What we already know about the adverse ocular effects of steroids can provide essential clues to testing new compounds. For Mapracorat, pre-clinical studies went beyond IL-6 levels to demonstrate that it could also attenuate other inflammation-associated cellular signaling events, such as increases in IL-1β, IL-8 and TNF-α in human ocular cells, similar to either dexamethasone or triamcinolone.31 In corneal epithelial cells, this same partial GR agonist inhibits hyperosmolar-induced cytokine release and MAPK pathways, suggesting a potential use in the therapy of dry eye. And in cultured human TM cells, it’s been shown that Mapracorat increases myocilin expression and secretion levels by only half of that seen with either dexamethasone or prednisolone.32 The close association between steroid-induced elevation of myocilin and steroid effects on IOP suggests that compounds like Mapracorat may represent an important step in the development of newer, better ocular steroid therapies.