Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in industrialized nations, affecting 30 -50 million people worldwide. The earliest clinical hallmark of AMD is the presence of drusen, extracellular deposits that accumulate beneath the retinal pigmented epithelium. Although drusen nearly always precede and increase the risk of choroidal neovascularization (CNV), the late vision-threatening stage of AMD, it is unknown whether drusen contribute to the development of CNV. Both in patients with AMD and in a recently described mouse model of AMD, early subretinal pigmented epithelium deposition of complement components C3 and C5 occurs, suggesting a contributing role for these inflammatory proteins in the development of AMD. Here we provide evidence that bioactive fragments of these complement components (C3a and C5a) are present in drusen of patients with AMD, and that C3a and C5a induce VEGF expression in vitro and in vivo. Further, we demonstrate that C3a and C5a are generated early in the course of laser-induced CNV, an accelerated model of neovascular AMD driven by VEGF and recruitment of leukocytes into the choroid. We also show that genetic ablation of receptors for C3a or C5a reduces VEGF expression, leukocyte recruitment, and CNV formation after laser injury, and that antibody-mediated neutralization of C3a or C5a or pharmacological blockade of their receptors also reduces CNV. Collectively, these findings establish a mechanistic basis for the clinical observation that drusen predispose to CNV, revealing a role for immunological phenomena in angiogenesis and providing therapeutic targets for AMD.angiogenesis ͉ inflammation ͉ injury A ge-related macular degeneration (AMD) is the leading cause of permanent vision loss among the elderly in many industrialized countries (1). The majority of vision loss due to AMD is a result of pathologic new blood vessels, termed choroidal neovascularization (CNV), invading the retina from the underlying choroid through fractures in Bruch membrane, the extracellular matrix between the choroid and the retinal pigmented epithelium (RPE). The earliest clinical hallmark of AMD is the appearance of drusen (2), localized lipoproteinaceous deposits between the RPE and Bruch membrane. Although their presence is an epidemiological risk factor for the development of CNV (3, 4), the mechanism of how, or whether, drusen provoke CNV remains undefined. Some investigators have suggested that drusen are epiphenomena, whereas others have claimed that drusen constituents act as a focal stimulus for inflammatory cells that secrete angiogenic molecules such as VEGF, and still others have suggested that drusen disturb RPE homeostasis by impairing transport across Bruch membrane (reviewed in ref. 5).Recent work has demonstrated that complement components C3 and C5 are constituents of drusen in patients with AMD (6-9). Their presence, as well as that of the membrane-attack-complex (MAC) C5b-9 and other acute-phase reactant proteins in RPE cells overlying drusen, ha...