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    • Despite the high risk characteristics

    2018-11-05

    Despite the high-risk characteristics of our patient cohort, none of them progressed to neovascular or wet AMD. As noted earlier, mice fed high cholesterol diet had a switch to the proangiogenic type of macrophages and increased wet AMD phenotype (Sene et al., 2013). Statins have been shown to reduce inflammatory cytokine IL-6 (Ito et al., 2002), to downregulate VEGF rifampicin in TNFα-induced tortuosity of retinal vessels in mice (Robinson et al., 2011), and to reduce laser-induced choroidal neovascularization in a mouse model of neovascular AMD (Yamada et al., 2007), suggesting a beneficial role of statins in preventing conversion to neovascular AMD. Our open-label pilot safety/efficacy study suggests that intensive statin treatment may cause regression of high-risk features of AMD, such as drusen, without progression to advanced AMD and without the vision loss that often accompanies spontaneous disappearance of drusen. These results are consistent with the “locally produced oil-spill” hypothesis (Curcio et al., 2011) of AMD pathogenesis. Of course there are several obvious limitations of our study. It is an open label, non-randomized pilot study with a small and rather homogeneous sample size that is followed on average for only 1.5years. It is known that rarely, spontaneous reduction or collapse of drusen without atrophy may occur and it is conceivable that our narrow cohort selected for such patients. In addition, we do not know how long the effects can last and how long statins should be administered. Finally, the effects of statins in cases with preexisting atrophy are not addressed in this pilot study. For these reasons, future larger randomized prospective studies are needed to assess the exact role of statins in AMD. These studies should take into account genotype and phenotype subgroups of AMD, as well as dosing, lipophilicity, and potency of the statin tested.
    Author Contributions
    Disclosures > Acknowledgments/Funding We like to thank Wendy Chao Ph.D. for professional editing of the manuscript. The study was supported by the Yeatts Family foundation, the Mass. Eye and Ear Neovascular AMD funds, the Loefflers Family foundation, and the Research to Prevent Blindness Foundation (DGV and JWM). The funders had no role in study design, data collection, data analysis, interpretation, or writing of the report.
    Introduction The promising potential of stem cell therapy for various diseases has been subject to much basic research and has attracted significant clinical interest. In clinical practice, however, such interventions remain largely experimental outside of bone marrow transplantation and autologous stem cell transplantation as related to chemotherapy (Dohner et al., 2015). Clinical implementation of stem cell treatment for erectile dysfunction (ED) represents a plausible candidate for such an approach. It has been reported that mesenchymal stem cells from bone marrow or adipose tissue can correct ED in animal models (Gimble et al., 2012; Lin et al., 2012). Prostate cancer is the most common male cancer affecting 17% of all men (Chung and Gillman, 2014), of which approximately 25% receive a prostatectomy. Due to penile nerve injury, up to 86% of patients experience ED (Salonia et al., 2012; Tal et al., 2009; Weyne and Albersen, 2014) following prostatectomy. ED is defined as the consistent or recurrent inability to attain or maintain an erection sufficient for satisfactory sexual performance (). ED following prostatectomy is an important medical condition that substantially decreases quality of life of the afflicted men and their sexual partners (Litwin et al., 1998). Besides prostatectomy, ED risk factors include widespread diseases such as hypertension and obesity, but also medications such as β-blockers and anti-depressants, as well as major life-style factors like smoking and alcohol use cause ED (Shabsigh et al., 2005). Moreover, age is a risk factor; approximately one third of men in their forties report ED symptoms, while more than half of men over 60years suffer from ED (Lewis et al., 2010). Although the prevalence and impact of ED remain substantial, current penile rehabilitation therapy following prostatectomy mainly consists of treatment with PDE-5 inhibitors or injection therapy, which have an unimpressive clinical efficacy around 27% or lower (Chung and Gillman, 2014; Weyne and Albersen, 2014; Weyne et al., 2015). This condition therefore presents a significant unmet medical need.