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Melecchi A, Amato R, Dal Monte M, Rusciano D, Bagnoli P, Cammalleri M. Restored retinal physiology after administration of niacin with citicoline in a mouse model of hypertensive glaucoma. Front Med (Lausanne) 2023; 10:1230941. [PMID: 37731716 PMCID: PMC10508956 DOI: 10.3389/fmed.2023.1230941] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Much interest has been addressed to antioxidant dietary supplements that are known to lower the risk of developing glaucoma or delay its progression. Among them, niacin and citicoline protect retinal ganglion cells (RGCs) from degeneration by targeting mitochondria, though at different levels. A well-established mouse model of RGC degeneration induced by experimental intraocular pressure (IOP) elevation was used to investigate whether a novel combination of niacin/citicoline has better efficacy over each single component in preserving RGC health in response to IOP increase. Methods Ocular hypertension was induced by an intracameral injection of methylcellulose that clogs the trabecular meshwork. Electroretinography and immunohistochemistry were used to evaluate RGC function and density. Oxidative, inflammatory and apoptotic markers were evaluated by Western blot analysis. Results The present results support an optimal efficacy of niacin with citicoline at their best dosage in preventing RGC loss. In fact, about 50% of RGCs were spared from death leading to improved electroretinographic responses to flash and pattern stimulation. Upregulated levels of oxidative stress and inflammatory markers were also consistently reduced by almost 50% after niacin with citicoline thus providing a significant strength to the validity of their combination. Conclusion Niacin combined with citicoline is highly effective in restoring RGC physiology but its therapeutic potential needs to be further explored. In fact, the translation of the present compound to humans is limited by several factors including the mouse modeling, the higher doses of the supplements that are necessary to demonstrate their efficacy over a short follow up period and the scarce knowledge of their transport to the bloodstream and to the eventual target tissues in the eye.
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Affiliation(s)
| | - Rosario Amato
- Department of Biology, University of Pisa, Pisa, Italy
| | - Massimo Dal Monte
- Department of Biology, University of Pisa, Pisa, Italy
- Interdepartmental Research Center Nutrafood “Nutraceuticals and Food for Health”, University of Pisa, Pisa, Italy
| | - Dario Rusciano
- Research Center, Fidia Farmaceutici S.p.A, Catania, Italy
| | - Paola Bagnoli
- Department of Biology, University of Pisa, Pisa, Italy
| | - Maurizio Cammalleri
- Department of Biology, University of Pisa, Pisa, Italy
- Interdepartmental Research Center Nutrafood “Nutraceuticals and Food for Health”, University of Pisa, Pisa, Italy
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Silvestri T, Daruich A, De Palma FDE, Mollo V, Naud MC, Aleo D, Spitaleri F, Kroemer G, Behar-Cohen F, Biondi M, Picard E, Maiuri MC, Mayol L. In Vitro and In Vivo Safety of Hyaluronic Acid-Decorated Microparticles for Intravitreal Injection of Palmitoylethanolamide, Citicoline, or Glial-Cell-Derived Neurotrophic Factor. Biomacromolecules 2023; 24:3510-3521. [PMID: 37531486 DOI: 10.1021/acs.biomac.3c00276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
The treatment of posterior eye segment diseases through intravitreal injection requires repeated injections of an active molecule, which may be associated with serious side effects and poor patient compliance. One brilliant strategy to overcome these issues is the use of drug-loaded microparticles for sustained release, aiming at reducing the frequency of injections. Therefore, the aim of this work was to assess the safety features of poly(lactic-co-glycolic acid) (PLGA)-based, hyaluronic acid-decorated microparticles loaded with palmitoylethanolamide (PEA), citicoline (CIT), or glial-cell-derived neurotrophic factor (GDNF). Microparticles were prepared by double emulsion-solvent evaporation and fully characterized for their technological features. Microparticles possessed a satisfactory safety profile in vitro on human retinal pigment epithelial (ARPE-19) cells. Interestingly, the administration of free GDNF led to a loss of cell viability, while GDNF sustained release displayed a positive effect in that regard. In vivo results confirmed the safety profile of both empty and loaded microparticles. Overall, the outcomes suggest that the produced microparticles are promising for improving the local administration of neuroprotective molecules. Further studies will be devoted to assess the therapeutic ability of microparticles.
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Affiliation(s)
- Teresa Silvestri
- Department of Pharmacy─Pharmaceutical Sciences, University of Bari Aldo Moro, Orabona St. 4, 70125 Bari, Italy
- Department of Pharmacy, University of Naples Federico II, D. Montesano St. 49, 80131 Naples, Italy
| | - Alejandra Daruich
- Centre de Recherche des Cordeliers, INSERM UMRS1138, Team "From Physiopathology of Ocular Diseases to Clinical Development", Sorbonne Université, Université Paris Cité, 75006 Paris, France
- Ophthalmology Department, Necker-Enfants Malades University Hospital, AP-HP, 149 Rue de Sèvres, Université Paris Cité, 75015 Paris, France
| | - Fatima Domenica Elisa De Palma
- Department of Molecular Medicine and Medical Biotechnologies, University of Napoli Federico II, Pansini St. 5, 80131 Naples, Italy
- Centre de Recherche des Cordeliers, INSERM UMRS1138, Université Paris Cité, Sorbonne Université, Team "Metabolism, Cancer & Immunity", 75006 Paris, France
- Cell Biology and Metabolomics platforms, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Valentina Mollo
- Italian Institute of Technology─Centre for Advanced Biomaterials for Healthcare, Largo Barsanti e Matteucci, 53, 80125 Naples, Italy
| | - Marie Christine Naud
- Centre de Recherche des Cordeliers, INSERM UMRS1138, Team "From Physiopathology of Ocular Diseases to Clinical Development", Sorbonne Université, Université Paris Cité, 75006 Paris, France
| | - Danilo Aleo
- Medivis Srl, Carnazza St. 34/C, 95030 Tremestieri etneo, Catania, Italy
| | - Fabiola Spitaleri
- Medivis Srl, Carnazza St. 34/C, 95030 Tremestieri etneo, Catania, Italy
| | - Guido Kroemer
- Centre de Recherche des Cordeliers, INSERM UMRS1138, Université Paris Cité, Sorbonne Université, Team "Metabolism, Cancer & Immunity", 75006 Paris, France
- Cell Biology and Metabolomics platforms, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Francine Behar-Cohen
- Centre de Recherche des Cordeliers, INSERM UMRS1138, Team "From Physiopathology of Ocular Diseases to Clinical Development", Sorbonne Université, Université Paris Cité, 75006 Paris, France
| | - Marco Biondi
- Department of Pharmacy, University of Naples Federico II, D. Montesano St. 49, 80131 Naples, Italy
- Interdisciplinary Research Centre on Biomaterials (CRIB), Piazzale Tecchio 80, 80125 Naples, Italy
| | - Emilie Picard
- Centre de Recherche des Cordeliers, INSERM UMRS1138, Team "From Physiopathology of Ocular Diseases to Clinical Development", Sorbonne Université, Université Paris Cité, 75006 Paris, France
| | - Maria Chiara Maiuri
- Department of Molecular Medicine and Medical Biotechnologies, University of Napoli Federico II, Pansini St. 5, 80131 Naples, Italy
