Since the lens is avascular, to procure nourishment and dispose of metabolic waste, it creates a microcirculation involving water channels, ion transporters, and cotransporters.
14–16 Intercellular GJ channels constituted by Cx membrane proteins form epithelial-to-epithelial, fiber-to-fiber, and epithelial-to-fiber cell connections at the plasma membrane.
17–20 Small molecules, such as ions, metabolites, and second messengers, pass between two such connected cells
21,22 and aid in intercellular communication. Three major GJ channel proteins are present in the lens. Cx43 (
α1 gene) and Cx50 (
α8 gene) are expressed in the epithelial cells; Cx46 (
α3 gene) and Cx50 are expressed in the fiber cells.
23,24 Along with GJ channels, lens water pores or aquaporin (AQPs)
2,11–16,25–34 namely AQP0, AQP1, and AQP5 have significant roles in lens microcirculation and homeostasis. In a simplified version of the microcirculation model, sodium ions enter the extracellular spaces at the anterior and posterior poles of the lens.
14–16,30 As the extracellular sodium flows toward the central part of the lens, the ions enter the fiber cells down their electrochemical potential across the fiber cell membranes. Once in the intracellular compartment, the flow reverses direction and moves from fiber cell to fiber cell through GJs back toward the lens equatorial surface. The Na-K-ATPase expressed in equatorial epithelial cells
35 pumps the sodium out. Through the processes of osmosis and hydrostatic pressure (HP), water follows the circulation of sodium.
36–38 The inward extracellular fluid flow carries nutrients and antioxidants to central fiber cells (reviewed previously
15) while the outward intracellular fluid flow carries waste products, such as lactic acid,
39,40 from central fibers to surface cells that can eliminate them.