Mineralocorticoid receptor is involved in rat and human ocular chorioretinopathy

• Published in: The Journal of clinical investigation 2012-07, Vol.122 (7), p.2672-2679
• Main Authors: Zhao, Min, Célérier, Isabelle, Bousquet, Elodie, Jeanny, Jean-Claude, Jonet, Laurent, Savoldelli, Michèle, Offret, Olivier, Curan, Antoine, Farman, Nicolette, Jaisser, Frédéric, Behar-Cohen, Francine
• Format: Article
• Language: English
• Subjects: Adult; Aldosterone - pharmacology; Aldosterone - physiology; Animals; Biomedical research; Central Serous Chorioretinopathy - chemically induced; Central Serous Chorioretinopathy - drug therapy; Central Serous Chorioretinopathy - metabolism; Choroid - blood supply; Corticosterone; Hormone receptors; Humans; Male; Middle Aged; Mineralocorticoid Receptor Antagonists - therapeutic use; Mineralocorticoids; Physiological aspects; Rats; Receptors, Mineralocorticoid - metabolism; Retina; Retina - pathology; Retinal detachment; Retinal diseases; Risk factors; Signal Transduction; Small-Conductance Calcium-Activated Potassium Channels - genetics; Small-Conductance Calcium-Activated Potassium Channels - metabolism; Spironolactone - analogs & derivatives; Spironolactone - therapeutic use; Treatment Outcome; Vasodilation - drug effects; Vasodilator Agents - therapeutic use; Visual Acuity - drug effects
• ISSN: 0021-9738; 1558-8238
• DOI: 10.1172/jci61427

Central serous chorioretinopathy (CSCR) is a vision-threatening eye disease with no validated treatment and unknown pathogeny. In CSCR, dilation and leakage of choroid vessels underneath the retina cause subretinal fluid accumulation and retinal detachment. Because glucocorticoids induce and aggravate CSCR and are known to bind to the mineralocorticoid receptor (MR), CSCR may be related to inappropriate MR activation. Our aim was to assess the effect of MR activation on rat choroidal vasculature and translate the results to CSCR patients. Intravitreous injection of the glucocorticoid corticosterone in rat eyes induced choroidal enlargement. Aldosterone, a specific MR activator, elicited the same effect, producing choroid vessel dilation -and leakage. We identified an underlying mechanism of this effect: aldosterone upregulated the endothelial vasodilatory K channel KCa2.3. Its blockade prevented aldosterone-induced thickening. To translate these findings, we treated 2 patients with chronic nonresolved CSCR with oral eplerenone, a specific MR antagonist, for 5 weeks, and observed impressive and rapid resolution of retinal detachment and choroidal vasodilation as well as improved visual acuity. The benefit was maintained 5 months after eplerenone withdrawal. Our results identify MR signaling as a pathway controlling choroidal vascular bed relaxation and provide a pathogenic link with human CSCR, which suggests that blockade of MR could be used therapeutically to reverse choroid vasculopathy.