- Centre de Recherche des Cordeliers, INSERM UMRS1138, Université Paris Cité, Sorbonne Université, Team "Metabolism, Cancer & Immunity", 75006 Paris, France
- Cell Biology and Metabolomics platforms, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Laura Mayol
- Interdisciplinary Research Centre on Biomaterials (CRIB), Piazzale Tecchio 80, 80125 Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Pansini St. 5, 80131 Naples, Italy
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Budihardja BM, Anggraini E, Pratiwi RW, Nastiti AD, Nusanti S. Neuroprotective Strategies for Nonarteritic Anterior Ischemic Optic Neuropathy: A Systematic Review. KOREAN JOURNAL OF OPHTHALMOLOGY 2023; 37:328-339. [PMID: 37563973 PMCID: PMC10427903 DOI: 10.3341/kjo.2022.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/08/2023] [Accepted: 07/22/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE Nonarteritic anterior ischemic optic neuropathy (NAION) is the second most common form of optic neuropathy. Most patients show no improvement over time. Until now, there is still no definitive therapy for NAION. The available literatures on the possible treatment of NAION are quite diverse and controversial. Neuroprotection strategies have been suggested as one of the potential treatments for NAION. This review aims to critically evaluate the literature on neuroprotective strategy for NAION. METHODS This report was written in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We performed a systematic literature search in Pubmed, Science Direct, Proquest, and Cochrane databases. Only neuroprotective agents that directly work in protecting neurons were included. The outcome of interest in this review is retinal ganglion cell density and apoptosis for animal studies and retinal nerve fiber layer thickness for human studies. RESULTS The systematic search identified 591 studies of which 24 met the eligibility criteria, including 21 animal studies and three human studies. Only a few of the studies evaluated the same treatments, showing how diverse neuroprotector treatments are currently being evaluated as NAION treatment. From 21 animal studies, 14 studies showed significantly higher retinal ganglion cell density (1.49- to 2.81-fold) with neuroprotective treatment compared to control group. Two of three human studies in this review had also found a beneficial effect of preserving retinal nerve fiber layer thickness in NAION patients. CONCLUSIONS This review suggests the potential of neuroprotection as a viable option in the quest for an effective treatment strategy for NAION. Further studies, particularly clinical studies, are necessary to establish its efficacy in NAION patients.
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Affiliation(s)
- Brigitta Marcia Budihardja
- Department of Ophthalmology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta,
Indonesia
| | - Erika Anggraini
- Department of Ophthalmology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta,
Indonesia
| | - Rianti Wulandari Pratiwi
- Department of Ophthalmology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta,
Indonesia
| | - Anya Dewi Nastiti
- Department of Ophthalmology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta,
Indonesia
| | - Syntia Nusanti
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, University of Indonesia, Jakarta,
Indonesia
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Tribble JR, Hui F, Quintero H, El Hajji S, Bell K, Di Polo A, Williams PA. Neuroprotection in glaucoma: Mechanisms beyond intraocular pressure lowering. Mol Aspects Med 2023; 92:101193. [PMID: 37331129 DOI: 10.1016/j.mam.2023.101193] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/25/2023] [Accepted: 06/04/2023] [Indexed: 06/20/2023]
Abstract
Glaucoma is a common, complex, multifactorial neurodegenerative disease characterized by progressive dysfunction and then loss of retinal ganglion cells, the output neurons of the retina. Glaucoma is the most common cause of irreversible blindness and affects ∼80 million people worldwide with many more undiagnosed. The major risk factors for glaucoma are genetics, age, and elevated intraocular pressure. Current strategies only target intraocular pressure management and do not directly target the neurodegenerative processes occurring at the level of the retinal ganglion cell. Despite strategies to manage intraocular pressure, as many as 40% of glaucoma patients progress to blindness in at least one eye during their lifetime. As such, neuroprotective strategies that target the retinal ganglion cell and these neurodegenerative processes directly are of great therapeutic need. This review will cover the recent advances from basic biology to on-going clinical trials for neuroprotection in glaucoma covering degenerative mechanisms, metabolism, insulin signaling, mTOR, axon transport, apoptosis, autophagy, and neuroinflammation. With an increased understanding of both the basic and clinical mechanisms of the disease, we are closer than ever to a neuroprotective strategy for glaucoma.
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Affiliation(s)
- James R Tribble
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Flora Hui
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Department of Optometry & Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Heberto Quintero
- Department of Neuroscience, University of Montreal, Montreal, Canada; Neuroscience Division, Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Sana El Hajji
- Department of Neuroscience, University of Montreal, Montreal, Canada; Neuroscience Division, Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Katharina Bell
- NHMRC Clinical Trials Centre, University of Sydney, Australia; Eye ACP Duke-NUS, Singapore
| | - Adriana Di Polo
- Department of Neuroscience, University of Montreal, Montreal, Canada; Neuroscience Division, Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Canada
| | - Pete A Williams
- Department of Clinical Neuroscience, Division of Eye and Vision, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
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Martucci A, Mancino R, Cesareo M, Pinazo-Duran MD, Nucci C. Combined use of coenzyme Q10 and citicoline: A new possibility for patients with glaucoma. Front Med (Lausanne) 2022; 9:1020993. [PMID: 36590976 PMCID: PMC9797721 DOI: 10.3389/fmed.2022.1020993] [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: 08/16/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Glaucoma is the leading cause of irreversible blindness worldwide. Several risk factors have been involved in the pathogenesis of the disease. By now, the main treatable risk factor is elevated intraocular pressure. Nevertheless, some patients, whose intraocular pressure is considered in the target level, still experience a progression of the disease. Glaucoma is a form of multifactorial ocular neurodegeneration with complex etiology, pathogenesis, and pathology. New evidence strongly suggests brain involvement in all aspects of this disease. This hypothesis and the need to prevent glaucomatous progression led to a growing interest in the pharmacological research of new neuroprotective, non-IOP-lowering, agents. The aim of this paper is to report evidence of the usefulness of Coenzyme Q10 and Citicoline, eventually combined, in the prevention of glaucomatous neurodegeneration.
