Angiogenesis Flashcards

1
Q

What is physioloical angiogenesis?

A

ESSENTIAL for embryonic development, wound healing and the menstrual cycle

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2
Q

What is vasculogenesis?

A

involves bone marrow progenitor cells (during development) that form blood vessels from scratch

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3
Q

What is angiogenesis?

A

Vessels sprout from a PRE-EXISTING blood vessel - most common in adults and involved in disease process

pro-angiogenic stimulus triggers the activation of specific selected endothelial cells -> conformational change

cytoskeleton changes polarity - allows it to sense the outside world (senses a stimulus that allows the direction of blood vessel formation)

At the same time, the cell communicates with other nearby endothelial cells, in order to instruct them to divide, to form vessels.

Cells begin to chew up the matrix, and eventually they fuse with a sprout coming from elsewhere

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4
Q

What is arteriogenesis?

A

collateral growth (mechanism through which collaterals are formed)

Collaterals may bypass a blockage

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5
Q

What features of the cytoskeleton of the tip of the endothelial cell allow it to for new vessels?

A

must be modified and it needs to control the interaction with neighbouring cells at cell-cell junctions.

  • The tip cells will keep on moving until they find another tip cell, with which they will fuse
  • tip cells themselves do not divide - require their neighbouring cells to divide behind them to push the tip cells towards the GF
  • Eventually, the tip cell will meet another tip cell and it will fuse and stabilise
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6
Q

How is angiogenesis regulated

A

There are activators and inhibitors of angiogenesis - balance of these 2 groups regulates angiogenesis

There are some proteins/regulators that are absolutely essential e.g. VEGF – a loss of one allele of VEGF is incompatible with life.

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7
Q

How does hypoxia trigger angiogenesis?

A

HIF is a growth factor that controls regulation of gene expression by oxygen

  • When oxygen is plentiful, HIF transcription factor is bound by a protein: pVHL – a tumour suppressor gene
  • When bound to HIF, pVHL induces ubiquitination (inactivation by the addition of ubiquitin) and degrades HIF.
  • THE MOMENT OXYGEN IS NOT PLENTIFUL, pVHL no longer binds to HIF -> HIF is not degraded and enters the nucleus to bind HIF-beta -> drives transcription of genes that promote angiogenesis, such as VEGF (vascular endothelial growth factor)
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8
Q

What are the different types of VGEF and VGEF receptors?

A
5 members of the VEGF family:
- VEGF-A
 VEGF-B
- VEGF-C
- VEGF-D
- PIGF (placental GF)

3 tyrosine kinase receptors for VEGF:

  • VEGFR-1
  • VEGFR-2
  • VEGFR-3

2 co-receptors for VEGF:

  • Neuropilin-1 (Nrp1)
  • Neuropilin-2 (Nrp2
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9
Q

What is notch signalling?

A

pathway crucial for selection of tip cells - between adjacent endothelial cells at the angiogenic front

  1. In stable blood vessels, Dll4 and Notch signalling maintain quiescence.
  2. VEGF activation increases expression of Dll4.
  3. Dll4 drives Notch signalling, which inhibits expression of VEGFR2 in the adjacent cell.
  4. Dll4-expressing tip cells acquire a motile, invasive and sprouting phenotype.
  5. Adjacent cells (Stalk cells) form the base of the emerging sprout, and proliferate to support sprout elongation.
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10
Q

What happens when the notch ligand binds to the notch receptor?

A

activates it by cleaving the intracellular domain (NICD) -> NICD translocates to the nucleus where it binds to the TF RBP-J and regulates transcription

When a tip cell is chosen, it begins to express notch ligand which binds to the stalk cells’ notch receptors

  • It tells them that ‘I am the tip cell, you are the stalk cells’

The stalk cells then begin to divide and push the tip cell towards the growth factor

  • the notch ligand is also called Delta-like ligand 4 (Dll4)
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11
Q

How is sprout outgrown guided and stabilised?

A

cells will interact with the ECM and there will be guidance systems in place

Macrophages carve out tunnels in the ECM, providing avenues for subsequent capillary infiltration - appear to help stabilise newly formed vessels (by promoting tip cell fusion)

Once the tip cells have fused and the stalk cells are separating to form a patent tube, the new vessel needs to stabilise - involves reforming the endothelial monolayer barrier and recruiting neural cells (pericytes) and switching off the active angiogenesis process

*MYELOID CELLS IN THE RETINA CAN HELP THE PROCESS BY WRAPPING AROUND ENDOTHELIAL CELLS, TO STABILISE THE PROCESS

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12
Q

What does vascular endothelial (VE)- cadherin do?

