BACKGROUND & AIMS:
PURPOSE:Intravitreal antivascular endothelial growth factor (anti-VEGF) application has revolutionized the treatment of choroidal neovascularization (CNV), a hallmark of wet age-related macular degeneration. However, additional treatment options are desirable as not all CNV lesions respond to anti-VEGF injections. Here, we assessed the feasibility of targeted delivery of cationic liposome-encapsulated paclitaxel (EndoTAG-1) in treating CNV. Furthermore, we investigated whether a new formulation of verteporfin encapsulated in cationic liposomes (CL-VTP) enhances the effect of photodynamic therapy (PDT).
METHODS:EndoTAG-1, LipoSPA, and CL-VTP were produced by encapsulating paclitaxel, succinyl-paclitaxel, or verteporfin in cationic liposomes (CL). Mice underwent argon laser coagulations at day 0 (D0) to induce CNV. EndoTAG-1 and LipoSPA were injected into the tail vein at D1, D3, D5, D7, and D9. Taxol, CL, or trehalose buffer alone was injected in control animals. At D10, all animals were perfused with fluorescein isothiocyanate (FITC)-dextran. Flatmounts comprising the retinal pigment epithelium, choroid, and sclera were prepared for quantifying the CNV by measuring the area of lesions perfused with FITC-dextran. For PDT, mice received an injection with CL-VTP or Visudyne at D10. One eye was treated with PDT while the other served as a control. Evaluation of RPE-choroid-scleral and retinal flatmounts was performed at D12, D14, or D17. Perfusion with FITC-dextran and tetramethylrhodamine-5-(and 6)-isothiocyanate-lectin staining was used to distinguish between perfused and non-perfused choroidal vessels.
RESULTS:EndoTAG-1 or LipoSPA significantly reduced CNV size to 15% compared to trehalose controls. The mean CNV area of mice treated with CL was reduced (though not significantly) to about one-half of the value of the trehalose control group. The same was observed for paclitaxel. Thus, the reduction in the CNV size between treatment with CL and treatment with EndoTAG-1 or LipoSPA was 40%, which was not significant. PDT using either CL-VTP or Visudyne reduced CNV size to 65% (D17) of trehalose control size. CNV size was further diminished to 56% with Visudyne and 53% with CL-VTP when PDT was repeated twice. Most importantly, PDT-associated retinal damage was less pronounced using CL-VTP compared to Visudyne.
CONCLUSIONS:Systemic intravenous injection of paclitaxel (EndoTAG-1)- or succinyl-paclitaxel (LipoSPA)-loaded CL had a significant antiangiogenic effect in a CNV mouse model. PDT with CL-VTP was as effective as Visudyne in neovascular obliteration but induced less tissue damage. Our data suggest that systemic application of cationic liposome formulations may serve to treat ocular neovascular diseases. This approach may reduce the need for intraocular injections and may benefit patients with neovascular lesions irresponsive to anti-VEGF treatment.
背景与目标:
目的:玻璃体内抗血管内皮生长因子(anti-VEGF)的应用彻底改变了脉络膜新生血管(CNV)的治疗方法,脉络膜新生血管是湿性年龄相关性黄斑变性的标志。但是,由于并非所有的CNV病变都对抗VEGF注射产生反应,因此需要其他治疗选择。在这里,我们评估了靶向脂质体包裹的紫杉醇(EndoTAG-1)靶向治疗CNV的可行性。此外,我们调查了封装在阳离子脂质体(CL-VTP)中的维替泊芬的新配方是否增强了光动力疗法(PDT)的效果。
方法:EndoTAG-1,LipoSPA和CL-VTP是通过将紫杉醇,琥珀酰-紫杉醇或verteporfin包裹在阳离子脂质体(CL)中制成的。在第0天(D0)对小鼠进行氩激光凝结以诱导CNV。将EndoTAG-1和LipoSPA注入D1,D3,D5,D7和D9的尾静脉。在对照动物中单独注射紫杉醇,CL或海藻糖缓冲液。在第10天,向所有动物灌注异硫氰酸荧光素(FITC)-葡聚糖。制备包含视网膜色素上皮,脉络膜和巩膜的扁平支架,以通过测量灌注FITC-右旋糖酐的病变面积来定量CNV。对于PDT,小鼠在D10时接受CL-VTP或Visudyne注射。一只眼用PDT治疗,另一只作为对照。在D12,D14或D17进行RPE脉络膜巩膜和视网膜平片的评估。用FITC-葡聚糖和四甲基罗丹明5-(和6)-异硫氰酸酯-凝集素染色进行灌注以区分灌注的和未灌注的脉络膜血管。
结果:与海藻糖对照组相比,EndoTAG-1或LipoSPA将CNV大小显着降低至15%。用CL治疗的小鼠的平均CNV面积减少(尽管不明显)至海藻糖对照组的一半左右。对于紫杉醇观察到相同的结果。因此,在CL治疗与EndoTAG-1或LipoSPA治疗之间CNV大小的减少为40%,这并不显着。使用CL-VTP或Visudyne的PDT可将CNV大小减小至海藻糖对照大小的65%(D17)。当PDT重复两次时,Visudyne的CNV大小进一步减小至56%,CL-VTP的CNV大小进一步减小至53%。最重要的是,与Visudyne相比,使用CL-VTP的PDT相关性视网膜损伤不那么明显。
结论:全身静脉注射紫杉醇(EndoTAG-1)或琥珀酰紫杉醇(LipoSPA)负载的CL在CNV小鼠模型中具有显着的抗血管生成作用。带有CL-VTP的PDT在新生血管闭塞方面与Visudyne一样有效,但引起的组织损伤较少。我们的数据表明,阳离子脂质体制剂的全身应用可能有助于治疗眼部新血管疾病。这种方法可以减少眼内注射的需要,并且可以使对抗VEGF治疗无反应的新生血管病变患者受益。