**Animal Models of Diabetic Retinopathy (Part 2)**

**Animal Models of Diabetic Retinopathy (Part 2)**

DOI: 10.5772/intechopen.70589

Larissa H.C. Tang, Ian Y.H. Wong and Amy C.Y. Lo

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.70589

Larissa H.C. Tang, Ian Y.H. Wong and

#### **Abstract**

Amy C.Y. Lo

Diabetic retinopathy (DR) is one of the leading causes of preventable vision impairment and blindness in the working-age population worldwide. Numerous animal models have been developed for therapeutic drug screening and to further increase our understanding of the molecular and cellular pathological processes involved in DR. Following our discussion of mouse models in "Animal Models of Diabetic Retinopathy Part 1," we describe the cellular, molecular, and morphological features of both rodent and nonrodent models of DR and their respective advantages and limitations in this chapter. To date, no animal model can holistically reproduce the pathological progression of human DR; most only display early or advanced lesions of DR. However, a thorough understanding of genotypic and phenotypic expressions of existing models will facilitate researchers' selection of the appropriate model to simulate their desired clinical scenarios.

**Keywords:** animals, blood glucose, blindness, diabetic complications, diabetes mellitus/ pathology/physiopathology, neovascularization, proliferative, retinal vessels

**1. DR features of animal models**

Among all the existing animal models of diabetic retinopathy (DR), mice and rats are most commonly used, possibly due to their small size, availability, genetic tractability, and relatively faster development of DR lesions as compared with larger animals. **Tables 1**–**3** summarize the cellular, molecular, and morphological features of rat and nonrodent models of DR. Features of mouse models are detailed in the previous chapter (Animal Models of Diabetic Retinopathy Part 1).

Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons

**Type of**

**Hyperglycemia**

**Cellular, morphological, and vascular features of human DR displayed in rat models**

**(Age at which correlates are first reported unless otherwise specified)**

**(+Time post treatment: diabetes, galactosemia, or induction of VEGF overexpression)**

**PDR features**

**Functional changes (ERG)**

**NPDR features**

Galactosefed

/

/

*• 4 mo+*: increased retinal microvascular cell

apoptosis^ [10]

*• 12 mo+*: pericyte ghosts [12] (*23 mo+*)\*^ [13]

Increased no. of acellular capillaries [12]

(*23 mo+*)\*^ [13]

Capillary BM thickening [12]

(*23 mo+*)\*^ [13]

(*28 mo+*

)*^* [14]

*• 24 mo+*: dilated, hypercellular vessels\*^ [13]

IRMAs\* [13]

*• 28 mo+*: disrupted retinal layers^ [14]

Gliosis^ [14]

Capillary dilatation^ [14]

Microaneurysms (OPL, INL)^ [14]

Increased number of endothelial

cells^ [14] *\*50% galactose diet; ^30% galactose diet*

*• 6 mo*: increased retinal capillary BM thickness

*• 7.7* ± *1.1 mo*: reduced and deranged basal

infoldings of the RPE basal plasmalemma [16]

*• 8 mo+*: decreased pericyte/endothelial cell

Animal Models of Diabetic Retinopathy (Part 2) http://dx.doi.org/10.5772/intechopen.70589 43

ratio [17]

Decreased number of pericytes [17]

Microinfarctions with nonperfused

areas [19]

BB rat

1

60–120 days (90% hyperglycemic by

[15, 18]

> 90–120 days)

[15]

**diabetes**

**Type of**

**Hyperglycemia**

**Cellular, morphological, and vascular features of human DR displayed in rat models**

**(Age at which correlates are first reported unless otherwise specified)**

**(+Time post treatment: diabetes, galactosemia, or induction of VEGF overexpression)**

**PDR features**

**Functional changes (ERG)**

*• 2 wks+*: decreased b-wave

amplitude [4] (*11 wks+* [9])

(*16 wks+* [6])

Decreased OP amplitude [4]

(*16 wks+* [6])

*• 8 wks+*: decreased OPs (not

observed at 11 wks) [95]

42 Experimental Animal Models of Human Diseases - An Effective Therapeutic Strategy

*• 11 wks+*: increased a-wave

implicit time [9]

Decreased a-wave amplitude [9]

(*10 wks+* [4])

Delayed OPs [9]

**NPDR features**

STZ

1

Within one wk

injection

*• 1 wk+*: reduced total retinal thickness [93]

*• 2 wks+*: increased retinal apoptosis [94]

BRB breakdown [5, 93] (*16 wks+* [6])

*• 4 wks+*: Müller cell gliosis [2, 3] (*6 wks+* [4])

(*12 wks+* [5])

Reduced NeuN-positive cells in GCL [3]

(*4 mo* reduced number of cells in GCL [1])

Reduced astrocyte number [5] (*6 wks+* [2])

Increased number of microglia [5] (*4 mo+* [3])

Reduced number of cells in ONL [93]

*• 6 wks+*: reduced astrocyte processes [2]

*• 8 wks+*: increased adherent leukocytes [7]

*• 16 wks+*: increased acellular capillaries [6]

(*8 mo+* [1])

Decreased number of pericytes [6]

*• 4 mo+*: reduced NeuN-positive cells in INL [3]

*• 8 mo+*: pericyte ghosts [1]

*• 12 mo+*: capillary BM thickening [8]

*• 6 wks+*: BRB breakdown [96]

*• 2 mo+*: neovascularization in midperiphery region [11] *• 5 mo+*: neovascularization in center

and mid-periphery regions [11]

*• 9 mo+*: neovascularization in all

regions [11]

*• 5 mo+*: capillary occlusion with endothelial

cell swelling [11]

*• 8 mo+*: retinal microvascular cell death [10]

*• 9 mo+*: IRMAs in lower capillary layer [11]

*• 12 mo+*: pericyte ghosts [12]

Increased no. of acellular capillaries [12]

(*18 mo+* [10])

Capillary BM thickening [12]

Alloxan

1

injection

**diabetes**

**Type of**

**Hyperglycemia**

**Cellular, morphological, and vascular features of human DR displayed in rat models**

**(Age at which correlates are first reported unless otherwise specified)**

**(+Time post treatment: diabetes, galactosemia, or induction of VEGF overexpression)**

**PDR features**

**Functional changes (ERG)**

*60 wks*:

*•* OPs [36]

Prolonged peak latencies of

**NPDR features**

OLEFT

2

18 wks of age

[30]

*• 24 wks*: increased leukocyte entrapment [38]

*• 28 wks*: reduced total retinal and RNFL

thickness [32]

*• 36 wks*: reduced number of RGCs [32]

Increased apoptosis in RNFL [32]

*• 40 wks*: increased GFAP immunoreactivity

in Müller cells [33]

*• 14 mo*: capillary BM thickening [31, 34]

Endothelial cell degeneration [31, 34]

Reduced pericyte area to total capillary

cross-sectional area ratio [34]

Caliber irregularity [34] (*64 wks*) [35]

Capillary tortuosity [34] (*64 wks*) [35]

(*17 mo*) [31]

Capillary loop formation [34] (*64 wks*) [35]

(*17 mo*) [31]

*• 64 wks*: capillary narrowing [35]

Microaneurysms [35] (*17 mo*) [31]

*• 19 mo*: decreased INL and photoreceptor

thickness [31]

Decreased RPE height [31]

Animal Models of Diabetic Retinopathy (Part 2) http://dx.doi.org/10.5772/intechopen.70589 45

Poorly developed basal infoldings [31]

**diabetes**

**Type of**

**Hyperglycemia**

**Cellular, morphological, and vascular features of human DR displayed in rat models**

**(Age at which correlates are first reported unless otherwise specified)**

**(+Time post treatment: diabetes, galactosemia, or induction of VEGF overexpression)**

**PDR features**

*24 mo*:

*•* *•*

Increased hyalinization of

intraretinal vessels [23]

*•*

Increased intravitreal proliferation

44 Experimental Animal Models of Human Diseases - An Effective Therapeutic Strategy

of fibrovascular elements [23]

Intravitreal and choroidal

neovascularization [23, 24]

**Functional changes (ERG)**

**NPDR features**

WBN/

2

9–12 age [20]

months of

Kob rat

*• 5 mo*: decreased outer segment

thickness [21] *• 10 mo*: clustering of capillaries into

tortuous

knots [22]

*• 11 mo*: decreased OPL and ONL

thickness [21] *• 14 mo*: capillary BM thickening [21]

Complete photoreceptor cell nuclei and

ONL loss ([21, 22], 169)

*• 15 mo*: decreased number of capillaries [22]

Capillary loop formation [22*]*

*• 19 mo*: acellular capillaries [24]

*• 14 wks*: increased VEGF-beta mRNA levels

ZDF rat

2

6–7 wks of age

[25]

in retina [26]

*• 27 wks*: capillary BM thickening [28]

(6–7 mo) [27]

Increased capillary hypercellularity [28]

(6–7 mo) [27]

*• 33–34 wks*: increased pericyte apoptosis and

presence of pericyte ghosts [29]

Increased endothelial cell apopotosis [29]

Increased number of acellular

capillaries [29]

**diabetes**

**Type of**

**Hyperglycemia**

**Cellular, morphological, and vascular features of human DR displayed in rat models**

**(Age at which correlates are first reported unless otherwise specified)**

**(+Time post treatment: diabetes, galactosemia, or induction of VEGF overexpression)**

**PDR features**

*P18*

*•* Intravitreal neovascularization in

peripheral retina [54, 58]

**Functional changes (ERG)**

*ERG Changes 4–5*

*hyperglycemia onset*

*•* Reduced a-waves, b-waves, and

c-wave amplitude

*•* Elevated b/a-wave ratio

*weeks after*

**NPDR features**

TetO rat

2

7–8

days after

*4–5*

*weeks+* [52]

incorporation

*•* RGC loss

*•* Reduced number of pericytes

*•* Increased number of stenotic vessels

*•* Increased number of veins with abnormal

vessel caliber (deep microvascular plexus)

*•* BRB breakdown

*•* Increased GFAP expression

*•* Reactive gliosis

*•* Increased inflammatory markers

*• P13*: perivascular astrocyte loss [54]

*ERG changes at p18*

*•* Reduced a-wave and b-wave

amplitude [57]

*• P14–16*: increased vascular permeability

(ceased at p18) [55]

*• P18*: reduced peripheral INL(and central),

IPL and total retinal thickness [56]

Increased Müller cell gliosis in peripheral

retina [54, 56]

Increased tortuosity of arterioles [57]

Decreased vessel profiles in outer and inner

plexuses in peripheral retina [54, 58]

Altered pericyte-endothelial

interactions [54] Shortened retinal outer segment length

This table has been modified from a review by Lai and Lo [19].

