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Valentina Reffatto, Tamila Williams, Mary Schmitz-Brown, Praveena K. Gupta, Gianmarco Vizzeri; FK506 treatment promotes neuroprotection in organ transplanted glaucoma patients: a retrospective chart review.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):628. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
FK506 is a potent immunosuppressive agent largely used in preventing allograft rejection in organ transplant recipients. FK506 has also been shown to block the neuronal apoptosis cascade by inhibiting Calcineurin (CaN) activation. Additionally, CaN activation is suggested to be a key player in Retinal ganglion cell (RGC) loss in primary open angle glaucoma (POAG). This retrospective study was undertaken to assess if FK506 may confer neuroprotective effect on the RGCs by preventing Retinal Nerve Fiber Layer (RNFL) thinning in glaucoma patients.
Retrospective chart review was performed to identify subjects who were being treated with FK506 after an organ transplant and had concomitant diagnosis of POAG. Eligible subjects were older than 50yrs and were taking FK506 for at least one year (n=10). Glaucoma progression analysis was performed using the inbuilt optical coherent tomography (OCT) image analysis software for RNFL thickness at superior (S), inferior (I), temporal (T), and Nasal (N) quadrants. Agreement between the treated group and the control group (POAG, n=28) was assessed by comparing the demographic variables using Mann-Whitney or chi-square test, as appropriate.
Mean follow-up time for the study period was 2.7 years. Average RNFL thickness decreased at a rate of 1.4 unit per year (p=0.0001) in the control glaucoma patients versus 0.4 unit per year (p=0.34) in the FK506 treated glaucoma patients. The superior and inferior RNFL quadrants in the control glaucoma had a 2.2 unit per year and 2.3 unit rate of thinning respectively (p=0.003 and p=0.0001), while the treated glaucoma patients had no significant loss. In addition, RNFL changes in nasal and temporal quadrant showed a tendency to be ameliorated in patients treated with FK506, although it was not statistically significant.
FK506 confers neuroprotective effect by retarding the loss of retinal ganglion cells in glaucoma patients as evident by the RNFL analysis data in our small but a pilot study. FK506 therapy offers a new promising avenue for neuroprotection in glaucoma patients and can be investigated further for use in conjunction with the available conventional glaucoma treatments.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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