An Alkali-burn Injury Model of Corneal Neovascularization in the Mouse

Summary

Neovascularization (NV) of the cornea can complicate multiple visual pathologies. Utilizing a controlled, alkali-burn injury model, a quantifiable level of corneal NV can be produced for mechanistic study of corneal NV and evaluation of potential therapies for neovascular disorders.

Abstract

Under normal conditions, the cornea is avascular, and this transparency is essential for maintaining good visual acuity. Neovascularization (NV) of the cornea, which can be caused by trauma, keratoplasty or infectious disease, breaks down the so called ‘angiogenic privilege' of the cornea and forms the basis of multiple visual pathologies that may even lead to blindness. Although there are several treatment options available, the fundamental medical need presented by corneal neovascular pathologies remains unmet. In order to develop safe, effective, and targeted therapies, a reliable model of corneal NV and pharmacological intervention is required. Here, we describe an alkali-burn injury corneal neovascularization model in the mouse. This protocol provides a method for the application of a controlled alkali-burn injury to the cornea, administration of a pharmacological compound of interest, and visualization of the result. This method could prove instrumental for studying the mechanisms and opportunities for intervention in corneal NV and other neovascular disorders.

Introduction

Corneal blindness is the fourth most common cause of blindness, responsible for approximately 4% of all cases¹. Corneal neovascularization (NV) plays a significant role in many of these pathologies, including herpetic keratitis (the leading infectious cause of blindness in the West) and trachoma (the leading cause of infectious blindness worldwide)². Current therapies include steroids, nonsteroidal anti-inflammatory drugs (NSAIDs), anti-VEGF therapies, and cyclosporin A as well as conventional or laser surgical techniques³. However, the severely debilitating nature of corneal NV based pathologies, the paucity of surgical facilities capable of treating corneal NV, and the lack of a strongly performing pharmacological option led a recent expert roundtable to conclude that, despite the extant therapies, the fundamental medical need presented by these pathologies remains unmet⁴.

The human cornea consists of 5 layers, 3 cellular layers (epithelial, stromal and endothelium) and 2 interface (Bowman membrane and Descemet membrane). It functions as a mechanical barrier and refractive surface for the eye. Its transparent nature is the consequence of a delicate balance of its components and is integral to its proper function⁵. Normally avascular, the cornea receives blood from microvessels running along its outer edge which are fed from the ciliary and ophthalmic arteries. Corneal NV occurs when a stimulus promotes angiogenesis of these vessels allowing them to grow towards the center of the cornea and thus limit vision⁶. Corneal angiogenesis includes hemangiogenesis and lymphangiogenesis, which result in the ingrowth of blood vessels and lymphatic vessels from the limbal vascular arcade towards the center of the cornea. This leads to a breakdown of corneal "angiogenic privilege", an increase in corneal opacity and fibrosis, disruption of the corneal layers, and edema⁷. The precise triggers of corneal NV are numerous, ranging from a response to infectious disease such as trachoma to a chemically induced state caused traditional medicines, industrial chemicals, or even chemical warfare agents.

The molecular mechanisms of this process are not, as yet, fully characterized; however, a few key players have been identified. Under normal conditions the cornea possesses a unique ‘angiogenic privilege' maintained by a redundant array of anti-angiogenic factors (such as soluble VEGF-R1)⁸. However, in response to an external stimulus (such as an injury), there will be a local upregulation of pro-angiogenic factors (e.g. VEGF-A). This tips the balance of pro and anti- angiogenic factors that underlies the cornea's angiogenic privilege, and leads to hemangiogenesis, lymphangeogenesis, and inflammation, therefore causing corneal pathology and even blindness⁹.

Given the unmet medical need of this highly debilitating pathology, it is of interest to the field to have a reliable animal model of corneal NV. Here we present such a model: controlled alkali-burn injury. Various eye-injury models based on using filter paper rings have been used since 1970s¹⁰. In 1989, a group of Harvard Medical School ophthalmologists characterized a standard model of a central corneal alkali-burn injury in rabbit based on soaking a piece of circular filter paper with sodium hydroxide (NaOH) and applying it to the cornea at a specific range of concentrations¹¹. Since then, this technique has been adapted for use in the mouse^12-14. Recently, the Wang lab studied the therapeutic effects of the histone deacetylase (HDAC) inhibitor SAHA in the pathogenesis of corneal NV using a mouse corneal alkali-burn injury model¹⁵. The methodology of the mouse corneal alkali-burn injury model presented here was built mainly on the prior work of two other papers^14,16.

Protocol

Note: The following protocol and representative results use the HDAC inhibitor SAHA as an example compound. However, this protocol is by no means limited to the use of SAHA, and is recommended as a general method to test the effects of soluble compounds on corneal neovascularization. Minor modifications will need to be made for degree of dilution as well as frequency and duration of application. Additionally, compounds that are easily soluble in water will be able to be administered in the absence of DMSO.

Ethical Statement: All animal experiments should only be performed in compliance with national law and institutional regulations. This protocol was approved for use by Tulane University Institutional Animal Care and Use Committee. 

