1
|
García-Llorca A, Carta F, Supuran CT, Eysteinsson T. Carbonic anhydrase, its inhibitors and vascular function. Front Mol Biosci 2024; 11:1338528. [PMID: 38348465 PMCID: PMC10859760 DOI: 10.3389/fmolb.2024.1338528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/03/2024] [Indexed: 02/15/2024] Open
Abstract
It has been known for some time that Carbonic Anhydrase (CA, EC 4.2.1.1) plays a complex role in vascular function, and in the regulation of vascular tone. Clinically employed CA inhibitors (CAIs) are used primarily to lower intraocular pressure in glaucoma, and also to affect retinal blood flow and oxygen saturation. CAIs have been shown to dilate vessels and increase blood flow in both the cerebral and ocular vasculature. Similar effects of CAIs on vascular function have been observed in the liver, brain and kidney, while vessels in abdominal muscle and the stomach are unaffected. Most of the studies on the vascular effects of CAIs have been focused on the cerebral and ocular vasculatures, and in particular the retinal vasculature, where vasodilation of its vessels, after intravenous infusion of sulfonamide-based CAIs can be easily observed and measured from the fundus of the eye. The mechanism by which CAIs exert their effects on the vasculature is still unclear, but the classic sulfonamide-based inhibitors have been found to directly dilate isolated vessel segments when applied to the extracellular fluid. Modification of the structure of CAI compounds affects their efficacy and potency as vasodilators. CAIs of the coumarin type, which generally are less effective in inhibiting the catalytically dominant isoform hCA II and unable to accept NO, have comparable vasodilatory effects as the primary sulfonamides on pre-contracted retinal arteriolar vessel segments, providing insights into which CA isoforms are involved. Alterations of the lipophilicity of CAI compounds affect their potency as vasodilators, and CAIs that are membrane impermeant do not act as vasodilators of isolated vessel segments. Experiments with CAIs, that shed light on the role of CA in the regulation of vascular tone of vessels, will be discussed in this review. The role of CA in vascular function will be discussed, with specific emphasis on findings with the effects of CA inhibitors (CAI).
Collapse
Affiliation(s)
- Andrea García-Llorca
- Department of Physiology, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Fabrizio Carta
- NEUROFARBA Department, Section of Pharmaceutical and Nutraceutical Sciences, University of Florence, Florence, Italy
| | - Claudiu T. Supuran
- NEUROFARBA Department, Section of Pharmaceutical and Nutraceutical Sciences, University of Florence, Florence, Italy
| | - Thor Eysteinsson
- Department of Physiology, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Ophthalmology, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
2
|
Diafas A, Dastiridou A, Samouilidou M, Tzamalis A, Mataftsi A, Tsinopoulos I, Kozobolis V, Ziakas N. The effect of acetazolamide on the retinal and choroidal vasculature of the macula and the optic disc using OCT angiography. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:125-131. [PMID: 36738925 DOI: 10.1016/j.oftale.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/30/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES To investigate the effect of acetazolamide (AZ) on the retinal and choroidal ocular microvasculature in the macula and radial peripapillary capillaries (RPC) of the optic disc with OCT Angiography (OCTA). MATERIALS AND METHODS Nine-month observational cross-sectional study. Forty-five eyes from 45 healthy participants who underwent cataract surgery were recruited. Macular retina and choriocapillaris vessel density (VD) and RPC VD in the optic disc area were compared before and 60min after 250mg acetazolamide per os. Intraocular pressure (IOP) and systemic blood pressure (BP) were also measured before each scan. RESULTS Mean age was 73.1±6.9 years. VDs in the superficial (SCP) and deep (DCP) capillary plexus of the retina and the choriocapillaris (CC) in the macular area showed no significant change (P>.5, for all parameters). VD in the RPC showed no significant change with AZ (P>.5, for all parameters). Foveal and parafoveal thickness increased from 248.98 (±23.89) to 250.33 (±23.74) and from 311.62 (±16.53) to 311.98 (±16.38) (P<.001 and P=.046), respectively. IOP decreased from 13.2 (±3.0) mmHg to 11.8 (±3.2) mmHg (P<.001), while systolic and diastolic BP decreased from 144.8 (±21.8) to 137.7 (±19.0) and from 80.0 (±12.7) to 76.2 (±11.7) (P=.021 and P=.030), respectively. CONCLUSIONS OCTA imaging did not reveal any significant changes in the VD of the optic disc or the retinal and choroidal VD in the macula with oral AZ one hour after its administration in otherwise healthy participants who underwent cataract surgery.
