Drusen are lipid-, mineral-, and protein-containing extracellular deposits that accumulate between the basal lamina of the retinal pigment epithelium (RPE) and Bruch’s membrane (BrM) of the human eye. They are a defining feature of age-related macular degeneration (AMD), a common sight-threatening disease of older adults. The appearance of heterogeneous internal reflectivity within drusen (HIRD) on optical coherence tomography (OCT) images has been suggested to indicate an increased risk of progression to advanced AMD. Here, in a cohort of patients with AMD and drusen, we show that HIRD indicated an increased risk of developing advanced AMD within 1 year. Using multimodal imaging in an independent cohort, we demonstrate that progression to AMD was associated with increasing degeneration of the RPE overlying HIRD. Morphological analysis of clinically imaged cadaveric human eye samples revealed that HIRD was formed by multilobular nodules. Nanoanalytical methods showed that nodules were composed of hydroxyapatite and that they differed from spherules and BrM plaques, other refractile features also found in the retinas of patients with AMD. These findings suggest that hydroxyapatite nodules may be indicators of progression to advanced AMD and that using multimodal clinical imaging to determine the composition of macular calcifications may help to direct therapeutic strategies and outcome measures in AMD.
PurposeExtracellular deposits containing hydroxyapatite, lipids, proteins, and trace metals that form between the basal lamina of the RPE and the inner collagenous layer of Bruch's membrane are hallmarks of early AMD. We examined whether cultured RPE cells could produce extracellular deposits containing all of these molecular components.MethodsRetinal pigment epithelium cells isolated from freshly enucleated porcine eyes were cultured on Transwell membranes for up to 6 months. Deposit composition and structure were characterized using light, fluorescence, and electron microscopy; synchrotron x-ray diffraction and x-ray fluorescence; secondary ion mass spectroscopy; and immunohistochemistry.ResultsApparently functional primary RPE cells, when cultured on 10-μm-thick inserts with 0.4-μm-diameter pores, can produce sub-RPE deposits that contain hydroxyapatite, lipids, proteins, and trace elements, without outer segment supplementation, by 12 weeks.ConclusionsThe data suggest that sub-RPE deposit formation is initiated, and probably regulated, by the RPE, as well as the loss of permeability of the Bruch's membrane and choriocapillaris complex associated with age and early AMD. This cell culture model of early AMD lesions provides a novel system for testing new therapeutic interventions against sub-RPE deposit formation, an event occurring well in advance of the onset of vision loss.
Retinal drusen formation is not only a clinical hallmark for the development of age-related macular degeneration (AMD) but also for other disorders, such as Alzheimer's disease and renal diseases. The initiation and growth of drusen is poorly and systemic side" of drusen. 6.2. Nineteen drusen proteins out of 89 were not assigned. 6.3. Blood proteins are an important source of drusen proteins. 7. Drusen and hydroxyapatite. 8. Drusen and plaques: age-related macular degeneration and atherosclerosis. 8.1. Clinical and epidemiological studies. 8.2. Histological and pathobiological similarities. 8.3. Genetics and molecular biology. 9. Future directions and conclusions.
