Glaucoma is a progressive optic neuropathy characterized by optic disc cupping, RGC death, and vision loss. POAG is the most common type of glaucoma. Glaucoma pathogenesis is multifactorial; however, a major risk factor for the development of glaucoma is elevated IOP. The pathophysiological mechanisms by which elevated IOP leads to optic nerve atrophy and retinal degeneration are unknown. This manuscript provides novel findings that the PI3K/Akt pathway plays a key role in δ-opioid receptor–mediated RGC neuroprotection against ocular hypertension–induced injury, thus suggesting that PI3k/Akt pathway could be a potential therapeutic target for glaucoma therapy.
The protein kinase B (Akt) family is comprised of three highly homologous isoforms: Akt-1 (PKBα), Akt-2 (PKBβ), and Akt-3 (PKBγ). Upon binding to growth factor and to their specific membrane receptor, an upstream regulator, PI3 kinase, phosphorylates Akt at the serine 473 and threonine 308 residues.
32 Phosphorylated and activated Akt then inhibits its downstream targets such as: proapoptotic proteins,
25,26 caspases,
27,28 and apoptosis signal regulating kinase-1.
33 The PI3K/Akt pathway plays a central role in multiple cellular processes and exerts a prosurvival and antiapoptotic effect.
34 In the eye, studies have provided limited evidence that the PI3K/Akt pathway protects the retina in nonglaucoma models
35–39; however, none of the studies provide concrete evidence that direct activation of Akt provides RGC neuroprotection in glaucoma. This manuscript provides data that strengthens the idea that the PI3/Akt pathway plays a crucial role in the δ-opioid receptor–mediated neuroprotection against ocular hypertension–induced RGC injury.
Activation of δ-opioid receptors reduced infarct size in stroke and myocardial ischemia models.
40,41 Activation of δ-opioid receptors is protective against hypoxia/excitotoxic injury in cortical neurons.
42 DADLE, a δ-opioid receptor agonist, has been shown to improve hippocampal neuronal survival against ischemia in a rat model.
43 Studies have also shown that δ-opioid receptor activation attenuates oxidative injuries in the brain exposed to ischemia/reperfusion by enhancing antioxidant ability and inhibition of caspase activity.
44 Moreover, δ-opioid receptors have been involved in neuroprotective mechanisms of Alzheimer
45 and Parkinson
46 diseases. Earlier, we have shown an upregulation of δ-opioid receptors in response to glaucomatous injury, which has indicated their involvement in endogenous neuroprotective pathways.
2 Additionally, we have shown that activation of δ-opioid receptors attenuates the production of TNF-α,
2 nitric oxide, inducible nitric oxide synthase,
20 and MMP-2 secretion from ONH astrocytes.
19 Although beneficial effects of δ-opioid receptor agonists in nonocular systems such as chronic pain, emotional disorders, and neuroprotection against various forms of injuries have been defined, the usefulness of δ-opioid receptor agonists against glaucomatous injury requires additional studies. It would also be intriguing to understand how short-term (7 days) δ-opioid receptor agonist treatment provided long-term (up to 42 days) RGC neuroprotection. We know opioid-induced epigenetic mechanisms exert prolonged functional effects that often involve changes in acetylation.
47–49 We speculate that δ-opioid receptor activation induces epigenetic changes that can provide long-term neuroprotection. The underlying mechanisms involved in δ-opioid receptor induced epigenetics remain largely unknown and require additional experiments that will be the focus of our future studies.
The current manuscript provides novel findings that the PI3K/Akt pathway is one of the potential targets of δ-opioid receptor agonist for RGC neuroprotection. We have shown that pretreatment of animals with a PI3/Akt inhibitor (LY-294002) blocked SNC-121–induced preservation of pattern ERGs and RGC integrity in a chronic glaucoma rat model. In this study, we have not determined axonal loss in ocular-hypertensive eyes. However, the reduction in Fluorogold labeling of RGCs in ocular-hypertensive eyes could be due to axonal loss. It is possible that axonal function also improved by SNC-121 treatment. Although studies have shown that opioid receptor agonists (e.g., bremazocine and morphine; 100 μg/2- to 4-kg body weight) have the ability to lower IOP in rabbits,
50–52 it remain unknown if topical application of δ-opioid agonists can lower IOP in rodents. Numerous cell types including activated macrophages, astrocytes, microglia, Müller cells, and neuronal cells can undergo stress during the progression of glaucoma, which will produce various neurotoxic substances (e.g., proinflammatory cytokines, nitric oxide, and MMPs). Earlier, we have shown that SNC-121 treatment blocked the production of TNF-α and nitric oxide in an ocular hypertensive rat model.
In the current study, we have seen a reduction in p-Akt immunostaining in both retina and optic nerve of ocular hypertensive eyes, which were increased in SNC-121–treated ocular-hypertensive animals. We also noticed co-localization of p-Akt and GFAP in optic nerve of ocular hypertensive eyes. Additionally, MMP-1, MMP-2, and MMP-3 were produced from the optic nerve within a week in response to ocular hypertensive injury, which was also inhibited in SNC-121–treated ocular-hypertensive animals (
Fig. 10). Furthermore, TNF-α induced MMPs production from ONH astrocytes is inhibited by SNC-121 treatment (
Fig. 11). Both in vivo and in vitro data presented in this manuscript provide evidence that SNC-121 treatment activates and phosphorylate Akt both in the retina and optic nerve and reduces MMP-1, MMP-2, and MMP-3 production. These data provide initial clues that MMPs are primarily produced from ONH astrocytes. In this study, we have not tested MMPs secretion from other glial cells so the involvement of other glial cells in MMPs production in response to glaucomatous injury cannot be ruled out. At this point, it is not clear how SNC-121 treatment attenuates the production of MMPs; nor what would be the downstream signaling targets of the δ-opioid receptor agonist. To dissect out signaling mechanisms we determined the roles of the PI3K/Akt pathway in MMP production using ONH astrocytes. Data shown in
Figures 11A to
11C demonstrated that TNF-α–induced MMP secretion from ONH astrocytes is marginally potentiated in the presence of PI3K inhibitor, LY-294002, suggesting that endogenous PI3K/Akt activity is required to regulate MMP secretion. Moreover, SNC-121–mediated inhibition of TNF-α–induced MMP secretion is fully blocked by LY-294002 (
Figs. 11A–C). These data provide novel information that PI3K/Akt activity is augmented by the δ-opioid receptor agonist, SNC-121, which negatively regulates the production of MMPs. These findings provide novel leads that a δ-opioid agonist could directly mitigate the destabilization/remodeling of the optic nerve by blocking the excessive production of MMPs.
In summary, this manuscript provides evidence that the δ-opioid receptor agonist, SNC-121, activates and phosphorylates Akt. Similar to our previously published studies, SNC-121 provided significant RGC neuroprotection up to 6-weeks post glaucomatous injury, and this neuroprotective effect of SNC-121 was blocked by LY-294002. The levels of phospho-Akt reduced in both the retina and optic nerves of ocular-hypertensive eyes, which was reversed to normal levels in SNC-121–treated animals; suggesting their potential role in neuroprotection. Overall, these studies provide novel insight that the PI3K/Akt signaling pathway plays a crucial neuroprotective role in δ-opioid receptor–mediated RGC neuroprotection. However, we cannot rule out the possibility of the involvement of other pathways/molecules in SNC-121–mediated neuroprotection.