Sympathetic nervous system modulates the ocular hypotensive action of MT2-melatonin receptors in normotensive rabbits

In silico drug discovery of melatonin receptor ligands with therapeutic potential

INTRODUCTION

The neurohormone melatonin (N-acetyl-5-methoxytryptamine) regulates circadian rhythms exerting a variety of effects in the central nervous system and in periphery. These activities are mainly mediated by activation of MT₁ and MT₂ GPCRs. MT₁/MT₂ agonist compounds are used clinically for insomnia, depression, and circadian rhythm disturbances.

AREA COVERED

The following review describes the design strategies that have led to the identification of melatonin receptor ligands, guided by in silico approaches and molecular modeling. Initial ligand-based design, mainly relying on pharmacophore modeling and 3D-QSAR, has been flanked by structure-based virtual screening, given the recent availability of MT₁ and MT₂ crystal structures. Receptor ligands with different activity profiles, agonist/antagonist and subtype-selective compounds, are available.

EXPERT OPINION

An insight on the pharmacological characterization and therapeutic perspectives for relevant ligands is provided. In silico drug discovery has been instrumental in the design of novel ligands targeting melatonin receptors. Ligand-based approaches has led to the construction of a solid framework defining structure-activity relationships to obtain compounds with a tailored pharmacological profile. Structure-based techniques could integrate previous knowledge and provide compounds with novel chemotypes and pharmacological activity as drug candidates for disease conditions in which melatonin receptor ligands are currently being investigated, including cancer and pain.

Decreased melatonin secretion in patients with glaucoma: Quantitative association with glaucoma severity in the LIGHT study

Glaucoma may be associated with circadian disruption due to its association with a loss of intrinsically photosensitive retinal ganglion cells. Clinical evidence demonstrating an association between glaucoma and circadian disruption is limited, and no large-scale studies have been performed. The purpose of this cross-sectional study was to determine whether the presence and severity of glaucoma is correlated with the urinary 6-sulfatoxymelatonin levels as a circadian rhythm parameter. We measured the level of urinary 6-sulfatoxymelatonin excretion (UME) in 118 glaucoma patients and 395 control participants without glaucoma. The UME in the glaucoma group was significantly lower than that of the control group without glaucoma (3.05 and 3.24 log ng/mg creatinine, respectively; P = .010). Next, we examined association of the severity of glaucoma and melatonin levels. In stratification analysis of the glaucoma groups, multivariable linear regression analyses adjusted for potential confounders indicated significantly lower UME by 0.30 log ng/mg creatinine in patients with functional severe glaucoma (visual field mean deviation ≤ -6 dB) compared with mild glaucoma (mean deviation > -6 dB; P = .040) and lower UME by 0.05 log ng/mg creatinine with each 10 μm thinning of the circumpapillary retinal nerve fiber layer thickness as the index of structural severity of glaucoma (P = .011). In conclusion, significant association between glaucoma and lower urinary 6-sulfatoxymelatonin was found. In addition, patients with functional and structural severe glaucoma were significantly associated with lower urinary 6-sulfatoxymelatonin levels. Our results indicate the possibility of a circadian disruption in patients with glaucoma.