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Affiliation(s)
- Alessio Martucci
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy,*Correspondence: Alessio Martucci,
| | - Raffaele Mancino
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Massimo Cesareo
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Maria Dolores Pinazo-Duran
- Ophthalmic Research Unit “Santiago Grisolia”, Foundation for the Promotion of Health and Biomedical Research of the Valencian Community (FISABIO), Valencia, Spain,Cellular and Molecular Ophthalmobiology Group, Department of Surgery, University of Valencia, Valencia, Spain
| | - Carlo Nucci
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
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6
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Lambuk L, Suhaimi NAA, Sadikan MZ, Jafri AJA, Ahmad S, Nasir NAA, Uskoković V, Kadir R, Mohamud R. Nanoparticles for the treatment of glaucoma-associated neuroinflammation. EYE AND VISION 2022; 9:26. [PMID: 35778750 PMCID: PMC9250254 DOI: 10.1186/s40662-022-00298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 06/09/2022] [Indexed: 12/03/2022]
Abstract
Recently, a considerable amount of literature has emerged around the theme of neuroinflammation linked to neurodegeneration. Glaucoma is a neurodegenerative disease characterized by visual impairment. Understanding the complex neuroinflammatory processes underlying retinal ganglion cell loss has the potential to improve conventional therapeutic approaches in glaucoma. Due to the presence of multiple barriers that a systemically administered drug has to cross to reach the intraocular space, ocular drug delivery has always been a challenge. Nowadays, studies are focused on improving the current therapies for glaucoma by utilizing nanoparticles as the modes of drug transport across the ocular anatomical and physiological barriers. This review offers some important insights on the therapeutic advancements made in this direction, focusing on the use of nanoparticles loaded with anti-inflammatory and neuroprotective agents in the treatment of glaucoma. The prospect of these novel therapies is discussed in relation to the current therapies to alleviate inflammation in glaucoma, which are being reviewed as well, along with the detailed molecular and cellular mechanisms governing the onset and the progression of the disease.
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Laksmita YA, Sidik M, Siregar NC, Nusanti S. Neuroprotective Effects of Citicoline on Methanol-Intoxicated Retina Model in Rats. J Ocul Pharmacol Ther 2021; 37:534-541. [PMID: 34495749 DOI: 10.1089/jop.2021.0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study aims to evaluate the effect of citicoline administration in suppressing retinal damage due to methanol intoxication. This study hypothesizes that citicoline will minimize the loss of retinal ganglion cells (RGCs), minimize disruption of photoreceptors, suppress ganglion layer edema, increase expression of bcl-2 as the antiapoptotic protein, and decrease expression of caspase-3 as the proapoptotic protein. Methods: Fifteen Sprague-Dawley rats were divided into 5 groups, including the control group (A); methanol groups, observed on day 3 (B1) and day 7 (B2); and methanol+citicoline groups, observed on day 3 (C1) and day 7 (C2). Rats in groups B and C were placed in an inhalation chamber filled with N2O:O2 during the experiment, then methanol was administered orally. Citicoline, 1 g/kg every 24 h, was orally administered for group C. Enucleation was performed and retinas of rats were prepared for histology and immunohistochemistry examination to evaluate photoreceptor morphology and RGC density, as well as bcl-2 and caspase-3 expression. Results: RGC density of citicoline-treated intoxicated rats was higher than no-citicoline methanol-intoxicated rats on both day 3 (P < 0.001) and day 7 (P < 0.001). The ganglion layer thickness of citicoline-treated intoxicated rats was thinner than no-citicoline intoxicated rats, which means citicoline-treated rats had milder ganglion layer edema. Citicoline-treated rats showed higher bcl-2 and lower caspase-3 expression than no-citicoline rats. No differences were found in photoreceptor findings among groups. Conclusions: This study demonstrated citicoline's potential benefits for management of ocular methanol intoxication. However, more preclinical and clinical trials are needed to obtain a preferred dosage and timing of citicoline administration.
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Affiliation(s)
- Yulinda Arty Laksmita
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Mohamad Sidik
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nurjati Chairani Siregar
- Department of Pathological Anatomy, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Syntia Nusanti
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Oddone F, Rossetti L, Parravano M, Sbardella D, Coletta M, Ziccardi L, Roberti G, Carnevale C, Romano D, Manni G, Parisi V. Citicoline in Ophthalmological Neurodegenerative Disease: A Comprehensive Review. Pharmaceuticals (Basel) 2021; 14:ph14030281. [PMID: 33804675 PMCID: PMC8003774 DOI: 10.3390/ph14030281] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/12/2022] Open
Abstract
Cytidine 5'-diphosphocholine has been widely studied in systemic neurodegenerative diseases, like Alzheimer's disease, Parkinson's disease, and brain ischemia. The rationale for the use of citicoline in ophthalmological neurodegenerative diseases, including glaucoma, anterior ischemic optic neuropathy, and diabetic retinopathy, is founded on its multifactorial mechanism of action and the involvement in several metabolic pathways, including phospholipid homeostasis, mitochondrial dynamics, as well as cholinergic and dopaminergic transmission, all being involved in the complexity of the visual transmission. This narrative review is aimed at reporting both pre-clinical data regarding the involvement of citicoline in such metabolic pathways (including new insights about its role in the intracellular proteostasis through an interaction with the proteasome) and its effects on clinical psychophysical, electrophysiological, and morphological outcomes following its use in ophthalmological neurodegenerative diseases (including the results of the most recent prospective randomized clinical trials).
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Affiliation(s)
- Francesco Oddone
- IRCCS-Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy; (F.O.); (D.S.); (L.Z.); (G.R.); (C.C.); (V.P.)
| | - Luca Rossetti
- Eye Clinic, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Via Antonio di Rudinì, 8, 20142 Milan, Italy; (L.R.); (D.R.)
| | - Mariacristina Parravano
- IRCCS-Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy; (F.O.); (D.S.); (L.Z.); (G.R.); (C.C.); (V.P.)
- Correspondence: ; Tel.: +39-6-8535-6727
| | - Diego Sbardella
- IRCCS-Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy; (F.O.); (D.S.); (L.Z.); (G.R.); (C.C.); (V.P.)
| | - Massimo Coletta
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (M.C.); (G.M.)
| | - Lucia Ziccardi
- IRCCS-Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy; (F.O.); (D.S.); (L.Z.); (G.R.); (C.C.); (V.P.)
| | - Gloria Roberti
- IRCCS-Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy; (F.O.); (D.S.); (L.Z.); (G.R.); (C.C.); (V.P.)
| | - Carmela Carnevale
- IRCCS-Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy; (F.O.); (D.S.); (L.Z.); (G.R.); (C.C.); (V.P.)
| | - Dario Romano
- Eye Clinic, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Via Antonio di Rudinì, 8, 20142 Milan, Italy; (L.R.); (D.R.)
| | - Gianluca Manni
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (M.C.); (G.M.)
| | - Vincenzo Parisi
- IRCCS-Fondazione Bietti, Via Livenza, 3, 00198 Rome, Italy; (F.O.); (D.S.); (L.Z.); (G.R.); (C.C.); (V.P.)
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9
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Potential neuroprotective biomolecules in ophthalmology. Int Ophthalmol 2020; 41:1103-1109. [PMID: 33180279 DOI: 10.1007/s10792-020-01634-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSES Retinal neurodegenerative diseases are responsible for a huge number of ocular problems worldwide. It seems that the progression of these diseases can be managed by the application of neuroprotective molecules particularly in the early stages. This article focuses on the most common neuroprotective bioagents under investigation in ophthalmology. METHODS We searched the web of science, PubMed and Scopus databases with these keywords: "glaucoma," "diabetic retinopathy," "age-related macular degeneration," "optic neuropathy and retinal degeneration" and/or "neuroprotection." RESULTS The most commonly utilized neuroprotective drugs for ophthalmology diseases were introduced in this study. It seems that these agents can be divided into three categories according to their mechanism of action: (A) neurotrophins, (B) decreasing effect on intraocular pressure and (C) inhibition of retinal neuron apoptosis. CONCLUSION A broad range of drugs has been illustrated in the literature for treatment of neuro-ophthalmic diseases. A good classification of the most applied drugs in this field can help specialists to prescribe the best matched drug considering the stage and progression of disease. However, controlled clinical trials are needed for better evaluation of the effects of these products.
