脉络膜新生血管阶段一

• 新生血管的成熟
PDGF,aFGF,Ang及受体Tie-1,Tie-2
RPE对CNV的双重调节功能
1.促进作用 生成促进血管内皮细胞增生和移行的VEGF,FGF,TGFa,TNF-a等等 诱导体内血管内皮细胞形成窗孔结构，影响新生血管的成 熟 2.抑制作用 直接接触抑制血管内皮细胞的移行 分泌抑制血管内皮细胞生长的物质：TGF-b,PEDF 释放凝血酶原激活物抑制因子，使纤维酶原向纤溶酶的转 化受阻，细胞外基质不能降解
STAT3+CNV
• • • • • • • • • • • • • • 1.A novel protective role for the innate immunity Toll-Like Receptor 3 (TLR3) in the retina via Stat3. Mol Cell Neurosci. 2014 Sep 28;63C:38-48 IF:3.73 TF-mediated protection of photoreceptors requires initial activation of the cytokine receptor gp130 in Müller glial cells. Proc Natl Acad Sci U S A. 2013 Nov 19;110(47):E4520-9 IF:9.81 3.Toll-like receptor 3 (TLR3) protects retinal pigmented epithelium (RPE) cells from oxidative stress through a STAT3-dependent mechanism. Mol Immunol. 2013 Jun;54(2):122-31 IF:3.0 4.Suppression of choroidal neovascularization through inhibition of APE1/Ref-1 redox activity. Invest Ophthalmol Vis Sci. 2014 Jun 26;55(7):4461-9 IF.3.66 5.IL-27 inhibits pathophysiological intraocular neovascularization due to laser burn. J Leukoc Biol. 2012 Feb;91(2):267-73 IF:4.3 6.Interleukin-6 receptor-mediated activation of signal transducer and activator of transcription-3 (STAT3) promotes choroidal neovascularization. Am J Pathol. 2007 Jun;170(6):2149-58 IF:4s choroidal neovascularisation in mice via the oxidative stressinduced activation of STAT3 signalling in RPE cells. PLoS One. 2012;7(10):e47600. doi: 10.1371/journal.pone.0047600. Epub 2012 Oct 19
巨噬细胞
激光诱导CNV，第一天巨噬细胞出现，第 三天达到高峰，5-7天后开始减少。
VEGF，MMP-9 蛋白水解酶（玻璃膜）
IL-1a,IL-1b,TNF-a IL-8,MCP-1
生成血管活性因子
巨噬细胞+RPE
参与血管内皮生长因子诱发脉络膜 新生血管的信号通路
• • • • MAPK途径 PI-3K-AKt/PKB途径 钙离子依赖性激酶途径 NO途径
HIF-1
Functions as a master transcriptional regulator of the adaptive response to hypoxia. Under hypoxic conditions, activates the transcription of over 40 genes, including erythropoietin, glucose transporters,glycolytic enzymes, vascular endothelial growth factor, HILPDA, and other genes whose protein products increase oxygen delivery or facilitate metabolic adaptation to hypoxia. Plays an essential role in embryonic vascularization, tumor angiogenesis and pathophysiology of ischemic disease.
脉络膜新生血管 CNV
CNV的发生机制
RPE-Bruch膜-脉络膜毛细血管复合体改变对CNV的影响
遗传 衰老 光损伤 玻璃膜疣 营养失调 炎症
炎症因子 血管因子
新生血管
C57BL/6J（B6） Laser-induced CNV
• 腹腔麻醉：0.5%戊巴比妥钠 • 散瞳：托品酰胺苯肾上腺素 • 激光：647.1 nm; 50mm spot size; 0.05 s duration; 360 mW. 1PD；3,6,9,12 o’clock positions
Fundus fluorescein angiography
3 min after intraperitoneal injection of 0.3 mL of 2%fluorescein sodium was injected into the intraperitoneal cavity of the mice.
细胞
名称
内皮细胞 RPE 巨噬细胞
细胞株
the murine cell line b-End3; human umbilical vein endothelial cells; Choroid-retinal endothelial cell line
human cell line ARPE19; the murine cell line RAW264.7
• • • • • • • • • • • • • • 1.Roles for the ubiquitin-proteasome pathway in protein quality control and signaling in the retina: implications in the pathogenesis of age-related macular degeneration. Mol Aspects Med. 2012 Aug;33(4):446-66 IF:10.3 2.Macular pigment lutein is antiinflammatory in preventing choroidal neovascularization. Arterioscler Thromb Vasc Biol. 2007 Dec;27(12):2555-62 IF:5.53 3.IKK2 inhibition attenuates laser-induced choroidal neovascularization. PLoS One. 2014;9(1):e87530 IF:3.53 4.TNF-α decreases VEGF secretion in highly polarized RPE cells but increases it in non-polarized RPE cells related to crosstalk between JNK and NF-κB pathways. PLoS One. 2013;8(7):e69994 IF:3.53 5.NLRP3 inflammasome activation in retinal pigment epithelial cells by lysosomal destabilization: implications for age-related macular degeneration. Invest Ophthalmol Vis Sci. 2013 Jan 7;54(1):110-20 IF:3.66 6.Regulatory role of HIF-1alpha in the pathogenesis of age-related macular degeneration (AMD). Ageing Res Rev. 2009 Oct;8(4):349-58 IF:7.63 7.Roles of NFκB-miR-29s-MMP-2 circuitry in experimental choroidal neovascularization. J Neuroinflammation. 2014 May 15;11:88 IF:4.9
NFκB受多种细胞内和细胞外的刺激如细胞因子，氧化剂自由基，紫 外线照射，细菌性或病毒性产物激活的转录调节子。激活的NFκB 易位到细胞核中，并刺激参与多种生物功能的基因的表达。NFκB 的不适当活化已经与许多炎症性疾病相关，而NFKB的持久性抑制 导致不适当的免疫细胞的发育或延缓细胞生长。
NF-kappa-B
P38内皮细胞移行
VEGF诱导活 化:ERK,JNK
ILK：内皮细胞增 生和移行
PI-3K:CEC增生
转录因子
• STAT3 • NF-kappa-B • HIF-1
STAT3
Signal transducer and transcription activator
退化期CNV的RPE细胞中，有STAT3的高表达， 而在已纤维化的盘状瘢痕中，STAT3的表达呈 阴性，提示STAT3的活化与CNV的纤维化有关。