O comprometimento macular na retinopatia diabética pode ocorrer devido a isquemia macular, hemorragias maculares intra-retinianas e pré-retinianas, descolamento macular tracional, neovascularização e mais freqüentemente o edema macular. Cerca de 10% da população total de pacientes com diabete melito (DM) e 25% daqueles com mais de 20 anos de evolução da doença apresentam edema macular, constituindo a principal causa de perda visual neste grupo de pacientes(1-3). Em pacientes com DM tipo 1, o edema macular é visto raramente antes dos primeiros nove anos após o diagnóstico de DM(4), ao contrário de pacientes diabéticos tipo 2 cujo início da maculopatia é mais precoce. A detecção e o tratamento precoce do edema macular podem resultar na melhora ou na estabilização da visão. Novas teorias sobre a fisiopatologia do edema macular surgiram nos últimos anos e novas terapias como a triancinolona sub-tenoneana ou intravítrea, os anti-VEGFs e implantes intravítreos de liberação lenta de dexametasona foram testadas a partir destes conhecimentos. Este manuscrito propõe a revisão destes conceitos e em especial, dos novos aspectos terapêuticos. / The macular commitment on diabetic retinopathy can occur due to macular ischaemia, intraretinal or preretinal haemorrhages, tractional detachment, neovascularization and more frequently, macular edema. About 10% of the diabetic population and 25% of those with more than 20 years of illness, present macular edema, constituting the main cause of visual loss in this group of patients (1-3). In diabetic type 1 patients, macular edema is rarely seen before 9 years after the diagnostic(4). On the other hand, in diabetic type 2 patients, the maculopathy appears earlier. The detection and the precocious treatment of macular edema can result a visual improvement or stabilization. New theories about the fisiopathology of macular edema had appeared in the last years and new therapies such as sub-tenonean or intravitreal triamcinolone, the anti- VEGFs and slow liberation intravitreal implants of dexametazone were tested since this knowledge. This article considers the revision of these concepts and specially, new therapeutic aspects.

O comprometimento macular na retinopatia diabética pode ocorrer devido a isquemia macular, hemorragias maculares intra-retinianas e pré-retinianas, descolamento macular tracional, neovascularização e mais freqüentemente o edema macular. Cerca de 10% da população total de pacientes com diabete melito (DM) e 25% daqueles com mais de 20 anos de evolução da doença apresentam edema macular, constituindo a principal causa de perda visual neste grupo de pacientes(1-3). Em pacientes com DM tipo 1, o edema macular é visto raramente antes dos primeiros nove anos após o diagnóstico de DM(4), ao contrário de pacientes diabéticos tipo 2 cujo início da maculopatia é mais precoce. A detecção e o tratamento precoce do edema macular podem resultar na melhora ou na estabilização da visão. Novas teorias sobre a fisiopatologia do edema macular surgiram nos últimos anos e novas terapias como a triancinolona sub-tenoneana ou intravítrea, os anti-VEGFs e implantes intravítreos de liberação lenta de dexametasona foram testadas a partir destes conhecimentos. Este manuscrito propõe a revisão destes conceitos e em especial, dos novos aspectos terapêuticos. / The macular commitment on diabetic retinopathy can occur due to macular ischaemia, intraretinal or preretinal haemorrhages, tractional detachment, neovascularization and more frequently, macular edema. About 10% of the diabetic population and 25% of those with more than 20 years of illness, present macular edema, constituting the main cause of visual loss in this group of patients (1-3). In diabetic type 1 patients, macular edema is rarely seen before 9 years after the diagnostic(4). On the other hand, in diabetic type 2 patients, the maculopathy appears earlier. The detection and the precocious treatment of macular edema can result a visual improvement or stabilization. New theories about the fisiopathology of macular edema had appeared in the last years and new therapies such as sub-tenonean or intravitreal triamcinolone, the anti- VEGFs and slow liberation intravitreal implants of dexametazone were tested since this knowledge. This article considers the revision of these concepts and specially, new therapeutic aspects.

