Derzeitiger Stand zur primären Neuroprotektion beim Glaukom

Zusammenfassung

Angesichts der zunehmenden Alterung unserer Gesellschaft wird es in den kommenden Jahren zu einem Anstieg von starken Sehbinderungen und Erblindungen, auch durch das Glaukom, kommen. Aktuell beschränken sich die Therapieoptionen lediglich auf die Behandlung der Symptome, was im besten Fall zu einer Verlangsamung der Progression führt, jedoch nicht zur Heilung. Es ist daher notwendig, neue Therapiestrategien zu entwickeln, um das Glaukom adäquat und effektiv behandeln zu können und damit die Lebensqualität der Betroffenen zu verbessern. Ein möglicher Ansatz scheint die primäre Neuroprotektion darzustellen, die unabhängig von einer Drucksenkung wirkt. Es gibt Hinweise, dass Komponenten des Immunsystems eine Rolle im Rahmen der Erkrankung bzw. des Unterganges der retinalen Ganglienzellen spielen. So wurden Hinweise auf eine Beteiligung von Hitzeschockproteinen, des Komplementsystems, aber auch von Mikrogliazellen gefunden. Daher scheint eine therapeutische Modulation dieser Faktoren ein interessanter neuer Angriffspunkt für die Neuroprotektion zu sein. Untersuchungen im Tiermodell zeigten bspw., dass eine Inhibition des Komplementsystems oder der Mikroglia zu einem Schutz führt. Durch eine Modulation der Hitzeschockproteine könnten entweder deren protektive Eigenschaften gefördert oder ihre schädliche Funktion gehemmt werden, um so einen Glaukomschaden zu verhindern. Diese neuroprotektiven Ansätze könnten in Zukunft die Therapieoptionen von Glaukompatienten erweitern.

Abstract

In view of the aging members of our society, there will be an increase in severe visual impairment and blindness, also due to glaucoma, in the coming years. Therapy options are limited to treat occurring symptoms. Currently, only a deceleration of the pathogenesis progression, but no cure, is available. Therefore, it is necessary to develop new therapeutic strategies to treat glaucoma adequately and effectively, thus improving the quality of life of those affected. One possible approach seems to be primary neuroprotection, which acts independently of an intraocular pressure reduction. There are indications that components of the immune system play a role in the context of the disease or the loss of retinal ganglion cells. Thus, evidence of an involvement of heat shock proteins, the complement system, but also, for example, microglial cells, were found. To this end, therapeutic modulation of these factors seems to be an interesting new target for neuroprotection. Studies in animal models have shown that an inhibition of the complement system or microglia leads to a protection. Modulation of heat shock proteins may enhance their protective properties or inhibit their destroying function to prevent glaucoma damage. These neuroprotective substances could expand the treatment options of glaucoma patients in the future.

Schlüsselwörter

Glaukom - Neuroprotektion - Komplementsystem - Hitzeschockprotein - Mikroglia

Key words

glaucoma - neuroprotection - complement system - heat shock protein - microglia

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