adrenomedullin and Macular-Degeneration

Adrenomedullin 2 (AM2; also known as intermedin) is a member of the adrenomedullin (AM) peptide family. Similarly to AM, AM2 partakes in a variety of physiological activities. AM2 has been reported to exert protective effects on various organ disorders; however, its significance in the eye is unknown. We investigated the role of AM2 in ocular diseases. The receptor system of AM2 was expressed more abundantly in the choroid than in the retina. In an oxygen-induced retinopathy model, physiological and pathologic retinal angiogenesis did not differ between AM2-knockout (AM2-/-) and wild-type mice. In contrast, in laser-induced choroidal neovascularization, a model of neovascular age-related macular degeneration, AM2-/- mice had enlarged and leakier choroidal neovascularization lesions, with exacerbated subretinal fibrosis and macrophage infiltration. Contrary to this, exogenous administration of AM2 ameliorated the laser-induced choroidal neovascularization-associated pathology and suppressed gene expression associated with inflammation, fibrosis, and oxidative stress, including that of VEGF-A, VEGFR-2, CD68, CTGF, and p22-phox. The stimulation of human adult retinal pigment epithelial (ARPE) cell line 19 cells with TGF-β2 and TNF-α induced epithelial-to-mesenchymal transition (EMT), whereas AM2 expression was also elevated. The induction of EMT was suppressed when the ARPE-19 cells were pretreated with AM2. A transcriptome analysis identified 15 genes, including mesenchyme homeobox 2 (Meox2), whose expression was significantly altered in the AM2-treated group compared with that in the control group. The expression of Meox2, a transcription factor that inhibits inflammation and fibrosis, was enhanced by AM2 treatment and attenuated by endogenous AM2 knockout in the early phase after laser irradiation. The AM2 treatment of endothelial cells inhibited endothelial to mesenchymal transition and NF-κB activation; however, this effect tended to be canceled following Meox2 gene knockdown. These results indicate that AM2 suppresses the neovascular age-related macular degeneration-related pathologies partially via the upregulation of Meox2. Thus, AM2 may be a promising therapeutic target for ocular vascular diseases.

Topics: Adrenomedullin; Animals; Choroidal Neovascularization; Endothelial Cells; Fibrosis; Humans; Inflammation; Macular Degeneration; Mice; Neuropeptides

Age-related macular degeneration (AMD) is a leading cause of visual impairment. Anti-vascular endothelial growth factor drugs used to treat AMD carry the risk of inducing subretinal fibrosis. We investigated the use of adrenomedullin (AM), a vasoactive peptide, and its receptor activity-modifying protein 2, RAMP2, which regulate vascular homeostasis and suppress fibrosis. The therapeutic potential of the AM-RAMP2 system was evaluated after laser-induced choroidal neovascularization (LI-CNV), a mouse model of AMD. Neovascular formation, subretinal fibrosis, and macrophage invasion were all enhanced in both AM and RAMP2 knockout mice compared with those in wild-type mice. These pathologic changes were suppressed by intravitreal injection of AM. Comprehensive gene expression analysis of the choroid after LI-CNV with or without AM administration revealed that fibrosis-related molecules, including Tgfb, Cxcr4, Ccn2, and Thbs1, were all down-regulated by AM. In retinal pigment epithelial cells, co-administration of transforming growth factor-β and tumor necrosis factor-α induced epithelial-mesenchymal transition, which was also prevented by AM. Finally, transforming growth factor-β and C-X-C chemokine receptor type 4 (CXCR4) inhibitors eliminated the difference in subretinal fibrosis between RAMP2 knockout and wild-type mice. These findings suggest the AM-RAMP2 system suppresses subretinal fibrosis in LI-CNV by suppressing epithelial-mesenchymal transition.

Topics: Adrenomedullin; Animals; Choroidal Neovascularization; Disease Models, Animal; Epithelial-Mesenchymal Transition; Fibrosis; Humans; Intravitreal Injections; Macular Degeneration; Mice, Knockout; Receptor Activity-Modifying Protein 2; Retinal Pigment Epithelium

Adrenomedullin (ADM) has been shown to take part in physiological and pathological angiogenesis. The purpose of this study was to investigate whether ADM signaling is involved in choroidal neovascularization (CNV) using a mouse model.. CNV was induced by laser photocoagulation in 8-week-old C57BL/6 mice. ADM mRNA expression significantly increased following treatment, peaking 4 days thereafter. The expression of ADM receptor (ADM-R) components (CRLR, RAMP2 and RAMP 3) was higher in CD31(+)CD45(-) endothelial cells (ECs) than CD31(-)CD45(-) non-ECs. Inflammatory stimulation upregulated the expression of ADM not only in cell lines but also in cells in primary cultures of the choroid/retinal pigment epithelium complex. Supernatants from TNFα-treated macrophage cell lines potentiated the proliferation of ECs and this was partially suppressed by an ADM antagonist, ADM (22-52). Intravitreous injection of ADM (22-52) or ADM neutralizing monoclonal antibody (mAb) after laser treatment significantly reduced the size of CNV compared with vehicle-treated controls (p<0.01).. ADM signaling is involved in laser-induced CNV formation, because both an ADM antagonist and ADM mAb significantly inhibited it. Suppression of ADM signaling might be a valuable alternative treatment for CNV associated with age-related macular degeneration.

Topics: Adrenomedullin; Animals; Antibodies, Neutralizing; Cell Line; Cell Proliferation; Choroidal Neovascularization; Culture Media, Conditioned; Disease Models, Animal; Epithelial Cells; Gene Expression Regulation; Lasers; Leukocyte Common Antigens; Macrophages; Macular Degeneration; Mice; Platelet Endothelial Cell Adhesion Molecule-1; Receptor Activity-Modifying Protein 2; Receptor Activity-Modifying Protein 3; Signal Transduction; Tumor Necrosis Factor-alpha

To explore the possible involvement of adrenomedullin in the pathophysiology of proliferative vitreoretinopathy.. The radioimmunoassay technique was used to determine immunoreactive adrenomedullin concentrations in the vitreous fluid from 41 eyes of 41 patients undergoing vitrectomy for a variety of retinal conditions, including proliferative vitreoretinopathy, proliferative diabetic retinopathy, age-related macular degeneration, and macular hole.. Immunoreactive adrenomedullin levels in the vitreous of patients with proliferative vitreoretinopathy were significantly higher than those of patients with proliferative diabetic retinopathy (P < .005), age-related macular degeneration (P < .001), and macular hole (P < .0001).. Adrenomedullin may be involved in the pathophysiology of proliferative vitreoretinopathy.

Topics: Adrenomedullin; Diabetic Retinopathy; Female; Humans; Macular Degeneration; Male; Middle Aged; Peptides; Radioimmunoassay; Retinal Perforations; Vasodilator Agents; Vitrectomy; Vitreoretinopathy, Proliferative; Vitreous Body