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal. / La rétroaction tubuloglomérulaire (RTG) est un mécanisme important dans le contrôle de la filtration glomérulaire et de l'hémodynamique rénale. Ce phénomène est relié aux cellules de la macula densa (MD) qui ont la capacité de détecter des changements dans la composition du liquide tubulaire et de transmettre cette information aux artérioles afférentes (AA) qui, en se contractant, diminuent le débit de filtration glomérulaire et augmentent la résistance hydraulique du rein. La nature du signal qui est envoyé des cellules de la MD vers les AA reste encore inconnue. On sait cependant qu'une haute concentration de NaCl dans la lumière tubulaire déclenche la RTG, et que le cotransporteur Na+ +:2Cl^- est probablement le "sensor". Pour progresser dans l'étude de la RTG, une meilleure connaissance des cellules de la MD est absolument requise puisque c'est d'elles qu'origine le signal. La présente thèse a pour but de contribuer à une meilleure identification et à la caractérisation des propriétés membranaires des cellules de la MD. Dans un premier temps, à l'aide de la technique de patch clamp en "single channel" nous avons mis en évidence une grande densité de canaux K+ dans la membrane apicale. Nous montrons que ce type de canal est sensible au pH et au Ca2+ mais insensible à l'ATP. Dans un second temps, nous optons pour la technique de microperfusion de tubule isolé combinée à la microfluorimétrie. Nous démontrons ainsi la présence d'un échangeur Na+ + à la membrane apicale qui répond à toute variation de la concentration luminale de Na+ et de NaCl ([Na+]i et [NaCl]i). Par ailleurs, en utilisant les effets secondaires du cotransporteur Na+ +:2Cl^- sur le pH, nous démontrons que ce transporteur s'équilibre lorsque [NaCl]i atteint 18 mM. Ainsi, nous concluons que dans les conditions physiologiques, le cotransporteur produit une réabsorption de NaCl mais en opérant très près de son équilibre. Dans un troisième temps, nous utilisons une méthode dont nous avons établi la faisabilité pour les cellules de la MD, et qui est basée sur l'utilisation de NH4+ pour déterminer l'amplitude de certains flux. Nous démontrons que le NH4+ entre dans les cellules par le cotransporteur Na+ +:2Cl^- et par un transporteur sensible au Ba2+, et en sort, lors du retrait de NH4+ luminal, exclusivement sous forme de NH3 et de H+. Bien que la nature du transporteur sensible au Ba2+ n'ait pu être résolue de façon définitive, nous démontrons qu'elle ne correspond ni au canal K+ ni à l'échangeur K/(NH4)H. Ces études nous ont toutefois amenés à présenter pour la première fois un modèle qui permet d'évaluer quantitativement les mesures de taux d'acidification (d[pH]i/dt) et d'en tirer des mesures de flux. Grâce à ce modèle, nos données montrent que la membrane apicale est très perméable au NH3 et, contrairement à ce qu'il a été admis jusqu'à présent, le flux de NH4+ n'est pas égal au flux de protons mesuré mais lui est plutôt 2 à 3 fois supérieur. Enfin, dans un dernier temps, nous avons montré que le cotransporteur a une haute affinité pour le Na+ et pour le Cl-. Nous avons aussi commencé à étudier les facteurs régulateurs de ce cotransporteur en observant une inhibition de 40 % du cotransport suite à l'augmentation de la [Cl^-]i par inhibition de sa sortie basolatérale (10 μM NPPB). De plus, l'ajout de dbAMPc + forskoline stimule la conductance basolatérale au Cl^- mais inhibe faiblement le cotransporteur apical. En conclusion, nous considérons que ces études ont significativement contribué à l'amélioration de nos connaissances sur les cellules de la MD et à la progression dans la compréhension de la RTG, puisque nous sommes maintenant en position de spéculer avec un peu plus de précision sur les effets secondaires d'une augmentation de [NaCl]i.

