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Revista Brasileira de Oftalmologia

Print version ISSN 0034-7280

Rev. bras.oftalmol. vol.73 no.4 Rio de Janeiro July/Aug. 2014 

Original Articles

Increased intercellular adhesion molecule-1 immunoreactivity in the sclera-choroid complex in hypercholesterolemia experimental model

Rogil José de Almeida Torres1 

Lucia de Noronha2 

Regiane do Rocio de Almeida Torres3 

Seigo Nagashima4 

Caroline Luzia de Almeida Torres5 

Andréa Luchini6 

Robson Antônio de Almeida Torres5 

Leonardo Brandão Précoma7 

Dalton Bertolim Précoma8 

1Postdoctoral Programme, Pontifical Catholic University of Paraná, Curitiba/PR, Brazil;

2Pontifical Catholic University of Paraná, Curitiba/PR, Brazil;

3,4Medical School of the Pontifical Catholic University of Paraná, Curitiba/PR, Brazil;

5Positivo University, Curitiba/PR, Brazil;

6Curitiba Ophthalmic Centre, Curitiba/PR, Brazil;

7Angelina Caron Hospital, Campina Grande do Sul/PR, Brazil;

8Pontifical Catholic University of Paraná, Curitiba/PR, Brazil;



The aim of this study is to investigate the expression of the intercellular adhesion molecule 1 (ICAM-1) in the sclera and choroid of hypercholesterolemic rabbits


New Zealand rabbits were divided into two groups: the normal diet group (NG), with 8 rabbits (8 eyes), was fed a standard rabbit diet for 4 weeks; the hypercholesterolemic group (HG), with 13 rabbits (13 eyes), was fed a 1% cholesterol- enriched diet for 8 weeks. Total serum cholesterol, triglyceride, HDL cholesterol and fasting blood glucose exams were performed at the start of the experiment and at the euthanasia time. HG and NG animals were euthanized after 8th week and 4th week, respectively. Their eyes were stained with hematoxylin-eosin and underwent histological, histomorphometric and immunohistochemical analyses with ICAM-1 antibody.


The diet has induced a significant increase in total cholesterol and triglyceride levels in HG when compared with NG (p<0.001). The histological analysis with hematoxylin-eosin revealed a large number of macrophages in the HG sclera-choroid complex. Moreover, a significant increase in the HG sclera and choroid thickness was observed in relation to NG (p<0.001). There was a significant increase in the ICAM-1 expression in HG sclera and choroid in relation to NG


This study has revealed that the hypercholesterolemic diet induces an increase in the ICAM-1 expression in the rabbits’ sclera and choroid.



O objetivo deste trabalho é avaliar a expressão da molécula de adesão intercelular-1 (ICAM-1) na esclera e coroide de coelhos hipercolesterolêmicos.


Coelhos New Zealand foram organizados em dois grupos: GN (grupo dieta normal), composto por 8 coelhos (8 olhos), recebeu ração padrão para coelhos, durante 4 semanas; GH (grupo hipercolesterolêmico), composto por 13 coelhos (13 olhos), recebeu dieta rica em colesterol a 1% por 8 semanas. Foi realizada a dosagem sérica de colesterol total, triglicerídeos, HDL colesterol, glicemia de jejum no início do experimento e no momento da eutanásia. Ao final da 4ª semana para o GN e 8ª semana para o GH foi realizada a eutanásia dos animais. Os olhos foram corados com hematoxilina-eosina e submetidos à análise histológica, histomorfométrica e imunohistoquímica com o anticorpo ICAM-1.


Observou-se significativo aumento do colesterol total e triglicerídeos do GH em relação ao GN (p<0,001). A avaliação histológica com hematoxilina eosina revelou grande quantidade de macrófagos no complexo esclero-coroidal do GH. No GH constatou-se significativo aumento da espessura da esclera e coroide em relação ao GN (p<0,001). Houve significativo aumento da expressão da ICAM-1 na esclera e coroide dos animais do GH em relação ao GN (p<0,001).


