Biological Factors for Age-Related Macular Degeneration

(03年04月08日修订) 老年性黄斑变性(AMD)是老年人不可逆转视力丧失的主要原因。治疗只适用于一小部分新生血管形式的AMD患者，而且预测的全身因素尚未确定。系统生物标记物被证明在其他年龄相关疾病中保护或增加风险，已被证明要么在眼睛和/或视网膜中发挥一些作用，要么根据现有证据有很强的生物学可信度。我们将测试某些被证明与氧化过程、炎症和/或血管疾病相关的生物因素与AMD相关的假设。总的假设是，AMD的临床表现与局部和系统的生物因素有关，可能受到可改变的环境和/或遗传因素的影响。我们建议在912名受试者(女性59%，男性41%)中检测这些生物标志物：5%的没有AMD的受试者，25%的轻度AMD受试者，45%的中度AMD受试者和25%的晚期AMD受试者只有一只眼睛，所有这些人都在1996年(超过90%)或1997年提供了空腹血液样本。受试者将被前瞻性地跟踪至少七年。这项研究是年龄相关眼病研究(AREDS)批准的辅助研究，旨在评估AMD和白内障的发病率、进展和风险因素，并包括一项随机试验，以评估抗氧化剂维生素和矿物质对这些疾病的影响。AREDS提供了一个独特的机会，可以有效和前瞻性地测试这些关联。这可能是AMD不同阶段患者中最大的一组，他们在AMD和其他潜在危险因素方面都有很好的特征。长期目标是为AMD的发病机制提供洞察力，并确定可能导致这一老年人视力丧失的常见原因的预防措施和改进治疗的可改变的风险或保护性因素。

(Revised 4/8/03) Age-related macular degeneration (AMD) is the leading cause of irreversible visual loss among elderly individuals. Treatment is available for only a small percentage of patients with the neovascular form of AMD and predictive systemic factors have not been identified. Systemic biomarkers shown to protect or increase risk in other age-related disorders have been shown either to play some role in the eye and/or retina, or there is strong biologic plausibility of a role based on available evidence. We will test the hypotheses that certain biological factors shown to be associated with oxidative processes, inflammation and/or vascular disease are associated with AMD. The overall hypothesis is that clinical manifestations of AMD are related to local and systemic biological factors, which may be influenced by modifiable environmental and/or genetic factors. We propose to examine these biomarkers with available assays in 912 subjects (59% female, 41% male): 5% of subjects with no AMD, 25% of subjects with mild AMD, 45 % of subjects with moderate AMD and 25% of subjects with advanced AMD in one eye only, all of whom provided a fasting blood specimen in 1996 (over 90%) or 1997. Subjects will be followed prospectively for at least seven years. This study is an approved ancillary investigation of the Age-Related Eye Disease Study (AREDS), which is designed to assess the incidence, progression and risk factors for AMD and cataract and includes a randomized trial to assess the effects of antioxidant vitamins and minerals on these diseases. AREDS provides a unique opportunity to test these associations efficiently and prospectively. This is likely the largest available cohort of patients with various stages of AMD who have been well characterized in terms of AMD and other potential risk factors. The long-term goal is to provide insight into the pathogenesis of AMD and to identify modifiable risk or protective factors that may lead to preventive measures and improved therapies for this common cause of visual loss in the elderly.