<p>The tubuloglomerular feedback mechanism is an important regulator in the juxtaglomerular apparatus and it detects flow dependent alterations in luminal NaCl concentration ([NaCl]) at the macula densa (MD) cell site via a Na+-K+-2Cl cotransporter. Signals are sent by the MD to adjust the afferent arteriole tone and altering release of renin. This signaling mechanism is unclear but MD cell calcium concentration, release of ATP and nitric oxide (NO) might be important.</p><p>In cultured rat glomerular mesangial cells the NO production was measured using confocal microscopy and calcium responses to ATP was measured with fura-2 using imaging techniques. NO from spermine-NONOate and L-arginine could resensitize, desensitized ATP receptors in a cGMP independent way. In mesangial cells from spontaneously hypertensive rats (SHR) less NO effect was found on ATP receptor de/resensitization indicating an impaired NO release or effect.</p><p>The macula densa cells were studied using microperfusion techniques with confocal and video imaging systems. Changes in [Ca2+]i from exposed macula densa plaques were assessed upon addition of agonists added to bath. The order of efficacy of agonists was UTP = ATP >> 2MesATP = ADP. Dose response curve for ATP added in bath showed an EC50 of 15 μM. Macula densa cell volume and NO concentration increased considerably with increasing luminal [NaCl] indicating an important role for NO in the signaling process to counteract a vasoconstrictor response and reset the sensitivity of the tubuloglomerular feedback mechanism. </p><p>In conclusion, the results showed 1). NO can increase the P2Y receptor resensitization in rat glomerular mesangial cells, acting through a cGMP-independent pathway. 2) An impaired NO generation/effect on P2Y receptors in mesangial cells from SHR rats. 3) Macula densa cells possess P2Y2, purinergic receptors on basolateral and that activation of these receptors results in the mobilization of Ca2+. 4) Increased luniinal [NaCl] delivery increased cell volume and the NO productions in the macula densa cells. </p>

The tubuloglomerular feedback mechanism is an important regulator in the juxtaglomerular apparatus and it detects flow dependent alterations in luminal NaCl concentration ([NaCl]) at the macula densa (MD) cell site via a Na+-K+-2Cl cotransporter. Signals are sent by the MD to adjust the afferent arteriole tone and altering release of renin. This signaling mechanism is unclear but MD cell calcium concentration, release of ATP and nitric oxide (NO) might be important. In cultured rat glomerular mesangial cells the NO production was measured using confocal microscopy and calcium responses to ATP was measured with fura-2 using imaging techniques. NO from spermine-NONOate and L-arginine could resensitize, desensitized ATP receptors in a cGMP independent way. In mesangial cells from spontaneously hypertensive rats (SHR) less NO effect was found on ATP receptor de/resensitization indicating an impaired NO release or effect. The macula densa cells were studied using microperfusion techniques with confocal and video imaging systems. Changes in [Ca2+]i from exposed macula densa plaques were assessed upon addition of agonists added to bath. The order of efficacy of agonists was UTP = ATP &gt;&gt; 2MesATP = ADP. Dose response curve for ATP added in bath showed an EC50 of 15 μM. Macula densa cell volume and NO concentration increased considerably with increasing luminal [NaCl] indicating an important role for NO in the signaling process to counteract a vasoconstrictor response and reset the sensitivity of the tubuloglomerular feedback mechanism. In conclusion, the results showed 1). NO can increase the P2Y receptor resensitization in rat glomerular mesangial cells, acting through a cGMP-independent pathway. 2) An impaired NO generation/effect on P2Y receptors in mesangial cells from SHR rats. 3) Macula densa cells possess P2Y2, purinergic receptors on basolateral and that activation of these receptors results in the mobilization of Ca2+. 4) Increased luniinal [NaCl] delivery increased cell volume and the NO productions in the macula densa cells.

