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Time-lapse imaging of vitreoretinal angiogenesis originating from both quiescent and mature vessels in a novel ex vivo system.

PURPOSE: Diabetic retinopathy (DR) is an angiogenic disease that leads to severe visual loss. However, adequate animal models of vitreoretinal neovascularization in proliferative diabetic retinopathy (PDR) have not yet been described. The purpose of this study was to develop a novel ex vivo system for assessing vitreoretinal angiogenic processes that originate from both quiescent and mature vessels that could be observed with time-sequential imaging. METHODS: The retinas of 7- to 8-week-old mice were cultured for 4 days, with or without several growth factors with novel procedures, and immunohistochemistry was performed. The retinas from Tie2-GFP mice were cultured with vascular endothelial growth factor (VEGF), and time-sequential imaging of vitreoretinal angiogenesis was acquired. RESULTS: Vascular sprouts were induced by both VEGF and placenta growth factor, but not by insulin-like growth factor-1, basic fibroblast growth factor or angiopoietin-2. In explants with or without VEGF, perivascular mural cells were dissociated from endothelial cells, which is an important step during angiogenesis and in the progression of DR. Furthermore, use of time-lapse observations of retinal neovascularization events visualized that the first step in vascular sprout emergence from quiescent vessels was a single cell extension. The leading edges of a sprouting endothelial cell extended and retracted in a sequential manner. From newly formed vessels, additional vascular sprouts then emerged and new vessels fused to each other, resulting in vascular branching. CONCLUSIONS: Time-lapse imaging of this system visualized the dynamic process in vitreoretinal neovascularization from quiescent and mature vessels.

Animals↗

Nitric oxide is proangiogenic in the retina and choroid.

Nitric oxide (NO) has been shown to have proangiogenic or antiangiogenic effects depending upon the setting. In this study, we used mice with targeted deletion of one of the three isoforms of nitric oxide synthase (NOS) to investigate the effects of NO in ocular neovascularization. In transgenic mice with increased expression of vascular endothelial growth factor (VEGF) in photoreceptors, deficiency of any of the three isoforms caused a significant decrease in subretinal neovascularization, but no alteration of VEGF expression. In mice with laser-induced rupture of Bruch's membrane, deficiency of inducible NOS (iNOS) or neuronal NOS (nNOS), but not endothelial NOS (eNOS), caused a significant decrease in choroidal neovascularization. In mice with oxygen-induced ischemic retinopathy, deficiency of eNOS, but not iNOS or nNOS caused a significant decrease in retinal neovascularization and decreased expression of VEGF. These data suggest that NO contributes to both retinal and choroidal neovascularization and that different isoforms of NOS are involved in different settings and different disease processes. A broad spectrum NOS inhibitor may have therapeutic potential for treatment of both retinal and choroidal neovascularization.

Animals↗

The range of PaO2 variation determines the severity of oxygen-induced retinopathy in newborn rats.

