Hong-Ming Cheng

Direct Measurement of Polyol Pathway Activity in the Ocular Lens

A method to measure the polyol pathway metabolic flux in the intact rabbit lens by 13C nuclear magnetic resonance spectroscopy is described. In the lens exposed to 35.5 mM glucose, the polyol pathway accounts for ⅓ of the total glucose turnover. The high metabolic activity of the pathway suggests a significant alteration in the reduced to oxidized pyridine nucleotide ratio in the lens exposed to high glucose.

The effect of high glucose and oxidative stress on lens metabolism, aldose reductase, and senile cataractogenesis

Diabetic cataractogenesis, a multifactorial process, was examined with nuclear magnetic resonance (NMR). P-31 NMR spectroscopic studies showed substantial alteration of both energy and membrane metabolism in the diabetic lens. Findings from a C-13 NMR spectroscopic determination of the sorbitol pathway flux in lenses incubated in 35.5 mmol/L glucose revealed that (1) one-third of total glucose consumed was channeled through this pathway, and (2) the turnover rate of NADPH to NADP was 3,000%/hr. Furthermore, a competition for NADPH between aldose reductase and glutathione reductase was demonstrated. It is important to note that all metabolic changes in hyperglycemic/diabetic lenses can be prevented by aldose reductase inhibitors, eg, sorbinil.

The Effect of Oxidation on Sorbitol Pathway Kinetics

The rapid conversion of glucose to sorbitol by aldose reductase and the consequent hyperosmolarity of the cytoplasm has been shown to be the primary cause of the so-called “sugar” or “osmotic” cataract in many animal lenses. It is not as clear, however, that hyperosmolarity is the principal factor in the etiology of cataracts in human diabetic subjects. In fact, the comparatively low activity of aldose reductase in the human lens as compared with several animal lenses, and the osmotically insignificant levels of sorbitol pathway products (sorbitol and fructose), suggest that hyperosmolarity, per se, may not be as important a factor in human cataract formation as it is in animals. We present evidence that the flux of glucose and sorbitol through the rat lens is markedly reduced by oxidative stress (0.1 mM H2O2). Sorbitol accumulation is reduced by 114%, sorbitol turnover is reduced by 78%, sorbitol production is reduced by 90%, fructose accumulation is reduced by 60%, and fructose turnover is reduced by 76% in the presence of 36 mM glucose. H2O2 does not affect glucose turnover, the glucose rate constant, or the ATP level significantly at 36 mM glucose, but at 5.5 mM glucose, 0.2 mM H2O2 leads to a rapid loss of ATP that can be prevented by 0.04 mM sorbinil, an aldose reductase inhibitor. These results suggest that inhibition of aldose reductase by sorbinil renders rat lenses better able to cope with oxidative stress. In the absence of an aldose reductase inhibitor, elevating ambient glucose may render a lens less able to scavenge oxidants by diverting NADPH into sorbitol production. The importance of the rate of flux of glucose through the sorbitol pathway, rather than the absolute concentration of sorbitol or fructose, is stressed in considering the mechanisms underlying complications of diabetes mellitus.

Shape of the myopic eye as seen with high-resolution magnetic resonance imaging

We have obtained multislice magnetic resonance (MR) images of the eye and calculated ocular dimensions along the three cardinal axes: antero-posterior (A-P), equatorial, and vertical. We found no difference in the shape of hyperopic (average refractive error: +3.72 D) and emmetropic eyes, both of which had an equatorial diameter longer than the A-P and vertical diameters. Myopic eyes (average refractive error: −6.54 D) were larger than hyperopic eyes, and most had the same spheroelliptical shape as that of the emmetropic and hyperopic eyes. The results suggest that during myopic progression an overall enlargement or a radial volume expansion has occurred.

Efficacy of Alrestatin, An Aldose Reductase Inhibitor, in Human Diabetic and Nondiabetic Lenses

Immediately after cataract extraction, lenses from diabetic and nondiabetic patients were collected, classified, and assayed or incubated in high-glucose medium. The distribution of cataract types within the diabetic and nondiabetic groups was almost identical. The aldose reductase (AR) inhibitor AY22,284 (Alrestatin) was as effective in blocking sorbitol formation in diabetic as in nondiabetic lenses. While there was no difference in the level of intralenticular glucose, the diabetic lens produced significantly more sorbitol than did the nondiabetic lens. Also, the activity of polyol dehydrogenase (PD) was much lower in the diabetic population. The diabetic lenses swelled slightly more (P <.2) than nondiabetic lenses in high glucose media, and AY22,284 was effective in reducing the swelling of diabetic lenses in 35.5 mM glucose medium. While these results are preliminary, they suggest that diabetes, in some way, may confer on the human lens an increased susceptibility to osmotic stress via the sorbitol pathway. It is also reassuring to note that an AR inhibitor is no less effective in blocking the more active AR in the diabetic than in the nondiabetic lens. The therapeutic implications of this are discussed.

