A review of drug options in age-related macular degeneration therapy and potential new agents

Investigation of vascular endothelial dysfunction in the patients with age-related macular degeneration

PURPOSE

This study aims to evaluate the association between age-related macular degeneration (AMD) and cardiovascular disease by using the noninvasive flow-mediated dilation (FMD) test to show endothelial dysfunction as an indicator of subclinical atherosclerosis.

METHOD

Participants in this study included 30 dry AMD patients, 30 wet AMD patients, and 30 healthy controls without any systemic disease, including AMD. FMD and the intima media thickness (IMT) of the carotid artery were compared between the groups.

RESULTS

Comparison of FMD between the groups showed a 10.96% brachial artery dilation in the healthy controls, 3.99% in the dry AMD group, and 5.03% in the wet AMD group. While a significant difference was not observed between the wet and dry AMD groups, comparison of the control group to the wet and dry AMD groups yielded a significant difference. When brachial artery dilation below 7% was accepted as an abnormal FMD, 26.7% of the healthy controls, 66.7% of the dry AMD patients and 76.7% of the wet AMD patients were found to be abnormal. Similarly, while no significant difference was observed between the wet and dry AMD groups, comparison of the control group with the wet and dry AMD patients yielded a significant difference. When an IMT below 0.7 mm was accepted as abnormal, 26.7% of the healthy controls, 33.3% of the dry AMD, and 43.3% of the wet AMD were found to have an abnormal IMT. However, differences between the groups did not reach statistical significance.

CONCLUSIONS

In this study, use of the FMD test showed endothelial dysfunction among AMD patients. No significant differences were found between the dry and wet AMD patient groups.

Early and intermediate age-related macular degeneration: update and clinical review

Age-related macular degeneration (AMD) is the leading cause of irreversible central vision loss in developed countries. With the aging of population, AMD will become globally an increasingly important and prevalent disease worldwide. It is a complex disease whose etiology is associated with both genetic and environmental risk factors. An extensive decline in the quality of life and progressive need of daily living assistance resulting from AMD among those most severely affected highlights the essential role of preventive strategies, particularly advising patients to quit smoking. In addition, maintaining a healthy diet, controlling other risk factors (such as hypertension, obesity, and atherosclerosis), and the use of nutritional supplements (antioxidants) are recommendable. Genetic testing may be especially important in patients with a family history of AMD. Recently, unifying criteria for the clinical classification of AMD, defining no apparent aging changes; normal aging changes; and early, intermediate, and late AMD stages, are of value in predicting AMD risk of progression and in establishing recommendations for the diagnosis, therapeutic approach, and follow-up of patients. The present review is focused on early and intermediate AMD and presents a description of the clinical characteristics and ophthalmological findings for these stages, together with algorithms for the diagnosis and management of patients, which are easily applicable in daily clinical practice.

MEMS-enabled implantable drug infusion pumps for laboratory animal research, preclinical, and clinical applications

Innovation in implantable drug delivery devices is needed for novel pharmaceutical compounds such as certain biologics, gene therapy, and other small molecules that are not suitable for administration by oral, topical, or intravenous routes. This invasive dosing scheme seeks to directly bypass physiological barriers presented by the human body, release the appropriate drug amount at the site of treatment, and maintain the drug bioavailability for the required duration of administration to achieve drug efficacy. Advances in microtechnologies have led to novel MEMS-enabled implantable drug infusion pumps with unique performance and feature sets. In vivo demonstration of micropumps for laboratory animal research and preclinical studies include acute rapid radiolabeling, short-term delivery of nanomedicine for cancer treatment, and chronic ocular drug dosing. Investigation of MEMS actuators, valves, and other microstructures for on-demand dosing control may enable next generation implantable pumps with high performance within a miniaturized form factor for clinical applications.

Vascular endothelial growth factor attenuates Nomega-nitro-L-arginine methyl ester-induced preeclampsia-like manifestations in rats

OBJECTIVES

To verify the hypothesis that vascular endothelial growth factor (VEGF) attenuates Nomega-Nitro-L-arginine Methyl Ester (L-NAME)-induced preeclampsia-like manifestations in rats.

