Diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD) are multifactorial diseases promoted by different signalling pathways, with factors other than VEGF contributing to the pathogenesis.
Real-world clinical practice analyzes involving > 78,000 patient eyes have shown that patients with DME or nAMD receive fewer anti-VEGF injections in clinical practice compared to clinical trials and may not meet efficacy expectations, potentially may be the cause of suboptimal vision improvement. 1,2
Graphic representation of the association of visual improvement with increasing anti-VEGF injections in nAMD
Reprint from Ophthalmology Retina, 4(1), Ciulla TA, et al., Visual acuity outcomes and anti-vascular endothelial growth factor therapy intensity in neovascular age-related macular degeneration patients: a real-world analysis of 49485 eyes, 19–30, copyright (2020), with permission from Elsevier.
Graphic representation of the association of visual improvement with increasing anti-VEGF injections in DME
Taken from Visual acuity outcomes and anti-VEGF therapy intensity in diabetic macular edema: a real-world analysis of 28658 eyes, Ciulla TA, et al. 0:1–6, copyright (2020), with permission from BMJ Publishing Group Ltd..
Diabetic macular edema (DME) and neovascular age-related macular degeneration (nAMD) are multifactorial diseases3,4 caused by vascular instability , characterized by vascular permeability, inflammation and neovascularization.5
Several signalling pathways together contribute to vascular instability, including the Ang–Tie pathway , and are activated by cellular stress conditions.5,6
Dr. Patricio G. Schlottmann
Dr. Charles Wykoff
Prof. Anat Loewenstein
M-IL-00001668
What happens to Ang-1 and Ang-2 values in retinal diseases?
Ang-2 values are increased in the vitreous of patients with retinal diseases or choroidal vascular diseases, including AMD, DR and RVO, thus supporting the role of the Ang-2–Tie2 signalling pathway in these pathological conditions.7,8
*p < 0.05; ***p < 0.0001. Kruskal–Wallis non-parametric analysis according to Dunn's method of multiple comparisons was used to show significant differences in the control groups. Adapted from Regula JT, et al. EMBO Mol Med. 2016;8(11):1265–88.© 2019 F. Hoffmann – La Roche AG Published under the terms of the CC BY 4.0 license. Open access article under the terms of the Creative Commons Attribution 4.0 license under which use, distribution, and reproduction in any medium is permitted provided the original work is properly cited.
Ang-1 values were similar in vitreous samples from patients with retinal diseases or vascular diseases of the choroid and in samples from healthy individuals, which indicates a stable expression in normal and pathological conditions.2,3
Adapted from Regula JT, et al. EMBO Mol Med. 2019;11:e10666.© 2019 F. Hoffmann – La Roche AG Published under the terms of the CC BY 4.0 license. Open access article under the terms of the Creative Commons Attribution 4.0 license under which use, distribution, and reproduction in any medium is permitted provided the original work is properly cited.
AMD, age-related macular degeneration; Ang, angiopoietin; DME, diabetic macular edema; DR, diabetic retinopathy; IVT, intravitreal; nAMD, neovascular age-related macular degeneration; PDR, proliferative diabetic retinopathy; RVO, retinal vein occlusion; Tie, tyrosine kinase with immunoglobulin-like domains; VEGF, vascular endothelial growth factor.
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Reference:
- Ciulla TA, et al. Ophthalmol Retina. 2020.;4:19.–30.
- Ciulla TA, et al. Br J Ophthalmol. 2021.;105:216.–21.
- Chakravarthy U, et al. Retina. 2018.;38:343.–51.
- Swaroop A, et al. Annu Rev Genomics Hum Genet. 2009.;10:19.–43.
- Joussen AM, et al. Eye. 2021.;35:1305.–16.
- Saharinen P, et al. Nat Rev Drug Discov. 2017.;16:635.–61.
- Regula JT, et al. EMBO Mol Med. 2016.;8:1265.–88.
- Regula JT, et al. EMBO Mol Med. 2019.;11:e10666