Este estudo demonstra que a dieta hipercolesterolêmica induz ao aumento da expressão da ICAM-1 na esclera e coroide de coelhos.

Palavras-Chave: Colesterol; Moléculas de adesão celular; Macrófagos; Coroide; Esclera; Degeneração macular

Palavras-Chave: Cholesterol; Cell adhesion molecules; Macrophages; Choroid; Sclera; Macular degeneration


Pathological intraocular neovascularisation is a complication that usually leads to blindness. Conditions associated with intraocular neovascularisation include retinopathy of prematurity, diabetic retinopathy, neovascular glaucoma, and age-related macular degeneration (AMD).AMD is a multifactorial disease that can be triggered by genetic, environmental, demographic, dietary, clinical, ocular, and lifestyle factors(1,2).

For decades, AMD was attributed to excessive, pathological accumulation of lipids in Bruch's membrane due to a dysfunction of retinal pigment epithelium (RPE) cells(3). More recently, the role of vascular endothelial growth factor (VEGF) in subretinal neovascularisation was clarified, which was critical to better understand the causes of AMD.As a result, major studies have been conducted to identify the mechanisms and the main cells responsible for releasing VEGF. Previous experimental and clinical studies aiming to identify the causes and cures for other organ diseases had demonstrated that hypoxia is the main stimulus for VEGF release(4), thus helping understand the formation of the subretinal neovascular network seen in exudative AMD(1). However, angiogenesis is a complex multi-stage process that involves not only growth factors, but also adhesion molecules and inflammatory cytokines, both of which have a key role in the process(5,6).

Intercellular adhesion molecule 1 (ICAM-1), or CD54, is a glycoprotein of the immunoglobulin superfamily. Similarly to other adhesion molecules, ICAM-1 is present in leukocytes and endothelial cells and participates in leukocyte recruitment to injured or inflamed tissue(7).A study performed in human donor eyes that aimed to assess ICAM-1 distribution in the choriocapillaris found a greater concentration of this immunoglobulin in the macula, as opposed to the peripheral region(8). This finding suggests a higher susceptibility of the macula to trafficking of immune cells such as macrophages, which helps explain the higher incidence of subretinal neovascular membrane in this region. In addition to producing VEGF(9), macrophages are also a source of inflammatory and pro-angiogenic cytokines such as interleukin 6 and tumour necrosis factors (TNF)(10,11), which mediate inflammatory response and contribute significantly to the formation of subretinal neovascular membranes(6,12-13).

Treatment with anti-angiogenic drugs has been more effective than previous therapies, although the visual prognosis is still limited(14). Therefore, an experimental model that induces the expression of adhesion molecules in the sclera-choroid complex can potentially simulate the changes observed in AMD. Improved understanding of the pathophysiology of AMD might support the development of more effective treatments for the condition.

The objective of this study was to assess ICAM-1 expression in the sclera-choroid complex of hypercholesterolemic rabbits.


The study protocol was approved by the Ethics Committee for Animal Research of the Pontifical Catholic University of Paraná, in accordance with the principles of the Declaration of Helsinki (1964) and the Association for Research in Vision and Ophthalmology (ARVO).

Experimental setting

The procedures described in this study were carried out in the Laboratory of Surgical Technique at PUC-PR and the Study Centre of the Angelina Caron Hospital. Animals were kept in a vivarium (macroenvironment) on 12/12-hour light cycles with air circulation and controlled temperature between 19 and 23ºC. During the experimental period, animals were fed water and standard Nuvital™ (Nuvital, Colombo, Brazil) rabbit feed ad libitum.

Animals and experimental design

Twenty-one male New Zealand albino rabbits (Oryctolagus cuniculus) were selected for this study from the Central Vivarium of PUC-PR. The animals had a mean age of 110 days and a mean weight of 2,770 grams. They were divided into two groups: a normal diet group (NG) with 8 rabbits and a hypercho-lesterolemic diet group (HG) with 13 rabbits. NG animals were fed Nuvital™ (Nuvital, Colombo, Brazil) standard laboratory rabbit feed and euthanised after 4 weeks. Rabbits from the HG group were fed Nuvital™ (Nuvital, Colombo, Brazil) standard laboratory rabbit feed with additional 1% cholesterol throughout the study (supplementary feed) and were euthanised after 8 weeks.