STUDY DESIGN

Forty pregnant Wistar rats were randomly divided into four groups: control, preeclampsia model, VEGF treatment, and VEGF prophylactic. On day 5 of gestation, L-NAME was injected subcutaneously in rats of the preeclampsia model, VEGF treatment, and VEGF prophylactic groups. VEGF was given after the occurrence of hypertension and proteinuria in the VEGF treatment group and from day 5 in the VEGF prophylactic group. Blood pressure was monitored and urine protein was assayed. Blood platelet was counted, and serum nitric oxide metabolites, endothelin-1, 6-keto-PGF-1alpha, and TXB2 were determined.

RESULTS

Blood pressure increased significantly on day 8 of gestation in the preeclampsia model and VEGF treatment groups compared with control (p < 0.05 for both) and remained elevated through the pregnancy in the preeclampsia model group. Blood pressure was significantly decreased after the administration of VEGF in the VEGF treatment group (p < 0.05). There was no significant difference in blood pressure between the VEGF prophylactic group and control (p > 0.05). Urine protein, platelet count, serum nitric oxide metabolites, endothelin-1, 6-keto-PGF-1alpha, and TXB2 were significantly different between control and the preeclampsia model group (p < 0.05), but not between control and the VEGF treatment or VEGF prophylactic groups (p > 0.05 for all).

CONCLUSION

VEGF attenuates L-NAME-induced preeclampsia-like manifestations in rats, suggesting the important role of VEGF in preeclampsia and providing a potential strategy for the prevention and treatment of preeclampsia.

Erythropoietin as a novel therapeutic agent for atrophic age-related macular degeneration

The purpose of this article is to propose a novel therapeutic approach to the treatment of age-related macular degeneration (ARMD), the leading cause of blindness in the elderly population (over 60 years of age) in developed countries. Although recent advances have been made in the treatment of the neovascular form of ARMD, there is still no effective treatment for the most prevalent atrophic form of ARMD. Although the exact etiology and molecular pathogenesis of the atrophic ARMD are not fully understood, it is believed that oxidative stress and local inflammation play a major role in the pathologic processes and that the disease is triggered by dysfunction in the retinal pigment epithelia, leading to the degeneration of macular photoreceptor cells, followed by irreversible loss of vision. Considering that erythropoietin (EPO) has antioxidant, anti-inflammatory, and neuroprotective properties, we hypothesize that it can be developed as a novel therapeutic agent for the treatment of the atrophic form of ARMD. Future studies are needed to confirm or rule out this hypothesis. If successful, such studies may also help shield the lights on molecular mechanisms of atrophic ARMD.

[Inhibition of angiogenesis in the anterior chamber of the eye]

BACKGROUND

Recent years have seen tremendous progress in our understanding of the mechanisms of neovascular diseases of the eye. Antiangiogenic treatment options are now widely used in the management of age-related maculopathy (AMD) and diabetic retinopathy. The aim of this article is to highlight some novel methods of local antiangiogenic treatment of the cornea and conjunctiva and in the anterior chamber of the eye.

METHODS

The study took the form of a literature review (PUBMED) and a review of the authors' own data.

RESULTS

Initial experience with novel inhibitors of angiogenesis, especially bevacizumab, used locally on cornea and conjunctiva is promising. Intracameral injections of VEGF inhibitors can be used to ameliorate neovascular glaucoma.

CONCLUSION

Novel antiangiogenic drugs are available for topical use in the anterior segment of the eye (as off-label use) and will improve the management of neovascular diseases affecting cornea and conjunctiva and in the anterior chamber of the eye.

New therapeutic targets in atrophic age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause of blindness in developed countries. There is no effective treatment for the most prevalent atrophic (dry) form of AMD. Atrophic AMD is triggered by abnormalities in the retinal pigment epithelium (RPE) that lies beneath the photoreceptor cells and normally provides critical metabolic support to these light-sensing cells. Secondary to RPE dysfunction, macular rods and cones degenerate leading to the irreversible loss of vision. Oxidative stress, formation of drusen, accumulation of lipofuscin, local inflammation and reactive gliosis represent the pathologic processes implicated in pathogenesis of atrophic AMD. This review discusses potential target areas for small-molecule and biologic intervention, which may lead to development of new therapeutic treatments for atrophic AMD.