Although only portions of the total pathway(s) have been demonstrated at this point, based on our data and observations from the literature on other tissues and cell types, a hypothetical transduction pathway is proposed
(Fig. 9) . In our working hypothesis, TM cells sense mechanical stretching and distortion produced by the effects of changes in IOP on the outflow resistance,
14 which is thought to reside in the juxtacanalicular region of the TM.
11 Stretching produces tension and relative movement of juxtacanalicular ECM macromolecules, which are directly or indirectly attached to TM cells through specific integrins.
12 13 47 48 49 The first transduction step probably involves adaptor proteins and kinases associated with the cytoplasmic tails of the integrins, where they interact with the cytoskeleton and signaling complexes at focal complexes or focal contacts.
48 49 50 51 This triggers activation of PI 3 kinase, which produces phosphatidylinositol-3,4,5-trisphosphate (PI3).
52 53 54 PI 3 kinase is specifically inhibited by wortmannin. PI3 facilitates activation of PKB by phosphorylation on S473 by ILK and on T308 by PDK1.
54 55 56 57 PI3 can also directly and/or indirectly activate mTOR, but mTOR can also be activated by several other wortmannin-insensitive mechanisms.
37 38 41 58 59 The p70 S6 kinase is phosphorylated on T389 by mTOR and on T412 by PKB and other kinases.
45 57 58 60 Activated p70 S6 kinase increases protein translation of selective genes, particularly those with tracts of pyrimidines (TOPs) in their extreme 5′ UTR, by mechanisms that are only partially understood.
38 44 60 61 The transcriptional initiation factor eIF-4E is thought to be phosphorylated primarily by MNK-1, which docks on the large adaptor/scaffold protein eIF-4G. The eIF-4E inhibitory binding protein 4E-BP1 is phosphorylated by mTOR and several other kinases.
41 Hyperphosphorylated 4E-BP1 releases eIF-4E, which binds directly to the 5′ cap of the mRNA to be translated and recruits the mRNA to a heterotrimeric complex with the large scaffold protein eIF-4G and the RNA helicase eIF-4A. This helicase is particularly important in regulating translation of genes with high levels of secondary structure in their 5′ UTRs.
37 38 43 44 61 Translational initiation and elongation follows with inclusion of several other factors, many of which are phosphorylated by mTOR and other kinases.