Serum total cholesterol, triglycerides, HDL cholesterol, and fasting glucose levels were measured for each rabbit at the baseline and at the time of euthanasia. Blood samples were taken by puncturing the marginal ear vein under general anaesthesia by intramuscular injection of ketamine 5 mg/kg and xylazine 35 mg/kg. Plasma levels of glucose, total cholesterol, HDL cholesterol, and triglycerides were determined using the automated enzymatic-colorimetric method (Architect™, Abbott Diagnostics). A total of 500 microlitres of serum from each animal were frozen for future analysis. The weight of rabbits was measured on a weekly basis.

The animals were euthanised by intravenous injection of 5 mL pentobarbital and their eyes were immediately fixed in 4% paraformaldehyde (Merck, Darmstadt, Germany) in a 0.1M phosphate buffer at pH 7.4 for 4 hours for histomorphometric and immunohistochemical analysis.

Preparation of supplementary feed

For the 1% hypercholesterolemic feed used throughout the 8 weeks of the experiment, 200 g of cholesterol 95% (Sigma-Aldrich™) were dissolved in 800 mL of chloroform (Biotec™) and the solution was uniformly distributed over 20 kg of Nuvital™ (Nuvital, Colombo, Brazil) rabbit feed. Before feeding it to the rabbits we waited for 24 hours to allow the chloroform to evaporate. Each animal was offered 600 g of feed per day(15).

Histomorphometric Analysis (quantitative)

Both eyes of each animal were removed and fixed, but only one was chosen at random for analysis. After fixation, the samples were evaluated macroscopically. An axial section was performed at the level of the optic nerve, dividing the ocular globe into two equal halves (upper and lower). The lower half was stored for future studies. The upper half was dehydrated, diaphanised and embedded in paraffin using a Leica™ TP 1020 tissue processor (Leica, Wetzlar, Germany). Paraffin blocks were produced using a Leica™ EG1160 embedding station. A Leica™ RM2145 microtome (Leica, Wetzlar, Germany) was used to obtain 5-µ-thick histological sections. The sections were placed on glass slides smeared with albumin, stained with haematoxylineosin, and mounted with 24x90-mm coverslips using Entellan Mounting Medium, Merck™ (Merck, Darmstadt, Germany).

For quantitative analysis the selected sections were stained with haematoxylin-eosin and evaluated microscopically with a 4x objective lens. Using a blue marker, the posterior segment of the half ocular globe was divided manually into 10 equal segments (from one pars plana to the contralateral pars plana). One image was obtained per segment using an Olympus BX50 microscope connected to a Sony camera and Image-Pro Plus™ software. In each captured image four linear morphometric measurements were taken using the Image-Pro Plus™ software in order to evaluate scleral and choroidal thickness in the 10 segments. Finally, the mean values of the four measurements in each segment were calculated for all samples. Thickness was expressed in micrometres.

Tissue preparation and immunohistochemical analysis

The histological cuts were deparaffinised and rehydrated, and then subjected to blocking of endogenous peroxidase. They were subsequently washed in deionised water and incubated in a moist chamber at 95ºC for 20 minutes for antigen retrieval, after which they were again subjected to blocking of endogenous peroxidase. Sections were covered with primary mouse anti-ICAM-1 monoclonal antibody diluted at 1:100 (Novocastra™, Newcastle upon Tyne, England). They were then covered with a secondary antibody, HRP-labelled anti-mouse polymer (Advance™ System, DakoCytomation, Inc., Carpinteria, CA, USA), and incubated at room temperature for 30 minutes. The sections were dripped with mixed DAB substrate (DakoCytomation, Inc., CA, USA) and incubated for another 3 to 5 minutes. Finally, the slices were counterstained with Mayer's haematoxylin and mounted.

