Short-wavelength and near-infrared autofluorescence imaging in recessive stargardt disease, choroideremia, PROM1-macular dystrophy and ocular albinism
Date
2023-05-26
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Abstract
Funduse sinine ja lähi-infrapuna autofluorestsentsuuring autosoom-retsessiivse Stardgardti tõve, koroidereemia, PROM1-maakuli düstroofia ja okulaarse albinismi patsientidel
Pärilikud võrkkestahaigused on juhtivaks nägemiskaotuse põhjuseks tööealise elanikkonna seas arenenud riikides. Tegemist on kliiniliselt ja geneetiliselt väga heterogeense haiguste grupiga, mistõttu diagnostika ja haiguse patogeneesi uurimine on olnud vaevarikas. Võrkkesta piltdiagnostika on oluline mitte-invasiivne meetod haiguste diagnoosimiseks ja uurimiseks. Konfokaalne skanneeriv laseroftalmoskoop valgustab võrkkesta erineva lainepikkusega laserkiirega ning salvestab tagasikiirgavat valgust luues silmapõhjast pildi. Funduse autofluorestsents (AF) uuringul kasutatakse ära silmapõhja enda naturaalseid fluorofoore. Lipofustsiini ergastamiseks kasutatakse sinise spektri laserkiirt (sinine AF) ja melaniini jaoks lähipuna laserkiirt (lähipuna AF). Nende fluorofooride jaotus ja kogus silmapõhjas muutub erinevate haigusprotsesside mõjul ning need muutused on tuvastatavad AF uuringul.
Antud doktoritöös uurisime sinise ja lähipuna AF uuringu pilte autosoom-retsesiivse Stargardti tõve (STGD1), koroidereemia, PROM1-maakuli düstroofia ning okulaarse albinismi patsientidel. Töö eesmärgiks oli paremini mõista sinise ja lähipuna AF signaali allikaid erinevate haigusseisundite korral, kus võrkkesta fluorofooride jaotus ning kogused on muutunud. Lisaks kvalitatiivsele piltide hindamisele kasutamise kvantitatiivset AF signaali tugevuse mõõtmist hindamaks lipofustsiini ja melaniini taset.
Uurimustöös näitasime, et melaniin on lähipuna AF signaali peamiseks allikaks. Lisaks näitasime, et melanin võib kaudselt moduleerida lipofustsiinist tuleneva sinise AF signaali, sest okulaarse albinismi kandjate hüpopigmenteeritud võrkkesta alade sinise AF signal oli tavapärasest kõrgem. AF signaali tugevuse mõõtmisel leidsime, et lipofustsiini kuhjumine võrkkestas põhjustab lisaks sinise AF signaali tõusule ka lähipuna AF signaali tõusu STGD1 patsientidel. Kvantitatiivsel analüüsil näitasime ka, et PROM1-maakuli düstroofia patsientide sinise AF signaal oli võrreldav terve silmapõhja signaali tugevusega, eristades seda fenotüübiliselt sarnasest STGD1 haigusest ning viidates ka sellele, et lipofustsiini üleliigne kuhjumine ei ole antud haigusele omane mehhanism. Koroidereemia ja STGD1 haigete uurimisel leidsime, et pigmentepiteeli rakkude kärbumine on nähtav AF signaali hääbumisena, samas lähipuna AF uuringaitab tuvastada varasemaid muutusi kui sinine AF uuring. Lipofustsiin ja melanin on mõlemad olulised võrkkesta rakkude seisundi biomarkerid, mida on võimalik mitte-invasiivsel moel AF uuringu abil analüüsida ning hinnata haiguse progressiooni.
