We have suggested that the meshwork cell loss, which is associated
with aging of the outflow system,
1 2 3 4 and which is more
marked in POAG,
2 3 4 5 may result in part from meshwork cells
being stimulated to migrate away from the
trabeculae.
4 5 10 The stimuli for migration we would
propose are chemoattractants present in the aqueous
humor.
17 We know that aqueous has a wide range of
glycoproteins and growth factors as its
constituents,
26 and these can serve not only as
mitogens but also as motogens for various cell types, including
meshwork cells.
15 17
Meshwork cell migration in vivo is based only on circumstantial and
qualitative evidence. For example, migratory meshwork cells have been
noted after the entry of debris into the outflow
system
11 13 ; however, there has also been an influx of
inflammatory cells to complicate identification. In noninflammatory
situations such as aging, POAG, and other forms of glaucoma, where
meshwork cell migration may or may not be occurring, the migratory
event is likely to be too infrequent for meaningful evaluation. If
migration accounted for all the meshwork cell loss in aging, for
example, then the rate of attrition could be as low as 20 cells per
day.
4 It is therefore not surprising that little or
nothing is known about the fate of migrating meshwork cells in the
outflow system or even the conditions that specifically initiate the
migratory activity in the first place.
Our investigations inevitably have had to turn to the simplest possible
test systems to try and dissect the complex events in vivo,
particularly with respect to the stimuli that may or may not provoke
meshwork cell migration. In vitro analysis of meshwork cell migration
has the severe limitation of being remote from the physiological and
pathologic events in vivo, so the findings need to be interpreted with
caution. On the other hand, our 48-well modified Boyden chamber assay
has particular strengths. The assay is miniaturized so that small
samples can be studied, the migration can be quantified readily, the
assay is reasonably reproducible, and complex environments can be
modeled as a series of simple steps.
Previous investigations from our laboratory have established that
bovine meshwork cells migrate positively to chemoattractants that vary
from glycoproteins to growth factors some of which are known
constituents of aqueous humor.
15 16 17 Bovine meshwork cells
also migrate very effectively to their own aqueous
humor.
5 17 The present study has shown, for the first
time, that the situation is similar in humans. We found that bovine
aqueous, aqueous from cataract patients, and aqueous from patients with
POAG were powerful chemoattractants for a range of cultured human
meshwork cells.
The response of our cells to human aqueous peaked at a 20% dilution in
serum-free medium as was also the case with bovine aqueous humor. Why
didn’t 100% aqueous produce a more marked effect than our optimum
dilution, given that its constituent chemoattractants would be 5 times
more concentrated? A potential explanation for our result might be that
the key chemoattractants were at supermaximal levels in undiluted
aqueous humor. However, this was not borne out by our previous
investigations of bovine meshwork cells, which showed that all the
active constituents investigated were below their migratory optimum in
aqueous humor.
15 16 For that matter, the present study has
shown that, with sFn at least, the situation was the same in the
human test system where optimum migration was produced by 5 to 20μ
g/ml, a concentration that was far higher than that normally found
in aqueous.
Aqueous humor has a complex cocktail of constituents, and it need not
be that all constituents either stimulate migration or are neutral. It
may be that there are inhibitors and that this inhibition impedes the
activation of migration at higher concentrations of aqueous. The
variable, but potent, family of transforming growth factor-βs can be
powerful mitogenic inhibitors and also are potential motogenic
inhibitors.
27 Family members are present in the aqueous
humor,
28 and although they have a minimal effect on
migration of meshwork cells on their own,
17 their action
in the presence of known stimulants has not yet been studied.
Another possible explanation comes from the work of Burke et
al.
29 They found that although 20% aqueous samples
stimulated the growth of cultured ocular fibroblasts, higher
concentrations were inhibitory. They explained the anomaly on the basis
of poor cell survival in 100% aqueous. Our migration assays were run
for a far shorter period than was needed for proliferation experiments,
and we found no evidence of aqueous toxicity at high concentrations.
None-the-less, our meshwork cells, adapted to culture conditions, may
have found near or full strength aqueous not to have been a
particularly favorable environment.
We were able to show clearly that aqueous in general was a powerful
chemoattractant for human meshwork cells; however, the following
question arises: Was there a difference between cataract and POAG
sources? The answer was not clear-cut because with two of our cell
systems there was significantly greater migration to the POAG aqueous[
BTM(w) and HTM-3], but in the other two the difference, although
favoring POAG aqueous, was not significant [HTM-5 and HTM(w)]. There
was an overall trend that indicated that the POAG aqueous was the more
powerful attractant, but it was not entirely conclusive. The question
arises whether by evaluating more specimens a more definitive answer
would arise. We suspected that it would not because we had a total
sample size of 144 aqueous specimens and conducted at least three
repeats of each run. The difference then seemed not to be sufficiently
large that by extra numbers, it would show clearly beyond the“
noise” in our assay and the natural biovariability in the
specimens.
The cataract aqueous served as our nonglaucomatous controls. But was
its chemoattraction substantially similar or perhaps even greater than“
normal” human aqueous? It was for this reason that we also
included normal bovine aqueous in the present study and found that our
panel of cells migrated just as well to it as to human cataractous
aqueous. Only 3 of our 63 POAG specimens had cataracts requiring
surgery, but they did not stand out from the rest in their ability to
stimulate migration. In the absence of direct comparison, we have
nothing to indicate that cataract aqueous was not a suitable control.
Indeed, evidence has been published that suggests that, at least on the
basis of protein composition, aqueous removed at cataract surgery is
more reliable than that taken from postmortem normal
eyes.
30
Originally we put forward the hypothesis that the circulating aqueous
humor is chemoattractive for trabecular meshwork cells and that
migration, activated by the chemoattractants in aqueous, might account
for some of the meshwork cell loss associated with aging and POAG. The
present study has shown powerful human meshwork cell chemoattraction to
aqueous in vitro and also demonstrated, on the evidence of
dose–response migration runs and antibody neutralization, that sFn is
a major, but not the only, attractant in the fluid. Based on our in
vitro experimental results, it might be thought surprising that cell
loss in vivo is so low in health and disease. Of course, our
experimental design is simplistic and does not take into account
factors that would prevent migration such as the presence of
cell-to-cell junctions, cell-to-trabecular adhesion, inhibitors in the
aqueous, receptor status of the meshwork cells, and many more. We do
think, however, that our positive results justify further research in
this area.
On the other hand, the second part of our hypothesis is that if the
chemoattraction of the aqueous in POAG is more pronounced than normal,
then the added migration pressure might explain why there are even
fewer remaining meshwork cells in the glaucomatous outflow system.
Although our results did not overwhelmingly support the proposal, they
were sufficiently positive to give it some credence. Again, other
factors need to be taken into consideration, not least of which is that
sampling aqueous in the anterior chamber is thought to underestimate
its protein content (and therefore its bioactivity) in the
meshwork.
31 In addition, there may or may not be
differences in receptor upregulation between POAG and normal meshwork
cells that would make the former more vulnerable to migratory
stimuli.
32 Future work will examine this possibility by
examining primary and early passage cultures from normals and persons
with POAG.
The authors thank Roger Hitchings, Peng Khaw, Colm O’Brien, Jorg
Sturmer, and Ian Cunliffe who provided the human aqueous specimens.