**Table 1.**

Summary of the cellular, molecular, and morphological features displayed in rat models of DR.

 [97]

Animal Models of Diabetic Retinopathy (Part 2) http://dx.doi.org/10.5772/intechopen.70589 47

OIR

/

/

of doxy-cycline

in drinking

water

[52]

**diabetes**

**Type of**

**Hyperglycemia**

**Cellular, morphological, and vascular features of human DR displayed in rat models**

**(Age at which correlates are first reported unless otherwise specified)**

**(+Time post treatment: diabetes, galactosemia, or induction of VEGF overexpression)**

**PDR features** *1 mo* (*post hyperglycemia*)

*• 1 mo+*: reduced retinal segmental

blood flow [38]

*• 12 mo*: migration and

accumulation of microglia/

macrophages in the subretinal

space [42]

*• 70 wks*: tractional retinal

*32 weeks*

46 Experimental Animal Models of Human Diseases - An Effective Therapeutic Strategy

*•* Prolonged OP peak

latencies [48]

*44 weeks* *•* Reduced a-, b-wave and OP1,

OP2, OP3 amplitudes [51]

*•* Increased OP2, OP3, OP4

implicit time [51]

detachment with fibrous

proliferation [44, 49]

*• 20 mo*: neovascularization (53%)

without ischemia [50]

*•* Tractional changes without retinal

detachment [50]

**Functional changes (ERG)**

**NPDR features**

GK rat

2 (nonobese)

4–6 wks of age [37] (glucose

time [38]

*• 3 mo+*: increased BRB permeability [39]

*• 28 wks*: increased ocular VEGF

concentrations [41]

*• 8 mo*: Increased endothelial/pericyte ratio [40]

*• 12 mo+*: Activated microglia [42]

*• 40 wks*: increased cellular apoptosis in GCL

SDT

2 (nonobese)

25 wks of age (male rats)

and INL [45]

Increased GFAP immunoreactivity

expression across the whole retina [45]

*• 44 wks*: increased retinal leukostasis [46]

*• 52–60 wks*: increased INL, ONL, PL,

choroidal and total retinal thickness [47]

*• 68 wks*: fluorescein leakage around the optic

disc [48]

Venous dilation [48]

Distorted retina [48] (*70 wks*) [44]

Protrusion of optic disc into the vitreous

*• 70 wks*: retinal thickening [44]

*• 77 wks*: anterior chamber hemorrhage with

fibrovascular changes around the iris [44, 49]

*• 49–82 wks*: acellular capillaries [49]

Pericyte loss [49]

Tortuous vessels [49]

Capillary nonperfusion [49]

*• 20 mo*: increased VEGF immunoreactivity

in vascular endothelial cells, GCL, INL,

border between ONL and OS [50]

(100% diabetic

by 40 wks of

age) [44]

in-tolerance

as early as at 2

wks of age)

*• 1 mo+*: increased retinal mean circulation

**diabetes**

**onset**

**Table 1.** Summary of the cellular, molecular, and morphological features displayed in rat models of DR.

**Model**

**Type of**

**Hyperglycemia**

**Cellular, morphological, and vascular features of human DR displayed in non-rodent models**

**(Age at which correlates are first reported unless otherwise specified)**

**+Time posttreatment: diabetes, galactosemia, or induction**

**diabetes**

**onset**

**(**

**of VEGF overexpression)**

**NPDR features**

Cat

Pancreatotomy

 1

1–2 surgery

*• 5* *• 6.5* *• 7.5*

*yrs.+*: IRMAs [69]

Capillary non-perfusion areas [69] (*9.4*

*yrs.+*: microvessel dilation and tortuosity

*• 8.5* *135 days+*

*•* *•*

Diet-induced

2

12–24 weeks

[72]

VEGF implant

 /

/

*• 7* *• 14*

*days+*: vascular leakage [73]

*days+*: increased dilation and tortuosity of vessels [73]

*• 14 days+*: neovascularization

(decreased after

21

days with almost

complete regression by

35 *VEGF + bFGF*

*• 48*

*hrs+*: grade + 1

Animal Models of Diabetic Retinopathy (Part 2) http://dx.doi.org/10.5772/intechopen.70589

neovascularization [74]

*• 4*

*days+*: grade 4

neovascularization [74]

*• 2 wks+*: total traction

retinal detachment

with significant

hemorrhage [74]

49

days) [73]

10% eyes: "Moderate vasculopathy with hard or soft exudates,

*• 135*

*days+*: 50% of

eyes: proliferative

retinopathy [75]

40% eyes: "Serious vasculopathy with serious retinal and preretinal

hemorrhages, vascular lesions, hemovitreous, venous thrombosis" [75]

*• 12 wks+*: increased number of microaneurysms

widespread hemorrhages" [75]

:

Rabbit

STZ injection

1

*yrs.+* [71])

weeks post

*• 3–10 mo+*: capillary BM thickening [70]

*yrs.+*: microaneurysm [69] (*7.7–9.4*

*yrs.+*: small intraretinal hemorrhages [69] (*7.7–9.4 yrs.+* [71])

*yrs.+* [71])

**PDR features**

**Functional**

**changes**

**(ERG)**

*• 8.5*

*yrs.+*: small foci of

*9.4 yrs.+*: decreased

b-wave

(trend) [71]

neovascularization

**Model**

**Type of**

**Hyperglycemia**

**Cellular, morphological, and vascular features of human DR displayed in non-rodent models**

**(Age at which correlates are first reported unless otherwise specified)**

**+Time posttreatment: diabetes, galactosemia, or induction**

**diabetes**

**onset**

**(**

**of VEGF overexpression)**

**NPDR features**

Dog

Galactose-fed /

/

*• 19 mo+*: pericyte loss [62] (*36 mo+*: increased endothelial/pericyte ratio [63])

*• 60 mo+*:

neovascularization [65]

*• 84 mo+*: intravitreal

retinal vascular growth

48 Experimental Animal Models of Human Diseases - An Effective Therapeutic Strategy

[62]

Partial detachment of

posterior vitreous [62]

*• 24 mo+*: uneven distribution of endothelial cells [62]

Acellular capillaries [98] (*36 mo+* [63])

Endothelial proliferation (in areas with pericyte loss) [62] (*36 mo+* [63])

*• 27 mo+*: microaneurysm [62] (*32–36 mo+* [64]) (*36 mo+* [63])

*• 33 mo+*: dot and blot hemorrhages [62, 64]

Capillary varicose enlargement [62]

Areas of nonperfusion [99] (*36 mo+* [65] (*56 mo+* [62]*)*

*• 36–48 mo+*: hemorrhage [62]

*• 56 mo+*: preretinal hemorrhage [62]

IRMAs [62]

*• 60 mo+*: AV shunts [62]

Arterial node formation [62]

Gliosis [62]

*• 1–3*

*• 4*

*yrs.+*: pericyte loss

Smooth muscle cell loss

*• 7*

*yrs.+*: microaneurysms

Acellular capillaries

IRMAs

*• 5*

*yrs.+*: microaneurysm [61]

Pericyte ghosts [61]

Increased endothelial/pericyte ratio [61]

Increased acellular capillaries [61]

BM thickening [61]

Vascular leakage, increased permeability of retinal blood vessels [100]

Alloxan

injection

*yrs.+*: capillary BM thickening

STZ injection

[60]

**PDR features**

**Functional**

**changes**

**(ERG)**

**Table 2.** Summary of the cellular, molecular, and morphological features displayed in nonrodent models of DR.

**Model** Monkey

STZ injection,

1

/

spontaneous or

pancreatectomy

[81]

**Type of**

**Hyperglycemia**

**Cellular, morphological, and vascular features of human DR displayed in non-human primate models**

**(Age at which correlates are first reported unless otherwise specified)**

**(+Time post treatment: diabetes, galactosemia, or VEGF overexpression–induction)**

**PDR features**

**Functional changes**

**(ERG)**

**NPDR features**

*Changes observed in diabetic monkeys with spontaneous or*

*pharmacologically-induced hypertension*

*• 6–15* Capillary dilatation

Capillary dropout

Cotton wool spots

Microaneurysms

Arteriolar dilatation and occlusion

Atrophic retinopathy

Spontaneous,

2

/

*• 3–8*

*yrs.+*: cotton wool spots [82]

*• 3–8* edema [82]

*yrs.+*: cystoid macular

*8 yrs.+*

*•* [83]

*•*

Reduced

amplitudes in

mfERG

*•* [83]

Delayed a-wave

Reduced OPs

:

Capillary dropout [82]

Microaneurysms Kim, #413}

IRMAs [82]

Nonperfused areas [82]

*• 8*

*yrs.+*: RGC loss [83]

Decreased ONL, IS, OS thickness [83]

Intra-vitreal

/

/

*• 2*

*days+*: tortuous vessels [85]

*• 2*

*days+*: grade 2 iris

neovascularization [85]

*• 8*

*days+*: grade 3 iris

neovascularization [85]

*• 19*

*days+*: neovascular

Animal Models of Diabetic Retinopathy (Part 2) http://dx.doi.org/10.5772/intechopen.70589

glaucoma [85]

Vascular leakage [85]

*• 3* *• 18*

*days+*: microaneurysms [84]

Intraretinal hemorrhage [84]

Venous beading [84]

*• 30*

VEGF implant

 /

/

*days+*: intraretinal hemorrhage and edema [84]

*• 3 wks+*: vascular leakage (BRB breakdown) [73]

*• 1 wk.+*: iris

neovascularization

(regressed between wks

2–3)

51

*• 2–3 wks+*: dilation of retinal vessels [73]

*Note*: *vascular changes peaked at 3*

 *wks*

*days+*: vessel dilatation [84]

VEGF injection

obese

*yrs.+*: focal intraretinal capillary leakage spots

**diabetes**

**Model**

**Type of**

**Hyperglycemia**

**Cellular, morphological, and vascular features of human DR displayed in non-rodent models**

**(Age at which correlates are first reported unless otherwise specified)**

**+Time posttreatment: diabetes, galactosemia, or induction**

**diabetes**

**onset**

**(**

**of VEGF overexpression)**

**NPDR features**

Swine

STZ injection

Alloxan

1

15–30 days

*• 90*

[76]

injection

1

1 wk [79]

*• 18 wks+*: capillary BM thickening with rarefaction [79]

*days+*: increased GFAP in Müller cells [76]

*• 20 wks+*: capillary BM thickening [77]

*• 20 wks* (*age*): pericyte loss [78]

Reduced total number of BRB capillaries [78]

Capillary collapse [78]

*• Day 28*: decreased IPL and INL [90]

Zebra

Glucoseinduced

1

1–2

days [90]

fish

Glucoseinduced

*• 6 dpf* (*3* vessels [89]

*days of glucose tx*): increased diameter of hyaloid-retinal

(*flk*:EGFP

transgenic

zebrafish)

Hypoxiainduced *vhl* mutants

/

/

/

/

*• 3*

*days+*: increased capillary sprouts in arterioles and veins [91]

*3 days+*: neovascularization

(increased vascular area)

(plateau at day 12) [91]

*7.5 dpf*:

*•* [101]

*•* Retinal detachment [101]

*•*

Intraretinal

neovascularization

(predominantly in IPL)

[101]

Severe macular edema

Increased number of branch points [91]

Reduced intercapillary distance [91]

*• 5.75 dpf*: increased hyaloid and choroidal vascular networks [101]

*• 6 dpf*: vascular leakage

*dpf =*

This table has been modified from a review by Lai and Lo [19].

