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. 2022 Feb 10;2(2):105–114. doi: 10.1038/s43587-021-00167-8

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© The Author(s) 2022

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Extended Data Fig. 5 — Normal 3β-HSD activity ensures the high turnover rate required by the meibomian gland to sustain its homeostasis. Aging attenuates meibomian NAD⁺-dependent steroidogenic activity, leading to MGD and MGD-associated dry eye disease. NAD⁺ precursor instillation on eyes restores NAD⁺-dependent enzymatic activity of 3β-HSD, which in turn recovers meibomian gland acinar cell proliferation and mitigates MGD. Hsd3b6 and its human counterpart HSD3B1 are the isozyme responsible for the meibomian gland tissue local 3β-HSD activity.