Positive and negative controls were used in all markings, and the slides were first analysed by an observer who did not know to which group the slides belonged (masked analysis). In this analysis, positive and negative results for the ICAM-1 marker were recorded. The positive areas acquired a brownish colour and were analysed using colour morphometry. For this procedure, images were captured in five consecutive fields, from the pars plana to the contralateral pars plana, using an Olympus BX50 microscope with a 40x objective lens, a Sony DXC-107A camera, and Image-Pro Plus software. This software allowed the observer to select and colour the positive areas. The immunoreactive surface area was then automatically calculated by the software and expressed in micrometres2. Data were compiled in a Microsoft Excel (Redmond, WA, USA) spreadsheet for statistical analysis. The variable immunoreactive area represents the sum of all positive areas in each of the five fields.

Statistical analysis

To compare groups with regard to the quantitative variables we used either Student's t-test for independent samples or the Mann-Whitney nonparametric test, as appropriate. Normality was assessed using the Shapiro-Wilk test. Values with p<0.05 were considered statistically significant. Data were analysed using Statistica 8.0 software.


Comparing groups with regard to glucose, total cholesterol, HDL, and triglycerides.

Laboratory values in NG (normal diet group) animals remained stable from the baseline to the end of the experiment. On the other hand, HG (hypercholesterolemic diet group) animals showed a significant increase in total cholesterol at the time of euthanasia.At the baseline, mean total cholesterol levels for both groups were approximately 41.3 mg/dL, and they reached 2146.8 mg/dL (p<0.001) in HG rabbits at the end of the experiment. Triglyceride levels also changed significantly in HG rabbits. Mean values at the baseline were approximately 46.5 mg/dL for both groups, and they reached 168.5 mg/dL (p=0.001) in HG animals at the time of euthanasia. No significant change was observed for glucose and HDL levels in this group at the end of the experiment.

Sclera and choroid staining with haematoxylin-eosin

Very few histiocytes were found in the sclera-choroid complex of NG animals (Figure 1), whereas HG samples revealed a large number of macrophages in these structures, causing their thickness to increase (Figure 2).

Figure 1 Sclera and choroid of an NG animal. Very few histiocytes can be observed in the sclera and choroid. 

Figure 2 Sclera and choroid of an HG animal. The sclera and choroid are thickened due to the large number of histiocytes. 

Comparing groups with regard to scleral-choroidal thickness (morphometry).

HG animals showed a significant increase in scleralchoroidal thickness relative to NG animals (p<0.001) (Table 1).

Table 1 Scleral-choroidal thickness (in micrometres) 

Variable Group N Mean Median Minimum Maximum Standard deviation P Value*
Scleral-choroidal GN 8 232,9 221,4 192,9 307,7 35,8  
morphometry GH 13 382,5 387,9 254,0 475,0 60,5 <0,001

*Student’s t-test for independent samples, p<0,05;

NG: Normal diet group; HG: Hypercholesterolemic diet group.

Comparing groups with regard to the total ICAM-1-immunoreactive area

HG animals showed a significant increase in ICAM-1 expression in the sclera-choroid complex relative to NG animals (p<0.001) (Table 2), characterised by the brownish colour acquired by immunoreactive areas (Figure 3-B). Conversely, the sclera-choroid of NG animals was thinner and predominantly blue, indicating low immunoreactivity to anti-ICAM-1 antibodies (Figure 3-A).

Table 2 Total surface area of the sclera-choroid immunoreactive to anti-ICAM-1 antibodies through colour morphometry. Values are expressed in micrometres2

Variable Group n Mean Median Minimum Maximum Standard deviation P value*
Immunoreactive GN 8 607,0 218,5 50,2 2200,4 858,7  
Area GH 13 3600,2 3288,7 1867,7 6368,8 1377,3 <0,001

*Mann–Whitney nonparametric test, p<0.05.