PURPOSE: This study was conducted to determine the potential influence of PaO2 fluctuation on the retinal neovascular response known to occur in newborn rats exposed to hyperoxic conditions. As an inherent corollary, the authors also defined the relationship between the fraction of inspired oxygen (FiO2) and the arterial blood oxygen tension (PaO2) in newborn rats. METHODS: Experiment 1 was composed of several oxygen-exposure protocols in which atmospheres of 10% oxygen concentration were alternated with different higher levels of ambient oxygen (50%, 40%, 30%, and room air). In experiment 2, two alternating oxygen concentrations were made to converge toward room air (20.9% oxygen) with each successive group of four treatment groups. These included another group exposed to alternating 50% and 10% oxygen, a group exposed to alternating 45% and 12.5% oxygen concentrations, one exposed to alternating concentrations of 40% and 15% oxygen, and a final group exposed to 35% and room air oxygen concentrations. In each case, oxygen was alternated between the two exposure concentrations every 24 hours. The term delta FiO2 is used to designate the difference in the two oxygen concentrations to which a treatment group was subjected, applying the units of fraction of inspired oxygen (i.e., delta FiO2 = 0.4 for the exposure to alternating 50% and 10% oxygen). At birth, litters of albino rats were placed in each of these environments for 13 or 14 days, after which PaO2 and retinal vascular development were assessed in some rats. The remainder were removed to room air for 4 days before the incidence and severity of abnormal neovascularization were measured. RESULTS: PaO2 and FiO2 were directly and linearly correlated (r2 = 0.998). In experiment 1, the extent of retinal vascular development on removal from oxygen was a linear function of delta FiO2. Retinal neovascularization subsequently occurred in all rats exposed to alternating 50% and 10% or 40% and 10% oxygen concentrations, but only a third of the 30% and 10% exposure group, indicating a minimum threshold for proliferative disease at delta FiO2 = 0.2. In experiment 2, retinal avascularity also increased linearly with increasing delta FiO2. There was a threshold for neovascularization between the exposure to alternating 45% and 12.5% oxygen and the 40% and 15% oxygen exposure (100% versus 4.8% incidence of neovascularization), indicating a requirement of < or = 12.5% oxygen episodes to stimulate a consistent proliferative response. CONCLUSIONS: These results suggest that PaO2 fluctuation and degree of hypoxia may have more influence on proliferative retinal disease in newborn rats than the extended hyperoxia that has historically received greater attention. Experimental designs that address the inherent differences in pulmonary function between intrinsically healthy animals and compromised premature infants are of substantial value to our understanding of the pathogenesis of retinopathy of prematurity.

Animals↗

[A novel molecular mechanism involving neuropilin-1 for vascular endothelial growth factor-induced retinal angiogenesis].

PURPOSE: The Neuropilin (NRP) family is a novel receptor family that has been found to bind to a key molecule in angiogenesis, vascular endothelial growth factor (VEGF). In vascular endothelial cells, NRP-1 functions as an isoform-specific receptor for VEGF165 and has predominant expression compared to NRP-2. Since little is known about its role in pathologic angiogenesis, we studied it in retinal angiogenesis. RESULTS: In cultured bovine retinal endothelial cells (BREC), VEGF selectively up-regulates NRP-1 expression. This response is mediated by VEGF receptor-2 (VEGFR-2) and transcriptional activation. NRP-1 functional blocking antibody inhibited VEGF-induced mitogenesis of BRECs in vitro. Moreover, inhibition of NRP-1 in a murine model of angioproliferative retinopathy reduced angiogenic response in the retina. CONCLUSION: Our results suggest that NRP-1 plays a critical role in VEGF-induced retinal angiogenesis and thus could be a viable therapeutic target for inhibition of retinal neovascularization.

Animals↗

Angiostatic effect of penetrating ocular injury: role of pigment epithelium-derived factor.

PURPOSE: To characterize the angiostatic effect of penetrating ocular injury and to begin to explore its mechanism, with an emphasis on the role of pigment epithelium-derived factor (PEDF). METHODS: Using the rat model of oxygen-induced retinopathy (OIR), single or multiple dry needle injuries were made, penetrating the globe of one eye; the opposite eye served as a control. Eyes were harvested from rats killed 1, 3, and 6 days after injury, and retinas were dissected and processed for assessment of neovascularization and microglial activation or were processed for genetic and proteomic analysis. Temporal and spatial expression patterns of PEDF were analyzed by in situ hybridization. RESULTS: Penetrating ocular injury resulted in a 30% decrease in neovascular area in the retinas of OIR rats. At day 1 after injury, needle insertion caused a 4.1-fold increase in retinal PEDF mRNA and a 1.5-fold increase in retinal PEDF protein. Vitreous PEDF protein increased 3.4-fold in injured eyes compared with noninjured eyes. In situ hybridization showed an increase in PEDF mRNA in areas surrounding the puncture site. Concentrated vitreous protein from injured eyes caused a 60% decrease in retinal neovascularization when injected into the vitreous cavity of OIR rats. Preincubation of vitreous samples with anti-PEDF partially abolished this efficacy. CONCLUSIONS: The pattern of angiostasis resulting from penetrating ocular injury is consistent with the release of an endogenous antiangiogenic factor from the wound site. Preliminary studies show a possible role for PEDF in this effect. Further characterization of this role and the identification of other factors may lead to new therapeutic strategies for angiogenic eye conditions.