Bei der Altersabhängigen Makuladegeneration (AMD) handelt es sich um eine Erkrankung des Auges, die die Macula lutea, die Stelle des schärfsten Sehens betrifft. Sie ist verbunden mit der Degeneration von RPE-Zellen, die zur Dystrophie von Photorezeptoren und damit zum Verlust des zentralen Sehvermögens führt. Eine ähnliche Pathophysiologie ist bei der sogenannten Retinalen Pigmentepitheldystrophie (RPED) des Hundes zu beobachten. Die Transplantation von gesunden RPE-Zellen in das betroffene Gebiet stellt eine vielversprechende Therapiemöglichkeit dar. Die Transplantatabstoßung als Kom-plikation schränkt die klinische Anwendung ein. Eine beim Patienten nach Transplantation lebenslang durchgeführte systemische Immunsuppression ist mit erheblichen Nebenwirkungen verbunden. Deshalb bietet die Gentherapie unter Einbezug immunsuppressiver Zytokine wie beispielsweise des Interleukin-10 (IL-10) eine Lösung. In der vorliegenden Arbeit wurde ein selbst konstruierter IL-10-Expressionsvektor (Plasmid pCIneoIL-10) mittels Gentransfer in humane RPE-Zellen in vitro eingebracht. Untersucht wurde die Wirkung des sezernierten IL-10 auf die Proliferation von allogenen T-Lymphozyten mit und ohne allogene Makrophagen als professionelle antigenpräsentierende Zellen (APC). Neben humanen Spender RPE-Zellen (Spender-hRPE-Zellen) wurde eine immortalisierte Permanent-Zelllinie (hTERT-RPE1-Zellen) eingesetzt, deren Hauptvorteil in einer gleichbleibend hohen Wachstumsrate lag. Als transientes Transfektions-system für den Transfer von IL-10-DNA in hRPE-Zellen wurden kationische Lipide gewählt. Drei verschiedene Lipidformulierungen wurden miteinander verglichen und das optimale Transfektionsreagenz:DNA-Verhältnis, mit dem die höchste Transfektionseffizienz erreicht werden konnte, evaluiert. Eine Transfektionseffizienz von 23,3 ± 9,0 % (hTERT-RPE1-Zellen) beziehungsweise 10,3 ± 4,5 % (Spender-hRPE-Zellen) konnte erreicht werden. Die Transfektion hatte weder einen negativen Einfluss auf die Vitalität der hRPE-Zellen, noch wurde der natürliche Zelltod, die Apoptose, erhöht. Die IL-10-mRNA-Expression wurde mittels RT-PCR nachgewiesen. Lediglich bei den transfizierten hRPE-Zellen konnte IL-10-mRNA gefunden werden. Mittels ELISA konnte das IL-10-Protein gemessen werden. Die Sekretion des IL-10 in den Kulturüberstand von transfizierten hRPE-Zellen wurde dafür über einen Zeitraum von 7 Tagen untersucht. Es konnte festgestellt werden, dass die maximale IL-10-Proteinkonzentration bei beiden Zelllinien am Tag 3 mit Werten von 10,3 ± 0,8 ng/ml (hTERT-RPE1-Zellen) und 3,1 ng/ml (Spender-hRPE-Zellen) lag. Es bestand überdies eine positive Korrelation zwischen Transfektionseffizienz und synthetisiertem IL-10. Es wurde außerdem gezeigt, dass durch Stimulation mit dem immunmodulatorischen Zytokin Interferon-gamma (IFN-g) hRPE-Zellen MHC Klasse II-Moleküle vermehrt exprimierten. Damit sind sie ebenso wie die Makrophagen zur Antigenpräsentation fähig. Die Wirkung des von den transfizierten hRPE-Zellen sezernierten IL-10 auf die Proliferation von T-Lymphozyten wurde zwischen Tag 2 und Tag 6 (hTERT-RPE1-Zellen) beziehungsweise zwischen Tag 2 und Tag 4 (Spender-hRPE-Zellen) photometrisch untersucht. Die Proliferation allogener T-Lymphozyten mit beziehungsweise ohne Makrophagen konnte durch das sezernierte IL-10 supprimiert werden. Bei den hTERT-RPE1-Zellen lag ohne die Anwesenheit von professionellen APC am Tag 6 eine signifikante Reduktion der T-Lymphozytenproliferation vor, während bei Kokultivierung mit Makrophagen Signifikanzen am Tag 5 und