Modulation of Intralocular Pressure by Tuning Transcriptional Control of Lipid Synthesis

Abstract

Glaucoma is an age-related optic neuropathy and is one of the leading causes of irreversible blindness. Primary open-angle glaucoma (POAG) is the predominant subtype of glaucoma. Elevated intraocular pressure (IOP) is a major risk factor for POAG and lowering IOP is the most effective therapeutic strategy. IOP is maintained by the balance of aqueous humor (AH) generation by the ciliary body and drainage by conventional outflow pathway including trabecular meshwork (TM). TM is a highly contractile and mechanosensitive tissue, and its contractility regulated by the actin cytoskeleton and extracellular matrix (ECM) is directly related to IOP regulation. Using multiomics analysis in human TM (HTM) cells, I identified that mechanical stretch caused the activation of sterol regulatory element binding proteins (SREBPs) related-lipid biogenesis pathways. Further, using immunofluorescence, and constitutive activation of each SREBP isoform, I discovered the mechanosensing role of SREBPs in HTM cells and mechanistically deciphered the attributes of SREBPs in regulating the contractile properties of TM. The pharmacological inhibition of SREBPs by fatostatin and molecular inactivation of SREBPs ex vivo and in vivo resulted in significant IOP lowering. Conversely, significantly elevated IOP was observed after using the pharmacological activator of SREBPs by clozapine and constitutive activation of SREBPs ex vivo and in vivo, respectively. As a proof of concept, fatostatin significantly decreased the SREBPs responsive genes and enzymes involved in lipogenic pathways and phospholipids, cholesterol, and triglyceride levels. The increased lipid biogenesis was found after constitutive activation of SREBP isoforms in HTM cells but with slightly different effects between each isoform. Further, I showed that fatostatin mitigated actin polymerization machinery and stabilization, and identified that SREBPs activation is a critical regulator of ECM engagement to the matrix sites. Lastly, I identified that cholesterol levels play an important role in regulating actin polymerization, focal adhesion formation, cell-ECM interactions, and membrane tension in HTM cells. Therefore, we have established the direct connection between cholesterol and TM contractility. Overall, I postulate that lowering de novo lipogenesis in the TM outflow pathway can hold the key to lowering IOP by modifying the TM biomechanics.