Proof of Concept for Levodopa Treatment in Rescuing Retinal Morphology and Visual Function in Albinism (PDF)

There is a paucity of treatments for oculocutaneous albinism (OCA), a condition characterised by pigment deficiency, abnormal retinal development, and significant visual disability. L-DOPA, a signalling molecule which is essential for normal retinal development, is deficient in OCA. Residual plasticity of the developing retina in young children with albinism has been demonstrated, suggesting a post-natal window for therapeutic rescue. In this study, we investigate if post-natal retinal morphology and visual function in OCA can be improved through oral Levodopa supplementation, if administered during the critical period of neuroplasticity

Proof of Concept for Levodopa Treatment in Rescuing Retinal Morphology and Visual Function in Albinism (Video)

There is a paucity of treatments for oculocutaneous albinism (OCA), a condition characterised by pigment deficiency, abnormal retinal development, and significant visual disability. L-DOPA, a signalling molecule which is essential for normal retinal development, is deficient in OCA. Residual plasticity of the developing retina in young children with albinism has been demonstrated, suggesting a post-natal window for therapeutic rescue. In this study, we investigate if post-natal retinal morphology and visual function in OCA can be improved through oral Levodopa supplementation, if administered during the critical period of neuroplasticity

Proof of Concept for Levodopa Treatment in Rescuing Retinal Morphology and Visual Function in Albinism (Slides)

There is a paucity of treatments for oculocutaneous albinism (OCA), a condition characterised by pigment deficiency, abnormal retinal development, and significant visual disability. L-DOPA, a signalling molecule which is essential for normal retinal development, is deficient in OCA. Residual plasticity of the developing retina in young children with albinism has been demonstrated, suggesting a post-natal window for therapeutic rescue. In this study, we investigate if post-natal retinal morphology and visual function in OCA can be improved through oral Levodopa supplementation, if administered during the critical period of neuroplasticity

A laser-induced mouse model of progressive retinal degeneration with central sparing displays features of parafoveal geographic atrophy

There are no disease-modifying treatments available for geographic atrophy (GA), the advanced form of dry age-related macular degeneration. Current murine models fail to fully recapitulate the features of GA and thus hinder drug discovery. Here we describe a novel mouse model of retinal degeneration with hallmark features of GA. We used an 810 nm laser to create a retinal lesion with central sparing (RLCS), simulating parafoveal atrophy observed in patients with progressive GA. Laser-induced RLCS resulted in progressive GA-like pathology with the development of a confluent atrophic lesion. We demonstrate significant changes to the retinal structure and thickness in the central unaffected retina over a 24-week post-laser period, confirmed by longitudinal optical coherence tomography scans. We further show characteristic features of progressive GA, including a gradual reduction in the thickness of the central, unaffected retina and of total retinal thickness. Histological changes observed in the RLCS correspond to GA pathology, which includes the collapse of the outer nuclear layer, increased numbers of GFAP + , CD11b + and FcγRI + cells, and damage to cone and rod photoreceptors. We demonstrate a laser-induced mouse model of parafoveal GA progression, starting at 2 weeks post-laser and reaching confluence at 24 weeks post-laser. This 24-week time-frame in which GA pathology develops, provides an extended window of opportunity for proof-of-concept evaluation of drugs targeting GA. This time period is an added advantage compared to several existing models of geographic atrophy

Oral human-equivalent L-DOPA/Carbidopa dosages administered during the postnatal critical period of neuroplasticity rescues retinal morphology and visual function in a mouse model of human albinism

