Stellenwert von Endothelin-1 beim Glaukom – ein kurzer Überblick

Zusammenfassung

Dieser Review-Artikel fokussiert sich auf verschiedene Aspekte der Endothelinrollen bei einem Glaukom; auf die Beteiligung von Endothelin bei anderen, vor allem vaskulären okulären Erkrankungen wird in diesem Artikel nicht im Detail eingegangen. Endothelin ist ein ubiquitäres Molekül, das in praktisch allen okulären Geweben vorhanden ist. Seine primäre physiologische Rolle ist die Steuerung des Gefäßdurchmessers und somit die Regulierung der Gewebedurchblutung. Sowohl die Sekretion als auch die Effekte des Endothelins finden lokal statt; ein Teil des Endothelins gelangt zwar in die systemische Zirkulation, jedoch ist dieser Teil variabel. Somit ist die Messung des Plasmaendothelinspiegels im venösen Blut nicht ideal für die Einschätzung der Endothelinfunktion, sowohl bei einzelnen Patienten als auch in Studienkohorten. Im Kontext der Glaukompathogenese lassen sich die wichtigsten Funktionen des Endothelins im Auge in Regulation des Augeninnendruckes, Regulation der Durchblutung und Aktivierung der Gliazellen/Astrozyten im hinteren Segment, in der Netzhaut und im Sehnerv einteilen. Bei so einem breiten Spektrum der Funktionen, die direkt bei der Pathogenese des Glaukoms involviert sind, liegt es auf der Hand, dass künftige therapeutische Ansätze beim Glaukom eine pharmakologische Modulation des Endothelins beinhalten sollten. Zu diesem Zweck ist derzeit die entsprechende Anwendung der zur Verfügung stehenden Endothelinantagonisten durch ihr ungünstiges Nebenwirkungsprofil beeinträchtigt.

Abstract

This review article is focused on the various facets of possible endothelinʼs role in glaucoma; involvement of endothelin in other ocular, in particular vascular, diseases is not specifically discussed. Endothelin is an ubiquitous molecule that occurs in practically all ocular tissues. Its primary physiological function is regulation of the blood vessel diameter and hence regulation of the blood supply in tissues. It is secreted locally, and exerts its effect also predominantly locally. This limits the value of venous blood sampling for estimation of the endothelin function in a particular patient, or in study cohorts as well. Endothelin is involved in the regulation of intraocular pressure, in the regulation of blood flow and in activation of retinal and optic nerve head astrocytes. All these functions are of high importance when it comes to pathogenesis of glaucoma. Possible future directions for glaucoma treatment should encompass pharmacological antagonism to endothelin, an avenue which is at present hindered by potentially serious side-effects of available endothelin-antagonists.

Schlüsselwörter

Endothelin-1 - Glaukom - Diagnostik

Key words

endothelin-1 - glaucoma - diagnostics

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