Angiogenesis Inhibitors↗

HLF/HIF-2alpha is a key factor in retinopathy of prematurity in association with erythropoietin.

An HLF (HIF-1alpha-like factor)/HIF-2alpha-knockout mouse is embryonic lethal, preventing investigation of HLF function in adult mice. To investigate the role of HLF in adult pathological angiogenesis, we generated HLF-knockdown (HLF(kd/kd)) mice by inserting a neomycin gene sandwiched between two loxP sequences into exon 1 of the HLF gene. HLF(kd/kd) mice expressing 80-20% reduction, depending on the tissue, in wild-type HLF mRNA were fertile and apparently normal. Hyperoxia-normoxia treatment, used as a murine model of retinopathy of prematurity (ROP), induced neovascularization in wild-type mice, but not in HLF(kd/kd) mice, whereas prolonged normoxia following hyperoxic treatment caused degeneration of retinal neural layers in HLF(kd/kd) mice due to poor vascularization. Cre-mediated removal of the inserted gene recovered normal HLF expression and retinal neovascularization in HLF(kd/kd) mice. Expression levels of various angiogenic factors revealed that only erythropoietin (Epo) gene expression was significantly affected, in parallel with HLF expression. Together with the results from intraperitoneal injection of Epo into HLF(kd/kd) mouse, this suggests that Epo is one of the target genes of HLF responsible for experimental ROP.

Animals↗

[PPAR gamma: a novel pharmacological target against retinal and choroidal neovascularization].

PPARg (peroxisome proliferator-activated receptor gamma) is a nuclear receptor that regulates the transcription of numerous genes involved in the differentiation, proliferation and apoptosis of various cell types. It was initially discovered in adipocytes as a differentiation agent, then was characterized in vascular endothelium and recently in choroidal and retinal endothelial cells. Agonists that bind to PPARgamma and stimulate its transcriptional activity are endogenous lipids such as lysophosphatidic acid and 15-d-PGJ2 as well as the synthetic pharmacological compounds, thiazolidinediones, used for treating type 2 diabetes. These ligands prevent choroidal and retinal neovascularization in several experimental animal models, notably through the inhibition of vascular endothelial growth factor (VEGF) receptor expression. Because of the high affinity and the low molecular weight of agonists, suitable for good bioavailability, PPARgamma could potentially be a novel pharmacological target of angiostatic agents, particularly useful to treat age-related macular degeneration and diabetic retinopathy.

Angiogenesis Inhibitors↗

Transgenic mice with increased expression of vascular endothelial growth factor in the retina: a new model of intraretinal and subretinal neovascularization.

Vascular endothelial growth factor (VEGF) has been implicated in retinal neovascularization (NV), but it has been difficult to produce retinal NV with exogenous VEGF. We investigated the effect of increased VEGF expression in the retina using tissue-specific, gain-of-function transgenic mice in which the bovine rhodopsin promoter is coupled to the gene for human VEGF. Three founder mice were obtained and used to generate transgenic lines. One of the lines shows increased expression of VEGF in the retina by reverse transcription coupled to polymerase chain reaction and Northern blots, and the VEGF is localized to photoreceptors by immunohistochemistry. These mice demonstrate new vessels originating from the deep capillary bed of the retina that extend beneath the photoreceptor layer into the subretinal space where they form clumps of blood vessels surrounded by proliferated retinal pigmented epithelial cells. The appearance is similar to subretinal NV seen in some patients, except that the blood vessels originate from the retinal vasculature rather than the choroidal vasculature. One of the other two lines of mice did not show increased expression of VEGF and did not have NV; the other line showed retinal degeneration. This study demonstrates that over-expression of VEGF in the retina is sufficient to cause intraretinal and subretinal NV and provides a valuable new animal model.

