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34 protocols using ranibizumab

1

Intravitreal OPT-302 and Ranibizumab for Neovascular AMD

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The 0.5 mg OPT-302 group received intravitreal 0.5 mg OPT-302 (50 μl) plus intravitreal 0.5 mg ranibizumab (50 μL; Lucentis, Novartis, Genentech); the 2.0 mg OPT-302 group received intravitreal 2.0 mg OPT-302 (50 μl) plus intravitreal 0.5 mg ranibizumab (50 μl); and the sham group received a sham intravitreal injection plus intravitreal 0.5 mg ranibizumab (50 μl). The ranibizumab injection was delivered before the OPT-302/sham injection. The sham injection was delivered by pressing the syringe hub against the conjunctiva (further details are described in the Supplementary Protocol and Statistical Analysis Plan, available at www.aaojournal.org). Key ocular assessments included ETDRS BCVA, ocular examination, IOP, and spectral-domain OCT (SD-OCT), repeated 4-weekly. The National Eye Institute 25-item Visual Function Questionnaire (VFQ-25) was completed at baseline and week 24, with fluorescein angiography and color photography at baseline, week 12, and week 24 (Table S1, available at www.aaojournal.org).
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2

Intravitreal Anti-VEGF Injections Protocol

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After induction, intravitreal injections of anti-VEGF drugs were administered immediately in the ranibizumab group (n = 30; ranibizumab 3 µl, 10 mg/ml, Novartis Co.), conbercept group (n = 30; conbercept 3 µl, 10 mg/ml, Chengdu Kanghong Biotechnologies Co. Ltd.), and ZY1 group (n = 6; ZY1 polypeptide 3 µl, 2 mg/ml, China Peptides Co., Ltd.), and 3 µl of phosphate-buffered saline was administered to the control (n = 38) and edema groups (n = 30). The injections were applied slowly over 30 s to allow diffusion of the drugs and vehicles.
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3

Isolation and Culture of Rabbit RPE Cells

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Rabbit RPE cells were isolated and maintained as described by Chang et al.12 (link) After incubating the globes with 2% dispase for 15 minutes, an incision was made 3 mm from the limbus and continued circumferentially. After removal of the cornea and lens, 4 radial incisions were made in the posterior segment, and this part was incubated in Dulbecco’s modified Eagle’s medium/Ham’s F12 (DMEM/ F12) medium augmented with 10% fetal bovine serum for 2 hours. Finally, the RPE cells were separated from the neural retina and choroid as a sheet with micropipettes and observed under a stereo microscope (Olympus BX51, Japan). Passage 3 cells were used for the study and drugs were applied to the cultures 24 hours after fresh cell plating.
Ranibizumab (Lucentis, Novartis, Switzerland), a fragment of a human monoclonal antibody against VEGF-A selectively binds all isoforms of VEGF-A (VEGF110, VEGF121, and VEGF165), was applied at a concentration of 0.125 mg/mL. Bevacizumab (Avastin, Genetech/Roche, USA), a monoclonal antibody against VEGF which is used off-label to treat various eye diseases, was added to the cultures at a concentration of 0.3125 mg/mL. Aflibercept (Eylea, Bayer Health Care, Germany), a fusion protein that binds to circulating VEGF (subtypes VEGF-A and VEGF-B) and placental growth factor (PGF), was used at a concentration of 0.5 mg/mL.
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4

Purification and Characterization of IgG

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Human IgG2 (hIgG2) was obtained from Sigma-Aldrich (St. Louis, MO). Human IgG Fab fragment (hFab) was obtained from Jackson ImmunoResearch Laboratories (West Grove, PA). Ranibizumab was obtained from Novartis Pharmaceuticals (Basel, Switzerland).
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5

Overexpression of BNIP3 and FUNDC1 in Retinal Cells

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BNIP3-overexpression plasmid and FUNDC1-overexpression plasmid were purchased from GeneCopoeia (United States). Briefly, human BNIP3 cDNA was cloned from NM_004052.4, mouse BNIP3 cDNA from NM_00976, human FUNDC1 from NM_173794, and mouse FUNDC1 cDNA from NM_028058. The resultant fragments were inserted into the OmickLinkTM Expression Vector pEZ-M02. Cultured 661W photoreceptors, Müller cells, and HUVECs were plated (1 × 106 cell/6 well) in DMEM + FBS. The medium was then exchanged for Opti-MEM (Gibco) with Lipofectamine and 5 μg of the BNIP3- and FUNDC1-overexpression plasmids for 48 h using Lipofectamine 3000 (GLPBIO, United States, GK20006) under normal culture conditions. The HIF-1α inhibitor LW6 was purchased from (GLPBIO, United States, GC32724) and dissolved in dimethyl sulfoxide (DMSO) to a final concentration of 10 mM for cell application. Similarly, chloroquine (CQ) (GLPBIO, United States, G6423) was dissolved in DMSO to a final concentration of 10 mM. All these solutions were stored at −20°C before use. Subgroups of cells were incubated with 0.625 mg/mL bevacizumab (Avastin®, Roche, Switzerland), 0.5 mg/mL aflibercept (Eylea®, Bayer, Germany), or 0.125 mg/mL ranibizumab (Lucentis®, Novartis, Switzerland) as indicated. When combined with bevacizumab, LW6 and CQ were used at 25 μM.
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6

