Single-cell profiling of trabecular meshwork identifies mitochondrial dysfunction in a glaucoma model that is protected by vitamin B3 treatment

  1. Nicholas Tolman
  2. Taibo Li
  3. Revathi Balasubramanian
  4. Guorong Li
  5. Violet Bupp-Chickering
  6. Ruth A. Kelly
  7. Marina Simón
  8. John Peregrin
  9. Christa Montgomery
  10. W. Daniel Stamer
  11. Jiang Qian
  12. Simon W.M. John

  • Curated by eLife

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    eLife Assessment

    This is a fundamental study that provides a detailed single-cell transcriptomic and epigenomic map of the mouse trabecular meshwor, identifying three distinct trabecular meshwor subtypes with specific functional roles. It links the glaucoma-associated transcription factor LMX1B to mitochondrial regulation in TM3 cells and demonstrates that nicotinamide treatment prevents IOP elevation in Lmx1bV265D/+ mutant mice, highlighting a potential metabolic therapeutic strategy for glaucoma. This convincing work would be further supported by data that link the transcriptional data with mitochondrial functional assays.

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Abstract

Since the trabecular meshwork (TM) is central to intraocular pressure (IOP) regulation and glaucoma, a deeper understanding of its genomic landscape is needed. We present a multimodal, single-cell resolution analysis of mouse limbal cells (includes TM). In total, we sequenced 9,394 wild-type TM cell transcriptomes. We discovered three TM cell subtypes with characteristic signature genes validated by immunofluorescence on tissue sections and whole-mounts. The subtypes are robust, being detected in datasets for two diverse mouse strains and in independent data from two institutions. Results show compartmentalized enrichment of critical pathways in specific TM cell subtypes. Distinctive signatures include increased expression of genes responsible for 1) extracellular matrix structure and metabolism (TM1 subtype), 2) secreted ligand signaling to support Schlemm’s canal cells (TM2), and 3) contractile and mitochondrial/metabolic activity (TM3). ATAC-sequencing data identified active transcription factors in TM cells, including LMX1B. Mutations in LMX1B cause high IOP and glaucoma. LMX1B is emerging as a key transcription factor for normal mitochondrial function and its expression is much higher in TM3 cells than other limbal cells. To understand the role of LMX1B in TM function and glaucoma, we single-cell sequenced limbal cells from Lmx1b V265D/+ mutant mice. In V265D/+ mice, TM3 cells were uniquely affected by pronounced mitochondrial pathway changes. This supports a primary role of mitochondrial dysfunction within TM3 cells in initiating the IOP elevation that causes glaucoma in these mice. Importantly, treatment with vitamin B 3 (nicotinamide), to enhance mitochondrial function and metabolic resilience, significantly protected Lmx1b mutant mice from IOP elevation.

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  1. eLife

    eLife Assessment

    This is a fundamental study that provides a detailed single-cell transcriptomic and epigenomic map of the mouse trabecular meshwor, identifying three distinct trabecular meshwor subtypes with specific functional roles. It links the glaucoma-associated transcription factor LMX1B to mitochondrial regulation in TM3 cells and demonstrates that nicotinamide treatment prevents IOP elevation in Lmx1bV265D/+ mutant mice, highlighting a potential metabolic therapeutic strategy for glaucoma. This convincing work would be further supported by data that link the transcriptional data with mitochondrial functional assays.

  2. eLife

    Reviewer #1 (Public review):

    Summary:

    This study provides a comprehensive single-cell and multiomic characterization of trabecular meshwork (TM) cells in the mouse eye, a structure critical to intraocular pressure (IOP) regulation and glaucoma pathogenesis. Using scRNA-seq, snATAC-seq, immunofluorescence, and in situ hybridization, the authors identify three transcriptionally and spatially distinct TM cell subtypes. The study further demonstrates that mitochondrial dysfunction, specifically in one subtype (TM3), contributes to elevated IOP in a genetic mouse model of glaucoma carrying a mutation in the transcription factor Lmx1b. Importantly, treatment with nicotinamide (vitamin B3), known to support mitochondrial health, prevents IOP elevation in this model. The authors also link their findings to human datasets, suggesting the existence of analogous TM3-like cells with potential relevance to human glaucoma.

