It is well known that NF-κB plays a seminal role in inflammation and drives expression of an expansive array of gene networks within the vasculature.
39 In the NF-κB signaling pathway, IκB-α, the cytoplasmic inhibitor of NF-κΒ, on its ubiquitination and subsequent degradation by the 26S proteasome allows NF-κB to translocate to the nucleus and engage in inflammatory gene expression.
40 Notably, recent evidence implicates NF-κB activation in the choroid with oxidative stress-induced injury. For instance, although not a model of AMD, light-induced photo-oxidative stress can also cause levels of lipid peroxides to become elevated in choroidal endothelial cells.
41 Others have related these toxic effectors of injury to ensuing inflammatory responses via NF-κB activation in choroidal endothelial cells.
42 Whereas these reports bear credence to oxidative stress pathways initiating inflammatory damage to the macula and contributing to AMD,
43 44 an important role for NF-κB activation in response to age-related production of advanced glycation end-products has also been reported.
45 Because many cytokines including the angioinflammatory protein TNF-α act through NF-κB signaling,
46 it is logical to deduce that TNF-α gene expression in the choroidal vasculature may also be critically dependent on NF-κB. This implies TNF-α expression with angioinflammatory processes in the choroid. Corroborating evidence for such a role is revealed in the finding that TNF-α is localized to CNV membranes and overexpressed in patients with AMD, who have a higher prevalence of CNV.
8 These findings, when taken together with those in our previous report that withaferin A potently attenuates TNF-α expression in vivo in a mouse model of inflammation at concentrations that are associated with its NF-κB inhibitory dose,
23 underscore the importance of harnessing the potential of withanolide-based therapies for CNV treatment. This hypothesis is further corroborated now by our findings that withanolide D antagonizes TNF-α-induced activation of the UPP and suppress NF-κB through preventing IκB-α degradation in HCECs, paralleling the mechanism of action of the proteasome inhibitors.
17 18 Finally, our investigations have revealed that these bioactive withanolides induce HO-1 protein expression in HUVECs and HCECs, a mechanism believed to relate to their known cytoprotective activity.
20 Withaferin A treatment of HUVECs was also found to increase HO-1 message levels significantly in cultured HUVECs, as assessed in three independent DNA microarray analysis experiments (Bargagna-Mohan P, et al.
IOVS 2005;46:ARVO E-Abstract 467). The upstream transcriptional mechanism by which withanolides induce HO-1 expression in endothelial cells has not been uncovered; we speculate that the UPP-targeting activity of withanolides may mimic the action of proteasome inhibitors, because the latter class of inhibitors are shown to induce the expression of HO-1 in cultured cells.
35 Finally, it is intriguing that in humans HO-1 levels decline with age in the macula,
47 an observation thought to relate to the general decline of protective mechanisms in the retina against oxidative stress. These collective data support the thesis that further investigation of UPP–NF-κB regulatory network in choroidal endothelial cells is warranted for better understanding of wet AMD.