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Analysis of the roles of microvessel endothelial cell random motility and chemotaxis in angiogenesis.

The growth of new capillary blood vessels, or angiogenesis, is a prominent component of numerous physiological and pathological conditions. An understanding of the co-ordination of underlying cellular behaviors would be helpful for therapeutic manipulation of the process. A probabilistic mathematical model of angiogenesis is developed based upon specific microvessel endothelial cell (MEC) functions involved in vessel growth. The model focuses on the roles of MEC random motility and chemotaxis, to test the hypothesis that these MEC behaviors are of critical importance in determining capillary growth rate and network structure. Model predictions are computer simulations of microvessel networks, from which questions of interest are examined both qualitatively and quantitatively. Results indicate that a moderate MEC chemotactic response toward an angiogenic stimulus, similar to that measured in vitro in response to acidic fibroblast growth factor, is necessary to provide directed vascular network growth. Persistent random motility alone, with initial budding biased toward the stimulus, does not adequately provide directed network growth. A significant degree of randomness in cell migration direction, however, is required for vessel anastomosis and capillary loop formation, as simulations with an overly strong chemotactic response produce network structures largely absent of these features. The predicted vessel extension rate and network structure in the simulations are quantitatively consistent with experimental observations of angiogenesis in vivo. This suggests that the rate of vessel outgrowth is primarily determined by MEC migration rate, and consequently that quantitative in vitro migration assays might be useful tools for the prescreening of possible angiogenesis activators and inhibitors. Finally, reduction of MEC speed results in substantial inhibition of simulated angiogenesis. Together, these results predict that both random motility and chemotaxis are MEC functions critically involved in determining the rate and morphology of new microvessel network growth.

Cell Division

The Involvement of PI3K-Akt Signaling in the Clinical and Pathological Findings of Idiopathic Multicentric Castleman Disease-Thrombocytopenia, Anasarca, Fever, Reticulin Fibrosis, and Organomegaly and Not Otherwise Specified Subtypes.

Idiopathic multicentric Castleman disease is a rare lymphoproliferative disorder that is clinically classified into idiopathic plasmacytic lymphadenopathy (IPL); thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly (TAFRO); and not otherwise specified (NOS). Although each subtype shows varying degrees of hypervascularity, no statistical data on the degree of vascularization have been reported. Additionally, the mechanisms underlying vascularization in each clinical subtype are poorly understood. Here, we aimed to clarify these mechanisms by evaluating the histopathological characteristics of each clinical subtype across 37 patients and performing a whole-transcriptome analysis focusing on angiogenesis-related gene expression. Histologically, TAFRO and NOS exhibited a significantly higher degree of vascularization than IPL (IPL vs TAFRO, P < .001; IPL vs NOS, P = .002). In addition, the germinal centers (GCs) were significantly more atrophic in TAFRO than in IPL. In TAFRO and NOS, "whirlpool vessels" in GCs were seen in most cases (TAFRO, 9/9, 100%; NOS, 6/8, 75%) but not in IPL (IPL vs TAFRO, P < .001; IPL vs NOS, P = .007). Likewise, immunostaining for Ets-related gene revealed higher levels in endothelial cells of GCs in TAFRO than in IPL (P = .014), and TAFRO and NOS were associated with a significantly higher number of endothelial cells in interfollicular areas compared with that in IPL (TAFRO vs IPL, P < .001; NOS vs IPL, P = .002). Gene expression analysis revealed that the PI3K-Akt signaling pathway was significantly enriched in the TAFRO and NOS (TAFRO/NOS) groups. This pathway, which may be activated by vascular endothelial growth factor A and some integrins, is known to affect angiogenesis by increasing vascular permeability, which may explain the clinical manifestations of anasarca and/or fluid retention in TAFRO/NOS. These results suggest that the PI3K-Akt pathway plays an important role in the pathogenesis of TAFRO/NOS.

