Role of complement receptors and microglia in age-related macular degeneration

年龄相关性黄斑变性（AMD）是工业化国家失明的主要原因。早期 AMD 表现为外视网膜和色素上皮之间的玻璃膜疣沉积。 AMD 可进展至晚期形式，包括脉络膜新生血管 (CNV) 和伴有光感受器和色素上皮黄斑变性的萎缩形式。 AMD 的病因尚不完全清楚。然而，对大型患者群体的遗传关联研究、AMD 眼的原位分析以及模仿 AMD 某些特征的动物模型已经确定了眼睛先天免疫失调的重要贡献。我们的 FOR2240 第一个资助期项目揭示了 AMD 患者眼液中补体因子的局部失调，并发现疾病进展与高反射灶（HF）作为视网膜免疫细胞潜在成像标记物的相关性。此外，利用光损伤范例和激光触发小鼠 CNV，我们对视网膜中的小胶质细胞和巨噬细胞进行了全面分析。关键免疫途径和免疫调节化合物的驻留小胶质细胞特异性靶向可以阐明小胶质细胞反应性、视网膜变性和新血管生成的恶性循环。这些发现共同为 AMD 发病机制中反应性小胶质细胞与异常补体蛋白相互作用提供了证据。然而，连接这两个系统的潜在机制尚未得到完全探索。在这个后续项目中，我们假设特别是过敏毒素补体裂解产物 C3a 和 C5a 通过受体介导的招募和激活维持慢性小胶质细胞反应性。我们进一步假设，高反射灶可能反映补体调节的小胶质细胞反应，因此可用于监测 AMD 患者和动物模型的疾病发展。该项目分为四个具体目标，其中我们将在体外确定 C3a/C5a 过敏毒素对小胶质细胞的影响，测试小胶质细胞 C3a/C5a 受体缺陷在激光 CNV 和光损伤模型中的影响，评估 C3aR/C5aR 在人类视网膜切片中的表达和定位，最后将 AMD 患者和对照中高反射灶的动态与眼补体因子相关联。这些研究的结果将为 AMD 的免疫相关病因学提供新的见解，并可能促进新型有效治疗方法的开发。

Age-related macular degeneration (AMD) is a leading cause of blindness in industrialized countries. Early AMD manifests as drusen deposits between the outer retina and the pigment epithelium. AMD can progress to late stage forms including choroidal neovascularization (CNV) and an atrophic form with macular degeneration of photoreceptors and the pigment epithelium. The etiology of AMD is not completely understood. However, genetic association studies in large patient cohorts and in situ analyses in AMD eyes as well as animal models mimicking some features of AMD have identified an important contribution of dysregulated innate immunity in the eye. Our project of the first funding period of FOR2240 has revealed local dysregulation of complement factors in ocular fluids of AMD patients and found a correlation of disease progression with hyperreflective foci (HF) as potential imaging markers for retinal immune cells. Furthermore, using a light damage paradigm and laser-triggered CNV in mice we established a comprehensive analysis of microglia and macrophages in the retina. Resident microglia-specific targeting of key immune pathways and immunomodulatory compounds could elucidate a vicious cycle of microglia reactivity, retinal degeneration and neoangiogenesis. These findings together provide evidence for an interaction of reactive microglia with aberrant complement proteins in the pathogenesis of AMD. However, the underlying mechanisms that link both systems are only incompletely explored. In this follow-up project we postulate that particularly the anaphylatoxin complement cleavage products C3a and C5a sustain chronic microglia reactivity via receptor-mediated recruitment and activation. We further postulate that hyperreflective foci could potentially mirror complement-regulated microglia responses and may therefore be used to monitor disease development in AMD patients and animal models. The project is subdivided into four specific aims in which we will determined the impact of C3a/C5a anaphylatoxins on microglia in vitro, test the effects of microglial C3a/C5a receptor deficiency in the laser-CNV and light damage models, evaluate the expression and localization of C3aR/C5aR in human retinal sections, and finally correlate the dynamics of hyperreflective foci with ocular complement factors in AMD patients and controls. The results of these studies will provide new insights into the immune-related etiology of AMD and may foster the development of novel effective treatments.