Fuchs endothelial corneal dystrophy: The vicious cycle of Fuchs pathogenesis.

Fuchs endothelial corneal dystrophy: The vicious cycle of Fuchs pathogenesis.
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DOI:
10.1016/j.preteyeres.2020.100863
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发表时间:
2021-01
影响因子:
17.8
通讯作者:
Jurkunas UV
Jurkunas UV
中科院分区:
医学1区
文献类型:
--
作者:
Ong Tone S;Kocaba V;Böhm M;Wylegala A;White TL;Jurkunas UV

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Fuchs角膜内皮营养不良(FECD)是最常见的原发性角膜内皮营养不良,也是全球角膜移植的主要适应症。FECD的特征在于角膜内皮细胞(CEC)的进行性衰退和后弹力层(DM)中细胞外基质(ECM)赘生物(称为guttae)的形成,其导致角膜水肿和视力丧失。FECD通常在50岁时出现,在妇女中的发病率更高。FECD是一种复杂的异质性遗传疾病,其中遗传和环境因素之间的相互作用导致细胞凋亡和异常ECM沉积。在这篇综述中,我们将讨论一个复杂的相互作用的遗传,表观遗传和外源性因素在煽动氧化应激,自动(线粒体)吞噬,未折叠的蛋白质反应,和线粒体功能障碍CEC变性。具体而言,我们探讨了影响细胞命运的因素进行凋亡,衰老,内皮细胞间质转化。这些发现将突出异常CEC-DM相互作用在触发FECD发病机制的恶性循环中的重要性。我们还将回顾FECD患者的临床特征、诊断工具以及当前的内科和外科治疗选择。FECD发病机制中的这些新范例为开发用于治疗FECD的新疗法提供了机会。
Fuchs endothelial corneal dystrophy (FECD) is the most common primary corneal endothelial dystrophy and the leading indication for corneal transplantation worldwide. FECD is characterized by the progressive decline of corneal endothelial cells (CECs) and the formation of extracellular matrix (ECM) excrescences in the Descemet’s membrane (DM), called guttae, that lead to corneal edema and loss of vision. FECD typically manifests in the fifth decades of life and has a greater incidence in women. FECD is a complex and heterogeneous genetic disease where interaction between genetic and environmental factors results in cellular apoptosis and aberrant ECM deposition. In this review, we will discuss a complex interplay of genetic, epigenetic, and exogenous factors in inciting oxidative stress, auto(mito)phagy, unfolded protein response, and mitochondrial dysfunction during CEC degeneration. Specifically, we explore the factors that influence cellular fate to undergo apoptosis, senescence, and endothelial-to-mesenchymal transition. These findings will highlight the importance of abnormal CEC-DM interactions in triggering the vicious cycle of FECD pathogenesis. We will also review clinical characteristics, diagnostic tools, and current medical and surgical management options for FECD patients. These new paradigms in FECD pathogenesis present an opportunity to develop novel therapeutics for the treatment of FECD.
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