The effects of oxygen stresses on the development of features of severe retinopathy of prematurity: knowledge from the 50/10 OIR model

The objective of this study is to determine growth factor expression and activation of signaling pathways associated with intravitreous neovascularization and peripheral avascular retina using a model of retinopathy of prematurity (ROP) relevant to today with oxygen monitoring in neonatal units. Studies using 50/10 oxygen-induced retinopathy (OIR) and 50/10 OIR+SO models were reviewed. Repeated fluctuations in oxygen increased retinal vascular endothelial growth factor (VEGF) even while peripheral avascular retina persisted and prior to the development of intravitreous neovascularization. Repeated fluctuations in oxygen increased VEGF₁₆₄ expression but not VEGF₁₂₀. Neutralizing VEGF bioactivity significantly reduced intravitreous neovascularization and arteriolar tortuosity without interfering with ongoing retinal vascularization. Repeated oxygen fluctuations led to retinal hypoxia and increased reactive oxygen species (ROS). Inhibiting ROS with NADPH oxidase inhibitor, apocynin, reduced avascular retina by interfering with apoptosis. Supplemental oxygen reduced retinal VEGF concentration and exacerbated NADPH oxidase activation to contribute to intravitreous neovascularization through activation of the JAK/STAT pathway. Oxygen stresses relevant to those experienced by preterm infants today trigger signaling of different pathways to cause avascular retina and intravitreous neovascularization. Increased signaling of VEGF appears important to the development of both avascular retina and intravitreous neovascularization.     

高氧诱导SD大鼠ROP动物模型的建立

目的:探讨用SD大鼠建立高氧诱导的早产儿视网膜病变(ROP)动物模型,为研究该病的发病机制及治疗提供理论基础。方法:新生SD大鼠24只分为2组,每组12只,实验组大鼠置于IPR-2小鼠隔离包,连续吸高浓度O27d后,再置于空气中饲养7d;对照组大鼠置于空气中饲养14d。通过视网膜铺片观察视网膜血管、组织切片HE染色观察视网膜新生血管、免疫组织化学观察VEGF和CD34蛋白的表达。结果:视网膜铺片显示实验组见大量无灌注区及新生血管芽,较对照组明显多。HE染色显示实验组内皮细胞数较对照组明显多。免疫组织化学表明CD34和VEGF在突破内界膜的细胞呈阳性表达。VEGF半定量测定显示实验组平均灰度值较对照组低,面密度值较对照组高。两组鼠生长发育均未见明显异常。结论:高氧诱导SD大鼠成功产生视网膜新生血管,可作为探究ROP疾病发生机制和治疗方法的可靠动物模型。     

缺氧诱导因子-1α与血管内皮生长因子在视网膜新生血管中的表达及相关性

目的:检测视网膜新生血管中缺氧诱导因子-1α(HIF-1α)的表达,研究其与血管内皮生长因子(VEGF)表达的相关性。方法:以高浓度氧诱导C57BL/6J小鼠建立视网膜新生血管模型,取对照组和给氧组幼鼠眼球作荧光素血管灌注,病理切片及免疫组织化学检测,分别观察视网膜血管的改变,视网膜新生血管内皮细胞数目及HIF-1α,VEGF蛋白的表达。结果:给氧组视网膜可见大量新生血管形成,新生血管内皮细胞核数为(23.38±1.07)个,与对照组相比差异有极显著性(P<0.01)。HIF-1α蛋白表达在神经节细胞层和突破视网膜内界膜的新生血管。VEGF蛋白表达在内核层,神经节细胞层和突破视网膜内界膜的新生血管。两者表达呈显著正相关(r=0.931,P<0.01)。结论:在视网膜新生血管形成中存在HIF-1α,VEGF的高表达,且两者表达密切相关。     

