NeoNotes Journal Club
Andrew B. Kairalla MD, Editor
3-059 | Additional Comments | Previous Article | Next Article | List of Articles | Submit Comments | Index | FSN Home Page
The role of IGF-1 and VEGF in Retinal Vascular Development. Presented by Lois Smith MD, Harvard Medical School, Children’s Hospital, Boston MA.
Retinopathy of Prematurity (ROP) remains a major cause of vision loss in children despite aggressive treatment in severe cases with laser or cryotherapy. If we can gain an understanding of the pathophysiology of this disease, then we might be able to prevent ROP and preserve normal retinal vascular development. ROP occurs in 2 phases. In phase 1, there is cessation of the normal vessel growth in the retina, and loss of vessels. Phase 2 of ROP is characterized by vasoproliferation that leads to neovascularization and retinal detachment. Vascular Endothelial Growth Factor (VEGF) stimulates retinal vascular growth. This factor is suppressed by hyperoxia, and this could be the major cause of the Phase 1 of ROP. In phase 2, high levels of VEGF are present in the avascular portions of the retina due to tissue hypoxia. A critical level of Insulin-like Growth Factor 1 (IGF-1) is necessary to trigger retinal neovascularization. IGF-1 levels are low in premature infants, and may be further suppressed by infection and poor nutrition. IGF-1 levels are not stimulated or inhibited by oxygen. Serum IGF-1 levels can predict which infants will develop significant ROP. It is speculated that restoration of IGF-1 in premature infants to normal levels could prevent this disease.
Comment.
Current treatment for ROP with
laser or cryotherapy destroys retinal tissue and rarely preserves normal
vision. It is very attractive to
consider that supplementing IGF-1 to normal levels in premature babies may
prevent this disease. This would
truly be a major advance. ABK.
Additional Comments: You may add your own comments to the discussion of this topic by selecting : Submit Comments.