In vitro studies have shown that ATR can mediate photoxidative damage to proteins present in the retina such as rod outer segment membrane protein (Rom-1), retinal degeneration slow protein (also known as peripherin II; Rds) and ABCA-4 when rod outer segments preparations are incubated with ATR and exposed to light.
20 Moreover, ATR has been shown to play a role in light-mediated damage by generating singlet oxygen molecules
35 and by oxidizing proteins
36 lipids
37 and DNA.
38 However, the actual mechanism through which ATR causes retinal damage is not well understood. In the normal retina, ATR is removed from the photoreceptor discs by ABCA-4.
30 However, ATP-binding cassette transporter (ABCA-4, ABCR) mutations have been found in a subpopulation of patients with certain retinal diseases such as RP,
39 rod–cone dystrophy,
40 AMD,
41 and Stargardt’s disease.
42 In these patients, there is delayed removal and thereby increased stores of ATR, which condenses with phosphatidylethanolamine (PE) in the photoreceptor outer segment disc membrane to form
N-retinylidene-phosphatidylethanolamine (NRPE).
43 In
ABCA-4-knockout mice, there is delayed clearance of ATR/NRPE from the retina
43 and these animals accumulate a threefold excess of NRPE compared with wild-type animals. Both the accumulation of NRPE and the condensation of NRPE with an additional molecule of ATR to form 2-(2,6-dimethyl-8-(2,6,6-trimethyl-l-cyclohexen-1-yl)-
1E,3E,4E,7E-octatetraenyl)-1-(2-hydroxylethyl)-4-(4-methyl-6-(2,6,6-trimethyl-1-cyclohexen-1-yl)-
1E,3E,5E-hexatrienyl)-pyridinium (A2E) were also found to be increased by 6.22- to 11.5-fold in the retinas of patients with certain forms of retinal dystrophies.
44 A2E irradiation with light results in the generation of reactive oxygen species (ROS), which can also cause oxidative damage to lipids and proteins and thus inhibit several antioxidant and lysosomal enzymes.