Silva Raquel Lima E, Kanan Yogita, Mirando Adam C, Kim Jayoung, Shmueli Ron B, Lorenc Valeria E, Fortmann Seth D, Sciamanna Jason, Pandey Niranjan B, Green Jordan J, Popel Aleksander S, Campochiaro Peter A
Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Sci Transl Med. 2017 Jan 18;9(373). doi: 10.1126/scitranslmed.aai8030.
Vascular endothelial growth factor (VEGF)-neutralizing proteins provide benefit in several retinal and choroidal vascular diseases, but some patients still experience suboptimal outcomes, and the need for frequent intraocular injections is a barrier to good outcomes. A mimetic peptide derived from collagen IV, AXT107, suppressed subretinal neovascularization (NV) in two mouse models predictive of effects in neovascular age-related macular degeneration (NVAMD) and inhibited retinal NV in a model predictive of effects in ischemic retinopathies. A combination of AXT107 and the current treatment aflibercept suppressed subretinal NV better than either agent alone. Furthermore, AXT107 caused regression of choroidal NV. AXT107 reduced the VEGF-induced vascular leakage that underlies macular edema in ischemic retinopathies and NVAMD. In rabbit eyes, which are closer to the size of human eyes, intraocular injection of AXT107 significantly reduced VEGF-induced vascular leakage by 86% at 1 month and 70% at 2 months; aflibercept significantly reduced leakage by 69% at 1 month and did not reduce leakage at 2 months, demonstrating the longer effectiveness of AXT107. AXT107 reduced ligand-induced phosphorylation of multiple receptors: VEGFR2, c-Met, and PDGFRβ. Optimal signaling through these receptors requires complex formation with β integrin, which was reduced by AXT107 binding to αβ AXT107 also reduced total VEGFR2 levels by increasing internalization, ubiquitination, and degradation. This biomimetic peptide is a sustained, multitargeted therapy that may provide advantages over intraocular injections of specific VEGF-neutralizing proteins.
血管内皮生长因子(VEGF)中和蛋白在多种视网膜和脉络膜血管疾病中具有治疗作用,但仍有部分患者疗效欠佳,且频繁眼内注射是影响良好预后的障碍。一种源自IV型胶原的模拟肽AXT107,在两种可预测新生血管性年龄相关性黄斑变性(NVAMD)疗效的小鼠模型中抑制了视网膜下新生血管形成(NV),并在一种可预测缺血性视网膜病变疗效的模型中抑制了视网膜NV。AXT107与目前的治疗药物阿柏西普联合使用,对视网膜下NV的抑制作用优于单独使用任何一种药物。此外,AXT107可使脉络膜NV消退。AXT107减少了缺血性视网膜病变和NVAMD中导致黄斑水肿的VEGF诱导的血管渗漏。在与人眼大小更接近的兔眼中,眼内注射AXT107在1个月时可使VEGF诱导的血管渗漏显著减少86%,在2个月时减少70%;阿柏西普在1个月时可使渗漏显著减少69%,在2个月时则无减少,这表明AXT107的作用持续时间更长。AXT107减少了配体诱导的多种受体的磷酸化:VEGFR2、c-Met和PDGFRβ。这些受体的最佳信号传导需要与β整合素形成复合物,而AXT107与αβ结合会减少这种复合物的形成。AXT107还通过增加内化、泛素化和降解来降低总VEGFR2水平。这种模拟肽是一种持续的多靶点治疗方法,可能比眼内注射特异性VEGF中和蛋白具有优势。