Cholinergic Dysfunction in Glaucoma
openNEI - National Eye Institute
Although intraocular pressure (IOP) is the only clinically modifiable risk factor for glaucoma, the exact role of IOP
elevation in glaucomatous neurodegeneration is unclear, as the cause of glaucoma remains unknown. Even
worse, glaucoma may progress in patients under controlled IOP, indicating that additional factors are pivotal to
its pathogenesis. A critical barrier to progress in investigating glaucoma mechanisms is the limited
comprehensive, quantitative, and non-invasive approaches for detecting and predicting the involvement of the
entire visual system during glaucoma development. We recently developed these needed approaches using
magnetic resonance imaging (MRI) and spectroscopy (MRS) to identify, for the first time, cholinergic dysfunction
in the brains of glaucoma patients and experimental animal models. Despite the known importance of choline-
containing compounds to the integrity of cell membrane and neurotransmission, very little is known about how
changes in cholinergic signaling in glaucoma reflect the structural and functional damage along the visual
pathway. Our primary objective is to investigate the role of this newly identified pathogenic cholinergic pathway
in glaucoma patients and our novel rat models using advanced MRI and MRS techniques. We will test the central
hypothesis that glaucoma is driven by impairments of the visual pathways that are mediated by the
cholinergic nervous system. Aim 1: Test how cholinergic lesioning, neuromodulation, and
supplementation contribute to glaucomatous damage and ameliorations in experimental rat models.
Adult Long Evans rats will be induced with experimental glaucoma by chronic IOP elevation via intracameral
hydrogel injection or lesioning of the basal forebrain followed by longitudinal eye, brain, and behavioral
assessments. We will stimulate the cholinergic neurons of these animal models to examine their role in
modulating IOP, visual brain activity, and visual function. We will also give different regimes of oral choline
supplementation to determine their dose-dependency, therapeutic windows, and efficacy in ameliorating the
deteriorations of glaucomatous visual pathways. Aim 2: Test the contribution of cholinergic nervous system
to glaucomatous damage in patients. By examining the brains of healthy subjects and primary open-angle
glaucoma patients with varying disease severity, we will determine the changes in neurochemicals relevant to
the cholinergic system and how they alter with the structure and function of the visual system. To ascertain when
cholinergic changes emerge in disease progression, we will define the relationships between cholinergic brain
features across glaucoma stages using advanced statistical modeling and information gain assessment. Impact:
Establishment and optimization of new, non-invasive glaucoma neuroimaging biomarkers and experimental
modeling systems will open up opportunities to determine the neurodegenerative substrates of glaucoma in vivo
and validate glaucoma neurotherapeutics. These findings will allow us to better monitor glaucoma progression
and guide future studies to determine the cause or the effect of glaucoma for more targeted interventions.
Up to $695K
health research