Collapse
Affiliation(s)
- A Diafas
- 2(nd) Departamento de Oftalmología, Universidad Aristóteles de Tesalónica, Facultad de Medicina, Hospital General Papageorgiou, Tesalónica, Greece; St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.
| | - A Dastiridou
- 2(nd) Departamento de Oftalmología, Universidad Aristóteles de Tesalónica, Facultad de Medicina, Hospital General Papageorgiou, Tesalónica, Greece
| | - M Samouilidou
- 2(nd) Departamento de Oftalmología, Universidad Aristóteles de Tesalónica, Facultad de Medicina, Hospital General Papageorgiou, Tesalónica, Greece
| | - A Tzamalis
- 2(nd) Departamento de Oftalmología, Universidad Aristóteles de Tesalónica, Facultad de Medicina, Hospital General Papageorgiou, Tesalónica, Greece
| | - A Mataftsi
- 2(nd) Departamento de Oftalmología, Universidad Aristóteles de Tesalónica, Facultad de Medicina, Hospital General Papageorgiou, Tesalónica, Greece
| | - I Tsinopoulos
- 2(nd) Departamento de Oftalmología, Universidad Aristóteles de Tesalónica, Facultad de Medicina, Hospital General Papageorgiou, Tesalónica, Greece
| | - V Kozobolis
- Instituto Oftalmológico de Tracia, Universidad Demócrito de Tracia, Alexandroupoli, Greece
| | - N Ziakas
- 2(nd) Departamento de Oftalmología, Universidad Aristóteles de Tesalónica, Facultad de Medicina, Hospital General Papageorgiou, Tesalónica, Greece
| |
Collapse
|
3
|
Kelada M, Hill D, Yap TE, Manzar H, Cordeiro MF. Innovations and revolutions in reducing retinal ganglion cell loss in glaucoma. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2021.1835470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Mary Kelada
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London NW1 5QH, UK
| | - Daniel Hill
- Glaucoma and Retinal Neurodegeneration Group, UCL Institute of Ophthalmology, London, UK
| | - Timothy E. Yap
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London NW1 5QH, UK
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, UK
| | - Haider Manzar
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London NW1 5QH, UK
| | - M. Francesca Cordeiro
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London NW1 5QH, UK
- Glaucoma and Retinal Neurodegeneration Group, UCL Institute of Ophthalmology, London, UK
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, UK
| |
Collapse
|
4
|
Dong YR, Huang SW, Cui JZ, Yoshitomi T. Effects of brinzolamide on rabbit ocular blood flow in vivo and ex vivo. Int J Ophthalmol 2018; 11:719-725. [PMID: 29862168 DOI: 10.18240/ijo.2018.05.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/15/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate if significant improvement of optic disc blood flow (ODBF) occurs after instillation of brinzolamide onto rabbit eyes. METHODS Testing of bilateral intraocular pressure (IOP) and left ODBF in 10 male rabbits took place every 3h over a 24h period. Brinzolamide (1% ophthalmic solution, two drops at 9:00 and 21:00) was administered to the left eye. ODBF, assessed using laser speckle flowgraphy, was determined as the mean blur rate (MBR). Furthermore, the effect of brinzolamide on isolated rabbit ciliary arteries using isometric tension recording system was performed. RESULTS After brinzolamide instillation, IOP was significantly decreased in the left eye. MBR-vessel was greater at 18:00 and 21:00 (P<0.05) than in the controls. MBR-tissue and MBR-average were greater at 18:00 (P<0.05) than in the controls. For isolated arteries pre-contracted with a high-K solution, brinzolamide induced concentration-dependent relaxation, reaching 46.1%±9% (n=21) at 1 mmol/L. In Ca2+-free solutions, incubation with brinzolamide suppressed 1 µmol/L histamine-induced contractions (P<0.05). CONCLUSION Brinzolamide decreases IOP and increases ocular blood flow. The direct vasodilatory effect of brizolamide is mediated by suppression of Ca2+ release from intracellular calcium stores.
