 2019, Ponce presents how applying this "cooperation between neurons and machine intelligence" to neurons in part of the macaque brain that responds to faces produced, from initial noise, a computational model that contained features of a face. "Our discovery was that you can couple computational models to neurons in the macaque brain that are visually responsive, and have the neurons guide the model to create pictures that activate them best," the assistant professor explains, "However, we were puzzled by some of the pictures that were created. Some made a lot of sense, like parts of faces or bodies, but others didn’t look like any one object. Instead, they were patterns that cut across semantic categories...We realized that the neurons in the macaque brain are learning specific motifs that don’t necessarily fit our language. The neurons have a language of their own that is about describing the statistics of the natural world." In a sequel of the research, published this year, Ponce applied computational models to both the posterior (upstream) parts of the macaque brain that process simple objects and the more anterior (downstream) parts that process complex shapes. In doing so, he was able to quantify the information coming from the neurons as having an intermediate level of complexity, somewhere between the simplicity of a line and the complexity of a photograph. In other experiments, he found that macaques prefer to look at parts of pictures that were similar to the features encoded by their neurons. "That gives us a clue that during development, the brain extracts important patterns from the world and stores those patterns in neurons," he says.

When asked what he wants to do next, Ponce answers that he is intrigued by many questions, such as extending his individual-neuron recordings to characterize full populations of neurons, or reconstructing images of what the brain sees based on the pattern of activity of neurons. He is also interested in how clusters of neurons that share a function develop where they do in the brain, and hopes that his approach will help to map that topography. Once we are able to characterize the patterns and networks of the brain, he states, we can then develop computational models to improve artificial visual systems. Ponce recalls his own medical training to connect his research to clinical applications, for example, to save lives through improved screening that "doesn't miss anything." Finally, he references his own childhood and inspiration from scientists to motivate his work in science outreach to youth, to inspire young students every year toward careers in science.

Large Association Study Finds Cataract Surgery Linked with Lower Risk of Dementia
Cataracts are an opacification or clouding of the eye's crystalline lens, most commonly as a result of aging and decades of filtering ultraviolet radiation. Although connections between poor vision and cognitive decline have been explored in many studies, ophthalmologists at University of Washington were interested in the effect of surgical intervention in the form of cataract extraction on dementia risk. Specifically, they looked at data from the Adult Changes in Thought (ACT) study, an ongoing longitudinal cohort study started in 1994 by Kaiser Permanente Washington and designed to study the development of dementia. Electronic medical records data was collected from 3,038 participants 65 years of age or older who had either cataract or glaucoma diagnosis before enrollment or during follow-up care. Among those included in the analysis, there were 853 cases of dementia (all cause) and 709 cases of Alzheimer's disease. Approximately half of the participants (1,382 individuals) had cataract surgery. Based on 23,554 person-years of follow-up, and after controlling for a variety of potentially confounding factors, participants who underwent cataract extraction in either eye had a 29% reduced risk of developing dementia compared to participants without surgery; moreover, the reduced risk applied for at least 10 years after surgery. Similar findings were seen in dementia specific to Alzheimer's disease. Importantly, no association was observed between glaucoma surgery and dementia risk. The authors point out that evaluation of glaucoma surgery, which, unlike cataract surgery, does not restore vision, was to address potential healthy patient bias. Although the mechanisms by which cataract extraction is associated with decreased dementia risk were not explored in this observational study, the researchers hypothesize that patients were getting higher quality sensory input after cataract extraction, highlighting neurological, circadian, and social improvements. Lead researcher of the study states, "This kind of evidence is as good as it gets in epidemiology. This is really exciting because no other medical intervention has shown such a strong association with lessening dementia risk in older individuals." Given the risk of cognitive decline in older age, interventions such as cataract surgery have major clinical relevance not only in enhancing quality of vision but also in improvement of mental health.

