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Contempo Updates | Clinician's Corner

Modulating Angiogenesis:  More vs Less

Branavan Sivakumar, MRCS (Eng); Lorraine E. Harry, MRCS (Edin); Ewa M. Paleolog, PhD
JAMA. 2004;292(8):972-977. doi:10.1001/jama.292.8.972.
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The concept of manipulation of the vascular bed to either increase or decrease the number of blood vessels has attracted considerable interest. This review focuses on angiogenesis as a therapeutic target, particularly in the context of cancer and arthritis, as well as on promoting angiogenesis in cardiovascular disease and the healing of bone fractures. Although once touted almost as a panacea for treatment of tumors, as well as other diseases associated with angiogenesis, such as diabetic retinopathy or rheumatoid arthritis, it is now clear that such enthusiasm was somewhat premature. Similarly, some clinical trials of therapeutic angiogenesis for the management of cardiovascular disease have been disappointing. Nevertheless, this exciting field of research holds promise for more targeted therapies.

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Figure. Potential Therapeutic Target Opportunities in the Angiogenesis Pathway
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Antiangiogenic therapy can target the angiogenic process at several different levels, including (A) binding of angiogenic factors, such as vascular endothelial growth factor (VEGF); (B) prevention of the binding of angiogenic factors to cognate endothelial receptors; and (C) interruption of downstream signaling pathways either through blockade of receptor tyrosine kinase domains or use of mimetic angiogenesis inhibitors.

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