Age-related macular disease (AMD) is a major cause of blindness and there is little treatment currently available by which the progress of the basic disorder can be modulated. Histological and clinical studies show that the major tissues involved are the outer retina, retinal pigment epithelium, Bruch’s membrane and choroid. Because of a wide variation of phenotype from one case to another, it has been suggested that accurate phenotyping would be necessary for assessment of the effectiveness of treatment that is tissue-directed. However, based on findings from the study of human donor material and animal models of disease and of cell culture, it is concluded that retinal pigment epithelial dysfunction plays a central role in the disease process in most, if not all, cases of early AMD. The metabolism of phagosomal material, particularly lipids, and energy generation are interdependent, and dysfunction of both appears to be important in the genesis of disease. Evidence exists to suggest that both can be modulated therapeutically. These metabolic functions are amenable to further investigation in both the normal state and in disease. Once fully characterised, it is likely that treatment could be directed towards a limited number of functions in single tissue, thus simplifying treatment strategies.

中文翻译：

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视网膜色素上皮在年龄相关性黄斑疾病中的作用：系统评价

年龄相关性黄斑病 (AMD) 是失明的主要原因，目前几乎没有可用的治疗方法可以调节基本疾病的进展。组织学和临床研究表明，涉及的主要组织是视网膜外层、视网膜色素上皮、布鲁赫膜和脉络膜。由于从一个病例到另一个病例的表型差异很大，因此有人建议准确的表型分析对于评估组织导向治疗的有效性是必要的。然而，根据人类供体材料和疾病动物模型和细胞培养的研究结果，可以得出结论，视网膜色素上皮功能障碍在大多数（如果不是全部）早期 AMD 病例的疾病过程中起核心作用。吞噬体物质的代谢，特别是脂质，和能量产生是相互依赖的，两者的功能障碍似乎在疾病的发生中很重要。有证据表明两者都可以在治疗上进行调节。这些代谢功能可以在正常状态和疾病状态下进行进一步研究。一旦完全表征，治疗很可能针对单个组织中有限数量的功能，从而简化治疗策略。