NG: Normal diet group; HG: Hypercholesterolemic diet group.

Figure 3 Scleral-choroidal immunoreactivity to anti-ICAM-1 antibodies. A. Sclera-choroid complex of an NG rabbit. The predominantly blue colour indicates low immunoreactivity to ICAM-1. Note the thin sclera and choroid. B. Sclera-choroid complex of an HG rabbit. The predominantly brownish colour indicates high immunoreactivity to ICAM-1. Note the large number of macrophages in the sclera (S). Thickened sclera and choroid. S: Sclera; C: Choroid. 


In a recent experimental study, our group demonstrated that a hypercholesterolemic diet increased MCP-1 expression in the sclera and choroid, suggesting that the changes in great vessels that induce atherosclerotic plaque formation might also occur in the sclera-choroid complex(16). After observing an increase in chemotactic molecules such as MCP-1, adhesion molecules had to be assessed to verify the hypothesis that atherosclerosis and AMD have similar pathophysiological mechanisms(17-19).

In a normal eye, immunoglobulin ICAM-1 expression is low in the vascular endothelium of the choroid and retina, as well as the RPE, Bruch’s membrane, and the external limiting membrane(20-22). However, under pathological conditions such as exudative AMD, there is a significant increase in ICAM-1 expression in choroidal vessels and RPE cells. This increase in immunoreactivity has been observed mainly around the subretinal neovascular membrane (SNM), where a large number of vessels is observed(23). Increased ICAM-1 expression in the RPE and choroid during SNM formation was also observed in experimental studies, suggesting this immunoglobulin is involved in the pathogenesis of AMD(24-25). This hypothesis was supported by another experiment where mice genetically deficient for ICAM1 or its counter-receptor CD18 were found to be less prone to SNM formation than normal mice(5).

In the present study, a cholesterol-enriched diet induced a significant increase in ICAM-1 expression in the sclera-choroid complex. As it is involved in leukocyte recruitment to inflamed tissues(26), the increased expression of this immunoglobulin may explain the significant rise in the number of macrophages and the consequent increase in scleral-choroidal thickness observed in this and other studies.

Inflammatory cells and the complement system play an important role in the pathogenesis of AMD(27). Furthermore, it has been demonstrated that macrophages produce inflammatory cytokines, tissue factor, VEGF, and other angiogenic factors(9,28-29). It has also been experimentally observed that the widespread depletion of macrophages decreases SNM activity(30). Hence, there is a consensus regarding the importance of macrophages in the pathogenesis of AMD. In this context, it is worth noting that oxidised LDL is the major stimulus for an increase in chemotactic molecules, adhesion molecules that attract macrophages to the inflammatory site, both in atherosclerosis and in AMD(31). However, increased ICAM-1 expression is induced not only by oxidised LDL, but also by native LDL(32). Thus, LDL deposited in Bruch's membrane, originating from the degradation of photoreceptor ends by RPE cells(2,31), can potentially increase the expression of these adhesion molecules. This may explain the increased number of macrophages and the onset of AMD. Therefore, experimental models that induce the accumulation of macrophages in the choroid by increasing the number of chemotactic or adhesion molecules may mimic macular degeneration, paving the way for future studies on therapies for the condition.


This study has demonstrated that increased serum cholesterol levels in an experimental model lead to increased ICAM-1 expression, which may explain the accumulation of macrophages in the sclera-choroid complex. Future research using drugs that interfere with this adhesion molecule may shed light on their possible use in the treatment of AMD.

Study conducted in the postgraduate unit of the Pontifical Catholic University of Paraná and the Angelina Caron Hospital (Campina Grande do Sul/PR).


We would like to thank Prof. Dr. Márcia Olandoski for her support on the statistical analysis of collected data.


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Received: December 17, 2013; Accepted: February 26, 2014

Autor correspondente: Rogil José de Almeida Torres, Rua Emiliano Perneta, nº 390 – conj. 1407. E-mail:

The authors declare no conflict of interest.

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