Sugar metabolism in the crystalline lens

Research on the sugar metabolism of the crystalline lens, past and preent, is reviewed. The chief energy source in the lens is the Embden-Meyerhof pathway; respiration and oxidative phosphorylation become more important as the lens ages. The function of the alpha-glycerophosphate cycle is not fully understood. The mechanisms involved in cataract formation, including those of hypoglycemic cataract and osmotic cataracts, are discussed. Sugar cataracts can be delayed or prevented with such aldose reductase inhibitors as flavonoids. By inhibiting aldose reductase, the formation and accumulation of sugar alcohols is stopped. This approach may be useful as a medical therapy for human diabetic senile cataracts.

Altered phosphate metabolism in the intact rabbit lens under high glucose conditions and its prevention by an aldose reductase inhibitor

Intact paired rabbit lenses were incubated in media containing 5.5 mM and 35.5 mM glucose (both at 290 +/- 3 mOsm) and examined by phosphorus-31 nuclear magnetic resonance spectroscopy. Lenses in 35.5 mM glucose exhibited an altered metabolic steady-state characterized by elevated alpha-glycerophosphate and depressed adenosine triphosphate concentrations. Time course studies revealed that these metabolic changes occurred chiefly during the initial 48 hr of incubation under high glucose conditions. The inclusion of an aldose reductase inhibitor in the medium prevented these changes in lenticular metabolism.

Response of the lens to oxidative-osmotic stress

Both aldose reductase and glutathione reductase share a common cofactor, NADPH. Glutathione reductase is preferentially activated due to its higher affinity for the cofactor. Since NADPH is primarily consumed by glutathione reductase, which in conjunction with glutathione peroxidase detoxifies H2O2 present in the aqueous humor, the cataractogenic role of sorbitol-induced osmotic pressure must therefore depend on the availability of NADPH for aldose reductase activity. We examined the response of the lens to an oxidative-osmotic double stress and found that the lens indeed produced 79% less sorbitol and 45% less fructose than a lens subjected to the osmotic stress alone. Morphological studies showed that photo-oxidation damaged the epithelium where the cation pump resided. However, with additional osmotic stress, the swelling of lens fibers in the posterior pole region became more pronounced, and cell nuclei deep in the lens nuclear bow were dislodged to the posterior pole. This could be explained by the slight but significant loss of K+ in the lenses under the double stress. Apparently, the slightly decreased 86Rb uptake (26% loss), caused by photooxidation could not maintain adequate ionic balance even though the stress from accumulation of sorbitol + fructose was sub-maximal. No disturbance in the glycolytic activity or to the 86Rb efflux was found in these lenses, however.

Proton magnetic resonance imaging of the ocular lens

Several osmotic cataract models as well as human diabetic lenses were tested by nuclear magnetic resonance spectroscopy and imaging. Both longitudinal (T1) and transverse (T2) relaxation times increased with increase in lens hydration. Therefore proton magnetic resonance imaging (MRI) can be used to detect changes of the biophysical environment of water proton in the lens. T2-weighted imaging sequence (spin-echo) can be used to differentiate lenses with hydrational changes since they exhibit higher signal intensity (because of long T2) than normal lenses at the same TE (echo time). A greater contrast can be achieved with the inversion-recovery sequence, which, in addition to contribution from T2, also incorporates T1 and proton density terms. Proton MRI is potentially useful for the detection of pre-cataractous changes.

Sorbitol/fructose metabolism in the lens

The function of the sorbitol pathway, both as a secondary energy source and as an osmotic counterbalancing force, was examined. Rat lenses were incubated in media containing fructose as the primary exogenous energy source, and 31P nuclear magnetic resonance (NMR) spectra were accumulated. Fructose was found to be a sub-optimal but usable substrate for glycolysis. The utilization of fructose was further confirmed by a 14C fructose tracer study, using high-pressure liquid chromatography. Thus the intralenticular pool of sorbitol + fructose could serve as a secondary energy source during severe hypoglycemia in the diabetic lens. However, fructose is not a physiologically significant alternative to glucose. 13C NMR spectroscopy was employed to determine the kinetics of sorbitol/fructose accumulation in lenses incubated in 35.5 mM 13C1-glucose, and the sorbitol/fructose consumption after the preincubated lenses were transferred to media containing no glucose. Based on these kinetic studies, we concluded that the sorbitol pathway cannot generate sorbitol/fructose fast enough to offset increased osmotic pressure from high glucose levels in the aqueous humor of the diabetic eye. The contribution of osmotic equivalents from sorbitol + fructose, however, cannot be ignored.