A team led by Professor David ‘Ted’ Garway-Heath, Glaucoma UK Professor of Ophthalmology for Glaucoma and Allied Studies, has been awarded a £1.9 million grant for a major four-year clinical trial to test the effectiveness of nicotinamide (NAM), a form of vitamin B3, as a treatment for glaucoma.
The trial will recruit 496 glaucoma patients across seven UK sites, with a pilot study starting at Moorfields and King’s College Hospital in London along with a third site yet to be confirmed. It will evaluate whether NAM, which replenishes molecules important for the functioning of mitochondria (the powerhouses of cells), protects glaucoma patients from progressive vision loss.
The trial builds on research which showed that patients with both high- and low-tension glaucoma have lower mitochondrial function than healthy patients. The same research also indicated that patients with ocular hypertension (higher than normal pressure inside the eye), but no signs of progression to glaucoma, have higher mitochondrial function.
The study will measure the impact of NAM on the capacity of mitochondria in peripheral blood lymphocytes (freely circulating white blood cells) to produce adenosine triphosphate (ATP), which provides energy to help cells function. The study will also investigate biomarkers (biological signs) that can predict disease progression for glaucoma.
Professor Garway-Heath, lead applicant for the grant, said: “We hope to find a treatment that isn’t directed at pressure in the eye, but that addresses the susceptibility of the patient to glaucoma. We also hope to identify a blood test to identify which patients will benefit from the new treatment.”
Starting in August 2022, the trial will recruit a diverse group of patients recently diagnosed with glaucoma at NHS sites across the country. If treatment with NAM proves successful, it could significantly reduce the damage to vision caused by glaucoma and the cost of treatment for the NHS.
The trial has been funded by the National Institute for Health Research’s Efficacy and Mechanism Evaluation Programme.