Meditation induces changes in trabecular meshwork gene expression in patients with primary open angle glaucoma

Abstract

Purpose : To evaluate the effect of meditation on trabecular meshwork gene expression in patients with advanced Primary Open Angle Glaucoma (POAG)

Methods : Thirty patients with advanced POAG aged more than 40 years with IOP not controlled on maximal topical medical therapy and scheduled for filtering surgery were randomized into two groups (Group 1 and 2). Patients with any other ocular or systemic diseases, performing yoga/meditation previously were excluded. Fifteen patients (group 1) underwent 3 weeks of 60 minute daily mindfulness meditation under a certified yoga instructor in addition to medical therapy while the other group (2) received medical therapy without meditation. All patients underwent trabeculectomy after 3 weeks by a single surgeon (TD). Trabecular meshwork tissue obtained during surgery was used to isolate RNA using trizol method. Gene expression was analysed using quantitative real time-PCR by a blinded investigator and expressed as fold change (2^-ΔΔCt) relative to group 2. A fold change of >2 was considered significant. Evaluated genes selected on the basis of microarray were involved in anti-inflammatory processes-Interleukin-4 (IL-4), raised IOP-Metallothionein-1(MT1E), protection against oxidative stress - Neuroglobin (NGB), prevention of neurodegeneration and Neuroprotection -Nerve factor growth receptor (NGFR) and Neuregulin (NRG1).

Results : There was no significant difference (p=0.32) in the mean age between group 1 (59.28±9.37 years) and group 2 (55.9±8.8 years). The mean deviation on Visual fields (Humphrey 30-2) was comparable in both groups (group 1: 14.15± 3.65dB, group 2: 15.2±2.92, p=0.08) at baseline. Gene expression analysis showed a significant upregulation of IL-4 (fold change= 56.83), NGB (fold change=48.09), NGFR (fold change=4.51) and NRG1 (fold change=73.43) in group 1 as compared to group 2. There was a significant downregulation of MT1E (fold change=-5.02).

Conclusions : Meditation was associated with significant changes in gene expression in the trabecular meshwork of patients with Primary Open Angle Glaucoma. There was upregulation of genes involved in anti-inflammatory mechanisms, antioxidant capacity and neuroprotection, and downregulation of genes associated with increased IOP. Meditation can positively modulate cellular mechanisms involved in glaucoma pathogenesis by direct impact on ocular tissues.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.