1. StructureLysyl Oxidase (LOX, also called protein-lysine 6-oxidase)(Genbank accession numbers: Nucleotide NM_002317.5, ProteinNP_002308.2, EC 1.4.3.13) is one of the five LOX family members(LOX and LOX Like1-4). The human LOX gene is located onchromosome 5q23.2. LOX is synthesized as a 50 kDa pre-proteincontaining 3 domains; the N-terminal signal peptide sequence(aa1-21), the N-terminal pro-peptide domain (aa 22-162), and theC-terminal catalytic domain (aa 162-417). The signal peptide isremoved by cleavage at the Cys21-Ala22 bond and the pro-peptidedomain is N-glycosylated in the endoplasmic reticulum and Golgiapparatus yielding a pro-enzyme, which is then secreted fromcells as a catalytically inactive protein. The 32 kDa active enzyme(C-terminal domain) is released by proteolytic cleavage of thepro-peptide at Gly162eAsp163 by procollagen C-proteinase (bonemorphogenetic protein 1; BMP-1) (Kagan and Li, 2003)(Fig. 1).2. FunctionLOX belongs to a family of amine oxidases. LOX was initiallyreported to be expressed andsecreted by fibrogenic cells but is nowknown to be expressed in several other cell types. LOX oxidizespeptidyl lysine and hydroxylysine residues in collagen and lysineresidues in elastin to produce peptidyl alpha-aminoadipic-delta-semialdehydes. These aldehyde modifications can spontaneouslycombine with vicinal peptidyl aldehydes or with epsilon-aminogroups of peptidyl lysine to form covalent cross-links that stabilizeand cause collagen and elastin fibers to be insoluble in the extra-cellular matrix (ECM). The significance of LOX was demonstrated inthe LOX knockout mouse, which could not survive at birth, due torupture of the aorta and diaphragm from incomplete elastin cross-linking. LOX is also essential for development of the distal andproximal airways, and the formation of alveoli in the lungs. LOX isalso critical for notochord formation and muscle development. LOXaffects differentiation of osteoblasts by forming cross-links in thesurrounding collagen matrix. These results underline the impor-tance of LOX in the morphogenesis and repair of connective tissuesof the cardiovascular, respiratory, skeletal, and other organ systems(Fongetal.,2009).LOXcanalsoinducecross-linkingbetweenlysinesin histones in the nucleus (Kagan and Li, 2003). LOX has also beenreported as a potent chemotactic agent for monocytes and vascularsmooth muscle cells.3. Disease involvementDuetotherangeofLOXbiologicalfunctions,abnormalitiesofLOXexpression underlie the development of a number of pathologicalprocesses related with an imbalance in ECM synthesis/degradation.LOX is expressed in several ocular tissues, and the followingdiseases of the eye have been linked with LOX:A. Keratoconus: Keratoconus is a corneal degeneration in whichthe extracellular matrix of the cornea loses its integrity, slowlychanging from the normal round shape to a cone shape. Onestudy reported that corneal LOX mRNA expression was signif-icantly lower in keratoconus patients when compared to theirage-matched controls. Another study showed that reducingcopper levels in tears results in keratoconus in an animalmodel. Copper is an essential cofactor for LOX activity.B. Diabetic retinopathy (DR): There are a number of reports oflower expression of LOX co-factors in DR retina samples andlower LOX cross-linking activity in vitreous samples of patientswith DR. However, theeffectofhigh glucose onLOXexpressionand enzymatic activity in cultured human retinal endothelialcells is less clear, with conflicting evidence suggesting eitherincreased or decreased LOX expression. Although discrepant,these studies indicate a potential involvement of LOX in theobserved DR phenotype.