Glaucoma, which affects approximately 70 million people, is a major cause of blindness throughout the world.
1 The most common form, primary open-angle glaucoma (POAG), is typically associated with elevated intraocular pressure, loss of peripheral vision, and accompanying damage to the optic nerve.
2 Myocilin mutations have been associated with juvenile and early onset POAG and a subset of adult POAG.
3 –6 Polansky et al.
7,8 identified and characterized a TM-inducible glucocorticoid response protein, which is also known as myocilin.
9 MYOC, the myocilin gene, codes for a 504-aa glycoprotein with homology to olfactomedin, a mucoid protein found in neuroepithelium.
8,10,11 It includes structural motifs for both N- and O-linked glycosylation, hyaluronan binding, and a myosin-like leucine zipper.
8 Myocilin is widely distributed in ocular tissues,
10,12 –16 and its mRNA is also expressed in various nonocular tissues, including the heart, skeletal muscle, kidney, and peripheral nerves.
8,10,17 –21 Both intracellular nonglycosylated and extracellular glycosylated and nonglycosylated forms of myocilin have been identified.
8,10 On gels, the primary band runs as a doublet of approximately 55 and 57 kDa, with a 66-kDa band apparent in some cases. Myocilin associations have been reported with mitochondria,
22 –24 exosome-like vesicles,
25,26 and components of the cytoskeleton and extracellular matrix.
14,27 –33 Myocilin interactions have also been demonstrated with a number of molecules associated with cell signaling and metabolism, including glyceraldehyde-3-phosphate dehydrogenase (GAPDH),
34 and optimedin, which is itself an olfactomedin-related protein.
35 To date, no clear molecular function for myocilin has been established,
10,36 and myocilin double knockout or overexpressing mice show no clear phenotype.
37 –40 Perfusion studies with recombinant myocilin have demonstrated both increases and decreases in outflow facility, depending on conditions.
41 In addition, studies of the glaucoma-related myocilin mutations suggest an involvement of the misfolded or unfolded protein response
42 in disease etiology.
10,43 –48 Recent studies
49 using a mouse model with the human myocilin gene implicate the involvement of a peroxisomal targeting signal-1 receptor (PTS1R), which is absent from the mouse gene, in the disease process.