Proliferative retinopathy: study of the contribution of neuroglial alterations and development of gene therapy approaches

La retinopatía diabética es la causa más común de ceguera adquirida en los países desarrollados, con una alta prevalencia en los pacientes diabéticos. El desarrollo de nuevas terapias requiere un buen conocimiento de la patología de la enfermedad y para ello son necesarios buenos modelos animales. Dichos modelos también resultan esenciales para ensayar el potencial de las nuevas terapias. El ratón transgénic IGF-I constituye un excelente modelo de retinopatía, ya que desarrolla la mayoría de las alteraciones vasculares presentes en los pacientes diabéticos. Para completar la caracterización del fenotipo de la retina de los animales TgIGF-I, la primera parte de esta tesis se centra en el estudio de las alteraciones de las neuronas y las células de la glia en las retinas transgénicas. Los resultados obtenidos muestran que los animales transgénicos presentan una pérdida progresiva de sus respuestas electroretinográficas resultando en una disfunción neuronal grave en los animales transgénicos de avanzada edad. Se detecta gliosis y microgliosis en las retinas de animales transgénicos jóvenes. La gliosis está relacionada con la pérdida de funciones esenciales para la supervivencia de las neuronas que realizan las células de Müller. Las retinas transgénicas presentan cambios en su metabolismo, relacionados con el reciclaje del glutamato, signos de estrés oxidativo y alteraciones en la homeostasis del potasio. Estas alteraciones pueden ser la causa de la disfunción neuronal observada en las retinas transgénicas, que además puede ser agravada por el incremento en la producción de citoquinas pro-inflamatorias. La segunda parte este trabajo se dedicó al estudio de la eficacia de una aproximación de terapia génica dirigida a contrarrestar la neovascularización y la neurodegeneración en la retinopatía diabética. Los vectores adeno-asociados (12V) de tipo 2 fueron escogidos para sobreexpresar el Pigmented Epithelium Derived Factor (PEDF), una proteina con potentes propiedades antiangiogénicas y neuroprotectoras. La transferencia génica del PEDF mediante vectores 12V induce la expresión a largo plazo de esta proteína y, como consecuencia, una marcada reducción de la neovascularization intravítrea, la normalización de la densidad capilar de la retina y la prevención del desprendimiento de retina. Esta reversión del fenotipo es paralela a la reducción de los niveles intraoculares de VEGF y la regulación negativa de efectores de la angiogénesis. Estos resultados demuestran la eficacia a largo plazo del a sobreexpresión de PEDF para contrarrestar la neovascularización retinal y ofrece evidencias para el uso de esta estrategia en el tratamiento de la retinopatía diabética y otras enfermedades proliferativas de la retina.Diabetic retinopathy (DR) is the most common cause of acquired blindness in developed countries, with a high prevalence in diabetic patients. The development of new effective therapies requires further investigations on disease pathogenesis and good animal models are essential to this end and to assay the potential efficacy of new experimental therapies. The TgIGF-I mice is a good model of retinopathy, developing many of the retinal vascular alterations observed in human diabetic patients. To fully characterize the eye pathology of the TgIGF-I, the first part of this work was focused in the study of the alterations of neurons and glial cells in the retinas of these mice. We found that TgIGF-I retinas showed a progressive decline in their electroretinographic responses that resulted in significantly impaired neuronal functionality in old animals. Gliosis and microgliosis were also detected in transgenic retinas at early ages. Gliosis is associated with the loss of essential neuron-supportive functions performed by Müller cells. We found that transgenic retinas showed changes in normal retinal metabolism, such as alterations in the glutamate metabolism, signs of oxidative stress and impaired potassium buffering, that may underlie neuronal dysfunction in transgenic retinas, which could be exacerbated by the increased production of pro-inflammatory cytokines. Thus, the second part of this work was dedicated to the study of the efficacy of a gene therapy approach aimed at counteracting neovascularization and neurodegeneration. Adeno-associated (AAV) vectors of serotype 2 were chosen to overexpress Pigmented Epithelium Derived Factor (PEDF), a protein with potent antiangiogenic and neuroprotective properties. AAV2-mediated PEDF gene transfer led to long-term production of PEDF and to a striking inhibition of intravitreal neovascularization, normalization of retinal capillary density, and prevention of retinal detachment. This was parallel to a reduction in the intraocular levels of Vascular Endothelial Growth Factor (VEGF), that was consistent with a downregulation of downstream effectors of angiogenesis. These results demonstrate long-term efficacy of AAV-mediated PEDF overexpression in counteracting retinal neovascularization and provide evidence towards the use of this strategy to treat angiogenesis in DR and other chronic proliferative retinal disorders

