Changes in retinal microvasculature and serum Gremlin-1 levels in acromegaly: A case-control study
Articles > Article · 2024
Authors: Gokcen Unal Kocabas, Onur FURUNDAOTURAN, Cumali DEĞİRMENCİ, Su Ozgur, Meltem Kocamanoglu, Cigdem Gozde Arslan, Esma Pehlivan Koroglu, Filiz AFRASHİ, Yasemin AKÇAY, Ilgın YILDIRIM ŞİMŞİR, Banu Pınar ŞARER YÜREKLİ
PHOTODIAGNOSIS AND PHOTODYNAMIC THERAPY, Journal Indexed in SCI Expanded, International, Scopus, 2024, vol 50, pp 104415-104415
DOI: 10.1016/j.pdpdt.2024.104415
Summary
Objective: There are controversial results about the effects of GH/IGF-1 on retinal vasculature. Gremlin-1 has roles in both pituitary tumorigenesis and angiogenesis. Therefore, we aimed to detect retinal micro-vascular changes in acromegaly with OCTA and examine its association with serum Gremlin-1 levels. Design: A cross-sectional, case-control study Methods: We included 53 acromegaly patients and age/gender-matched 31 healthy controls. To evaluate retinal structure, optical coherence tomography angiography (OCTA) imaging was performed. Gremlin -1 levels were measured by the ELISA method. Results: Acromegaly patients had significantly lower superficial total density (p < 0.001), superficial parafoveal density (p = 0.002), superficial perifoveal density (p < 0.001); deep total density (p < 0.001), deep parafoveal density (p < 0.001), deep perifoveal density (p < 0.001). Total thickness and perifoveal thickness were significantly lower in the acromegaly group. Gremlin-1 levels were significantly lower in acromegaly patients (1.22(0.13) vs 1.38(0.29); p = 0.015, for acromegaly and control groups, respectively). We assessed study groups based on glucose tolerance status. Normal glucose tolerance (NGT) acromegaly patients had significantly lower superficial total density (p = 0.036), superficial perifoveal density (p = 0.003), deep total density (p = 0.023), and deep perifoveal density (p = 0.023) compared to NGT controls. According to backward linear regression analysis, the presence of acromegaly itself consistently showed a significant negative impact on all types of vascular density. Conclusion: Patients with acromegaly have decreased vascular density and lower levels of Gremlin-1 independent of glucose tolerance status. Acromegaly may cause a reduction in gremlin-1 as a compensatory mechanism due to high IGF-1 levels known as an angiogenic factor, which in turn leads to the decrease in vascular density, or gremlin-1 may already have shown a decline in response to chronic inflammation and endothelial dysfunction in acromegaly resulting in a reduction in vascular density.