Octreotide, a somatostatin analogue, fails to inhibit hypoxia-induced retinal neovascularization in the neonatal rat

Therapeutic uses of somatostatin and its analogues: Current view and potential applications

Somatostatin is an endogeneous cyclic tetradecapeptide hormone that exerts multiple biological activities via five ubiquitously distributed receptor subtypes. Classified as a broad inhibitory neuropeptide, somatostatin has anti-secretory, anti-proliferative and anti-angiogenic effects. The clinical use of native somatostatin is limited by a very short half-life (1 to 3min) and the broad spectrum of biological responses. Thus stable, receptor-selective agonists have been developed. The majority of these somatostatin therapeutic agonists bind strongly to two of the five receptor subtypes, although recently an agonist of wider affinity has been introduced. Somatostatin agonists are established in the treatment of acromegaly with recently approved indications in the therapy of neuroendocrine tumours. Potential therapeutic uses for somatostatin analogues include diabetic complications like retinopathy, nephropathy and obesity, due to inhibition of IGF-1, VEGF together with insulin secretion and effects upon the renin-angiotensin-aldosterone system. Wider uses in anti-neoplastic therapy may also be considered and recent studies have further revealed anti-inflammatory and anti-nociceptive effects. This review provides a comprehensive, current view of the biological functions of somatostatin and potential therapeutic uses, informed by the wide range of pharmacological advances reported since the last published review in 2004 by P. Dasgupta. The pharmacology of somatostatin receptors is explained, the current uses of somatostatin agonists are discussed, and the potential future of therapeutic applications is explored.

Insulin-like growth factors, angiopoietin-2, and pigment epithelium-derived growth factor in the hypoxic retina

As the response of the adult retina to hypoxia is likely to differ from that already established in the neonatal animal, this study was undertaken to examine the expression patterns of insulin-like growth factor-I (IGF-I) and -II (IGF-II), angiopoietin-2 (Ang-2), and pigment epithelium-derived growth factor (PEDF) in normal and hypoxic retinas of adult rats. In the latter, the retinas were examined from 3 hr to 14 days after hypoxic exposure. The mRNA and protein expression of IGF-I, IGF-II, Ang-2, and PEDF in the retina was determined by real-time RT-PCR, Western blotting, and immunohistochemistry. The results showed up-regulated expression of IGF-I, IGF-II, and Ang-2 mRNA and protein in response to hypoxia, whereas PEDF expression was drastically reduced, suggesting that increased expression of IGF-I and IGF-II may be involved not only in neovascularization but also in neuroprotection in hypoxic conditions. The up-regulation of Ang-2, a proangiogenic factor, and the down-regulation of PEDF, an antiangiogenic factor, is indicative of an imbalance between pro- and antiangiogenic factors in the hypoxic retina that may favor neovascularization. This was supported by the increased density of rat endothelial cell antigen-1 (RECA-1) protein quantification and RECA-1-stained blood vessels in the inner retina.

Medical treatment of diabetic retinopathy with somatostatin analogues

Traditional management strategies for retinal neovascularisation accompanying proliferative diabetic retinopathy include photocoagulation laser therapy. The development of preventative pharmacological treatments aimed at replacing or delaying this acute intervention has been an active research area and somatostatin analogues have shown promise in reducing the progression of retinal vascular pathologies. This review summarises the present knowledge on the molecular and cellular mechanisms of neovascularisation, and the rationale for the therapeutic use of somatostatin analogues as well as the results of two key recent clinical trials using octreotide. The potential use of octreotide and other somatostatin analogues in reducing the risk of severe visual impairment in proliferative diabetic retinopathy is discussed and pharmacological treatment regimens are proposed as an additional strategy or a less invasive alternative to laser therapy.

The potential role of octreotide in the treatment of diabetic retinopathy

Proliferative diabetic retinopathy is the main cause of vision loss in young and middle-aged adults. There is no accepted pharmaceutical therapy for this disease, although analogs of the naturally occurring growth hormone inhibitor, somatostatin, have been considered leading candidates for developing such therapies. This review examines the history of somatostatin analogs, especially octreotide, in the treatment of ocular complications of diabetes mellitus. The historical observations that indicated a role for somatostatin in retinopathy are discussed from an endocrinology perspective. The molecular mechanisms by which somatostatin may exert its anti-angiogenic effects, both indirect (through antagonism of the growth hormone axis) and direct (through direct antiproliferative and apoptotic effects on endothelial cells mediated by specific receptor subtypes) are described. Animal models that were used to demonstrate an anti-angiogenic effect of octreotide are detailed, as are the results of numerous clinical trials that used octreotide and other somatostatin analogs to treat diabetic retinopathy. The mixed results of these clinical results are examined along with possible explanations as to why these analogs both have and have not shown efficacy in limited clinical settings. Even with these mixed results, somatostatin analogs remain the only therapeutic alternative to patients with proliferative diabetic retinopathy who have failed to respond to panretinal photocoagulation.