Humans

A modified filtering operation for neovascular glaucoma.

Thirteen patients with useful vision but suffering from uncontrollable neovascular glaucoma due to total angle closure were treated with modified filtering operations. Ten (77%) of the cases were controlled more than one year postoperatively. Most patients whose pressures were controlled maintained their preoperative visual acuities. These visual results appear to be better than those reported with cyclocryotherapy, where vision is usually lost despite satisfactory pressure control.

Adolescent

Iris neovascular tufts. Relationship to rubeosis, insulin, and hypotony.

Iris neovascular tufts are abnormal proliferations of twisted microcapillary loops that project from the iris pupillary border. They appear to be a morphologic variant of rubeosis iridis. This study searched for iris neovascular tufts by biomicroscopy and iris fluorescein angiography. They were found in two of 16 (12.5%) myotonic dystrophy patients, in two of 30 (6.7%) maturity-onset diabetics, and in zero of 14 (0%) juvenile-onset diabetics. Myotonic and adult-onset diabetics have in common pancreatic beta-cell dysfunction, abnormally high serum insulin levels, and possibly defective hormone-receptor interactions. Whether these factors contribute to the altered blood-iris barrier and iris neovascular tufts in these groups is uncertain, but a correlation is suggested because the myotonic with the highest insulin level also had the most prominent tufts. Hyperinsulinemia and ocular hypotony are associated with neovascular tufts.

Adolescent

Binocular diplopia associated with subretinal neovascular membranes.

A series of patients were seen with binocular diplopia secondary to subretinal neovascular membrane in one eye. The pathophysiology underlying the diplopia is the establishment of rivalry between central and peripheral fusional mechanisms. This diplopia is not relieved by appropriate prism therapy.

Adult

Presumed ocular histoplasmosis syndrome. A clinicopathologic correlation of a treated case.

A patient with bilateral presumed ocular histoplasmosis had been successfully treated in his symptomatic right eye with laser photocoagulation for subretinal neovascularization in two areas of the macula. The left eye also showed neovascularization clinically and histopathologically but was not treated because there was no detectable leakage and the vision was not affected. There was no change in the left eye over a two-year period. Clinicopathologic correlation of the treated and untreated macular lesions and the peripapillary and peripheral lesions is presented.

Eye

Retinal breaks after photocoagulation of proliferative sickle cell retinopathy.

Retinal breaks developed in four eyes of four patients with hemoglobin SC disease and advanced proliferative sickle cell retinopathy (PSR) after argon laser photocoagulation of feeder vessels. These cases represented 8.7% of the 46 eyes with PSR treated with the argon laser at our institution in 1977 and 1978. In three patients, the retinal breaks were immediately adjacent to the site of photocoagulation. A scleral buckling procedure was necessary in only one of the four eyes; the breaks were successfully managed in the other three cases by encirclement with further laser treatment. None of the four eyes lost vision. In patients with vitreous traction in association with seafan neovascularization, argon laser photocoagulation may result in retinal breaks and retinal detachment.

Adult

Use of flurbiprofen to inhibit corneal neovascularization.

Following the suggestion that prostaglandins are involved in corneal neovascularization, two inhibitors of prostaglandin formation, prednisolone acetate and flurbiprofen sodium, have been evaluated in two experimental models of corneal neovascularization. The fatty acid cyclooxygenase inhibitor, flurbiprofen, at concentrations of 0.01% and 0.1%, significantly decreased the rate of vessel growth compared with vehicle controls in both silver nitrate cauterization and anterior chamber alloxan models of corneal neovascularization. Prednisolone, at a concentration of 1%, was used as a positive control. It did inhibit neovascularization in the latter model, but was ineffective in the former. It is concluded that 0.1% flurbiprofen is equipotent to 1% prednisolone as an inhibitor of corneal neovascularization. The mechanism is unknown but is likely to be via inhibition of prostaglandin formation and/or inhibition of leukocytic infiltration.

