The current study had some limitations. First, although we focused on the role of TGF-β1 among the growth factors (i.e., TGF-β1, -β2, EGFR, PDGFB, and TGF-α) because RT-qPCR showed that TGF-β1 was greatly altered by shear stress (
Fig. 4), we could not eliminate the possibility that other growth factors might have affected the findings in this study. Second, we could not create more than 12 dyne/cm
2 of shear stress due to the limitation of the peristaltic pump. Shear stress on the corneal epithelial cells during blinking cannot be calculated because the tear film thickness is unknown during blinking. When calculated based on the thickness of the aqueous layer in the tear film when the eye is open,
28 the shear stress on the corneal epithelial cells might be higher than in this experimental condition. Nevertheless, this experimental condition affected TGF-β signaling possibly because of the amount of microvilli and membrane-associated mucins, which should cushion and protect the corneal epithelial cells from shear stress during blinking.
29,30 The corneal epithelial cells in vivo have microvilli covered with membrane-associated mucins; meanwhile, the corneal epithelial cells in vitro have fewer microvilli and membrane-associated mucins due to passage accompanied by trypsinization. Another in vivo study is needed. Third, we used SV40 immortalized HCECs,
10 which are the most often used HCECs, because numerous uniform cells were needed for shear stress experiments. The SV40 immortalized HCECs have altered genomic contents.
31 We need to interpret the results in the current study with caution. Fourth, our experimental system was a closed circuit that included just corneal epithelial cells. That might be why shear stress decreased the level of total TGF-β1 in the culture supernatant from baseline, although elevated levels of active TGF-β1 in the tears of patients with dry eye have been reported.
17 Corneal and conjunctival epithelial cells are both sources of TGF-β and a potential target for TGF-β, and conjunctival epithelial cells secreted TGF-β1 more than corneal epithelial cells.
15 In addition, conjunctival epithelial cells might have more effects than the cornea in in vivo experiments, because the conjunctival area is larger than that of the cornea on the ocular surface. Further investigations of the effects of shear stress on conjunctival epithelial cells and in vivo experiments on forced blinking are needed.