A
  • Constitutively expressed at junctions
  • Mediates adhesion between endothelial cells (via homophillic interaction between cadherins)
  • Controls contact inhibition of cell growth
  • Promotes survival of EC
  • essential for stabilisation and quiescence - loss of cadherin control is one of the hallmarks of some epithelial cancers
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13
Q

What do pericytes do?

A

Pericytes can wrap around the capillaries- produce a growth factor called ANGIOPOIETIN-1 (stabilising factor)

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14
Q

What are mural cells?

A

generally refers to smooth muscle cells and perictyes

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15
Q

What happens in the angiopoietin-Tie2 ligand-receptor system?

A

There are two ligands, which are ANTAGONISTIC: angiopoietin-1 (promotes stability, anti-inflammatory, homeostatic) and angiopoietin-2 (stored in endothelial cells, antagonises angiopoietin-1).

  • Tie2 is a receptor that can bind to Angiopoietin 1
  • Angiopoietin 1, when it binds to Tie2, promotes quiescence in the vasculature
  • Angiopoietin 2 gets released when you need to form new blood vessels, when you need to respond to inflammation or when the vasculature needs to be destabilised
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16
Q

When do tumours require new blood vessels?

How do they do this?

A

larger than 1mm^2 (less than this - receive oxygen and nutrients from diffusion from host vasculature)

Tumours secrete angiogenic factors that stimulate the formation of new blood vessels

Newly vascularised tumour no longer relies solely on diffusion from host vasculature - facilitates its progressive growth, migration, proliferation and further neovessel formation

  • Angiogenic Switch: there’s a point at which the tumour gets to a certain size where diffusion is no longer sufficient, so some cells within the tumour become hypoxic and send angiogenic signals - can occur at different stages in the tumour-progression pathway, depending on the nature of the tumour and its environment
17
Q

Why is heamorrage common in tumours?

A

NOT properly formed because the signals are not physiological - imbalance in the signals that are regulating angiogenesis

18
Q

What are the features of tumour blood vessels?

A

can be:

  • Irregularly shaped, dilated, tortuous
  • Not organised into definitive venules, arterioles and capillaries
  • Leaky and haemorrhagic, partly due to the over-production of VEGF
  • Perivascular cells often become loosely associated
  • Some endothelial cells may recruit endothelial progenitor cells from the bone marrow
19
Q

How can you target the VGEF pathway in cancer?

A

anti-VEGF antibody

Anti-angiogenic therapy can help normalise the tumour blood vessels. However, if you go for very aggressive anti-angiogenic therapy, you could end up damaging the ability to deliver other drugs to the tumour

*The aim now is to normalise tumour blood vessels to reduce hypoxia and improve the efficiency of drug delivery

20
Q

What is avastin (/bevacizumab)?

A

Anti-VEGF Humanised MAb (mouse antibody)

  • limited efficacy and many side effects: GI perforation, Hypertension, Proteinuria, Venous thrombosis, Haemorrhage AND Wound healing complications
  • no overall survival advantage over chemotherapy alone
  • No quality-of-life or survival advantage
  • These side effects are because VEGF is essential for the homeostasis of the endothelium

AVASTIN IS NOT FIRST LINE TREATMENT. IT IS RESERVED FOR VERY ADVANCED CANCER.

21
Q

What are the modes of unconventional resistance to VEGF blockade?

A
  • tumour adopts an evasive strategy and adapts to bypass the specific angiogenic blockade
  • Intrinsic or pre-existing difference - particular tumour in particular place in a particular person, was not very sensitive to VEGF anyway, so knocking out VEGF made little difference
22
Q

What can anti-VEGFalso be used for?

A

Age-related macular degeneration (AMD)

AMD: abnormal growth of choroidal vessels -> leaky vessels cause oedema -> VISUAL IMPAIRMENT

The pharmaceutical company made the Avastin into a slightly modified form – Lucentis

  • A lot of studied have shown that Avastin works just as well as Lucentis and Avastin is much cheaper - ranibizumab (Lucentis), $2,023 per dose (up to 12 injections per year), Bevacizumab (Avastin), $55 per dose

Many patients become refractory to treatment >2 years

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23
Q

How can angiogenic therapy be used in other diseases?

A

Anti-angiogenic therapies for abnormal retina vascularization (diabetic retinopathy, wet AMD)

Pro-angiogenic therapies for ischemic diseases (myocardial infarction, peripheral ischemic disease)

24
Q

When would you want to promote angiogenesis?

A

ischaemia - to prevent damage