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Lyndell L. Lim, Rachel Goh, Celestine Wong, Tania Cipriani, Luba Robman, Lucy Busija, Robyn H. Guymer; Can Systemic Markers Of Inflammation Predict Subtypes Of Age Related Macular Degeneration?. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6637.
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Age-related macular degeneration (AMD) is now postulated to be the result of a chronic inflammatory process. We investigated the possible association between a range of systemic inflammatory biomarkers with each of the subtypes of AMD.
This was a cross-sectional study involving 236 patients from the Royal Victorian Eye & Ear Hospital and community volunteers from July 2008 to May 2009. As determined by fundus photography and angiography (as indicated) 46 had early AMD, 24 had geographic atrophy (GA), 124 had choroidal neovascularisation (CNV) and 42 were controls. Investigated inflammatory markers included C-reactive protein, CC chemokine ligand-2/monocyte chemotactic protein-1 (CCL2/MCP-1), soluble intercellular adhesion molecule-1, interleukin-1β, interleukin-2, interleukin-6, tumor necrosis factor-alpha (TNF-α), and transforming growth factor-β1. Results were analysed with binary and multinomial logistic regression.
Mean levels of CCL2/MCP-1 differed between controls and all AMD (p=0.007). In subgroup analysis, an inverse relationship was found between the levels of CCL2/MCP-1 with both GA (OR = 0.989, 95% CI = 0.975 - 0.996, p = 0.008) and CNV (OR = 0.990, 95% CI = 0.981 - 0.999, p = 0.025). A similar inverse relationship was found between levels of TNF-α and the presence of CNV (OR = 0.19, 95% CI = 0.06 - 0.69, p = 0.011).After adjusting for confounders such as age, gender, and intake of anti-inflammatory medication, multinomial logistic regression showed that CNV remained inversely related to levels of both CCL2/MCP-1 and TNF-α (OR 0.990, 95% CI 0.977-0.998, p=0.017 and OR 0.553, 95% CI 0.333-0.919, p=0.022 respectively). No significant associations were found with the other cytokines.
CCL2/MCP-1 and TNF-α appear to be associated with specific subsets of AMD. This reaffirms a role of inflammation in the pathogenesis of AMD and the possibility that these, and other inflammatory biomarkers may have a future role in monitoring AMD.
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