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1From the Departments of Mechanical and Industrial Engineering and 2Ophthalmology, University of Toronto, Toronto, Ontario, Canada.
| Abstract |
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METHODS. After baseline facility measurement in human eye bank eyes (n = 9 pairs), one eye of each pair received anterior chamber exchange and continued perfusion with medium containing 1 µM latrunculin-B. Contralateral eyes were treated in a similar manner with vehicle. Eyes were fixed by anterior chamber exchange and perfusion with universal fixative at 8 mm Hg (corresponding to a physiologic pressure of 15 mm Hg in vivo), and outflow pathway tissues were examined by transmission and scanning electron microscopy.
RESULTS. Perfusion of eyes with 1 µM latrunculin-B caused a continuous and ongoing increase in outflow facility, resulting in a net facility difference of 64% 2 hours after drug administration (P < 0.006). Transmission electron microscopy showed subtle and focal detachment of the inner wall of Schlemms canal, rarefaction of the juxtacanalicular tissue (JCT), and cell-cell and cell-matrix detachment. Scanning electron microscopy showed collapsed vacuoles in the inner wall of Schlemms canal and a marked increase in the number and size of border (paracellular) pores in the inner wall.
CONCLUSIONS. Latrunculin-B increases outflow facility in postmortem human eyes. The mechanism of facility increase is most likely due to loss of mechanical integrity of the trabecular meshwork as a consequence of reduction in cell-cell and cell-matrix adhesion. The facility increase and the extent of inner wall separation from the JCT that we observed were both qualitatively similar to that reported in living monkey eyes, but the magnitude of the facility increase and morphologic changes were much less than in the living monkey. This supports the idea that inner wall separation from the JCT may modulate outflow facility.
The latrunculins are specific actin-disrupting agents that act by sequestering monomeric G-actin, thereby promoting depolymerization of F-actin filaments.5 6 Among the latrunculins, latrunculin (Lat)-B has been the most extensively tested for its effects on outflow facility. It increases outflow facility in living monkey eyes at high3 7 and low8 doses, as well as in perfused porcine anterior segments.9 However, the effects of Lat-B on outflow facility have not been tested in human eyes.
The goals of the present work were twofold. First, we wanted to determine the effects of Lat-B on outflow facility in enucleated human eyes. Second, we wanted to investigate how Lat-B affects ultrastructure and architecture of the trabecular meshwork (including the inner wall of Schlemms canal) so as to gain insight into the mechanism(s) whereby Lat-B affects outflow facility.
Our results show that perfusion with 1 µM Lat-B has a dramatic influence on outflow facility in enucleated human eyes, similar in magnitude to that in enucleated porcine eyes, but less than that in living monkey eyes. However, unlike in the monkey eye, this facility increase is accompanied by only very modest rarefaction of the juxtacanalicular tissue (JCT) and separation of the inner wall of Schlemms canal from the JCT. However, there were increased openings between inner wall cells (more border or paracellular pores) in Lat-B-treated human eyes.
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Ostensibly normal human eyes were obtained from eye banks and managed in accordance with the Declaration of Helsinki. After discarding four pairs of eyes with unstable or asymmetric baseline facility traces, or unacceptable trabecular meshwork morphology, nine pairs remained in the study. The mean donor age was 76.1 years (range, 6483), and the mean postmortem time to the start of perfusion was 22.5 hours (range, 1627.5). Baseline facility was measured for 60 to 90 minutes by perfusion into the posterior chamber with DBG. All perfusions were performed at a constant pressure of 8 mm Hg (corresponding to 15 mm Hg in vivo) using previously described techniques.10 At the completion of baseline facility measurement, one eye of each pair received anterior chamber exchange with a solution of 1 µM Lat-B. Contralateral eyes were treated in a similar manner with vehicle. Care was taken during the anterior chamber exchange to maintain a constant IOP of 8 mm Hg. Eyes were then further perfused with their respective solution at 8 mm Hg for approximately 120 minutes, while measuring facility.
