Retinal and choroidal microangiopathies: therapeutic opportunities

Microvasc Res. 2007 Sep-Nov;74(2-3):131-44. doi: 10.1016/j.mvr.2007.04.011. Epub 2007 May 21.

Abstract

Pathological angiogenesis in the retina and underlying choroid is a major cause of visual impairment in all age groups. The last decade has seen an explosion in the clinical availability of antiangiogenic compounds. Emphasis has been placed on inhibitors of the VEGF signaling pathway and considerable success has been achieved with aptamers and antibodies that bind VEGF. However, regression of neovascularization is rarely permanent and the regrowth of new vessels, often within a few months, requires multiple applications of drug. A number of antiangiogenic factors such as IGFBP3, SDF-1 blockers, PEDF, gamma-secretase, Delta-like ligand 4, and integrin antagonists have been identified, which act either indirectly on the VEGF system or independent of it. The importance of other candidates such as HIF-1alpha and protein kinase CK2, which act as "master" regulators of angiogenesis, offer realistic alternative targets for pharmacological intervention. The concept of combination therapy is rapidly gaining interest in the eye field and co-administration of two angiogenic agents (e.g., a CK2 inhibitor with a somatostatin analog, octreotide) are often significantly more effective at inhibiting retinal angiogenesis than either drug alone. The following review will discuss the current therapies available for aberrant ocular angiogenesis, consider new candidate targets for development of antiangiogenic compounds and emphasize the importance of combinatorial pharmacological agents in the treatment of such a dynamic cellular event as angiogenesis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Angiogenesis Inhibitors / therapeutic use*
  • Animals
  • Choroid / blood supply
  • Choroid / drug effects*
  • Choroid / pathology
  • Choroidal Neovascularization / drug therapy*
  • Eye Diseases / drug therapy*
  • Eye Diseases / genetics
  • Eye Diseases / pathology
  • Humans
  • Models, Biological
  • Neovascularization, Pathologic / drug therapy*
  • Neovascularization, Pathologic / physiopathology
  • Nerve Growth Factors / genetics
  • Nerve Growth Factors / therapeutic use*
  • Retinal Neovascularization / drug therapy*
  • Retinal Vessels / drug effects*
  • Retinal Vessels / pathology

Substances

  • Angiogenesis Inhibitors
  • Nerve Growth Factors