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2015 ; 49
(ä): 67-81
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Molecular pathogenesis of retinal and choroidal vascular diseases
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Campochiaro PA
Prog Retin Eye Res
2015[Nov]; 49
(ä): 67-81
PMID26113211
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There are two major types of ocular neovascularization that affect the retina,
retinal neovascularization (NV) and subretinal or choroidal NV. Retinal NV occurs
in a group of diseases referred to as ischemic retinopathies in which damage to
retinal vessels results in retinal ischemia. Most prevalent of these are diabetic
retinopathy and retinal vein occlusions. Subretinal and choroidal NV occur in
diseases of the outer retina and Bruch's membrane, the most prevalent of which is
age-related macular degeneration. Numerous studies in mouse models have helped to
elucidate the molecular pathogenesis underlying retinal, subretinal, and
choroidal NV. There is considerable overlap because the precipitating event in
each is stabilization of hypoxia inducible factor-1 (HIF-1) which leads to
upregulation of several hypoxia-regulated gene products, including vascular
endothelial growth factor (VEGF), angiopoietin 2, vascular endothelial-protein
tyrosine phosphatase (VE-PTP), and several others. Stimulation of VEGF signaling
and suppression of Tie2 by angiopoietin 2 and VE-PTP are critical for sprouting
of retinal, subretinal, and choroidal NV, with perturbation of Bruch's membrane
also needed for the latter. Additional HIF-1-regulated gene products cause
further stimulation of the NV. It is difficult to model macular edema in animals
and therefore proof-of-concept clinical trials were done and demonstrated that
VEGF plays a central role and that suppression of Tie2 is also important.
Neutralization of VEGF is currently the first line therapy for all of the above
disease processes, but new treatments directed at some of the other molecular
targets, particularly stabilization of Tie2, are likely to provide additional
benefit for subretinal/choroidal NV and macular edema. In addition, the
chronicity of these diseases as well as the implication of VEGF as a cause of
retinal nonperfusion and progression of background diabetic retinopathy make
sustained delivery approaches for VEGF antagonists a priority.
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