In the present study, we used the murine model of conjunctivalization of the cornea from alkali burn, a relevant model to reflect chemical injury in human ocular surface leading to vision loss because of corneal scarring and neovascularization.
1 Considering immunotherapy in clinical practice, highly purified peptides for vaccination have several advantages over full-length proteins. Peptides are more easily synthesized, and they lack the potential dangers of infection by recombinant viruses or exposure to exogenous allergens. Clinically, DC vaccination is already established in the cancer field.
44 The sustained effect of immunotherapy may theoretically benefit patients with chemical burn-induced corneal neovascularization; this angiogenic activity lasts at least several months. Long-term attention should be paid, however, to systemic adverse events potentially caused by the antiangiogenic action of VEGFR2-targeting CTLs. Additionally, VEGF signaling through VEGFR2, weakly expressed on normal vascular and nonvascular cells in various organs including the eye, is suggested to play physiologic roles in cell survival and tissue maintenance.
45 Importantly, CTLs induced by active immunization against VEGFR2 in the present and previous studies
12 14 15 16 17 18 do not target functional VEGFR2 to block its downstream signaling but induce apoptosis exclusively in endothelial cells that present the epitope peptide(s) naturally processed from VEGFR2 protein (VEGFR2
400–408 in the present study) with the MHC class I molecule. In previous data on mice receiving anti-VEGFR2 immunotherapy, vaccination of
S. typhimurium transfected with a VEGFR2-containing plasmid led to delayed wound healing and negligible impact on fertility.
16 In contrast, vaccination of DCs pulsed with VEGFR2 full-length protein did not affect wound healing.
15 Similarly, mice immunized with VEGFR2
400–408, which we used in the present study, exhibited no obvious side effects.
12 18 In the eye as well, VEGFR2
400–408 immunization did not affect retinal vasculature or leukocyte recruitment in our study (data not shown). Minimal side effects observed in these series of immunotherapy suggest that the MHC-mediated presentation of the VEGFR2 epitope peptide(s) is preferentially limited to proliferating endothelial cells during tumor growth and corneal chemical injury. However, delayed wound healing,
16 conceivably resulting from cytotoxicity for proliferating endothelial cells, has raised safety concerns as a potential adverse event in future clinical settings.