1. Preparation of Materials (in Order of Use)

1. Cut a piece of cellulose filter paper (11 μm) into 2 mm circles.
2. Prepare a 1 M solution of NaOH by dissolving 20 g of NaOH in 500 ml distilled H₂O. Store at room temperature. CAUTION: NaOH solutions are corrosive and can cause alkali-burns.
3. Prepare an anesthetic cocktail by diluting 10 ml of 100 mg/ml ketamine and 2.5 ml of 20 mg/ml xylazine in 37.5 ml of 1x PBS for a final concentration of 20 mg/ml ketamine and 4 mg/ml xylazine.
4. Prepare a 0.5% solution of proparacaine hydrochloride (for topical analgesia) by dissolving 500 mg of proparacaine hydrochloride in 100 ml of filtered PBS.
5. Prepare 1x PBS by dissolving 8 g NaCl, 0.2 g of KCl, 1.44 g Na₂HPO_4, and 0.23 g of NaH₂PO₄ in 900 ml of distilled H₂O. Adjust to 7.4 pH. Bring the solution to a final volume of 1,000 ml with distilled H₂O and filter to ensure sterility.
6. Prepare 1,000x stock solutions of SAHA at ~100 mM in dimethyl sulfoxide (DMSO) by dissolving 26.4 mg of SAHA in 1 ml of DMSO. Dilute to a 1x (~10 μM) solution in filtered PBS for each use. Store the stock solution at -20 °C for up to one month. CAUTION: DMSO is a known toxin and mutagen.
7. Prepare a 4% solution of paraformaldehyde (PFA) for fixation. Under a chemical hood, dissolve 4 g of PFA in 90 ml of PBS. Bring the mixture to 65 °C and titrate to a pH of 7.4. Once the PFA has dissolved, bring the solution to a final volume of 100 ml. Store at 4 °C for up to one month. CAUTION: PFA is a known to be allergenic, carcinogenic, and toxic.
8. Prepare 1x blocking buffer by diluting 5 ml of goat serum and 500 ul of Triton X-100 into 94.5 ml of PBS.
9. Prepare 1x washing buffer by diluting 500 ul of Triton X-100 into 99.5 ml of PBS.

2. Alkali-Burn Injury & Compound Treatment

1. Soak a round piece of filter paper, ~2 mm in diameter, in a solution of 1 M NaOH.
2. Anesthetize the mouse with an injection of 100 mg/kg ketamine and 5 mg/kg xylazine, which is ~100 μl of the anesthetic cocktail from step 1.3 per 25 g mouse. Anesthesia should take ~1-2 min to set in. Depth of anesthesia may be determined by gently pinching the toe or tail of the animal, if anesthesia is sufficient there should be no response. Note: Care should be taken to ensure the mouse does not succumb to anesthesia induced hypothermia.
3. Using an eyedropper, topically apply a drop of 0.5% proparacaine hydrochloride to the corneal surface for local analgesia.
4. Using sterile forceps, pick up a piece of NaOH soaked filter paper. If you notice excess NaOH clinging to or dripping from the filter paper, briefly tap the soaked filter paper on a dry piece of filter paper to absorb the excess. Place the piece of NAOH soaked filter paper on the central cornea. Leave it for 30 sec to generate an acute alkali-burn of ~2 x 2 mm² in area. A surgical microscope is helpful in properly placing the filter paper. Note: Only one eye of the mouse should be injured with the other serving as a control.
5. Remove the filter paper. Using a 10 ml syringe, gently flush the eye with 10 ml of 1x PBS twice to wash away residual 1 M NaOH.
6. Immediately apply a drop of 1x SAHA working solution (or a vehicle control consisting of PBS diluted DMSO containing no SAHA) topically to the cornea. Repeat application 3x/day for 14 days. Note: during this period a topical antibiotic ointment is not recommended as it may interfere with the development of the injury and the delivery of the compound. Use a liquid antibiotic solution, such as 3% Gentamicin solution, instead.
7. Proceed directly to Clinical Assessment (Protocol 3 below) or sacrifice the mouse and enucleate the eyes for corneal flat mount (Protocol 4 below) or conventional paraffin/frozen histology.

3. Clinical Assessment

1. Perform a daily examination of the mice in a blinded fashion under a surgical microscope and score corneal NV based on corneal opacity, NV, and vessel size. Use at least two observers and record a final score that is the average of the two.
   1. Score corneal opacity on a scale of 0-4. 0 = completely clear; 1 = slightly hazy, iris and pupil easily visible; 2 = slightly opaque, iris and pupil still detectable; 3 = opaque, pupils hardly detectable; and 4 = completely opaque with no view of the pupil.
   2. Score NV on a scale of 0-3. 0 = no neovessels; 1 = neovessels at the corneal limbus; 2 = neovessels spanning the corneal limbus and approaching the corneal center; 3 = neovessels spanning the corneal center.
   3. Score vessel size on a scale of 0-3. 0 = no neovessels; 1 = neovessels detectable under surgical microscope; 2 = neovessels easily seen under surgical microscope; 3 = neovessels easily seen without the microscope.
2. Using a digital camera, take representative images of the eye at 7 days and 14 days.

