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1 From the Departments of Pharmaceutical Sciences, 2 Ophthalmology, 3 Medicine, 4 Physiology and Biophysics, 5 Biomedical Engineering, and 6 Molecular Pharmacology and Toxicology, and the 7 Will Rogers Institute Pulmonary Research Center, Schools of Pharmacy, Medicine, and Engineering, University of Southern California, Los Angeles, California.
| Abstract |
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METHODS. RCECs were grown on membrane filters to exhibit tight barrier properties (transepithelial electrical resistance, TEER,
1 k
/cm2). Uptake, efflux, and transepithelial transport of GSH were determined in the presence or absence of extracellular Na+ under conditions of inhibition of GSH biosynthesis and degradation. Uptake was determined at 15 minutes after instillation of 3H-GSH to the apical or basolateral bathing fluid. GSH efflux was estimated from the time course of release of prebiosynthesized 35S-GSH. Transepithelial transport was assessed by instillation of 3H-GSH in either the apical or basolateral bathing fluid, followed by sampling from respective contralateral sides.
RESULTS. Apical uptake and efflux showed Na+ dependency up to 65%. GSH uptake in the initial 15 minutes was linear in the presence of 1 mM GSH (labeled and unlabeled) in Na+-containing buffer. The uptake rate was higher from the apical fluid than from the basolateral fluid. A Hill analysis of the Na+-dependent process yielded a coupling ratio for Na+ to GSH of 1.25:1. The efflux rate of GSH into the apical fluid was marginally dependent on the apical presence of Na+ and was significantly greater than that in the basolateral fluid. Basolateral efflux of GSH was primarily Na+ independent, whereas basolateral uptake almost exclusively was Na+ dependent. Depolarizing the RCEC membrane potential decreased GSH efflux into either apical or basolateral fluids (5 pmol/min · 106 cells). Hyperpolarization significantly increased the rate of GSH efflux into the apical fluid (120 pmol/min · 106 cells), whereas the basolateral efflux was not affected. Apparent permeability of GSH across RCEC layers was approximately eight times higher in the basolateral-to-apical (secretion) direction than the opposite (absorption) direction.
CONCLUSIONS. GSH is transported across RCEC membranes by both Na+-dependent and -independent processes. Analysis of the Na+-dependent uptake process gave an approximate 1:1 coupling ratio for Na+-GSH cotransport. The Na+-independent component is highly sensitive to cell membrane potential. Net secretion of GSH into the apical fluid may play a role in the protection of conjunctival tissue and tear film from oxidant insults.
| Introduction |
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Glutathione (GSH) is the most abundant, endogenous thiol-containing tripeptide present in nearly all cell types. Its vital roles in cells include detoxification of electrophiles, maintenance of thiol status of proteins, free radical scavenging, provision of an intracellular store for cysteine, and participation in immunoprotection.11 No information is available to date on the metabolism, transport, or biosynthesis of GSH in normal conjunctiva, let alone the effect of tissue GSH status and metabolism on development of conjunctival diseases.
Export of GSH into the extracellular space contributes predominantly to the turnover of cellular GSH. A facilitative GSH efflux system that is Na+ independent and functions to mediate GSH transport from high millimolar tissue concentrations to micromolar levels in vascular fluid has been characterized in several cell types.12 In recent years, evidence has been presented for a role of the adenosine triphosphate (ATP)-binding cassette (ABC) transporter family as GSH carriers. Some reports suggest that organic anion transporter protein (oatp1), the hepatic basolateral organic solute transporter, and Mrp1 or -2, the ATP-dependent multidrug resistance-associated plasma membrane transport proteins (basolateral or canalicular, respectively), all mediate GSH efflux in hepatocytes.13 14 Evidence for the presence of Na+-dependent GSH uptake transporters in tissues such as the lens and liver have also been presented in recent studies,15 16 although the plasma membrane transport mechanisms with respect to asymmetry and regulation have not been studied to date.
