Klin Monbl Augenheilkd 2023; 240(02): 125-129
DOI: 10.1055/a-1965-0044
Übersicht

Glaucoma as a Neurodegenerative and Inflammatory Disease

Das Glaukom ist eine neurodegenerative und neuroinflammatorische Erkrankung
Verena Prokosch
Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
,
Panpan Li 
Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
,
Xin Shi 
Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
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Abstract

Glaucoma is a neurodegenerative disease that leads to irreversible loss of vision through degeneration of the retinal ganglia cells (RGCs). Glaucoma is one of the most frequent causes of blindness in the world. Intraocular pressure is the main risk factor for the occurrence and development of this disease. Treatment is largely based on reducing internal optical pressure. However, some patients may deteriorate or become blind, despite normal or reduced internal optical pressure. The pathophysiological details are still unclear. Neuroinflammatory processes are also apparently an additional cause. In principle, innate or local responses of the adaptive immune system can be distinguished. The reaction of the innate immune system, particularly the local microglial cells, has long been studied. The macroglia with the astrocytes and Müller cells and their homeostatic effects have also long been known. On the other hand, it has long been thought that the retina with its RGZs was inert to adaptive immunological reactions – due to the function of the blood brain barrier. However, this system may be disturbed by antigen presentation, leading to a reaction of the adaptive immune system, with B cell and T cell responses. In this context, the key proteins are presumably heat shock proteins. We now know that neuroinflammation is important in glaucoma, as in other neurodegenerative diseases. It is important to increase our understanding of these phenomena. In this review article, we present our current knowledge of the role of the micro- and macroglia, the adaptive immune system, and the heat shock proteins.

Zusammenfassung

Das Glaukom ist eine neurodegenerative Erkrankung, die zu irreversiblem Sehverlust durch Degeneration der retinalen Ganglienzellen (RGZ) führt. Glaukom ist weltweit eine der häufigsten Ursachen für Erblindung. Der Augeninnendruck ist der Hauptrisikofaktor für das Entstehen und Fortschreiten der Erkrankung. Die Senkung des Augeninnendrucks ist die Hauptstütze der Behandlung. Trotz normalem oder gesenktem Augeninnendruck zeigen einige Patienten jedoch eine Verschlechterung bis hin zur Erblindung. Die genaue Pathophysiologie ist dabei nach wie vor unklar. Eine der weiteren Ursachen scheinen neuroinflammatorische Prozesse zu sein. Prinzipiell kann man dabei zwischen Antworten des innaten oder lokalen sowie des adaptiven Immunsystems unterscheiden. Die Reaktion des innaten Immunsystems, vor allem der lokalen Mikrogliazellen, ist dabei schon länger untersucht worden. Aber auch die Makroglia mit den Astrozyten und Müller-Zellen und ihrer homöostatischen Wirkung sind bereits länger bekannt. Bezüglich des adaptiven Immunsystems galt die Netzhaut mit ihren RGZs hingegen aufgrund der funktionierenden Blut-Hirn-Schranke lange Zeit inert gegenüber adaptiven immunologischen Reaktionen. Kommt es jedoch zu Störungen desselben mit Antigenpräsentation, kann es auch zu einer Reaktion des adaptiven Immunsystems mit Antwort der B- und T-Zellen kommen. Schlüsselproteine in diesem Kontext sind vermutlich die Hitzeschockproteine. Heute weiß man, dass die Neuroinflammation beim Glaukom wie auch bei anderen neurodegenerativen Erkrankungen eine wichtige Rolle spielt. Das weitere Verständnis derselben ist von großer Bedeutung. In dieser Übersichtsarbeit wollen wir die Rolle der Mikro- und Makroglia, des adaptiven Immunsystems und der Hitzeschockproteine und das Wissen dazu präsentieren.

Key words

glaucoma - neuroinflammation - neurodegeneration

Schlüsselwörter

Glaukom - Inflammation - Neurodegeneration


Publication History

Received: 17 August 2022

Accepted: 18 October 2022

Accepted Manuscript online:
20 October 2022

Article published online:
22 February 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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