Captopril and vascular endothelial growth factor in a mouse model of retinopathy

PURPOSE: Angiotensin converting enzyme (ACE) inhibition has been shown in animal models of retinopathy and in patients with diabetes to improve retinal neovascularization. The mechanism is not clearly identified, but could potentially be mediated via vascular endothelial growth factor modification. The objective of this study was to determine the effect of captopril, an angiotensin converting enzyme (ACE) inhibitor, on retinal VEGF, VEGF-R1, and VEGF-R2 expression in a mouse model of oxygen induced retinopathy (OIR). METHODS: A mouse model of OIR was used and retinal tissue was obtained at P7, prior to oxygen exposure, at P12, just after oxygen exposure, and at P17, the time of maximal retinal neovascularization for VEGF, VEGF-R1 and VEGF-R2 assessment. A group of animals were treated with captopril (0.5 mg/kg/d SC from P7 for five days). RESULTS: Captopril plus OIR treated animals had higher levels of retinal VEGF mRNA and protein at P12 (p < 0.05) and lower levels at P17 (p < 0.05) than OIR animals. VEGF-R1 mRNA expression increased 16 fold from P7 to P17 (p < 0.05) in room air reared animals. VEGF-R1 mRNA expression was unaffected by OIR and/or captopril treatment. VEGF-R2 mRNA expression decreased from P7 to P17 by 1.5-fold in room air reared animals (p = 0.001). Retinal VEGF-R2 mRNA and protein expression were significantly higher at P12 in OIR plus captopril treated animals than OIR animals (p = 0.01). CONCLUSIONS: In summary, captopril maintains VEGF and increases VEGF-R2 expression during the period of hyperoxia when VEGF expression is normally suppressed. Captopril treatment during oxygen exposure is associated with a reduction in the angiogenic response at day 17 as manifested by decreased VEGF and VEGF-R2 expression in retinal tissue. Angiotensin converting enzyme inhibition is associated with changes in expression of VEGF and VEGF-R2 in the evolution of retinal neovascularization in the mouse model of retinopathy.     

氧诱导视网膜病变鼠模型血管内皮 生长因子mRNA的表达

目的分析氧诱导视网膜病变动物模型血管内皮生长因子（VEGF）基因的调节规律，阐明早产儿视网膜病变（ROP）新生血管形成的可能机制。方法将36只7 d 龄C₅₇BL/6J幼鼠暴露在（75±2）% 浓度的高氧状态下5 d，随后在正常氧环境下5 d，作为氧诱导模型组；另24只同日龄幼鼠作为正常对照组。采用荧光素血管灌注及视网膜铺片法观察视网膜血管形态；半定量逆转录-聚合酶链反应(RP-PCR)观察各组VEGF mRNA的变化。结果氧诱导模型的视网膜血管形态特征为高氧状态下表层和深层血管的中心区出现无灌注，相对低氧状态下2 d后开始出现新生血管，其部位在中周部。RF-PCR结果显示，VEGF的表达与眼内新生血管的发生存在明确的时空对应关系，即高氧状态下，VEGF mRNA转录下降，相对低氧状态下，VEGF mRNA过度转录。结论缺氧是视网膜新生血管发生的主要原因；高氧之后的相对低氧使VEGF表达增加，可能会降低ROP新生血管的发生。(中华眼底病杂志,2005,21:292-295)     

17 Beta-estradiol increases VEGF receptor-2 and promotes DNA synthesis in retinal microvascular endothelial cells.

PURPOSE: Estrogen is known to promote angiogenesis in gonads. The presence of estrogen receptors in the vascular endothelium of organs other than gonads has been reported. The goal of this study was to determine whether estrogen promotes the proliferation of retinal microvascular endothelial cells and to explore the mechanism of it. METHODS: DNA was quantitated using primary cultures of bovine retinal endothelial cells that were incubated with different doses of 17 beta-estradiol (E2), VEGF, or both. The changes in expression level of VEGF and VEGF receptor-2 (VEGFR2) were measured using northern blot analysis after treatment with E2. The presence of estrogen receptors in the endothelial cells was studied by immunohistochemistry and western blot analysis. RESULTS: 17 Beta-estradiol (E2) increased the DNA level in bovine retinal capillary endothelial cells (BRECs) by 177% at 1 nM (P < 0.05) and 150% at 10 nM (P < 0.05) by comparison with unstimulated BREC. One hundred nanomole tamoxifen completely blocked the E2-induced DNA synthesis in BRECs. Ten nanomole E2 augmented vascular endothelial growth factor (VEGF)-induced DNA synthesis in BRECs significantly (160%, P < 0.01). Ten nanomole E2 also increased VEGF mRNA expression, which peaked after 24 hours (6.7 times, P < 0.05), and VEGF receptor-2 (VEGFR2) mRNA expression, which peaked after 9 hours (2.4 times, P < 0.05). The mRNA expression level of VEGFR2 peaked with 10 nM E2 (P < 0.05) and that of VEGF reached maximum with 1 nM E2 (15 times, P < 0.001). VEGFR2 and VEGF proteins increased in parallel with their mRNA levels. Immunocytochemistry showed estrogen receptor expression in BRECs, and western blot analysis indicated the presence of a 67-kDa protein that was compatible with the estrogen receptor. CONCLUSIONS: These findings suggest that E2 may stimulate BREC growth by the receptor-mediated pathway and that E2 may augment the VEGF-dependent angiogenesis partly through the upregulation of VEGFR2.     