Animals↗

Geldanamycin treatment reduces neovascularization in a mouse model of retinopathy of prematurity.

BACKGROUND: The benzoquinoid antibiotic 17-allylaminogeldanamycin (17-AAG) inhibits the Ras/Raf/MEK and PI3-Kinase signaling pathways and down-regulates vascular endothelial factor expression. Here we use a mouse model of oxygen-induced retinopathy to investigate the effect of 17-AAG on retinal neovascularization and vascular recovery. MATERIAL AND METHODS: C57BL/6 mice were exposed to 75% oxygen from postnatal day 7 (P7) to P12 and recovered in room air thereafter. Beginning with P12 mice were treated for 5 days by daily IP injection of 17-AAG (12.5 mg/kg body weight) micro dispersed in an emulsion of 4% Lipoid EPC, 5% sucrose, and 0.9% NaCl or Wortmannin (100 microg/kg body weight). On P17, the retinal vascular and avascular area, neovascular blood vessel tufts, and main vessel tortuosity were quantified after perfusion of the mice with FITC-Concanavalin A. The mRNA levels of VEGF, angiopoietin 1 and 2 were quantified by real-time RT-PCR. RESULTS: After 17-AAG treatment, a reduction of the vascular area was measured from 37.8 +/- 5.2% to 30.8 +/- 5.7% (P = 0.005), and an increase of the avascular area from 10.8 +/- 5.6% to 20.3 +/- 6.6% (P = 0.001). No alteration of the vascular pattern, the number of blood vessel tufts and the main vessel tortuosity was achieved by treatment with the PI-3 kinase inhibitor Wortmannin. After treatment with 17-AAG, the numbers of tufts (127.9 33.2) were different from the controls (173.7 +/- 55.2, P = 0.035), but not the main vessel tortuosity. No significant change in VEGF and angiopoietin 1 mRNA expression could be achieved with either of the treatments. Wortmannin treatment also did not change the angiopoietin 2 mRNA level, whereas the level was reduced in 17-AAG treated mice retina from 436-fold (+/- 64) to 200-fold (+/-55) (P = 0.035). CONCLUSION: An IP injection of 17-AAG is able to reduce angioproliferative retinopathy in a mouse model for oxygen-induced retinopathy. Our data indicate that the mechanism does not involve a direct or indirect reduction of the VEGF mRNA level, but acts downstream of the VEGF pathway. Thus, 17-AAG probably does not work by PI-3 kinase inhibition but via the Ras/Raf/MEK pathway. These data underline the potential utility of tyrosine kinase inhibitors in hypoxia induced neovascularization.

Angiopoietin-1↗

[Proliferative retinopathy in chronic myeloid leukemia].

BACKGROUND: In 50% of patients with acute and chronic myelocytic leukemia retinal alterations occur which are similar to those of nonproliferative diabetic retinopathy or hypertensive retinopathy. Retinal neovascularizations, however, are rarely seen and only found in patients with the chronic disease. PATIENTS AND METHODS: We report on the clinical course of three patients with advanced stage of proliferative retinopathy in CML. In two patients, the diagnosis of CML was established after ocular involvement. Therapy was planned according to the principles, which have proven effective in other vasoproliferative retinopathies. Eyes with neovascular changes were only treated by panretinal scatter photocoagulation of the avascular zones. In the cases with complications like vitreous hemorrhage and traction retinal detachment, vitreoretinal surgery was performed. RESULTS: Using this therapeutic principles in 4 of 6 eyes a visual acuity > 0.7 could be preserved. In three eyes impending macular involvement by traction retinal detachment was prevented. CONCLUSION: The therapeutic approach, which is valid for proliferative retinopathies of various etiology is also beneficial for ocular complications in CML.

Adult↗

Laser chorioretinal venous anastomosis for nonischemic central retinal vein occlusion.