Tag 6 erkennbar waren. Die immunsuppressive Wirkung von IL-10 konnte mittels Anti-IL-10-Antikörper neutralisiert werden. Damit wurde bewiesen, dass die proliferations-supprimierende Wirkung auf IL-10 zurückzuführen war. Diese Ergebnisse könnten demnach neue Möglichkeiten zur Verhinderung einer Abstoßungsreaktion nach RPE-Zelltransplantation bei Patienten mit AMD eröffnen / Age-related macular degeneration (AMD) is a disease of eyes affecting the macula lutea, the area of the retina with the highest density of retinal pigment epithelial cells (RPE cells). The disease is characterized by degeneration of RPE cells resulting in dystrophy of photoreceptors and finally loss of central vision. Transplantation of healthy RPE cells is a promising possibility for therapy but rejection of the allotransplant limits clinical application. One way to avoid this complications is a systemic immunosuppression of the recipient but this is combined with many side effects. In this thesis a self-constructed IL-10 expression vector (plasmid pCIneoIL-10) has been transferred into human RPE cells in vitro by gene transfer. In addition to human donor RPE cells a permanent RPE cell line (hTERT-RPE1 cells) was employed. Kationic lipids were used as transient transfection system for transfer of pCIneoIL-10 into hRPE cells. Three different lipid formulations and various ratios of transfection reagent:DNA were evaluated for highest transfection efficacy. With the optimized protocols a transfection efficacy of 23,3 ± 9,0 % (hTERT-RPE1 cells) and 10,3 ± 4,5 % (donor hRPE cells) was achieved. A negative influence on the viability of the hRPE cells after transfection was not observed. The IL-10 mRNA expression was analysed by reverse transcription-polymerase chain reaction (RT-PCR). Only in transfected hRPE cells the IL-10 mRNA-amplicon with 383 bp in size was found. Secretion of IL-10 protein in the cell culture supernatants of transfected hRPE cells was investigated using an enzyme-linked immunosorbent assay (ELISA) daily for 7 days. The IL-10 protein concentrations peaked at day 3 with 10,3 ± 0,8 ng/ml (hTERT-RPE1 cells) and 3,1 ng/ml (donor hRPE cells). The amount of secreted IL-10 positively correlated with transfection efficacy. After stimulation with the immunmodulatory cytokine interferon-gamma (IFN-g) the expression of MHC class II molecules on hRPE cells is increasing. Therefore they are able to present antigens similar to macrophages. Hence, the effects of recombinantly expressed IL-10 on the proliferation of allogeneic T lymphocytes were investigated both with and without allogeneic macrophages as professional antigen presenting cells (APC). Proliferation of T lymphocytes has been investigated colorimetrically between day 2 and day 6 (hTERT-RPE1 cells) and day 2 and day 4 (donor hRPE cells) respectively. The proliferation of allogeneic T lymphocytes with and without macrophages could be suppressed by the secreted IL-10. Signifikant reduction of proliferation was observed at day 6 in absence of professional APC (14,1 ± 1,1 % to 100% of untransfected control) and between day 5 (44,1 ± 4,9 %) and day 6 (37,4 ± 6,3%) in the presence of macrophages. It was possible to neutralize the immunosuppressive effect of IL-10 with anti-IL-10 antibodies. Proving that the suppressive effect of T lymphocyte proliferation was caused by IL-10. Thus, the specific IL-10 gene transfer into hRPE cells prior to transplantation may prevent rejection process and could prove a reliable method to help prevent loss of central vision due to AMD.

