Age-related macular degeneration (AMD) is a late-onset, multifactorial, neurodegenerative disease of the retina and the leading cause of irreversible vision loss in the elderly in the Western world. We describe here a murine model that combines three known AMD risk factors: advanced age, high fat cholesterol-rich (HF-C) diet, and apolipoprotein E (apoE) genotype. Eyes of aged, targeted replacement mice expressing human apoE2, apoE3, or apoE4 and maintained on a HF-C diet show apoE isoform-dependent pathologies of differential severity. ApoE4 mice are the most severely affected. They develop a constellation of changes that mimic the pathology associated with human AMD. These alterations include diffuse sub-retinal pigment epithelial deposits, drusenoid deposits, thickened Bruch's membrane, and atrophy, hypopigmentation, and hyperpigmentation of the retinal pigment epithelium. In extreme cases, apoE4 mice also develop marked choroidal neovascularization, a hallmark of exudative AMD. Neither age nor HF-C diet alone is sufficient to elicit these changes. We document choroidal neovascularization and other AMD-like ocular pathologies in an animal model that exploits known AMD risk factors. The model is additionally attractive because it is not complicated by invasive experimental intervention. Our findings in this model implicate the human apoE E4 allele as a susceptibility gene for AMD and support the hypothesis that common pathogenic mechanisms may underlie AMD and Alzheimer's disease.amyloid ͉ choroidal neovascularization ͉ macula ͉ retinal pigment epithelium ͉ cholesterol A ge-related macular degeneration (AMD) is the leading cause of irreversible vision loss in people over the age of 65, accounting for the majority of registered blindness in Western Europe and North America (1). A family of disorders, AMD is characterized by progressive loss of central, high-acuity vision due to dysfunction and death of photoreceptors (PRs) in the center of the retina, the macula. AMD pathology also impacts the retinal pigment epithelium (RPE, the cells responsible for support of PRs and maintenance of the choroidal blood-eye barrier), the choriocapillaris (CC, the primary capillary bed of the choroid), and Bruch's membrane (BrM, a stratified extracellular matrix between the RPE and the CC). Early AMD is characterized by moderate vision loss associated with characteristic extracellular lesions that form between the RPE and BrM. These lesions can be focal (drusen) or diffuse (basal deposits) (2-4). Late AMD is subdivided into two forms, dry or wet. Dry (geographic atrophy) is characterized by PR loss causing severe visual impairment concomitant with extensive RPE atrophy, whereas wet (exudative) features the sequela of choroidal neovascularization (CNV, i.e., in growth of the CC through BrM and under the RPE in the plane of drusen and basal deposits) (5).AMD is a complex disease in which the contributions of many genetic and environmental factors are confounding. The strongest known risk factor for AMD is advanced age, with the ri...

The aryl hydrocarbon receptor (AhR) is a nuclear receptor that regulates xenobiotic metabolism and detoxification. Herein, we report a previously undescribed role for the AhR signaling pathway as an essential defense mechanism in the pathogenesis of early dry age-related macular degeneration (AMD), the leading cause of vision loss in the elderly. We found that AhR activity and protein levels in human retinal pigment epithelial (RPE) cells, cells vulnerable in AMD, decrease with age. This finding is significant given that age is the most established risk factor for development of AMD. Moreover, AhR −/− mice exhibit decreased visual function and develop dry AMD-like pathology, including disrupted RPE cell tight junctions, accumulation of RPE cell lipofuscin, basal laminar and linear-like deposit material, Bruch's membrane thickening, and progressive RPE and choroidal atrophy. High-serum low-density lipoprotein levels were also observed in AhR −/− mice. In its oxidized form, this lipoprotein can stimulate increased secretion of extracellular matrix molecules commonly found in deposits from RPE cells, in an AhR-dependent manner. This study demonstrates the importance of cellular clearance via the AhR signaling pathway in dry AMD pathogenesis, implicating AhR as a potential target, and the mouse model as a useful platform for validating future therapies.retinal pigment epithelium | retinal disease | toxin metabolism | oxidized low density lipoprotein A ge-related macular degeneration (AMD) is the leading cause of vision loss in individuals over the age of 55 y in the Western world (1). It is a complex and heterogeneous disease, multifactorial with genetic, systemic health, and environmental factors regulating its initiation and progression (2, 3). Phenotypically, eyes with the dry clinical subtype are characterized by accumulation of focal and diffuse extracellular lipid protein-rich deposits below the retinal pigment epithelial cells (sub-RPE in 85-87% of cases) and/or within Bruch's membrane. These deposits include drusen, basal laminar, and basal linear deposits (4, 5) and are associated with RPE dysfunction, apoptosis, and ultimately degeneration. The latter of which, RPE atrophy and degeneration, is seen in an advanced form of dry AMD called geographic atrophy. Currently, there are no treatment options available for these patients. Despite advances in our understanding of the composition of sub-RPE deposits (6-8), the critical molecular events and signaling pathways leading to progressive RPE dysfunction and extracellular deposit biogenesis are still unknown.

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