The genes involved in the regulation of tear secretion and associated calcium functions were also shut down in our study. For example, calcium is an important factor in tear secretion as a second messenger activated by neuronal input through cholinergic M3 muscarinic receptor, adrenergic α1 receptor, and vasoactive intestinal peptide (VIP) receptor.
3 Several proteins modulate calcium activity including annexin,
44 calcium binding protein P22,
45 voltage-dependent calcium channel,
46 calmodulin,
47 and calponin.
48 Almost all of them primarily showed downregulation in this study, indicating decreased calcium activity (see
Supplemental Table S2, group 13, calcium regulation). We found that some other related genes, such as secretory carrier member proteins 3 and 4, were also downregulated, although secretory carrier member protein 1 was upregulated (Supplemental Table S2, group 17, secretion related). Some genes for proteins secreted by the lacrimal epithelium were also primarily downregulated, such as lysozyme (Supplemental Table S2, group 3, proteolysis) and transforming growth factor (Supplemental Table S2, group 10, growth factor). This suggests that overall tear secretion activity is low. This finding was surprising, because it seems intuitively that the lacrimal gland cells should have been stimulated to produce more rather than less tearing in response to eye pain. The suppression of secretion-related gene expression further supports the concept that nearly all cell systems were shut down and brought to resting status to protect the cells from the damage produced by overstimulation. This finding is consistent with a phenomenon that has been observed in ophthalmic clinical practice for many years. Creation or exacerbation of dry eye is quite common after cornea trauma, such as laser in situ keratomileusis (LASIK) corneal surgery or wearing contact lenses to correct vision defects.
4 9 10 49 Tear production was found to decrease after LASIK.
8 11 Suppression of tear production is an alternative mechanism that may occur as a direct result of corneal overstimulation and not as a consequence of LASIK-induced corneal denervation, as previously considered.
50 The cornea-to-lacrimal gland feedback mechanism has been proposed as a cause for the dry eye that occurs after LASIK procedures and other forms of corneal trauma.
2 3 4 Our finding that corneal injury induces widespread gene suppression in the lacrimal gland may provide genetic evidence to support this mechanism.