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The potential use of stem cell technology and regenerative medicine in the treatment of glaucoma is a current hot topic in the field. Targets for such therapies include the retina and optic nerve, but the trabecular meshwork is another potential target. In this regard, the study by Du et al. is of considerable interest. In these recent studies, the researchers have isolated a population of cells from post mortem human trabecular meshwork by fluorescence-activated cell sorting and clonal proliferation. When maintained in culture, these cells express markers characteristic of mesenchymal stem cells but also appear to express genes including Notch1 and OCT 3/4 which are more typical of pluripotent stem cells. In the presence of either aqueous humor or serum, these pluripotent cells can be differentiated into cells with features of trabecular meshwork cells, including the expression of several typical trabecular meshwork markers and the ability to phagocytose fluorescently labeled particles almost as efficiently as 'normal' trabecular meshwork cells.
The work presented appears carefully performed and is interesting for a number of reasons. Firstly, the relative ease by which these trabecular meshwork-derived pluripotent cells can be differentiated in vitro into apparently functional trabecular meshwork cells is encouraging for future translation. Further work will be required to determine if such cells, when transplanted in to the anterior chamber, can localize to the trabecular meshwork and modulate aqueous outflow. Secondly, by shedding light on how the differentiation of the resident population of trabecular meshwork stem cells to form mature trabecular meshwork cells is controlled, this study raises the intriguing possibility that strategies to induce such differentiation could be used therapeutically in glaucoma. Further work to test this hypothesis in relevant models could be of considerable interest.