Glaucoma is a group of progressive optic neuropathies affecting approximately 1% of the population worldwide.
1–3 POAG, the most prevalent form of glaucoma, results in irreversible blindness and is estimated to affect more than 60 million people.
2 Important risk factors for POAG include age, race, and elevated IOP. Elevated IOP results from increased resistance of aqueous humor (AH) outflow through the trabecular meshwork (TM) due to excess accumulation of extracellular matrix (ECM) proteins.
4–6
TGF-β2 is the most abundant TGF-β isoform in the eye.
7,8 A number of studies have reported elevated levels of TGF-β2 (2–5ng/mL) in the AH of patients with POAG.
7,9–11,51 Endogenous TGF-β2 levels are elevated in both cultured glaucomatous TM (GTM) cell stains and GTM tissues.
12,48,49 In other tissues, TGF-β signaling has been shown to mediate fibrotic changes, including increased ECM protein deposition.
13–15 Our laboratory and others have suggested a similar role for TGF-β2 in the TM, reporting increased synthesis and secretion of ECM proteins and a potential role for ECM deposition in POAG.
16–19 In addition, TGF-β2 treatment of cultured human TM cells induces cross-linking of fibronectin via induction of tissue transglutaminase.
20,21,50 We have also recently reported that TGF-β2 simulates the synthesis and secretion of lysyl oxidases, enzymes that also cross-link ECM collagen and elastin fibers.
22 In the human anterior segment organ culture model, perfusion with TGF-β2 promotes a focal accumulation of fine fibrillar extracellular material in the TM, increased fibronectin levels, and elevated IOP.
23–25 In addition, intraocular injection of a viral vector encoding bioactive TGF-β2 induced ocular hypertension in rats and mice and significantly decreased AH outflow facility in the mouse.
25
Our laboratory has previously reported that TM cells express several members of the bone morphogenetic protein (BMP) family, including BMP ligands (BMP2, BMP4, BMP5, and BMP7), receptors (BMPR1a, BMPR1b, and BMPR2), and BMP antagonists gremlin, noggin, and follistatin.
26–28 BMPs elicit multiple functions in a variety of ocular tissues
28 and other cell types.
29,30 For example, BMP4 and BMP7 blocked TGF-β2 induction of a variety of ECM proteins, including fibronectin-1, collagens IV and VI, TSP-1, and PAI-1.
19,31 BMP antagonists tightly regulate BMP cellular activity by either binding directly to BMP ligands or to the type I BMP receptor.
32–34 We reported greater levels of the BMP antagonist gremlin in GTM cells and tissues.
19 In addition, gremlin antagonizes BMP4 inhibition of TGF-β2–induced cellular ECM proteins FN and PAI-1 and elevates IOP in perfusion-cultured human anterior segment.
19 We have proposed that gremlin potentiates the profibrotic effects of TGF-β2 in the TM by blocking BMP4 regulation of TGF-β2 activity.
19 However, whether gremlin is the only mediator that blocks BMP activity in the TM is currently unknown, and the role(s) of other potential BMP antagonists in the TM has not been reported.
Follistatin (FST) is also a secreted BMP antagonist whose mRNA expression has been previously reported in TM cells.
26 FST was first identified as a follicle-stimulating hormone inhibiting molecule present in ovarian follicle fluid. It has since been shown to be a multifactorial regulatory protein that exerts a majority of its effects by neutralization of activin (Act) molecules or by inhibition of BMPs.
35–38 FST and Act are usually coexpressed, and FST is known to bind and inhibit Act with high affinity.
The primary FST transcript undergoes alternative splicing to produce mRNAs (FST 317/344) that encode two FST proteins, FST 288 and FST 315 (
Fig. 1).
39,40 The FST 315 isoform is encoded by all six exons, whereas the FST 288 isoform lacks expression of exon 6, which encodes the acidic C-terminal tail. Both isoforms contain the heparin-binding sequence (HBS) of basic residues, which is essential for binding to cell-surface heparin-sulfated proteoglycans.
41–43 It has been proposed that the acidic tail in FST 315 interacts with the basic residues within the HBS, thereby suppressing the cell-surface binding activity of FST 315.
44 These biochemical distinctions suggest that each isoform may be responsible for different subsets of biological activities, depending on their degree of cell-surface localization and subsequent compartmentalization within tissues. The finding that FST 315 is the predominant circulating FST isoform in human serum supports this concept.
45
The biological activities as well as the underlying mechanisms for FST and Act involvement in the TM have not been explored. The purpose of this study was to (1) assess FST and Act expression in NTM and GTM cells and tissues and (2) determine whether exogenous TGF-β2 regulates the expression of FST in cultured NTM and GTM cells. A better understanding of the role of BMP antagonists in human TM may identify potential therapeutic targets for the treatment of glaucoma.