4. Corneal Staining and Flat Mounts

1. Fix enucleated eye in 4% PFA for at least 1 hr at 4 °C.
2. Transfer the eye to 1x PBS and use forceps to carefully remove excess tissue.
3. With the aid of a surgical microscope, use a needle (18 gauge) or micro-knife to perforate the pericorneal region of the eye (note: this should release fluid from the eye).
   1. From the perforation made in section 4.3.1 use a pair of surgical scissors to cut the anterior portion of the eye (cornea) from the posterior portion.
4. Transfer the cornea back into 4% PFA for fixation overnight at 4 °C.
5. Discard the 4% PFA (CAUTION: PFA is hazardous and must be disposed of in accordance with institutional regulations) and rinse the cornea three times with 1x PBS to remove any residual PFA.
6. Incubate in 1x blocking buffer for at least 2 hr at room temperature to permeabilize the tissue and prevent nonspecific binding of the primary antibody.
   1. Apply primary antibody in 1x blocking buffer, at a 100-500 fold dilution. (e.g. rat anti-mouse-PECAM-1 for detecting blood vessels at 1:100, rabbit anti-mouse-LYVE-1 for detecting lymphatic vessels at 1:500, and/or rat anti-mouse-F4/80 for detecting macrophages at 1:100). Incubate at 4 °C overnight.
   2. Wash six times with 1x washing buffer for 1 hr each time at room temperature to fully remove unbound primary antibody.
   3. Apply a secondary antibody in 1x blocking buffer at a 500-1,000 fold dilution. (e.g. a 488 nm fluorescent tagged goat anti-rat-IgG at 1:800 or a 594 nm fluorescent tagged goat anti-rabbit-IgG at 1:800). Incubate at 4 °C overnight.
   4. Wash three times with 1x PBS for 1 hr each at room temperature to fully remove unbound secondary antibody.
7. Transfer the cornea into fresh 1x PBS and, with the aid of a surgical microscope, carefully make four incisions from periphery towards the center. This should divide the cornea into four quadrants of approximately equal size (the resulting shape should look rather like a butterfly) and allow it to lie flat on a slide.
8. Mount with a mounting medium appropriate for fluorescent imaging. For best results, samples should be imaged immediately and digital photographs taken, but may be stored for several weeks protected from light at 4 °C.

Results

After alkali-burn injury, corneal NV occurs in a predictable, time-dependent fashion. Figure 1 demonstrates the stark difference both in neovascularization and corneal opacity between an untreated animal (Figure 1A) and an animal treated with the HDAC inhibitor SAHA (Figure 1B) at the 7 day time point.

Figures 2A and 2B demonstrate a corneal flat mount of an untreated control eye with primary PECAM-1 and LYVE-...

Discussion

The protocol presented here results in reproducible levels of hemangiogenesis, lymphangiogenesis, and inflammation, making it an ideal system to study these three (interrelated) processes. While this method produces centralized corneal NV, several methods that have been developed to cause more directed NV, namely suturing of the cornea¹⁷ and implanted growth-factor expressing pellets¹⁸, might also be of interest. Our protocol is designed for use in the adult mouse, providing an easy to use anim...

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
1 ml Syringe	BD	309659
18 G Needle	BD	305918
10 ml Syringe	BD	306575
25 G Needle	BD	305916
Anti-F4/80 (rat anti-mouse)	AbD Serotech	MCA497RT
Anti-LYVE-1 (rabbit anti-mouse)	Abcam	ab14917
Anti-PECAM-1 (rat anti-mouse)	BD	553370
Anti-IgG Alexa 488 (goat anti-rat)	Invitrogen	A11006
Anti-IgG Alexa 594 (goat anti-rabbit)	Invitrogen	A11012
Camera	Tucsen	TCC 5.0 ICE
Coverslips	Fisher	12-548-B
DMSO	Sigma	D4540-1L	Caution: Mutagenic, Toxic
Forceps (Blunt), Iris	WPI	15915
Forceps (Sharp), Dumont #4	WPI	500340
KCl	Fisher	P217-500
Ketamine Solution	MedVet	RXKETAMINE	Controlled substance, proper license required for use.
Light Source for Microscope	AmScope	LED-14M-YA
Microscope (Stereo 7X-45X)	AmScope	SM-1B
Mounting Medium, VECTASHIELD	Vector	H-1000
NaCl	Fisher	S271-10
NaH2PO4	Fisher	S397-500
NaOH	Fisher	S318-1	Caution: Corrosive
Paraformaldehyde		P6148-500G	Caution: Allergenic, Carcenogenic, Toxic
Proparacaine Hydrochloride	Sigma	P4554-1G
Scissors (5 mm blade), Vanas	WPI	14003
Goat Serum	MPBio	92939249
Microscope Slides	Fisher	12-550-15
Triton X-100	Sigma	T8787-100ML
Whatman Grade 1 Filter Paper	Whatman	1001-6508
Xylazine Solution	MedVet	RXANASED-20