Somatostatin Analogue Mimics Acute Ischemic Preconditioning in a Rat Model of Myocardial Infarction

We tested the hypothesis that octreotide, a somatostatin analogue, can mimic ischemic preconditioning (PC) to provide cardioprotection against myocardial infarction. An ischemia-reperfusion model of adult Wistar rats was used. Infarct size was expressed as a percentage of the area at risk under different treatment protocols. Octreotide PC (35 microg/Kg 20 minutes before ischemia-reperfusion) significantly decreased infarct size (18 +/- 4%) versus control (60 +/- 7%). The somatostatin receptor antagonist cyclo-somatostatin (0.5 mg/Kg) could blunt the above cardioprotection. Administration of either chelerythrine (a protein kinase C inhibitor, 2 mg/Kg) or genistein (a tyrosine kinase inhibitor, 5 mg/Kg) could also block octreotide PC (54 +/- 7% and 58 +/- 6%, respectively). Pretreatment with the mitochondrial ATP-sensitive potassium channel antagonist 5-hydroxydecanoic acid (5-HD) and the sarcolemmal ATP-sensitive potassium channel antagonist glibenclamide could abolish the effects of octreotide PC (54 +/- 6% and 52 +/- 6%). Chelerythrine, however, had no effect on octreotide PC. In conclusion, the present study demonstrates that octreotide can mimic ischemic PC to reduce infarct size. Acute effects of octreotide PC involve the activation of protein kinase C, tyrosine kinase C, and mitochondrial ATP-sensitive potassium channels, but not systemic IGF-I activation.

Somatostatin analogues: multiple roles in cellular proliferation, neoplasia, and angiogenesis

Angiogenesis, the development of new blood vessels is a crucial process both for tumor growth and metastatic dissemination. Additionally, dysregulation in angiogenesis has been implicated in the pathogenesis of cardiovascular disease, proliferative retinopathy, diabetic nephropathy, and rheumatoid arthritis (RA). The neuropeptide somatostatin has been shown to be a powerful inhibitor of neovascularization in several experimental models. Furthermore, somatostatin receptors (sst) are expressed on endothelial cells; particularly, sst2 has been found to be uniquely up-regulated during the angiogenic switch, from quiescent to proliferative endothelium. The present manuscript reviews the anti-angiogenic activity of somatostatin and its analogues in neoplastic and nonneoplastic disease. The role of sst subtypes particularly sst2 in mediating its angioinhibitory activity is described. Somatostatin agonists may also exert their anti-angiogenic activity indirectly by inhibition of growth factors like vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and the growth hormone (GH)/insulin-like growth factor-I (IGF-I) axis or through its immunomodulatory effects. However, the therapeutic utility of somatostatin agonists as anti-angiogenic drugs in these diseases remains confusing because of conflicting results from different studies. More basic research, as well as patient-oriented studies, is required to firmly establish the clinical potential of somatostatin agonists in therapeutic angiogenesis. The currently available somatostatin agonists have high affinity of sst2 with lower affinities for sst3 and sst5. The emergence of novel somatostatin agonists especially bispecific analogues (agonists targeting multiple cellular receptors) and conjugates (synthesized by chemically linking somatostatin analogues with other antineoplastic agents) with improved receptor specificity signify a new generation of anti-angiogenics, which may represent novel strategies in the treatment of neovascularization-related diseases.

