Effect of nitric oxide synthesis inhibition on post-occlusive choroidal blood flow in rats

The nitric oxide-guanylate cyclase pathway and glaucoma

Glaucoma is a prevalent optic neuropathy characterized by the progressive dysfunction and loss of retinal ganglion cells (RGCs) and their optic nerve axons, which leads to irreversible visual field loss. Multiple risk factors for the disease have been identified, but elevated intraocular pressure (IOP) remains the primary risk factor amenable to treatment. Reducing IOP however does not always prevent glaucomatous neurodegeneration, and many patients progress with the disease despite having IOP in the normal range. There is increasing evidence that nitric oxide (NO) is a direct regulator of IOP and that dysfunction of the NO-Guanylate Cyclase (GC) pathway is associated with glaucoma incidence. NO has shown promise as a novel therapeutic with targeted effects that: 1) lower IOP; 2) increase ocular blood flow; and 3) confer neuroprotection. The various effects of NO in the eye appear to be mediated through the activation of the GC- guanosine 3:5'-cyclic monophosphate (cGMP) pathway and its effect on downstream targets, such as protein kinases and Ca²⁺ channels. Although NO-donor compounds are promising as therapeutics for IOP regulation, they may not be ideal to harness the neuroprotective potential of NO signaling. Here we review evidence that supports direct targeting of GC as a novel pleiotrophic treatment for the disease, without the need for direct NO application. The identification and targeting of other factors that contribute to glaucoma would be beneficial to patients, particularly those that do not respond well to IOP-dependent interventions.

The complex interaction between ocular perfusion pressure and ocular blood flow - relevance for glaucoma

Glaucoma is an optic neuropathy of unknown origin. The most important risk factor for the disease is an increased intraocular pressure (IOP). Reducing IOP is associated with reduced progression in glaucoma. Several recent large scale trials have indicated that low ocular perfusion pressure (OPP) is a risk factor for the incidence, prevalence and progression of the disease. This is a strong indicator that vascular factors are involved in the pathogenesis of the disease, a hypothesis that was formulated 150 years ago. The relation between OPP and blood flow to the posterior pole of the eye is, however, complex, because of a phenomenon called autoregulation. Autoregulatory processes attempt to keep blood flow constant despite changes in OPP. Although autoregulation has been observed in many experiments in the ocular vasculature the mechanisms underlying the vasodilator and vasoconstrictor responses in face of changes in OPP remain largely unknown. There is, however, recent evidence that the human choroid regulates its blood flow better during changes in blood pressure induced by isometric exercise than during changes in IOP induced by a suction cup. This may have consequences for our understanding of glaucoma, because it indicates that blood flow regulation is strongly dependent not only on OPP, but also on the level of IOP itself. Indeed there is data indicating that reduction of IOP by pharmacological intervention improves optic nerve head blood flow regulation independently of an ocular vasodilator effect.

Adenylyl and guanylyl cyclase activity in the choroid

The choroid, a low-resistance vascular structure provides nourishment to and removal of potential toxic waste products from the adjacent non-vascularized outer layers of the retina, macula, and optic disc region and may be involved in the pathology of normal tension glaucoma. This study is aimed at delineating the biochemical pharmacology of vascular tone control in this tissue. By using a procedure to harvest fresh choroidal tissue, we studied some basic characteristics of the adenylyl (AC) and guanylyl cyclase (GC) enzyme systems in this tissue using the 3H-cAMP/32P-ATP tracer method. Compared to respective baseline measurements (100+/-SEM%), AC activity was stimulated (p < 0.05) by forskolin (FSK, 477+/-59%), fluoroaluminate (AlF(4), 360+/-10.3%), isoproterenol (ISO, 129+/-5.5%), vasoactive intestinal peptide (VIP, 132+/-6.1%), calmodulin (CAM)+Mn2+ (196+/-69%), and dose-dependently by prostaglandin (PG) E2 (up to 162+/-3.6%). The antagonist drug calmidazolium inhibited the CAM-dependent increase but also blocked basal activity (47+/-2.0%) without affecting the FSK response. Other CAM blockers (TFP, W5) produced similar results but were not completely selective for CAM-activated cyclase. GDPbetaS, a blocker of G-protein coupling to AC did not affect AC responses to FSK, ISO, and AlF4, but decreased the response to PGE2. N-ethyl-carboxamido adenosine (NECA), which activates adenosine A2 receptors, did not synergize with FSK or add to ISO responses and did not activate AC by itself. In the GC system activity was stimulated (p< 0.05) by CAM+Mn2+ (239+/-27%), by atrial natriuretic peptide (ANP, up to 143+/-1.4%) and sodium nitroprusside (SNP, up to 179+/-1.6%). These results show that choroidal tissue has significant activities of the adenylyl and guanylyl cyclase second messenger systems potentially responsive to hormones/neurotransmitters that may control the degree of relaxation in this vascular tissue.

Effects of inhibition of nitric oxide synthase on basal anterior segment ocular blood flows and on potential autoregulatory mechanisms

Experiments were undertaken to determine the role played by nitric oxide (NO) in basal ocular blood flow in the anterior aspect of the eye. Subsequent studies focused on existence of autoregulatory mechanisms and on the potential involvement of NO. Cats were anesthetized with pentobarbital (36 mg/kg, i.p.). A femoral artery and vein were cannulated for measuring blood pressure and for drug administration, respectively. Anterior segment blood flow was measured in a continuous fashion from the long posterior ciliary artery (LPCA) using ultrasonic flowmetry and from the anterior choroid using laser-Doppler flowmetry. A needle was placed into the anterior chamber, and autoregulatory mechanisms were studied by decreasing ocular perfusion pressure via stepwise elevations of IOP. Non-selective inhibition of NO synthase with L-NAME (20 mg/kg, i.v.) significantly decreased basal blood flow from both sites. L-NAME (5 mg/kg, i.v.) was without effect as was D-NAME (25 mg/kg, i.v.). Increasing IOP produced a linear decrease on LPCA blood flow indicating absence of autoregulation. In contrast, stepwise elevation of IOP produced a delayed, non-linear response in the anterior choroid suggestive of a strong autoregulatory response. Neither response to elevated ocular perfusion pressure was further altered by inhibition of NO synthase with L-NAME (20 mg/kg, i.v.). The results confirm previous reports that nitric oxide plays a pivotal role in maintenance of basal ocular blood flow. Autoregulation was not seen in the LPCA. In contrast, there was a clear autoregulatory response in the anterior choroid, although neither response was altered by inhibition of NO synthase.