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10
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Cinar E, Yuce B, Aslan F, Erbakan G. Neuroprotective Effect of Citicoline Eye Drops on Corneal Sensitivity After LASIK. J Refract Surg 2020; 35:764-770. [PMID: 31830292 DOI: 10.3928/1081597x-20191021-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the accelerator role of a topically administered neuroprotective eye drop (citicoline) on the recovery of corneal sensitivity after laser in situ keratomileusis (LASIK). METHODS In this prospective, controlled study, 78 eyes of 78 patients (mean age: 26.8 ± 7.6 years) were enrolled in the study group and their eyes were treated with topical citicoline three times a day for 1 month postoperatively. Seventy-eight eyes of 78 patients (mean age: 26.1 ± 7.4 years) were randomly selected as the control group and their eyes were treated with lubricant hyaluronic acid (0.15%) eye drops three times a day for 1 month. Corneal sensitivity was assessed in both groups using a Cochet-Bonnet esthesiometer at baseline and 1, 2, 3, 4, 6, 8, and 12 weeks after the LASIK procedure. RESULTS Corneal sensitivity at 1, 2, 3, 4, and 6 weeks after LASIK was significantly better in the citicoline group than the control group (P < .05 for all). Differences between the groups at 8 and 12 weeks after LASIK were not significant (P > .05). CONCLUSIONS Topically administered citicoline eye drops had beneficial effects in the early recovery of corneal sensitivity during the first 6 weeks after LASIK, suggesting that citicoline may play a significant role in accelerating corneal reinnervation. [J Refract Surg. 2019;35(12):764-770.].
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11
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Rasooli R, Pirsalami F, Moezi L. Posible involvement of nitric oxide in anticonvulsant effects of citicoline on pentylenetetrazole and electroshock induced seizures in mice. Heliyon 2020; 6:e03932. [PMID: 32462085 PMCID: PMC7240119 DOI: 10.1016/j.heliyon.2020.e03932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/17/2019] [Accepted: 05/01/2020] [Indexed: 12/30/2022] Open
Abstract
Cerebroneurovascular trauma is recognized as an important risk factor in the development of seizure and epilepsy. Administration of citicoline in these situations is a conventional therapeutic strategy, which combines neurovascular protection and repair effects. The aim of the present study is clarifying the effect of acute and sub-chronic citicoline administration on pentylenetetrazole (PTZ) and electroshock induced seizures in mice. Besides we examined the probable role of NO and its interaction with citicoline in seizure experiments. Male mice were received acute and sub-chronic regimens of different doses of citicoline (62.5, 125, 250 and 500 mg/kg) before the intravenous or intraperitoneal PTZ-induced seizures or electroshock. To clarify the probable role of NO, 7-nitroindazole (7-NI) (60 mg/kg) or aminoguanidine (AG) (100 mg/kg) were injected 5 min before citicoline in separate groups. The results revealed that neither acute nor sub-chronic treatment with citicoline could affect the seizures induced by intravenous or intraperitoneal PTZ, but in electroshock model, citicoline showed anti-epileptic properties. Co-administration of citicoline and selective nitric oxide synthase (NOS) inhibitors amplified the anticonvulsant effect of citicoline. The current results indicated that citicoline has anticonvulsant effects probably through the inhibition of NO.
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Affiliation(s)
- Rokhsana Rasooli
- Department of Pharmacology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatema Pirsalami
- Department of Pharmacology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Moezi
- Department of Pharmacology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Nanomedicine and Nanobiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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12
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Effect of neuroprotective citicoline eye drops on macular microcirculation. Int Ophthalmol 2020; 40:2237-2246. [PMID: 32388671 DOI: 10.1007/s10792-020-01404-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVE To use optical coherence tomography (OCTA) examination of the retinal microvascular structures to evaluate the effect of neuroprotective eye drops (citicoline, OMK1®) administered for laser in situ keratomileusis (LASIK) surgery. PATIENTS AND METHODS This prospective study included 45 patients treated with citicoline after LASIK and 48 patients not treated with citicoline after LASIK as a control group. In both groups, the foveal avascular zone (FAZ), retinal superficial vascular density (SVD), and deep vascular density (DVD) in the foveal and parafoveal areas were measured preoperatively and at 1 and 3 months postoperatively using OCTA. RESULTS No significant difference was detected between the groups in terms of preoperative SVD or DVD in the foveal and parafoveal zones and all quadrants (superior, inferior, temporal, and nasal) (P > 0.05). Similarly, no significant difference was detected between the citicoline group and control group in terms of SVD or DVD in the foveal and parafoveal zones at 1 and 3 months after LASIK (P > 0.05). CONCLUSIONS Despite their neuroprotective effect, topical citicoline drops had no significant effect on the superficial and deep microvascular structures of the retina or choriocapillaris.
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13
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Bolandghamat S, Behnam-Rassouli M. Recent Findings on the Effects of Pharmacological Agents on the Nerve Regeneration after Peripheral Nerve Injury. Curr Neuropharmacol 2020; 18:1154-1163. [PMID: 32379588 PMCID: PMC7709152 DOI: 10.2174/1570159x18666200507084024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/27/2020] [Accepted: 04/24/2020] [Indexed: 12/22/2022] Open
Abstract
Peripheral nerve injuries (PNIs) are accompanied with neuropathic pain and functional disability. Despite improvements in surgical repair techniques in recent years, the functional recovery is yet unsatisfied. Indeed a successful nerve repair depends not only on the surgical strategy but also on the cellular and molecular mechanisms involved in traumatic nerve injury. In contrast to all strategies suggested for nerve repair, pharmacotherapy is a cheap, accessible and non-invasive treatment that can be used immediately after nerve injury. This study aimed to review the effects of some pharmacological agents on the nerve regeneration after traumatic PNI evaluated by functional, histological and electrophysiological assessments. In addition, some cellular and molecular mechanisms responsible for their therapeutic actions, restricted to neural tissue, are suggested. These findings can not only help to find better strategies for peripheral nerve repair, but also to identify the neuropathic effects of various medications and their mechanisms of action.
