There are now treatments available that target VEGF to prevent vessel overgrowth, and they often provide dramatic benefits at first. Unfortunately, these benefits can fade with time.
A team of researchers at the University of Virginia (UVA) Health System have discovered an unknown contributor to harmful blood vessel growth in the eye that could lead to new treatments for blinding macular degeneration and other common causes of vision loss.
According to a UVA news release, Jayakrishna Ambati, MD, and Shao-bin Wang, PhD, and their colleagues have identified a new target to prevent the formation of abnormal tangles of blood vessels associated with eye conditions such as neovascular age-related macular degeneration, proliferative diabetic retinopathy and ischemic retinal vein occlusion.
“Our study1 has opened up the possibility of mitigating aberrant blood vessel growth in eye diseases by targeting the epigenetic machinery,” Ambati, the founding director of UVA’s Center for Advanced Vision Science and a member of the University of Virginia School of Medicine’s Department of Ophthalmology., said in the news release
Ambati pointed out through local targeting of the epigenetic regulator, we have gained a deeper understanding of how ocular immune cells can cause a loss of control over blood vessel growth under the retina.
“This approach also offers a new direction for the development of more effective, cost-efficient and accessible interventions, thereby avoiding issues such as drug resistance, which is a growing concern with conventional anti-VEGF therapies used in clinical treatments,” he explained in the news release.
Understanding Vision Loss
Scientists have known that abnormal vessel overgrowth in the eye is fueled by excessive amounts of a substance called “vascular endothelial growth factor-A,” or VEGF, that plays an important role in blood vessel formation. There are now treatments available that target VEGF to prevent vessel overgrowth, and they often provide dramatic benefits at first. Unfortunately, these benefits can fade with time. That leaves doctors in need of better treatments to help preserve patients’ eyesight.
The university noted that the research by Ambati and Wang identifies a key protein that determines VEGF levels. Blocking this protein in lab mice reduced their VEGF levels significantly, and it did so in a targeted way, without unwanted side effects.
Ambati’s team pointed out that they observed no toxic effects on the retina, the light-sensing portion of the eye where the vessel overgrowth occurs.
“This fat mass and obesity-associated (FTO) protein was previously shown to be correlated with obesity in humans,” Ambati noted. “Unexpectedly, we found it also play important roles in regulating ocular neovascularization through an epigenetic mechanism.”
Moreover, Ambati explained the discovery finally answers a longstanding question about how ocular immune cells, such as macrophages, contribute to abnormal blood vessel growth under the retina.
“This question was first investigated by our team 20 years ago, and we're thrilled to have found an answer,” he said.
In addition to identifying a promising target for the development of new treatments for vision loss, the discovery sheds important light on the fundamental mechanisms responsible for the blood vessel overgrowth that robs millions of people of their sight.
UVA noted in the news release that neurovascular age-related macular degeneration alone affects more than 200 million people worldwide. While much more research and testing will be needed before the new finding could be translated into a treatment, the UVA scientists are excited about the potential of the discovery.
Wang added that strategies currently used for treating ocular neovascular disorders, which primarily focus on regulating the protein levels of VEGF, are not perfect.
“Therefore, it is imperative to identify more targetable candidates to develop alternative therapies,” Wang said. “We are hopeful that our study will pave the way for the development of new treatments, ultimately reducing the burden of neovascular-related illnesses.”
The research was supported by the National Institutes of Health, grants R01EY028027, R01EY029799, R01EY031039 and R01AG082108; the UVA Strategic Investment Fund; the DuPont Guerry III professorship; a gift from Mr. and Mrs. Eli W. Tullis; the Annette Lightner Fund; BrightFocus Foundation Award M2020114; and the Owens Family Foundation.
1 Jayakrishna Ambati, MD, Shao-bin Wang, PhD, et.al. Signal Transduction and Targeted Therapy. Published February 20, 2023. Accessed March 1, 2023. DOI: 10.1038/s41392-022-01277-4