Citicoline Modulates Glaucomatous Neurodegeneration Through Intraocular Pressure-Independent Control

Yolandi van der Merwe, Matthew C. Murphy, Jeffrey R. Sims, Muneeb A. Faiq, Xiao Ling Yang, Leon C. Ho, Ian P. Conner, Yu Yu, Christopher K. Leung, Gadi Wollstein, Joel S. Schuman, Kevin C. Chan

Research output: Contribution to journalArticlepeer-review


Glaucoma is a neurodegenerative disease that causes progressive, irreversible vision loss. Currently, intraocular pressure (IOP) is the only modifiable risk factor for glaucoma. However, glaucomatous degeneration may continue despite adequate IOP control. Therefore, there exists a need for treatment that protects the visual system, independent of IOP. This study sought, first, to longitudinally examine the neurobehavioral effects of different magnitudes and durations of IOP elevation using multi-parametric magnetic resonance imaging (MRI), optokinetics and histology; and, second, to evaluate the effects of oral citicoline treatment as a neurotherapeutic in experimental glaucoma. Eighty-two adult Long Evans rats were divided into six groups: acute (mild or severe) IOP elevation, chronic (citicoline-treated or untreated) IOP elevation, and sham (acute or chronic) controls. We found that increasing magnitudes and durations of IOP elevation differentially altered structural and functional brain connectivity and visuomotor behavior, as indicated by decreases in fractional anisotropy in diffusion tensor MRI, magnetization transfer ratios in magnetization transfer MRI, T1-weighted MRI enhancement of anterograde manganese transport, resting-state functional connectivity, visual acuity, and neurofilament and myelin staining along the visual pathway. Furthermore, 3 weeks of oral citicoline treatment in the setting of chronic IOP elevation significantly reduced visual brain integrity loss and visual acuity decline without altering IOP. Such effects sustained after treatment was discontinued for another 3 weeks. These results not only illuminate the close interplay between eye, brain, and behavior in glaucomatous neurodegeneration, but also support a role for citicoline in protecting neural tissues and visual function in glaucoma beyond IOP control.

Original languageEnglish (US)
Pages (from-to)1339-1359
Number of pages21
Issue number2
StatePublished - Apr 2021


  • Citicoline
  • Glaucoma
  • Intraocular pressure
  • Magnetic resonance imaging
  • Optokinetics
  • Visual system

ASJC Scopus subject areas

  • Pharmacology
  • Clinical Neurology
  • Pharmacology (medical)


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