Takagi Hitoshi
Department of Ophthalmology, Hyogo Prefectural Amagasaki Hospital, Japan.
Nippon Ganka Gakkai Zasshi. 2007 Mar;111(3):207-30; discussion 231.
Ocular vascular diseases such as diabetic retinopathy, retinal vein occlusion, and age-related macular degeneration, whose population increases along with aging, have become leading causes of severe visual disturbance. Macular edema and serous retinal detachment are associated with abnormal vascular leakage and tractional retinal detachment, and neovascular glaucoma is caused by retinal neovascularization. Such ocular vascular diseases are caused by vascular cell aging and vascular damage associated with lifestyle-related diseases including diabetes mellitus, hypertension, hyperlipidemia, and obesity. In the present study, we investigated molecular mechanisms in such vascular deficiencies using vascular cell biology methodology, and we propose novel strategies for the treatment of such vascular diseases. Along with aging, oxidative stress and physical stress, such as mechanical stretch, continuously and directly insult vascular cells. Such stress induces apoptosis by intracellular signaling through stress kinases in cultured retinal vascular cells. Inhibition of such stress kinases could be an effective treatment to protect the vascular cells against age-related damage. In a retinal vascular developmental model, pericyte loss causes pathology mimicking macular edema and proliferative diabetic retinopathy. Angiopoietin 1 (Ang 1) secreted by pericytes suppresses oxidative stress-induced intracellular signaling through stress kinases linked to cell apoptosis and normalizes such retinal pathology. This suggests that the paracrine action of Ang 1 in the pericytes is necessary to sustain normal retinal vasculature, and that Ang 1-triggered intracellular signaling is useful for the treatment of vascular cell pathology associated with pericyte loss. In diabetic retinopathy and retinal vein occlusion, retinal vessels regress along with retinal vascular cell apoptosis, and the retina becomes ischemic followed by pathological retinal neovascularization. VEGF has been recognized as a predominant factor to induce the ischemic retinal neovascularization. We found that retinal vascular cells have a characteristic pattern in VEGF receptor expression, which causes vascular pathology more frequently in the retina than in other organs. Neuropilin 1 (NRP 1), which enhances VEGF receptor function, is abundantly expressed in the retinal endothelial cells and is upregulated by VEGF itself and by hypoxia to regulate a positive feedback mechanism in retinal neovascularization. This receptor could be a unique target for retina-specific therapy. Lifestyle-related diseases increase along with aging and have further increased due to changes in Japanese lifestyle imitating that of Western countries. We found that the renin-angiotensin system which regulates hypertension and cardiovascular diseases, and adipocytokines which are abnormally secreted in obesity, act as proangiogenic factors. Regulation of such lifestyle-related disease factors is important for the treatment of retinal vascular diseases. Finally, we found that erythropoietin is an ischemia-induced angiogenic factor that acts independently and as potently as VEGF in proliferative diabetic retinopathy (PDR). Our study utilizing human vitreous samples demonstrates that the VEGF level is particularly high and strongly associated with angiogenic activity in PDR patients. The potential of VEGF inhibitors has recently been recognized in clinical applications. The manipulation of each angiogenic factor and adipocytokine that we report here could become potential therapy in the near future.
诸如糖尿病性视网膜病变、视网膜静脉阻塞和年龄相关性黄斑变性等眼部血管疾病,其患病人数随着老龄化而增加,已成为严重视力障碍的主要原因。黄斑水肿和浆液性视网膜脱离与异常血管渗漏及牵拉性视网膜脱离相关,而新生血管性青光眼是由视网膜新生血管形成所致。此类眼部血管疾病是由血管细胞衰老以及与包括糖尿病、高血压、高脂血症和肥胖症在内的生活方式相关疾病所伴发的血管损伤引起的。在本研究中,我们运用血管细胞生物学方法研究了此类血管缺陷的分子机制,并提出了治疗此类血管疾病的新策略。随着衰老,氧化应激和物理应激,如机械拉伸,持续且直接地损伤血管细胞。这种应激通过培养的视网膜血管细胞中应激激酶的细胞内信号传导诱导细胞凋亡。抑制此类应激激酶可能是保护血管细胞免受与年龄相关损伤的有效治疗方法。在视网膜血管发育模型中,周细胞丢失会导致类似黄斑水肿和增殖性糖尿病性视网膜病变的病理改变。周细胞分泌的血管生成素1(Ang 1)通过与细胞凋亡相关的应激激酶抑制氧化应激诱导的细胞内信号传导,并使此类视网膜病理改变正常化。这表明Ang 1在周细胞中的旁分泌作用对于维持正常视网膜血管系统是必要的,并且Ang 1触发的细胞内信号传导对于治疗与周细胞丢失相关的血管细胞病理改变是有用的。在糖尿病性视网膜病变和视网膜静脉阻塞中,视网膜血管随着视网膜血管细胞凋亡而退化,视网膜变得缺血,随后发生病理性视网膜新生血管形成。血管内皮生长因子(VEGF)已被认为是诱导缺血性视网膜新生血管形成的主要因素。我们发现视网膜血管细胞在VEGF受体表达上具有特征性模式,这使得血管病变在视网膜中比在其他器官中更频繁地发生。增强VEGF受体功能的神经纤毛蛋白1(NRP 1)在视网膜内皮细胞中大量表达,并由VEGF自身和缺氧上调,以调节视网膜新生血管形成中的正反馈机制。该受体可能是视网膜特异性治疗的独特靶点。生活方式相关疾病随着老龄化而增加,并且由于模仿西方国家的日本生活方式的改变而进一步增多。我们发现调节高血压和心血管疾病的肾素 - 血管紧张素系统以及在肥胖症中异常分泌的脂肪细胞因子充当促血管生成因子。调节此类生活方式相关疾病因子对于治疗视网膜血管疾病很重要。最后,我们发现促红细胞生成素是一种缺血诱导的血管生成因子,在增殖性糖尿病性视网膜病变(PDR)中独立发挥作用且作用强度与VEGF相当。我们利用人玻璃体样本的研究表明,PDR患者的VEGF水平特别高且与血管生成活性密切相关。VEGF抑制剂的潜力最近在临床应用中得到了认可。我们在此报告的对每种血管生成因子和脂肪细胞因子的调控在不久的将来可能成为潜在的治疗方法。