In the normal adult, angiogenesis (defined as the growth of new blood vessels from preexisting capillaries) is tightly regulated and limited to wound healing, pregnancy, and uterine cycling. Our understanding of the molecular events involved in the angiogenic process has advanced significantly since the purification of the first angiogenic molecules more than two decades ago.
1 This process, under physiologic conditions, may be turned on by specific angiogenic molecules such as basic and acidic fibroblast growth factor (FGF),
2 vascular endothelial growth factor (VEGF),
3 angiogenin,
4 transforming growth factor,
5 interferon,
6 tumor necrosis factor-α,
7 and platelet-derived growth factor.
8 Angiogenesis can also be suppressed by inhibitory molecules, such as interferon-α,
9 thrombospondin-1,
10 angiostatin,
11 endostatin,
12 hemopexin-like domain of MMP-2 (PEX),
13 pigment epithelium-derived factor,
14 and fragments of tryptophan tRNA synthetase.
15 16 It is the balance of these naturally occurring stimulators and inhibitors that tightly controls the normally quiescent capillary vasculature.
17 When this balance is upset, as in certain disease states, capillary endothelial cells are induced to proliferate, migrate, and form new blood vessels. In most eye diseases that result in loss of vision, the cause is abnormal angiogenesis. It is the unregulated growth of retinal or choroidal vasculature in the adult eye that leads to extravasated fluid (macular edema), frank hemorrhage, and even tractional retinal detachment, resulting in the loss of vision associated with such diseases as diabetic retinopathy, age-related macular degeneration, retinopathy of prematurity, and rubeotic glaucoma.