Journal
RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES
Volume 30, Issue 9, Pages 1350-1367Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/IAE.0b013e3181f57e30
Keywords
age-related macular degeneration; angiogenesis; choroidal neovascularization; complement; geographic atrophy; neuroprotection; oxidative damage; treatment
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Funding
- Lincy Foundation
- Foundation Fighting Blindness
- National Eye Institute
- Advanced Cell Technology
- Research to Prevent Blindness
- Janice Mitchell Vassar and Ashby John Mitchell Fellowship
- Joseph J. and Marguerite DiSepio Retina Research Fund
- New Jersey Lions Eye Research Foundation
- Eye Institute of New Jersey
- Alexion Pharmaceuticals
- Carl Zeiss Meditec
- Potentia Pharmaceuticals
- CoMentis
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Purpose: To review treatments under development for age-related macular degeneration (AMD) in the context of current knowledge of AMD pathogenesis. Methods: Review of the scientific literature published in English. Results: Steps in AMD pathogenesis that appear to be good targets for drug development include 1) oxidative damage; 2) lipofuscin accumulation; 3) chronic inflammation; 4) mutations in the complement pathway; and 5) noncomplement mutations that influence chronic inflammation and/or oxidative damage (e. g., mitochondria and extracellular matrix structure). Steps in neovascularization that can be targeted for drug development and combination therapy include 1) angiogenic factor production; 2) factor release; 3) binding of factors to extracellular receptors (and activation of intracellular signaling after receptor binding); 4) endothelial cell activation (and basement membrane degradation); 5) endothelial cell proliferation; 6) directed endothelial cell migration; 7) extracellular matrix remodeling; 8) tube formation; and 9) vascular stabilization. Conclusion: The era of pathway-based therapy for the early and late stages of AMD has begun. At each step in the pathway, a new treatment could be developed, but complete inhibition of disease progression will likely require a combination of the various treatments. Combination therapy will likely supplant monotherapy as the treatment of choice because the clinical benefits (visual acuity and frequency of treatment) will likely be superior to monotherapy in preventing the late-stage complications of AMD. RETINA 30: 1350-1367, 2010
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