Retinopathy of prematurity: molecular pathology and therapeutic strategies

Retinopathy of prematurity (ROP) is an ischemia-induced proliferative retinopathy, which affects premature infants with low birth weight. It is a leading cause of visual impairment and blindness in children, and shares pathophysiological characteristics with other common ocular diseases such as diabetic retinopathy, central vein occlusion, and age-related macular degeneration. Pathologically similar inherited diseases such as Norrie disease suggest a possible genetic component in the susceptibility to ROP. The process of retinal neovascularization in ROP and in animal models of oxygen-induced retinopathy is complex, and involves angiogenic factors, such as vascular endothelial growth factor, and basement membrane components. Potential medical therapies for ROP, including modulators of angiogenic factors, inhibitors of basement membrane changes, endogenous inhibitors such as pigment epithelium derived factor, and anti-inflammatory drugs, have shown efficacy against neovascularization in several animal models. Some of these therapies are in clinical trials now for diabetic retinopathy and age-related macular degeneration, and in the future may prove efficacious for the treatment of ROP.

Antiangiogenic effects of somatostatin analogues

Inhibition of angiogenesis has become a target for antineoplastic therapy and for treatment of retinal neovascularization. The presence of somatostatin receptors on tumour cells and on the proliferating vascular endothelium has led to several in vitro and in vivo studies to investigate the antiproliferative and antiangiogenic effects of somatostatin analogues. Currently available data suggest that somatostatin analogues might inhibit angiogenesis directly through somatostatin receptors present on endothelial cells and also indirectly through the inhibition of growth factor secretion such as IGF-I and vascular endothelial growth factor (VEGF) and reducing monocyte chemotaxis. However, beneficial effects on inhibition of neovascularization have been questioned by some studies. More work is therefore required to firmly establish the role of somatostatin analogues as potential antiangiogenic therapy. The currently available somatostatin analogues have high affinity for somatostatin receptor subtype 2 (sst2) and, to a lesser extent, sst5 and sst3. However, because vascular endothelial cells express several types of somatostatin receptors, it will be important to investigate somatostatin analogues with different receptor subtype affinities, which might increase the spectrum of available therapy for tumours.

Somatostatin, acting at receptor subtype 1, inhibits Rho activity, the assembly of actin stress fibers, and cell migration

Somatostatin regulates multiple biological functions by acting through a family of five G protein-coupled receptors, somatostatin receptors (SSTRs) 1-5. Although all five receptor subtypes inhibit adenylate cyclase activity and decrease intracellular cAMP levels, specific receptor subtypes also couple to additional signaling pathways. In CCL39 fibroblasts expressing either human SSTR1 or SSTR2, we demonstrate that activation of SSTR1 (but not SSTR2) attenuated both thrombin- and integrin-stimulated Rho-GTP complex formation. The reduction in Rho-GTP formation in the presence of somatostatin was associated with decreased translocation of Rho and LIM kinase to the plasma membrane and fewer focal contacts. Activation of Rho resulted in the formation of intracellular actin stress fibers and cell migration. In CCL39-R1 cells, somatostatin treatment prevented actin stress fiber assembly and attenuated thrombin-stimulated cell migration through Transwell membranes to basal levels. To show that native SSTR1 shares the ability to inhibit Rho activation, we demonstrated that somatostatin treatment of human umbilical vein endothelial cells attenuated thrombin-stimulated Rho-GTP accumulation. These data show for the first time that a G protein-coupled receptor, SSTR1, inhibits the activation of Rho, the assembly of focal adhesions and actin stress fibers, and cell migration.

Somatostatin analogs inhibit neonatal retinal neovascularization

The goal of this study was to determine the effect of two somatostatin analogs, Woc4D and octreotide, on oxygen induced retinopathy in the mouse. Oxygen induced retinopathy was produced in C57BL6 mice. Octreotide and Woc4D were administered from post-natal day 12-16. Retinopathy was assessed by a retinal scoring system utilizing fluorescein perfused retinal whole mounts. Animals treated with Woc4D and octreotide, respectively, had median retinopathy scores of 4(3,5) [median(25th, 75th quartile)] with P = 0.01 and 3.5(2.9,4.3) with P = 0.01 compared to oxygen and sham treated oxygen animals with scores of 6.6(5.3,8.5) and 7.4(5.8,8.6), respectively. Woc4D and octreotide treated animals had decreased blood vessel tufts and decreased extra-retinal neovascularization when compared to oxygen treated animals. Pituitary growth hormone (GH) mRNA expression was increased 8.3-fold by Woc4D treatment and 106-fold by oxygen exposure, and GH and mRNA was markedly reduced by Woc4D as well as octreotide. Growth as measured by animal weight was unaffected by either treatment. Woc4D and octreotide inhibited retinal neovascularization in an equally effective manner in the mouse model of oxygen induced retinopathy.