    Strengths:

    The study is methodologically rigorous, integrating single-cell transcriptomic and chromatin accessibility profiling with spatial validation and in vivo functional testing. The identification of TM subtypes is consistent across mouse strains and institutions, providing robust evidence of conserved TM cell heterogeneity. The use of a glaucoma model to show subtype-specific vulnerability, combined with a therapeutic intervention-gives the study strong mechanistic and translational significance. The inclusion of chromatin accessibility data adds further depth by implicating active transcription factors such as LMX1B, a gene known to be associated with glaucoma risk. The integration with human single-cell datasets enhances the potential relevance of the findings to human disease.

    Weaknesses:

    Although the LMX1B transcription factor is implicated as a key regulator in TM3 cells, its role in directly controlling mitochondrial gene expression is not fully explored. Additional analysis of motif accessibility or binding enrichment near relevant target genes could substantiate this mechanistic link. The therapeutic effect of vitamin B3 is clearly demonstrated phenotypically, but the underlying cellular and molecular mechanisms remain somewhat underdeveloped - for instance, changes in mitochondrial function, oxidative stress markers, or NAD+ levels are not directly measured. While the human relevance of TM3 cells is suggested through marker overlap, more quantitative approaches, such as cell identity mapping or gene signature scoring in human datasets, would strengthen the translational connection.

    Overall, this is a compelling and carefully executed study that offers significant advances in our understanding of TM cell biology and its role in glaucoma. The integration of multimodal data, disease modeling, and therapeutic testing represents a valuable contribution to the field. With additional mechanistic depth, the study has the potential to become a foundational resource for future research into IOP regulation and glaucoma treatment.

  3. eLife

    Reviewer #2 (Public review):

    Summary:

    This elegant study by Tolman and colleagues provides fundamental findings that substantially advance our knowledge of the major cell types within the limbus of the mouse eye, focusing on the aqueous humor outflow pathway. The authors used single-cell and single-nuclei RNAseq to very clearly identify 3 subtypes of the trabecular meshwork (TM) cells in the mouse eye, with each subtype having unique markers and proposed functions. The U. Columbia results are strengthened by an independent replication in a different mouse strain at a separate laboratory (Duke). Bioinformatics analyses of these expression data were used to identify cellular compartments, molecular functions, and biological processes. Although there were some common pathways among the 3 subtypes of TM cells (e.g., ECM metabolism), there also were distinct functions. For example:

    • TM1 cell expression supports heavy engagement in ECM metabolism and structure, as well as TGF2 signaling.

    • TM2 cells were enriched in laminin and pathways involved in phagocytosis, lysosomal function, and antigen expression, as well as End3/VEGF/angiopoietin signaling.

    • TM3 cells were enriched in actin binding and mitochondrial metabolism.

    They used high-resolution immunostaining and in situ hybridization to show that these 3 TM subtypes express distinct markers and occupy distinct locations within the TM tissue. The authors compared their expression data with other published scRNAseq studies of the mouse as well as the human aqueous outflow pathway. They used ATAC-seq to map open chromatin regions in order to predict transcription factor binding sites. Their results were also evaluated in the context of human IOP and glaucoma risk alleles from published GWAS data, with interesting and meaningful correlations. Although not discussed in their manuscript, their expression data support other signaling pathways/ proteins/ genes that have been implicated in glaucoma, including: TGF2, BMP signaling (including involvement of ID proteins), MYOC, actin cytoskeleton (CLANs), WNT signaling, etc.

    In addition to these very impressive data, the authors used scRNAseq to examine changes in TM cell gene expression in the mouse glaucoma model of mutant Lmxb1-induced ocular hypertension. In man, LMX1B is associated with Nail-Patella syndrome, which can include the development of glaucoma, demonstrating the clinical relevance of this mouse model. Among the gene expression changes detected, TM3 cells had altered expression of genes associated with mitochondrial metabolism. The authors used their previous experience using nicotinamide to metabolically protect DBA2/J mice from glaucomatous damage, and they hypothesized that nicotinamide supplementation of mutant Lmx1b mice would help restore normal mitochondrial metabolism in the TM and prevent Lmx1b-mediated ocular hypertension. Adding nicotinamide to the drinking water significantly prevented Lmxb1 mutant mice from developing high intraocular pressure. This is a laudable example of dissecting the molecular pathogenic mechanisms responsible for a disease (glaucoma) and then discovering and testing a potential therapy that directly intervenes in the disease process and thereby protects from the disease.