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Affiliation(s)
- Samira Bolandghamat
- Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Iran
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14
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Popa AV, Kee CS, Stell WK. Retinal control of lens-induced astigmatism in chicks. Exp Eye Res 2020; 194:108000. [PMID: 32171734 DOI: 10.1016/j.exer.2020.108000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Astigmatism is a refractive error due to meridional differences in refractive powers of lens or cornea. The resulting failure to focus image points in a single plane causes blurred vision at all distances. In this study, using an animal model of lens-induced astigmatism, we tested the hypothesis that induced astigmatism is due to processing of astigmatic retinal image information by the brain, which causes distorted growth in the anterior segment via centrifugal neural projections. METHODS To induce astigmatism, +4.00DS/-8.00DC crossed-cylinder-lens goggles were affixed over the right eyes of 7-day-old chicks (P7), with the -8.00DC axis oriented vertically (at 90°) or horizontally (180°) (n = 12 each); the left eyes were without goggles (non-goggled). For all experiments, refractive errors of both eyes were measured by streak retinoscopy, before and after 1 week of lens wear. To test whether neuronal pathways between retina and brain are required, axonal conduction within the eye was blocked by intravitreal injections of tetrodotoxin (TTX; 7 μL of 10-4M) in phosphate-buffered saline (PBS), or of PBS alone (7 μL); fellow open eyes received PBS alone. Pupillary light reflex (PLR) and optokinetic response (OKR) were measured, to assess the efficacy and duration of TTX action. To test whether retinal circuitry is required, groups of chicks (n = 12 each) were treated at P7 by intravitreal injection of 20 μL of mixed excitotoxins (2 μmol N-methyl-D-aspartate, 0.2 μmol quisqualic acid, 0.2 μmol kainic acid; in water) into goggled or non-goggled eyes, to compromise retinal circuitry needed for emmetropization. RESULTS Crossed-cylinder goggles reliably induced refractive astigmatism. Maximum astigmatic error was induced when the cylindrical axis was oriented at 90° (vertically). TTX effectively blocked nerve conduction within the eye for 48 h after injection. Goggled eyes developed astigmatism after treatment with TTX or PBS, but not after excitotoxins. CONCLUSION Our hypothesis was rejected. In this model, the compensatory astigmatism induced by crossed-cylinder lenses is intrinsic to the eye, and mediated by visual processing in the retina.
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Affiliation(s)
- Anca-Vanessa Popa
- O'Brien Centre for the Bachelor of Health Sciences Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chea-Su Kee
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region; Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - William K Stell
- Department of Cell Biology and Anatomy and Department of Surgery, Hotchkiss Brain Institute and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada.
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15
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Gandolfi S, Marchini G, Caporossi A, Scuderi G, Tomasso L, Brunoro A. Cytidine 5'-Diphosphocholine (Citicoline): Evidence for a Neuroprotective Role in Glaucoma. Nutrients 2020; 12:E793. [PMID: 32197303 PMCID: PMC7146438 DOI: 10.3390/nu12030793] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/10/2020] [Accepted: 03/16/2020] [Indexed: 02/07/2023] Open
Abstract
Glaucoma, a heterogeneous set of progressively degenerative optic neuropathies characterized by a loss of retinal ganglion cells (RGCs) and typical visual field deficits that can progress to blindness, is a neurodegenerative disease involving both ocular and visual brain structures. Although elevated intraocular pressure (IOP) remains the most important modifiable risk factor of primary open-angle glaucoma (POAG) and is the main therapeutic target in treating glaucoma, other factors that influence the disease course are involved and reaching the optimal IOP target does not stop the progression of glaucoma, as the visual field continues to narrow. In addition to a managed IOP, neuroprotection may be beneficial by slowing the progression of glaucoma and improving the visual defects. Citicoline (cytidine 5'-diphosphocholine) is a naturally occurring endogenous compound that has been investigated as a novel therapeutic agent for the management of glaucoma. Citicoline has demonstrated activity in a range of central neurodegenerative diseases, and experimental evidence suggests a it performs a neuromodulator and neuroprotective role on neuronal cells, including RGCs, associated with improvement in visual function, extension of the visual field and central benefits for the patient. This review aims to critically summarize the current evidence for the neuroprotective properties of citicoline in glaucoma.
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Affiliation(s)
- Stefano Gandolfi
- Ophthalmology Unit, Department of Biological, Biotechnological and Translational Sciences, University of Parma, Via Gramsci, 14, 43126 Parma, Italy;
| | - Giorgio Marchini
- Ophthalmology Unit, Department of Neurosciences, Biomedicine and Movement, University of Verona, P. le L. A. Scuro, 10, 37134 Verona, Italy;
| | - Aldo Caporossi
- Ophthalmology Unit, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy., Largo F. Vito 1, 00168 Rome, Italy;
| | - Gianluca Scuderi
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome “Sapienza”, Via di Grottarossa 1035/1039, 00189 Rome, Italy;
| | - Livia Tomasso
- Bausch & Lomb IOM spa Viale Martesana 12, 20090 Vimodrone (MI), Italy;
| | - Andrea Brunoro
- Bausch & Lomb IOM spa Viale Martesana 12, 20090 Vimodrone (MI), Italy;
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16
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Carnevale C, Manni G, Roberti G, Micera A, Bruno L, Cacciamani A, Altafini R, Quaranta L, Agnifili L, Tanga L, Riva I, Oddone F. Human vitreous concentrations of citicoline following topical application of citicoline 2% ophthalmic solution. PLoS One 2019; 14:e0224982. [PMID: 31725734 PMCID: PMC6855484 DOI: 10.1371/journal.pone.0224982] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/26/2019] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To evaluate the presence and concentration of citicoline and its metabolites (choline, cytidine and uridine) in the vitreous body in human eyes after topical application of an ophthalmic solution of citicoline 2%, in vivo. METHODS Twenty-one subjects affected by epiretinal membrane with surgical indication for pars-plana vitrectomy underwent treatment with 1 drop 3 times/day of a solution of citicoline 2%, 0.2% high molecular weight hyaluronic acid and 0.01% benzalkonium chloride (OMK1, Omikron Italia s.r.l., Rome, Italy) 14 days before surgery and 2 hours prior to surgery. Five additional patients served as controls and received an OMK1 vehicle solution without citicoline. The vitreous samples were taken at the beginning of the pars-plana vitrectomy and analyzed for qualitative/quantitative determination of vitreous concentration of citicoline and its metabolites by means of high performance liquid chromatography. RESULTS The overall mean concentration of citicoline in patients treated with citicoline 2% solution was 406.72 ± 52.99 μg/mL, while the mean concentration of choline, cytidine and uridine was 180.88 ± 41.49 μg/mL, 44.45 ± 10.19 μg/mL and 330.41 ± 75.8 μg/mL, respectively. The concentration of citicoline in phakic eyes (n = 13, 366.61 ± 129.61 μg/mL) was lower compared to that found in pseudophakic eyes (n = 8, 435.89 ± 131.42 μg/mL) and the difference was not statistically significant. The concentration of citicoline in the control eyes was 45.66 ± 26.36 μg/mL, while the concentration of choline, cytidine and uridine were 17.21 ± 9.93 μg/mL, 6.24 ± 3.6 μg/mL and 172.80 ± 99.76 μg/mL, respectively. CONCLUSION Citicoline can reach the human vitreous in high concentration when administered in ophthalmic solution. This evidence contributes to the build-up of the pyramid of the evidences required for determining the role of citicoline administered in ophthalmic formulation in retinal and optic nerve neurodegenerative diseases.