Our laboratory has developed an air-interface culture of pigmented rabbit conjunctival epithelial cells.17 18 This culture model of conjunctival epithelial cell layers exhibits tight barrier properties17 and both active Cl- secretion and Na+ absorption.7 In this study, we have examined the metabolism and transport of GSH across primary cultured rabbit conjunctival epithelial cell (RCEC) layers. Evidence for saturable and asymmetrical transport processes for GSH in conjunctival epithelial cells is presented herein.
| Methods |
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Male, Dutch-belted pigmented rabbits, weighing 2.0 to 2.5 kg, were used for isolation of conjunctival epithelial cells, as described in detail in our previous publications.17 18 Briefly, rabbits were killed with an injection of 85 mg/kg pentobarbital sodium solution into a marginal ear vein. Conjunctival tissues were excised and incubated in 0.2% protease type XIV (Sigma, St. Louis, MO) at 37°C for 30 minutes. Epithelial cells were scraped off using a sterile scalpel blade, suspended in a minimum essential medium (S-MEM) containing 10% fetal bovine serum (FBS) and 0.5 mg/mL DNase I (Sigma, St. Louis, MO), and centrifuged at 200g for 10 minutes. After two consecutive washes of the pelleted cells with S-MEM containing 10% FBS, with filtration of resuspended cells through a 40-µm cell strainer (Becton Dickinson Labware, Franklin Lakes, NJ), the final cell pellet was resuspended in PC-1 medium (BioWhittaker, Walkersville, MD) supplemented with 2 mM L-glutamine, 100 U/mL penicillin, 100 µg/mL streptomycin, 50 µg/mL gentamicin, and 1 µg/mL amphotericin B. These cells at a density of 1.2 x 106 cells/cm2 (day 0) were then placed onto polystyrene membrane filters (12 mm diameter, 0.4 µm pore size; Clearwell; Corning-Costar, Cambridge, MA) that were precoated with a mixture of 25 µg/cm2 rat tail type I collagen (Collaborative Biomedical Products, Bedford, MA) and cultured in a humidified atmosphere of 5% CO2 and 95% air at 37°C. The volumes of the apical and basolateral compartments were 0.5 and 1.5 mL, respectively, on days 0 through 4. On day 4 and thereafter, the cells were maintained at an air interface defined by the nominal absence of the apical bathing fluid and 0.8 mL of medium present in the basolateral compartment. These air-interfaced cultures of RCEC layers were used in all our studies. Characterization using light and electron microscopy showed that primary cultures of RCEC layers contained goblet and squamous cells, with the former comprising approximately 4% in the air-interfaced configuration. A sporadic and diffuse periodic acid-Schiff (PAS)-positive staining pattern was seen in all air-interfaced cultures of RCEC layers, suggestive of the presence of mucin-secreting goblet cells.18 19 20 Ion transport characteristics of these cultures are similar to those of the excised conjunctival tissue.
Measurement of Bioelectric Parameters
Potential difference (PD) and transepithelial electrical resistance (TEER) were monitored from day 2 onward, to assess viability and barrier tightness using an epithelial voltohmmeter (EVOM; World Precision Instruments, Sarasota, FL), and the equivalent short circuit current (Ieq) was calculated using Ohms law: Ieq = PD/TEER.18
The RCEC layers were used for GSH transport studies after reaching peak electrical parameters from days 5 through 8: peak TEER of approximately 1 k
/cm2 and PD of approximately 17 mV.18
The final cell density of confluent RCEC layers was 0.65 x 106 cells/cm2 (day 7).
GSH Concentration and
-Glutamyl Transpeptidase and
-Glutamylcysteine Synthetase Expression in RCECs
The GSH level in RCEC layers was determined using the Tietze recycling assay.21
The presence of
-glutamyl transpeptidase (GGT) in RCECs and in normal conjunctival tissue was confirmed by Western blot analysis of cell proteins with an antibody kindly provided by Marie Hanigan (University of Virginia Health Sciences Center, Charlottesville, VA). The polyclonal antibody was raised against a peptide sequence consisting of 20 amino acids in the N terminus of the human GGT protein.22
Anti-rabbit IgG conjugated to horseradish peroxidase was used as the secondary antibody. A human hepatoma cell line (HepG2) was used as a positive control. Procedures for homogenization of conjunctival tissue and RCEC layers and processing for Western blot analysis were similar to that for
-glutamylcysteine synthetase (GCS), described in the next section.
Presence of the regulatory, light subunit (GCS-LS) and catalytic, heavy subunit (GCS-HS) of GCS in conjunctiva was verified by Western blot analysis of cell proteins obtained from RCEC layers and excised conjunctival tissue. Rat liver homogenates were used as a positive control for GCS. Rabbit polyclonal antibodies for GCS-LS and -HS were a gift from Terrence Cavanagh (University of Washington, Seattle, WA).
