Based on data acquired from the effects of various pharmacologic modulators of contractile function, cytoskeletal integrity, and cell adhesions in TM cells, inhibitors of TM tissue contractility and actin/myosin interactions have been identified as having potential therapeutic significance for lowering IOP in patients with glaucoma.
4 6 7 8 Members of the Rho GTPase subfamily of monomeric GTPases, including Rho, Rac, and Cdc42, Rap1, and heterotrimeric G-proteins including G12/13 and Gq, which are isoprenylated proteins, play critical role(s) in smooth muscle contraction, maintenance of cell morphology, cytoskeletal organization, trafficking, and cell adhesive interactions.
12 13 14 15 16 24 25 Specific inhibitors of Rho GTPase, Rho kinase, myosin light chain kinase, and myosin II have been demonstrated to increase aqueous humor outflow and to lower IOP in various perfusion and live animal models.
4 8 21 26 27 28 29 In addition to this class of pharmacologic agents, cholesterol-lowering statins, which are inhibitors of HMG-CoA reductase (the rate-limiting enzyme of the cholesterol biosynthetic pathway) have also been documented to increase aqueous outflow in perfused eye anterior segments.
23 Anecdotally, human patients on a statin treatment regimen are reported to have a lowered incidence of glaucoma.
30 Although the precise mechanism behind the lowered incidence of glaucoma in this group of patients is not completely understood, supplementation with geranylgeranyl pyrophosphate has been shown to reverse the statin-induced increases in aqueous humor outflow facility in perfused eyes, indicating a potential significance for protein geranylgeranyl isoprenylation in the modulation of aqueous humor outflow.
23 Furthermore, statins have been demonstrated to impair Rho GTPase activity in various cell types because of their ability to lower the levels of isoprenoids.
23 31