**Table 2.**

Summary of the cellular, molecular, and morphological features displayed in nonrodent models of DR.

*days post fertilization*

**PDR features**

**Functional**

**changes**

**(ERG)**

50 Experimental Animal Models of Human Diseases - An Effective Therapeutic Strategy

**Table 3.** Summary of the cellular, molecular, and morphological features displayed in nonhuman primate models of DR. **1.1. Rat models**

*1.1.1. Pharmacological*

*<IP_ADDRESS>. Alloxan injection*

*1.1.2. Diet induced*

*<IP_ADDRESS>. Streptozotocin (STZ) injection*

Sprague Dawley rats did not develop any lesions.

and extended to all regions of the retina by 9 months [11].

Streptozotocin (STZ) injection diabetic rats reproduce early symptoms of DR, though prominent differences have been identified between rat strains possibly as a result of differing genetic susceptibility to DR development. A report comparing differences in the development of DR lesions in Sprague Dawley, Lewis, and Wistar rats revealed that neuronal loss in the ganglion cell layer (GCL) occurred only in Lewis rats, while both Lewis and Wistar rats showed degeneration of capillaries with pericyte ghosts after 8 months of hyperglycemia [1].

Animal Models of Diabetic Retinopathy (Part 2) http://dx.doi.org/10.5772/intechopen.70589 53

In general, neuronal and glial changes appear to precede vascular changes in this model. Retinal apoptosis and retinal thinning developed within 1–2 weeks of hyperglycemia. Müller cell gliosis, as evidenced by increased glial fibrillary acidic protein (GFAP) expression, was prominent beginning at 4 weeks of hyperglycemia [2–5]. Studies have also documented a reduction in astrocyte number and processes [2, 5], decrease in the number of cells in the GCL [1, 3], and an increase in number of microglia [1, 3] after 4–6 weeks of hyperglycemia. Blood-retina barrier (BRB) breakdown was present after 2 weeks of hyperglycemia, while other vascular changes, including acellular capillaries [1, 6], leukostasis [7], and arterial and venous capillary basement membrane (BM) thickening [8], were only present after a longer period of hyperglycemia. Pericyte loss became evident after 4 [6] or 8 months [1] of hyperglycemia. Retinal dysfunction was evidenced by decreased b-wave [4, 6, 9] and OP amplitude [4, 6] and decreased a-wave amplitude [4, 9] with

delayed oscillatory potentials (OP) [9] as early as at 2 weeks and 10 weeks, respectively.

Studies using alloxan injections for diabetes-induction are limited, and none have assessed for neurodegenerative lesions of DR. Alloxan-induced diabetic rats were found to have BRB breakdown within 6 weeks of hyperglycemia. With a longer duration of diabetes, there was retinal microvascular cell death [10], intraretinal microvascular abnormalities (IRMA) [11], pericyte ghosts [12], acellular capillaries [10, 12], and capillary BM thickening [12]. Neovascularization began in the mid-peripheral retina after 2 months of hyperglycemia

Galactose-fed rats display many retinal microangiopathy features that resemble non-proliferative diabetic retinopathy (NPDR). Four months of 30% galactose-fed diet resulted in increased retinal microvascular cell apoptosis [10]. With a longer duration of galactosemia, pericyte ghosts, acellular capillaries, vessel dilation, capillary BM thickening, and IRMAs became evident in both 30 and 50% galactose-fed rats [12–14]. Long-term galactosemia of 28 months further resulted in gliosis, displacement or disruption of retinal layers, an increase in the number of endothelial cells, and microaneurysm formation in the outer plexiform layer (OPL) and inner nuclear layer (INL) [14].

#### **1.1. Rat models**

#### *1.1.1. Pharmacological*

#### *<IP_ADDRESS>. Streptozotocin (STZ) injection*

Streptozotocin (STZ) injection diabetic rats reproduce early symptoms of DR, though prominent differences have been identified between rat strains possibly as a result of differing genetic susceptibility to DR development. A report comparing differences in the development of DR lesions in Sprague Dawley, Lewis, and Wistar rats revealed that neuronal loss in the ganglion cell layer (GCL) occurred only in Lewis rats, while both Lewis and Wistar rats showed degeneration of capillaries with pericyte ghosts after 8 months of hyperglycemia [1]. Sprague Dawley rats did not develop any lesions.

In general, neuronal and glial changes appear to precede vascular changes in this model. Retinal apoptosis and retinal thinning developed within 1–2 weeks of hyperglycemia. Müller cell gliosis, as evidenced by increased glial fibrillary acidic protein (GFAP) expression, was prominent beginning at 4 weeks of hyperglycemia [2–5]. Studies have also documented a reduction in astrocyte number and processes [2, 5], decrease in the number of cells in the GCL [1, 3], and an increase in number of microglia [1, 3] after 4–6 weeks of hyperglycemia. Blood-retina barrier (BRB) breakdown was present after 2 weeks of hyperglycemia, while other vascular changes, including acellular capillaries [1, 6], leukostasis [7], and arterial and venous capillary basement membrane (BM) thickening [8], were only present after a longer period of hyperglycemia. Pericyte loss became evident after 4 [6] or 8 months [1] of hyperglycemia. Retinal dysfunction was evidenced by decreased b-wave [4, 6, 9] and OP amplitude [4, 6] and decreased a-wave amplitude [4, 9] with delayed oscillatory potentials (OP) [9] as early as at 2 weeks and 10 weeks, respectively.

#### *<IP_ADDRESS>. Alloxan injection*

Studies using alloxan injections for diabetes-induction are limited, and none have assessed for neurodegenerative lesions of DR. Alloxan-induced diabetic rats were found to have BRB breakdown within 6 weeks of hyperglycemia. With a longer duration of diabetes, there was retinal microvascular cell death [10], intraretinal microvascular abnormalities (IRMA) [11], pericyte ghosts [12], acellular capillaries [10, 12], and capillary BM thickening [12]. Neovascularization began in the mid-peripheral retina after 2 months of hyperglycemia and extended to all regions of the retina by 9 months [11].

#### *1.1.2. Diet induced*

**Model** Marmoset

Galactose-fed

/

/

*• 2.5*

*yrs.+*: microaneurysm

Increased acellular capillaries

Pericyte loss

BM thickening

BRB breakdown

52 Experimental Animal Models of Human Diseases - An Effective Therapeutic Strategy

This table has been modified from a review by Lai and Lo [19].

**Table 3.**

Summary of the cellular, molecular, and morphological features displayed in nonhuman primate models of DR.

(30%) [86]

**Type of**

**Hyperglycemia**

**Cellular, morphological, and vascular features of human DR displayed in non-human primate models**

**(Age at which correlates are first reported unless otherwise specified)**

**(+Time post treatment: diabetes, galactosemia, or VEGF overexpression–induction)**

**PDR features**

*•*

Macular edema and

thickening

**Functional changes**

**(ERG)**

**NPDR features**

**diabetes**

**onset**

Galactose-fed rats display many retinal microangiopathy features that resemble non-proliferative diabetic retinopathy (NPDR). Four months of 30% galactose-fed diet resulted in increased retinal microvascular cell apoptosis [10]. With a longer duration of galactosemia, pericyte ghosts, acellular capillaries, vessel dilation, capillary BM thickening, and IRMAs became evident in both 30 and 50% galactose-fed rats [12–14]. Long-term galactosemia of 28 months further resulted in gliosis, displacement or disruption of retinal layers, an increase in the number of endothelial cells, and microaneurysm formation in the outer plexiform layer (OPL) and inner nuclear layer (INL) [14].

#### *1.1.3. Transgenic*

#### *<IP_ADDRESS>. Biobreeding (BB) rats*

The diabetes-prone biobreeding (BB) rat is a T1D model derived from outbred Wistar rats. BB rats develop insulitis with selective β-cell destruction, hyperglycemia, hyperketonemia, ketonuria, and hypoinsulinemia. Rapid progression to fatal diabetic ketoacidosis results if exogenous insulin is not administered. The majority of rats develop hyperglycemia by the age of 90–120 days [15]. Existing reports have demonstrated reduced and deranged basal infoldings of the retinal pigment epithelium (RPE) basal plasmalemma [16], pericyte loss, reduced pericyte to endothelial cell ratios [17], capillary BM thickening [15, 18], and microinfarctions [19]. Microaneurysm formation and neovascularization were absent even after 11 months of diabetes [19]. Characterization studies of DR using this model remain limited. Subsequent inbreeding and outbreeding have produced various genetically distinct substrains (named after the origin of the colony), including the BBDP/Wor, BB/OK, and BB/Pfd rat. Care should be taken when comparing results of studies utilizing rats of different substrains due to potential genetic and phenotypic differences.

hyperglycemia, hyperinsulinemia, insulin resistance, and obesity at 6–7 weeks of age [25]. Studies have reported increased vascular endothelial growth factor (VEGF) expression in the retina that correlated with retinal levels of inflammatory markers at 14 weeks of age [26], capillary BM thickening with increased retinal capillary hypercellularity at 27 weeks [27, 28], and increased pericyte apoptosis, endothelial apoptosis, presence of pericyte ghosts and number of acellular capillaries as compared to the lean controls by 33–34 weeks [29]. The rats have a relatively short lifespan of 1 year but do not require insulin treatment while exhibiting consistently marked hyperglycemia with glucose levels averaging at 500 mg/dL when fed with the appropriate diet. To date, few reti-

Animal Models of Diabetic Retinopathy (Part 2) http://dx.doi.org/10.5772/intechopen.70589 55

nal morphological and therapeutic drug studies have been performed on this rat model.

age of 1 and 6 months followed by significant weight loss after the age of 9 months [31].