HIF-2alpha-haploinsufficient mice have blunted retinal neovascularization due to impaired expression of a proangiogenic gene battery

PURPOSE: To characterize the effect of HIF-2alpha haploinsufficiency on retinal neovascularization and angiogenic signaling in neonatal mice. METHODS: Retinal samples were obtained from HIF-2alpha-haploinsufficient (Epas1+/-) and wild-type (Epas1+/+) neonatal mice subjected to an oxygen-induced retinopathy (OIR) protocol. Histologic and molecular studies were performed immediately, 12 hours, or 5 days after initiation of the hypoxia phase of the OIR protocol. Molecular profiling was performed in mouse brain endothelial cells maintained in normoxia or hypoxia. Transfection studies assessed the response of isolated promoter regions from proangiogenic genes to HIF-1alpha or -2alpha overexpression. RESULTS: Epas1+/- mice exhibited no significant differences in retinal vasculature during normal development but had reduced retinal neovascularization in an OIR protocol. Multiple proangiogenic factors were induced during the hypoxia phase in Epas1+/+ OIR retinal samples, whereas Epas1+/- OIR retinal samples had absent or blunted induction of these same factors. Several, but not all, proangiogenic factors were induced in mouse brain endothelial cells after hypoxia. In transfection assays, most proangiogenic promoter regions were preferentially activated by HIF-2alpha relative to HIF-1alpha. CONCLUSIONS: HIF-2alpha deficiency results in reduced neovascularization and blunted inducibility of multiple proangiogenic factors in the retinas of mice with OIR. The authors propose that HIF-2alpha is a master regulator of proangiogenic factors in retinal vascular endothelial cells, the predominant cell type of the retina in which HIF-2alpha is expressed. Future studies will address whether the molecular and functional roles for HIF-2alpha identified from these studies can be generalized to other pathophysiological states involving neovascularization.     

Effects of sustained hyperoxia on revascularization in experimental retinopathy of prematurity

PURPOSE: To investigate the effects of prolonged hyperoxia on vascular recovery and glia survival after experimentally induced retinopathy of prematurity (ROP) in the mouse. METHODS: The effects of hyperoxia on revascularization and vitreous neovascularization were compared between mice raised in 75% oxygen from postnatal day (P)7 to P12, followed by room air recovery and mice raised in 75% oxygen from P7 to P27. The status of astrocytes and Müller cells was evaluated by glial fibrillary acidic protein (GFAP) immunohistochemistry on retinal wholemounts and serial sections. A window of susceptibility to oxygen-induced vaso-obliteration was defined by comparing the extent of retinal vaso-obliteration resulting from 2 days of hyperoxia beginning on P7, P9, P11, P13, or P15. RESULTS: Oxygen-induced vaso-obliteration of retinal capillaries was limited to the period between birth and P15. Paradoxically, revascularization was markedly accelerated and neovascularization markedly reduced in mice maintained in prolonged hyperoxia (P7-P27) compared with mice recovering in room air. The extended use of 75% oxygen during the recovery period was associated with preservation of astrocytes and Müller cells in the avascular retina. CONCLUSIONS: The antiangiogenic effect of hyperoxia on retinal capillaries is strongly dependent on postnatal age. A protocol of continuous 75% supplemental oxygen accelerates recovery of inner retinal vasculature and prevents vitreous neovascularization, by a mechanism that may involve preservation of inner retinal glia.     