Animals

Optic disc edema in juvenile-onset diabetes.

The clinical and photographic records of patients with juvenile-onset diabetes and nonneurologic disc edema were reviewed to determine the natural history of the disease. Six female and two male patients, 14 to 40 years old, who had had diabetes for seven to 22 years had no visual complaints or mild blurring. All had 6/9 or better visual acuity and normal blood pressure. Visual fields were normal or showed an enlarged blind spot. The edematous discs had superficial, dilated, radially oriented, fluorescein-incontinent capillaries. Two patients had simultaneous neovascularization of the disc. Three received laser photocoagulation, and five received no therapy. In the seven followed up for six months or more, the edema resolved, resulting in 6/6 visual acuity. These findings suggest the edema resulted from a reversible vasculopathy that, due to few symptoms, may be more common than is presently appreciated.

Adolescent

Chorioretinal and choriovitreal neovascularization. Their presence after photocoagulation of proliferative sickle cell retinopathy.

Delayed development of choroidally fed neovascularization represents a potentially serious complication of feeder vessel photocoagulation of proliferative sickle cell retinopathy (PSR). Of the 53 photocoagulated eyes, choroidally fed neovascularization developed in 21 within one month to seven years (mean, 32.8 months). This complication appeared in eyes treated with argon laser and xenon arc. In 11, neovascular tissue remained flat in the chorioretinal scar (chorioretinal neovascularization), but in ten, the vessels grew into the vitreous (choriovitreal neovascularization). In many cases of chorioretinal neovascularization, the only subsequent complication was local vitreous hemorrhage. Visual acuities remained near normal. The development of choriovitreal neovascularization was associated with vitreous hemorrhages or retinal detachment in six of ten cases. Final visual acuities, however, were 20/50 or better in nine. Photocoagulation in some cases converted chorioretinal neovascularization to choriovitreal neovascularization or seemed to stimulate further growth of choriovitreal neovascularization. We now recommend no treatment for most cases of choroidally fed neovascularization. Photocoagulation techniques for PSR should attempt to minimize the development of choroidally fed neovascularization.

Adult

Radial chorioretinal folds. A sign of choroidal neovascularization.

A radial pattern of chorioretinal folds surrounding the margins of a localized macular detachment occurred in four patients with drusen of Bruch's membrane. Biomicroscopic and angiographic findings suggested that contraction of a subpigment epithelial choroidal neovascular membrane caused a focal area of shrinkage, or puckering, of the choroid and a series of chorioretinal folds radiating outward from the edge of the membrane. In two eyes, these radial folds developed early in the course of the macular detachment before any other reliable biomicroscopic signs of choroidal neovascularization were present.

Aged

Peripapillary subretinal neovascularization in presumed sarcoidosis.

Peripapillary subretinal neovascularization developed in both eyes of two young women with bilateral chronic granulomatous uveitis. Despite intensive medical therapy, central vision was lost in two eyes owing to disciform scarring that extended to the macula. The neovascularization in the other two eyes was treated successfully with argon laser photocoagulation. Neither of the patients had the clinical or roentgenographic findings typical of sarcoidosis. Both, however, showed elevated serum angiotensin-converting enzyme activity, which provides indirect evidence for the diagnosis of sarcoid uveitis.

Adolescent

Visual outcome in moderate and severe proliferative diabetic retinopathy.

Four hundred eyes with moderate or severe proliferative diabetic retinopathy, initial good vision, and an average follow-up of 44.3 months were studied. Final visual acuity was 20/40 or better in 33% of these eyes, 20/50 to 5/200 in 32%, and 5/200 or worse in 35%. A poor visual prognosis was correlated with a traction detachment or relatively poor visual acuity at initial examination. No correlation was found between the length of follow-up and final visual prognosis. General guide-lines are available for the management of these patients' conditions.

Diabetic Retinopathy