Angiogenic factor in vitreous from diabetic retinopathy

Angiogenesis-Inflammation Cross Talk in Diabetic Retinopathy: Novel Insights From the Chick Embryo Chorioallantoic Membrane/Human Vitreous Platform

Pathological angiogenesis of the retina is a key component of irreversible causes of blindness, as observed in proliferative diabetic retinopathy (PDR). The pathogenesis of PDR is complex and involves vascular, inflammatory, and neuronal mechanisms. Several structural and molecular alterations associated to PDR are related to the presence of inflammation that appears to play a non-redundant role in the neovascular response that characterizes the retina of PDR patients. Vascular endothelial growth factor (VEGF) blockers have evolved over time for the treatment of retinal neovascularization. However, several limitations to anti-VEGF interventions exist. Indeed, the production of other angiogenic factors and pro-inflammatory mediators may nullify and/or cause resistance to anti-VEGF therapies. Thus, appropriate experimental models are crucial for dissecting the mechanisms leading to retinal neovascularization and for the discovery of more efficacious anti-angiogenic/anti-inflammatory therapies for PDR patients. This review focuses on the tight cross talk between angiogenesis and inflammation during PDR and describe how the chick embryo chorioallantoic membrane (CAM) assay may represent a cost-effective and rapid in vivo tool for the study of the relationship between neovascular and inflammatory responses elicited by the vitreous humor of PDR patients and for the screening of novel therapeutic agents.

A chronic grey matter penumbra, lateral microvascular intussusception and venous peduncular avulsion underlie diabetic vitreous haemorrhage

The landmark publications that gave such impetus to our understanding of proliferative diabetic retinopathy are reviewed in the light of more recent reports. Briefly, confluence of small areas of capillary closure in the midperipheral and peripheral retina results in arteriovenous shunting and abnormal oxygen partial pressure gradients. These gradients embrace a chronic ischaemic penumbra that stimulates neuroglial secretion of angiogenic growth factors and upregulation of their receptors in the retinal venous endothelium and adventitia. The blood shunting produces biomechanical stresses within the veins and induces microvascular intussusception near arteriovenous crossings, giving way to neovascular outgrowths and/or segmental venous lesions (such as omega loops and coils) that penetrate the inner limiting lamina. The lamellar collagenous matrix of the vitreous cortex is then exploited for integrin-dependent rete expansion along chemotactic gradients. During posterior vitreous detachment, haemorrhaging takes place from the arterialised veins as venous neovascular peduncles are avulsed.

Microvascular complications and the diabetic pregnancy

Without strict glycemic control, diabetic pregnancies are frequently complicated by spontaneous abortion, stillbirth, or congenital malformation. Retrospective studies have been largely reassuring that pregnancy does not accelerate morbid outcomes in women with diabetic vascular disease. Improved outcomes of high-risk pregnancy in women with pregestational, type 1, or type 2 diabetes mellitus remain challenging, depending on a comprehensive and multidisciplinary team approach and extensive preconception counseling.

Plantar thrombotic nodules with marked neovascularization in diabetes: a symptom which has been overlooked?

A 69-year-old woman with diabetes has had multiple subcutaneous nodules on the soles for 11 months. She suffered from uncontrolled diabetes mellitus, hypercholesteremia, and cardiovascular thrombosis and had a past history of photocoagulation therapy for proliferative diabetic retinopathy. Histological examination revealed vascular thrombosis surrounded by neovascularization in the subcutaneous tissue. The basement membranes of vessels were thickened and strongly stained with periodic acid-Schiff. An increased serum concentration of von Willebrand factor antigen was observed. With control of her diabetes, the nodules almost disappeared. Her curious skin manifestation is speculated to be a diabetes-mellitus-related change in which endothelial injury and the subsequent induction of angiogenetic factors may play important roles. It is possible that this kind of skin manifestation has been overlooked or not examined histopathologically.