Effect of Melatonin and Its Analogs on Tear Secretion

Melatonin has been shown to enhance tear secretion associated with dinucleotide diadenosine tetraphosphate. This study investigated the isolated action of melatonin and its analogs, agomelatine, N-butanoyl-2-(2-methoxy-6H-isoindolo[2,1-a]indol-11-yl) ethanamine (IIK7), and 5-methoxycarbonylamino-N-cetyltryptamine (5-MCA-NAT) (10 µl at 100 µM), on tear secretion when applied topically in the rabbit cornea and its relationship with the melatonin MT1, MT2, and MT3/quinone reductase QR2 receptors. The results showed a significant increase in tear secretion, with a maximal effect at 60 minutes for the agonists (138.9% ± 6.5%, 128.9% ± 6.4%, and 120.0% ± 5.2%, respectively; P < 0.05; 100% control) but not for melatonin (101.6% ± 7.9%; P > 0.05). Agonist action was tested combined with the antagonists DH97 (MT2 selective), prazosin (MT3/QR2 inhibitor), and luzindole (nonselective MT membrane receptor) (10 µl at 100 µM). DH97 reversed the effect of agomelatine, IIK7, and 5-MCA-NAT up to 30.85% ± 7.6%,108% ± 7.2%, and 87.01% ± 7.6%, respectively (P < 0.05; 100% control). Luzindole antagonized agomelatine and 5-MCA-NAT up to 67.35% ± 7.6% and 92.12% ± 8%, respectively (P < 0.05). Prazosin only reversed 5-MCA-NAT action up to 84.2% ± 7.7% (P < 0.05). These results suggest different pathways for the agonists to act through MT membrane receptors. Therefore, agomelatine, IIK7, and 5-MCA-NAT act through MT membrane receptors as secretagogues of tear secretion, and these analogs could be considered excellent therapeutic candidates for dry eye treatment. SIGNIFICANCE STATEMENT: Currently, dry eye with aqueous deficit is treated by adding artificial tears palliatively. This study shows that topical installation of three melatonin analogs (agomelatine, IIK7, and 5-MCA-NAT), but not melatonin, in therapeutic doses in the rabbit cornea significantly increases tear production, acting through different melatonin membrane receptor subtypes. Therefore, this study suggests that melatoninergic compounds could be considered excellent therapeutic candidates for dry eye treatment and ocular surface diseases occurring with a reduction in tear production.

Ocular Clocks: Adapting Mechanisms for Eye Functions and Health

Vision is a highly rhythmic function adapted to the extensive changes in light intensity occurring over the 24-hour day. This adaptation relies on rhythms in cellular and molecular processes, which are orchestrated by a network of circadian clocks located within the retina and in the eye, synchronized to the day/night cycle and which, together, fine-tune detection and processing of light information over the 24-hour period and ensure retinal homeostasis. Systematic or high throughput studies revealed a series of genes rhythmically expressed in the retina, pointing at specific functions or pathways under circadian control. Conversely, knockout studies demonstrated that the circadian clock regulates retinal processing of light information. In addition, recent data revealed that it also plays a role in development as well as in aging of the retina. Regarding synchronization by the light/dark cycle, the retina displays the unique property of bringing together light sensitivity, clock machinery, and a wide range of rhythmic outputs. Melatonin and dopamine play a particular role in this system, being both outputs and inputs for clocks. The retinal cellular complexity suggests that mechanisms of regulation by light are diverse and intricate. In the context of the whole eye, the retina looks like a major determinant of phase resetting for other tissues such as the retinal pigmented epithelium or cornea. Understanding the pathways linking the cell-specific molecular machineries to their cognate outputs will be one of the major challenges for the future.

Activation of MT2 receptor ameliorates dendritic abnormalities in Alzheimer's disease via C/EBPα/miR-125b pathway

Impairments of dendritic trees and spines have been found in many neurodegenerative diseases, including Alzheimer's disease (AD), in which the deficits of melatonin signal pathway were reported. Melatonin receptor 2 (MT2) is widely expressed in the hippocampus and mediates the biological functions of melatonin. It is known that melatonin application is protective to dendritic abnormalities in AD. However, whether MT2 is involved in the neuroprotection and the underlying mechanisms are not clear. Here, we first found that MT2 is dramatically reduced in the dendritic compartment upon the insult of oligomer Aβ. MT2 activation prevented the Aβ-induced disruption of dendritic complexity and spine. Importantly, activation of MT2 decreased cAMP, which in turn inactivated transcriptional factor CCAAT/enhancer-binding protein α(C/EBPα) to suppress miR-125b expression and elevate the expression of its target, GluN2A. In addition, miR-125b mimics fully blocked the protective effects of MT2 activation on dendritic trees and spines. Finally, injection of a lentivirus containing a miR-125b sponge into the hippocampus of APP/PS1 mice effectively rescued the dendritic abnormalities and learning/memory impairments. Our data demonstrated that the cAMP-C/EBPα/miR-125b/GluN2A signaling pathway is important to the neuroprotective effects of MT2 activation in Aβ-induced dendritic injuries and learning/memory disorders, providing a novel therapeutic target for the treatment of AD synaptopathy.

