Structural and molecular changes in the aging choroid: implications for age-related macular degeneration

K R Chirco; E H Sohn; E M Stone; B A Tucker; R F Mullins

doi:10.1038/eye.2016.216

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Structural and molecular changes in the aging choroid: implications for age-related macular degeneration

Journal article

Open access

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Structural and molecular changes in the aging choroid: implications for age-related macular degeneration

K R Chirco, E H Sohn, E M Stone, B A Tucker and R F Mullins

Eye (London), Vol.31(1), pp.10-25

01/2017

DOI: 10.1038/eye.2016.216

PMCID: PMC5233940

PMID: 27716746

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Abstract

Age-related macular degeneration (AMD) is a devastating disease-causing vision loss in millions of people around the world. In advanced stages of disease, death of photoreceptor cells, retinal pigment epithelial cells, and choroidal endothelial cells (CECs) are common. Loss of endothelial cells of the choriocapillaris is one of the earliest detectable events in AMD, and, because the outer retina relies on the choriocapillaris for metabolic support, this loss may be the trigger for progression to more advanced stages. Here we highlight evidence for loss of CECs, including changes to vascular density within the choriocapillaris, altered abundance of CEC markers, and changes to overall thickness of the choroid. Furthermore, we review the key components and functions of the choroid, as well as Bruch's membrane, both of which are vital for healthy vision. We discuss changes to the structure and molecular composition of these tissues, many of which develop with age and may contribute to AMD pathogenesis. For example, a crucial event that occurs in the aging choriocapillaris is accumulation of the membrane attack complex, which may result in complement-mediated CEC lysis, and may be a primary cause for AMD-associated choriocapillaris degeneration. The actions of elevated monomeric C-reactive protein in the choriocapillaris in at-risk individuals may also contribute to the inflammatory environment in the choroid and promote disease progression. Finally, we discuss the progress that has been made in the development of AMD therapies, with a focus on cell replacement.

Retinal Pigment Epithelium - pathology

Aging - physiology

Capillaries - pathology

Bruch Membrane - pathology

Humans

Risk Factors

Choroid - blood supply

Endothelial Cells - pathology

Choroid - pathology

Macular Degeneration - pathology

Details

Title: Subtitle: Structural and molecular changes in the aging choroid: implications for age-related macular degeneration
Creators: K R Chirco - Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA, USA
E H Sohn - Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA, USA
E M Stone - Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA, USA
B A Tucker - Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA, USA
R F Mullins - Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, IA, USA
Resource Type: Journal article
Publication Details: Eye (London), Vol.31(1), pp.10-25
DOI: 10.1038/eye.2016.216
PMID: 27716746
PMCID: PMC5233940
NLM abbreviation: Eye (Lond)
ISSN: 1476-5454
eISSN: 1476-5454
Publisher: England
Grant note: R01 EY024605 / NEI NIH HHS R01 EY026547 / NEI NIH HHS
Language: English
Date published: 01/2017
Academic Unit: Iowa Neuroscience Institute; Ophthalmology and Visual Sciences
Record Identifier: 9983979973602771

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