Purpose : Evidence of ongoing retinal development in children with albinism has been demonstrated. L-DOPA, a key molecule for the correct development of the retina, is known to be deficient in the developing albino eye, resulting in abnormalities of retinal structure and visual impairment. Thus, we investigated if human equivalent doses of L-DOPA/Carbidopa (i.e. doses established for the treatment of infantile dystonia and amblyopia), can rescue visual function in a mouse model of human oculocutaneous albinism (OCA), if administered during the postnatal critical period of neuroplasticity.Methods : C57BL/6J (B6; n=24) and C57BL/6J-c2J OCA (CALBs; n=10) mice were treated with a 28-day course of oral L-DOPA/Carbidopa 9.4/2.3 mg/kg, from 15 to 43 days postnatal age (PNA) and compared to untreated B6 mice (n=8) and CALBs (n=16). Retinal morphology and function were assessed at 6 weeks PNA using optical coherence tomography and electroretinography. Photopic spatial frequency thresholds (i.e. visual acuity) were assessed by optokinetic nystagmus using an OptoMotry system at 7 weeks PNA.Results : At 6 weeks PNA, the outer nuclear layer (ONL) thickness of untreated CALBs was significantly increased (61.5±0.2 vs 66.6±0.2 μm; p=0.0004). The ONL of treated CALBs (61.9±0.2 μm) recovered the same thickness found in B6 mice (61.3±0.3μm; p=0.779). A- and B-wave amplitudes were significantly diminished in untreated CALBs (284±18 vs 176±15 μV; p=0.0033; and -136±19 vs -85±9 μV; p=0.0298). Treated CALBs recovered amplitudes similar to B6 mice (340±16 and -183±9 μV, respectively). Photopic spatial frequency thresholds, were significantly lower in untreated CALBs; clock-wise (CW) (0.458±0.059 vs 0.188±0.095 c/d; p=0.0038) and clock-counter-wise (CCW) (0.401±0.012 vs 0.107±0.001 c/d; p=0.0012). Both thresholds improved in treated CALBs, reaching comparable levels to B6 mice (CW: 0.419±0.021 vs 0.292±0.026 c/d; p=0.1009; and CCW: 0.382±0.027 vs 0.330±0.044 c/d, respectively; p=0.5778).Conclusions : Our results demonstrate that human equivalent doses of oral L-DOPA/Carbidopa supplementation during the critical postnatal period of retinal neuroplasticity can rescue visual function and retinal morphology in a mouse model of albinism. This novel work brings an effective treatment for children with albinism one step closer

Human equivalent doses of l-DOPA rescues retinal morphology and visual function in a murine model of albinism

l-DOPA is deficient in the developing albino eye, resulting in abnormalities of retinal development and visual impairment. Ongoing retinal development after birth has also been demonstrated in the developing albino eye offering a potential therapeutic window in humans. To study whether human equivalent doses of l-DOPA/Carbidopa administered during the crucial postnatal period of neuroplasticity can rescue visual function, OCA C57BL/6 J-c2J OCA1 mice were treated with a 28-day course of oral l-DOPA/Carbidopa at 3 different doses from 15 to 43 days postnatal age (PNA) and for 3 different lengths of treatment, to identify optimum dosage and treatment length. Visual electrophysiology, acuity, and retinal morphology were measured at 4, 5, 6, 12 and 16 weeks PNA and compared to untreated C57BL/6 J (WT) and OCA1 mice. Quantification of PEDF, βIII-tubulin and syntaxin-3 expression was also performed. Our data showed impaired retinal morphology, decreased retinal function and lower visual acuity in untreated OCA1 mice compared to WT mice. These changes were diminished or eliminated when treated with higher doses of l-DOPA/Carbidopa. Our results demonstrate that oral l-DOPA/Carbidopa supplementation at human equivalent doses during the postnatal critical period of retinal neuroplasticity can rescue visual retinal morphology and retinal function, via PEDF upregulation and modulation of retinal synaptogenesis, providing a further step towards developing an effective treatment for albinism patients.</p

Evidence that the Ser192Tyr/Arg402Gin in cis tyrosinase gene haplotype is a disease-causing allele in oculocutaneous albinism type 1B (OCA1B)

Oculocutaneous albinism type 1 (OCA1) is caused by pathogenic variants in the TYR (tyrosinase) gene which encodes the critical and rate-limiting enzyme in melanin synthesis. It is the most common OCA subtype found in Caucasians, accounting for ~50% of cases worldwide. The apparent 'missing heritability' in OCA is well described, with ~25-30% of clinically diagnosed individuals lacking two clearly pathogenic variants. Here we undertook empowered genetic studies in an extensive multigenerational Amish family, alongside a review of previously published literature, a retrospective analysis of in-house datasets, and tyrosinase activity studies. Together this provides irrefutable evidence of the pathogenicity of two common TYR variants, p.(Ser192Tyr) and p.(Arg402Gln) when inherited in cis alongside a pathogenic TYR variant in trans. We also show that homozygosity for the p.(Ser192Tyr)/p.(Arg402Gln) TYR haplotype results in a very mild, but fully penetrant, albinism phenotype. Together these data underscore the importance of including the TYR p.(Ser192Tyr)/p.(Arg402Gln) in cis haplotype as a pathogenic allele causative of OCA, which would likely increase molecular diagnoses in this missing heritability albinism cohort by 25-50%