Endothelial-cell-stimulating angiogenesis factor (ESAF) activates progelatinase A (72 kDa type IV collagenase), prostromelysin 1 and procollagenase and reactivates their complexes with tissue inhibitors of metalloproteinases: a role for ESAF in non-inflammatory angiogenesis

Endothelial-cell-stimulating angiogenesis factor (ESAF) has been shown to activate procollagenase and reactivate complexes of collagenase and gelatinase A with tissue inhibitor of metallo-proteinase (TIMP)-1. In the present paper we show a purification protocol for bovine pineal ESAF and that purified ESAF activates progelatinase A and prostromelysin-1. Unlike the activation of procollagenase by plasmin/plasminogen activator, which requires the presence of stromelysin for full activation, ESAF is able to activate fully all three proenzymes. Purified ESAF is also shown to reactivate the complexes of gelatinase A, collagenase and stromelysin-1 with TIMP-2. Once separated, both enzyme and inhibitor are active; however, ESAF binds to the enzyme in a manner preventing it from further inhibition by TIMP. ESAF is the only physiological molecule able to reactivate the TIMP/enzyme complex.

Growth factors in retinal diseases: proliferative vitreoretinopathy, proliferative diabetic retinopathy, and retinal degeneration

The goal of this review is to present the current knowledge on specific growth factor involvement in posterior segment eye disease. Growth factors can be defined as multifunctional signals which modify cell growth or proliferation, alone or in concert, by binding to specific cell surface receptors. Their biological effects on cells include cell adhesion, migration, survival, differentiation, extracellular matrix secretion, protease and protease inhibitor release, production of other growth activities, and angiogenesis. Growth factors couple the cell to the microenvironment. As some growth factors are soluble mediators of wound repair and angiogenesis, it seems possible that proliferative vitreoretinopathy and proliferative diabetic retinopathy are caused or aggravated by these factors. Other factors act as survival factors and can possibly prevent retinal degeneration. The multifunctional nature of growth factors makes it probable that practical uses will be found for these agents in the future.

The basic fibroblast growth factor-saporin mitotoxin acts through the basic fibroblast growth factor receptor

We have confirmed the hypothesis that a mitotoxin resulting from the conjugation of basic fibroblast growth factor and saporin exerts its cytotoxic effect through specific interaction with the basic fibroblast growth factor (FGF) receptor. Accordingly, the mitotoxin stimulates tyrosine phosphorylation of the 90 kD substrate that characterizes the initial cellular response to basic FGF. Cross-linking experiments show that radio-labeled basic fibroblast growth factor-saporin (FGF-SAP) binds to the receptor. Suramin, an inhibitor of growth factor receptor binding, inhibits the cytotoxicity of basic FGF-SAP. In a study of 4 different cell types, there is a decrease in the ED50 of the mitotoxin as the receptor number per cell increases. We have verified the cytotoxicity of the mitotoxin in 3 different assay systems. As expected, it is effective in the inhibition of protein synthesis and DNA synthesis, as well as of cell count. Binding of basic FGF-SAP which will result in cytotoxicity occurs very rapidly; 5 minutes of incubation of 10 nM basic FGF-SAP with cells results in 80% inhibition of cell count. The in vitro data indicate that the basic FGF-SAP is a receptor specific and potent suicide antagonist of basic FGF. Its potential as an anti-FGF for therapeutic and research uses in vivo is discussed.

Low molecular weight angiogenesis factors

A number of substances have been proposed for the role of angiogenesis factors. Many of these are of protein origin and are therefore amenable to the tools of the molecular biologist. However a number of low molecular weight angiogenesis factors are emerging as important initiators and/or cofactors of neovascularization. Of these a number are known to stimulate angiogenesis indirectly, possibly through an inflammatory response. Some putative angiogenic factors stimulate microvessel endothelial cells nonspecifically, also causing migration and proliferation of large vessel cells. Others are specific for microvessel cells either for stimulating migration, proliferation or both. The nature and action of the low molecular weight factors in vivo and in vitro are reviewed.

Increased procollagenase activating angiogenic factor in the vitreous humour of oxygen treated kittens

Previous studies have demonstrated an increase in a low molecular weight angiogenic factor (ESAF) present in the retinae of kittens with oxygen induced retinopathy. The present paper describes differences in the quantity of ESAF extracted from the vitreous humour of control and oxygen treated animals and proposes a mechanism for the induction of intravitreal neovascularisation.

