A new possible strategy of prevention and preventive treatment of age-related macular degeneration

Fischer, Tamás

doi:10.1556/oh.2008.28237

Cited by 4 publications

(1 citation statement)

References 46 publications

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“…Statins also appear to have beneficial effects on other ARMD pathways such as oxidative damage and inflammation (Guymer et al, 2005;2008). Choroidal neovascular membranes associated with ARMD include macrophages (Grossniklaus, 2000), which may respond to statins.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Potential of Statins in Age-related Macular Degeneration

Shahsuvaryan¹

2011

Sierra Leone j. biomed. res.

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Age-related macular degeneration (ARMD) is the leading cause of irreversible vision loss, affecting one in three people aged 75 and above. Although exciting new pharmaceuticals to treat ARMD such as endothelial growth factor (VEGF) inhibitors, are now available, they are effective only in selected group of patients, and can be used only during a narrow time window. Monthly intravitreal anti-VEGF injections with systemic exposure to anti-VEGF could be replaced by new drugs taken in a non-invasive way. Statins are the most commonly used lipid lowering drugs. The objective of this review is therefore to evaluate the evidence and discuss the rationale behind the recent suggestions that statins may be useful in the prevention and the treatment of age-related macular degeneration. This review recognised that there are potentially multiple biological bases for the protective effect of statins on the risk of ARMD. Thus, it is time to conduct a randomised controlled trial to provide direct evidence of the effectiveness of specific type statin in lowering the incidence and progression of ARMD. New intervention as statins usage to prevent the development of age-related macular degeneration and its progression remain an important strategy to limit the morbidity due to this significant public health problem.

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Section: Introductionmentioning

confidence: 99%

Therapeutic Potential of Statins in Age-related Macular Degeneration

Shahsuvaryan¹

2011

Sierra Leone j. biomed. res.

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Vascular endothelial dysfunction, oxidative stress – a new topic within the referal section of Orvosi Hetilap

Fischer¹

2008

Orvosi Hetilap

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The author describes some of the numerous domains regarding the new topic called "Vascular endothelial dysfunction, oxidative stress". The endothelium is responsible for the constancy and integrity of the milieu interieur by producing various substances. Endothelial dysfunction occurs when there is imbalance between vasodilators and vasoconstrictors, growth factors and their inhibitors, proinflammatory and antiinflammatory agents, prothrombotic and fibrinolytic activities. The reason for this imbalance may be response to vascular endothelial or intimal injury caused by mechanical, physical, chemical, microbiological, immunologic, genetic damage or any of their combination. Endothelial dysfunction occurring on the huge inner surface of the vessels (the endothelium) is responsible for the triggering of atherosclerosis, which is a chronic vascular disease. All the risk factors of vascular pathology are leading to chronic (cardio)vascular diseases by causing endothelial dysfunction. Decreased endogenous antioxidative capacity leads to oxidative stress by free radical reactions of physiological oxidative metabolic processes, ending as the ultimate reason for endothelial dysfunction induced by risk factors. The therapeutic and preventive effects of causal antioxidant treatments having intracellular and mitochondrial effects (statins, angiotensin-converting-enzyme inhibitors, angiotensin-receptor-blockers, acetylsalicylic acid, and third generation beta-blockers) should be emphasized. It is also important to underline the physiological-pathophysiological-therapeutic consubstantiality and systemic nature of human vasculature and to emphasize the preventive-therapeutic significance of the vascular consequence cascade. And finally, there has been large process in the assessment of oxidative stress and consecutive endothelial dysfunction which revolutionized our clinical point of view.

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A new possible strategy for prevention and preventive treatment of age-related macular degeneration resting on recent clinical and pathophysiological observations

Fischer¹

2009

Orvosi Hetilap

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The beneficial effect achieved by the treatment of endothelial dysfunction in chronic cardiovascular diseases is already an evidence belonging to the basic treatment of the disease. Given the fact that the vascular system is uniform and consubstantial both physiologically, pathophysiologically and in terms of therapy, and that it plays a key role in age-related macular degeneration (AMD)--a disease leading to tragic loss of vision with its etiology and therapy being unknown--endothelial dysfunction should be treated. The pleiotropic effects of ACE-inhibitors, AR-blockers and statins and third generation beta blockers help to restitute the balance between vasodilators and vasoconstrictors in endothelial dysfunction caused by oxidative stress, the balance of growth factors and their inhibitors, pro- and anti-inflammatory substances and prothrombotic and fibrinolytic factors, inhibit the formation of oxidative stress and its harmful effects; while aspirin with its pleiotropic effects acting as an antiaggregation substance on platelets helps to set the endothelial layer back to its normal balance regarding its vasodilating, antithrombotic, antiadhesive and anti-inflammatory functions; trimetazidine as an adjuvant agent helps to normalize, to restore the disturbed metabolism of the retinal tissue functioning insufficiently, in the end. The angiotensin II receptor blocker telmisartan with its peroxisome proliferator-activated receptor-gamma (PPAR-gamma) agonist effect inhibits the development of choroidal neovascularisation (CNV) and improves it clinically favourably. The third generation beta adrenergic receptor blocker carvedilol and nebivolol as well as the peroxisome proliferator-activated receptor-gamma agonist pioglitazone elicit their antioxidant vascular protective effects mitochondrially. For the above reasons it is suggested that, as a part of long term primary and/or secondary prevention, the following groups of patients with AMD receive--taking into consideration all possible side effects--ACE-inhibitor and/or AR blocker and statin and aspirin treatment, and trimetazidine as adjuvant medicine, and third generation beta adrenergic receptor blockers: 1. those without macular degeneration but being above the age of 50 and having risk factors inducing endothelial dysfunction; 2. those, who already developed AMD in one eye as a prevention in the second, unaffected eye; and 3. those patients who developed AMD in both eyes in order to ameliorate or merely slow the progression of the disease. Besides, it is advisory and important to eliminate AMD risk factors (cardiovascular risk factors also) inducing oxidative stress with consecutive endothelial dysfunction.

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A new possible strategy of prevention and preventive treatment of age-related macular degeneration

Cited by 4 publications

References 46 publications

Therapeutic Potential of Statins in Age-related Macular Degeneration

Therapeutic Potential of Statins in Age-related Macular Degeneration

Vascular endothelial dysfunction, oxidative stress – a new topic within the referal section of Orvosi Hetilap

A new possible strategy for prevention and preventive treatment of age-related macular degeneration resting on recent clinical and pathophysiological observations

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