Inherited retinal diseases are the leading cause of visual impairment among the working age-group in the developed countries. Because of genetic and phenotypical heterogeneity, diagnosis and understanding pathogenesis of inherited retinal disease has been challenging. Retinal imaging studies which are noninvasive, are an invaluable source of information. Fundus autofluorescence (FAF) utilizes natural fluorophores to create an image of the retina. Lipofuscin is the primary source for short-wavelength autofluorescence (SW-AF) and melanin for near-infrared autofluorescence (NIR-AF). The amount and distribution of these fluorophores changes in the different disease processes and is detectable in FAF images. In this study we analyzed SW-AF and NIR-AF images in cases of genetically confirmed recessive Stargardt disease (STGD1), choroideremia, PROM1-macular disease and ocular albinism. The aim was to qualitatively describe FAF in conditions with varying levels of lipofuscin or melanin as well as to quantify FAF signal intensities. We also aimed at finding new clinical implications for autofluorescence imaging in evaluating inherited retinal disease. We confirmed that melanin is the major source of NIR-AF signal by analyzing ocular albinism carriers and mice models with varying fundus pigmentation, but we also found that presence of melanin can modulate SW-AF signal strength. As a novel finding we confirmed that lipofuscin contributes to NIR-AF signal intensity in cases with excessive bisretinoid lipofuscin levels like seen in STGD1. The analysis of choroideremia and STGD1 patients showed that retinal pigment epithelium atrophy causes loss of signal in both SW-AF and NIR-AF, but NIR-AF could be more sensitive in detecting early cell degeneration. Quantifying the autofluorescence signal intensity helps to further understand disease processes as it is an indirect measure for levels of retinal fluorophores. We showed PROM1-macular dystrophy does not present with elevated levels of SW-AF indicating that excessive lipofuscin accumulation is likely not part of its disease mechanism. That knowledge is valuable in differentiating it from phenotypically similar STGD1 or when developing therapeutic approaches. Lipofuscin and melanin are both valuable retinal biomarkers for evaluating retinal health by using non-invasive autofluorescence imaging.
Inherited retinal diseases are the leading cause of visual impairment among the working age-group in the developed countries. Because of genetic and phenotypical heterogeneity, diagnosis and understanding pathogenesis of inherited retinal disease has been challenging. Retinal imaging studies which are noninvasive, are an invaluable source of information. Fundus autofluorescence (FAF) utilizes natural fluorophores to create an image of the retina. Lipofuscin is the primary source for short-wavelength autofluorescence (SW-AF) and melanin for near-infrared autofluorescence (NIR-AF). The amount and distribution of these fluorophores changes in the different disease processes and is detectable in FAF images. In this study we analyzed SW-AF and NIR-AF images in cases of genetically confirmed recessive Stargardt disease (STGD1), choroideremia, PROM1-macular disease and ocular albinism. The aim was to qualitatively describe FAF in conditions with varying levels of lipofuscin or melanin as well as to quantify FAF signal intensities. We also aimed at finding new clinical implications for autofluorescence imaging in evaluating inherited retinal disease. We confirmed that melanin is the major source of NIR-AF signal by analyzing ocular albinism carriers and mice models with varying fundus pigmentation, but we also found that presence of melanin can modulate SW-AF signal strength. As a novel finding we confirmed that lipofuscin contributes to NIR-AF signal intensity in cases with excessive bisretinoid lipofuscin levels like seen in STGD1. The analysis of choroideremia and STGD1 patients showed that retinal pigment epithelium atrophy causes loss of signal in both SW-AF and NIR-AF, but NIR-AF could be more sensitive in detecting early cell degeneration. Quantifying the autofluorescence signal intensity helps to further understand disease processes as it is an indirect measure for levels of retinal fluorophores. We showed PROM1-macular dystrophy does not present with elevated levels of SW-AF indicating that excessive lipofuscin accumulation is likely not part of its disease mechanism. That knowledge is valuable in differentiating it from phenotypically similar STGD1 or when developing therapeutic approaches. Lipofuscin and melanin are both valuable retinal biomarkers for evaluating retinal health by using non-invasive autofluorescence imaging.
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Keywords
eye diseases, hereditary diseases, retinal diseases, ocular fundus, retina, diagnostic imaging