Ranibizumab Intravitreal Injection Procedure

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ranibizumab treatment performed was as follows: First, surface anesthesia was administered with tetracaine eye drops. The eyelid was opened with an eyelid opener, and the conjunctival sac was effectively cleaned with iodophor solution (Alcon, USA). The needle was inserted into the flat part of the ciliary body about 3.5 mm from the infratemporal part to the corneal margin (making sure that the needle tip is perpendicular to the scleral surface). When the needle was clearly inserted into the vitreous cavity, 0.05 ml of ranibizumab (Novartis Pharma Stein AG, Switzerland) was slowly injected into the vitreous cavity. Ofloxacin eye ointment (Japan Santen Pharmaceutical Company) was applied to the conjunctival sac to cover the affected eyes, and Tobramycin eye drops (American Alcon Company) were applied to the eyes two weeks after the operation.
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7

Retrospective Anti-VEGF Study for DME

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This was a retrospective multi-center study involving multiple eye clinics in the Australian states of South Australia and Tasmania. All participants were enrolled through the Tasmanian Ophthalmic Biobank Study (University of Tasmania) or the Genetic Risk Factors in Complications of Diabetes Study (Flinders University). The eligibility criteria included T1 and T2 DM patients ≥18 years who had received any intravitreal anti-VEGF injections (Aflibercept, Regeneron; Bevacizumab, Genentech; Ranibizumab, Novartis) between 2013 and 2020 for the treatment of DME. DME cases were defined as those with clinically diagnosed center-involving DME and confirmed by central macular thickness (CMT ≥ 315 microns) measured by optical coherence tomography (OCT). Eyes with cysts in the central 1000 microns or any intraretinal or subretinal fluid were included in this study, independent of the CMT parameter. Exclusion criteria were: (a) any vitreoretinal surgery, systemic anti-VEGF therapy, or intra-ocular steroid in the six months preceding the initiation of anti-VEGF injection, (b) insufficient visibility of the fundus for retinal diagnosis, (c) incomplete follow-up data, and (d) inability to give consent. The better responding eye was included as the study eye for patients receiving bilateral anti-VEGF injections.
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8

Intravitreal Injections for nAMD

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The procedures used were approved by the Ethics Committee of Mie University Hospital (approval number. H2020-021), and they conformed to the tenets of the Declaration of Helsinki. The medical records of nAMD patients who were treatment naïve and had started the treatment of the nAMD by intravitreal injections of ranibizumab (Lucentis; Novartis, Bulach, Switzerland) or aflibercept (Eylea; Bayer, Basel, Switzerland) between April 1, 2009, and December 31, 2018, at the Mie University Hospital, Mie, Japan, were reviewed.
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9

Immune Status in Retinal Diseases

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We included participants with either PCV in one or both eyes, neovascular AMD in one or both eyes, or healthy retinas. Participants were only included if they had no history of an ongoing immune disease (e.g. any diagnose of cancer, autoimmune diseases, or infectious diseases) or immune modulating treatment (i.e. chemotherapy, immune therapy, steroids, or any other therapy with the purpose of modulating immune function) to avoid blurring of results. Participants were only included if they had not received VEGF inhibitors within 4 weeks (Ranibizumab, Novartis, Basel, Switzerland) or 8 weeks (Aflibercept, Bayer, Lever-kusen, Germany) to avoid potential interaction of systemic antibodies in flow cytometric preparations. Detailed diagnosis with retinal angiography was made on treatment-naïve eyes, but patients were not recruited on their initial visit because recent onset of CNV is associated with acute immune activity [6 (link)]. We measured plasma C-reactive protein and post-hoc excluded any participant with levels >15 mg·L−1 to avoid including participants with an ongoing immunological acute response [59 (link)].
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10

Anti-VEGF Drugs for Retinal Disease

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Anti-vascular endothelial growth factor drugs used in our hospital include ranibizumab (Swiss Novartis), conbercept (Chengdu Kanghong Biotechnology Co., Ltd.), and aflibercept (Germany Bayer). IOP was measured by Full Auto Tonometer (Canon, Japan) and central macular thickness (CMT) was measured in a 512*128 mode by Cirrus HD-OCT 5000 (Zeiss, Germany).
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