The ROCK‐inhibitor ripasudil suppresses the expression of extracellular matrix proteins in Fuchs endothelial corneal dystrophy

Abstract

AbstractPurpose: Fuchs endothelial corneal dystrophy (FECD) is characterized by a progressive loss of human corneal endothelial cells (HCEC) and excess deposition of extracellular matrix (ECM). As FECD pathophysiology involves Rho‐associated kinase (ROCK) signalling activation, we investigated the effect of various ROCK inhibitors on the expression of ECM proteins and proteolytic enzymes using ex vivo and in vitro models.Methods: Endothelial cell‐Descemet membrane lamellae (DM) from donor corneas (n = 20) and FECD patients (n = 100) undergoing Descemet membrane endothelial keratoplasty were used as ex vivo model. A human corneal endothelial cell line (HCEC‐12) served as in vitro model. Rho‐ROCK signalling pathway components and the effects of the ROCK inhibitors ripasudil (10/30 μM), Y‐27632 (10/30 μM), and netarsudil (1 μM) on the expression of ECM proteins and proteolytic enzymes were analysed, with or without addition of transforming growth factor β1 (TGFβ1, 5 ng/ml), using quantitative real‐time PCR and Western Blot analysis.Results: Constitutive expression of components of the Rho‐ROCK signalling pathway was higher in DM specimens from FECD patients compared to DM from normal donors. Stimulation with all three ROCK inhibitors significantly downregulated the expression of ECM genes, such as collagen 3 alpha 1 (COL3A1) and fibronectin 1 (FN1), in both FECD and normal DM as well as in HCEC‐12, compared to untreated controls, with ripasudil showing the most significant effect. Downregulation of COL1A1 and FN1 by ripasudil was verified on protein level as well. Ripasudil also suppressed the TGFβ‐induced expression and phosphorylation of downstream molecules of the TGFβ pathway (SMAD2) as well as of the Rho‐ROCK pathway (MLC2). Ripasudil further upregulated gene expression of proteolytic enzymes, e.g. matrix metalloproteinase 1 (MMP1) and MMP3.Conclusions: These findings suggest that inhibition of ROCK signalling in FECD patients may have a beneficial effect by suppressing expression and stimulating turnover of abnormal ECM components.