The Otsuka Long-Evans Tokushima fatty (OLETF) rat is a T2D model originally generated from selective breeding of the Long-Evans rats that spontaneously exhibited polyuria, polydipsia, and obesity. The OLETF rat is characterized by mild obesity, a late onset of chronic hyperglycemia after the age of 18 weeks, male inheritance, pancreatic islet hyperplasia, and the development of T2D as a result of metabolic syndrome [30]. Significant weight gain occurs between the

The rats display an array of retinal cellular morphological changes corresponding to the early stage of DR. Increased leukocyte entrapment was first reported in 24-week-old rats. Spectral domain optical coherence tomography (SD-OCT) revealed significant thinning of the total retinal and retinal nerve fiber layer (RNFL) at the age of 28 weeks [32]. There was retinal ganglion cells (RGC) loss with nonuniform distribution of remaining RGCs and increased apoptosis in the RNFL at 36 weeks [32]. GFAP and VEGF immunoreactivity were upregulated, with VEGF expression extending across all layers of the retina into the OPL [33]. By 14 months of age, there were endothelial cell degeneration, capillary BM thickening, and pericyte loss [31, 34]. A longer duration of hyperglycemia resulted in the reduction in INL thickness, photoreceptor thickness, and RPE height with poorly developed basal infoldings, suggestive of neurodegeneration. Rats aged 14–17 months have consistently exhibited marked microvascular changes, including vessel tortuosity, caliber irregularity, capillary loop formation, capillary narrowing, and microaneurysms [31, 34, 35]. One study further revealed prolonged peak latencies of OPs on ERG, particularly OP1 and OP3, [36], although experimental conditions may have

Existing characterization studies have only been performed by a selective number of research groups. Despite the similarities in the pathophysiology of T2D in OLETF rats and humans, the use of OLETF rats in DR studies is limited by the model's late onset of hyperglycemia and absence of late-stage DR features. The presence of hemorrhages, exudates, and acellular capillaries has not been reported in rats up to 19 months of age [31], signifying its unsuitability as

The GK rat is a nonobese T2D model that develops glucose intolerance at 2 weeks of age and significant hyperglycemia by the age of 4–6 weeks [37]. The rats were generated from repeated

*<IP_ADDRESS>. Otsuka Long-Evans Tokushima fatty (OLETF) rats*

accounted for such abnormalities.

an angiopathic DR model.

*<IP_ADDRESS>. Nonobese Goto-Kakizaki (GK) rats*

#### *<IP_ADDRESS>. Wistar Bonn/Kobori (WBN/Kob) rats*

The Wistar Bonn/Kobori (WBN/Kob) rat is a nonobese T2D strain of Wistar rats that develop exocrine pancreatic insufficiency characterized by α- and β-cell destruction. Male rats develop hyperglycemia at around 9–12 months of age, while females remain unaffected [20].

The retinal changes in this rat model have long been argued to be more degenerative than diabetic. At the age of 5 months, prior to the development of hyperglycemia, the rats showed signs of retinal degeneration with the loss of rods and cones and thinning of the photoreceptor layers [21]. Although retinal capillary changes, such as capillary BM thickening [21], reduced capillary number, formation of capillary loops, presence of acellular capillaries, and clustering of capillaries into tortuous knots [22], were observed after hyperglycemic development, it is uncertain whether these changes arose from the development of diabetes or resulted from further progression of retinal degeneration. WBN/Kob rats survive for a longer duration under diabetic conditions compared to other models. Perhaps, this prolonged survival and hyperglycemia duration had led to the development of intravitreal and choroidal neovascularization, which was accompanied by the hyalinization of intraretinal vessels and increased proliferation of fibrovascular elements in the vitreous at 24 months of age [23, 24]. Such features had not been previously reported in other rats. The proliferative changes were mostly absent in nondiabetic age-matched female counterparts [23], suggesting that the WBN/Kob rat may serve as a diabetic angiopathy model. Nevertheless, the retinal degenerative changes in the WBN/ Kob rats are arguably different from that of human DR, making it a less suitable model for DR.

#### *<IP_ADDRESS>. Zucker diabetic fatty (ZDF) rats*

The Zucker diabetic fatty rat (ZDF/Gmi, fa/fa) is a T2D model derived from the partial inbreeding of the fa/fa line. The rats carry an inherited mutation in the leptin receptor and need to be maintained on a specialized diet to ensure consistent diabetes development. Male rats display marked hyperglycemia, hyperinsulinemia, insulin resistance, and obesity at 6–7 weeks of age [25]. Studies have reported increased vascular endothelial growth factor (VEGF) expression in the retina that correlated with retinal levels of inflammatory markers at 14 weeks of age [26], capillary BM thickening with increased retinal capillary hypercellularity at 27 weeks [27, 28], and increased pericyte apoptosis, endothelial apoptosis, presence of pericyte ghosts and number of acellular capillaries as compared to the lean controls by 33–34 weeks [29]. The rats have a relatively short lifespan of 1 year but do not require insulin treatment while exhibiting consistently marked hyperglycemia with glucose levels averaging at 500 mg/dL when fed with the appropriate diet. To date, few retinal morphological and therapeutic drug studies have been performed on this rat model.

#### *<IP_ADDRESS>. Otsuka Long-Evans Tokushima fatty (OLETF) rats*

*1.1.3. Transgenic*

*<IP_ADDRESS>. Biobreeding (BB) rats*

tial genetic and phenotypic differences.

*<IP_ADDRESS>. Zucker diabetic fatty (ZDF) rats*

*<IP_ADDRESS>. Wistar Bonn/Kobori (WBN/Kob) rats*

The diabetes-prone biobreeding (BB) rat is a T1D model derived from outbred Wistar rats. BB rats develop insulitis with selective β-cell destruction, hyperglycemia, hyperketonemia, ketonuria, and hypoinsulinemia. Rapid progression to fatal diabetic ketoacidosis results if exogenous insulin is not administered. The majority of rats develop hyperglycemia by the age of 90–120 days [15]. Existing reports have demonstrated reduced and deranged basal infoldings of the retinal pigment epithelium (RPE) basal plasmalemma [16], pericyte loss, reduced pericyte to endothelial cell ratios [17], capillary BM thickening [15, 18], and microinfarctions [19]. Microaneurysm formation and neovascularization were absent even after 11 months of diabetes [19]. Characterization studies of DR using this model remain limited. Subsequent inbreeding and outbreeding have produced various genetically distinct substrains (named after the origin of the colony), including the BBDP/Wor, BB/OK, and BB/Pfd rat. Care should be taken when comparing results of studies utilizing rats of different substrains due to poten-

54 Experimental Animal Models of Human Diseases - An Effective Therapeutic Strategy

The Wistar Bonn/Kobori (WBN/Kob) rat is a nonobese T2D strain of Wistar rats that develop exocrine pancreatic insufficiency characterized by α- and β-cell destruction. Male rats develop hyperglycemia at around 9–12 months of age, while females remain unaffected [20]. The retinal changes in this rat model have long been argued to be more degenerative than diabetic. At the age of 5 months, prior to the development of hyperglycemia, the rats showed signs of retinal degeneration with the loss of rods and cones and thinning of the photoreceptor layers [21]. Although retinal capillary changes, such as capillary BM thickening [21], reduced capillary number, formation of capillary loops, presence of acellular capillaries, and clustering of capillaries into tortuous knots [22], were observed after hyperglycemic development, it is uncertain whether these changes arose from the development of diabetes or resulted from further progression of retinal degeneration. WBN/Kob rats survive for a longer duration under diabetic conditions compared to other models. Perhaps, this prolonged survival and hyperglycemia duration had led to the development of intravitreal and choroidal neovascularization, which was accompanied by the hyalinization of intraretinal vessels and increased proliferation of fibrovascular elements in the vitreous at 24 months of age [23, 24]. Such features had not been previously reported in other rats. The proliferative changes were mostly absent in nondiabetic age-matched female counterparts [23], suggesting that the WBN/Kob rat may serve as a diabetic angiopathy model. Nevertheless, the retinal degenerative changes in the WBN/ Kob rats are arguably different from that of human DR, making it a less suitable model for DR.

The Zucker diabetic fatty rat (ZDF/Gmi, fa/fa) is a T2D model derived from the partial inbreeding of the fa/fa line. The rats carry an inherited mutation in the leptin receptor and need to be maintained on a specialized diet to ensure consistent diabetes development. Male rats display marked The Otsuka Long-Evans Tokushima fatty (OLETF) rat is a T2D model originally generated from selective breeding of the Long-Evans rats that spontaneously exhibited polyuria, polydipsia, and obesity. The OLETF rat is characterized by mild obesity, a late onset of chronic hyperglycemia after the age of 18 weeks, male inheritance, pancreatic islet hyperplasia, and the development of T2D as a result of metabolic syndrome [30]. Significant weight gain occurs between the age of 1 and 6 months followed by significant weight loss after the age of 9 months [31].

The rats display an array of retinal cellular morphological changes corresponding to the early stage of DR. Increased leukocyte entrapment was first reported in 24-week-old rats. Spectral domain optical coherence tomography (SD-OCT) revealed significant thinning of the total retinal and retinal nerve fiber layer (RNFL) at the age of 28 weeks [32]. There was retinal ganglion cells (RGC) loss with nonuniform distribution of remaining RGCs and increased apoptosis in the RNFL at 36 weeks [32]. GFAP and VEGF immunoreactivity were upregulated, with VEGF expression extending across all layers of the retina into the OPL [33]. By 14 months of age, there were endothelial cell degeneration, capillary BM thickening, and pericyte loss [31, 34]. A longer duration of hyperglycemia resulted in the reduction in INL thickness, photoreceptor thickness, and RPE height with poorly developed basal infoldings, suggestive of neurodegeneration. Rats aged 14–17 months have consistently exhibited marked microvascular changes, including vessel tortuosity, caliber irregularity, capillary loop formation, capillary narrowing, and microaneurysms [31, 34, 35]. One study further revealed prolonged peak latencies of OPs on ERG, particularly OP1 and OP3, [36], although experimental conditions may have accounted for such abnormalities.

Existing characterization studies have only been performed by a selective number of research groups. Despite the similarities in the pathophysiology of T2D in OLETF rats and humans, the use of OLETF rats in DR studies is limited by the model's late onset of hyperglycemia and absence of late-stage DR features. The presence of hemorrhages, exudates, and acellular capillaries has not been reported in rats up to 19 months of age [31], signifying its unsuitability as an angiopathic DR model.

