Optic Neuritis (ON)

Optic neuritis is usually characterized by unilateral or bilateral reduction of vision which is frequently associated with pain which is exacerbated by eye movement. Protheragen has developed an extensive set of services concerning the diagnostics and therapeutics of optic neuritis. Our skills include performing molecular diagnostics, therapeutic development, and providing preclinical research services.

Introduction to Optic Neuritis (ON)

Optic neuritis (ON) reflects inflammation of the optic nerve that results in acute vision loss usually associated with unilateral eye pain upon movement. ON is commonly seen in conjunction with multiple sclerosis (MS) and other demyelinating conditions; however, it may also develop secondary to infectious, autoimmune, or granulomatous processes. ON remains one of the leading causes of visual disturbance among the young adult population, and its significant burden on healthcare requires an in-depth understanding of its pathophysiology, diagnostic modalities, and therapeutic strategies.

Optic neuritis can be anatomically divided into two major subtypes: papillitis and retrobulbar optic neuritis. Papillitis refers to ON involving the intra‑ocular optic nerve head (optic disc), characterized by visible optic‑disc swelling on fundus examination; it occurs more frequently in pediatric patients and infectious‑mediated cases. In contrast, retrobulbar optic neuritis affects the segment of optic nerve behind the eyeball, with a normal‑appearing optic disc during acute episodes, and represents the predominant subtype in adult multiple‑sclerosis‑associated optic neuritis. Papillitis may arise from autoimmune, infectious, or metabolic triggers.

Fig.1 Approach to the diagnosis of acute optic neuritis (ON). (Phuljhele S., et al., 2021)

Diagnostics Development for Optic Neuritis (ON)

AQP4-IgG Testing: The test checks for the presence of certain antibodies which are targeted against a specific aquaporin-4 water channel protein produced by astrocytes. In the context of NMOSD, the presence of AQP4-IgG is highly specific and also assists in separating it from other types of ON like MS associated optic neuritis.

MOG-IgG Testing: Detection of antibodies directed against myelin oligodendrocyte glycoprotein is crucial for MOG-IgG-associated optic neuritis. This subtype of ON is highly aggressive and is usually associated with extreme vision loss and marked edema of the optic disc, which requires quick and urgent interventions.

Infectious‑Etiology Diagnostic Workup: For suspected papillitis or infection‑triggered optic neuritis, laboratory workup is required to identify underlying pathogens. Serological assays for HSV, CMV and syphilis are routinely performed. PCR testing on cerebrospinal fluid (CSF) or aqueous humor can confirm HSV‑related optic neuropathy. CSF analysis including oligoclonal band detection may also offer supporting evidence for MS‑associated optic neuritis.

Therapeutics Development for Optic Neuritis (ON)

In severe or recurrent forms of ON, long-term use of immunosuppressants such as mycophenolate mofetil, rituximab, or azathioprine is warranted. These drugs adjuvantly take care of flareups and manage autoimmune disorders. For example, azathioprine has been used successfully in chronic relapsing inflammatory optic neuropathy which leads to ON episodes and vision loss over time.

Current studies focus on finding newer therapies for ON, trying out different protective agents, and targeting specific inflammatory processes. For instance, pilot studies showed that erythropoietin and simvastatin are effective for optic nerve regeneration. Moreover, there is research on antibodies to LINGO-1, an inhibitor of axonal growth, for the purpose of increasing optic nerve repair and visual results.

Disclaimer: Protheragen focuses on providing preclinical research service. This table is for information exchange purposes only. This table is not a treatment plan recommendation. For guidance on treatment options, please visit a regular hospital.

In addition, antiviral or antibacterial drugs are the core treatment for optic neuritis caused by infectious pathogens. Acyclovir is used to treat herpes simplex virus (HSV)-associated optic neuritis to reduce the severity of the disease and shorten its course. Ganciclovir is used to treat cytomegalovirus-associated optic neuritis, usually in combination with systemic corticosteroids to reduce inflammation. Syphilitic optic neuritis can be treated with penicillin-type drugs. For diabetic optic neuropathy, periocular corticosteroid injections can reduce optic disc edema and improve visual prognosis.

Our Services

We, at Protheragen, are exceedingly proud of the offering of diagnostic and therapeutic development services related to optic neuritis as it is comprehensive in its scope. We have identified and continuously engaged our leading researchers and technologically innovative experts because they are profoundly dedicated to advancing the field of ON diagnosis and therapeutics development.

Diagnostics Development

• Karyotype Analysis Service
• Omics Analysis Service
• Biomarker Development Service
• Artificial Intelligence Service
• Customized Diagnostics Development

Therapeutic Development

• Small Molecule Drug
• Cell Therapy
• Gene Therapy
• Therapeutic Antibody
• Therapeutic Peptide
• Therapeutic Protein
• Customized Therapy Development

Disease Models

• AQP4-IgG Passive Transfer Models
• AQP4-IgG Positive Serum Injection Models
• AQP4-Specific T Cell Transfer Models
• Experimental Autoimmune Encephalomyelitis (EAE) Models

We also provide specialized preclinical animal models for papillitis to recapitulate its characteristic opticdisc pathological injuries.

At Protheragen, we appreciate the fact that every client comes with a different set of needs. This is why we have developed a full range of tailored services that meet the needs of our partners in optic neuritis research and drug development. If you are interested in our services, please feel free to contact us.

References

• Phuljhele Swati, Sachin Kedar, and Rohit Saxena. "Approach to optic neuritis: An update." Indian journal of ophthalmology 69.9 (2021): 2266-2276.
• Bennett, Jeffrey L. "Optic neuritis." Continuum: lifelong learning in neurology 25.5 (2019): 1236-1264.
• Wilhelm, Helmut, and Martin Schabet. "The diagnosis and treatment of optic neuritis." Deutsches Ärzteblatt International 112.37 (2015): 616.