Leukocytic infiltration of the choroid and retina often occurs in diseases such as PVR, ARMD, and proliferative diabetic retinopathy (PDR), all of which may finally result in severe visual loss. Inflammation appears to be important mechanistically in the pathogenesis of these diseases. For example, RPE, glial, and fibroblast cellular proliferation leading to the formation of periretinal membranes follows the initial inflammatory stage of PVR.
41 In ARMD, macrophages, and lymphocytes as well as reactive, migrating, or proliferating hRPE cells that are often found adjacent to the newly formed vessels in subretinal space.
2 42 43 44 45 These ARMD lesions appear to underlie the subretinal plasma leakage and subretinal neovascularization seen clinically.
42 Mononuclear phagocytes and lymphocytes have also been identified in surgically removed human PDR fibrovascular membranes.
46 Therefore, hRPE cells and mononuclear phagocytes and their products may be responsible for initiation and perpetuation of these retinal diseases. Our studies have shown that the proinflammatory cytokines IL-1 and TNF, as well as monocyte binding, induce hRPE cells to secrete MCP-1 and IL-8. These hRPE chemokines may directly participate in retinal neovascularization and periretinal proliferation. Recently, in an in vitro model, hRPE MCP-1 and IL-8 were shown to be involved in vascular tube formation.
47 IL-8 has been known to induce angiogenesis and is present in the vitreous of patients with retinal neovascularization.
48 49 The importance of MCP-1 in neovascularization of the posterior segment of the eye has been suggested by several studies. For instance, high levels of MCP-1 in vitreous have been detected in PVR (72%) and in PDR (76%).
50 Another study has shown that proliferation of RPE cells is associated with upregulation of MCP-1 expression.
51 In addition, vitreous treatment (a model for studying PVR) upregulates MCP-1 gene expression in ARPE-19 cells.
52 Likewise, in patients with ARMD, MCP-1 has been found in association with keratin-positive cells (RPE cells) and CD68-positive cells (macrophages/RPE) in surgical excised choroidal neovascular membranes (Murata T, et al.
IOVS 2001;42:ARVO Abstract 1215). Furthermore, intravitreous injection of anti-MCP-1 significantly reduces ischemia-induced retinal neovascularization.
53 Actually, on the one hand MCP-1 mediates the recruitment of monocyte infiltration, producing the indirect effect on neovascularization.
52 On the other hand, MCP-1 induces endothelial cell migration directly, as first reported by Weber et al. in 1999.
54 Further study has demonstrated that MCP-1 induces endothelial cell migration in vitro, and endothelial cells arising from aortic rings in the absence of an inflammatory response produced in vivo angiogenesis in a matrigel plug assay,
55 and was an inducer in corneal neovascularization.
56