#### *<IP_ADDRESS>. Nonobese Goto-Kakizaki (GK) rats*

The GK rat is a nonobese T2D model that develops glucose intolerance at 2 weeks of age and significant hyperglycemia by the age of 4–6 weeks [37]. The rats were generated from repeated selective inbreeding of normal Wistar rats based on their glucose intolerance indices [37]. After 1 month of hyperglycemia, the rats displayed significantly increased retinal mean circulatory time and reduced retinal segmental blood flow [38]. BRB permeability was increased after 3 months of hyperglycemia [39]. Eight-month-old rats presented with an increased endothelial/pericyte ratio that increased with the duration of hyperglycemia [40]. At 28 weeks, there were increased ocular VEGF concentrations, with significant immunoreactivity in the choroid [41]. This corresponds to the VEGF localization in the eyes of diabetic patients [41]. With 12 months of chronic hyperglycemia, microglia were activated and migrated into the subretinal space between the outer segment and RPE [42], as seen in human proliferative diabetic retinopathy (PDR) with diabetic maculopathy [43]. These retinal microcirculatory changes, however, were not accompanied with retinal vessel diameter or morphological changes. The stable diabetic state of this model allows for the investigation of retinal changes over an extended duration of diabetes.

*<IP_ADDRESS>. TetO rat*

*1.1.4. Angiogenesis*

**1.2. Nonrodent models**

c-waves, and an elevated b/a-wave ratio.

*<IP_ADDRESS>. Oxygen-induced Retinopathy (OIR)*

The NTac:SD-Tg(H1/tetO-RNAi:Insr) (TetO) transgenic rat is a newly reported rat model of T2D exhibiting both hyperglycemia and hyperinsulinemia [52]. The insulin receptor (INSR) gene is reversibly knocked down through the use of tetracycline-inducible small hairpin RNA (shRNA) expression systems [53]. INSR expression is inhibited upon doxycycline administration in drinking water, resulting in insulin resistance. After 4–5 weeks of hyperglycemia, RGC and pericyte loss were observed. The rats displayed an increase in the number of stenotic vessels and veins with abnormal caliber. Blood-retina barrier (BRB) disruption was evidenced by albumin extravasation and reduced zonula occludens-1 expression in the RPE. Increased expression of GFAP and inflammatory markers was also observed in the rat retinae. Functionally, ERG studies revealed significantly decreased scotopic a-waves, b-waves, and

Animal Models of Diabetic Retinopathy (Part 2) http://dx.doi.org/10.5772/intechopen.70589 57

The reversible nature of the tetracycline-inducible shRNA system allows for fine modulation of the degree of hyperglycemia to be induced in the rats. This may be useful for the reproduction of clinical situations in an animal model. The rats also project an array of early and late features of human DR within a shorter time span as compared with other rodent models of DR. Given that only one study to date has documented retinopathy changes in the TetO rat, no detailed reports of the timeframe of pathophysiological changes in the retinae are currently available.

In Sprague-Dawley rats, the OIR model predominantly induced vascular changes in the peripheral retina. Two days after pups were transferred to normoxia, there was evident perivascular astrocyte loss [54]. This was followed by significantly increased vascular permeability until P18 [55]. At P18, there was significant reduction in INL, inner plexiform layer (IPL), and total retinal thickness [56] and increased arteriole tortuosity [57]. Increased Müller cell gliosis, as demonstrated by increased GFAP immunoreactivity, was particularly prominent in avascular areas of the retina [56]. Although pericyte apoptosis, a prominent feature of DR, was not observed, pericyte-endothelial interactions were abnormal [54]. This may likewise compromise vascular wall stability. Intravitreal neovascularization was accompanied with decreased blood vessel profiles in the outer and inner plexuses and abnormal vessel tufts extending from the superficial plexus in an extraretinal direction [54, 58]. Functionally, a- and b-wave amplitudes on ERG were reduced in OIR rats [55]. It has been suggested that the degree of vascular hyperpermeability, development of vascular pathologies, and area of avascularity differs, according to the strain of mice used and the degree of VEGF overexpression [55, 59]. Researchers should be meticulous in their selection of rat strains to ensure that desired phenotypes are displayed.

Nonrodent models, including dogs, cats, rabbits, pigs, and zebrafish, have been used for DR studies. Larger animals have eyes that are more similar to human eyes in terms of size and

#### *<IP_ADDRESS>. Spontaneously diabetic Torii (SDT) rats*

The spontaneously diabetic Torii (SDT) rat is a type 2 diabetic inbred strain of the Sprague-Dawley rat generated by selective breeding of SD rats with polyuria and glucosuria. The rats display glucosuria, hypoinsulinemia, and hyperglycemia without signs of ketonuria. There are prominent sex differences in diabetes development in these rats. Female and male rats develop hyperglycemia by 10 and 20 weeks, respectively, but 100% cumulative incidence of diabetes was only observed in male 40-week-old rats [44]. Merely, 33.3% of female rats developed diabetes by 65 weeks of age [44].

The SDT rat is one of the few rodent models that display advanced lesions and features resembling PDR with prolonged hyperglycemia. Increased cellular apoptosis in the GCL and INL and increased GFAP expression spanning the entire retina [45] were evident at the age of 40 weeks. There was increased retinal leukostasis [46] and retinal thickening [47] by the age of 44 and 52–60 weeks, respectively. Long-standing hyperglycemia in rats older than 60 weeks of age has been shown to result in the distortion of the retina, fluorescein leakage around the optic disc, vessel tortuosity, capillary nonperfusion, neovascularization, and tractional retinal detachment accompanied by proliferative fibrous formations [48] (70 weeks) [44, 49]. Anterior chamber hemorrhage with fibrous proliferation around the iris and posterior synechia formation were also noted in a few cases [44, 49]. A major discrepancy between the rat model and human DR is the development of retinal neovascularization and proliferative DR features in the SDT rat in the absence of retinal ischemia [50]. The presence of microaneurysms and areas of vascular nonperfusion were also rarely reported in this model. Retinal dysfunction was evidenced by delayed OP peak latencies at 32 weeks of age [48] and reduced a-wave, b-wave, and OP amplitudes with increased OP implicit times at the age of 44 weeks [51].

The SDT rat has a relatively long lifespan without requiring exogenous insulin administration. Hence, it may serve as a unique rodent model for PDR, considering that the SDT rate retinae can be exposed to high concentrations of VEGF for a longer period of time. Some researchers have further introduced the *fa* mutation of the leptin receptor gene found in ZF rats into the SDT rat to create a SDT fatty rat that develops diabetes and diabetes-associated complications at a younger age.

#### *<IP_ADDRESS>. TetO rat*

selective inbreeding of normal Wistar rats based on their glucose intolerance indices [37]. After 1 month of hyperglycemia, the rats displayed significantly increased retinal mean circulatory time and reduced retinal segmental blood flow [38]. BRB permeability was increased after 3 months of hyperglycemia [39]. Eight-month-old rats presented with an increased endothelial/pericyte ratio that increased with the duration of hyperglycemia [40]. At 28 weeks, there were increased ocular VEGF concentrations, with significant immunoreactivity in the choroid [41]. This corresponds to the VEGF localization in the eyes of diabetic patients [41]. With 12 months of chronic hyperglycemia, microglia were activated and migrated into the subretinal space between the outer segment and RPE [42], as seen in human proliferative diabetic retinopathy (PDR) with diabetic maculopathy [43]. These retinal microcirculatory changes, however, were not accompanied with retinal vessel diameter or morphological changes. The stable diabetic state of this model allows for the investigation of retinal changes over an extended duration of diabetes.

56 Experimental Animal Models of Human Diseases - An Effective Therapeutic Strategy

The spontaneously diabetic Torii (SDT) rat is a type 2 diabetic inbred strain of the Sprague-Dawley rat generated by selective breeding of SD rats with polyuria and glucosuria. The rats display glucosuria, hypoinsulinemia, and hyperglycemia without signs of ketonuria. There are prominent sex differences in diabetes development in these rats. Female and male rats develop hyperglycemia by 10 and 20 weeks, respectively, but 100% cumulative incidence of diabetes was only observed in male 40-week-old rats [44]. Merely, 33.3% of female rats devel-

The SDT rat is one of the few rodent models that display advanced lesions and features resembling PDR with prolonged hyperglycemia. Increased cellular apoptosis in the GCL and INL and increased GFAP expression spanning the entire retina [45] were evident at the age of 40 weeks. There was increased retinal leukostasis [46] and retinal thickening [47] by the age of 44 and 52–60 weeks, respectively. Long-standing hyperglycemia in rats older than 60 weeks of age has been shown to result in the distortion of the retina, fluorescein leakage around the optic disc, vessel tortuosity, capillary nonperfusion, neovascularization, and tractional retinal detachment accompanied by proliferative fibrous formations [48] (70 weeks) [44, 49]. Anterior chamber hemorrhage with fibrous proliferation around the iris and posterior synechia formation were also noted in a few cases [44, 49]. A major discrepancy between the rat model and human DR is the development of retinal neovascularization and proliferative DR features in the SDT rat in the absence of retinal ischemia [50]. The presence of microaneurysms and areas of vascular nonperfusion were also rarely reported in this model. Retinal dysfunction was evidenced by delayed OP peak latencies at 32 weeks of age [48] and reduced a-wave, b-wave,

and OP amplitudes with increased OP implicit times at the age of 44 weeks [51].

The SDT rat has a relatively long lifespan without requiring exogenous insulin administration. Hence, it may serve as a unique rodent model for PDR, considering that the SDT rate retinae can be exposed to high concentrations of VEGF for a longer period of time. Some researchers have further introduced the *fa* mutation of the leptin receptor gene found in ZF rats into the SDT rat to create a SDT fatty rat that develops diabetes and diabetes-associated

*<IP_ADDRESS>. Spontaneously diabetic Torii (SDT) rats*

oped diabetes by 65 weeks of age [44].

complications at a younger age.

The NTac:SD-Tg(H1/tetO-RNAi:Insr) (TetO) transgenic rat is a newly reported rat model of T2D exhibiting both hyperglycemia and hyperinsulinemia [52]. The insulin receptor (INSR) gene is reversibly knocked down through the use of tetracycline-inducible small hairpin RNA (shRNA) expression systems [53]. INSR expression is inhibited upon doxycycline administration in drinking water, resulting in insulin resistance. After 4–5 weeks of hyperglycemia, RGC and pericyte loss were observed. The rats displayed an increase in the number of stenotic vessels and veins with abnormal caliber. Blood-retina barrier (BRB) disruption was evidenced by albumin extravasation and reduced zonula occludens-1 expression in the RPE. Increased expression of GFAP and inflammatory markers was also observed in the rat retinae. Functionally, ERG studies revealed significantly decreased scotopic a-waves, b-waves, and c-waves, and an elevated b/a-wave ratio.

The reversible nature of the tetracycline-inducible shRNA system allows for fine modulation of the degree of hyperglycemia to be induced in the rats. This may be useful for the reproduction of clinical situations in an animal model. The rats also project an array of early and late features of human DR within a shorter time span as compared with other rodent models of DR. Given that only one study to date has documented retinopathy changes in the TetO rat, no detailed reports of the timeframe of pathophysiological changes in the retinae are currently available.

