Abstract
Age-related macular degeneration (AMD) is a major cause of vision loss in the elderly, and it has two times the prevalence of Alzheimer disease in the United States. The underlying metabolic/vascular disease, with secondary neurodegeneration of photoreceptors, is still poorly understood, despite clinical success in treating neovascular complications. Most enigmatic have been drusen, the characteristic extracellular lesions that develop posterior to a support cell layer, the retinal pigment epithelium (RPE). Drusen are established ocular risk factors for progression to sight-threatening stages of disease. A major impediment to understanding drusen has been the scarcity of suitable experimental systems. In PNAS, the work by Johnson et al. (1) describes an RPE culture system exhibiting secretion of druse component apolipoprotein E, a cholesterol transporter, and activation of systemically derived complement, a pathway fingered in AMD by multiple genetic association studies.
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