A preliminary evaluation of dexamethasone palmitate emulsion: a novel intravitreal sustained delivery of corticosteroid for treatment of macular edema.

PURPOSE: Dexamethasone palmitate (DXP) is a lipophilic prodrug of dexamethasone (DXM), a potent corticosteroid used to treat a variety of ophthalmic diseases. The aim of the study was to characterize the sustained release capacity (in rabbit), efficacy (in rat and rabbit), and safety (in rabbit, cat, and minipig) of intravitreal (IVT) DXP emulsions in preclinical models. METHODS: Oil-in-water emulsions of DXP were administered by IVT injections in rats, rabbits, cats, or minipigs. Efficacy was assessed in rabbits by the inhibition of VEGF-induced vascular leakage and in rats by inhibition of laser-induced choroidal neovascularization. Concentrations of DXP and DXM in aqueous humor, vitreous, retina, choroid, and blood were determined to characterize the ocular and systemic pharmacokinetic (PK) profile. Complete ophthalmic examinations (indirect ophthalmoscopy, slit-lamp biomacroscopy, electroretinography, tonometry) were performed to assess the ocular safety of IVT DXP doses up to 2,600 µg in minipig, followed by histopathologic examinations. A validated feline model of DXM-induced elevated intraocular pressure (IOP) was used to assess the ocular hypertensive impact (i.e., the safety) of an IVT injection of DXP emulsion. RESULTS: Rat and rabbit efficacy data demonstrated that IVT injections of DXP emulsions were effective. Rabbit PK data demonstrated that following a single 1,280 µg IVT injection resulted in sustained DXM levels in the retina and choroid (1,179.6 and 577.7 ng/g with a half-life of 189 and 103 days, respectively) sufficient to inhibit VEGF-induced vascular hyper-permeability for up to 9 months. No adverse ocular findings were observed in the rabbit at the 1,280 µg DXP dose. Plasma levels of DXP and DXM were close to the lower limit of quantification (0.5 ng/mL). In minipigs, no systemic effects were observed at a dose up to 2,600 µg DXP. In steroid responsive cats, IVT DXP emulsions increased IOP to a lesser extent than triamcinolone acetonide with a more rapid return to basal levels and no evidence of cataract formation. CONCLUSIONS: IVT injections of DXP emulsions were well tolerated and shown to be efficacious for the sustained release of the drug, with the potential to control vascular leakage up to 9 months following a single IVT injection. These data suggest that IVT injections of DXP emulsions could be a safe and effective alternative IVT drug delivery vehicle for corticosteroid to treat back of the eye diseases complicated by macular edema.

Anti-inflammatory effects of lipoxins on lipopolysaccharide-induced uveitis in rats.

PURPOSE: Lipoxins exert potent anti-inflammatory and pro-resolving actions by reducing polymorphonuclear neutrophil (PMN) infiltration. This study describes the effect of lipoxin A4 and a stable analog on the resolution of ocular inflammation induced by intravitreal injection of lipopolysaccharides (LPS) in rats. METHODS: Six- to eight-week-old male Sprague Dawley (SD) rats were injected intravitreally with 2.5 microL physiologically balanced solution (LPS) containing 5 ng LPS, or 5 ng LPS + 50 ng LXA4 or 5 ng LPS + 50 ng 15-epi-LXA4 analog. Rats were anesthetized with intraperitoneal injection of a ketamine and xylazine cocktail. At 24 h, the animals were again anesthetized and the eyes examined for clinical signs of inflammation. The animals were then euthanized by CO2 inhalation and aqueous humor was collected in heparinized saline. Aqueous humor PMNs were counted using an Improved Neubauer Hemocytometer, and the protein concentration was determined by standard procedure. After enucleation, the eyes were dissected to remove the lens and the ocular tissues were frozen in liquid nitrogen and stored at -80 degrees C. Myeloperoxidase assay was done by a standard procedure. RESULTS: Compared to untreated LPS-injected controls, rats treated with either LXA4 or its stable analog had lower clinical inflammation score, significantly reduced aqueous humor PMN cell counts, aqueous humor protein levels, and the MPO values. The difference between the mean values of aqueous humor protein and MPO in the LXA4 and the analog injected eyes was not statistically significant, but PMN cell counts were significantly different. CONCLUSIONS: The ocular inflammatory response to intravitreally injected LPS in rats is significantly reduced by simultaneous injection of LXA4 or its analog. This finding supports an earlier independent observation of the ocular anti-inflammatory effect of LXA4. Further investigation of lipoxins in the eye might offer a novel therapeutic approach to treating ocular inflammation in man.

Plasma membrane Ca-ATPase isoform expression in human cataractous lenses compared to age-matched clear lenses.