Large Single-Cell Gene Atlas of Human Eye Disorders
An international team led by researchers from several universities in Singapore, with colleagues in the U.S. and other countries, have produced the first single-cell atlas of human and porcine eyes. They report applying single-cell RNA sequencing to catalogue more than 50,000 cells in human and porcine eyes, as well as developing a cell atlas that distinguishes these cells by the activity of their genes. The use of porcine eyes (and other animal species, such as zebrafish) in this study allowed for comparison of interspecies differences as well as conserved regulating factors in the eye, which the authors state is lacking in integrative research of the eye. The study produced a wide range of findings, some of which are simple, such as evidence of adult stems cells in iris tissue. Others have clinical implications regarding ocular routes of infection and disease transmission. For example, the team found that ACE2 and TMPRSS2, the primary cell surface proteins responsible for entry of SARS-CoV-2 into human, are expressed in the eye's conjunctival cells. Some of the researchers also worked on lab techniques in regenerative medicine, such as using embryonic stem cells to generate retinal ganglion cell (RGC) progenitors in culture; they discovered that a switch called KLF7 could accelerate RGC generation, with results that could inform potential therapies for eye diseases like glaucoma that results from progressive damage to the RGCs that make up the optic nerve. They are working to further validate the KLF7-derived RGCs for preclinical studies, with broad aims of understanding key molecular switches to better engineer lab-grown cells as a means of therapy.

i27-Breg: Discovery of a New Anti-inflammatory B Cell
Scientists at the National Eye Institute have discovered a new type of B cell that tempers the immune system, thereby reducing chronic inflammation in autoimmune diseases. Termed regulatory B cells (Bregs), these cells represent a small population of B cells that are derived from plasma blasts or plasma cells; although similar to other Bregs, the newly discovered cells express a distinct genetic profile of innate B-1a cell lineage. Bregs patrol the blood and function in modulating the immune system through expression of anti-inflammatory cytokines (e.g., IL-10 and IL-35) that counterbalance the physiological effects of pro-inflammatory cytokines (e.g., IFN-gamma and IL-17). A balance between pro- and anti-inflammatory cytokines is essential to a healthy immune system, one that can mount a robust response against pathogens while not reacting excessively to self-cells, as in autoimmune disease. In lab tests in mice, purified infusion of i27-Breg suppressed autoimmune uveitis (and encephalomyelitis) through "up-regulation of inhibitory receptors (Lag3, PD-1), suppression of T-cell (Th17/Th1) responses, and propagation of inhibitory signals that converted conventional B cells to regulatory lymphocytes that secrete IL-10 and/or IL-35 in eye, brain, and spinal cord." Unlike i35-Breg, a similar Breg also discovered by these researchers, i27-Breg demonstrated a quicker response to suppress autoimmune uveitis and MS-like disease. i27-Breg also has an advantage of being able to proliferate to sustain IL-27 secretion in vivo, suggesting that it may have greater therapeutic potential over biologics (IL-10 or IL-35), which are rapidly cleared by the body. Notably, IL-27 receptor is necessary for any therapeutic effect, as i27-Breg infusions into mice lacking the IL-27 receptor failed to attenuate disease symptoms. Finally, because i27-Breg is neither antigen-specific nor disease-specific, the researchers point out that it could be effective immunotherapy for a wide range of autoimmune diseases. They are currently working on the use of exosomes (extracellular vesicles) as a vector to deliver lab-grown IL-27 into the body, which they acknowledge is less technically challenging than producing Breg cells in the lab.

Suprachoroidal Bionic Eye Implant Trialled in Sheep
Researchers in Australia are investigating a new type of bionic eye implant for the treatment of degenerative retinal diseases. The result of "decades of experience and technological breakthroughs in the field of implantable electronics," the Phoenix99  Bionic Eye is a 98-channel visual prosthesis comprising two components: a stimulator implanted in the eye in the suprachoroidal space and a communication module positioned under the skin behind the ear. This system is attached to an external glasses-mounted miniature camera that captures images to send instructions wirelessly to the communication module behind the ear, which decodes and transfers the signals to the stimulation module behind the retina. The research team has tested implantation of 9 devices in an ovine (sheep) model, reporting positive results up to 3 months in this study. One of the engineers on the project remarks, "Importantly, we found the device has a very low impact on the neurons required to ‘trick’ the brain. There were no unexpected reactions from the tissue around the device and we expect it could safely remain in place for many years." Implant stability and safety profile were assessed with indirect ophthalmoscopy, infrared imaging, and optical coherence tomography. Biocompatibility was evaluated with histological analysis with an emphasis on the health of the retinal cells; only mild fibrosis and inflammation of the surrounding tissue were observed. Although assessments of visual function were not conducted, the researchers state being confident with the results in terms of safety to submit ethics approval for human clinical trials. They continue to make refinements in more advanced stimulation and surgical techniques in the meantime.

