Editors Selection (IGR: 7-3) | International Glaucoma Review #6

Editors Selection IGR 7-3

Basic science: Schlemms endothelium and outflow

Comment by David Epstein on:

13090 A new insight into the cellular regulation of aqueous outflow: how trabecular meshwork endothelial cells drive a mechanism that regulates the permeability of Schlemm's canal endothelial cells, Alvarado JA; Alvarado RG; Yeh RF et al., British Journal of Ophthalmology, 2005; 89: 1500-1505

There is much circumstantial evidence that aqueous humor outflow function through the trabecular meshwork outflow pathway is likely regulated and subject to modification. Yet definitive evidence for specific, critical pathways and mechanisms has been limited and often frustrated by existing model systems. It is also commonly believed that laser therapy to the trabecular meshwork outflow pathway not only produces a beneficial biological effect on outflow pathway function, but might also offer a clue to normal homeostatic mechanisms and potential abnormalities that may be involved in certain forms of glaucoma.

Laser treatment of trabecular meshwork cells causes the release of factors that increase the permeability of Schlemm's canal endothelia

In this context, Alvarado et al. (781) present important new findings in a very relevant and 'neat' model system that has implications for both the normal regulation of outflow and potential insights into abnormal mechanisms. They found that laser treatment of trabecular meshwork cells causes the release of factors that increase the permeability of Schlemm's canal endothelia. Related cytokine signaling pathways have been demonstrated in other cell systems and also in other studies of the trabecular meshwork. What is very unique about the present work is the documentation of the effect of these cytokines on Schlemm's canal conductivity.

The implication of this work is that Schlemm's canal endothelia in situ contribute to measured steady state aqueous humor outflow resistance and that abnormalities in the latter may underlie certain forms of glaucoma.

This is an important study, that increases our understanding of trabecular meshwork outflow pathway function, and which also provides meaningful insight into possible pathogenetic mechanisms present in glaucoma. Furthermore, this work might point us in new directions for novel glaucoma therapy.

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