#### *1.1.4. Angiogenesis*

#### *<IP_ADDRESS>. Oxygen-induced Retinopathy (OIR)*

In Sprague-Dawley rats, the OIR model predominantly induced vascular changes in the peripheral retina. Two days after pups were transferred to normoxia, there was evident perivascular astrocyte loss [54]. This was followed by significantly increased vascular permeability until P18 [55]. At P18, there was significant reduction in INL, inner plexiform layer (IPL), and total retinal thickness [56] and increased arteriole tortuosity [57]. Increased Müller cell gliosis, as demonstrated by increased GFAP immunoreactivity, was particularly prominent in avascular areas of the retina [56]. Although pericyte apoptosis, a prominent feature of DR, was not observed, pericyte-endothelial interactions were abnormal [54]. This may likewise compromise vascular wall stability. Intravitreal neovascularization was accompanied with decreased blood vessel profiles in the outer and inner plexuses and abnormal vessel tufts extending from the superficial plexus in an extraretinal direction [54, 58]. Functionally, a- and b-wave amplitudes on ERG were reduced in OIR rats [55]. It has been suggested that the degree of vascular hyperpermeability, development of vascular pathologies, and area of avascularity differs, according to the strain of mice used and the degree of VEGF overexpression [55, 59]. Researchers should be meticulous in their selection of rat strains to ensure that desired phenotypes are displayed.

#### **1.2. Nonrodent models**

Nonrodent models, including dogs, cats, rabbits, pigs, and zebrafish, have been used for DR studies. Larger animals have eyes that are more similar to human eyes in terms of size and structure. Larger eyes also allow for the extraction of retinal cells and components of the vitreous for further *in vitro* studies. Nonhuman primates are ultimately most similar to humans anatomically, particularly in regard to the presence of the macula. However, significant costs, ethical challenges, genetic intractability, and feasibility issues regarding the housing and handling of such large animals greatly limit their use. Further studies are required for the establishment of reported features in the following nonrodent models due to the small sample sizes and large intra-species variations in existing reports.

choriocapillaris. Pharmacological, diet-induced hyperglycemia and hypercholesterolemia (lard, sucrose, and cholesterol-added chow [72]), and VEGF injection models (implantation of a human recombinant VEGF pellet into the vitreous [73, 74]) have been used in rabbits for DR studies. However, the presence of DR lesions is highly variable between and within models. Rabbits with STZ-induced diabetes demonstrated varying degrees of retinopathy after 135 days of hyperglycemia. Some showed proliferative retinopathy, while others only demonstrated moderate vasculopathy with hemorrhages and hard or soft exudates [75]. Dietinduced hyperglycemic and hypercholesterolemic rabbits only exhibited an increased number of microaneurysms after 12–24 weeks of special feeding. The development of vascular pathologies and neovascularization in the VEGF implant model was limited by the gradual depletion of VEGF [73]. Neovascularization developed 14 days after the implant was inserted, but there was almost complete regression by 35 days. The addition of basic fibroblast growth factor (bFGF) to the pellet in another study demonstrated a faster induction of retinopatholo-

Animal Models of Diabetic Retinopathy (Part 2) http://dx.doi.org/10.5772/intechopen.70589 59

gies [74], but angiogenic responses may vary depending on the strain of rabbits used.

[80]. However, it is not a suitable angiogenesis model for DR.

The retinal structure of the pig eye, with its holangiotic retinal circulation and area centralis comparable to the human macula, closely resembles that of the human eye [66]. Few studies have examined morphological changes in the pig retinae. Alloxan-induced pigs developed Müller cell gliosis at 90 days of hyperglycemia [76]. By 20 weeks, pigs developed capillary BM thickening [77], pericyte loss, and capillary collapse with a reduction in the total number of BRB capillaries [78]. STZ-induced pigs showed similar results, with capillary BM thickening and lamellation and rarefaction on electron microscopy at 20-week post-STZ treatment [79]. A proliferative vitreoretinopathy swine model has also been developed, whereby vitreal and retinal detachments were induced surgically prior to the intravitreal injection of RPE cells

Monkeys are the most common primate models used for DR studies. Investigations in 39 STZinduced, pancreatectomy-induced, or spontaneously hyperglycemic T1D monkeys revealed only mild ocular changes after 6–15 years of diabetes [81]. There were no signs of PDR. Only diabetic monkeys that spontaneously developed hypertension or those that were pharmacologically induced to develop hypertension displayed ischemic retinopathy changes, including microaneurysms, capillary dilatation and dropout, focal intraretinal capillary leakage spots, cotton wool spots, and arteriolar lesions. Spontaneously obese type 2 diabetic monkeys developed various retinal lesions and displayed signs of retinal functional loss on ERG, but lesion development was highly variable among individual monkeys [82, 83]. Occurrence of retinopathy was significantly correlated with the presence of hypertension, as seen in the type 1 diabetic monkey models. Angiogenesis monkey models have also been reported, where repeated intravitreal VEGF injections resulted in vessel tortuosity, dilation, leakage, microaneurysm

*1.2.4. Porcine models*

*1.2.5. Nonhuman primates*

*<IP_ADDRESS>. Monkey models*

#### *1.2.1. Dog models*

Diabetes has been induced in dogs via STZ injections or galactose feeding. Both diabetic and galactose-fed galactosemic dogs display retinal lesions similar to those of human DR, though a long duration of galactose feeding is required for the development of vessel changes associated with PDR. Diabetic dogs displayed capillary BM thickening within 1 year of hyperglycemia, pericyte and smooth muscle cell loss at 4 years, and microaneurysms, acellular capillaries, and IRMAs after 7 years of diabetes [60]. Similar lesions were found in alloxaninduced diabetic dogs after 5 years of diabetes, though such changes were significantly more evident in galactosemic dogs [61]. Galactosemic dogs have been reported to develop features of both NPDR and PDR [62–65], including intravitreal retinal vascular growth and partial detachment of the posterior vitreous after 84 months of 30% galactose feeding [62]. Some have suggested that pericyte destruction and microaneurysm formation are age dependent, with younger animals developing such symptoms at a faster rate than older animals [63].

#### *1.2.2. Cat models*

The cat eye has a retinal and choroidal circulation comparable to that of the human eye [66]. The feline lens advantageously does not develop diabetic cataracts, thus allowing for clear visualization of the fundus [67]. The majority of studies of diabetic cats involve induction of diabetes via pancreatectomy. Among the few studies published, there are discrepancies regarding the presence of reported lesions. Within the small sample size, some observed microaneurysms, capillary BM thickening, increased vessel tortuosity, decreased b-waves, capillary nonperfusion, and small intraretinal hemorrhages [68–71], while other cats did not develop microaneurysms or hemorrhage [68]. It is worth noting that the inner half of the diabetic retinae becomes hypoxic prior to the development of apparent capillary nonperfusion. This may be comparable with hypoxia-stimulated VEGF expression in humans prior to the development of DR [67]. The use of cats for DR studies is less feasible due to the slow development of lesions and high costs.

#### *1.2.3. Rabbit models*

Although the rabbit globe is significantly larger than that of rodents, rabbits possess a merangiotic retinal circulation, where the inner retina is supplied by choriocapillaris [66]. Humans, rodents, dogs, cats, pigs, and primates have a dual holangiotic circulation, where the inner retina is supplied by central and cilioretinal arteries, and the outer retina is supplied by the choriocapillaris. Pharmacological, diet-induced hyperglycemia and hypercholesterolemia (lard, sucrose, and cholesterol-added chow [72]), and VEGF injection models (implantation of a human recombinant VEGF pellet into the vitreous [73, 74]) have been used in rabbits for DR studies. However, the presence of DR lesions is highly variable between and within models. Rabbits with STZ-induced diabetes demonstrated varying degrees of retinopathy after 135 days of hyperglycemia. Some showed proliferative retinopathy, while others only demonstrated moderate vasculopathy with hemorrhages and hard or soft exudates [75]. Dietinduced hyperglycemic and hypercholesterolemic rabbits only exhibited an increased number of microaneurysms after 12–24 weeks of special feeding. The development of vascular pathologies and neovascularization in the VEGF implant model was limited by the gradual depletion of VEGF [73]. Neovascularization developed 14 days after the implant was inserted, but there was almost complete regression by 35 days. The addition of basic fibroblast growth factor (bFGF) to the pellet in another study demonstrated a faster induction of retinopathologies [74], but angiogenic responses may vary depending on the strain of rabbits used.

#### *1.2.4. Porcine models*

structure. Larger eyes also allow for the extraction of retinal cells and components of the vitreous for further *in vitro* studies. Nonhuman primates are ultimately most similar to humans anatomically, particularly in regard to the presence of the macula. However, significant costs, ethical challenges, genetic intractability, and feasibility issues regarding the housing and handling of such large animals greatly limit their use. Further studies are required for the establishment of reported features in the following nonrodent models due to the small sample

Diabetes has been induced in dogs via STZ injections or galactose feeding. Both diabetic and galactose-fed galactosemic dogs display retinal lesions similar to those of human DR, though a long duration of galactose feeding is required for the development of vessel changes associated with PDR. Diabetic dogs displayed capillary BM thickening within 1 year of hyperglycemia, pericyte and smooth muscle cell loss at 4 years, and microaneurysms, acellular capillaries, and IRMAs after 7 years of diabetes [60]. Similar lesions were found in alloxaninduced diabetic dogs after 5 years of diabetes, though such changes were significantly more evident in galactosemic dogs [61]. Galactosemic dogs have been reported to develop features of both NPDR and PDR [62–65], including intravitreal retinal vascular growth and partial detachment of the posterior vitreous after 84 months of 30% galactose feeding [62]. Some have suggested that pericyte destruction and microaneurysm formation are age dependent, with

younger animals developing such symptoms at a faster rate than older animals [63].

The cat eye has a retinal and choroidal circulation comparable to that of the human eye [66]. The feline lens advantageously does not develop diabetic cataracts, thus allowing for clear visualization of the fundus [67]. The majority of studies of diabetic cats involve induction of diabetes via pancreatectomy. Among the few studies published, there are discrepancies regarding the presence of reported lesions. Within the small sample size, some observed microaneurysms, capillary BM thickening, increased vessel tortuosity, decreased b-waves, capillary nonperfusion, and small intraretinal hemorrhages [68–71], while other cats did not develop microaneurysms or hemorrhage [68]. It is worth noting that the inner half of the diabetic retinae becomes hypoxic prior to the development of apparent capillary nonperfusion. This may be comparable with hypoxia-stimulated VEGF expression in humans prior to the development of DR [67]. The use of cats for DR studies is less feasible due to the slow develop-

Although the rabbit globe is significantly larger than that of rodents, rabbits possess a merangiotic retinal circulation, where the inner retina is supplied by choriocapillaris [66]. Humans, rodents, dogs, cats, pigs, and primates have a dual holangiotic circulation, where the inner retina is supplied by central and cilioretinal arteries, and the outer retina is supplied by the

sizes and large intra-species variations in existing reports.