RCEC layers or excised conjunctival tissues were homogenized with the use of a tissue grinder (Pyrex brand 16 x 150 mm; Corning, Inc., Corning, NY) in a homogenizing buffer (250 mM sucrose, 10 mM phosphate [pH 7.4], with antiprotease cocktails [Sigma]). Homogenates were centrifuged at 13,000g for 10 minutes at 4°C. The supernatants were used for Western blot analysis, as described previously.23 Because the synthetic peptides used to generate GCS antibodies were linked to ovalbumin (OVA), we used an OVA-containing blocking agent in Western blot analysis. The secondary antibody was horseradish peroxidase-conjugated goat anti-rabbit IgG (Roche Molecular Biochemicals, Indianapolis, IN).
GSH Uptake
RCECs grown on 12-mm internal diameter, 0.4-µm pore size membrane filters (
0.7 x 106 cells/well) were pretreated for 30 minutes with 1 mM acivicin and 10 mM D,L-buthionine sulfoximine (BSO) in NaCl buffer composed of 135 mM NaCl, 1.2 mM MgCl2, 0.81 mM MgSO4, and 25 mM HEPES (pH adjusted to 7.4 using Tris-base) before all uptake studies.24
To dissociate GGT-mediated breakdown and resynthesis from intact GSH uptake, we performed all studies in the presence of acivicin and BSO, inhibitors of GSH breakdown and synthesis, respectively. Acivicin is an irreversible inhibitor of GGT, and BSO is an inhibitor of the rate-limiting enzyme of GSH biosynthesis GCS.11
Evidence for the expression of these two enzymes in normal rabbit conjunctival tissue and in primary RCECs was established by Western blot analysis. In initial experiments, the optimal incubation time (for assessing the linear uptake from the apical and basolateral fluids) was determined by incubating the BSO-acivicin-treated cells for 2, 5, 10, 15, 30, and 60 minutes with 3H-GSH ([glycine-2-3H]; 50 Ci/mmol, Perkin Elmer Life Sciences Inc., Boston, MA) at 2.5 µCi/mL (>98% purity estimated by HPLC) containing 1 mM unlabeled GSH in NaCl buffer. To assess temperature dependency, cellular uptake was performed in three wells per time point, individually for each fluid domain (e.g., apical or basolateral) at 37°C and 4°C. The latter data represent nonspecific binding of GSH to RCECs. Cellular uptake was terminated by suctioning off the dosing solution at indicated time points, and the accumulated cellular radioactivity was determined after three consecutive washes in ice-cold NaCl buffer, 100 mL each. RCEC layers were then cut out, and cells were lysed with a 0.5-mL mixture of 0.1% Triton X-100 and 0.1 N NaOH for 1 hour at room temperature. All transport data for labeled GSH were corrected for nonspecific adsorption at 4°C. Some RCEC layers were incubated with trypsin-EDTA (0.05% and 0.02%, respectively) for 10 minutes at 37°C to liberate the cells from the polystyrene filters, and the number of cells was then counted for normalization of GSH transport data.
Concentration Dependency and Na+ Requirement of GSH Uptake
To determine whether GSH entry into RCEC layers exhibits sodium dependency at varying GSH concentrations, apical or basolateral uptake studies were performed for 15 minutes. For this purpose, 0.01, 0.1, and 1 mM unlabeled GSH was dissolved in an NaCl or choline chloride buffer containing both 2 mM dithiothreitol (DTT) and 2.5 µCi 3H-GSH. DTT was used to maintain GSH in reduced form for the duration of incubations in our transport studies. The choline chloride buffer had the same composition as the NaCl buffer, except that 135 mM choline chloride was substituted for 135 mM NaCl.
Effect of varying the sodium concentration on GSH uptake was evaluated using the data obtained from 0.1 mM GSH uptake studies, where 2 mM DTT and 2.5 µCi 3H-GSH were present in incubation buffers containing 0, 5, 10, 20, 35, 85, or 135 mM NaCl. These buffers were prepared by mixing the NaCl and choline chloride buffers in different proportions. Uptake of GSH from apical and basolateral fluids were measured as described earlier. GSH uptake data were plotted against Na+ concentration and analyzed using the logarithmic form of the Hill equation: log [v/(Vmax - v)] = n log (S)- log K') as described earlier,25 where v, Vmax, n, and K' represent the initial velocity, maximal velocity, number of substrate binding sites, and a constant comprising multiple interaction factors and the intrinsic dissociation constant, respectively. The Hill analysis was performed by computer (Origin, ver.6.0; Microcal Software, Inc., Northampton, MA).
