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The clinical applicability of the dynamic retinal vessel analysis to assess the effectiveness of new therapies and cardiovascular risk

Dr. Manja Reimann, Ph.D.

Autonomous and Neuroendrocrinologically function laboratory
at the Center for Clinical Neurosciences

A major focus of research in the autonomous function and neuroendocrinology Laboratory is the evaluation of methods for the assessment of cardiovascular function in terms of clinical applicability. In our laboratory for future use methods of detection of autonomic regulation of blood pressure and endothelial function, both important functional parameters for the evaluation of therapeutic success and cardiovascular risk in the treatment of neurological and metabolic diseases. We were able to show on the basis of the dynamic retinal vessel analysis that a single short lipoprotein aphaeresis treatment in patients with advanced atherosclerotic heart disease lead to a significant improvement of retinal endothelial function (1). This functional increase was observed mainly in the venous microcirculation whereby it could be demonstrated that retinal veins represent a highly dynamic component that actively responds to metabolic changes. Furthermore we found that treatment of cancer patients with the angiogenesis inhibitor Bevacizumab lead in a blood pressure-independent setting to an impairment of retinal flicker dilatation (2).

In a recently conducted comparison of methods we could show that functional imaging of retinal micro circulation is superior to other methods in the detection of changes in micro vascular endothelial function.

Only two of the four methods including flow-induced vasodilatation of the artery brachialis and the dynamic retinal vessel analysis were capable of showing a significant reduction in endothelial function after experimentally induced hypertriglyceridemia (unpublished results) ( 3).

These results are establishing evidence that the dynamic retinal vessel analysis is a useful addition for the follow-up of diseases associated with increased cardiovascular risk.

Furthermore the use of this method for the evaluation of therapy effects in the clinic could be extremely valuable for early recognition of harmful side effects and to assess the effectiveness of the therapy with respect to cardiovascular endpoints.

1. Reimann M, Prieur S, Lippold B, et al. Retinal vessel analysis in hypercholesterolemic patients before and after LDL apheresis. Atheroscler Suppl 2009;10: 39-43.

2. Reimann M, Folprecht G, Haase R, et al. Anti-Vascular endothelial growth factor therapy impairs endothelial function of retinal microcirculation in colon cancer patients - an observational study. Exp Transl Stroke Med 2013;5: 7.

3. Reimann M, Vilser W, Weiss N, Ziemssen T. Non-invasive assessment of endothelial function in different vascular beds. submitted.

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