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Affiliation(s)
| | - Gianluca Manni
- IRCCS-Fondazione Bietti, Rome, Italy
- DSCMT, University of Rome Tor Vergata, Rome, Italy
| | | | | | | | | | | | - Luciano Quaranta
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia-IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
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Therapeutic Strategies for Attenuation of Retinal Ganglion Cell Injury in Optic Neuropathies: Concepts in Translational Research and Therapeutic Implications. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8397521. [PMID: 31828134 PMCID: PMC6885158 DOI: 10.1155/2019/8397521] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/07/2019] [Accepted: 10/28/2019] [Indexed: 12/19/2022]
Abstract
Retinal ganglion cell (RGC) death is the central and irreversible endpoint of optic neuropathies. Current management of optic neuropathies and glaucoma focuses on intraocular pressure-lowering treatment which is insufficient. As such, patients are effectively condemned to irreversible visual impairment. This review summarizes experimental treatments targeting RGCs over the last decade. In particular, we examine the various treatment modalities and determine their viability and limitations in translation to clinical practice. Experimental RGC treatment can be divided into (1) cell replacement therapy, (2) neuroprotection, and (3) gene therapy. For cell replacement therapy, difficulties remain in successfully integrating transplanted RGCs from various sources into the complex neural network of the human retina. However, there is significant potential for achieving full visual restoration with this technique. Neuroprotective strategies, in the form of pharmacological agents, nutritional supplementation, and neurotrophic factors, are viable strategies with encouraging results from preliminary noncomparative interventional case series. It is important to note, however, that most published studies are focused on glaucoma, with few treating optic neuropathies of other etiologies. Gene therapy, through the use of viral vectors, has shown promising results in clinical trials, particularly for diseases with specific genetic mutations like Leber's hereditary optic neuropathy. This treatment technique can be further extended to nonhereditary diseases, through transfer of genes promoting cell survival and neuroprotection. Crucially though, for gene therapy, teratogenicity remains a significant issue in translation to clinical practice.
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Faiq MA, Wollstein G, Schuman JS, Chan KC. Cholinergic nervous system and glaucoma: From basic science to clinical applications. Prog Retin Eye Res 2019; 72:100767. [PMID: 31242454 PMCID: PMC6739176 DOI: 10.1016/j.preteyeres.2019.06.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 02/08/2023]
Abstract
The cholinergic system has a crucial role to play in visual function. Although cholinergic drugs have been a focus of attention as glaucoma medications for reducing eye pressure, little is known about the potential modality for neuronal survival and/or enhancement in visual impairments. Citicoline, a naturally occurring compound and FDA approved dietary supplement, is a nootropic agent that is recently demonstrated to be effective in ameliorating ischemic stroke, traumatic brain injury, Parkinson's disease, Alzheimer's disease, cerebrovascular diseases, memory disorders and attention-deficit/hyperactivity disorder in both humans and animal models. The mechanisms of its action appear to be multifarious including (i) preservation of cardiolipin, sphingomyelin, and arachidonic acid contents of phosphatidylcholine and phosphatidylethanolamine, (ii) restoration of phosphatidylcholine, (iii) stimulation of glutathione synthesis, (iv) lowering glutamate concentrations and preventing glutamate excitotoxicity, (v) rescuing mitochondrial function thereby preventing oxidative damage and onset of neuronal apoptosis, (vi) synthesis of myelin leading to improvement in neuronal membrane integrity, (vii) improving acetylcholine synthesis and thereby reducing the effects of mental stress and (viii) preventing endothelial dysfunction. Such effects have vouched for citicoline as a neuroprotective, neurorestorative and neuroregenerative agent. Retinal ganglion cells are neurons with long myelinated axons which provide a strong rationale for citicoline use in visual pathway disorders. Since glaucoma is a form of neurodegeneration involving retinal ganglion cells, citicoline may help ameliorate glaucomatous damages in multiple facets. Additionally, trans-synaptic degeneration has been identified in humans and experimental models of glaucoma suggesting the cholinergic system as a new brain target for glaucoma management and therapy.
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Affiliation(s)
- Muneeb A Faiq
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, United States
| | - Gadi Wollstein
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, United States
| | - Joel S Schuman
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, United States
| | - Kevin C Chan
- Department of Ophthalmology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, United States; Department of Radiology, New York University (NYU) School of Medicine, NYU Langone Health, New York, NY, United States; Center for Neural Science, Faculty of Arts and Science, New York University, New York, NY, United States.
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19
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Parisi V, Barbano L, Di Renzo A, Coppola G, Ziccardi L. Neuroenhancement and neuroprotection by oral solution citicoline in non-arteritic ischemic optic neuropathy as a model of neurodegeneration: A randomized pilot study. PLoS One 2019; 14:e0220435. [PMID: 31348806 PMCID: PMC6660126 DOI: 10.1371/journal.pone.0220435] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 07/05/2019] [Indexed: 12/02/2022] Open
Abstract
PURPOSE To evaluate whether treatment with Citicoline in oral solution (OS-Citicoline) would increase visual function, retinal ganglion cells (RGCs) function, and neural conduction along visual pathways (neuroenhancement), and/or induce preservation of RGCs fibers' loss (neuroprotection) in non-arteritic ischemic optic neuropathy (NAION), a human model of neurodegeneration. METHODS Thirty-six patients with NAION and 20 age-matched controls were enrolled. Nineteen NAION patients received 500 mg/day of OS-Citicoline for a 6-month period followed by 3-month of wash-out (NC Group); 17 NAION patients were not treated (NN Group) from baseline to 9 months. In all subjects at baseline, and in NC and NN eyes at 6 and 9 months of follow-up, we assessed Visual Acuity (VA), Pattern Electroretinogram (PERG), Visual Evoked Potentials (VEP), retinal nerve fiber layer thickness (RNFL-T), and Humphrey 24-2 visual field mean deviation (HFA MD). Mean differences were statistically evaluated with ANOVA between Groups, and linear correlations were analysed with Pearson's test. RESULTS At 6 months, significant differences between groups for all parameters were observed (ANOVA, p<0.01). In NC eyes, VA increased, PERG responses increased, VEP recordings improved and were significantly correlated with increases in HFA MD (p<0.01), and RNFL-T was unmodified or improved. In contrast, in NN eyes, VA, PERG, VEP responses, RNFL-T, and HFA MD were further worsened. Significant differences were still present at 9-month follow-up in the NN Group and after 3 months of OS-Citicoline wash-out in NC eyes. CONCLUSIONS OS-Citicoline treatment induced neuroenhancement (improvement in RGCs function and neural conduction along visual pathways related to improvement of visual field defects) and neuroprotection (unmodified or improved RNFL morphological condition) in a human model of NAION involving fast RGCs degeneration. TRIAL REGISTRATION ClinicalTrials.gov NCT03758118.
