By I. Lim Jennifer
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Additional resources for Age-Related Macular Degeneration, 2nd Edition
Locally synthesis or blood-derived) as well as the mechanisms for activation (typical cascades vs. enzymatic cleavage) remain unknown. Finally, oxidants have been implicated as important mediators and ampliﬁers in progression of renal disease (173). Direct Evidence for Innate or Antigen-Specific Immune Effectors Direct evidence for the role of immune mechanism in AMD is scant. The best data suggest an important role for macrophage-mediated innate immunity (22,50–58). Investigators have observed that choroidal macrophages appear to be important in the pathogenesis of both early and late AMD.
C3 and other complement proteins can be cleaved into biologically activated fragments by various enzyme systems, in the absence of the entire cascade, to activate certain speciﬁc cellular functions. Further, complement activation inhibitors can be produced by cells within tissues, including the RPE, serving as local protective mechanism against complement-mediated injury (20,21). Recently, several components of the complement system have been identiﬁed within Bruch’s membrane and drusen indicating a potential role for complement in AMD (22).
Amplification Mechanisms for Both Forms of Immunity Although innate or antigen-speciﬁc immunity may directly induce injury or inﬂammation, in most cases, these effectors initiate a process that must be ampliﬁed in order to produce overt clinical manifestations. Molecules generated within tissues which amplify immunity are termed “mediators”, and several categories of molecules qualify including: (i) cytokines (growth factors, angiogenic factors, others), (ii) oxidants (free radicals, reactive nitrogen), (iii) plasma-derived enzyme systems (complement, kinins, and ﬁbrin), (iv) vasoactive amines (histamine and serotonin), (v) lipid mediators [prostaglandins (PGs), leukotrienes, other eicosanoids, and platelet activating factors], and (vi) neutrophil-derived granule products.
Age-Related Macular Degeneration, 2nd Edition by I. Lim Jennifer
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