GSH Efflux
For GSH efflux studies, RCEC layers were prelabeled on day 6 with 10 µCi/mL 35S-cysteine (Cysteine, L-[35S]; >1000 Ci/mmol, Perkin Elmer Life Sciences Inc., Boston, MA) from both bathing fluids for 12 hours in the presence of 1 mM DTT and 1 mM acivicin. Cell layers were washed three times with respective buffers (i.e., NaCl or choline chloride buffers) before efflux measurements to remove extracellular radioactivity. Next, efflux studies were performed in fresh NaCl and choline chloride buffers. Efflux of radiolabeled compounds in RCECs to apical or basolateral bathing fluids was determined by measuring the released radioactivity in 100-µL aliquots of extracellular fluid at 1, 2, 4, 5, 15, and 30 minutes. Depolarization of an inside negative cell membrane potential was achieved by incubating RCEC layers in an apical high-K+ buffer (i.e., 135 mM KCl and 5 mM NaCl, with other ionic compositions being the same as those in NaCl buffer) for 10 to 15 minutes at 37°C, with or without the presence of 1 µM of the K+ ionophore valinomycin in both bathing fluids. Such a buffer composition creates conditions in which the buffers K+ concentration closely resembles or (by the inclusion of valinomycin) approaches that in the cytoplasm of cells, making the cell membrane potential less negative. Hyperpolarization of the cell membrane was achieved by the addition of 1 µM valinomycin to the regular NaCl incubation buffer for 10 to 15 minutes at 37°C, from either the apical or basolateral fluids, depending on the extracellular fluid compartment in which the efflux of radiolabeled compounds was being determined. Valinomycin added to the apical compartment allows K+ to escape from the high (>100 mM) cytoplasmic concentration of RCEC layers, into the NaCl incubation buffer, in which there is a low K+ concentration (5 mM), making the potential across the apical membrane more negative. The same rationale applies to basolateral membrane hyperpolarization.
Transepithelial GSH Flux
Transepithelial flux of GSH was determined by spiking the ipsilateral bathing fluid with 2.5 µCi 3H-GSH and sampling aliquots at 5, 15, 30, and 60 minutes from the contralateral bathing fluid.8
18
26
These studies were conducted in the presence of 0.01 mM unlabeled GSH in NaCl buffer at 37°C, under conditions of inhibition of GSH synthesis and degradation (pretreatment with 10 mM BSO and 1 mM acivicin, respectively). The integrity of the epithelial barrier was monitored by measuring the PD and TEER of RCEC layers, before and after flux experiments. The apparent permeability coefficient (Papp) was estimated from the steady state slope of a plot of the cumulative amount of the radiolabeled tracer appearing in the contralateral fluid versus time.18
Apparent permeability is expressed as Papp = J/(A · C0), where the steady state flux (J) of GSH is normalized by both the effective surface area (A) and initial dose concentration (C0).
Statistical Analysis
The results are expressed as the mean ± SEM for four to six determinations per data group. An unpaired, two-tailed Students t-test was used to determine the statistical difference between two group means. When comparing three or more group means, one-way analysis of variance (ANOVA) was used. Statistical significance among the group means was determined by the modified Fisher least-squares difference approach. Differences were considered statistically significant when P
0.05.
| Results |
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Requirement of Na+ for GSH uptake was examined next with the duration of these studies set at 15 minutes. Uptake data of 3H-GSH shown in Figure 2
were obtained after a 30-minute pretreatment of RCECs with both acivicin and BSO at 37°C in NaCl or choline chloride buffer. Labeled GSH uptake from either apical or basolateral fluids was competitively inhibited by unlabeled GSH and was partially Na+ dependent at all unlabeled GSH concentrations (Fig. 2)
. Apical 3H-GSH uptake was greater than basolateral uptake in the presence of Na+, except for 0.10 mM GSH, as determined by ANOVA (Fig. 2)
. It should be noted that TEER of RCEC layers (1000 ± 100
/cm2, n = 18) did not change significantly during the uptake period when incubated in Na+-containing or Na+-free buffers compared with that in the regular culture medium.