58 Experimental Animal Models of Human Diseases - An Effective Therapeutic Strategy

*1.2.1. Dog models*

*1.2.2. Cat models*

ment of lesions and high costs.

*1.2.3. Rabbit models*

The retinal structure of the pig eye, with its holangiotic retinal circulation and area centralis comparable to the human macula, closely resembles that of the human eye [66]. Few studies have examined morphological changes in the pig retinae. Alloxan-induced pigs developed Müller cell gliosis at 90 days of hyperglycemia [76]. By 20 weeks, pigs developed capillary BM thickening [77], pericyte loss, and capillary collapse with a reduction in the total number of BRB capillaries [78]. STZ-induced pigs showed similar results, with capillary BM thickening and lamellation and rarefaction on electron microscopy at 20-week post-STZ treatment [79]. A proliferative vitreoretinopathy swine model has also been developed, whereby vitreal and retinal detachments were induced surgically prior to the intravitreal injection of RPE cells [80]. However, it is not a suitable angiogenesis model for DR.

#### *1.2.5. Nonhuman primates*

#### *<IP_ADDRESS>. Monkey models*

Monkeys are the most common primate models used for DR studies. Investigations in 39 STZinduced, pancreatectomy-induced, or spontaneously hyperglycemic T1D monkeys revealed only mild ocular changes after 6–15 years of diabetes [81]. There were no signs of PDR. Only diabetic monkeys that spontaneously developed hypertension or those that were pharmacologically induced to develop hypertension displayed ischemic retinopathy changes, including microaneurysms, capillary dilatation and dropout, focal intraretinal capillary leakage spots, cotton wool spots, and arteriolar lesions. Spontaneously obese type 2 diabetic monkeys developed various retinal lesions and displayed signs of retinal functional loss on ERG, but lesion development was highly variable among individual monkeys [82, 83]. Occurrence of retinopathy was significantly correlated with the presence of hypertension, as seen in the type 1 diabetic monkey models. Angiogenesis monkey models have also been reported, where repeated intravitreal VEGF injections resulted in vessel tortuosity, dilation, leakage, microaneurysm formation, venous beading, capillary nonperfusion, and preretinal neovascularization [84]. Both VEGF injections and implants resulted in iris neovascularization [73, 85]. Despite their anatomical similarities to human eyes, DR development is highly variable and exceedingly slow, making it an impractical model for DR studies.

or without macular edema in the presence of prolonged hyperglycemia. However, the majority of existing animal models only display early or advanced lesions of DR. DR has a complex etiology, with various genetic and environmental factors implicated in its disease susceptibility and progression. Animal models are particularly important for the screening of novel therapeutic interventions. The clinical application of gene therapy for DR has been garnering increasing interest, and this may call for animal models that better reflect the intricacies of DR pathogenesis. Mice and rats are highly genetically tractable, but current transgenic models are based on isolated crosses [92]. Increasing development and use of resources such as The Collaborative Cross [92] may be required to enhance future identification and development of mouse strains with complex traits and epigenetics that are more reflective of the clinical scenario. Only by identifying and manipulating genes that mediate clinically relevant phenotypes can we realize and exploit the full genetic tractability of the mouse to better model DR.

Animal Models of Diabetic Retinopathy (Part 2) http://dx.doi.org/10.5772/intechopen.70589 61

and Amy C.Y. Lo1,2\*

2 Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong,

[1] Kern TS, et al. Comparison of three strains of diabetic rats with respect to the rate at which retinopathy and tactile allodynia develop. Molecular Vision. 2010;**16**:1629-1639 [2] Ly A, et al. Early inner retinal astrocyte dysfunction during diabetes and development of hypoxia, retinal stress, and neuronal functional loss. Investigative Ophthalmology &

[3] Zeng XX, Ng YK, Ling EA. Neuronal and microglial response in the retina of strepto-

[4] Li Q, et al. Early retinal damage in experimental diabetes: Electroretinographical and

[5] Rungger-Brandle E, Dosso AA, Leuenberger PM. Glial reactivity, an early feature of diabetic retinopathy. Investigative Ophthalmology & Visual Science. 2000;**41**(7):1971-1980

[6] Si YF, et al. Treatment with hydrogen sulfide alleviates streptozotocin-induced diabetic

zotocin-induced diabetic rats. Visual Neuroscience. 2000;**17**(3):463-471

morphological observations. Experimental Eye Research. 2002;**74**(5):615-625

retinopathy in rats. British Journal of Pharmacology. 2013;**169**(3):619-631

1 Department of Ophthalmology, The University of Hong Kong, Hong Kong

**Author details**

Larissa H.C. Tang<sup>1</sup>

Hong Kong

**References**

, Ian Y.H. Wong<sup>1</sup>

\*Address all correspondence to<EMAIL_ADDRESS>
Visual Science. 2011;**52**(13):9316-9326

#### *<IP_ADDRESS>. Marmoset models*

An alternate primate model is the marmoset. The marmoset has large eyeballs in respect to its body size with anatomical features closely resembling those of the human eye. The only study to date characterizing the development of retinal DR lesions in these animals reported the development of microaneurysms with increased acellular capillaries, pericyte loss, BM thickening, BRB breakdown, and macular edema in marmosets that were put on a 30% galactoserich diet for two and a half years [86].

#### *1.2.6. Zebrafish models*

Zebrafish (*Danio rerio*) uniquely offers the tractable genetics of rodent models and a retinal structure resembling that of the human eye. They have the distinctive five-layered human retinal structure, though they lack the subretinal plexi found in the inner and outer retina of human retinae [87, 88]. Despite lacking a macula, the density and number of cones in the zebrafish are comparable to that of humans.

Researchers have developed high-glucose diabetic and angiogenic models to mimic DR. Hyperglycemia was induced by immersing zebrafish into glucose-added water [89, 90]. This resulted in reduced IPL and INL thickness [90] and increased diameter of hyaloid retinal vessels [33]. Zebrafish subjected to a hypoxia-induced retinopathy model developed neovascular features after 3 days [91]. One group developed an angiogenesis model using *vhl* (von Hippel-Lindau tumor suppressor gene) mutant fish. By inactivating the *vhl* tumor suppressor gene, hypoxia-inducible factor was upregulated, resulting in overproduction of VEGF. Extensive neovascularization and PDR features were observed in these *vhl* mutant zebrafish, but such a model is not commercially available.

The short lifespan, rapid development, and capability of zebrafish to breed in exceedingly large numbers allow for high-throughput screening [88], genetic screening, and significantly shorter experimental turnover times as compared with that of rodents. Techniques for developing transgenic lines and gene-targeting mutations have also been established. Although the presence of DR-like lesions and exact models ideal for the simulation of DR have not yet been well established, the zebrafish represents a promising short-term model for future DR drug screening.


In Africa, viable wastewater-based resource recovery initiatives are emerging with public–private partnerships (African Development Bank et al., 2020), which follow a circular economy approach. Implementing integrated wastewater treatment improves sanitation (and associated benefits), protects freshwater resources, contributes to agriculture and energy needs, and tackles an important source of marine litter.

# *5.4.9 Improve Chemical and Industrial Pollution Control Through Targeted and Cost-Effective Measures in Priority Issues*

Industry generates a substantial amount of wastewater. Although significant industrial hubs are limited to a few countries in Africa such as South Africa, Egypt, Morocco, and Tunisia. Mining, paper mills, tanneries, textiles, food, and beverage production, sugar refineries, oil production, and pharmaceutical production have been flagged as major contributors to the discharge of toxic wastewater (African Development Bank et al., 2020). Wastewater reuse and treatment for industry have several benefits, including pollution (including microplastics) reduction.

Eutrophication, as discussed under point 8 is driven by nutrient input into the marine environment. It is primarily derived from land-based sources, mainly through stormwater runoffs over agricultural land where nitrogen, phosphorus, and potassium (N–P–K)-based fertilisers are applied.

Chemical and industrial pollution control go further than wastewater. With adequate pollution control, marine litter, and chemical pollutants (that can be sorbed and transport by plastics), can be greatly reduced.

# *5.4.10 International Responses are Needed to Deal with Transboundary Waste*

Within Africa, there is a strong signal that litter found close to urban centres originates from local sources (Ryan et al., 2018; Weideman et al., 2020). However, on the eastern boundary specifically, transboundary plastic litter from south-east Asia and ship sourced waste has been identified as a further source (Duhec et al., 2015; Ryan et al., 2021; Ryan, 2020b; van der Mheen et al., 2020) (see Chap. 2 for further details). Though Africa can tackle its local sources, the long-distance drift of marine litter through currents is beyond African intervention. Global solutions, such as the Global Treaty to End Plastic Pollution, are needed to support Africa in tackling international sources of marine litter.

Global solutions for reducing plastic marine litter are welcomed. These include reduction and circularity of design in all products. But more than that, a coordinated global response is necessary through this global agreement that practically reduces waste formation and stops leakage into the environment.

# **5.5 Steps to Consider for Local Sources**

Stakeholder engagement is central to preventing marine litter through reduction, waste minimisation, reuse, recycling, and waste management. In Africa, with many stakeholders successfully operating in the reuse and recycling space specifically, stakeholder engagement becomes pivotal when planning on, and implementing changes or new concepts. Figure 5.2 indicates the stakeholders generally found in the waste management space.

First and foremost, waste minimisation through reduction, reuse and recycling should be considered. This is particularly pertinent in Africa, where funding is an issue.

Considering plastics specifically, the plastic flows and leakage assessments carried out by IUCN/UNEP in Kenya (IUCN et al., 2020a), Tanzania (IUCN et al., 2021a), Mozambique (IUCN et al., 2020b), and South Africa (IUCN et al., 2021b)

**Fig. 5.2** Considerations in tackling marine litter through waste management—African stakeholder engagement, on average. Adapted from EPA (2020)

outline priority interventions across all lifecycle stages of plastics to minimise leakage potential.