VEGF siRNA抑制鼠视网膜新生血管的实验研究

背景血管内皮生长因子（VEGF）在视网膜新生血管的发生过程中发挥重要作用,抑制VEGF是目前视网膜新生血管治疗和预防研究的热点。VEGF小片段干扰RNA（VEGFsiRNA）在抗肿瘤新生血管的研究中已经取得了显著疗效,但对于视网膜新生血管的干预作用报道较少。目的研究VEGF siRNA对鼠视网膜新生血管的抑制作用。方法48只新生C57BL／6J幼鼠采用随机数字表法随机分为正常对照组、模型对照组、空载体组和VEGF siRNA质粒转染组,每组12只幼鼠。7日龄C57BL／6J幼鼠36只及其母鼠置于密闭的氧舱5d建立缺氧性新生血管模型,其中12只幼鼠不进行质粒转染作为模型对照组,其余24只鼠玻璃体腔内注射脂质体（LF2000）包裹的空载体质粒或VEGF siRNA表达质粒。待小鼠19日龄时获取小鼠眼球并分离视网膜,用苏木精一伊红染色法计数各组小鼠视网膜新生血管内皮细胞核的数目,用实时荧光定量聚合酶链反应（tea-time PCR）法检测视网膜中VEGF mRNA的表达,并应用免疫荧光技术检测小鼠视网膜中VEGF蛋白的表达。结果正常对照组、模型对照组、空载体组和VEGFsiRNA质粒转染组19日龄小鼠视网膜突破内界膜的内皮细胞细胞核数目分别为（0．19±0．09）个、（24．89±2．03）个、（23．65±2．15）个和（8．83±1．12）个,表明VEGFsiRNA质粒转染组小鼠的新生血管内皮细胞数明显低于模型对照组和空载体组,差异均有统计学意义（q=5．67、q=4．97,P〈0．01）。Real-time PCR检测表明,正常对照组小鼠视网膜中仅见弱的VEGF mRNA表达,而模型对照组与空载体组VEGF mRNA表达量为正常对照组的52．3倍和36．7倍,VEGF siRNA质粒转染组小鼠视网膜VEGF mRNA的表达量为正常对照组的3．5倍,明显低于模型对照组与空载体组。VEGF siRNA对VEGF mRNA的抑制率为43．39％。免疫荧光染色显示,正常对照组小鼠VEGF蛋白呈弱阳性表达,模型对照组和空载体组VEGF小鼠视网膜中VEGF蛋白表达呈强阳性,VEGF siRNA质粒转染组VEGF蛋白表达明显减弱。结论玻璃体腔注射VEGF siRNA表达质粒可有效抑制C57BL／6J小鼠氧诱导视网膜病变模型新生血管的形成。     

Inhibition of oxygen-induced retinopathy in RTP801-deficient mice

PURPOSE: Ischemic proliferative retinopathy, which occurs as a complication of diabetes mellitus, prematurity, or retinal vein occlusion, is a major cause of blindness worldwide. In addition to retinal neovascularization, it involves retinal degeneration, of which apoptosis is the main cause. A prior report has described the cloning of a novel HIF-1-responsive gene, RTP801, which displays strong hypoxia-dependent upregulation in ischemic cells of neuronal origin, both in vitro and in vivo. Moreover, inducible overexpression of RTP801 promotes the apoptotic death of differentiated neuron-like PC12 cells and increases their sensitivity to ischemic injury and oxidative stress. The purpose of the study was to examine the potential role of RTP801 in the pathogenesis of retinopathy, using RTP801-deficient mice. METHODS: Wild-type and RTP801-knockout mice were used in a model of retinopathy of prematurity (ROP). Their retinas were collected at postnatal day (P)14 and P17. They were examined by fluorescein angiography and by analysis of VEGF expression, neovascularization, and apoptosis. RESULTS: The expression of RTP801 was induced in the wild-type retina after hypoxia treatment. The retinal expression of VEGF after transfer to normoxic conditions was similarly upregulated in both wild-type and knockout mice. Nevertheless, the retinas of the RTP801-knockout mice in an ROP model showed a significant reduction in retinal neovascularization (P < 0.0001) and in the number of apoptotic cells in the inner nuclear layer (P < 0.0001). CONCLUSIONS: In the absence of RTP801 expression, development of retinopathy in the mouse model of ROP was significantly attenuated, thus implying an important role of RTP801 in the pathogenesis of ROP.     

