The role of the cytokine TNF-α in choroidal neovascularization: a systematic review

TNF-& alpha; is a multifunctional cytokine produced by macrophages and T cells. This proinflammatory substance is considered to play a crucial role in the inflammatory process associated with age-related macular degeneration (AMD). The current review aimed to describe evidence for an association between TNF-& alpha; and AMD reported in various studies. The MEDLINE, Embase, PubMed and Global Health databases were systematically searched to identify studies that investigated the role of TNF-& alpha; in AMD. A total of 24 studies were deemed eligible for the review. To better understand and integrate the evidence, the studies were categorised into four major groups in relation to the role of TNF-& alpha; in AMD: (1) those examining biological signalling pathways through which TNF-& alpha; exerts its effect; (2) investigating levels of TNF-& alpha;; (3) exploring the genetics underlying the role of TNF-& alpha;; and (4) assessing anti-TNF-& alpha; agents as potential treatments for AMD. TNF-& alpha; is thought to directly contribute to choroidal neovascularization (CNV) enhancement and has been shown to exert its effect by augmenting the inflammatory response through other signalling pathways. Additionally, different genes have been found to be associated with activities linked to TNF-& alpha; in AMD. Overall, measurement of systemic and local levels of TNF-& alpha; has not yielded consistent findings, with variable conclusions for the role of anti-TNF-& alpha; agents in remission of AMD symptoms. The role of TNF-& alpha; in neovascular AMD is not clear, and not all anti-TNF-& alpha; agents are safe. The potential of this cytokine in atrophic AMD has not been examined. Future studies should address these unresolved questions.