The role and therapeutic potential of melatonin in age-related ocular diseases

The eye is continuously exposed to solar UV radiation and pollutants, making it prone to oxidative attacks. In fact, oxidative damage is a major cause of age-related ocular diseases including cataract, glaucoma, age-related macular degeneration, and diabetic retinopathy. As the nature of lens cells, trabecular meshwork cells, retinal ganglion cells, retinal pigment epithelial cells, and photoreceptors is postmitotic, autophagy plays a critical role in their cellular homeostasis. In age-related ocular diseases, this process is impaired, and thus, oxidative damage becomes irreversible. Other conditions such as low-grade chronic inflammation and angiogenesis also contribute to the development of retinal diseases (glaucoma, age-related macular degeneration and diabetic retinopathy). As melatonin is known to have remarkable qualities such as antioxidant/antinitridergic, mitochondrial protector, autophagy modulator, anti-inflammatory, and anti-angiogenic, it can represent a powerful tool to counteract all these diseases. The present review analyzes the role and therapeutic potential of melatonin in age-related ocular diseases, focusing on nitro-oxidative stress, autophagy, inflammation, and angiogenesis mechanisms.

Melatonin synthesis in the human ciliary body triggered by TRPV4 activation: Involvement of AANAT phosphorylation

Melatonin is a substance synthesized in the pineal gland as well as in other organs. This substance is involved in many ocular functions, giving its synthesis in numerous eye structures. Melatonin is synthesized from serotonin through two enzymes, the first limiting step into the synthesis of melatonin being aralkylamine N-acetyltransferase (AANAT). In this current study, AANAT phosphorylation after the activation of TRPV4 was studied using human non-pigmented epithelial ciliary body cells. Firstly, it was necessary to determine the adequate time and dose of the TRPV4 agonist GSK1016790A to reach the maximal phosphorylation of AANAT. An increase of 72% was observed after 5 min incubation with 10 nM GSK (**p < 0.05, n = 6) with a concomitant rise in N-acetyl serotonin and melatonin synthesis. The involvement of a TRPV4 channel in melatonin synthesis was verified by antagonist and siRNA studies as a previous step to studying intracellular signalling. Studies performed on the second messengers involved in GSK induced AANAT phosphorylation were carried out by inhibiting several pathways. In conclusion, the activation of calmodulin and calmodulin-dependent protein kinase II was confirmed, as shown by the cascade seen in AANAT phosphorylation (***p < 0.001, n = 4). This mechanism was also established by measuring N-acetyl serotonin and melatonin levels. In conclusion, the activation of a TRPV4 present in human ciliary body epithelial cells produced an increase in AANAT phosphorylation and a further melatonin increase by a mechanism in which Ca-calmodulin and the calmodulin-dependent protein kinase II are involved.

Elevated intraocular pressure increases melatonin levels in the aqueous humour

PURPOSE

To study the levels of melatonin in the aqueous humour of normotensive and hypertensive intraocular pressure (IOP) patients and to compare them to an animal model of glaucoma.

METHODS

A total of 37 eyes of 37 patients who underwent cataract surgery were included in the study and were divided into normotensive patients, with IOP below 21 mmHg (n = 23), and hypertensive patients, with IOP > 21 mmHg (n = 14). Glaucomatous DBA/2J (n = 6) and control C57BL/6J (n = 6) mice presenting 3 and 12 months of age for each strain were also used. Human and mice aqueous humours were aspirated using a 30-gauge Rycroft cannula on a tuberculin syringe and further processed to quantify melatonin by high-performance liquid chromatography analysis.