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Affiliation(s)
| | | | | | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome—Polo Pontino, Latina, Italy
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Parisi V, Oddone F, Ziccardi L, Roberti G, Coppola G, Manni G. Citicoline and Retinal Ganglion Cells: Effects on Morphology and Function. Curr Neuropharmacol 2018; 16:919-932. [PMID: 28676014 PMCID: PMC6120106 DOI: 10.2174/1570159x15666170703111729] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/07/2017] [Accepted: 06/22/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Retinal ganglion cells (RGCs) are the nervous retinal elements which connect the visual receptors to the brain forming the nervous visual system. Functional and/or morphological involvement of RGCs occurs in several ocular and neurological disorders and therefore these cells are targeted in neuroprotective strategies. Cytidine 5-diphosphocholine or Citicoline is an endogenous compound that acts in the biosynthesis of phospholipids of cell membranes and increases neurotransmitters' levels in the Central Nervous System. Experimental studies suggested the neuromodulator effect and the protective role of Citicoline on RGCs. This review aims to present evidence of the effects of Citicoline in experimental models of RGCs degeneration and in human neurodegenerative disorders involving RGCs. METHODS All published papers containing experimental or clinical studies about the effects of Citicoline on RGCs morphology and function were reviewed. RESULTS In rodent retinal cultures and animal models, Citicoline induces antiapoptotic effects, increases the dopamine retinal level, and counteracts retinal nerve fibers layer thinning. Human studies in neurodegenerative visual pathologies such as glaucoma or non-arteritic ischemic neuropathy showed a reduction of the RGCs impairment after Citicoline administration. By reducing the RGCs' dysfunction, a better neural conduction along the post-retinal visual pathways with an improvement of the visual field defects was observed. CONCLUSION Citicoline, with a solid history of experimental and clinical studies, could be considered a very promising molecule for neuroprotective strategies in those pathologies (i.e. Glaucoma) in which morpho-functional changes of RGCc occurs.
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Affiliation(s)
- Vincenzo Parisi
- IRCCS-Fondazione GB Bietti, Via Livenza, 3, 00198 Rome, Italy
| | | | - Lucia Ziccardi
- IRCCS-Fondazione GB Bietti, Via Livenza, 3, 00198 Rome, Italy
| | - Gloria Roberti
- IRCCS-Fondazione GB Bietti, Via Livenza, 3, 00198 Rome, Italy
| | | | - Gianluca Manni
- IRCCS-Fondazione GB Bietti, Via Livenza, 3, 00198 Rome, Italy.,DSCMT, Università di Roma Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
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Iulia C, Ruxandra T, Costin LB, Liliana-Mary V. Citicoline - a neuroprotector with proven effects on glaucomatous disease. Rom J Ophthalmol 2018; 61:152-158. [PMID: 29450391 PMCID: PMC5710031 DOI: 10.22336/rjo.2017.29] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Citicoline is the generic name of cytidine-5’-diphosphocholine (CDP-choline), an endogenous compound that is able to increase the levels of neurotransmitters in the central nervous system by interacting with the synthesis of cellular membranes phospholipids, especially phosphatidylcholine. Exogenous Citicoline, administered by ingestion or injection, is hydrolyzed and dephosphorylated in order to form cytidine and choline, which resynthesize CDP-choline inside brain cells. It has proven neuroprotective effects in Alzheimer disease, stroke, and Parkinson’s disease, as well as in glaucoma and amblyopia. Citicoline acts as a neuroprotector for those patients with progressive glaucomatous disease in spite of well-controlled intraocular pressure. The purpose of this review was to outline the main features of Citicoline and the evidences of its effect in glaucoma.
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Affiliation(s)
- Chitu Iulia
- Department of Ophthalmology, University Emergency Hospital, Bucharest, Romania
| | - Tudosescu Ruxandra
- Department of Ophthalmology, University Emergency Hospital, Bucharest, Romania
| | - Leasu-Branet Costin
- Department of Ophthalmology, University Emergency Hospital, Bucharest, Romania
| | - Voinea Liliana-Mary
- Department of Ophthalmology, University Emergency Hospital, Bucharest, Romania
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22
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Neuroprotective agents in the management of glaucoma. Eye (Lond) 2018; 32:938-945. [PMID: 29472700 PMCID: PMC5944652 DOI: 10.1038/s41433-018-0050-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/22/2018] [Accepted: 01/25/2018] [Indexed: 01/05/2023] Open
Abstract
Glaucoma is an optic neuropathy, specifically a neurodegenerative disease characterized by loss of retinal ganglion cells (RGCs) and their axons. The pathogenesis of RGC loss in glaucoma remains incompletely understood and a broad range of possible mechanisms have been implicated. Clinical evidence indicates that lowering intraocular pressure (IOP) does not prevent progression in all patients; therefore, risk factors other than those related to IOP are involved in the disease. The need for alternative, non-IOP-lowering treatments focused at preventing progression, that is, neuroprotectants, has become of interest to both the patient and the physician. Experimental evidence accumulated during the past two decades lend a great deal of support to molecules endowed with neuroprotective features. However, translation to the clinic of the latter drugs results unsuccessful mostly because of the lack of reliable in vivo measure of retinal damage, thus hampering the good therapeutic potential of neuroprotective agents given alone or as adjuvant therapy to IOP-lowering agents. Further research effort is needed to better understand the mechanisms involved in glaucoma and the means to translate into clinic neuroprotective drugs.
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Neuroprotection in Glaucoma: Old and New Promising Treatments. Adv Pharmacol Sci 2017; 2017:4320408. [PMID: 30723498 PMCID: PMC5664381 DOI: 10.1155/2017/4320408] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/02/2017] [Accepted: 09/13/2017] [Indexed: 12/21/2022] Open
Abstract
Glaucoma is a major global cause of blindness, but the molecular mechanisms responsible for the neurodegenerative damage are not clear. Undoubtedly, the high intraocular pressure (IOP) and the secondary ischemic and mechanical damage of the optic nerve have a crucial role in retinal ganglion cell (RGC) death. Several studies specifically analyzed the events that lead to nerve fiber layer thinning, showing the importance of both intra- and extracellular factors. In parallel, many neuroprotective substances have been tested for their efficacy and safety in hindering the negative effects that lead to RGC death. New formulations of these compounds, also suitable for chronic oral administration, are likely to be used in clinical practice in the future along with conventional therapies, in order to control the progression of the visual impairment due to primary open-angle glaucoma (POAG). This review illustrates some of these old and new promising agents for the adjuvant treatment of POAG, with particular emphasis on forskolin and melatonin.
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Grieb P, Jünemann A, Rekas M, Rejdak R. Citicoline: A Food Beneficial for Patients Suffering from or Threated with Glaucoma. Front Aging Neurosci 2016; 8:73. [PMID: 27092075 PMCID: PMC4824764 DOI: 10.3389/fnagi.2016.00073] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/28/2016] [Indexed: 12/13/2022] Open
Abstract
Oral form of citicoline, a nootropic and neuroprotective drug in use for almost five decades, recently was pronounced a food supplement in both USA and EU. The idea of adding citicoline to topical treatment of primary open angle glaucoma (POAG) aimed at decreasing intraocular pressure (IOP) appeared as a logical consequence of accepting neurodegenerative character of this disease. Experimental data, and also few clinical studies indicate that this substance has potential to counteract some important pathological mechanisms which seem to contribute to POAG initiation and progression, such as excitotoxicity and oxidative stress.
