Nutraceuticals/Drugs Promoting Mitophagy and Mitochondrial Biogenesis May Combat the Mitochondrial Dysfunction Driving Progression of Dry Age-Related Macular Degeneration: Nutraceuticals/Drugs Promoting Mitophagy and Mitochondrial Biogenesis May Combat the Mitochondrial Dysfunction Driving Progression of Dry Age-Related Macular Degeneration

In patients with age-related macular degeneration (AMD), the crucial retinal pigment epithelial
(RPE) cells are characterized by mitochondria that are structurally and functionally defective.
Moreover, deficient expression of the mRNA-editing enzyme Dicer is noted specifically in
these cells. This Dicer deficit up-regulates expression of Alu RNA, which in turn damages mitochondria—
inducing the loss of membrane potential, boosting oxidant generation, and causing mitochondrial
DNA to translocate to the cytoplasmic region. The cytoplasmic mtDNA, in conjunction
with induced oxidative stress, triggers a non-canonical pathway of NLRP3 inflammasome activation,
leading to the production of interleukin-18 that acts in an autocrine manner to induce apoptotic
death of RPE cells, thereby driving progression of dry AMD. It is proposed that measures which
jointly up-regulate mitophagy and mitochondrial biogenesis (MB), by replacing damaged mitochondria
with “healthy” new ones, may lessen the adverse impact of Alu RNA on RPE cells, enabling
the prevention or control of dry AMD. An analysis of the molecular biology underlying mitophagy/
MB and inflammasome activation suggests that nutraceuticals or drugs that can activate
Sirt1, AMPK, Nrf2, and PPARα may be useful in this regard. These include ferulic acid, melatonin
urolithin A and glucosamine (Sirt1), metformin and berberine (AMPK), lipoic acid and broccoli
sprout extract (Nrf2), and fibrate drugs and astaxanthin (PPARa). Hence, nutraceutical regimens
providing physiologically meaningful doses of several or all of the: ferulic acid, melatonin, glucosamine,
berberine, lipoic acid, and astaxanthin, may have potential for control of dry AMD.