Electron microscopic immunocytochemical evidence for the mechanism of blood-retinal barrier breakdown in galactosemic rats and its association with aldose reductase expression and inhibition.

Blood-retinal barrier (BRB) breakdown occurs in human diabetic retinopathy and can lead to significant loss of vision. The galactosemic rat serves as a model for human diabetic retinopathy and develops many of the same ocular complications, including BRB failure. Aldose reductase (AR), an enzyme in the polyol pathway, has been implicated in several of these complications. Electron microscopic immunocytochemical staining for albumin can be used to visualize extravasated albumin in control and galactosemic rats with and without AR inhibition to reveal the mechanism for galactosemia-related BRB failure without the use of tracer substances, and to determine whether AR activity influences this mechanism. Electron microscopic immunocytochemical labeling of AR can reveal the cellular distribution of AR in normal and galactosemic rat retina and determine whether a correlation exists between BRB breakdown and AR expression in cells that form or influence the BRB. Extravascular albumin is demonstrable as early as 2.5 months in galactosemic rats, which is prior to the presentation of ultrastructural changes. Albumin-positivity is visualized in retinal vascular endothelial (RVE) cell cytoplasm from galactosemic rats both diffusely and within vesicles, but it is not detected in comparably aged normal rat RVE cells or within the tight junctions of the RVE or RPE (the cells that form the BRB) in control or galactosemic rats, suggesting that BRB breakdown in galactosemic rats may be mediated through two mechanisms: a permeation of the RVE cell membrane leading to diffuse cytoplasmic positivity for albumin, and vesicular transport across the RVE. The AR inhibitor, sorbinil, prevents diffuse cytoplasmic staining of RVE cells, but not vesicular staining, implying that RVE membrane permeability may be altered by AR activity, but vesicle formation does not appear to be affected. AR was immunocytochemically demonstrated in some RVE cells from galactosemic rats, but not from controls. In perivascular astrocytes, which may influence the integrity of the inner BRB, AR labeling was augmented in galactosemic rats. Increased AR expression in RVE cells and perivascular astrocytes from galactosemic rats provides additional support for a role for AR in galactosemia-related BRB failure.