The plasma membrane calcium ATPase (PMCA) pump is the major mechanism by which calcium is removed from the lens. The aim of this study was to determine if mRNA and proteins levels of PMCA isoforms changed with age or lens opacity. mRNA was quantified using a quantitative real-time reverse transcription polymerase chain reaction assay (RT-PCR). PMCA protein levels were quantified using Western blot analysis. No PMCA mRNA or proteins were detected in human lens fiber cells. The mRNA and protein levels of PMCA1, 3 and 4 in the epithelium of cataractous lenses were similar to those of epithelium from age-matched clear lenses and were also the same in younger lenses. PMCA2 mRNA and protein levels were 1.6-2.5 times higher, respectively, in cataractous lenses compared to age-matched clear lenses. Elevated PMCA2 expression in cataractous lenses might be a compensatory mechanism to overcome higher intracellular calcium levels in cataract.

Regulation of sarco/endoplasmic and plasma membrane calcium ATPase gene expression by calcium in cultured human lens epithelial cells.

Since Ca(2+)-ATPase is a major determinant of calcium homeostasis in the lens, we examined the expression of Ca(2+)-ATPase by calcium. An immortalized human lens epithelial cell line, HLE B-3, was treated with thapsigargin to inhibit sarco/endoplasmic reticulum Ca(2+)-ATPase (SERCA) releasing calcium from intracellular stores. Isoforms of the plasma membrane Ca(2+)-ATPase (PMCA) and SERCA were quantified by Western blot and quantitative real time reverse transcription polymerase chain reaction. We showed that both PMCA1 and SERCA3 isoform protein and mRNA are upregulated two- to three-fold in thapsigargin-treated HLE B-3 cells in a time and dose-dependent manner. Thapsigargin did not change the protein or mRNA levels of PMCA2, 3, 4 or SERCA2b. Considering the harmful effects of increased intracellular calcium levels, the upregulation of both SERCA and PMCA pumps suggests it is a compensatory mechanism to restore the calcium concentration to the physiological resting level.

The influence of membrane lipid structure on plasma membrane Ca2+ -ATPase activity.

Lipid composition and Ca(2+)-ATPase activity both change with age and disease in many tissues. We explored relationships between lipid composition/structure and plasma membrane Ca(2+)-ATPase (PMCA) activity. PMCA was purified from human erythrocytes and was reconstituted into liposomes prepared from human ocular lens membrane lipids and synthetic lipids. Lens lipids were used in this study as a model for naturally ordered lipids, but the influence of lens lipids on PMCA function is especially relevant to the lens since calcium homeostasis is vital to lens clarity. Compared to fiber cell lipids, epithelial lipids exhibited an ordered to disordered phase transition temperature that was 12 degrees C lower. Reconstitution of PMCA into lipids was essential for maximal activity. PMCA activity was two to three times higher when the surrounding phosphatidylcholine molecules contained acyl chains that were ordered (stiff) compared to disordered (fluid) acyl chains. In a completely ordered lipid hydrocarbon chain environment, PMCA associates more strongly with the acidic lipid phosphatidylserine in comparison to phosphatidylcholine. PMCA associates much more strongly with phosphatidylcholine containing disordered hydrocarbon chains than ordered hydrocarbon chains. PMCA activity is influenced by membrane lipid composition and structure. The naturally high degree of lipid order in plasma membranes such as those found in the human lens may serve to support PMCA activity. The absence of PMCA activity in the cortical region of human lenses is apparently not due to a different lipid environment. Changes in lipid composition such as those observed with age or disease could potentially influence PMCA function.

Prostaglandin E2 receptor subtypes, EP1, EP2, EP3 and EP4 in human and mouse ocular tissues--a comparative immunohistochemical study.

The purpose of the present study was to compare the localization of prostaglandin E(2) receptor subtypes in normal human and mouse ocular tissues. Paraffin embedded sections of normal human and mouse (129 Sv/Ev) eyes were treated with EP(1), EP(2), EP(3) and EP(4) specific antibodies and subsequently incubated with Alexa Fluor secondary antibody (Ex/Em=555/571) to detect the presence of EP receptor proteins. Fluorescence of the localized antibodies was visualized in a Carl Zeiss Microscope (Axiovert 200) and photographed using Carl Zeiss Axiocam camera. In mice EP(1) and EP(3) receptor subtypes were only moderately expressed, EP(3) receptor expression being almost negligible. In human cornea and iris ciliary body, EP(1) and EP(3) receptors were prominently expressed. EP(4) receptor was expressed moderately in human and mouse ocular tissues. EP(2) receptor was the most prominently and abundantly expressed receptor in both human and mouse ocular tissues. It is concluded that the pattern of the distribution of EP receptor subtypes in the ocular tissues are similar in human and mouse. Thus, 129 Sv/Ev strains of mice would make an appropriate animal model for studying the ocular pathophysiological roles of prostaglandin receptor agonists.

ATPases and lens ion balance.

In the lens, different cells appear to be specialized such that some have a high capacity for energy-dependent ion transport while others do not. This short review describes the distribution of functional Na,K-ATPase activity and Ca-ATPase activity in the lens. Movement of ions in the extracellular space between lens fibers, a topic studied by David Maurice 25 years ago, is discussed together with cell-to-cell movement of ions which is facilitated by extensive coupling in the lens cell mass. The expression of different Na,K-ATPase and Ca-ATPase isoforms in lens epithelium and fiber cells is considered along with mechanisms that potentially regulate the activity of these transport proteins.