One of these nine pairs of eyes was noteworthy. It was originally identified as being from a donor with primary open-angle glaucoma. A review of the medical records indicated that the donor, an 89-year-old woman, had received a diagnosis of primary open-angle glaucoma in the mid-1980s and was treated with betaxolol HCl and pilocarpine at that time. Cataract surgery was performed in 1993 (OS) and 1998 (OD) and glaucoma medications were discontinued in 1993. IOP measurements 1 month before death in 2001 were 14 mm Hg OU, and facility measurements in our laboratory gave baseline facilities of 0.20 µL/min per mm Hg OU. We therefore considered these eyes to be normal, but because of their unusual history (including 8 years of glaucoma medications) we examined how they might differ from the other eyes in the study, as described more fully later.
We present the facility data in two ways. The first is obtained by simple averaging of facility data between eyes, and the results are reported as the mean ± SEM. The second is obtained by normalizing the raw facility data, thereby allowing comparison of relative facility changes between pairs of eyes. Normalization involved dividing the measured facility at each time for a given eye by the average facility reading for that eye in the 30-minute period before anterior chamber exchange with Lat-B. The percentage facility change due to Lat-B perfusion was then computed as 100 · (Cnorm, post Cnorm, pre), where Cnorm, pre and Cnorm, post were the normalized facilities before and after Lat-B exchange. The statistical significance of facility changes due to Lat-B was computed from a paired two-tailed Students t-test using the percentage normalized facility change as the statistic of interest.
Morphology
At the conclusion of facility measurement after Lat-B perfusion, all eyes were fixed by anterior chamber exchange and perfusion with 3% paraformaldehyde at 8 mm Hg, after which the eye was opened, and wedges of outflow tissue were cut. Half the wedges from each eye, including tissue from every quadrant, were then immersion fixed overnight in universal fixative (2.5% paraformaldehyde, 2.5% glutaraldehyde in Sörensens buffer) for use in electron microscopy, whereas the other half of the wedges were immersion fixed in 3% paraformaldehyde overnight. In two of the nine pairs, the duration of perfusion with fixative was for 60 to 90 minutes. In the other seven pairs, the fixation duration was adjusted so as to equalize fixative volume between fellow eyes of a pair and hence compensate for fixative-induced pore formation in the inner wall of Schlemms canal.11 We refer to this fixation approach as "fixative volume compensation."
Tissue from eyes that had been fixed using fixative volume compensation was processed for transmission electron microscopy (TEM) and scanning electron microscopy. Briefly, for TEM, radial segments of the limbal area were dissected, postfixed in 1% osmium tetroxide, dehydrated, infiltrated, and embedded in Epon-Araldite. Ultrathin sections were stained with uranyl acetate and lead citrate. Samples from all four quadrants were examined, except for three pairs of eyes where only two of the four quadrants were examined. Adjacent tissue samples were microdissected and processed using conventional methods12 13 to produce scanning electron microscopy montages of the inner and outer walls of Schlemms canal. Standard techniques11 12 14 were used to measure the density and size of pores between inner wall cells (paracellular, border or "B " pores) and pores through inner wall cells (intracellular or "I " pores). Inner wall samples from all four quadrants were analyzed in four pairs of eyes and from one quadrant only in two pairs of eyes. The average area analyzed per quadrant by SEM was 128,000 µm2.
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| Discussion |
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We also observed a small increase in the facility of control eyes, but this was not statistically significant for the 30-minute period before fixation. This small increase could be due to the DMSO in the vehicle, although, at the concentrations that we used, DMSO has been reported to have no effect on facility in the living monkey eye.16 Perhaps human donor eyes are more sensitive to DMSO, which could explain the cell debris that was occasionally seen in the outflow tissues in this study.