Deutschsprachige Zusammenfassung Dissertation zur Erlangung des akademischen Grades Dr. med. Titel: Mögliche Korrelation zwischen dem Stadium der altersabhängigen Makuladegeneration und der zentralen Hornhautdicke eingereicht von: Christian Koch angefertigt an der: Klinik und Poliklinik für Augenheilkunde Universität Leipzig betreut von: Professor Dr. med. Peter Wiedemann Klinik und Poliklinik für Augenheilkunde Universität Leipzig Monat und Jahr: Juni 2015 Annahme: Es soll ein statistischer Zusammenhang zwischen der zentralen Hornhautdicke in der Pupillenmitte mit dem nicht exsudativen frühen Stadium der AMD, dem exsudativen späten Stadium der AMD und einer Kontrollgruppe überprüft werden. Methodik: Die erste Studiengruppe stellten 48 Augen von 48 Patienten mit einer Form der frühen AMD dar (Durchschnittsalter 75,4 Jahre, 70,8% der Probanden waren Frauen). Die zweite Studiengruppe bildeten 49 Augen von 49 Patienten mit einer Form der späten AMD (Durchschnittsalter 79,8 Jahre, 59,2% der Probanden waren Frauen). Als Kontrollgruppe wurden 49 Augen von 49 Individuen ohne retinale oder korneale Erkrankungen genutzt (Durchschnittsalter 68,9 Jahre, 59,2% der Probanden waren Frauen). Die Vermessung der Hornhautdicke in Pupillenmitte im Sinne der Hornhautmittendicke erfolgte als Pachymetrie mit der Oculus Pentacam. Ergebnisse: Die durchschnittliche zentrale Hornhautdicke betrug bei der Kontrollgruppe 552,76 μm (SD 36,27 μm), bei der nicht exsudativen Gruppe 552,19 μm (SD 31,27 μm) und bei der exsudativen Gruppe 553,73 μm (SD 33,11 μm). Die Extrempunkte der Kontrollgruppe lagen bei 483 und 640 μm, der Gruppe der nicht exsudativen AMD bei 480 und 617 μm und Minimum und Maximum der exsudativen Gruppe bei 473 und 617 μm. Es gab keine statistisch signifikanten Unterschiede im arithmetischen Mittel der zentralen Hornhautdicke in Pupillenmitte bei der Studiengruppe mit früher AMD im Vergleich mit der Studiengruppe mit später AMD und jeweils im Vergleich zur Kontrollgruppe (P > 0,05). Schlussfolgerung: Die Messwerte der zentralen Hornhautdicke bei Patienten mit früher AMD, später AMD und Kontrollindividuen unterscheiden sich nicht. Die Erhebung der Hornhautmittendicke bietet somit keine Screeningmöglichkeit zur Erkennung einer AMD. / English Abstract Central corneal thickness in patients with AMD Koch, C.; Jochmann, C.; Wiedemann, P. University of Leipzig, Department of Ophthalmology and Eye Hospital, Leipzig, Germany Purpose: To evaluate central corneal thickness in patients with AMD in the early and late phase and a control group. Method: The first study group was made up of 48 eyes of 48 patients with early AMD (mean age 75.4 years, 70.8 % women), the second study group was made up of 49 eyes of 49 patients with late AMD (mean age 79.8 years, 59.2 % women). 49 eyes of 49 individuals without any retinal or corneal damage (mean age 68.9 years, 59.2 % women) were used as control group. The central corneal thickness was measured with the Oculus Pentacam pachymetry. Results: The mean central corneal thickness in early non-exudative AMD group was found to be 552.19 μm (SD 31.27 μm), while the mean central corneal thickness in the late exudative AMD group was measured as 553.73 μm (SD 33.11 μm). The control group had a mean central corneal thickness of 552.76 μm (SD 36.27 μm). There were no statistically significant differences in the mean central corneal thickness in the early non-exudative AMD group in comparison with the late exudative AMD group and each of them compared to the control group (P > 0,05). Conclusion: The central corneal thickness measurements do not differ in patients with early non-exudative AMD, late exudative AMD and control subjects.