AL-2512, a novel corticosteroid: preclinical assessment of anti-inflammatory and ocular hypertensive effects.

The anti-inflammatory efficacy and ocular hypertensive effect of AL-2512 were characterized in rodent and feline models of ocular inflammation. Neutrophil influx into ocular tissue following topical ocular administration of test drugs was evaluated in models of endotoxin-induced uveitis. In rats, the anti-inflammatory efficacy of AL-2512 was compared with that of 0.1% dexamethasone. Test drug or vehicle was administered topically before subplantar injection of endotoxin. Neutrophil influx was assessed at 24 hours. Feline eyes, injected intravitreally with endotoxin, were treated topically with 0.1% AL-2512, 1.0% prednisolone acetate or vehicle at various timepoints before and after endotoxin injection. At 12 hours, protein concentration and leukocyte count in aqueous humor were determined. In the feline intraocular pressure (IOP) model, after baseline IOP values were established, AL-2512, dexamethasone, or vehicle was administered topically to both eyes of cats. IOP was measured daily before and during treatment. Topical ocular administration of AL-2512 inhibited endotoxin-induced leukocyte influx in rodent and feline models of uveitis. In rats, AL-2512 significantly inhibited neutrophil influx by 89%, compared with 93% by dexamethasone. In feline eyes, AL-2512 significantly (p < 0.05) inhibited leukocyte infiltration of aqueous humor by 59%, compared to 37% inhibition by prednisolone acetate. Intraocular pressure in cats treated for 32 days with AL-2512 or dexamethasone increased 6% and 18%, respectively. The ocular anti-inflammatory effect of AL-2512 was equivalent to dexamethasone and superior to prednisolone acetate in rat and feline models of ocular inflammation, respectively. This steroid provides anti-inflammatory efficacy equivalent to dexamethasone with a reduced risk of inducing ocular hypertension.

Regional distribution of Na,K-ATPase activity in porcine lens epithelium.

PURPOSE: It has been established that Na,K-ATPase activity is higher in lens epithelium than fibers. However, others have suggested the Na,K-ATPase enzyme may be inactive or absent in the central 10% of the epithelium. Studies were conducted to measure and compare Na,K-ATPase specific activity and to examine Na,K-ATPase protein expression in the anterior and equatorial regions of porcine lens epithelium. METHODS: Na,K-ATPase activity was determined by measuring the ouabain-sensitive rate of adenosine triphosphate (ATP) hydrolysis. Western blot analysis was used to detect Na,K-ATPase catalytic subunit (alpha) and glycoprotein subunit (beta) protein as well as beta-actin which was used as a loading control. RESULTS: Na,K-ATPase specific activity was more than two times higher in the equatorial epithelium than the anterior 50% of the epithelium. However, the abundance of Na,K-ATPase alpha1 isoform protein was similar in the two regions. Neither the alpha2 nor alpha3 Na,K-ATPase isoform could be detected in the anterior or equatorial epithelium, but Na,K-ATPase beta1 protein was detected in both regions. In contrast to the observed regional difference in Na,K-ATPase activity, the activity of a different P-type ATPase, plasma membrane Ca-ATPase (PMCA), was not significantly different in the anterior and central epithelium. Western blot analysis indicated the presence of two PMCA isoforms, PMCA2, and PMCA4. CONCLUSIONS: Na,K-ATPase activity is significantly higher at the equatorial region of the epithelium compared with the anterior, even though the level of Na,K-ATPase protein is similar in the two regions. It is possible that nonuniform distribution of functional Na,K-ATPase activity contributes to the driving force for circulating solute movement through the lens fiber mass.

Blood-aqueous barrier in prostaglandin EP2 receptor knockout mice.

The role of prostaglandin EP(2) receptors in the disruption of the blood-aqueous barrier was examined using EP(2) receptor-deficient mice. Eyes were topically treated with EP receptor agonists or subjected to paracentesis. Fluorescein angiography was performed after topical treatment with 2.0 icrog butaprost. The results show that EP receptor agonists, PGE( 2) and the EP(2) receptor-selective agonist butaprost, increased aqueous humor protein in EP(2) +/+ wild-type mice to 18.0 mg/ml and 12.0 mg/ml, respectively, from the control value of 2.7 mg/ml. The increase in aqueous humor protein concentration in response to these EP receptor agonists was reduced significantly in EP(2) receptor-deficient mice. Fluorescein leakage into the anterior chamber, two minutes after its injection, was significantly greater in butaprost-treated wild-type mice than in butaprost-treated knockout mice. Protein concentration, 15 min after paracentesis, increased from 2.2 mg/ml to 25.0 mg/ml in the aqueous humor of the eyes of wild-type mice, while the increase in knockout mice was 10.6 mg/ml. These results suggest that EP( 2) and EP(4) receptors mediate the disruption of the blood-aqueous barrier induced by EP receptor agonists and paracentesis.