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Arquivos Brasileiros de Oftalmologia

Print version ISSN 0004-2749On-line version ISSN 1678-2925

Arq. Bras. Oftalmol. vol.83 no.3 São Paulo May/June 2020  Epub May 29, 2020 


Mechanisms and biomarker candidates in pterygium development

Mecanismos e candidatos a biomarcadores no desenvolvimento do pterígio

Thiago Gonçalves dos Santos Martins1  2  3

Thomaz Gonçalves dos Santos Martins4 

1Universidade Federal de São Paulo, São Paulo, SP, Brazil.

2Ludwig Maximilians University, Munique, Alemanha.

3University of Coimbra, Coimbra, Portugal.

4Hospital da Piedade, Rio de Janeiro, RJ, Brazil

Dear Editor:

In response to the article titled “Mechanisms and biomarker candidates in pterygium development”, published in your esteemed journal, which is a well thought out and written paper, I would like to raise few points regarding this study.

Pterygium may have among its causes factors such as: changes in cholesterol metabolism, inflammation, viral infection, oncogenic proteins, lymphangiogenesis, and epithelial-mesenchymal cell transition(1). We would like to add one more factor that may be related to the pathophysiology of pterygium.

Healthy conjunctival tissues may have Nod-like receptor pyrin3 (NLRP3). In pterygium, the NLRP3/caspase-1 pathway may be abnormally activated, accompanied by aberrant expression of IL-18 and IL-1β. There is a correlation between the number of fibroblasts and NLRP3. Activation of the NLRP3/caspase-1 pathway may be a cause of angiogenesis and fibroblast proliferation, which could induce pterygium recurrence. Nod-3 (NLRP3), caspase-1, IL-18 and IL-1β pyrodynamic receptors are common markers of pyroptosis, which is a form of programmed cell death that includes the release of inflammatory factors(2-4).

Mitomycin C use in pterygium surgery reduces the recurrence rate, suppressing angiogenesis and fibroblast proliferation, inhibiting NLRP3/caspase-1 pathway activation and the expression of inflammatory factors such as TGF-β1, VEGF, and IL-6(2-4).

Funding: This study received no specific financial support.


1 Wanzeler AC, Barbosa IA, Duarte B, Borges D, Barbosa EB, Kamiji D, et al. Mechanisms and biomarker candidates in pterygium development. Arq Bras Oftalmol. 2019;82(6):528-36. [ Links ]

2 Lamkanfi M, Dixit VM. Inflammasomes and their roles in health and disease. Annu Rev Cell Dev Biol. 2012;2:137-61. [ Links ]

3 Martinon F, Burns K, Tschopp J. The inflammasome: a molecular platform triggering activation of inflammatory caspases and processing of proIl-beta. Mol Cell. 2002;10(2):417-26. [ Links ]

4 Im H, Ammit AJ. The NLRP3 inflammasome: role in airway inflammation. Clin Exp Allergy. 2014;44(2):160-72. [ Links ]

Received: December 10, 2019; Accepted: December 23, 2019

Corresponding author: Thiago Gonçalves dos Santos Martins. E-mail:

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.