Feasibility analysis of Triptolide's role in treating filtering bleb fibrosis after the filtration surgery of glaucoma

At present, filtration surgery remains an important treatment of glaucoma, and filtering bleb fibrosis is the main cause for treatment failure. Filtering bleb fibrosis is a common fiber hyperplastic disease, and it relates to the activation and proliferation of fibroblasts and the excessive production of extracellular matrix(ECM)such as collagen protein. The most frequently-used drugs for filtering bleb fibrosis in clinic are 5-fluoro-2,4(1h, 3h)pyrimidinedione(5-Fu)and mitomycin(MMC). Although they are effective in some degree, they also have some serious side effects which restrict their clinical use. Triptolide(TPL)is a major active component of the medicinal plant, tripterygium wilfordii hook.f.(TWHF). TPL has multiple pharmacological activities including immunosuppressive, anti-inflammatory, anti-cancer and anti-fertility activity. Reviewing related literatures published in recent ten years, we confirmed that TPL seemed to possess a pharmacological activity in treating filtering bleb fibrosis. Since it has three major functions: 1. inhibit the activation and proliferation of fibroblasts and the excessive production of collagen protein; 2. alleviate the inflammatory reaction after surgical wound to suppress fibrous scar formation; 3.TPL has a protective effect on retinal ganglion cells(RGCs). We further find that TPL's anti-fibrosis activity mainly results from that it inhibits TGF-β/Smad,NF-κB and PI3K/AKT signal transduction pathway. This comprehensive analysis about the feasibility of Triptolide's role in treating filtering bleb fibrosis after the filtration surgery of glaucoma can help us develop new drugs for filtering bleb fibrosis and exploit TPL's clinical value on some level