Made available in DSpace on 2014-07-29T15:25:22Z (GMT). No. of bitstreams: 1 tese joao arraes ciencias saude.pdf: 3252483 bytes, checksum: be116024cf6d2b2b6cef094fc736420d (MD5) Previous issue date: 2009-06-19 / Antiangiogenesis therapy has become a first-line treatment for neovascular age-related macular degeneration (AMD). Bevacizumab has proven to be efficient and cost effective, however its use in AMD is still off-label. PURPOSES: Evaluating the histological toxicity of bevacizumab on the neurosensorial retina (NSR) and the retinal pigmented epithelium (RPE) in pigmented rabbit eyes; evaluating if a fast increase in vitreous volume after a 0.1 ml balanced saline solution (BSS) intravitreal injection (IVI) in a rabbit eye will lead to histological damages in the NSR and RPE; and evaluating postoperative clinical complications after an IVI in rabbits eyes. METHODS: Eighteen pigmented rabbits (36 eyes) were divided into 4 groups a Control Group (3 rabbits - 6 eyes), which did not receive any IVI; the rabbits were sacrificed at the beginning of the study. Thirty eyes of the fifteen remaining rabbits were distributed to three groups: a sham group (S), that received a 0.1 ml balanced saline solution (BSS) IVI (ten eyes); group 1, that received a 1.25 mg (0.1 ml) bevacizumab IVI (ten eyes); and group 2, that received a 2.5 mg (0.1 ml) bevacizumab IVI (ten eyes). Postoperative clinical evaluation included inspection of the anterior segment and indirect binocular ophthalmoscopy. The rabbits were sacrificed 90 days after the procedure and both eyes of all the rabbits were enucleated. Histological examination of the NSR and RPE were performed and their morphological features and layer thickness were analyzed. RESULTS: No significant postoperative clinical complications were observed either in the neurossensorial retina or in the RPE. Histological morphology and thickness of the NSR and RPE layers did not differ significantly between BBS-injected eyes and bevacizumab-injected eyes. CONCLUSIONS: A rapid increase in vitreous volume, after 0.1 ml BSS IVI did not lead to any histological damage in the NSR and RPE in rabbit eyes. After a 90-day follow-up period, a single Bevacizumab 1.25 and 2.5 mg intravitreal injection did not lead any toxic damage in the NSR and RPE. No important postoperative complications in pigmented rabbit eyes were observed and it appears to be a safe procedure for the treatment of retinal neovascular diseases / A terapia anti-angiogênica tornou-se o tratamento de primeira linha para a forma neovascular da degeneração macular relacionada à idade. O Bevacizumabe é uma droga com boa eficácia e custo-efetividade, porém seu uso nesta doença ainda é considerado off-label. OBJETIVOS: Avaliar a toxicidade sobre a retina neurossensorial (RNS) e epitélio pigmentado da retina (EPR) da injeção intra-vítrea (IV) de bevacizumabe em olhos de coelhos não albinos; avaliar se o aumento súbito do volume vítreo após a injeção IV de 0,1ml de solução salina balanceada (SSB) no olho do coelho leva a danos histológicos na RNS e EPR; e avaliar as complicações clínicas pós-operatórias após a injeção IV em olhos de coelhos. MÉTODOS: 18 coelhos não albinos (36 olhos) foram distribuídos em 4 grupos. O grupo controle (3 coelhos 6 olhos), o qual não recebeu injeção IV, foi sacrificado no início do estudo. Os trinta olhos dos 15 coelhos restantes foram distribuídos em 3 grupos (1:1:1): Grupo Placebo (injeção IV de 0,1ml de SSB); Grupo 1 (injeção IV de 1,25mg/0,1ml de bevacizumabe); e Grupo 2 (injeção IV de 2,5mg/0,1ml de bevacizumabe). Os coelhos foram acompanhados por um período de 90 dias após o procedimento, quando então foram submetidos a eutanásia. Todos os coelhos tiveram seus olhos enucleados e avaliados histologicamente. Foram realizadas avaliação clínica pós-operatória (inspeção do segmento anterior e oftalmoscopia binocular indireta) e avaliação histológica da morfologia