Clinical Trials Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 15, 2021; 12(3): 278-291
Published online Mar 15, 2021. doi: 10.4239/wjd.v12.i3.278
Altered spontaneous brain activity in patients with diabetic optic neuropathy: A resting-state functional magnetic resonance imaging study using regional homogeneity
Gui-Ying Guo, Li-Juan Zhang, Biao Li, Rong-Bin Liang, Qian-Min Ge, Hui-Ye Shu, Qiu-Yu Li, Yi-Cong Pan, Chong-Gang Pei, Yi Shao
Gui-Ying Guo, Li-Juan Zhang, Biao Li, Rong-Bin Liang, Qian-Min Ge, Hui-Ye Shu, Qiu-Yu Li, Yi-Cong Pan, Chong-Gang Pei, Yi Shao, Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Guo GY was involved in the data curation and writing of the original draft; Zhang LJ performed the data curation and formal analysis, and participated in the writing and editing of the manuscript; Li B was involved in the data curation, and writing, review, and editing of the manuscript; Liang RB took part in the data curation and supervision of the study; Ge QM was involved in the study conceptualization and methodology design; Shu HY was involved in data validation and visualization; Li QY participated in the methodology design and data visualization; Pan YC was involved in methodology design and data validation; Shao Y and Pei CG were involved in the study conceptualization, data curation, funding acquisition, and project administration; all authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81660158 and No. 81400372; Natural Science Research Foundation of Jiangxi Province, No. 20161ACB21017; and Medical Science Foundation of Jiangxi Province, No. 20181BBG70004 and No. 20164017.
Institutional review board statement: This study is in line with the principles specified by the Declaration of Helsinki. Before asking subjects to sign an informed consent form, we explained the purpose of the study and the possible risks in detail. The protocol was approved by the Medical Ethics Committee of the First Affiliated Hospital of Nanchang University (No. 2015029).
Clinical trial registration statement: This study is registered at Medical Ethics Committee of the First Affiliated Hospital of Nanchang University. The registration identification number is JX2015029.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: This is not an industry supported study. The authors report no conflicts of interest in this work.
Data sharing statement: The datasets used and/or analyzed during the present study are available from the corresponding author on reasonable request.
CONSORT 2010 statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi Shao, MD, Professor, Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Donghu District, Nanchang 330006, Jiangxi Province, China. freebee99@163.com
Received: November 20, 2020
Peer-review started: November 20, 2020
First decision: December 24, 2020
Revised: December 30, 2020
Accepted: February 11, 2021
Article in press: February 11, 2021
Published online: March 15, 2021
Processing time: 101 Days and 23.6 Hours
ARTICLE HIGHLIGHTS
Research background

Diabetes is a common chronic disease. Given the increasing incidence of diabetes, more individuals are affected by diabetic optic neuropathy (DON), resulting in decreased vision. Whether DON leads to abnormalities of other visual systems, including the eye, the visual cortex, and other brain regions, remains unknown.

Research motivation

We are more concerned about the damage of DON to the optic disc and vision nowadays, and whether DON leads to abnormalities of other visual systems, including the eye, the visual cortex, and other brain regions remains unknown. In this study, we investigated the underlying regional homogeneity (ReHo) of brain-activity abnormalities in patients with DON and their relationship with clinical features. Our study may contribute to understanding altered neural mechanisms present in patients with DON.

Research objectives

The aim of the current study was to use ReHo to investigate the local characteristics of spontaneous brain activity in patients with diabetic optic neuropathy and brain activity deficits and to identify the underlying pathophysiological mechanisms of DON.

Research methods

We matched 22 patients with DON with 22 healthy controls (HCs). All subjects underwent resting-state functional magnetic resonance imaging. The ReHo technique was used to record spontaneous changes in brain activity. Receiver operating characteristic (ROC) curves were applied to differentiate between ReHo values for patients with DON and HCs. We also assessed the correlation between Hospital Anxiety and Depression Scale scores and ReHo values in DON patients using Pearson correlation analysis.

Research results

ReHo values of the right middle frontal gyrus (RMFG), left anterior cingulate (LAC), and superior frontal gyrus (SFG)/left frontal superior orbital gyrus (LFSO) were significantly lower in DON patients compared to HCs. Among these, the greatest difference was observed in the RMFG. The result of the ROC curves suggest that ReHo values in altered brain regions may help diagnose DON, and the RMFG and LAC ReHo values are more clinically relevant than SFG/LFSO. We also found that anxiety and depression scores of the DON group were extremely negatively correlated with the LAC ReHo values (r = -0.9336, P < 0.0001 and r = -0.8453, P < 0.0001, respectively).

Research conclusions

Three different brain regions show ReHo changes in DON patients, and these changes could serve as diagnostic and/or prognostic biomarkers for patients with DON. They could also guide the development of new measures to prevent and treat optic neuropathy.

Research perspectives

We have identified three different regions of brain dysfunction in DON patients, including the RMFG, LAC, and SFG/LFSO. The RMFG brain region has the most significant decrease and the highest diagnostic value, suggesting that it could be used to study how optic neuropathy develops in patients with diabetes. Changes of spontaneous brain activity in different brain regions show different ReHo values, thus revealing brain activity in DON patients.