In Other News
(1) New contrast sensitivity test created by NECO faculty
(2) The human visual system's awesome complexity: Are we ready for self-driving cars?
(3) Dark adaptometry device for screening of Plaquenil retinal toxicity

Thursday, December 16, 2021

Interview: From Neurons to Artificial Visual Systems, with a Dash of Inspired Science Outreach

Article: Seeing Shapes: Understanding brain’s visual system could inform development of better artificial systems
Source: Harvard Medical School
Published: December 7, 2021 

The brain's visual system is central to our perception and interpretation of the world we see. Yet, how it gathers and integrates visual information into a cohesive whole still remains largely a mystery. Harvard Medicine News  interviewed Carlos Ponce, M.D., Ph.D., assistant professor of neurobiology at HMS, about his interest in the visual system and how he uses this information to build better computational models. Ponce explains that his research is focused on the brain's ventral stream, or parts of the visual system that analyze and categorize shapes, whether they be faces, objects, scenes, etc. He uses macaque monkeys as animal models, since they are an experimental model with brains most similar to humans. Using images as stimuli and electrophysiology recordings, Ponce studies how the responses of neurons approximate our visual perception. As he explains, "The pictures represent a hypothesis, and the neural response is an evaluation of that." However, images that are selected by human minds cannot fully capture the range of variability and nuance in visual stimuli that the brain encounters in the world; the images we select as input are limited by our imaginations and biases. This is where advances in computational modeling come in handy. The models not only learn from the input of millions of pictures, but can also generate entirely new images.

A computational model linked to visual neurons in the macaque brain
incrementally reveals an image of an eye, synthesized by the model
from information encoded by visual neurons
In an earlier paper from 2019, Ponce presents how applying this "cooperation between neurons and machine intelligence" to neurons in part of the macaque brain that responds to faces produced, from initial noise, a computational model that contained features of a face. "Our discovery was that you can couple computational models to neurons in the macaque brain that are visually responsive, and have the neurons guide the model to create pictures that activate them best," the assistant professor explains, "However, we were puzzled by some of the pictures that were created. Some made a lot of sense, like parts of faces or bodies, but others didn’t look like any one object. Instead, they were patterns that cut across semantic categories...We realized that the neurons in the macaque brain are learning specific motifs that don’t necessarily fit our language. The neurons have a language of their own that is about describing the statistics of the natural world." In a sequel of the research, published this year, Ponce applied computational models to both the posterior (upstream) parts of the macaque brain that process simple objects and the more anterior (downstream) parts that process complex shapes. In doing so, he was able to quantify the information coming from the neurons as having an intermediate level of complexity, somewhere between the simplicity of a line and the complexity of a photograph. In other experiments, he found that macaques prefer to look at parts of pictures that were similar to the features encoded by their neurons. "That gives us a clue that during development, the brain extracts important patterns from the world and stores those patterns in neurons," he says.

When asked what he wants to do next, Ponce answers that he is intrigued by many questions, such as extending his individual-neuron recordings to characterize full populations of neurons, or reconstructing images of what the brain sees based on the pattern of activity of neurons. He is also interested in how clusters of neurons that share a function develop where they do in the brain, and hopes that his approach will help to map that topography. Once we are able to characterize the patterns and networks of the brain, he states, we can then develop computational models to improve artificial visual systems. Ponce recalls his own medical training to connect his research to clinical applications, for example, to save lives through improved screening that "doesn't miss anything." Finally, he references his own childhood and inspiration from scientists to motivate his work in science outreach to youth, to inspire young students every year toward careers in science.