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Affiliation(s)
- Pawel Grieb
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences Warsaw, Poland
| | - Anselm Jünemann
- Department of Ophthalmology, University of Rostock Rostock, Germany
| | - Marek Rekas
- Department of Ophthalmology, Military Institute of Medicine Warsaw, Poland
| | - Robert Rejdak
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of SciencesWarsaw, Poland; Department of General Ophthalmology, Medical University of LublinLublin, Poland
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25
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Mao J, Liu S, Fu C. Citicoline retards myopia progression following form deprivation in guinea pigs. Exp Biol Med (Maywood) 2016; 241:1258-63. [PMID: 26979720 DOI: 10.1177/1535370216638773] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/18/2016] [Indexed: 11/17/2022] Open
Abstract
The retinal dopaminergic system is involved in the myopic shift following form deprivation. Citicoline has been demonstrated to stimulate the dopaminergic system in the brain and retina. Furthermore, citicoline has been used in many neurogenic diseases, such as senile cognitive impairment, stroke and Parkinson's disease as well as in amblyopia and glaucoma. Our aim was to investigate the effect of citicoline on the refractive state and retinal dopamine level in form deprivation myopia of guinea pigs. Guinea pigs, at an age of four weeks, were randomly divided into normal control, deprivation, deprived + citicoline and deprived + vehicle groups. Form deprivation myopia was induced by a translucent eye shield covering the right eye. Citicoline was injected intraperitoneally twice a day (500 mg/kg, 9 am and 9 pm) for 10 days. In vitro, retinal explants were cultured with citicoline for 24 h, with a final citicoline concentration of 100 µmol/L. The ocular refractive parameters and retinal dopamine content were measured. After occlusion for 10 days, the form-deprived eyes became myopic with an increase in axial length and a decrease in retinal dopamine content. The intraperitoneal injection of citicoline reduced the myopic degree (from -3.25 ± 0.77D to -0.62 ± 0.47D, P < 0.001) and partially raised retinal dopamine levels (from 0.55 ± 0.21 ng to 0.81 ± 0.24 ng, P < 0.01) in the form-deprived eyes. After 24 h of culturing retinal explants with citicoline, retinal dopamine content increased significantly (from 0.42 ± 0.14 ng to 0.62 ± 0.21 ng, P < 0.05). These results demonstrated that an intraperitoneal injection of citicoline could retard the myopic shift induced by form deprivation in guinea pigs, which was mediated by an increase in the retinal dopamine levels.
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Affiliation(s)
- Junfeng Mao
- Department of Ophthalmology, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Shuangzhen Liu
- Department of Ophthalmology, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Chunyan Fu
- Department of Pathology, Xiangya Hospital, Changsha, Hunan 410008, China
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Roberti G, Tanga L, Michelessi M, Quaranta L, Parisi V, Manni G, Oddone F. Cytidine 5'-Diphosphocholine (Citicoline) in Glaucoma: Rationale of Its Use, Current Evidence and Future Perspectives. Int J Mol Sci 2015; 16:28401-17. [PMID: 26633368 PMCID: PMC4691046 DOI: 10.3390/ijms161226099] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 11/30/2022] Open
Abstract
Cytidine 5'-diphosphocholine or citicoline is an endogenous compound that acts in the biosynthetic pathway of phospholipids of cell membranes, particularly phosphatidylcholine, and it is able to increase neurotrasmitters levels in the central nervous system. Citicoline has shown positive effects in Parkinson's disease and Alzheimer's disease, as well as in amblyopia. Glaucoma is a neurodegenerative disease currently considered a disease involving ocular and visual brain structures. Neuroprotection has been proposed as a valid therapeutic option for those patients progressing despite a well-controlled intraocular pressure, the main risk factor for the progression of the disease. The aim of this review is to critically summarize the current evidence about the effect of citicoline in glaucoma.
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Affiliation(s)
- Gloria Roberti
- IRCCS-Fondazione GB Bietti, Via Livenza, 3, 00198 Rome, Italy.
| | - Lucia Tanga
- IRCCS-Fondazione GB Bietti, Via Livenza, 3, 00198 Rome, Italy.
| | | | - Luciano Quaranta
- DSMC, Università degli studi di Brescia, USVD "Centro per lo studio del Glaucoma" P.le Spedali Civili, 1, 25123 Brescia, Italy.
| | - Vincenzo Parisi
- IRCCS-Fondazione GB Bietti, Via Livenza, 3, 00198 Rome, Italy.
| | - Gianluca Manni
- DSCMT, Università di Roma Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
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Nivison-Smith L, Sun D, Fletcher EL, Marc RE, Kalloniatis M. Mapping kainate activation of inner neurons in the rat retina. J Comp Neurol 2014; 521:2416-38. [PMID: 23348566 DOI: 10.1002/cne.23305] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 12/06/2012] [Accepted: 01/17/2013] [Indexed: 11/10/2022]
Abstract
Kainate receptors mediate fast, excitatory synaptic transmission for a range of inner neurons in the mammalian retina. However, allocation of functional kainate receptors to known cell types and their sensitivity remains unresolved. Using the cation channel probe 1-amino-4-guanidobutane agmatine (AGB), we investigated kainate sensitivity of neurochemically identified cell populations within the structurally intact rat retina. Most inner retinal neuron populations responded to kainate in a concentration-dependent manner. OFF cone bipolar cells demonstrated the highest sensitivity of all inner neurons to kainate. Immunocytochemical localization of AGB and macromolecular markers confirmed that type 2 bipolar cells were part of this kainate-sensitive population. The majority of amacrine (ACs) and ganglion cells (GCs) showed kainate responses with different sensitivities between major neurochemical classes (γ-aminobutyric acid [GABA]/glycine ACs > glycine ACs > GABA ACs; glutamate [Glu]/weakly GABA GCs > Glu GCs). Conventional and displaced cholinergic ACs were highly responsive to kainate, whereas dopaminergic ACs do not appear to express functional kainate receptors. These findings further contribute to our understanding of neuronal networks in complex multicellular tissues.
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Affiliation(s)
- Lisa Nivison-Smith
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, 2052, Australia
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Park CH, Kim YS, Lee HK, Kim YH, Choi MY, Jung DE, Yoo JM, Kang SS, Choi WS, Cho GJ. Citicoline reduces upregulated clusterin following kainic acid injection in the rat retina. Curr Eye Res 2008; 32:1055-63. [PMID: 18085470 DOI: 10.1080/02713680701758719] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the effects of citicoline on upregulated clusterin and retinal damage induced by kainic acid (KA). METHODS KA was injected into the vitreous of rats. Effects of systemic citicoline treatments were estimated by measuring the thickness of the various retinal layers, immunoblotting, and immunohistochemical techniques. RESULTS One day after KA injection, the immunoreactivity of clusterin increased significantly. In rats treated with KA plus citicoline, clusterin immunoreactivity was markedly reduced compared to KA-treated rats. Western blot analysis showed that clusterin protein levels were increased in KA-treated rats, but decreased in KA plus citicoline-treated rats. Apoptotic cell death was determined by TUNEL method. Citicoline reduced the expression of clusterin, as well as the expression of TUNEL after KA injection in the rat retina. CONCLUSION The increased expression of clusterin following KA injection in the rat retina suggests the presence of neurodegenerative events; citicoline may provide neuroprotection against neuronal cell damage.
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Affiliation(s)
- Chang Hwan Park
- Department of Anatomy and Neurobiology, College of Medicine, Institute of Health Science, Medical Research Center for Neural Dysfunction, Gyeongsang National University, Gyungnam, South Korea
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