RESULTS

Melatonin levels in normotensive patients (IOP below 21 mmHg) presented values as medians (first quartile; third quartile) of 14.62 (5.38;37.99) ng/ml (n = 23), while hypertensive patients (IOP above 21 mmHg) showed melatonin concentrations of 46.63 (10.28; 167.28) ng/ml (n = 14; p < 0.039). Glaucoma mice presented melatonin values of 0.37 (0.34; 0.59) ng/ml (at 3 months of age, before the pathology starts), which increased to 1.55 (0.94; 1.88) ng/ml (at 12 months of age, when the pathology is fully developed and IOP is maximum; n = 6, p < 0.001). Control mice did not significantly modified melatonin concentrations between 3 and 12 months of age.

CONCLUSION

Patients with high IOP present increased concentrations of melatonin in their aqueous humour compared to normotensive patients. This has been confirmed in a glaucomatous animal model in which it has been possible to see a correlation between the development of the pathology, with an increase in IOP, and a concomitant elevation of melatonin in the aqueous humour.

Rhodium-Catalyzed NH-Indole-Directed C-H Carbonylation with Carbon Monoxide: Synthesis of 6H-Isoindolo[2,1-a]indol-6-ones

An efficient synthesis of 6H-isoindolo[2,1-a]indol-6-ones through rhodium-catalyzed NH-indole-directed C-H carbonylation of 2-arylindoles with carbon monoxide has been developed. Preliminary mechanistic studies revealed that this reaction proceeds via N-H bond cleavage and subsequent C-H bond cleavage. Reaction monitoring via ESI-MS was used to support the formation of five-membered rhodacycle species in the catalytic cycle.

24-h monitoring devices and nyctohemeral rhythms of intraocular pressure

Intraocular pressure (IOP) is not a fixed value and varies over both the short term and periods lasting several months or years. In particular, IOP is known to vary throughout the 24-h period of a day, defined as a nyctohemeral rhythm in humans. In clinical practice, it is crucial to evaluate the changes in IOP over 24 h in several situations, including the diagnosis of ocular hypertension and glaucoma (IOP is often higher at night) and to optimize the therapeutic management of glaucoma. Until recently, all evaluations of 24-h IOP rhythm were performed using repeated IOP measurements, requiring individuals to be awakened for nocturnal measurements. This method may be imperfect, because it is not physiologic and disturbs the sleep architecture, and also because it provides a limited number of time point measurements not sufficient to finely asses IOP changes. These limitations may have biased previous descriptions of physiological IOP rhythm. Recently, extraocular and intraocular devices integrating a pressure sensor for continuous IOP monitoring have been developed and are available for use in humans. The objective of this article is to present the contributions of these new 24-h monitoring devices for the study of the nyctohemeral rhythms. In healthy subjects and untreated glaucoma subjects, a nyctohemeral rhythm is consistently found and frequently characterized by a mean diurnal IOP lower than the mean nocturnal IOP, with a diurnal bathyphase - usually in the middle or at the end of the afternoon - and a nocturnal acrophase, usually in the middle or at the end of the night.

Melatonin receptors trigger cAMP production and inhibit chloride movements in nonpigmented ciliary epithelial cells