Insulin-like growth factor I (IGF-I)-induced chronic gliosis and retinal stress lead to neurodegeneration in a mouse model of retinopathy

Insulin-like growth factor I (IGF-I) exerts multiple effects on different retinal cell types in both physiological and pathological conditions. Despite the growth factor's extensively described neuroprotective actions, transgenic mice with increased intraocular levels of IGF-I showed progressive impairment of electroretinographic amplitudes up to complete loss of response, with loss of photoreceptors and bipolar, ganglion, and amacrine neurons. Neurodegeneration was preceded by the overexpression of genes related to retinal stress, acute-phase response, and gliosis, suggesting that IGF-I altered normal retinal homeostasis. Indeed, gliosis and microgliosis were present from an early age in transgenic mice, before other alterations occurred, and were accompanied by signs of oxidative stress and impaired glutamate recycling. Older mice also showed overproduction of pro-inflammatory cytokines. Our results suggest that, when chronically increased, intraocular IGF-I is responsible for the induction of deleterious cellular processes that can lead to neurodegeneration, and they highlight the importance that this growth factor may have in the pathogenesis of conditions such as ischemic or diabetic retinopathy

Progressive neurologic and somatic disease in a novel mouse model of human mucopolysaccharidosis type IIIC

Mucopolysaccharidosis type IIIC (MPSIIIC) is a severe lysosomal storage disease caused by deficiency in activity of the transmembrane enzyme heparan-α-glucosaminide N-acetyltransferase (HGSNAT) that catalyses the N-acetylation of α-glucosamine residues of heparan sulfate. Enzyme deficiency causes abnormal substrate accumulation in lysosomes, leading to progressive and severe neurodegeneration, somatic pathology and early death. There is no cure for MPSIIIC, and development of new therapies is challenging because of the unfeasibility of cross-correction. In this study, we generated a new mouse model of MPSIIIC by targeted disruption of the Hgsnat gene. Successful targeting left LacZ expression under control of the Hgsnat promoter, allowing investigation into sites of endogenous expression, which was particularly prominent in the CNS, but was also detectable in peripheral organs. Signs of CNS storage pathology, including glycosaminoglycan accumulation, lysosomal distension, lysosomal dysfunction and neuroinflammation were detected in 2-month-old animals and progressed with age. Glycosaminoglycan accumulation and ultrastructural changes were also observed in most somatic organs, but lysosomal pathology seemed most severe in liver. Furthermore, HGSNAT-deficient mice had altered locomotor and exploratory activity and shortened lifespan. Hence, this animal model recapitulates human MPSIIIC and provides a useful tool for the study of disease physiopathology and the development of new therapeutic approaches. Summary: A new animal model of the severe neurodegenerative lysosomal disorder mucopolysaccharidosis IIIC recapitulates the human disease, with progressive CNS and somatic lysosomal pathology, and shortened lifespan

Proliferative retinopathy: study of the contribution of neuroglial alterations and development of gene therapy approaches

