Neuropathy in the Choroid is induced by Corticoids (NEUROCOR): A link to central serous chorioretinopathy – NEUROCOR

In the retina, the metabolic activity of photoreceptors relies on choroidal blood flow, tightly regulated by nerves from the autonomous nervous system (ANS). Retinal imaging has recognized “pachychoroid”, defined as thick choroid, dilation of choroidal vessels and attenuation of the choriocapillaris, suggesting choroidal blood flow deregulation. But the neural component of pachychoroid is not described. Pachychoroid leads to a spectrum of diseases, including central serous chorioretinopathy (CSCR). Highest associated risk factorfor CSCR is intake of glucocorticoids that act through binding to gluco and mineralocorticoid receptors (MR).
Our group has demonstrated MR pathway overactivation causes choroidal pathology close to pachychoroid. Recently, we observed morphologic alterations of choroidal nerves in transgenic rodents knock in for human MR, most suggestive of peripheral neuropathy.
Systemic deregulation of the ANS, measured by the heart rate variability or by pupillometry have been shown in CSCR. But, choroidal nerves have never been explored in pachychoroid or in CSCR and no link is been made between corticoids, ANS deregulations and pachychoroid.
The NEUROCOR project objectives are: - to characterize in depth choroidal innervation and its link with vessels in rodents and in humans, -to evaluate whether specific choroidal nerves alterations induce vasculopathy observed in pachychoroid eyes, - to decipher the link between choroidal neuropathy and corticoids, - to analyze the metabolism of corticoids and ANS parameters in a cohort of patients with pachychoroid and explore choroidal nerves.
Result from the present project will elucidate the link between choroidal neuropathy, pachychoroid and MR pathway and help to identify surrogate markers of choroidal neuropathy. These markers could serve as clinical endpoint in trials evaluating mineralocorticoid receptor antagonists in patients with pachychoroid and associated complications.