Collapse
Affiliation(s)
- Ya-Ru Dong
- Department of Ophthalmology, the Second Hospital of Jilin University, Changchun 130041, Jilin Province, China.,Department of Ophthalmology, Akita University School of Medicine, Akita 010-8543, Japan
| | - Shi-Wei Huang
- Department of Ophthalmology, the Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Ji-Zhe Cui
- Department of Ophthalmology, the Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Takeshi Yoshitomi
- Department of Ophthalmology, Akita University School of Medicine, Akita 010-8543, Japan
| |
Collapse
|
5
|
Lima-Gómez V, Bermúdez-Zapata DA, Blanco-Hernández DMR. [Efficacy of dorzolamide in reducing retinal thickness after photocoagulation in diabetic macular oedema]. CIR CIR 2015; 83:3-8. [PMID: 25982601 DOI: 10.1016/j.circir.2014.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/25/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Focal photocoagulation interrupts vascular leakage in diabetic macular edema, and allows the retinal pigment epithelium to withdraw fluid that thickens the retina; this mechanism could be enhanced by dorzolamida, a topical carbonic anhydrase inhibitor. OBJECTIVE To determine the efficacy of dorzolamida compared against placebo, in reducing retinal thickness after focal photocoagulation, in eyes with diabetic macular oedema. MATERIAL AND METHODS Experimental, comparative, prospective, longitudinal, double blind study in diabetics with focal macular oedema treated with photocoagulation. Treated eyes were randomly assigned three weeks after the procedure to receive dorzolamide (group 1) or placebo (group 2), three times daily during three weeks. Means of visual acuity, center point thickness and macular volume were compared 3 and 6 weeks after photocoagulation within groups (Wilcoxon's t) and between groups (Mann-Whitneys's U). RESULTS Sixty-nine eyes form patients aged 58.3 ± 8.3 years; 37 were assigned to group 1 and 42 to group 2. Mean center point thickness changed from 178.4 ± 34μm to 170 ± 29.1μm in group 1 (p = 0.04), and from 179.2 ± 22.4μm to 178.6 ± 20.8μm in group 2 (p = 0.7); mean macular volume changed from 7.63 ± 0.52mm(3) to 7.50 ± 0.50mm(3) in group 1 (p = 0.02) and from 7.82 ± 0.43mm(3) to 7.76 ± 0.42mm(3) in group 2 (p = 0.014). CONCLUSIONS The efficacy of dorzolamide was higher than that of placebo, to reduce retinal thickness after focal photocoagulation in diabetics with macular oedema.
Collapse
|
6
|
Schargus M, Suckert N, Schultz T, Kakkassery V, Dick HB. Femtosecond laser-assisted cataract surgery without OVD: a prospective intraindividual comparison. J Refract Surg 2015; 31:146-52. [PMID: 25751829 DOI: 10.3928/1081597x-20150220-01] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/22/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare femtosecond laser-assisted cataract surgery without the use of ophthalmic viscosurgical device (OVD) with standard phacoemulsification using OVD. METHODS This was a prospective, randomized, single-center trial of 37 patients (74 eyes) diagnosed as having significant cataract in both eyes. Randomly, one eye underwent standard phacoemulsification with OVD (the OVD group); this group acted as controls. The other eye was treated with the femtosecond laser; the subsequent manual part of the procedure was performed without OVD (non-OVD group). Time of surgery, amount of fluid used during phacoemulsification, central corneal thickness, intraocular pressure, endothelial cell count, and visual acuity were documented over the 6-month follow-up. RESULTS There were no major complications and no significant difference in overall surgery time (non-OVD: 375 ± 81 seconds; OVD: 362 ± 43 seconds; P = .713) and in the quantity of fluid passing through the eye (non-OVD: 187 ± 35 mL; OVD: 186 ± 27 mL; P = .952) between groups. Endothelial cell loss after 6 months was not significantly different between groups (non-OVD: -2.4%; OVD: -2.7%; P = .880). Central corneal thickness was not different at 1 week postoperatively between groups (non-OVD: 575 ± 45 µm; OVD: 573 ± 46 µm; P = .820). Three patients in the OVD group and one patient in the non-OVD group experienced intraocular pressure greater than 25 mm Hg at 1 day postoperatively. There were no significant differences in corrected distance visual acuity between groups (logMAR non-OVD: 0.024; OVD: 0.038; P = .461). CONCLUSIONS Femtosecond laser-assisted treatment allows the cataract surgeon to perform phacoemulsification and intraocular lens implantation without the use of OVD at no additional risk to the corneal endothelium. Furthermore, there was a tendency toward fewer increases in intraocular pressure in patients treated with the femtosecond laser.