La retinopatía diabética es la causa más común de ceguera adquirida en los países desarrollados, con una alta prevalencia en los pacientes diabéticos. El desarrollo de nuevas terapias requiere un buen conocimiento de la patología de la enfermedad y para ello son necesarios buenos modelos animales. Dichos modelos también resultan esenciales para ensayar el potencial de las nuevas terapias. El ratón transgénic IGF-I constituye un excelente modelo de retinopatía, ya que desarrolla la mayoría de las alteraciones vasculares presentes en los pacientes diabéticos. Para completar la caracterización del fenotipo de la retina de los animales TgIGF-I, la primera parte de esta tesis se centra en el estudio de las alteraciones de las neuronas y las células de la glia en las retinas transgénicas. Los resultados obtenidos muestran que los animales transgénicos presentan una pérdida progresiva de sus respuestas electroretinográficas resultando en una disfunción neuronal grave en los animales transgénicos de avanzada edad. Se detecta gliosis y microgliosis en las retinas de animales transgénicos jóvenes. La gliosis está relacionada con la pérdida de funciones esenciales para la supervivencia de las neuronas que realizan las células de Müller. Las retinas transgénicas presentan cambios en su metabolismo, relacionados con el reciclaje del glutamato, signos de estrés oxidativo y alteraciones en la homeostasis del potasio. Estas alteraciones pueden ser la causa de la disfunción neuronal observada en las retinas transgénicas, que además puede ser agravada por el incremento en la producción de citoquinas pro-inflamatorias. La segunda parte este trabajo se dedicó al estudio de la eficacia de una aproximación de terapia génica dirigida a contrarrestar la neovascularización y la neurodegeneración en la retinopatía diabética. Los vectores adeno-asociados (AAV) de tipo 2 fueron escogidos para sobreexpresar el Pigmented Epithelium Derived Factor (PEDF), una proteina con potentes propiedades antiangiogénicas y neuroprotectoras. La transferencia génica del PEDF mediante vectores AAV induce la expresión a largo plazo de esta proteína y, como consecuencia, una marcada reducción de la neovascularization intravítrea, la normalización de la densidad capilar de la retina y la prevención del desprendimiento de retina. Esta reversión del fenotipo es paralela a la reducción de los niveles intraoculares de VEGF y la regulación negativa de efectores de la angiogénesis. Estos resultados demuestran la eficacia a largo plazo del a sobreexpresión de PEDF para contrarrestar la neovascularización retinal y ofrece evidencias para el uso de esta estrategia en el tratamiento de la retinopatía diabética y otras enfermedades proliferativas de la retina.Diabetic retinopathy (DR) is the most common cause of acquired blindness in developed countries, with a high prevalence in diabetic patients. The development of new effective therapies requires further investigations on disease pathogenesis and good animal models are essential to this end and to assay the potential efficacy of new experimental therapies. The TgIGF-I mice is a good model of retinopathy, developing many of the retinal vascular alterations observed in human diabetic patients. To fully characterize the eye pathology of the TgIGF-I, the first part of this work was focused in the study of the alterations of neurons and glial cells in the retinas of these mice. We found that TgIGF-I retinas showed a progressive decline in their electroretinographic responses that resulted in significantly impaired neuronal functionality in old animals. Gliosis and microgliosis were also detected in transgenic retinas at early ages. Gliosis is associated with the loss of essential neuron-supportive functions performed by Müller cells. We found that transgenic retinas showed changes in normal retinal metabolism, such as alterations in the glutamate metabolism, signs of oxidative stress and impaired potassium buffering, that may underlie neuronal dysfunction in transgenic retinas, which could be exacerbated by the increased production of pro-inflammatory cytokines. Thus, the second part of this work was dedicated to the study of the efficacy of a gene therapy approach aimed at counteracting neovascularization and neurodegeneration. Adeno-associated (AAV) vectors of serotype 2 were chosen to overexpress Pigmented Epithelium Derived Factor (PEDF), a protein with potent antiangiogenic and neuroprotective properties. AAV2-mediated PEDF gene transfer led to long-term production of PEDF and to a striking inhibition of intravitreal neovascularization, normalization of retinal capillary density, and prevention of retinal detachment. This was parallel to a reduction in the intraocular levels of Vascular Endothelial Growth Factor (VEGF), that was consistent with a downregulation of downstream effectors of angiogenesis. These results demonstrate long-term efficacy of AAV-mediated PEDF overexpression in counteracting retinal neovascularization and provide evidence towards the use of this strategy to treat angiogenesis in DR and other chronic proliferative retinal disorders

Long-term retinal PEDF overexpression prevents neovascularization in a murine adult model of retinopathy

