Thomas Kozar

CSET 2100

Professor Stephen Ornes

October 29, 2019

News Story

Researchers have found a novel use for the erectile dysfunction medication, tadalafil, commonly
known as Cialis, in treating the underlying causes of the degenerative eye disease glaucoma. The disease
is characterized by the death of cells in the retina, causing gradually worsening eyesight until the
sufferer is completely blind. Currently, treatments for glaucoma target a side effect of the disease,
increased pressure inside the eye, merely slowing down the progression of the disease. According to
pharmacologist Rebecca Sappington, formerly of Vanderbilt University Medical Center in Nashville,
Tennessee, treatment with tadalafil may be able to offer glaucoma patients a much better outcome. Not
only might it stop vision loss, but there is a chance that it could reverse some of the damage done to a
patient’s vision.

Sappington’s research focuses on targeting and manipulating certain biosynthetic pathways, the
biological assembly lines responsible for producing a certain molecule the body needs to sustain life. To
evaluate tadalafil’s effectiveness, Sappington and her team, now of Wake Forest Medical Center in
Winston-Salem, North Carolina, used micro-doses of the drug, twenty-five times smaller than the
currently prescribed dosage, targeting the biosynthetic pathway of the molecule cyclic guanylate
monophosphate (cGMP) in mice. cGMP was selected as the molecule to target because of its ability to
widen blood vessels, decreasing the pressure in the eye, and in turn delaying the progression of
glaucoma. However, the data which Sappington collected from her mouse model provided a surprising
finding. Tadalafil was able to decrease the rate at which the cells of the retina died, but the small dose
had little to no effect on the pressure of the eye.

This finding led Sappington and her colleagues to conduct further experiments into other
underlying effects of increased cGMP. Cells of the retina were plated onto petri dishes, half of which
were treated with tadalafil. The rate of death of the cells in the two sets of plates were then monitored.
The treated plates died at a significantly slower rate, leading to the conclusion that increased cGMP
levels had a protective effect on the cells, decreasing and impeding cellular death. Their results were
published in the journal Nuerobiology of Disease in January of 2019.

As my conversation with Sappington was wrapping up, she expressed her biggest concern about
the public knowing of this study, “Cialis [at its prescribed dose] is actually detrimental to someone who
has glaucoma, so if they went out and took their uncle’s or brother’s prescription that would be harmful
to them from a glaucoma perspective. The devil is in the details here.” Other experts echo Sappington’s
sentiment. “Despite the results of this study, chronic use of tadalafil has been linked to other
neurodegenerative diseases, so the effects of off label use of the drug are unclear” said pharmacologist
Yoichi Osawa of the University of Michigan in Ann Arbor. While human trials using small doses of Cialis
to treat glaucoma are ongoing, it is important to remember that this medicine is not approved by the
FDA to treat this condition, and one should consult their healthcare provider before using any
medication.