Carbon Monoxide Therapy: Evidence and Prospects for Preventing and Treating Retinal Diseases

Area of Science:

• Ophthalmology
• Pharmacology
• Biomedical Engineering

Background:

• Carbon monoxide (CO), known for toxicity, is explored for therapeutic benefits in ocular medicine.
• CO therapy utilizes low-dose, controlled administration to leverage cytoprotective effects like anti-inflammation and anti-apoptosis.

Purpose of the Study:

• To review preclinical and clinical findings on carbon monoxide therapy for ocular diseases.
• To evaluate current and emerging CO delivery methods for retinal disorders, focusing on safety and efficacy.

Main Methods:

• Literature review of preclinical models (retinal ischemia-reperfusion, optic nerve crush, ocular hypertension, autoimmune uveitis) and clinical trials.
• Analysis of carbon monoxide delivery systems, including inhaled CO and CO-releasing molecules (CORMs).

Main Results:

• Preclinical studies demonstrate anti-inflammatory and anti-apoptotic effects of CO in various retinal disease models.
• Clinical trials suggest acceptable safety for inhaled CO and CORM-based interventions, but results lack robustness and reproducibility.

Conclusions:

• A strong preclinical basis exists for CO therapy in retinal disorders, but clinical translation is limited.
• Enhanced delivery strategies, precise dosing (PK/PD-informed), and mechanism-specific trials are crucial for bridging the efficacy gap.