[Sustained rapamycin drug delivery system in prevention of high risk corneal allograft rejection and neovascularization in rabbits]

Abstract

Objective: To evaluate the immunosuppressive and antiangiogenesis effects of rapamycin drug delivery system (RAPA DDS) in high risk rabbit model of penetrating keratoplasty (PK).

Methods: (1) RAPA DDS preparation: 50 mg of PGLC and 50 mg of RAPA were mixed as a RAPA drug delivery system. (2) High risk rabbit model: Corneal vascularization was induced in 45 New Zealand white rabbits (45 eyes) by passing 5 - 0 silk sutures in corneal stroma in each quadrant. (3) 40 rabbits with corneal neovascularization beyond three quadrants were received a unilateral 7 mm diameter central PK. The 40 were divided into four treatment groups: Group A, control group and received no therapy; Group B, 1 mg PGLC carrier was implanted in the anterior chamber; Group C, 1% RAPA eye drops was applied four times daily; Group D, 0.5 mg RAPA DDS was implanted in the anterior chamber. (4) Postoperative examination: The cornea allografts (opacity, edema and neovascularization) were examined by the slit-lamp biomicroscopy for ninety days. Rejection index (RI) and neovascularization index (NI) of these animal models were recorded. RAPA concentration in the aqueous humor was detected on 2, 4, 8 and 12 weeks in group C and D after surgery; the expressions of IL-2R, MCP-1, Fas/FasL in samples were detected with in situ hybridization; TNF-alpha and VEGF were detected with immuno-histochemical technique three weeks after the operation in all groups. Histochemical method was carried out on the procured specimens of cornea, retina, liver and kidney at ninety days.

Results: (1) Allografts rejection: Mean survival times in 4 trial groups were (16.5 +/- 2.5), (16.0 +/- 2.6), (47.1 +/- 13.2), (87.6 +/- 5.8) d respectively (P = 0.000). (2) Corneal neovascularization: Mean NI was 2.4 +/- 0.7, 2.1 +/- 0.5, 0.6 +/- 0.5, 0.3 +/- 0.5 (P = 0.000) 2 weeks after the operation, and the NI value was 3.8 +/- 0.5, 3.8 +/- 0.4, 0.8 +/- 0.7, 0.4 +/- 0.8 (P = 0.000) 12 weeks after the operation in groups A, B, C and D respectively. (3) RAPA concentration in aqueous humor: Mean RAPA concentration in aqueous humor was 10.7, 12.0, 9.2, 7.0 ng/ml in group D in the 2, 4, 8 and 12 weeks after the operation respectively. RAPA can not be detected in group C. (4) Cytokine expression: IL-2R, MCP-1, TNF-alpha and VEGF were overexpression in group A and B, and undetectable in group C and D. Fas and FasL were negative in all groups. (5) No inflammatory cell infiltration was found in retina, liver and kidney tissue ninety days after the surgery.

Conclusions: Sustained RAPA DDS and eyedrops can prolong allograft survival and inhibit cornea neovascularization in rabbit model. However, RAPA DDS is better than eyedrops.