Specific involvement of SRC family kinase activation in the pathogenesis of retinal neovascularization

PURPOSE: Src family kinases (SFKs) are membrane-attached nonreceptor protein tyrosine kinases that link a variety of extracellular cues to intracellular signal pathways. The purpose of this study was to characterize the roles of SFKs in vascular endothelial growth factor (VEGF)-mediated retinal angiogenesis. METHODS: Primary rat retinal glial Müller cells and bovine and human retinal microvascular endothelial cells (RMECs) were used in the in vitro studies. A rat model of retinopathy of prematurity (ROP) was used in the in vivo studies. RESULTS: In vitro, SFKs were essential for hypoxia-induced VEGF expression in Müller cells and for VEGF signaling in RMECs. However, neither process required significant further phosphorylation of the SFK activation loop Tyr416. In vivo, in a rat model of ROP, a pronounced increase of retinal SFK Tyr416 phosphorylation was observed that was specifically associated with pathologic angiogenesis. These retinas also expressed significantly higher levels of VEGF than did those in healthy controls. Immunohistochemical analysis indicated that Müller cells were the major source of the elevated level of phospho-SFK Tyr416. Intravitreous injection of a selective SFK inhibitor, PP2, significantly reduced retinal VEGF and retinopathy in the ROP model, indicating that SFKs acted as important regulators in abnormal retinal angiogenesis. CONCLUSIONS: Together, these data suggest that SFK activation through a Tyr416-dependent mechanism may be an important factor in the pathogenesis of retinal neovascularization.     

Mechanism of angiostatin induced reduction of vascular leakage in retina and iris of rats with retinopathy of prematurity

AIM: To study the effect of an intravitreal injection of angiostatin on vascular leakage in the retina and iris of oxygen-induced retinopathy of prematurity (ROP). METHODS: Brown Norway rats at postnatal day 7 (P7) were exposed to hyperoxia (750mL/L O₂) for 5 days (P7-12) and then returned to normoxia to induce retinopathy. Angiostatin was reconstituted in sterile Phosphate Buffered Saline (PBS) and diluted to desired different concentrations. Angiostatin solution was injected into the vitreous of the right eye of the ROP rats at P14 and the age-matched normal rats through pars plana using a glass capillary, and the left eye received the same volume of sterile PBS as the control. Vascular permeability was quantified at 1, 2 and 3 days after the injection by measuring albumin leakage from blood vessels into the retina and iris using the Evans blue method and normalized by total protein concentrations. The expression of vascular endothelial growth factor (VEGF) in retina was evaluated using the Western Blot analysis and immunohis- tochemistry 24 hours following the injection. RESULTS: ROP rats showed significant increases of vascular permeability in the retina and iris (P <0.01). Angiostatin reduces vascular permeability in a dose-dependent manner in the retina of ROP rats. The reduction showed a time course trend. Angiostatin injection reduced retinal vascular permeability by approximately 1.5 and 2-fold at P15 (P <0.05) and P16 (P < 0.01), respectively. Angiostatin injection significantly reduced VEGF levels in the retina of ROP rats but did not affect retinal VEGF levels in normal rats. CONCLUSION: Angiostatin significantly decreases patholog- ical vascular permeability in the retina and iris of ROP rats but not in normal rats. Angiostatin down-regulates VEGF expression in retina of ROP rats. These results suggest that angiostatin may have a therapeutic potential in the treatment of ROP and other diseases with vascular leakage.     

Downregulation of vascular endothelial growth factor and integrinbeta3 by endostatin in a mouse model of retinal neovascularization

Retinal neovascularization is among the leading causes of vision impairment throughout the world. Intraocular expression of vascular endothelial growth factor (VEGF), an angiogenic protein, and integrins, a group of cell adhesion molecules, is closely correlated with neovascularization in such neovascular diseases. The purpose of this study is to determine the effect of endostatin, a potent anti-angiogenic factor, on gene expression of vascular endothelial growth factor (VEGF) and integrinbeta3 in a mouse model of oxygen-induced retinopathy. C57BL/6 mice were given intravitreous injections of 1.0 microg endostatin at P12. At P17, retinal VEGF and integrinbeta3 mRNA levels were measured by real-time quantitative PCR in the hyperoxia mice and in the endostatin-treated mice. Analysis of 12 separate experiments revealed a 3.5-fold decrease in VEGF levels between hyperoxia mice and endostatin-treated mice (p<0.01) and a 2.5-fold decrease in integrinbeta3 levels between hyperoxia mice and endostatin-treated mice (p<0.01). These data suggest that intraocular expression of VEGF and integrinbeta3 mRNA is down-regulated by endostatin, which may provide a new therapeutic approach for ocular neovascularization.     

