Faculty of Life Sciences & Medicine, King's College London, London, SE1 7EH, UK.
Department of Biology, Edge Hill University, Ormskirk, L39 4QP, UK.
Exp Eye Res. 2023 Aug;233:109561. doi: 10.1016/j.exer.2023.109561. Epub 2023 Jul 8.
Adrenaline is a sympathomimetic drug used to maintain pupil dilation and to decrease the risk of bleeding. The aim of this study was to demonstrate if adrenaline could exert antifibrotic effects in glaucoma surgery. Adrenaline was tested in fibroblast-populated collagen contraction assays and there was a dose-response decrease in fibroblast contractility: matrices decreased to 47.4% (P = 0.0002) and 86.6% (P = 0.0036) with adrenaline 0.0005% and 0.01%, respectively. There was no significant decrease in cell viability even at high concentrations. Human Tenon's fibroblasts were also treated with adrenaline (0%, 0.0005%, 0.01%) for 24 h and RNA-Sequencing was performed on the Illumina NextSeq 2000. We carried out detailed gene ontology, pathway, disease and drug enrichment analyses. Adrenaline 0.01% upregulated 26 G1/S and 11 S-phase genes, and downregulated 23 G2 and 17 M-phase genes (P < 0.05). Adrenaline demonstrated similar pathway enrichment to mitosis and spindle checkpoint regulation. Adrenaline 0.05% was also injected subconjunctivally during trabeculectomy, PreserFlo Microshunt and Baerveldt 350 tube surgeries, and patients did not experience any adverse effects. Adrenaline is a safe and cheap antifibrotic drug that significantly blocks key cell cycle genes when used at high concentrations. Unless contraindicated, we recommend subconjunctival injections of adrenaline (0.05%) in all glaucoma bleb-forming surgeries.
肾上腺素是一种拟交感神经药物,用于维持瞳孔扩张并降低出血风险。本研究旨在证明肾上腺素是否可以在青光眼手术中发挥抗纤维化作用。在成纤维细胞填充的胶原收缩测定中测试了肾上腺素,结果显示成纤维细胞收缩力呈剂量依赖性下降:基质分别减少了 47.4%(P=0.0002)和 86.6%(P=0.0036),肾上腺素浓度分别为 0.0005%和 0.01%。即使在高浓度下,细胞活力也没有明显下降。人眼Tenon 纤维也用肾上腺素(0%、0.0005%、0.01%)处理 24 小时,然后在 Illumina NextSeq 2000 上进行 RNA 测序。我们进行了详细的基因本体、途径、疾病和药物富集分析。肾上腺素 0.01%上调了 26 个 G1/S 和 11 个 S 期基因,下调了 23 个 G2 和 17 个 M 期基因(P<0.05)。肾上腺素表现出与有丝分裂和纺锤体检查点调节相似的途径富集。在小梁切除术、PreserFlo Microshunt 和 Baerveldt 350 管手术中,也在结膜下注射肾上腺素 0.05%,患者没有出现任何不良反应。肾上腺素是一种安全且廉价的抗纤维化药物,在高浓度使用时可显著阻断关键的细胞周期基因。除非有禁忌症,否则我们建议在所有青光眼造瘘手术中结膜下注射肾上腺素(0.05%)。