    Strengths:
    There are numerous strengths in this comprehensive study including:
    • Deep scRNA sequencing that was confirmed by an independent dataset in another mouse strain at another university.
    • Identification and validation of molecular markers for each mouse TM cell subset along with localization of these subsets within the mouse aqueous outflow pathway.
    • Rigorous bioinformatics analysis of these data as well as comparison of the current data with previously published mouse and human scRNAseq data.
    • Correlating their current data with GWAS glaucoma and IOP "hits".
    • Discovering gene expression changes in the 3 TM subgroups in the mouse mutant Lmx1b model of glaucoma.
    • Further pursuing the indication of dysfunctional mitochondrial metabolism in TM3 cells from Lmx1b mutant mice to test the efficacy of dietary supplementation with nicotinamide. The authors nicely demonstrate the disease modifying efficacy of nicotinamide in preventing IOP elevation in these Lmx1b mutant mice, preventing the development of glaucoma. These results have clinical implications for new glaucoma therapies.

    Weaknesses:
    • Occasional over-interpretation of data. The authors have used changes in gene expression (RNAseq) to implicate functions and signaling pathways. For example: they have not directly measured "changes in metabolism", "mitochondrial dysfunction" or "activity of Lmx1b".
    • In their very thorough data set, there is enrichment of or changes in gene expression that support other pathways that have been previously reported to be associated with glaucoma (such as TGF2, BMP signaling, actin cytoskeletal organization (CLANs), WNT signaling, ossification, etc. that appears to be a lost opportunity to further enhance the significance of this work.

  4. eLife

    Reviewer #3 (Public review):

    Summary:In this study, the authors perform multimodal single-cell transcriptomic and epigenomic profiling of 9,394 mouse TM cells, identifying three transcriptionally distinct TM subtypes with validated molecular signatures. TM1 cells are enriched for extracellular matrix genes, TM2 for secreted ligands supporting Schlemm's canal, and TM3 for contractile and mitochondrial/metabolic functions. The transcription factor LMX1B, previously linked to glaucoma, shows the highest expression in TM3 cells and appears to regulate mitochondrial pathways. In Lmx1bV265D mutant mice, TM3 cells exhibit transcriptional signs of mitochondrial dysfunction associated with elevated IOP. Notably, vitamin B3 treatment significantly mitigates IOP elevation, suggesting a potential therapeutic avenue.

    This is an excellent and collaborative study involving investigators from two institutions, offering the most detailed single-cell transcriptomic and epigenetic profiling of the mouse limbal tissues-including both TM and Schlemm's canal (SC), from wild-type and Lmx1bV265D mutant mice. The study defines three TM subtypes and characterizes their distinct molecular signatures, associated pathways, and transcriptional regulators. The authors also compare their dataset with previously published murine and human studies, including those by Van Zyl et al., providing valuable cross-species insights.

    Strengths:

    (1) Comprehensive dataset with high single-cell resolution
    (2) Use of multiple bioinformatic and cross-comparative approaches
    (3) Integration of 3D imaging of TM and SC for anatomical context
    (4) Convincing identification and validation of three TM subtypes using molecular markers.

    Weaknesses:

    (1) Insufficient evidence linking mitochondrial dysfunction to TM3 cells in Lmx1bV265D mice: While the identification of TM3 cells as metabolically specialized and Lmx1b-enriched is compelling, the proposed link between Lmx1b mutation and mitochondrial dysfunction remains underdeveloped. It is unclear whether mitochondrial defects are a primary consequence of Lmx1b-mediated transcriptional dysregulation or a secondary response to elevated IOP. Additional evidence is needed to clarify whether Lmx1b directly regulates mitochondrial genes (e.g., via ChIP-seq, motif analysis, or ATAC-seq), or whether mitochondrial changes are downstream effects.
    Furthermore, the protective effects of nicotinamide (NAM) are interpreted as evidence of mitochondrial involvement, but no direct mitochondrial measurements (e.g., immunostaining, electron microscopy, OCR assays) are provided. It is essential to validate mitochondrial dysfunction in TM3 cells using in vivo functional assays to support the central conclusion of the paper. Without this, the claim that mitochondrial dysfunction drives IOP elevation in Lmx1bV265D mice remains speculative. Alternatively, authors should consider revising their claims that mitochondrial dysfunction in these mice is a central driver of TM dysfunction.