Melatonin and its analog 5-MCA-NAT (5-methylcarboxyamino-N-acetyl tryptamine) are active compounds reducing intraocular pressure (IOP). This action is mediated through MT2 and the putative MT3 melatonin receptor, producing a transient reduction of IOP that lasts for a few hours and has not yet been characterized. The use of melatonin and its analog are causing a decrease in chloride efflux from rabbit nonpigmented epithelial cells (NPE), possibly explaining the decrease in IOP. Melatonin and 5-MCA-NAT inhibited rabbit NPE chloride release in a concentration-dependent manner, whereas the pD2 values were between 4.5 ± 1.2 and 4.4 ± 1.0, respectively. Melatonin hypotensive action was enhanced by the presence of MT2 antagonists, such as DH97 (N-pentanoyl-2-benzyltryptamine) and 4-P-P-DOT (4-phenyl-2-propionamidotetralin) and by the nonselective melatonin receptor antagonist luzindole. Prazosin (1.5 µM) partially reverses the melatonin action by acting as a selective MT3 antagonist. However, at 15 nM it acts as an α-adrenergic receptor antagonist, enhancing the melatonin effect. Regarding the intracellular pathways triggered by melatonin receptors, neither phospholipase C/protein kinase C pathway nor the canonical reduction of intracellular cAMP was responsible for melatonin or 5-MCA-NAT actions. On the contrary, the application of these substances produced a concentration-dependent increase of cAMP, with pD2 values of 4.6 ± 0.2 and 4.9 ± 0.7 for melatonin and 5-MCA-NAT, respectively. In summary, melatonin reduces the release of chloride concomitantly to cAMP generation. The reduction of Cl(-) secretion accounts for a decrease in the water outflow and therefore a decrease in aqueous humor production. This could be one of the main mechanisms responsible for the reduction of IOP after application of melatonin and 5-MCA-NAT.

Is the melatonin receptor type 1 involved in the pathogenesis of glaucoma?

Melatonin in the mammalian eye is synthesized by the photoreceptors and its levels show a clear daily pattern with high levels at night and lower levels during the day. It is synthesized in the ciliary body and secreted into the aqueous humor with a pattern similar to what has been reported for the retina. It acts by interacting with a family of G-protein coupled receptors that are negatively coupled with adenylate cyclase. Melatonin receptor subtypes MT1 and MT2 have been identified in the retina. Both are found in the inner nuclear layer (horizontal and amacrine cells), in the inner plexiform layer, ganglion cells (RGC) and retinal pigmented epithelium. They are also present in the ciliary body. Several studies implicate melatonin in the rhythmic regulation of intraocular pressure. MT1 and MT2 melatonin receptors are expressed in many parts of the eye. Melatonin receptors are expressed in the iris and ciliary body. Recent studies showed that mice lacking MT1 receptors have elevated intraocular pressure during the night and show a significantly reduced number of RGCs. These new studies suggest that dysfunctional melatonin signaling may be considered a possible risk factor in the pathogenesis of glaucoma and that mice deficient in MT1 receptors may be an animal model of glaucoma.

Melatonin and derivatives as promising tools for glaucoma treatment

Neurohormones melatonin and its analogues are present with an important physiological and pharmacological ability to reduce intraocular pressure (IOP); thus, they are suitable for the treatment of ocular hypertension often associated with glaucoma. It is demonstrated that two of its analogues, 5-MCA-NAT and IIK7, are more effective than melatonin to reduce IOP for a longer period of time. The research for the discovery of better compounds resulted in the development of newer and improved analogues compared to 5-MCA-NAT and IIK7. Furthermore, already commercially available drugs currently used as treatment for other pathologies, presenting a resemblance to the melatonin structure, are being tested as potential glaucoma drugs. In this sense, agomelatine, which is already used as an anti-depressant medicine, is recognized as a worthy candidate since it reduces IOP, even under hypertensive conditions. To sum up, the use of melatonin and its analogues as promising anti-glaucomatous substances is of great importance and should be given serious consideration.

