In glaucoma, the second most common cause of blindness, an elevated intraocular pressure (IOP) is one of the risk factors for damage to the optic nerve. Currently, application of ocular hypotensive drugs is the mainstream approach to glaucoma therapy, and extensive efforts have been made to develop anti-glaucoma drugs that lower IOP. These drugs are intended either to modulate aqueous humor outflow at sites in the trabecular meshwork or ciliary muscle, [1][2][3][4][5] or to inhibit the production of aqueous humor by the ciliary body. Aqueous humor outflow consists of conventional trabecular meshwork outflow and unconventional uveoscleral outflow. It has been proposed that TM plays the major role in the regulation of normal aqueous humor outflow to maintain normal range of IOP. [6][7][8][9] At present, many ocular hypotensive agents that modulate uveoscleral outflow (such as the prostaglandin derivatives) are in use as anti-glaucoma drugs. In contrast, there are no drugs that act directly on the trabecular meshwork to increase conventional outflow, even though this constitutes approximately 90% of the normal eye's total aqueous outflow.
10)Thus, an effective modulator of conventional outflow might be capable of exerting a powerful ocular hypotensive effect and be of great value as a next-generation ocular hypotensive drug.Ethacrynic acid (ECA) is well known as a sulfhydryl (SH) reactive diuretic and a NaϪ co-transport system inhibitor, 11,12) and it has been observed to increase aqueous humor outflow and lower IOP. ECA has been reported to increase aqueous humor outflow facility in enucleated animal and human eyes and in living monkey eyes, [13][14][15][16][17] and these effects have been correlated with changes in human trabecular meshwork cell shape and cytoskeleton in vitro.18) IOP lowering also has been observed in living human eyes with glaucoma. 19) ECA thus seems to have the potential to become an ocular hypotensive agent by its targeting of the trabecular meshwork, a site at which it seems to cause reversible changes in both cell shape and attachment.18) Nevertheless, because of its possible ocular side effects, there is a need for derivatives of ECA with even greater ocular safety 16,17) and corneal penetration. 20) To broad the therapeutic index, which is shown as the ratio of doses between the IOP reducing effects and potential side effects, may lead to find the clinically useful ocular hypotensive drugs. We, therefore, synthesized thirty-two compounds and evaluated ECA derivatives that might retain the strong cytoskeletal modulating activity of ECA while having a lower cytotoxicity potential, i.e. a broader therapeutic index. The structural modifications of ECA examined involved both the phenoxyacetic acid and the acryloyl moieties. Among these, we found a new ECA derivative, SA9000, which appeared to have a broader therapeutic index. In the present study, we examined the effects of SA9000 on IOP in cats and monkeys, and also evaluated changes in corneal endothelial and epithelial morphology as surrog...