Claudin 5 (Cldn5) is a critical tight junction protein essential for maintaining paracellular barrier integrity across endothelial and epithelial cells in barrier-forming tissues, including the blood–brain barrier and blood–retinal barrier. Cldn5 plays a central role in regulating vascular permeability, immune responses, and tissue homeostasis. The complex distribution and organ-specific regulation of Cldn5 underscore its potential as a promising therapeutic target. This review comprehensively analyzes the role of Cldn5 in endothelial and epithelial barrier function, its regulation of vascular permeability, and the discrepancies in the literature regarding its expression, regulation, and function in both physiological and pathological conditions across multiple organ systems, including the retina, brain, lung, heart, gut, kidney, liver, skin, and peripheral nerves, while emphasizing its tissue-specific expression patterns. We discuss how both reduced and excessive expressions of Cldn5 can disrupt barrier integrity and contribute to the pathogenesis of ischemic retinopathies, neuroinflammation, cardiovascular injury, and other forms of barrier dysfunction. Furthermore, we explore the dual role of Cldn5 as both a biomarker and a therapeutic target, highlighting emerging strategies such as RNA silencing, pharmacological stabilizers, and transcriptional modulators in controlling barrier leakage in disease conditions.

Diabetic retinopathy, a major cause of vision loss, is characterized by neurovascular changes in the retina. The lack of effective treatments to preserve vision in diabetic patients remains a significant challenge. A previous study from our laboratory demonstrated that 12-week treatment with MDL 72527, a pharmacological inhibitor of spermine oxidase (SMOX, a critical regulator of polyamine metabolism), reduced neurodegeneration in diabetic mice. Utilizing the streptozotocin-induced diabetic mouse model and MDL 72527, the current study investigated the effectiveness of SMOX inhibition on the measures of vision impairment and neuro-glial injury following 24 weeks of diabetes. Reductions in visual acuity, contrast sensitivity, and inner retinal function in diabetic mice were improved by MDL 72527 treatment. Diabetes-induced changes in neuronal-specific class III tubulin (Tuj-1), synaptophysin, glutamine synthetase, and vimentin were attenuated in response to SMOX inhibition. In conclusion, our findings show that SMOX inhibition improved visual acuity, contrast sensitivity, and inner retinal function and mitigated diabetes-induced neuroglial damage during long-term diabetes. Targeting SMOX signaling may provide a potential strategy for reducing retinal neuronal damage and preserving vision in diabetes.