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0.4% of the original dose) was predominantly (>96%) in the form of GSH under these experimental conditions. Time-course experiments conducted up to 30 minutes in NaCl or choline chloride buffers showed that GSH efflux (picomoles per million cells) was linear for the first 5 minutes in the presence or absence of Na+ in the incubation buffer (Fig. 4)
. The apical efflux was slower with Na+-containing buffer than without Na+ in the buffer by ANOVA (Fig. 4A)
, whereas there was no significant difference between those in the presence or absence of Na+ in the basolateral fluid (Fig. 4B)
. The initial rates of efflux in the apical fluid in the presence and absence of Na+ were 50 and 90 pmol/min per 106 cells, respectively. The basolateral efflux with or without Na+ was approximately the same at 20 pmol/min per 106 cells.
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/cm2, n = 18) of the cell layers estimated before and after the experiments did not change significantly.
Transepithelial Transport of GSH in Cultured RCECs
The flux of GSH, estimated from the steady state slope of a plot of the cumulative amount of the radiolabeled tracer appearing in the contralateral fluid versus time,18
was several times higher than the paracellular passive diffusion marker mannitol and exhibited directionality unlike mannitol. Unidirectional flux in the apical-to-basolateral direction (Jab) and that in the basolateral-to-apical direction (Jba), were 37.7 pmol/h · cm2 and 308 pmol/h · cm2, respectively. Thus, net flux (Jba - Jab) of GSH was 270 pmol/h · cm2 in the basolateral-to-apical direction, suggesting net carrier-mediated GSH secretion into apical fluid. The transepithelial permeabilities (Papp = J/[A · C0]) for GSH measured in the presence and absence of Na+ ions are summarized in Table 1
. In the absorptive (i.e., apical-to-basolateral) direction, the presence or absence of Na+ in the incubation buffer of both apical and basolateral compartments made no significant difference in Papp for GSH. However, in the secretory (i.e., basolateral-to-apical) direction, the Papp for GSH was two times higher in the presence of Na+ than in its absence in the choline chloride incubation medium (Table 1)
. Additionally, basolateral-to-apical permeability for GSH was eight and four times greater than that of the apical-to-basolateral direction in the presence and absence of Na+, respectively. GSH Papp was two orders of magnitude greater than that for mannitol.
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| Discussion |
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At the outset we established the presence of biosynthetic and degradative machinery for GSH in primary cultured RCECs and in the excised conjunctival tissue. Western blot analysis showed the expression of both subunits of the rate-limiting enzyme of GSH synthesis, GCS, and of the degradative enzyme, GGT. Although there is no report on enzymatic activity or expression of GCS in conjunctiva, GGT activity was demonstrated in human tear fluid in one study.27
The 1 mM steady state concentration of GSH in primary cultured RCEC, calculated from the data in Figure 1 (assuming 510-µm radii for spherical epithelial cells) is similar to several epithelial cell types but is significantly lower than that of lens epithelium or the hepatocyte.28
The turnover rate of approximately 4 hours for GSH in conjunctiva also lies between that in liver (
2 hours) and the lens (
24 hours).11
16
28
To dissociate GGT-mediated breakdown and resynthesis from intact GSH uptake, we performed all studies in the presence of acivicin and BSO, inhibitors of GSH breakdown and synthesis, respectively. Both Na+-dependent and -independent uptake of GSH were found in RCECs. Sodium-dependent GSH uptake in RCECs was greater from apical fluid and almost exclusively mediated the GSH transport across the basolateral membrane (Fig. 2) . The Na+-dependent GSH transporter has been reported to mediate GSH uptake against a concentration gradient.29 30 Sodium-GSH cotransport has been described only in some tissues that include the eye, brain endothelium, and epithelial cells from kidney and intestine.24 29 30 31 32 33 34 35 Furthermore, in addition to sodium, other cations such as K+, Ca2+, and Mg2+ increase GSH uptake in intestine.34 35 Whereas uptake is electroneutral with monovalent cations, electrogenic transport was demonstrated with divalent cations in brush border membrane vesicle preparations.35 In our present studies, Na+-dependent GSH transport in RCECs was electroneutral. Hill analysis of Na+-coupled GSH uptake in RCEC confirmed the requirement of at least 1 mole of sodium for each 1 mole of GSH taken up (Fig. 3) . However, the exact mechanisms underlying Na+-coupled GSH transport are unknown to date.