CCR7/p-ERK1/2/VEGF signaling promotes retinal neovascularization in a mouse model of oxygen-induced retinopathy

AIM: To investigate the role of CCR7/p-ERK1/2/VEGF signaling in the mouse model of oxygen-induced retinopathy (OIR). METHODS: Neonatal C57BL/6J mice were evenly randomized into four groups: normoxia, OIR, OIR control (treated with scramble siRNA), and OIR treated (treated with CCR7 siRNA). Normoxia group was not specially handled. Postnatal day 7 (P7) mice in the OIR group were exposed to 75%±5% oxygen for 5d (P7-P12) and then maintained under normoxic conditions for 5d (P12-P17). Mice in the OIR control and OIR treated groups were given injections of scramble or CCR7 siRNA plasmid on P12 before returning to normoxic conditions for 5d (P12-P17). Retina samples were collected from all mice on P17, stained with adenosine diphosphatase (ADPase), and retinal neovascularization (RNV) was assessed. Retinas were also stained with hematoxylin and eosin (H&E) for RNV quantitation. The distribution and expression of CCR7, p-ERK1/2 and vascular endothelial growth factor (VEGF) were assessed via immunohistochemistry, Western blot, and quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: High oxygen promoted retinal neovascularization (P<0.05) and increased the number of endothelial nuclei in new vessels extending from the retina to the vitreous body; CCR7 promoted this process (P<0.05). CCR7 and VEGF mRNA were expressed at higher levels in the OIR and OIR control groups than in the normoxia and OIR treated groups. CCR7, p-ERK1/2, and VEGF protein were expressed in the retinas of mice in the OIR and OIR control groups. Intravitreal injection of CCR7 siRNA significantly reduced CCR7, p-ERK1/2, and VEGF expression in the OIR mouse model (all P<0.05). CCR7 significantly enhanced the neovascularization and non-perfusion areas in the OIR group (P<0.05). CCR7 siRNA significantly reduced levels of p-ERK1/2 and VEGF as compared to OIR controls (P<0.05). CONCLUSION: These results suggest that CCR7/p-ERK 1/2/VEGF signaling plays an important role in OIR. CCR7 may be a potential target for the prevention and treatment of retinopathy of prematurity.     

Matrix metalloproteinase-9 and vascular endothelial growth factor expression change in experimental retinal neovascularization

AIM: To investigate the signal transduction mechanism of matrix metalloproteinase-9 (MMP-9) mediated- vascular endothelial growth factor (VEGF) expression and retinal neovascularization (RNV) in oxygen-induced retinopathy (OIR) model. METHODS: C57BL/6J mice were divided into four groups: control group, OIR group, OIR control group (phosphate-buffered saline by intravitreal injection) and treated group [tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) by intravitreal injection]. OIR model was established in C57BL/6J mice exposed to 75%±2% oxygen for 5d. mRNA level and protein expression of MMP-9, TIMP-1 and VEGF were measured by real-time polymerase chain reaction and Western blotting, and located by immunohistochemistry. RESULTS: Levels of MMP-9 and VEGF in retina were significantly increased in animals with OIR and OIR control group. Levels of TIMP-1 in retina was significantly reduced in animals with OIR and OIR control group. Furthermore, a significant correlation was found between MMP-9 and VEGF. Intravitreal injection of TIMP-1 significantly reduced MMP-9 and VEGF expression of the OIR mouse model (all P<0.05). CONCLUSION: These results demonstrate that MMP-9-mediated up-regulation of VEGF promotes RNV in retinopathy of prematurity (ROP). TIMP-1 may be a potential target for the prevention and treatment of ROP.     

Pathogenese der Retinopathia praematurorum

Retinopathy of prematurity (ROP) is a vascular disease of the eye unique to preterm infants. The distinctive feature of ROP is that is an illness of the still-maturing organism. Thus, an understanding of the normal fetal development of the retina is fundamental to understanding the pathogenesis of ROP. Animal models of ROP differ in important attributes, a fact that is important for interpretation of results. However, all models have in common the finding that ROP is a biphasic disease. In the first phase, relative hyperoxia results in vaso-obliteration and vessel loss. The second phase is characterized by hypoxia-induced neovascularization resulting in retinal detachment and blindness. Oxygen-dependent vascular endothelial growth factor (VEGF) and oxygen-independent insulin-like growth factor (IGF-1) have been identified as important factors in the pathogenesis of ROP. These findings suggest new therapeutic approaches. Substitution of IGF-1 during the first phase of the disease may help prevent vessel loss, and administration of anti-angiogenic substances during the second phase may prevent pathological neovascularization.     

