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2014 ; 54
(4
): 1-13
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Genomic and proteomic pathophysiology of pseudoexfoliation glaucoma
#MMPMID25171640
Vazquez LE
; Lee RK
Int Ophthalmol Clin
2014[Fal]; 54
(4
): 1-13
PMID25171640
show ga
PEX stems from a pathologic elastotic process involving the cross-linking gene
lysyl oxidase-like-1 (LOXL1), and is associated with abnormal formation of
elastic extracellular matrix. We previously described a protein sink model to
explain PEX material deposition on the lens capsule and other intraocular
surfaces. Recent research findings not only provide evidence to support this
hypothesis, but also further our understanding of the fundamental disease
process. A key aspect of the pathogenic process is the compromise of
blood-aqueous barrier integrity in PEXG. Decreased level of LOXL1 is associated
with decreased elastin incorporation into elastic tissues, including the elastic
lamina of blood vessels. This results in unincorporated elastin that is released
as soluble elastin, and leakage of serum proteins, inflammatory cytokines, and
extracellular matrix components into aqueous humor. This ultimately leads to
aggregation and precipitation of large protein complexes, or PEX material,
throughout intraocular surfaces as described in the protein sink model. The
pathologic PEX process also affects the biomechanical properties of elastic
tissues, such as the trabecular meshwork, lens zonules, and lamina cribrosa. This
may be part of the primary pathologic process with intrinsically altered
extracellular matrix proteins. This fundamental change in the structural
composition of these tissues may alter their rigidity, elasticity, and other
biomechanical properties. This likely contributes to increased trabecular
meshwork outflow resistance and high intraocular pressure, and mechanical injury
to retinal ganglion cell axons at the lamina cribrosa, which are conducive to
glaucoma. These pathophysiologic processes combined may underlie some of the
clinical hallmarks observed in PEXG.