[Frontiers in Bioscience S1, 376-390, June 1, 2009]

TGFb in fibroproliferative diseases in the eye

Shizuya Saika1, Osamu Yamanaka1, Yuka Okada1, Sai-ichi Tanaka1, Takeshi Miyamoto1, Takayoshi Sumioka1, Ai Kitano1, Kumi Shirai1, Kazuo Ikeda1

1Department of Ophthalmology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan, 2Department of Anatomy, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno, Osaka, 545-8585, Japan

TABLE OF CONTENTS

1. Abstract
2. Introduction
3. Overview of Transforming growth factor b (TGFb signal transduction
4. Central role of TGFb in fibrogenic reaction
5. Generation of myofibroblasts by TGFb
6. Epithelial-mesenchymal transition (EMT)
7. Outline of ocular fibrotic disorders
8. Fibrosis/scarring in ocular surface, i. e., cornea and conjunctiva
9. Strategies to prevent excess fibrogenic reaction in ocular surface tissue by targeting TGFb signals
10. EMT and fibrotis diseases in the eye; lens epithelium EMT
11. EMT and fibrotis diseases in the eye; retinal pigment epithelium EMT and retinal fibrosis (PVR)
12. Corneal endothelium EMT
13. Proliferative diabetic retinopathy
14. Blocking EMT by introduction of anti-Smad genes suppresses EMT-related ocular diseases
15. Other strategies that target TGFb/Smad signaling for prevention/treatment of ocular tissue fibrosis
16. Summary and perspective
17. Acknowledgement
18. References

1. ABSTRACT

Transforming growth factor b (TGFb) is believed to be the most important ligand in the pathogenesis of fibrotic diseases in the eye. Such ocular fibrotic diseases include scarring in the cornea and conjunctiva, fibrosis in the corneal endothelium, post-cataract surgery fibrosis of the lens capsule, excess scarring the tissue around the extraocular muscles in the strabismus surgery and proliferative vitreoretinopathy. In the proliferative stage of diabetic retinopathy, fibrogenic reaction causes tractional retinal detachment in association with contraction of the tissue. A myofibroblast, the major cellular component in the fibrotic lesions, is derived from both mesenchymal cells (in cornea and conjunctiva) and epithelial cell types (lens or retinal pigment epithelium or corneal endothelium) through epithelial-mesenchymal transition (EMT). The myofibroblasts cause excess accumulation of fibrogenic extracellular matrix with resultant tissue contraction and impaired functions. Although various cytokine signaling pathways are involved in the fibrogenic reaction in tissues, TGFb/Smad signal is the critical one. Blocking Smad signal by chemical or natural inhibitors or anti-Smad gene introduction effectively suppress fibrogenic reaction; inhibition of both fibroblast-myofibroblast conversion or EMT. Such strategies can be clinically tested.