My rating of this study: 🌸🌸🌸🌸🌸

Rose O, Johnson J, Wang B, et al. "Visual prototypes in the ventral stream are attuned to complexity and gaze behavior." Nature Communications.  12:6723. 18 November 2021. https://doi.org/10.1038/s41467-021-27027-8 

Wednesday, December 15, 2021

Large Association Study Finds Cataract Surgery Linked with Lower Risk of Dementia & Alzheimer's Disease

Article: Cataract surgery linked with lessened dementia risk
Source: University of Washington Medicine
Published: December 6, 2021
Article: Cataract Surgery Linked to Lower Risk of Developing Dementia, Even 10 Years Later
Source: ScienceAlert
Published: December 10, 2021 

Cataracts are an opacification or clouding of the eye's crystalline lens, most commonly as a result of aging and decades of filtering ultraviolet radiation. Although connections between poor vision and cognitive decline have been explored in many studies, ophthalmologists at University of Washington were interested in the effect of surgical intervention in the form of cataract extraction on dementia risk. Specifically, they looked at data from the Adult Changes in Thought (ACT) study, an ongoing longitudinal cohort study started in 1994 by Kaiser Permanente Washington and designed to study the development of dementia. Electronic medical records data was collected from 3,038 participants 65 years of age or older who had either cataract or glaucoma diagnosis before enrollment or during follow-up care. Among those included in the analysis, there were 853 cases of dementia (all cause) and 709 cases of Alzheimer's disease. Approximately half of the participants (1,382 individuals) had cataract surgery. Based on 23,554 person-years of follow-up, and after controlling for a variety of potentially confounding factors, participants who underwent cataract extraction in either eye had a 29% reduced risk of developing dementia compared to participants without surgery; moreover, the reduced risk applied for at least 10 years after surgery. Similar findings were seen in dementia specific to Alzheimer's disease. Importantly, no association was observed between glaucoma surgery and dementia risk. The authors point out that evaluation of glaucoma surgery, which, unlike cataract surgery, does not restore vision, was to address potential healthy patient bias. Although the mechanisms by which cataract extraction is associated with decreased dementia risk were not explored in this observational study, the researchers hypothesize that patients were getting higher quality sensory input after cataract extraction, highlighting neurological, circadian, and social improvements. Lead researcher of the study states, "This kind of evidence is as good as it gets in epidemiology. This is really exciting because no other medical intervention has shown such a strong association with lessening dementia risk in older individuals." Given the risk of cognitive decline in older age, interventions such as cataract surgery have major clinical relevance not only in enhancing quality of vision but also in improvement of mental health.

My rating of this study: 🌸

Lee CS, Gibbons LE, Lee AY, et al. "Association Between Cataract Extraction and Development of Dementia." JAMA Internal Medicine.  238:3391-3398. 6 December 2021. https://doi.org/10.1001/jamainternmed.2021.6990 

Tuesday, December 14, 2021

Large Single-Cell Gene Atlas of Human Eye Disorders

Article: First single-cell atlas of human, porcine eyes maps genes involved in eye disorders
Source: Agency for Science, Technology, and Research (Singapore)
Published: December 6, 2021 

Creating a disease map of the human eye  (click to enlarge)
An international team led by researchers from several universities in Singapore, with colleagues in the U.S. and other countries, have produced the first single-cell atlas of human and porcine eyes. They report applying single-cell RNA sequencing to catalogue more than 50,000 cells in human and porcine eyes, as well as developing a cell atlas that distinguishes these cells by the activity of their genes. The use of porcine eyes (and other animal species, such as zebrafish) in this study allowed for comparison of interspecies differences as well as conserved regulating factors in the eye, which the authors state is lacking in integrative research of the eye. The study produced a wide range of findings, some of which are simple, such as evidence of adult stems cells in iris tissue. Others have clinical implications regarding ocular routes of infection and disease transmission. For example, the team found that ACE2 and TMPRSS2, the primary cell surface proteins responsible for entry of SARS-CoV-2 into human, are expressed in the eye's conjunctival cells. Some of the researchers also worked on lab techniques in regenerative medicine, such as using embryonic stem cells to generate retinal ganglion cell (RGC) progenitors in culture; they discovered that a switch called KLF7 could accelerate RGC generation, with results that could inform potential therapies for eye diseases like glaucoma that results from progressive damage to the RGCs that make up the optic nerve. They are working to further validate the KLF7-derived RGCs for preclinical studies, with broad aims of understanding key molecular switches to better engineer lab-grown cells as a means of therapy.

My rating of this study:

Gautam P, Hamashima K, Chen Y, et al. "Multi-species single-cell transcriptomic analysis of ocular compartment regulons." Nature Communications.  12:5675. 28 September 2021. https://doi.org/10.1038/s41467-021-25968-8