Comparing the Influence of 7-S-Immunglobulins on Choroidal Neovascularisations in Patients with Age-related Macular Eegeneration with Proliferation of Choroidal Endothelial Pig Cells

Abstract

Abstract: : Purpose: We assume that the proliferation and its potential in endothelial cells have a decisive role in the pathogenesis and progredience of choroidal neovascularisations (CNV). The concomitant presentation of clinical and experimental data may show and explain comprehensively the clinical effects. In order to observe the influence of 7-S-Immunglobulins (IG) on CNV in patients with age-related macular degeneration (ARMD) treatment with IG was applicated. IG in patients with idiopathic CNV has shown promising results (2522;ARVO 2002). Blockade of proliferation by IG on human choroidal endothelial cells have been observed (1300;ARVO 2002). In general human donors are older, therefore the proliferation rate of the choroidal endothelial cells is lower. We performed the proliferation test on choroidal endothelial cells (CEC) from young pigs (6-9 months) in order to simulate the high proliferation rate of part of the CNV's. Methods: 8 consecutive ARMD-patients (mean age 69 years) with occult CNV received repetitive infusion of intravenous IG treatment. Every 3-6 weeks 1.2-2g/kg were applied on an individual base dependant on the clinical course. The aim of this study is the development of visual acuity measured with ETDRS-charts. CEC was obtained from pig-eyes. Angiogenetic stimulant vascular endothelial growth factor (VEGF) was used. The VEGF-stimulated CEC was exposed to IG at concentrations of 10 mg/ml and 40 mg/ml. The proliferation rate was tested by counting CEC in a Thomae chamber. Results: All patients showed good tolerance of the IG-infusions. No significant side-effects were observed. An involution and scaring of the CNV was observed clinically and angiographically. Three months prior to treatment a mean decrease of visual acuity was observed at 2.4 lines. Two months after treatment commenced visual acuity showed a mean improvement of 1.2 lines at five months 1.4 lines. CEC proliferation was blocked by IG both dependent on the initial growth factor (control) and IG concentration. Conclusions: 7-S-Immunglobulins seem to positively influence the natural course of CNV in patients with ARMD. The clinical data are supported by the in vitro results. Further investigations are necessary to clarify the mechanisms of action and the indications for 7-S-Immunglobulins. Acknowledgement: We thank Mrs. B. Martiny and Mrs. B. Heisig-Salentin for their excellent technical support.

Keywords: age-related macular degeneration • choroid: neovascularization