Melatonin and its analog 5-methoxycarbonylamino-N-acetyltryptamine potentiate adrenergic receptor-mediated ocular hypotensive effects in rabbits: significance for combination therapy in glaucoma

Melatonin is currently considered a promising drug for glaucoma treatment because of its ocular hypotensive and neuroprotective effects. We have investigated the effect of melatonin and its analog 5-methoxycarbonylamino-N-acetyltryptamine, 5-MCA-NAT, on β₂/α(2A)-adrenergic receptor mRNA as well as protein expression in cultured rabbit nonpigmented ciliary epithelial cells. Quantitative polymerase chain reaction and immunocytochemical assays revealed a significant β₂-adrenergic receptor downregulation as well as α(2A)-adrenergic receptor up-regulation of treated cells (P < 0.001, maximal significant effect). In addition, we have studied the effect of these drugs upon the ocular hypotensive action of a nonselective β-adrenergic receptor (timolol) and a selective α₂-adrenergic receptor agonist (brimonidine) in normotensive rabbits. Intraocular pressure (IOP) experiments showed that the administration of timolol in rabbits pretreated with melatonin or 5-MCA-NAT evoked an additional IOP reduction of 14.02% ± 5.8% or 16.75% ± 5.48% (P < 0.01) in comparison with rabbits treated with timolol alone for 24 hours. Concerning brimonidine hypotensive action, an additional IOP reduction of 29.26% ± 5.21% or 39.07% ± 5.81% (P < 0.001) was observed in rabbits pretreated with melatonin or 5-MCA-NAT when compared with animals treated with brimonidine alone for 24 hours. Additionally, a sustained potentiating effect of a single dose of 5-MCA-NAT was seen in rabbits treated with brimonidine once daily for up 4 days (extra IOP decrease of 15.57% ± 5.15%, P < 0.05, compared with brimonidine alone). These data confirm the indirect action of melatoninergic compounds on adrenergic receptors and their remarkable effect upon the ocular hypotensive action mainly of α₂-adrenergic receptor agonists but also of β-adrenergic antagonists.

Melatonin receptor agonist-induced reduction of SNP-released nitric oxide and cGMP production in isolated human non-pigmented ciliary epithelial cells

The present study was designed to determine the effects of melatonin and its receptor agonists on SNP-released nitric oxide (NO) and cGMP production in aqueous humor producing cells of the ciliary body because these effects may play a role in melatonin receptor-mediated regulation of intraocular pressure (IOP). NO release protocols were carried out using human non-pigmented ciliary epithelial (hNPCE) cells treated in dye free DMEM containing l-arginine (10(-3) M). The cGMP experimental protocols were performed using dye free DMEM containing 3-isobutyl-1-methylxanthine (IBMX, 10(-4) M). The effects of varying concentrations (10(-13), 10(-11), 10(-9), 10(-7), and 10(-5) M) of melatonin, 5-MCA-NAT (putative MT(3) agonist), N-butanoyl-2-(2-methoxy-6H-isoindolo[2, 1-a]indol-11-yl)ethanamine (IIK7; selective MT(2) agonist) or S-27633-1 (selective MT(1) agonist) on sodium nitroprusside (SNP)-released NO or cGMP production were determined in separate experiments. NO and cGMP levels were measured using a colorimetric assay or enzyme immunoassay (EIA), respectively. Melatonin receptor selectivity was evaluated using luzindole (LUZ; nonselective MT(1)/MT(2) antagonist) or 4-phenyl-2-propionamidotetralin (4P-PDOT; selective MT(2) antagonist). Melatonin, 5-MCA-NAT, and IIK7 all caused concentration-dependent reduction of SNP-released NO and cGMP production. The inhibitory actions of melatonin, 5-MCA-NAT and IIK7 were either completely blocked at 10(-13), 10(-11), and 10(-9) M concentrations of the agonists or partially at 10(-7) and 10(-5) M in the presence of luzindole or 4P-PDOT. Results from this study suggest that melatonin and its analogs, 5-MCA-NAT and IIK7 inhibit SNP-released NO and cGMP production via activation of MT(2) receptors in human NPCE cells. These actions may play a role in melatonin agonist-induced regulation of aqueous humor secretion and IOP.

