Division of Ophthalmology, Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden.
Division of Cardiovascular Medicine, Department of Health, Medicine and Caring Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden.
Exp Mol Med. 2021 Feb;53(2):189-201. doi: 10.1038/s12276-021-00566-2. Epub 2021 Feb 15.
Blinding eye diseases such as corneal neovascularization, proliferative diabetic retinopathy, and age-related macular degeneration are driven by pathological angiogenesis. In cancer, angiogenesis is key for tumor growth and metastasis. Current antiangiogenic treatments applied clinically interfere with the VEGF signaling pathway-the main angiogenic pathway-to inhibit angiogenesis. These treatments are, however, only partially effective in regressing new pathologic vessels, and the disease relapses following cessation of treatment. Moreover, the relapse of pathological angiogenesis can be rapid, aggressive and more difficult to treat than angiogenesis in the initial phase. The manner in which relapse occurs is poorly understood; however, recent studies have begun to shed light on the mechanisms underlying the revascularization process. Hypotheses have been generated to explain the rapid angiogenic relapse and increased resistance of relapsed disease to treatment. In this context, the present review summarizes knowledge of the various mechanisms of disease relapse gained from different experimental models of pathological angiogenesis. In addition, the basement membrane-a remnant of regressed vessels-is examined in detail to discuss its potential role in disease relapse. Finally, approaches for gaining a better understanding of the relapse process are discussed, including prospects for the management of relapse in the context of disease.
致盲性眼病,如角膜新生血管、增生性糖尿病视网膜病变和年龄相关性黄斑变性,是由病理性血管生成驱动的。在癌症中,血管生成是肿瘤生长和转移的关键。目前临床上应用的抗血管生成治疗方法通过干扰 VEGF 信号通路(主要的血管生成通路)来抑制血管生成。然而,这些治疗方法在消退新生病理性血管方面仅部分有效,并且在治疗停止后疾病会复发。此外,病理性血管生成的复发比初始阶段的血管生成更迅速、更具侵袭性,且更难以治疗。复发发生的方式尚不清楚;然而,最近的研究开始揭示血管再生成过程背后的机制。已经提出了一些假说来解释快速血管生成复发和复发性疾病对治疗的耐药性增加。在这种情况下,本文综述总结了从不同病理性血管生成实验模型中获得的关于疾病复发的各种机制的知识。此外,还详细检查了基底膜(消退血管的残留物),以讨论其在疾病复发中的潜在作用。最后,讨论了更好地理解复发过程的方法,包括从疾病角度管理复发的前景。
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