The Role of Deregulated MicroRNAs in Age-Related Macular Degeneration Pathology.

Purpose: We previously identified three microRNAs (miRNAs) with significantly increased expression in the serum of patients with age-related macular degeneration (AMD) compared with healthy controls. Our objective was to identify potential functional roles of these upregulated miRNAs (miR-19a, miR-126, and miR-410) in AMD, using computational tools for miRNAs prediction and identification, and to demonstrate the miRNAs target genes and signaling pathways. We also aim to demonstrate the pathologic role of isolated sera-derived exosomes from patients with AMD and controls using in vitro models. Methods: miR-19a, miR-126, and miR-410 were investigated using bioinformatic approaches, including DIANA-mirPath and miR TarBase. Data on the resulting target genes and signaling pathways were incorporated with the differentially expressed miRNAs in AMD. Apoptosis markers, human apoptosis miRNAs polymerase chain reaction arrays and angiogenesis/vasculogenesis assays were performed by adding serum-isolated AMD patient or control patient derived exosomes into an in vitro human angiogenesis model and ARPE-19 cell lines. Results: A number of pathways known to be involved in AMD development and progression were predicted, including the vascular endothelial growth factor signaling, apoptosis, and neurodegenerative pathways. The study also provides supporting evidence for the involvement of serum-isolated AMD-derived exosomes in the pathology of AMD, via apoptosis and/or angiogenesis. Conclusions: miR-19a, miR-126, miR-410 and their target genes had a significant correlation with AMD pathogenesis. As such, they could be potential new targets as predictive biomarkers or therapies for patients with AMD. Translational Relevance: The functional analysis and the pathologic role of altered miRNA expression in AMD may be applicable in developing new therapies for AMD through the disruption of individual or multiple pathophysiologic pathways.

Identification of Novel Serum MicroRNAs in Age-Related Macular Degeneration.

Purpose: To identify circulating microRNAs (miRNA) associated with age-related macular degeneration (AMD). Thus differentially expressed serum miRNA could be used as AMD biomarkers. Methods: This study involved total RNA isolation from sera from patients with atrophic AMD (n = 10), neovascular AMD (n = 10), and age- and sex-matched controls (n = 10). A total of 377 miRNAs were coanalyzed using array technologies, and differentially regulated miRNAs were determined. Extensive validation studies (n = 90) of serum from AMD patients and controls confirmed initial results. Total RNA isolation was carried out from sera from patients with atrophic AMD (n = 30), neovascular AMD (n = 30), and controls (n = 30). Fourteen miRNAs from the discovery dataset were coanalyzed using quantitative real-time polymerase chain reaction (qRT-PCR) to validate their presence. Results: Unsupervised hierarchical clustering indicated that AMD serum specimens have a different miRNA profile to healthy controls. We successfully identified and validated the differentially regulated miRNAs in serum from AMD patients versus controls. The biomarker potential of three miRNAs (miR-126, miR-19a, and miR-410) was confirmed by qRT-PCR, with significantly increased quantities in serum of AMD patients compared with healthy controls. Conclusions: Increased quantities of miR-126, miR-410, and miR-19a in serum from AMD patients indicate that these miRNAs could potentially serve as diagnostic AMD biomarkers. All three miRNAs significantly correlated with AMD pathogenesis. Translational Relevance: The discovery of new AMD miRNA may act as biomarkers in evaluating AMD diagnosis and prognosis.

Panel-Based Population Next-Generation Sequencing for Inherited Retinal Degenerations.

Inherited retinopathies affect approximately two and a half million people globally, yet the majority of affected patients lack clear genetic diagnoses given the diverse range of genes and mutations implicated in these conditions. We present results from a next-generation sequencing study of a large inherited retinal disease patient population, with the goal of providing clear and actionable genetic diagnoses. Targeted sequencing was performed on 539 individuals from 309 inherited retinal disease pedigrees. Causative mutations were identified in the majority (57%, 176/309) of pedigrees. We report the association of many previously unreported variants with retinal disease, as well as new disease phenotypes associated with known genes, including the first association of the SLC24A1 gene with retinitis pigmentosa. Population statistics reporting the genes most commonly implicated in retinal disease in the cohort are presented, as are some diagnostic conundrums that can arise during such studies. Inherited retinal diseases represent an exemplar group of disorders for the application of panel-based next-generation sequencing as an effective tool for detection of causative mutations.

Maintenance of perioperative antiplatelet and anticoagulant therapy for vitreoretinal surgery.

BACKGROUND: The objective of this study was to prospectively assess the risk of bleeding from vitreoretinal surgery in a continuous unbiased cohort of patients taking unsuspended antiplatelet or anticoagulant therapy. DESIGN: Prospective hospital-based study. PARTICIPANTS: Eighty-five patients taking unsuspended aspirin, clopidogrel and/or warfarin therapy undergoing all forms of vitreoretinal surgery at The Mater Misericordiae University and The Mater Private Hospital, Dublin, Ireland. METHODS: Consecutive patients undergoing vitreoretinal surgery taking unsuspended antiplatelet or anticoagulant therapy over a 1-year period were included in this prospective study to evaluate the intraoperative and postoperative bleeding complications. MAIN OUTCOME MEASURES: The intraoperative and postoperative bleeding rates. RESULTS: One hundred and seven vitreoretinal procedures were performed on 85 patients taking unsuspended antiplatelet or anticoagulant therapy. The intraoperative bleeding rate was 23%, the majority of which consisted of mild bleeding into the vitreous cavity during vitrectomy. The postoperative bleeding rate was 22%, consisting of 3.7% anterior chamber haemorrhage, 11% dispersed vitreous cavity haemorrhage, 4.7% dense vitreous cavity haemorrhage, 0.9% subretinal haemorrhage and 1.9% localized choroidal haemorrhage. The single greatest significant independent predictor of intraoperative bleeding was proliferative diabetic retinopathy and of postoperative bleeding was the presence of diabetes mellitus. CONCLUSIONS: There were no cases of uncontrolled intraoperative haemorrhage or serious postoperative choroidal haemorrhage. Mild haemorrhagic oozing during vitrectomy and dispersed vitreous cavity haemorrhage postoperatively were common. For the majority of patients taking antiplatelet or anticoagulant medication, these agents can be safely continued in the vitreoretinal surgical perioperative period.