Ocular surface diabetic disease: A neurogenic condition?

Zazzo, Antonio Di; Coassin, Marco; Micera, Alessandra; Mori, Tommaso; Piano, Maria De; Scartozzi, Luca; Sgrulletta, Roberto; Bombardieri, Stefano

doi:10.1016/j.jtos.2020.09.006

Cited by 29 publications

(16 citation statements)

References 42 publications

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“…Among these, BCID and dry eye disease, in particular, are life-threatening complications that critically affect women's daily life, beyond their complex fighting against cancer. This status may be due to a loss or failure of immune regulatory mechanisms, which usually maintain homeostasis by para-inflammation [96,97], subsequent to the hormonal changes, such as in other ocular diseases [24,98]. The BCID pathogenesis is also associated with a systemic estrogen-level drop, and a consequent functional hyperandrogenism, as in case of PCOS, and, rarely, with an unexpected hypoandrogenism, as in case of physiological menopause.…”

Section: Discussionmentioning

confidence: 99%

Sex Hormones Related Ocular Dryness in Breast Cancer Women

Grasso

Zazzo

Giannaccare

et al. 2021

JCM

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Background: Dry eye syndrome (DES) is strictly connected to systemic and topical sex hormones. Breast cancer treatment, the subsequent hormonal therapy, the subsequent hyperandrogenism and the early sudden menopause, may be responsible for ocular surface system failure and its clinical manifestation as dry eye disease. This local dryness is part of the breast cancer iatrogenic dryness, which affects overall mucosal tissue in the fragile population of those with breast cancer. Methods: A literature review regarding the role of sex hormone changes and systemic hormonal replacement treatments (SHRT) in DES available on PubMed and Web of Science was made without any restriction of language. Results: Androgens exert their role on the ocular surface supporting meibomian gland function and exerting a pro-sebaceous effect. Estrogen seems to show a pro/inflammatory role on the ocular surface, while SHRT effects on dry eye are still not well defined, determining apparently contradictory consequences on the ocular surface homeostasis. The role of sex hormones on dry eye pathogenesis is most likely the result of a strict crosstalk between the protective androgens effects and the androgen-modulating effects of estrogens on the meibomian glands. Conclusions: Patients with a pathological or iatrogenic hormonal imbalance, such as in the case of breast cancer, should be assessed for dry eye disease, as well as systemic dryness, in order to restore their social and personal quality of life.

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Section: Discussionmentioning

confidence: 99%

Sex Hormones Related Ocular Dryness in Breast Cancer Women

Grasso

Zazzo

Giannaccare

et al. 2021

JCM

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“…Therefore, the para-inflammatory response may be dysregulated in the self-limiting on-off ability, leading to long-term persistent low-grade chronic inflammation, such as in inflammaging [ 12 , 13 , 14 ], in longstanding diabetes [ 15 ], in chronic cicatrizing conjunctivitis [ 16 ] or in the intensity of the response itself, such as in US.…”

Section: Discussionmentioning

confidence: 99%

Ocular Surface Failure in Urban Syndrome

Antonini

Gaudenzi

Spelta

et al. 2021

JCM

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Background: Nowadays, the continuous increase in air pollution has significantly changed air quality, leading to the onset of the so-called urban syndrome (US), an allergic-like conjunctivitis triggered by pollutants. These patients are characterized by persistent dysregulation of ocular surface para-inflammation, causing chronic low-grade inflammation and ocular discomfort, with significant consequences for occupational health and job productivity prospects. This study aims to investigate the effects of topical glycerophosphoinositol (GPI) eye drops on the signs and symptoms of US. Methods: A multicenter prospective open interventional study was performed. Patients affected by US, enrolled from occupational medicine clinics, were treated with eye drops containing 0.001% GPI in 0.2% HA vehicle three times a day. Ocular surface disease index (OSDI), tear break-up time (T-BUT), Schirmer test, Oxford score, hyperemia and ocular surface symptoms were recorded at patient enrolment (T0), after 1 week (T1) and after 1 month (T2) of treatment. Results: A total of 113 consecutive patients (226 eyes) were included. OSDI score displayed a significant improvement after one week (T0: 39.9 ± 19, T1: 20.8 ± 17.9, T2: 18.4 ± 15.6, p < 0.0001); T-BUT (T0: 5.2 ± 2, T1: 7.7 ± 2.2, T2: 9.7 ± 1.8, p < 0.0001) and Schirmer Test (T0: 6.6 ± 2.4, T1: 9.7 ± 2.7, T2: 12.6 ± 2.6, p < 0.0001) progressively improved from T0 to T2. Conclusions: trice-daily topic instillation of 0.001% GPI in 0.02% HA vehicle resulted an effective and well tolerated treatment in US patients.

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“…Interestingly, one study demonstrated that, in diabetic patients with ocular surface disease, NPY was significantly increased compared with healthy controls via conjunctival impression cytology [ 473 ]. The NPY levels also correlated with increases in ICAM-1, possibly indicating the role of NPY in the inflammation of the ocular surface [ 473 ]. However, the same study failed to detect an increase in NPY among allergic conjunctivitis patients [ 474 ].…”

Section: Neuropeptides and Their Receptors In The Corneamentioning

confidence: 99%

“…Enhances corneal angiogenesis through the Y2 receptor. [[462][463][464][465][466][467][468][469][470][471][472][473][474][475] SST Pro-and anti-inflammatory effects. Correlates with activation state of immune cells.…”

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confidence: 99%

Immunomodulatory Role of Neuropeptides in the Cornea

2022

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The transparency of the cornea along with its dense sensory innervation and resident leukocyte populations make it an ideal tissue to study interactions between the nervous and immune systems. The cornea is the most densely innervated tissue of the body and possesses both immune and vascular privilege, in part due to its unique repertoire of resident immune cells. Corneal nerves produce various neuropeptides that have a wide range of functions on immune cells. As research in this area expands, further insights are made into the role of neuropeptides and their immunomodulatory functions in the healthy and diseased cornea. Much remains to be known regarding the details of neuropeptide signaling and how it contributes to pathophysiology, which is likely due to complex interactions among neuropeptides, receptor isoform-specific signaling events, and the inflammatory microenvironment in disease. However, progress in this area has led to an increase in studies that have begun modulating neuropeptide activity for the treatment of corneal diseases with promising results, necessitating the need for a comprehensive review of the literature. This review focuses on the role of neuropeptides in maintaining the homeostasis of the ocular surface, alterations in disease settings, and the possible therapeutic potential of targeting these systems.

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Ocular surface diabetic disease: A neurogenic condition?

Cited by 29 publications

References 42 publications

Sex Hormones Related Ocular Dryness in Breast Cancer Women

Sex Hormones Related Ocular Dryness in Breast Cancer Women

Ocular Surface Failure in Urban Syndrome

Immunomodulatory Role of Neuropeptides in the Cornea

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