Pericyte dysfunction and loss of interpericyte tunneling nanotubes promote neurovascular deficits in glaucoma

Significance The current lack of understanding of the mechanisms leading to neurovascular deficits in glaucoma is a major knowledge gap in the field. Retinal pericytes regulate microcirculatory blood flow and coordinate neurovascular coupling through interpericyte tunneling nanotubes (IP-TNTs). We demonstrate that pericytes constrict capillaries in a calcium-dependent manner during glaucomatous stress, decreasing blood supply and compromising neuronal function. Moreover, ocular hypertension damages IP-TNTs and impairs light-evoked neurovascular responses. The reestablishment of calcium homeostasis in pericytes restores vascular and neuronal function, and prevents retinal ganglion cell death in glaucomatous eyes. This study provides important insights into the therapeutic potential of pericytes to counter vascular dysregulation in glaucoma.