Neovascularization associated with diabetic retinopathy (DR) and other ocular disorders is a leading cause of visual impairment and adult-onset blindness. Currently available treatments are merely palliative and offer temporary solutions. Here, we tested the efficacy of antiangiogenic gene transfer in an animal model that mimics the chronic progression of human DR. Adeno-associated viral (AAV) vectors of serotype 2 coding for antiangiogenic Pigment Epithelium Derived Factor (PEDF) were injected in the vitreous of a 1.5 month-old transgenic model of retinopathy that develops progressive neovascularization. A single intravitreal injection led to long-term production of PEDF and to a striking inhibition of intravitreal neovascularization, normalization of retinal capillary density, and prevention of retinal detachment. This was parallel to a reduction in the intraocular levels of Vascular Endothelial Growth Factor (VEGF). Normalization of VEGF was consistent with a downregulation of downstream effectors of angiogenesis, such as the activity of Matrix Metalloproteinases (MMP) 2 and 9 and the content of Connective Tissue Growth Factor (CTGF). These results demonstrate long-term efficacy of AAV-mediated PEDF overexpression in counteracting retinal neovascularization in a relevant animal model, and provides evidence towards the use of this strategy to treat angiogenesis in DR and other chronic proliferative retinal disorders

Insulin-like growth factor I (IGF-I)-induced chronic gliosis and retinal stress lead to neurodegeneration in a mouse model of retinopathy

Insulin-like growth factor I (IGF-I) exerts multiple effects on different retinal cell types in both physiological and pathological conditions. Despite the growth factor's extensively described neuroprotective actions, transgenic mice with increased intraocular levels of IGF-I showed progressive impairment of electroretinographic amplitudes up to complete loss of response, with loss of photoreceptors and bipolar, ganglion, and amacrine neurons. Neurodegeneration was preceded by the overexpression of genes related to retinal stress, acute-phase response, and gliosis, suggesting that IGF-I altered normal retinal homeostasis. Indeed, gliosis and microgliosis were present from an early age in transgenic mice, before other alterations occurred, and were accompanied by signs of oxidative stress and impaired glutamate recycling. Older mice also showed overproduction of pro-inflammatory cytokines. Our results suggest that, when chronically increased, intraocular IGF-I is responsible for the induction of deleterious cellular processes that can lead to neurodegeneration, and they highlight the importance that this growth factor may have in the pathogenesis of conditions such as ischemic or diabetic retinopathy

Progressive neurologic and somatic disease in a novel mouse model of human mucopolysaccharidosis type IIIC

Mucopolysaccharidosis type IIIC (MPSIIIC) is a severe lysosomal storage disease caused by deficiency in activity of the transmembrane enzyme heparan-α-glucosaminide N-acetyltransferase (HGSNAT) that catalyses the N-acetylation of α-glucosamine residues of heparan sulfate. Enzyme deficiency causes abnormal substrate accumulation in lysosomes, leading to progressive and severe neurodegeneration, somatic pathology and early death. There is no cure for MPSIIIC, and development of new therapies is challenging because of the unfeasibility of cross-correction. In this study, we generated a new mouse model of MPSIIIC by targeted disruption of the Hgsnat gene. Successful targeting left LacZ expression under control of the Hgsnat promoter, allowing investigation into sites of endogenous expression, which was particularly prominent in the CNS, but was also detectable in peripheral organs. Signs of CNS storage pathology, including glycosaminoglycan accumulation, lysosomal distension, lysosomal dysfunction and neuroinflammation were detected in 2-month-old animals and progressed with age. Glycosaminoglycan accumulation and ultrastructural changes were also observed in most somatic organs, but lysosomal pathology seemed most severe in liver. Furthermore, HGSNAT-deficient mice had altered locomotor and exploratory activity and shortened lifespan. Hence, this animal model recapitulates human MPSIIIC and provides a useful tool for the study of disease physiopathology and the development of new therapeutic approaches. Summary: A new animal model of the severe neurodegenerative lysosomal disorder mucopolysaccharidosis IIIC recapitulates the human disease, with progressive CNS and somatic lysosomal pathology, and shortened lifespan