Variations in myocilin are not a common cause of nonhereditary forms of glaucoma,
22 as single nucleotide polymorphisms are found in both glaucoma and control populations. However, from a protein perspective, it is easy to envision broader relevance of wild-type myocilin to glaucoma pathogenesis. Most cells deal with proteostasis-related problems, imbalances in protein production, trafficking, and degradation, by undergoing apoptosis. However, long-lived cells such as TM cells
23 are programmed to avoid cell death
24 and, consequently, are particularly sensitive to the accumulation of misfolded proteins.
25 Toxicity of long-lived cells can be triggered by environmental factors as well as destabilizing mutations.
26 Although wild-type OLF is thermally stable when folded,
12 it possesses an intrinsic propensity to form a misfolded precipitate of a particular kind called amyloid that is common to many misfolding disorders.
26 In vitro, purified OLF remains unchanged when incubated at 37°C for weeks at high concentration, but aggregation is readily initiated by adding mimics of glaucoma-associated environmental stressors, including low levels of acid (pH fluctuations), peroxide (oxidative stress), mechanical shear (rocking), and elevated temperature.
27,28 Even though transgenic mice overexpressing wild-type myocilin do not develop glaucoma,
29 and overexpression alone cannot drive the association of normal myocilin with Grp94,
15 myocilin driven to misfold by impairing cellular glycosylation interacts with Grp94, culminating in accumulation and toxicity observed for disease-causing variants.
15 The misfolding susceptibility of wild-type myocilin is further supported by histopathological studies demonstrating its accumulation into punctate bodies in several forms of glaucoma.
30 Whether accumulated wild-type myocilin contributes to TM damage and outflow resistance remains unknown, but it is clear that our understanding of wild-type myocilin function and dysfunction remains blurry.