Despite the fact that AMD is the leading cause of blindness in patients older than 60 years in the United States, no uniformly accepted treatment leads to significant recovery of visual function. Developing prevention strategies for AMD has assumed great importance. It has been established that zinc intake, with or without other supplements, can reduce the progression of intermediate to advanced AMD.
1 However, the safety margin of a heavy metal compound such as zinc is always a serious consideration.
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The pharmacokinetics of supplemented zinc compound is determined by the tissue distribution and activity of the zinc transporter proteins ZnT and Zip.
7 8 9 Results from our present study suggest that Zip2 is a plasma membrane zinc transporter expressed in cultured RPE cells. Our results indicate that the overexpression of Zip2 led to an increased population of cells with higher intracellular zinc
(Fig. 3B) . Moreover, when exposed to 100 μM ZnCl2, both the percentage of cells with higher zinc content and the relative zinc content increased markedly
(Fig. 3B) . Thus, Zip2 is functioning in the RPE and regulates the uptake of zinc.
We have reported that compounds that induce phase 2 detoxification enzymes can protect the RPE from oxidative injury.
13 24 25 Results from our recent study further confirmed that zinc is one such compound that can activate the Nrf2-ARE pathway and increase GSH synthesis in the RPE.
13 Cells overexpressing Zip2 had higher basal levels of Nrf2
(Fig. 4A)and higher expression of GCL, the rate-limiting enzyme controlling GSH synthesis
(Figs. 4B 4C) . More important, these cells showed more robust response to zinc and sulforaphane treatment
(Fig. 4) . At 50 and 100 μM, ZnCl2 was not effective in activating Nrf2 in vector-transduced cells, but cells with increased Zip2 responded well to the same concentrations of zinc and showed increased GSH synthesis
(Fig. 5) . In cultured RPE cells, zinc is toxic at concentrations higher than 150 μM. Thus, by increasing Zip2 expression, the amount of zinc required to activate Nrf2 was decreased by twofold to threefold, and, consequently, the safety margin could be greatly improved.
The expression of Zip2 is altered in response to the increase in or depletion of extracellular zinc levels. Zinc treatment upregulated Zip2, whereas TPEN treatment downregulated it
(Fig. 1) . Transcriptional regulation of Zip2 indicates that its expression can be modulated in the RPE by interventional strategies. The human
Zip2 gene is located on chromosome 14, and its transcriptional regulation has not been well characterized. How the transcription factors function in the context of varying zinc availability remains to be determined.
One limitation of the study is that it was performed in cultured RPE cells. Any cell culture system has limitations, and the results from in vitro studies may not fully reflect the in vivo process of zinc transport in the retina. It will be interesting to measure age-related changes of the zinc transporter proteins in the retina and compare the local responses to zinc supplementation as a function of age. It is possible that in AMD patients, dietary availability of zinc may not be limited; rather, age-related changes to the transporters of zinc in the retina could have occurred. The resultant decrease in tissue concentration of zinc in the retina could compromise the antioxidant activities and may contribute to the degenerative process.
In summary, we have characterized the functions of a major Zn transporter protein in the RPE. Increased Zip2 potentiated the Nrf2-dependent antioxidant response. In addition to direct supplementation of zinc, modulating the expression of the Zn transporter proteins could have potential implications in slowing the process of retinal degeneration.