    (2) Mechanism of NAM-mediated protection is unclear: The manuscript states that NAM treatment prevents IOP elevation in Lmx1bV265D mice via metabolic support, yet no data are shown to confirm that NAM specifically rescues mitochondrial function. Do NAM-treated TM3 cells show improved mitochondrial integrity? Are reactive oxygen species (ROS) reduced? Does NAM also protect RGCs from glaucomatous damage? Addressing these points would clarify whether the therapeutic effects of NAM are indeed mitochondrial.

    (3) Lack of direct evidence that LMX1B regulates mitochondrial genes: While transcriptomic and motif accessibility analyses suggest that LMX1B is enriched in TM3 cells and may influence mitochondrial function, no mechanistic data are provided to demonstrate direct regulation of mitochondrial genes. Including ChIP-seq data, motif enrichment at mitochondrial gene loci, or perturbation studies (e.g., Lmx1b knockout or overexpression in TM3 cells) would greatly strengthen this central claim.

    (4)Focus on LMX1B in Fig. 5F lacks broader context: Figure 5F shows that several transcription factors (TFs)-including Tcf21, Foxs1, Arid3b, Myc, Gli2, Patz1, Plag1, Npas2, Nr1h4, and Nfatc2-exhibit stronger positive correlations or motif accessibility changes than LMX1B. Yet the manuscript focuses almost exclusively on LMX1B. The rationale for this focus should be clarified, especially given LMX1B's relatively lower ranking in the correlation analysis. Were the functions of these other highly ranked TFs examined or considered in the context of TM biology or glaucoma? Discussing their potential roles would enhance the interpretation of the transcriptional regulatory landscape and demonstrate the broader relevance of the findings.

    Other weaknesses:

    (1) In abstract, they say a number of 9,394 wild-type TM cell transcriptomes. The number of Lmx1bV265D/+ TM cell transcriptomes analyzed is not provided. This information is essential for evaluating the comparative analysis and should be clearly stated in the Abstract and again in the main text (e.g., lines 121-123). Including both wild-type and mutant cell counts will help readers assess the balance and robustness of the dataset.

    (2) Did the authors monitor mouse weight or other health parameters to assess potential systemic effects of treatment? It is known that the taste of compounds in drinking water can alter fluid or food intake, which may influence general health. Also, does Lmx1bV265D/+ have mice exhibit non-ocular phenotypes, and if so, does nicotinamide confer protection in those tissues as well? Additionally, starting the dose of the nicotinamide at postnatal day 2, how long the mice were treated with water containing nicotinamide, and after how many days or weeks IOP was reduced, and how long the decrease in the IOP was sustained.
    (3) While the IOP reduction observed in NAM-treated Lmx1bV265D/+ mice appears statistically significant, it is unclear whether this reflects meaningful biological protection. Several untreated mice exhibit very high IOP values, which may skew the analysis. The authors should report the mean values for IOP in both untreated and NAM-treated groups to clarify the magnitude and variability of the response.
    (4) Additionally, since NAM has been shown to protect RGCs in other glaucoma models directly, the authors should assess whether RGCs are preserved in NAM-treated Lmx1b V265D/+ mice. Demonstrating RGC protection would support a synergistic effect of NAM through both IOP reduction and direct neuroprotection, strengthening the translational relevance of the treatment.
    (5) Can the authors add any other functional validation studies to explore to understand the pathways enriched in all the subtypes of TM1, TM2, and TM3 cells, in addition to the ICH/IF/RNAscope validation?
    (6) The authors should include a representative image of the limbal dissection. While Figure S1 provides a schematic, mouse eyes are very small, and dissecting unfixed limbal tissue is technically challenging. It is also difficult to reconcile the claim that the majority of cells in the limbal region are TM and endothelium. As shown in Figure S6, DAPI staining suggests a much higher abundance of scleral cells compared to TM cells within the limbal strip. Additional clarification or visual evidence would help validate the dissection strategy and cellular composition of the captured region.

  5. Version published to 10.1101/2024.11.01.621152v1 on bioRxiv