血管抑素降低ROP幼鼠视网膜及虹膜血管渗漏性的作用机制研究

目的：探讨血管抑素（angiostatin）玻璃体注射对氧诱导的早产儿视网膜病变（retinopathy of prematurity，ROP）的视网膜及虹膜血管渗漏的作用及其机制。方法：将出生7d（P7）的Brown Norway鼠置高氧环境（750mL／L O2）5d后再置正常氧环境诱导ROP，建立ROP动物模型，并以年龄相匹配的正常鼠作为正常对照。所有ROP鼠（P14）及正常鼠均右眼玻璃体腔注射血管抑素，左眼注射相同剂量的PBS（磷酸盐缓冲生理盐水）作为对照。用Evans蓝微血管渗透性检测法及总蛋白标准化分别于注射后1，2和3d检测视网膜和虹膜的血管渗透性；用Western blot蛋白印迹分析和免疫组化方法检测注射24h后血管内皮生长因子（vascular endothelial growth factor，VEGF）在视网膜的表达。结果：ROP鼠视网膜及虹膜的血管渗透性明显增加（P〈0．01）；中剂量（3．75ug/眼）和高剂量（7．5ug/眼）血管抑素降低ROP鼠视网膜血管渗透性（P〈0．05，P〈0．01），而低剂量组（1．88ug／眼）没有引起明显改变，呈现剂量依赖型；三种不同剂量的血管抑素玻璃体注射后ROP鼠的虹膜均未发生明显的血管渗透性的改变。血管抑素注射后第1d和第2d视网膜血管渗透性明显降低（P〈0．05。P〈0．01），而第3d无明显降低，其作用呈现出时间进程。Western blot蛋白印迹和免疫组化分析表明血管抑素显著降低了ROP鼠视网膜的VEGF水平，但对正常鼠无影响。结论：血管抑素可以降低ROP鼠视网膜的病理性血管渗漏，其血管渗透性下降可能与血管抑素下调VEGF的表达有关。血管抑素可能对ROP等其他视网膜血管渗漏性疾病具有潜在的治疗作用。     

The dipeptide Arg-Gln inhibits retinal neovascularization in the mouse model of oxygen-induced retinopathy

PURPOSE: Premature infants undergoing intensive care are highly vulnerable to amino acid deprivation. Supplementation of glutamine or arginine has resulted in beneficial effects in human neonates. This study was conducted to examine the effect of the dipeptide arginyl-glutamine (Arg-Gln) on vascular endothelial cell growth factor (VEGF) levels in primary human retinal pigment epithelial (hRPE) cell cultures and on inhibition of neovascularization in the oxygen-induced retinopathy (OIR) model. METHODS: The effects of Arg-Gln on VEGF levels were measured in supernates from hRPE cells by using ELISAs. For in vivo studies, mouse pups received twice-daily intraperitoneal injections of Arg-Gln, a control dipeptide (Ala-Gly) or were not injected. Retinal flatmounts from one cohort were prepared and retinal vessel morphology examined. The contralateral eyes were embedded, sectioned, and stained to count preretinal neovascular nuclei. RNA was isolated from retinas of selected animals and was used to quantify VEGF mRNA by real-time RT-PCR. RESULTS: Treatment of hRPE cells with Arg-Gln decreased VEGF levels in a dose-dependent manner. In the OIR model, Arg-Gln at 5 g/kg per day reduced preretinal neovascularization by 82%+/-7% (P<0.005), when compared with the control dipeptide Ala-Gly, and reduced VEGF mRNA by 64%+/-9% (P<0.001). CONCLUSIONS: Arg-Gln dramatically inhibited retinal neovascularization in the OIR model. This effect was associated with a reduction in retinal VEGF mRNA levels. Similarly the dipeptide reduced VEGF expression in hRPE cells, a cell type likely to respond to retinal hypoxia by expressing VEGF. Arg-Gln appears to be safe and, with future studies in human infants, may prove beneficial in the prevention of ROP.