Diabetic retinopathy. Pathogenesis and the role of retina-derived growth factor in angiogenesis

Diabetic retinopathy results from a combination of systemic and ocular abnormalities. Vasodilation, basement membrane pathology, microaneurysms, abnormal blood flow and tissue oxygenation, connective tissue abnormalities, and retinal ischemia are all components of early diabetic retinopathy. The pathogenesis of neovascularization is discussed with respect to the effects of vasodilation, vascular leakage, vitreous changes, and retinal ischemia. The evidence supporting Michaelson's hypothesis that a chemical messenger from the retina provides the stimulus for neovascularization is cited. The sequence of events involved in angiogenesis are cellular and basement membrane changes, endothelial cell migration, endothelial cell proliferation, and vessel formation. The experimental evidence in support of a role for retina-derived growth factor as a mediator of these cellular events is reviewed.

Experimental diabetes mellitus impairs the function of the retinal pigmented epithelium

The retinal pigmented epithelium (RPE), which influences the composition of the retinal extracellular fluid, is significantly affected in diabetes. Changes in RPE morphology, permeability, and electrophysiology in experimentally diabetic animals have been described. To facilitate the study of diabetes-related changes in RPE metabolism, we applied the techniques of quantitative histochemistry to pure samples of RPE and individual retinal layers from eyes of normal and alloxan-diabetic rabbits. Glucose within the RPE approximated serum levels in both normal and diabetic animals. Other changes in diabetics included increased sorbitol, decreased myo-inositol, elevated total Na, and loss of measurable Na+-K+-ATPase activity within the RPE. The altered ion metabolism was associated with a progressive decrease in the amplitude of the RPE-generated c-wave of the electroretinogram. The deterioration of the c-wave was arrested by treatment of the diabetic animals with either myo-inositol supplementation or with sorbinil, an inhibitor of aldose reduction. Diabetic alterations in the RPE might impair the ability of the tissue to maintain normal transport functions. The subsequently altered composition of the extracellular environment of the retina may play an important role in the pathogenesis of diabetic retinopathy.

Partial purification of a 5.7K glycoprotein from bovine vitreous which inhibits both angiogenesis and collagenase activity

An inhibitor of angiogenic activity similar to that described by Raymond and Jacobson (1) has been partially purified and shown to be a glycoprotein of molecular mass 5,700. This inhibitor gave rise to an avascular zone on the chick vitelline plexus and also negated the action of a low Mr angiogenic factor. When the angiogenic inhibitor was incubated with mammalian collagenase it inhibited the enzyme activity by nearly 70%. The relevance of these findings to the role of collagenase in angiogenesis is discussed.

Tumor-derived angiogenesis factors from rat Walker 256 carcinoma: an experimental investigation and review

Angiogenesis, the process of developing a hemovascular network, is an essential feature of the growth of solid tumors, and is induced by factors secreted by tumor cells. Assay procedures suitable for the investigation of angiogenesis, and for the screening of angiogenesis factors during purification are reviewed; and a number of reports describing the purification of angiogenesis factors, primarily from the rat Walker 256 carcinoma as starting material, are discussed. Work from the authors' laboratory is also presented. Walker 256 cells grown in large-scale culture were the source of a reproducible and homogeneous source of angiogenic material. Factors secreted by these cells were isolated by a series of chromatographic steps. Ion exchange chromatography on carboxymethyl-Sephadex produced two active fractions, one of which was fractionated into several macromolecular species by lectin affinity and hydrophobic adsorption chromatography. The other gave a high mol.wt, active fraction that was resolved into a low mol.wt, active component and a non-angiogenic but possibly carrier molecule with a mol.wt of 140,000. While none of the angiogenic factors were identified chemically, the results demonstrate the existence of both high and low mol.wt tumor-secreted angiogenic substances, confirming the hypothesis for tumor-induced angiogenesis and predicting potential means to interfere with the process of tumor growth.