OBJECTIVE: This study aimed to test the efficacy and safety of laser chorioretinal anastomosis for central retinal vein occlusion (CRVO). DESIGN: The study design was a consecutive case series. PARTICIPANTS: Eight eyes of eight patients were treated. INTERVENTION: The argon laser was used in the method of McAllister and Constable to attempt to form an anastomosis. The patients were observed for 1 to 19 months (median, 11 months). MAIN OUTCOME MEASURES: Visual acuity, anastomosis success, and complications were measured. RESULTS: Twenty attempts to create anastomoses were made with 2 successful anastomoses but not of a therapeutic type. Three patients developed rubeosis, retinal neovascularization at the laser site, and vitreous hemorrhage. Traction retinal detachment occurred twice and neovascular glaucoma occurred once. Secondary panretinal photocoagulation, pars plana vitrectomy, and glaucoma seton were required in three patients, one patient, and one patient, respectively. Visual acuity improved in two patients independent of failed attempts at anastomosis creation and did not improve or worsened in six patients, including the two patients with the successfully created anastomoses. CONCLUSION: Laser chorioretinal anastomosis for nonischemic CRVO has greater risks and less success than the initial report suggested. Further refinement of the technique is needed before it is adopted extensively. Even when successful, macular pigment epithelial scarring can limit vision, implying a relatively short time window for its effective application in the face of severe macular edema. Successful laser chorioretinal anastomosis does not preclude development of anterior segment neovascularization.

Aged↗

Abnormal panretinal response pattern to carbogen inhalation in experimental retinopathy of prematurity.

PURPOSE: Present technologies are not able to determine which retinas are at risk for the development of neovascularization in retinopathy of prematurity (ROP). In this study, the authors evaluated whether a novel magnetic resonance imaging (MRI) method could be used to identify differences between control retinas and those that will develop neovascularization in the newborn rat model of retinopathy of prematurity (ROP). METHODS: MRI and a 2-minute carbogen (95% O2/5% CO2) inhalation challenge (see ref. 11) were used to measure noninvasively the change in the posterior vitreous oxygen tension in specific locations across the full extent of the retina in day-12 rats raised in either room air (control, n = 7) or variable oxygen conditions (experimental ROP, n = 7). The experimental ROP animals were examined 2 days before the onset of neovascularization. RESULTS: In the ROP group, the response to carbogen was lower (P < 0.05) at every distance from the optic nerve than in the control group. Within the ROP group, the vascular midperipheral retinal reaction to carbogen, 1 to 2 mm from the optic nerve, was as low as that from the avascular periphery, 2 to 3 mm from the optic nerve. Although the vascular central retinal response to carbogen, 0 to 1 mm from the optic nerve, was greater than either the vascular midperipheral retina or the avascular periphery in the ROP group, theoretically this difference could be caused by oxygen diffusing from the hyaloidal circulation. CONCLUSIONS: Carbogen-challenge MRI seems to be a useful tool for assessing the risk of retinal neovascularization in the newborn rat ROP model. This MRI method has potential clinical applicability, for example, because effective laser therapy with retinal sparing may be possible if focal photocoagulation, guided by an MRI map, is performed.

Administration, Inhalation↗

Inhibition of intraocular proliferations with intravitreal corticosteroids.

Autotransplantation of one fourth million tissue cultured fibroblasts from rabbit rump skin into the vitreous cavity resulted in intravitreal strand formation and traction retinal detachment (27 of 47 eyes, 57%). A single intravitreal injection of 1 mg of dexamethasone alcohol inhibited fibroblast growth as judged by the significantly reduced number of retinal detachments (11 of 46 eyes, 24%). Retinal neovascularization that was observed when fibrous strands came into contact with vascularized retina (nine of 47 eyes, 19%) was also inhibited after corticosteroid application (two of 46 eyes, 4%).

Animals↗

Inherited retinal venous beading.

Four affected family members in two generations demonstrated an unusual, probably autosomal dominant, retinal vascular disorder called inherited retinal venous beading. The proband had retinal neovascularization, exudation, and vitreous hemorrhage. The other three affected family members had significant venous beading and varying degrees of arteriolar tortuosity. Family members with venous beading had low to normal leukocyte and neutrophil counts, which differed significantly from unaffected family members.