The Na+-independent transport of GSH has been shown in a number of hepatic and nonhepatic tissues.16 The facilitative GSH transporter mediates GSH efflux under physiological conditions from high-millimolar concentrations in the cells28 to micromolar levels in extracellular fluids. The human tear film GSH concentration is approximately 110 µM.36 37 Accordingly, GSH efflux was dominant compared with uptake in RCECs. The rates of GSH efflux into either apical or basolateral fluid were significantly greater than those observed for uptake. Moreover, apical efflux rate of GSH was greater than the basolateral rate. The significantly lower apical efflux in the presence of sodium than that in its absence may be due to Na+-dependent apical reuptake of the GSH secreted into the apical fluid.
Glutathione is negatively charged at physiological pH. Hence, the resting electrochemical potential acting across cell membranes favors and essentially regulates the efflux of GSH.16 34 35 Cell membrane potential is primarily determined by the relative impermeability of cells to potassium ions. At steady state, there is a high cytoplasmic concentration of potassium compared with that of extracellular fluid levels. The presence of the K+ ionophore valinomycin caused potassium to leak from the RCECs, hyperpolarizing the existing inside-negative cell membrane potential. A more negative membrane potential resulted in an increasing GSH efflux rate into apical fluid when valinomycin was included in the apical bathing solution. Basolateral efflux did not change drastically under the same conditions. Moreover, when a buffer containing high potassium concentrations was introduced to the apical compartment in the presence or absence of valinomycin at both sides of RCEC layers, the GSH efflux into the apical and basolateral fluids was virtually abolished. High extracellular potassium (135 mM KCl and 5 mM NaCl) depolarizes the cell membrane potential, making it less negative. The presence of the ionophore valinomycin probably accelerates the equilibration of cytoplasmic and extracellular concentrations of potassium across cell membranes, but apparently was not needed to achieve the depolarizing effect on RCEC apical and/or basolateral membranes.
A composite, hypothetical scheme built from extrapolation of the rates of conjunctival GSH transport we observed to those that might be operating in vivo is presented in Figure 5 . The transport rates (uptake and efflux at each cell membrane, as well as paracellular diffusion) shown in Figure 5 were determined by making some assumptions. We assumed GSH concentrations of 0.107 and 0.015 mM for the tear side and serosal side respectively based on literature data,28 36 whereas the intracellular GSH concentration measured in this study was approximately 1 mM. The calculated unidirectional flux rates of GSH transport across each cell membrane and net movement are expressed as picomoles of GSH per hour per square centimeter. The efflux rates of GSH were significantly higher than those for uptake for both apical and basolateral membranes and thus are the determining factors for direction of net GSH flux across RCEC layers. Net GSH secretion of 1080 pmol/h · cm2 was estimated, which is the result of the vectorial sum of all flux rates. It should be noted that the permeability coefficients include a passive diffusional component of transepithelial GSH transport (which should be the same in either apical-to-basolateral or opposite direction, with a similar GSH concentration gradient across the epithelium). The net secretion of GSH in the basolateral-to-apical direction is thought to play an important role in protection of the conjunctiva from injury by exogenous toxic chemicals and oxidants. However, to what extent conjunctival GSH secretion contributes to overall levels in tear film in health and disease remains to be studied further.
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| Acknowledgements |
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| Footnotes |
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Supported by National Eye Institute Grants EY11135 (RK) and EY12356 (VHLL); National Heart, Lung, and Blood Institute Grants HL38658 (K-JK) and HL64365 (K-JK, VHLL); and American Heart Association Grant AHA-GIA 990542N. HJG is the recipient of a Predoctoral Fellowship from the American Foundation for Pharmaceutical Education.
Submitted for publication September 12, 2001; revised December 17, 2001; accepted January 2, 2002.
Commercial relationships policy: N.
The publication costs of this article were defrayed in part by page charge payment. This article must therefore be marked "advertisement" in accordance with 18 U.S.C.
1734 solely to indicate this fact.
Corresponding author: Ram Kannan, Division of GI and Liver Diseases-HMR 803A, USC School of Medicine, 2011 Zonal Avenue, Los Angeles, CA 90033; kannan{at}hsc.usc.edu
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