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Vascular-endothelial growth factor [VEGF] in patients with peripheral ischemia

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Vascular endothelial growth factor (VEGF) is a key cytokine responsible for the spontaneous new blood vessel formation in the course of peripheral ischemia. It has repeatedly been observed in patients with critical leg ischemia that their clinical status does not reflect any effective local neovascularization processes as well as VEGF system up-regulation. Therefore, the aim of present study was to compare the proangiogenic status, assessed as the serum VEGF concentration, in patients with mild, moderate, and severe peripheral ischemia and to analyze to what extend it is influenced by the therapy applied. Serum VEGF level was evaluated by ELISA method in 31 patients with peripheral ischemia at different time points throughout the treatment. On Day 0 (before treatment), Day 2, and Day 7, VEGF concentration was significantly higher in subjects with critical leg ischemia (Group I) than in other groups (P<0.001). In Group I, VEGF decline was reported on Day 30 following radical surgery, while in a group of moderate disease treated by revascularization surgery a significant increase in serum VEGF concentration was observed (Day 7 and Day 30) (P=0.02). Serum cytokine level in the patients with mild ischemia (Group III) on pharmacotherapy was stable throughout the observation period. Interestingly, the increase in VEGF levels throughout the study period from Day 0 to Day 30 was significantly greater in unsuccessfully treated patients compared with subjects who positively responded to therapy or did not show any response at all. We conclude that mechanisms other than hypoxia might drive the observed up-regulation of VEGF production in peripheral ischemia.
Tumor endothelial cells are actively involved in the neovascularization processes that accompany tumor growth. Their easy accessibility for systemically applied therapeutics makes them interesting targets for therapeutic intervention. Especially for drug targeting-based therapeutics that often consist of macromolecular moieties, the tumor endothelium is considered a much better target than the tumor cells located behind the vascular wall barrier. In this review, the general principles underlying the development and choices in the development of vascular drug-targeting strategies are discussed. An overview of target epitopes identified in the past two decades is followed by a summary of those strategies that directly or indirectly induced tumor blood flow blockade in vivo. The demonstrated therapeutic success in pre-clinical animal models in debulking large tumor masses and inhibiting tumor outgrowth warrant further development of these therapeutic approaches. Yet, more effort should be put in studies in which the efficacy of different effector activities aimed at the same target, of one effector activity aimed at different targets, and of multiple target strategies are be compared. Combining these data with proper inventories on the molecular basis of tumor endothelial heterogeneity in general will make possible the development of tumor vascular drug-targeting strategies towards clinical application.
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