Retinal neovascularization is the leading cause of severe vision loss and irreversible blindness in developed countries, affecting people of all ages.
1 It is the characteristic pathologic event of diverse retinal diseases such as retinopathy of prematurity (ROP) and diabetic retinopathy. Retinal ischemia and hypoxia have been identified as the major driving forces behind these angiogenic conditions, and hypoxia-inducible vascular endothelial growth factor (VEGF, or VEGF-A) is a crucial stimulator and regulator of the pathogenesis.
2 3 4 In the vertebrate retina, Müller cells are the most abundant glial cells and play active roles in the maintenance of retinal extracellular homeostasis and the metabolic support of neurons.
5 They are the major VEGF-secreting cell type in the retina during ischemia-induced neovascularization,
6 7 though other retinal cells may contribute to a lesser extent.
8 9 10 VEGF has a profound impact on multiple functions in endothelial cells, such as proliferation, migration, survival, tube formation, and vascular permeability.
11 12 These biologic effects are mediated through the high-affinity tyrosine kinase receptors VEGFR-1 (flt-1) and, more important, VEGR-2 (KDR/flk-1).
11 12 VEGF stimulation leads to receptor dimerization and autophosphorylation. These events subsequently initiate intracellular signal cascades that activate various signal molecules, such as mitogen-activated protein kinase (MAPK), focal adhesion kinase (FAK), and Akt/protein kinase B, which, among other signal molecules, are involved in the regulation of cell proliferation, migration, and survival, respectively.
11 12 In the eye, retinal microvascular endothelial cells (RMECs) undergo dysregulated proliferation and differentiation in proliferative retinopathies such as those mentioned.
4