The complexity of ischemic retinal degeneration is underscored by the fact that the resultant retinal pathology depends not only on the duration of ischemia but also on which vascular bed is affected (i.e., choroidal, retinal, or optic nerve head) and by differences in retinal cell responses to the ischemic and postischemic environments. However, retinal preconditioning studies have shown that brief periods of noninjurious retinal ischemia or hypoxia can provide robust retinal protection to subsequent ischemic injury. Associated with this neuroprotective response is the upregulation and downregulation of several genes.
2,31–35 Hence, the modulation of retinal gene expression can increase the retina's resistance to ischemic injury.
The reversible acetylation of histones plays a critical role in gene expression and in many other cellular events. Protein acetylation of conserved lysine residues in the histone tail by HATs enhances gene expression by neutralizing the positively charged histones and relaxing the histone-histone and histone-DNA interactions that limit transcription factor access to the DNA. However, deacetylation often accompanies the suppression of gene expression by promoting chromatin condensation and limiting transcription factor access. Since the discovery that p53 is a substrate for HATs and HDACs, there has been a rapidly growing list of proteins other than histones that undergo reversible acetylation.
8,9 These findings have established that protein acetylation and deacetylation, like phosphorylation, have multiple roles in regulating cellular processes.
To date, 18 HDACs in four general classes have been identified in humans. These enzymes have been shown to modulate transcription,
36,37 cell cycle progression,
38,39 differentiation,
40 and apoptosis.
41 Class I HDACs (HDAC1, 2, 3, and 8) are found in almost all tissues, whereas class II HDACs (HDAC4, 5, 6, 7, 9, and 10) have a restricted tissue distribution. Class III HDACs are homologous to yeast silent information regulator 2 (Sir2), are NAD
+ dependent, and include SIRT1 to SIRT7. HDAC11 alone represents class IV HDACs. Both class I and class II HDACs are found in the nucleus and the cytosol and are inhibited by TSA.
In the retina, organ culture studies using developing retina explants (p2–p15) have demonstrated that inhibition of HDAC activity by TSA results in hyperacetylation of retinal proteins, downregulation of transcription factors necessary for rod development, upregulation of apoptotic factors, and increased cell death after 20 hours of exposure.
23,24 However in adult explants (p60), the TSA-induced upregulation of apoptotic genes and cellular apoptosis was not observed.
24 In the present in vivo study, we found that 2 hours after systemic administration of TSA (2.5 mg/kg), adult rats increased their retinal histone acetylation, and this increase in acetylation was observed in cell bodies throughout the retina. In normal (nonischemic) eyes, administration of TSA for 3 days did not produce any significant change in retinal function, as measured by electroretinography or morphology. These in vivo results are consistent with previous organ culture studies that support the idea that acute inhibition of retinal HDACs can be tolerated in adult animals. In addition, these data provide the initial evidence that the retinal efficacy of systemically administered TSA is not limited by the pharmacokinetic restrictions imposed by the inner and outer blood-retina barriers.
Although studies in the brain have provided evidence that HDAC inhibitors are neuroprotective, their potential usefulness in ameliorating retinal degenerative changes has received little attention. As shown in
Figures 2 and
3, treatment with TSA starting 1 hour before ischemic injury provided significant neuroprotection. This neuroprotective response was measured by an improvement in both a- and b-wave amplitudes of the electroretinogram and morphologic preservation of the retina. These results support the idea that inhibition of HDAC activity can ameliorate ischemic injury to both the outer and the inner retinal regions.
Our understanding of the pathophysiologic events that lead to ischemic retinal degeneration remain incomplete; however, recent studies have shown that expression and secretion of the inflammatory cytokine TNF-α play a central role in this process.
42 This degenerative response to elevated TNF-α levels likely involves the stimulation of TNFR1 and the downstream activation of the intrinsic apoptotic pathway as well as caspase-independent processes through the secretion of metalloproteinases and reactive-oxygen species.
43–45 Inhibition of HDAC activity has been shown to suppress TNF-α expression induced by LPS.
23 In addition, HDAC inhibitors have been shown to modulate downstream signaling associated with TNFR1 activation, such as caspases, NFκB, and JAK/STAT.
18,19 To investigate the neuroprotective actions associated with HDAC inhibition, we evaluated how pretreatment with TSA alters ischemia-induced expression of TNF-α in the retina. Previous studies
42 have shown that in the normal rat retina, TNF-α levels are very low but rise rapidly (3–12 hours) after ischemic injury. As shown in
Figure 5, we measured a significant rise in total retinal TNF-α 4 hours after ischemic injury. This early increase in TNF-α level was blocked by pretreatment with TSA. These studies provided initial evidence that TSA administration produces a significant anti-inflammatory effect in the retina, similar to that observed in other tissues. A variety of cell types, including activated macrophages, astrocytes, microglia, and neuronal cells, under stress or ischemic conditions have been proposed for the enhanced production of TNF-α. To evaluate whether invading macrophages are responsible for the elevated TNF-α levels in the ischemic retina, we stained retinal sections of normal and ischemic eyes with ED-1 antibody (a marker for activated-macrophages). No positive staining with ED-1 antibody 4 hours after ischemia was observed (data not shown). We hypothesized that retinal and optic nerve head astrocytes and microglial cells are the major sources of acute TNF-α production and the site of TSA actions in suppressing TNF-α expression.
In arthritis models, HDAC inhibitors have been shown to suppress not only the expression of TNF-α but also the secretion of MMPs resulting from TNF-α receptor activation in these cells.
20–22 Because the expression and secretion of MMPs have also been linked to retinal degeneration,
43,44 we evaluated whether TSA administration could modulate MMP secretion induced by TNF-α. As shown in
Figure 6, the addition of TSA blocked TNF-α–induced expression and secretion of both MMP-1 and MMP-3 from cultured astrocytes. These studies support the idea that inhibiting HDAC activity may provide cytoprotection by stabilizing the extracellular matrix while maintaining the blood retinal barrier. The silencing of MMPs and TNF-α observed in this study may reflect the upregulation of transcriptional repressors or the requirement for the inclusion of specific HDACs in the transcriptome for these proteins.
In summary, our study demonstrates that pretreatment with the HDAC inhibitor TSA can significantly reduce retinal injury initiated by ischemia/reperfusion. This retinal protective action was associated with the suppression of retinal TNF-α expression. In vitro studies provided evidence that TSA can also inhibit the downstream action of TNF-α, suppressing the increases in MMPs associated with TNF-α receptor stimulation. These findings support the idea that the regulation of acetylation in the retina provides a viable neuroprotective strategy for the treatment of retinal diseases in which ischemia may play a role in the etiology of the disease.
Supported in part by National Institutes of Health Grants EY009741 (CEC) and HL095696 (DRM) and by an unrestricted grant from Research to Prevent Blindness to Storm Eye Institute, Medical University of South Carolina.