Role of Glucocorticoids and Glucocorticoid Receptors in Glaucoma Pathogenesis

dc.creatorPatel, Pinkal D.
dc.creatorKodati, Bindu
dc.creatorClark, Abbot F.
dc.creator.orcid0000-0003-3594-6560 (Clark, Abbot F.)
dc.description.abstractThe glucocorticoid receptor (GR), including both alternative spliced isoforms (GRalpha and GRbeta), has been implicated in the development of primary open-angle glaucoma (POAG) and iatrogenic glucocorticoid-induced glaucoma (GIG). POAG is the most common form of glaucoma, which is the leading cause of irreversible vision loss and blindness in the world. Glucocorticoids (GCs) are commonly used therapeutically for ocular and numerous other diseases/conditions. One serious side effect of prolonged GC therapy is the development of iatrogenic secondary ocular hypertension (OHT) and OAG (i.e., GC-induced glaucoma (GIG)) that clinically and pathologically mimics POAG. GC-induced OHT is caused by pathogenic damage to the trabecular meshwork (TM), a tissue involved in regulating aqueous humor outflow and intraocular pressure. TM cells derived from POAG eyes (GTM cells) have a lower expression of GRbeta, a dominant negative regulator of GC activity, compared to TM cells from age-matched control eyes. Therefore, GTM cells have a greater pathogenic response to GCs. Almost all POAG patients develop GC-OHT when treated with GCs, in contrast to a GC responder rate of 40% in the normal population. An increased expression of GRbeta can block GC-induced pathogenic changes in TM cells and reverse GC-OHT in mice. The endogenous expression of GRbeta in the TM may relate to differences in the development of GC-OHT in the normal population. A number of studies have suggested increased levels of endogenous cortisol in POAG patients as well as differences in cortisol metabolism, suggesting that GCs may be involved in the development of POAG. Additional studies are warranted to better understand the molecular mechanisms involved in POAG and GIG in order to develop new disease-modifying therapies to better treat these two sight threatening forms of glaucoma. The purpose of this timely review is to highlight the pathological and clinical features of GC-OHT and GIG, mechanisms responsible for GC responsiveness, potential therapeutic options, as well as to compare the similar features of GIG with POAG.
dc.description.sponsorshipThis research was supported by NIH grants EY016242 and EY030967. We also would like to thank research collaborators, as well as former graduate students and postdoctoral fellows from the Clark lab.
dc.identifier.citationPatel, P. D., Kodati, B., & Clark, A. F. (2023). Role of Glucocorticoids and Glucocorticoid Receptors in Glaucoma Pathogenesis. Cells, 12(20), 2452.
dc.rights.holder© 2023 by the authors.
dc.rights.licenseAttribution 4.0 International
dc.subjectanimal models
dc.subjectanti-inflammatory steroids
dc.subjectglucocorticoid receptor
dc.subjectocular hypertension
dc.subjectprimary open-angle glaucoma
dc.subjectsteroid glaucoma
dc.subject.meshGlaucoma, Open-Angle / chemically induced
dc.subject.meshGlaucoma, Open-Angle / pathology
dc.subject.meshGlaucoma / metabolism
dc.subject.meshOcular Hypertension / metabolism
dc.titleRole of Glucocorticoids and Glucocorticoid Receptors in Glaucoma Pathogenesis
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
3.02 MB
Adobe Portable Document Format
full text article