Adult↗

Peripapillary subretinal neovascularization in sarcoidosis: remission and exacerbation during oral corticosteroid therapy.

BACKGROUND: In sarcoidosis, peripapillary subretinal neovascularization is rare. The role of corticosteroid therapy for subretinal neovascularization is controversial. CASE: A 38-year-old female patient weighing 38 kg with histologically diagnosed sarcoidosis presented with peripapillary subretinal neovascularization, retinal phlebitis, a hyperemic disc, and snowball vitreous opacities in the left eye. OBSERVATION: Oral betamethasone therapy at an initial dose of 3 mg/day reduced the size of subretinal neovascular membrane, and the membrane became fibrous. Despite the total initial 140 mg of betamethasone given over 2.5 months and the additional total 700 mg of prednisolone given over the next 2 months, the subretinal neovascularization recurred. Six months after the first recurrence, a second recurrence developed during the tapering-off period of oral corticosteroid therapy. At the second recurrence, the oral corticosteroid therapy was ineffective in reducing the size of the neovascular membrane. CONCLUSION: In our patient, oral corticosteroids temporarily suppressed peripapillary subretinal neovascularization but failed to prevent extension of neovascular membrane to the fovea because of recurrent sarcoidosis. Over time, oral corticosteroids appear to lose their effectiveness for treating repeated recurrence of peripapillary subretinal neovascularization associated with sarcoidosis.

Administration, Oral↗

Severe periphlebitis, peripheral retinal ischemia, and preretinal neovascularization in patients with multiple sclerosis.

Two patients with definite multiple sclerosis and marked retinal periphlebitis developed occlusive peripheral retinal vasculitis, which resulted in peripheral retinal ischemia and peripheral retinal neovascularization. Results of investigation for other causes of peripheral proliferative retinopathies were negative in both patients although one patient had a positive anticardiolipin antibody. Both patients have been followed up for over seven years and have maintained good visual acuity with mild regression of the preretinal neovascularization without laser intervention. An analysis of these two cases and six other reported cases indicates that severe periphlebitis can evolve into occlusive peripheral vasculitis, which results in peripheral retinal neovascularization in patients with multiple sclerosis.

Adult↗

Idiopathic polypoidal choroidal vasculopathy and sickle cell retinopathy.

PURPOSE: To report a patient who had concomitant idiopathic polypoidal choroidal vasculopathy and sickle cell retinopathy. METHOD: Case report. A 46-year-old black woman presented with sudden onset of "blurring" in the left eye. Her ocular history was unremarkable, and her medical history was relevant for sickle cell disease with yearly episodes of sickle cell crises. RESULTS: Both eyes had evidence of idiopathic polypoidal choroidal vasculopathy and peripheral retinal neovascularization secondary to sickle cell disease. The left eye had hemorrhagic retinal pigment epithelial detachments secondary to idiopathic polypoidal choroidal vasculopathy. CONCLUSION: We present this case as an example of concomitant sickle cell retinopathy and idiopathic polypoidal choroidal vasculopathy. We are unaware of previous reports with these findings.

Anemia, Sickle Cell↗

[Laser treatment in diabetes-related eye complications].

Argon laser photocoagulation for diabetic retinopathy predominantly involves scatter photocoagulation of either the macula (for diabetic macular edema) or a large portion of the retina (panretinal photocoagulation). In both cases the laser treatment destroys a part of the photoreceptor layer, allowing the diffusion of oxygen and nutrients from the choroid to the inner retina, thus improving the metabolic state of the inner retina. Metabolic imbalance (hypoxia) can be linked with diabetic macular edema through hemodynamic principles according to Starlings law. The connection between the metabolic imbalances and retinal neovascularization is less clear and may involve chemical mitogens, hemodynamic considerations and other unknown factors.

Blood-Retinal Barrier↗