Melatonin: an underappreciated player in retinal physiology and pathophysiology

In the vertebrate retina, melatonin is synthesized by the photoreceptors with high levels of melatonin at night and lower levels during the day. Melatonin exerts its influence by interacting with a family of G-protein-coupled receptors that are negatively coupled with adenylyl cyclase. Melatonin receptors belonging to the subtypes MT(1) and MT(2) have been identified in the mammalian retina. MT(1) and MT(2) receptors are found in all layers of the neural retina and in the retinal pigmented epithelium. Melatonin in the eye is believed to be involved in the modulation of many important retinal functions; it can modulate the electroretinogram (ERG), and administration of exogenous melatonin increases light-induced photoreceptor degeneration. Melatonin may also have protective effects on retinal pigment epithelial cells, photoreceptors and ganglion cells. A series of studies have implicated melatonin in the pathogenesis of age-related macular degeneration, and melatonin administration may represent a useful approach to prevent and treat glaucoma. Melatonin is used by millions of people around the world to retard aging, improve sleep performance, mitigate jet lag symptoms, and treat depression. Administration of exogenous melatonin at night may also be beneficial for ocular health, but additional investigation is needed to establish its potential.

Ocular disorders and the utility of animal models in the discovery of melatoninergic drugs with therapeutic potential

INTRODUCTION

  The pineal indole-derived hormone melatonin is a modulator of circadian and seasonal rhythms with an important role in ocular health and disease. This could be due to specific melatonin receptors that have been identified in structures such as cornea, lens, ciliary body, retina, choroid and sclera. In addition, a local synthesis of melatonin occurs in several of these ocular tissues.

AREAS COVERED

The authors review existing literature on the most common animal models where ocular melatonin actions have been tested. The therapeutic potential of melatonin in diabetic keratopathy and retinopathy, keratitis, cataracts, glaucoma, uveitis, age-related macular degeneration and retinitis pigmentosa is discussed. Furthermore, the authors comment on the usefulness of different animal models for the development of melatoninergic drugs with therapeutic potential.

EXPERT OPINION

The use of animals for the study of ocular diseases and the potentiality of melatonin and its analogs, as future therapeutic drugs, should be performed on the basis of a rationale study. It is important to note that melatonin receptors seem to be widespread all over the eye. This strongly suggests that, in order to modify the physiology and biochemistry of malfunctioning ocular tissue, the melatonin receptors which are present in that tissue must be first identified. Second there is the need to confirm that those receptors targeted perform the desirable responses, and as a third measure, to use selective agonists (or antagonists) instead of melatonin. However, although some animals mimic ocular pathologies relatively well, and these can be used in melatonin studies, there is still a long way to go till some of the results obtained in animal models could be used for human therapy.

Involvement of carbonic anhydrases in the ocular hypotensive effect of melatonin analogue 5-MCA-NAT

We have previously demonstrated that melatonin and its analogue, 5-methoxycarbonylamino-N-acetyltryptamine (5-MCA-NAT), reduce intraocular pressure (IOP) in New Zealand rabbits. More recently, we have shown that 5-MCA-NAT can also regulate ciliary adrenoceptor gene expression. Like adrenoceptors, carbonic anhydrase (CA) enzymes are involved in aqueous humour secretion by the ocular ciliary epithelium. Moreover, CA enzymes have been reported to be regulated by melatonin. Hence, the aim of this study was to investigate whether the hypotensive effect of 5-MCA-NAT is also because of a regulation of CA genes and enzymes. Time course of 5-MCA-NAT effect on rabbit IOP was followed for 7 hr every day for up to 144 hr (6 days). 5-MCA-NAT reduced IOP, maximally by 51.30 ± 2.41% (at 3 hr), and the hypotensive effect was maintained for up to 96 hr with a single application. IOP studies with 5-MCA-NAT plus Trusopt(®) and immunohistochemical analysis confirmed that CA are molecular targets of 5-MCA-NAT. In addition, real-time quantitative PCR (qPCR) and immunocytochemical assays were performed to determine changes in CA2 (CAII) and CA12 (CAXII) expression in cultured rabbit nonpigmented ciliary epithelial cells (NPE) treated with 5-MCA-NAT. NPE cells showed a prominent decrease in both CA, at the mRNA and protein levels. These data confirm that the long-term hypotensive effect of 5-MCA-NAT is also due, to a down-regulation of CA2 (CAII) and CA12 (CAXII) expression.