Collapse
|
7
|
Swenson ER. New insights into carbonic anhydrase inhibition, vasodilation, and treatment of hypertensive-related diseases. Curr Hypertens Rep 2015; 16:467. [PMID: 25079851 DOI: 10.1007/s11906-014-0467-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Carbonic anhydrase (CA) and its inhibitors are relevant to many physiological processes and diseases. The enzyme is differentially expressed throughout the body, in concentration and subcellular location, and as 13 catalytically active isoforms. Blood vessels contain small amounts of CA, but the enzyme's role in vascular physiology and blood pressure regulation is uncertain. However, considerable recent evidence points to vasodilation by CA inhibitors. CA inhibition in vascular smooth muscle, endothelium, heart, blood cells, and nervous system could all contribute. It is equally plausible that other targets besides CA for all known CA inhibitors may account for their vascular effects. I will review this knowledge and important remaining gaps relating to treatment of hypertensive-related diseases with potent sulfonamide inhibitors, such as acetazolamide; but also the possibility that CA inhibition by thiazides and loop diuretics, although generally weaker, may have antihypertensive effects beyond their inhibition of renal sodium transporters.
Collapse
Affiliation(s)
- Erik R Swenson
- Department of Veterans Affairs, Pulmonary and Critical Care Medicine, VA Puget Sound Health Care System, University of Washington, 1660 South Columbian Way, Seattle, WA, USA,
| |
Collapse
|
8
|
Schmidl D, Schmetterer L, Garhöfer G, Popa-Cherecheanu A. Pharmacotherapy of glaucoma. J Ocul Pharmacol Ther 2015; 31:63-77. [PMID: 25587905 PMCID: PMC4346603 DOI: 10.1089/jop.2014.0067] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 10/31/2014] [Indexed: 12/25/2022] Open
Abstract
Glaucoma is a group of diseases involving the optic nerve and associated structures, which is characterized by progressive visual field loss and typical changes of the optic nerve head (ONH). The only known treatment of the disease is reduction of intraocular pressure (IOP), which has been shown to reduce glaucoma progression in a variety of large-scale clinical trials. Nowadays, a relatively wide array of topical antiglaucoma drugs is available, including prostaglandin analogues, carbonic anhydrase inhibitors, beta-receptor antagonists, adrenergic agonists, and parasympathomimetics. In clinical routine, this allows for individualized treatment taking risk factors, efficacy, and safety into account. A major challenge is related to adherence to therapy. Sustained release devices may help minimize this problem but are not yet available for clinical routine use. Another hope arises from non-IOP-related treatment concepts. In recent years, much knowledge has been gained regarding the molecular mechanisms that underlie the disease process in glaucoma. This also strengthens the hope that glaucoma therapy beyond IOP lowering will become available. Implementing this concept with clinical trials remains, however, a challenge.
Collapse
Affiliation(s)
- Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Leopold Schmetterer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | |
Collapse
|
9
|
Kim YH, Lee MV, Ahn JH. Comparison of Ocular Pulse Amplitude Measured Using Dynamic Contour Tonometry and Ocular Blood Flow Analyzer. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.12.1906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yong Hyun Kim
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Mar Vin Lee
- Department of Ophthalmology, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Jae Hong Ahn
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
10
|
Abstract
INTRODUCTION Carbonic anhydrase (CA) inhibitors have an impressive safety record despite the multiple functions that CA isozymes serve because they are not fully inhibited with most dosing. While reducing the targeted CA-dependent process sufficiently for disease control, residual activity and uncatalyzed rates in combination with compensations are adequate to avoid lethal consequences. Some drugs have in vitro selectivity differences against the 13 active isozymes, but none are convincingly selective in vivo or clinically. Efforts to synthesize selective inhibitors should result in safer drugs with fewer side effects. AREAS COVERED This review will focus on approved drugs with CA-inhibiting activity, whether used directly for this purpose or others. Side effects are discussed in relation to various organ systems and the disease being treated. Causes of side effects are considered, and strategies for symptom reduction are given. EXPERT OPINION Common side effects of paresthesias, dyspepsia, lassitude and fatigue in 30 - 40% of patients are generally tolerable or abate, but if not can be partially relieved by bicarbonate supplementation. The most important safety concerns are severe acidosis, respiratory failure and encephalopathy in patients with renal, pulmonary and hepatic disease where caution is critical, as is also the case in persons with sulfa drug allergies.
Collapse
Affiliation(s)
- Erik R Swenson
- University of Washington - Medical Service, VA Puget Sound Health Care System , 1660 S Columbian Way, S-111-PLUM, Seattle, WA 98108 , USA
| |
Collapse
|
11
|
Jang SR, Lee MV, Ahn JH. Comparison of Dorzolamide-Timolol Fixed Combination and Latanoprost, Effects on Intraocular Pressure and Ocular Pulse Amplitude. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.6.854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Se Ran Jang
- Department of Ophthalmology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Mar Vin Lee
- Department of Ophthalmology, DMC BunDang Jesaeng General Hospital, Seongnam, Korea
| | - Jae Hong Ahn
- Department of Ophthalmology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|