Purpose-To investigate the relationship between drusen extent and foveolar choroidal blood flow in non-exudative AMD.Methods-Total drusen area, average druse area, and total drusen number were determined using a computer program developed to quantify the extent of manually outlined drusen from fundus photographs of 157 patients (239 eyes) with non-exudative AMD. Laser Doppler flowmetry was used to assess relative choroidal blood velocity (ChB Vel ), volume (ChB Vol ), and flow (ChB Flow ) in the center of the fovea.Results-We found a significant inverse relationship between total drusen area and ChB Vol or ChB Flow . For every 1 mm 2 increase in total drusen area, ChB Vol decreased by 0.0061 arbitrary units (AU; p=0.03) and ChB Flow decreased by 0.23 AU (p=0.049). Average druse area was also significantly inversely related to ChB Vol and ChB Flow . For every 0.01 mm 2 increase in average druse area, the ChB Vol decreased by 0.0149 AU (p=0.001) and the ChB Flow decreased by 0.4951 AU (p=0.003). Adjustment for age weakened the significance, though it remained strong for average druse area versus ChB Flow (p=0.017) and ChB Vol (p=0.004). The computer-aided quantification of drusen used in this study showed high intra-and inter-grader agreement.Conclusion-In patients with non-exudative AMD, there is an association between increased drusen extent and decreased ChB Vol and ChB Flow . This suggests the presence of ischemia and possibly the reason why patients with high risk drusen are prone to advanced disease.
Nucleic acid-based vaccines are effective in infectious disease models but have yielded disappointing results in tumor models when tumor-associated selfantigens are used. Incorporation of helper epitopes from foreign antigens into tumor vaccines might enhance the immunogenicity of DNA vaccines without increasing toxicity. However, generation of fusion constructs encoding both tumor and helper antigens may be difficult, and resulting proteins have unpredictable physical and immunologic properties. Furthermore, simultaneous production of equal amounts of highly immunogenic helper and weakly immunogenic tumor antigens in situ could favor development of responses against the helper antigen rather than the antigen of interest. We assessed the ability of 2 helper antigens (-galactosidase or fragment C of tetanus toxin) encoded by one plasmid to augment responses to a self-antigen (lymphomaassociated T-cell receptor) encoded by a separate plasmid after codelivery into skin by gene gun. This approach allowed ad- IntroductionPlasmid-encoded antigens have been used to induce immune responses in experimental animals and humans for more than a decade. Plasmid-based nucleic acid vaccines are attractive because of simplicity, low cost, and safety, but suboptimal immunogenicity and limited efficacy against certain pathogens and tumors have limited their utility. A variety of strategies have been developed to enhance DNA vaccine efficacy. These approaches include:(1) modification of DNA vaccines to include improved expression plasmids 1 or incorporation of viral vectors 2 ; (2) modifications of cDNA sequences encoding antigen to enhance antigenicity, 3 codon adjustments to optimize transcription, 1,4 or generation of string-ofepitope constructs incorporating selected subunits of antigens 5,6 ; (3) improved delivery systems, including methods for more efficient in vivo transfection of host cells, such as in vivo electroporation 6 or gene gun 7 ; and (4) the use of adjuvants. 8 Adjuvants include conventional adjuvants, such as Freund adjuvant, and the more recently developed chemically defined ("molecular") adjuvants. The latter are intended to enhance immune responses while avoiding, or at least significantly reducing, adverse effects associated with conventional adjuvants.Entities with a wide variety of biologic effects have been used as chemically defined adjuvants for DNA vaccines, including biologic response modifiers such as cytokines (eg, granulocytemacrophage colony-stimulating factor [GM-CSF] 9 ) and costimulatory molecules 10,11 as well as monoclonal antibodies (mAbs) that block undesired or trigger desired pathways, such as anti-CD40 12 or anti-CD137. 13 An alternative strategy involves codelivery of "helper antigens" (ie, foreign antigens that induce strong T-cell responses) with weak antigens of interest. Helper antigens are selected based on their high immunogenicity and enhance responses to weaker antigens via incompletely characterized bystander effects. Proteins previously used as helper antigens include keyh...
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