The morphologic correlates of this increased facility included occasional focal detachment of the inner wall of Schlemms canal from the JCT and a very pronounced increase in the density and mean size of paracellular pores. We did not measure the extent of inner wall detachment, but estimate that detached areas represented no more than approximately 10% to 15% of the total length of the inner wall of Schlemms canal. The inner wall detachment and associated rarefaction of the JCT that we observed is qualitatively consistent with those reported by Sabanay et al.15 in the living monkey eye. However, they reported very extensive regions of inner wall detachment, "stretching" of inner wall cells, and associated rarefaction and "ballooning" of the underlying JCT. The inner wall detachment that we observed was much smaller in magnitude and extent than that seen in monkey eyes. There are several possible explanations as to why there was such a pronounced difference between monkey and human eyes in their morphologic and facility responses to Lat-B. It could be a postmortem effect, since we perfused enucleated human eyes while monkey experiments were performed in live animals. It could be an age difference, because the human eyes were relatively elderly while monkeys would tend to be younger. However, we believe that it is most likely that this difference is related to differences in the extent of attachment between the inner wall and the underlying JCT. The human eye is invested with a very extensive network of elastic tendons that extend into the subendothelial region of the JCT,17 18 and these tendons show increased amounts of surrounding sheath-derived plaque materials with age.19 This network would be likely to help stabilize the JCT and inner wall region in the aged human eye, most probably to a greater extent than in younger monkey eyes. The difference between the monkey and human results may also be due in part to differences in the perfusion protocol. When perfusing monkey eyes, it is necessary to elevate IOP above the spontaneous level, thereby leading to increased mechanical stresses on the TM. When the TM is exposed to both cytoskeletal-disrupting agents, such as Lat-B, and elevated mechanical stresses, distension, and ballooning of the JCT may be the natural result.
The increased inner wall separation seen in the monkey eye seems to be consistent with the greater Lat-B induced facility increase in the monkey eye compared with the human eye. This is also consistent with findings suggesting that washout (present in the monkey and absent in the human20 ) correlates with inner wall separation from the JCT.21 In addition to inner wall detachment, we observed "collapsed" inner wall giant vacuoles, thinning of the walls of giant vacuoles, and a notable increase in number and size of paracellular pores in Lat-B-treated eyes. Giant vacuole collapse could reflect redirection of fluid to lower resistance pathways (e.g., possibly due to focal JCT rarefaction or increased density of inner wall openings, or possibly may indicate that actomyosin tone is necessary to deflate giant vacuoles. An increased density of inner wall pores was not reported in previous studies of Lat-B,15 but could easily have been present but undetectable by transmission and light microscopy of conventional sagittal sections. We estimate that conventional ultrathin sagittal sections through the TM (two per quadrant x four quadrants) visualize only approximately 0.01% of the inner wall, making it difficult to detect even relatively large increases in small, infrequently occurring structures such as inner wall pores. Our experience is that observation of an increase in the density of such structures requires the large sampling area provided by scanning electron microscopy. Of course, because the physiological role of inner wall pores is unclear (including which pores, if any, are artifactual11 22 ), their role in facilitating outflow after lat-B treatment is circumstantial at present.
As an aside, it is interesting to comment on the features of the pair of eyes that had received glaucoma medications for many years. The facility of these eyes was normal, but the control eye of this pair had almost double the paracellular pore density and size of the other control eyes, and the response of inner wall pores to Lat-B was remarkably different from that in all other eyes. We cannot explain this difference, but note that Grierson et al.23 have shown that pilocarpine administration increases inner wall pore size and density. We speculate that pilocarpine administration (or other glaucoma medications) may have affected inner wall pores in this pair of eyes as well.
Generally speaking, the morphologic changes we observed were consistent with a loss of mechanical integrity in the trabecular meshwork/inner wall of Schlemms canal. Considering the rapidity and the magnitude of the Lat-B induced facility increase, this loss of integrity due to reduced cell-cell and cell-matrix attachment seems to be the most likely source of the facility change. We cannot say what the ultimate cause of the facility increase was. Likely candidates include the increase in inner wall paracellular pore density and inner wall separation from the JCT. However, the fact that greater inner wall separation was associated with greater facility increase (when comparing monkey eyes to human eyes) surely is interesting, is consistent with observations in bovine eyes,21 and suggests that agents that target inner wall-JCT attachment could be important in modulating outflow facility.
| Acknowledgements |
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Supported by Canadian Institutes of Health Research Grant MA-10051.
Submitted for publication March 14, 2005; revised August 24 and September 30, 2005; accepted February 27, 2006.
Disclosure: C.R. Ethier, None; A.T. Read, None; D.W.-H. Chan, None
The publication costs of this article were defrayed in part by page charge payment. This article must therefore be marked "advertisement" in accordance with 18 U.S.C.
1734 solely to indicate this fact.
Corresponding author: C. Ross Ethier, Department of Mechanical and Industrial Engineering, 5 Kings College Road, University of Toronto, Toronto, Ontario M5S 3G8, Canada; ethier{at}mie.utoronto.ca.
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