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Reduced Blood-flow and Increased Endothelin-1 Plasma Lvels in Patients with Optic Neuritis

Pache M., Kaiser H. J., Haufschild T., Flammer J.,
Universität Basel, Kantonsspital, Augenklinik (Basel)

Purpose: Increased endothelin-1 (ET-1) plasma levels have been found in various autoimmune diseases including multiple sclerosis (MS). ET-1 is a potent vasoconstrictor, which might also function as a pro-inflammatory mediator. Given the fact that ET-1 is a potent vasoconstrictor in ocular vessels, we hypothesized that ocular and peripheral blood flow might be reduced in patients with optic neuritis. Therefore, we evaluated ET-1 plasma levels in these patients and measured peripheral and extraocular blood flow velocity in parallel.
Method: ET-1 plasma levels were determined in 12 patients with acute optic neuritis (M: F = 5:7; mean age 36 ± 10 years; clinically and laboratory supported MS: n = 10) by means of a specific radioimmunoassay. In addition, color doppler imaging (CDI) of the extraocular vessels as well as a nailfold capillaroscopy, combined with a cold provocation test, were carried out.
Results: Patients with optic neuritis showed a significantly reduced peak systolic velocity (11.0 ± 1.8 vs. 9.4 ± 1.8 cm/s; p < 0.006) and enddiastolic velocity (3.7 ± 1.0 vs. 2.2 ± 0.3 cm/s; p < 0.0001) as well as an increased resistive index (0.8 ± 0.1 vs. 0.71 ± 0.05; p < 0.004) in the central retinal artery (CRA) when compared to normal values. Interestingly, the reduction of blood flow was not restricted to the affected eye but was present in both eyes. A significantly higher percentage of cold-induced blood-flow standstill in patients with optic neuritis (n = 7) in comparison to our normal values were observed (58% vs. 13.3%). ET-1 plasma levels were significantly increased in MS patients (3.7 ± 2.2 pg/ml) when compared to healthy controls (normal values for males: 1.67 ± 0.3 pg/ml, for females: 1.42 ± 0.28 pg/ml.
Conclusions: Patients with acute optic neuritis exhibit elevated levels of ET-1 and significant alterations of extraocular and peripheral blood flow.