Purpose: Micrometer-sized spherules formed of hydroxyapatite or whitlockite were identified within extracellular deposits that accumulate in the space between the basal lamina (BL) of retinal pigment epithelium (RPE) and the inner collagenous layer of Bruch's membrane (sub-RPEeBL space). This investigation aimed to characterize the morphologic features, structure, and distribution of these spherules in aged human eyes with and without clinical indications of age-related macular degeneration (AMD).Design: Experimental study.Participants: Five human eyes with varying degrees of sub-RPEeBL deposits were obtained from the University College London Institute of Ophthalmology and Moorfield's Eye Hospital Tissue Repository or the Advancing Sight Network. Two eyes were reported as having clinical indications of AMD (age, 76e87 years), whereas 3 were considered healthy (age, 69e91 years).Methods: Cadaveric eyes with sub-RPEeBL deposits were embedded in paraffin wax and sectioned to a thickness of 4-10 mm. Spherules were identified and characterized using high-resolution scanning electron microscopy (SEM), energy-dispersive x-ray spectroscopy, and time-of-flight secondary ion mass spectroscopy.Main Outcome Measures: High-resolution scanning electron micrographs of spherules, the size-frequency distribution of spherules including average diameter, and the distribution of particles across the central-peripheral axis. Elemental maps and time-of-flight secondary ion mass spectra also were obtained.Results: The precipitation of spherules is ubiquitous across the central, mid-peripheral, and far-peripheral axis in aged human eyes. No significant difference was found in the frequency of spherules along this axis. However, statistical analysis indicated that spherules exhibited significantly different sizes in these regions. Indepth analysis revealed that spherules in the sub-RPEeBL space of eyes with clinical signs of AMD were significantly larger (median diameter, 1.64 mm) than those in healthy aged eyes (median diameter, 1.16 mm).Finally, spherules showed great variation in surface topography and internal structure.Conclusions: The precipitation of spherules in the sub-RPEeBL space is ubiquitous across the centraleperipheral axis in aged human eyes. However, a marked difference exists in the size and frequency of spherules in eyes with clinical signs of AMD compared to those without, suggesting that the size and frequency of spherules may be associated with AMD.
Calcium ions intensity depletion identified in tooth cementum of a patient with six documented full-term pregnancies, using ToF-SIMS.
28Life-history parameters such as pregnancies, skeletal trauma, and renal disease have previously 29 been identified from hypomineralized growth layers (incremental lines) of acellular extrinsic 30 fiber cementum (AEFC). The precise periodicity of these growth layers remains vaguely 31 approximated, so causal life-history explanations using tooth cementum cannot yet be 32 rigorously calculated or tested. On the other hand, we show how life history parameters in 33 AEFC can be identified by two contrasting elemental detection methods. Based on our results 34 we reject the possibility of accurate estimation of pregnancies and other life history parameters 35 from cementum using scanning electron microscopy alone. Here, we propose a new 36 methodological approach for cementum research, Time-of-Flight Secondary Ion Mass 37 Spectrometry (ToF-SIMS), to measure degree and distribution of mineralization of cementum 38 growth layers. Our results show that Tof-SIMS can significantly increase our knowledge of 39 cementum composition and is therefore a powerful new tool for life history researchers. 40 41 131 Cluster ion sources, such as Bi 3 , are used to identify larger HAp fragment ions at for example 132 m/z 485, 541, 597, and 653, identified as Ca 5 P 3 O 12 + , Ca 6 P 3 O 13 + , Ca 7 P 3 O 14 + , and Ca 8 P 3 O 15 + , 133 respectively. Ionic species sputtered from the surface under the bismuth bombardment are 134 steered into a reflectron time-of-flight mass analyzer. Before mass spectrometry was 135 performed, an Ar n + cluster ion beam was used to remove any surface organic contaminants. 136 Identified peaks strongly localized to cementum growth layers were mapped on single ion 137 maps. Positive-ion spectra were acquired from two different 100×100 μm regions of tooth 138 encompassing the entire cementum width from mesio-buccal and disto-buccal side of the tooth, 139 respectively to localize of HAp and identification of different CaP phases within cementum 140 layers. Results 147 SEM-EDS 148No visual evidence of cementum growth layering was found SEM micrograph using Philips 149 XL30 FEG-SEM (Hillsboro, OR, USA) equipped with an Oxford instruments energy 150 dispersive x-ray analysis detector (Fig 1a). The Ca:P ratio (by atomic percent) ranged from 151 1.47 to 1.73, with 1.59 as average value. Line scan for Ca showed no significant change in its 152 relative amounts across the width of the cementum (Fig 1b), except in the case of line spectrum 153 (8) which exhibits the lowest relative amount of Ca as of 0.13(atomic %), as well as the lowest 154 Ca:Pa ratio as of 1.29 by atomic % (Fig.1a). However, these low readings for the line spectrum 155 (8) are due to an intruding artefact deposited in cementum, which can be clearly observed on 156 electron photomicrograph of a transverse section of midroot cementum (Fig 1a), and should 157 not be taken into account when interpreting mineral distribution across the AEFC width of our 158 sample.
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