Once waste is reduced, waste management planning should consider the following factors (see Fig. 5.2) (EPA, 2020):

	- Costs of not taking action on e.g., tourism, human health
	- Operational costs
	- Sustainable financing of implementation, enforcement, and monitoring
	- Equipment and solutions that suited to environmental and social conditions
	- Technical capacity required for equipment and solutions
	- Staff capacity and expertise (or sustainable finance needed for training)
	- ensuring systems and initiatives can survive administrative changes
	- establish long-term, sustainable systems that continue across administrations
	- work towards long-term staff and industry commitments
	- Changing consumption and waste disposal patterns
	- Projections on waste production linked to population and economic growth

# **5.6 Concluding Remarks**

Africa has a predominantly young population. A young population is indicative of a dynamic, innovative population with huge potential to implement change. Despite limited resources, Africa has shown innovative solutions to waste management, resource recovery, and new solutions in tackling marine litter. These solutions are predominantly driven by the industry (informal and formal sectors) and NGOs. These existing solutions should be supported, and where financially sustainable, scaled up to cover new and more extensive areas (where economically viable through the economics of scale) or integrated into the implementation of adequate institutional, legal, and policy frameworks.

Given the diversity of the African continent, there is a need to develop a decision framework for local, national, and regional actions to feed into global commitments. This will assist African nations to implement the best measures for their unique social and economic situations. Each country is best placed to appreciate its own national solutions and limitations. This includes stakeholder involvement, financial and technical capacity needs related to addressing plastic pollution issues.

Mitigation actions need to target different sources of marine litter. The actions required to target local sources occur on land before the litter enters the African waters. Tackling sea-based sources, where the ships stop (or are based) at African ports, requires both sea-based (behaviour) and land-based (port reception facilities) approaches. However, to tackle offshore inputs of marine litter into Africa, both sea-based sources and transboundary sources e.g., originating from south-east Asia, Africa needs the international communities to support in implementing actions across boundaries and regions.

Regarding local sources, tackling marine litter and waste mismanagement in Africa has the potential to both create new jobs and protect existing jobs, in particular those related to the Blue Economy. By successfully dealing with this issue, Africa can contribute to better pollution control, mitigate climate change protect biodiversity, and achieve other SDGs.

Additionally, nature-positive solutions are still extensively utilised across Africa and have the potential to grow and to enhance partnerships between industry and government. Nature-positive solutions have the potential to grow and enhance the sustainable growth of the Blue-Green and circular economy, tackle climate change, mitigate climate change, improve sanitation and wastewater management, and reduce marine litter.

With limited resources, African researchers have developed substantial research, focusing on characterisations, amounts, and distributions. Even with the existing knowledge gaps, the scale of the current problem is clear. The status and future projections mean that its paramount to implement mitigation now, without waiting on further research on the scale of marine litter or impacts.

Monitoring mitigation effectiveness is needed to support the science-policy interface. The development of the science-policy interface in Africa can bring about rapid, sustainable change regarding the circular economy, waste management, and marine litter. This can occur provided a cohesive and homogenised enabling institutional, legal, and policy environment is created to support innovation and public–private sector partnerships at national and regional levels. Existing frameworks and networks within Africa can support such change, helping to implement reduction, resource recovery, and service delivery, monitored with comparable techniques to measure long-term mitigation effectiveness.

**Acknowledgements** We would like to acknowledge the valuable insights proved by Clever Mafuta, Morten Sorensen, Peter Ryan, Anham Salyani, Salieu Sankoh, Tony Ribbink, Abdoulaye Diagana, Alison Amoussou, as well as Jost Dittkirst and the Plastic Task Force of the Secretariat of the Basel, Rotterdam and Stockholm Conventions in peer-reviewing this chapter. We would also like to acknowledge Nieves López and Federico Labanti (Studio Atlantis) for creating the illustrations.

# **References**

*Environmental Science-Processes & Impacts, 23*, 240–274. https://doi.org/10.1039/D0EM00 312C

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**Author details**

Ruben Rose, Alexey Gorin, Mathias Voß and Helmut Fickenscher\* Institute for Infection Medicine, University Medical Center Schleswig-Holstein, Christian-Albrecht University of Kiel, Kiel, Germany

\*Address all correspondence to<EMAIL_ADDRESS>
© 2022 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


**1. Introduction**

The ocular parasitic infections (OPI) are considered significant causes of ocular pathologies worldwide [1]. The common protozoal parasites primarily infecting the ocular tissue(s) are *Acanthamoeba* species and *Toxoplasma gondii* [2–7]. In addition, case studies of eye diseases caused by *Leishmania, Trypanosoma cruzi, Entamoeba histolytica, Hartmannella, Plasmodium falciparum, Microsporidia* and *Giardia lamblia* have been rarely reported [1, 8, 9]. Among the helminths, ocular infections are caused primarily by nematode parasites (*Onchocerca volvulus,*

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*Loa loa, Toxocara canis and Toxocara cati*) [1, 8, 10–12]. In addition, case studies of ocular infections caused by other nematodes (*Angiostrongylus cantonensis, Dirofilaria repens*, *Trichinella spiralis, Thelazia callipaeda, Baylisascaris procyonis, Wuchereria bancrofti* and *B. malayi), c*estodes (*T.soli‐ um cysticercus*, *Echinococcus granulosus,* and *Multiceps multiceps* larvae) and trematodes (*Fasciola hepatica and Schistosoma* species) have been reported from different geographical areas [1, 8, 13–15]. The ectoparasites infecting the eye include larvae of flies [16] (*Oestrus ovis*, *Rhinoestrus purpureus, Dermatobia hominis, Chrysomia bezziana, Lucilia* spp., *Cuterebra, Hypoderma, Cochlio‐ myia, Wohlfahrtia, Gastrophilus*), *Phthirus pubis*, hard and soft ticks (belonging to class Arach‐ nida) [1, 17]. Ocular pentastomiasis caused by the larval stage of Pentastomida, the crustaceanrelated parasites, is reported to cause permanent loss of vision due to the retinal detachment or lens subluxation [18]. Further, with the advent of HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome), few ocular infections have also been reported in HIV-infected patients [19, 20].

Ocular parasitic infections have been widely reported from different geographical areas (Table 1), mainly depending on the endemicity of the parasite(s). The prevalence depends primarily on the geographical distribution of the parasite, socioeconomic environment and immune status of the patient. The common modes of infection are direct contact (blepharoconjunctivitis caused by *Leishmania, Acanthamoeba* keratitis, microsporidial infections, infestation caused by lice and mites) [21–23], through blood stream (Toxoplasma chorioretinitis, retinal involvement in malaria, uveitis caused by *Toxocara)* [1, 23, 24], congenital transmission (Toxoplasmosis) and zoonotic transmission (primarily infectious diseases of animals that can naturally be trans‐ mitted to humans) [25]. In addition, few of the helminths that may lead to ocular infection are transmitted by vectors (onchocerciasis, dirofilariasis and thelaziasis), consumption of conta‐ minated food (sparganosis, trichinellosis) and indirectly from the environment (fascioliasis, ascariasis and echinococcosis).

Adult and/or larval stages of the parasites may reside in human ocular tissues externally or in the ocular globe. The clinical symptoms and signs vary, depending on the etiological agent and the ocular tissue/part involved. However, local defense mechanisms and host immune responses play role in establishing the infection. The pathology in the eye can occur due to direct damage by the infecting pathogen, indirectly by toxic products, immune mediated or ectopic localization by ectoparasites. The clinical diagnosis usually mimics other pathologies due to numerous etiologies both infectious and non-infectious, which can cause conjunctivitis, keratitis, uveitis and endopthalmitis [26]. Thus, a high index of clinician suspicion is required for infective parasite etiology in patients having inflammation in the eye. In addition, eye can be involved in various systemic disorders and thorough ocular examination along with history of travel to the endemic area, risk factors and other associated medical illness that help in establishing the preliminary diagnosis. However, confirmatory diagnosis is usually achieved by direct demonstration of parasite in clinical samples and/or pathological changes observed by either slit lamp or biopsy examination [1, 8, 27, 28]. The antigen and antibody detection in ocular fluids and/or serum usually substantiates the clinical diagnosis in few parasitic infections (Toxoplasmosis, malaria, leishmaniasis, ocular gnathostomiasis, cysticercosis, toxocariasis, echinococcosis) [1, 10, 29, 30]. Molecular techniques including detection of parasite DNA by polymerase chain reaction (PCR) have added new dimensions in the diagnosis and species identification [31–36]. The treatment of choice is mostly surgical excision, while in few infections, medical treatment is usually advised either in conjunction with surgical procedure (onchocerciasis, dirofilariasis [37], cysticercosis [38], echinococcosis [39], myiasis, infections due to ticks and mites) or for inoperable patients. Although surgical excision is usually reserved for worms that are large, it is also recommended for space-occupying lesions of the orbit. Drug resistance is posing problem for the effective medical treatment, thus necessitating the discovery of new antiparasitic drugs [32]. Prevention and control measures differ in various infections and usually include proper health education and awareness of various risk factors. The various experimental animal models for few of the ocular infections have been successfully established to study the pathogenic mechanisms, drug efficacy and local immune responses [40, 41].

Although issues mainly are the timely diagnosis and treatment, yet many challenges need to be considered/addressed.


**6. Conclusions**

We have demonstrated that one or two plasma tubes can be used to focus, spread, and steer antenna beams. We have also shown that we can simulate convex and concave plasma lenses by using cylindrical plasma tubes. Focusing by a plasma is useful because it can be used to increase the gain of an antenna, and to quickly reconfigure the beamwidth as needed without physically moving the antenna. With this technology, there is no need for phased arrays. Beam steering with a plasma allows tuning to different frequencies which is a difficult task for standard antennas. Our experimental results with 44 GHz showed a dramatic improvement in beam steering and focusing characteristics compared to beam focusing and steering at 24 GHz. The shorter wavelength compared to the spatial variation in plasma density over the radius of the plasma tube, the easier it is to steer and focus antenna beams. These results have been incorporated in a new smart plasma antenna design which appears in another paper.

Driving the plasma with short high-current pulses allows CW operation at higher frequencies with a minimum amount of ionization power and higher plasma densities. Circuits for pulse forming and voltage multiplication are presented. The maximum frequency that a plasma antenna can operate CW has previously been limited by the high DC current needed to ionize the plasma. We minimize the average ionization power and increase the plasma density by using fast current pulsing with a short duty cycle. The average current is much lower but the average plasma density remains high than in the DC mode.


*4.8. Measurements of Reactive Oxygen Species (ROS) Content and Enzyme Activity*

To better understand the function of *ZmWRKY106* under drought treatment, we assessed the activities of superoxide dismutase (SOD), peroxide dismutase (POD), catalase (CAT) and the ROS content in WT and transgenic lines at 0, 4, 12 and 24 h after drought stress. The ROS content and the activities of SOD, POD, and CAT were measured as previously described [19]. To obtain reproducible results, each experiment was repeated three times. Values are means ±SD and statistically significant differences were based on the Student's test.