Removal of melatonin receptor type 1 increases intraocular pressure and retinal ganglion cells death in the mouse

Previous studies have demonstrated that melatonin is effective in lowering intraocular pressure and that it may also protect ganglion cells. We have recently reported that, in mice lacking the melatonin receptors type 1, 25-30% ganglion cells die out by 18months of age, suggesting that these receptors might be important for ganglion cells survival. In this study we show that the loss of ganglion cells is specific for melatonin receptors type 1 knock-out since mice lacking the melatonin receptors type 2 did not show any significant change in the number ganglion cells during aging. Furthermore, we report that melatonin receptors type 1 knock-out mice have higher intraocular pressure during the nocturnal hours than control or melatonin receptors type 2 knock-out mice at 3 and 12months of age. Finally, our data indicate that administration of exogenous melatonin in wild-type, but not in melatonin receptors type 1 knock-out, can significantly reduce intraocular pressure. Our studies indicate that the decreased viability of ganglion cells observed in melatonin receptors type 1 knock-out mice may be a consequence of the increases in the nocturnal intraocular pressure thus suggesting that intraocular pressure levels at night and melatonin signaling should be considered as risk factor in the pathogenesis of glaucoma.

5-MCA-NAT does not act through NQO2 to reduce intraocular pressure in New-Zealand white rabbit

Solid data support the idea that the MT(3) melatonin binding site is an enzyme, quinone reductase 2 (NQO2), rather than a membrane melatonin receptor. However, the melatonin analogue, 5-methoxycarbonylamino-N-acetyltryptamine (5-MCA-NAT), reduces intraocular pressure (IOP) via MT(3) melatonin receptors. Therefore, the aim of this work was to test whether the melatonin binding site, MT(3), is indeed the enzyme NQO2 in New Zealand rabbit eyes. To investigate this, the action of several substrates and inhibitors for NQO2 was compared to 5-MCA-NAT in their ability to modify IOP. Also, the effect of 5-MCA-NAT on IOP produced after NQO2 silencing by means of a siRNA was determinated. Altogether, the results led us to conclude that the in vivo effect of the MT(3) ligand 5-MCA-NAT on IOP is not mediated by the enzyme NQO2, suggesting the existence of another melatonin receptor.

New treatments for ocular hypertension

Glaucoma is a neurodegenerative pathology that affects the optic nerve producing blindness. This disease is often a consequence of an abnormal increase of intraocular pressure (IOP) due to a reduction in the ability of the eye to drain a transparent fluid termed aqueous humour. The dynamics of the aqueous humour is highly controlled by the autonomic nervous system, mainly the sympathetic, regulating its production and parasympathetic controlling the evacuation of aqueous humour. This has led pharmaceutical companies to develop chemicals which, by acting via different targets can substantially reduce IOP. Parasympathomimetics, adrenergic antagonists, plus eventually adrenergic agonists, are commonly used for the reduction of IOP and therefore for treatment of glaucoma. New substances linked to the nervous system that innervates the eye are emerging as interesting candidates. Nucleotides, commonly costored with catecholamines or acetylcholine or the indole melatonin, present interesting properties reducing IOP. Moreover new technological ideas such as the use of siRNA (small interference RNA) to silence protein expression demonstrate the relevance of this method to approach ocular hypertension and glaucoma from a different point of view. These three main groups of molecules: nucleotides, melatonins and siRNAs, are reviewed since they appear as firm candidates for the treatment of glaucoma in the near future.