e da espessura das camadas da RNS e EPR. RESULTADOS: Não foram observadas complicações clínicas pós-operatórias significantes. A morfologia histológica e espessura das camadas da RNS e EPR não apresentou diferença significante entre os grupos controle e placebo, grupo placebo e grupo 1 e grupo placebo e grupo 2. CONCLUSÕES: A injeção IV de 1,25mg/0,1ml e 2,5mg/0,1ml bevacizumabe não leva a alterações histológicas tóxicas na RNS e EPR, nem a complicações clínicas pós-operatórias importantes em olhos de coelhos não albinos. A injeção IV de 0,1ml de SSB não leva a danos histológicos ao RNS e ao EPR em olhos de coelhos não albinos

<p>The kidney is the major organ regulating the extracellular fluid volume and thereby the arterial blood pressure. The neuronal isoform of nitric oxide synthase (nNOS) in the kidney is predominantly located in the macula densa cells. These cells are sensors for both renin release and the tubuloglomerular feedback mechanism (TGF), which is an important regulator of the glomerular filtration rate and afferent arteriole tone. The aim of this investigation was to elucidate the function of nNOS in the macula densa cells.</p><p>Acute nNOS inhibition in rats resulted in an increased TGF responsiveness and unchanged blood pressure while, after chronic inhibition, the TGF was normalised and the blood pressure was elevated. The plasma renin concentration was elevated in rats on long-term low salt diet, but was not significantly affected by chronic nNOS inhibition. On the other hand, nNOS inhibition for four days increased plasma renin concentration in rats treated with a low salt diet. The renal vasculature of rats exhibits a diminished renal blood flow and intracellular Ca2+ response to angiotensin II after one week blockade of nNOS while angiotensin II’s effect on the renal blood flow was abolished after four weeks treatment. Acute extracellular volume expansion diminish the TGF sensitivity thus assisting the elimination of excess fluid but after acute addition of nNOS inhibitor to volume expanded rats the TGF sensitivity restored.</p><p>In conclusion, the results from the present study suggest an important role for nNOS in the macula densa cells in the regulation of the arterial blood pressure and the modulation of the TGF response.</p>

The kidney is the major organ regulating the extracellular fluid volume and thereby the arterial blood pressure. The neuronal isoform of nitric oxide synthase (nNOS) in the kidney is predominantly located in the macula densa cells. These cells are sensors for both renin release and the tubuloglomerular feedback mechanism (TGF), which is an important regulator of the glomerular filtration rate and afferent arteriole tone. The aim of this investigation was to elucidate the function of nNOS in the macula densa cells. Acute nNOS inhibition in rats resulted in an increased TGF responsiveness and unchanged blood pressure while, after chronic inhibition, the TGF was normalised and the blood pressure was elevated. The plasma renin concentration was elevated in rats on long-term low salt diet, but was not significantly affected by chronic nNOS inhibition. On the other hand, nNOS inhibition for four days increased plasma renin concentration in rats treated with a low salt diet. The renal vasculature of rats exhibits a diminished renal blood flow and intracellular Ca2+ response to angiotensin II after one week blockade of nNOS while angiotensin II’s effect on the renal blood flow was abolished after four weeks treatment. Acute extracellular volume expansion diminish the TGF sensitivity thus assisting the elimination of excess fluid but after acute addition of nNOS inhibitor to volume expanded rats the TGF sensitivity restored. In conclusion, the results from the present study suggest an important role for nNOS in the macula densa cells in the regulation of the arterial blood pressure and the modulation of the TGF response.