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Abstract
Age-related Macular Degeneration (AMD) is the major cause of vision loss after age 50
in the United States.[4] Although an important association of the complement cascade with AMD
has recently been made, we still do not understand the pathogenesis of the disease. AMD is
characterized by loss of the retinal pigment epithelium (RPE) within the macula (i.e., the center
of the retina), and in turn, loss of the overlying foveal photoreceptors. Since RPE and
photoreceptors can both be generated from stem cells using cell culture, there is hope for future
cell replacement therapy. But, aging changes in Bruch's membrane, the scaffold on which the
RPE are anchored, may complicate such therapy, and require surgical repair of Bruch's
membrane to provide a suitable environment for cell survival and function. In this paper, well
see how the stem cell therapy can effectively cured the AMD.
CHAPTER I
Introduction
Age-related Macular Degeneration (AMD) is a retina disease which destroy a part or a
whole retina or retinal epithelial pigment. This disease caused by lipid product which precipitate
in the Bruch membrane, or it caused by an abnormalities of coroid blood vessel which make a
subretinal neovascular membrane.
Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss
in the industrialized world. Physicians have traditionally recognized two types of macular
degeneration: dry and wet. The dry, or nonexudative, form involves both atrophic and
hypertrophic changes of the retinal pigment epithelium (RPE) underlying the central macula, as
well as drusen deposition beneath the RPE. Patients with nonexudative AMD can progress to the
wet, or exudative, form of AMD, in which pathologic choroidal neovascular membranes
(CNVM) develop under the retina, leak fluid and blood, and, ultimately, cause a centrally
blinding disciform scar over a relatively short time course if left untreated. Approximately 1020% of patients with nonexudative AMD eventually progress to the exudative form, which is
responsible for the majority of the estimated 1.75 million cases of advanced AMD in the United
States.
The stem cell therapy is a new path to make the patient of AMD can see clearly, this
therapy can cure their scotoma and make their vision better. Just like before they had AMD.
CHAPTER II
I. Epidemiology
AMD is the leading cause of irreversible visual loss in the United States, with variable
degrees of age-related macular changes occurring in more than 10% of the population aged 65-74
years and 25% of the population older than 74 years
ruptures, the blood will fill the subretinal membrane and even the retina itself. This event will
make the vision of the patient is blurred.[5,6]
V. Stem Cells
Stem cells have the remarkable potential to develop into many different cell types in the
body during early life and growth. In addition, in many tissues they serve as a sort of internal
repair system, dividing essentially without limit to replenish other cells as long as the person or
animal is still alive. When a stem cell divides, each new cell has the potential either to remain a
stem cell or become another type of cell with a more specialized function, such as a muscle cell, a
red blood cell, or a brain cell. Stem cells are distinguished from other cell types by two important
characteristics.[9]
First, they are unspecialized cells capable of renewing themselves through cell division,
sometimes after long periods of inactivity. Second, under certain physiologic or experimental
conditions, they can be induced to become tissue- or organ-specific cells with special functions.
In some organs, such as the gut and bone marrow, stem cells regularly divide to repair and
replace worn out or damaged tissues. In other organs, however, such as the pancreas and the
heart, stem cells only divide under special conditions. Until recently, scientists primarily worked
with two kinds of stem cells from animals and humans embryonic stem cells and non-embryonic.
[9]
macula (to restore the integrity of the substrate for proper RPE cell attachment),
immunosuppression if allogeneic cells are to be transplanted, and finally cell replacement using
RPE and photoreceptor progenitors derived from stem cells in culture. So the stem cell makes a
new RPE, and the scar tissue on the RPE is removed by maculoplasty. [4]
The first trials of cell replacement have been performed using mature photoreceptors or
their late progenitors as donor cells for transplantation into dystrophic mouse retinas. They have
been shown to partially engraft and to survive for long periods in the host retina, but they fail to
integrate efficiently within the host tissue.1 Alternative cell sources such as neural
progenitor/stem cells have therefore been investigated.[2]
Map.
Clearly
visible
is
the
improvement
in
retinal
sensitivity.
The following picture shows the Visual Fields. Here, too, one can see an improved retinal
sensitivity.[3]
CHAPTER IV
Conclusion
AMD had great numbers in USA, and many other industrial countries. The impact of this
disease is so great, it can make an old people to lose their centar vision, they had blind spot on
their vision and many others. But there is a new therapy for this disease, it called stem cells
therapy. About the stem cell therapy the result of the pre-clinical tiran and the clinical trial of this
therapy showing good signs. So the people with AMD can cure their sickness and they can see
things clearly now.
References
1.
James B, Chew C, Bron A. Lecture Notes Oftalmology. 9 thed. Jakarta : Penerbit
Erlangga;2006.
2.
Ali RR, Sowden JC. Therapy may yet Stem from Cells in the Retina. Br J Ophthalmology
2003; 87: 1058-1059.
3.
The X-cell center at the institute of regenerative medicine. Stem cell treatment for
macular degeneration. Available at : http://www.xcell-center.com/treatments/diseasestreated/macular-degeneration.aspx. Accesed June 8, 2010
4.
Wang W, Dean DC, Kaplan HJ. Age-Related Macular Degeneration. Discovery Medicine
2010; 9(44):13-15.
5.
E-medicine.
ARMD,
Non-exudative.
Available
at
:
http://emedicine.medscape.com/article/1223154-overview. Accesed May 30, 2010.
6.
E-medicine.
ARMD,
Exudative.
Available
at
:
http://emedicine.medscape.com/article/1226030-overview. Accesed May 30, 2010.
7.
Ambati J, Ambati JK, et al. Age-Related Macular Degeneration: Etiology, Pathogenesis,
and Therapeutic Strategies. Survey of Opthalmology 2003; 48:257-293.
8.
Mathieu JM, Schloendorn J, et al. Medical Bioremediation of Age-Related
Disease.Microbial Cell Factories 2009; 8: 8-9.
9.
Introduction: What are stem cells, and why are they important. Available at :
http://stemcells.nih.gov/info/basics/basics1.asp. Accessed: June 6, 2010.