[Lifestyle-related diseases and anti-aging ophthalmology: suppression of retinal and choroidal pathologies by inhibiting renin-angiotensin system and inflammation].

Lifestyle-related diseases cause macro-and microangiopathies in the major organs including the brain, heart, kidney, and eye, and as a result, shorten the lifespan. The renin-angiotensin system (RAS) has recently been shown to contribute to the processes of accelerated aging caused by lifestyle-related diseases from visceral obesity in the early stage to late-onset organ damage. Vision-threatening diabetic retinopathy and age-related macular degeneration (AMD), associated with lifestyle-related diseases as risk factors for progression, develop retinal and choroidal neovascularization (CNV), respectively, in their advanced stages. We have found that tissue RAS is activated in the pathogenesis of diabetic retinopathy and CNV, leading to angiotensin type 1 receptor(AT1-R)-mediated expression of inflammation-related molecules including vascular endothelial growth factor (VEGF), intercellular adhesion molecule (ICAM)-1, and monocyte chemotactic protein(MCP)-1. Neuronal dysfunction in diabetic retinopathy is also shown to result from AT1-R-mediated degradation of synaptic proteins. Moreover, we revealed for the first time that the receptor for prorenin [(pro) renin receptor] is expressed in the eye, although prorenin was until recently believed to be just an inactive precursor of renin. Prorenin binds to the receptor that causes dual activation of its intracellular signaling and tissue RAS, and this pathogenic mechanism is termed receptor-associated prorenin system (RAPS)'. We have demonstrated the contribution of RAPS to the pathogenesis of CNV and dual regulation of VEGF and MCP-1 by signal transduction via (pro) renin receptor and AT1-R. Next, we report the potential validity of food factor supplements as a therapeutic strategy for preventing the retinal and choroidal pathologies driven by RAS-induced inflammatory and angiogenic molecules. Functional food factors examined include lutein in yellow-green vegetables, the omega-3 polyunsaturated fatty acid eicosapentaenoic acid purified from fish oil, and red pigment astaxanthin from salmon and shrimp. We recently revealed that these food factors prevent intraocular angiogenesis and inflammation by inhibiting the expression of inflammatory molecules including VEGF, ICAM-1, and MCP-1. Preventive medicine for AMD and diabetic retinopathy, both of which have lifestyle-related diseases as a systemic background, has attracted growing attention. In the present review, we provide biological evidence for RAS inhibition and food factor supplementation in the early intervention for retinal and choroidal pathologies as an 'anti-aging ophthalmology' approach.