wARMD抗VEGF治疗应答不良的影响因素及靶向周细胞的治疗策略

Influencing factors of poor response to anti-vascular endothelial growth factor drug therapy for wet age-related macular degeneration and therapeutic strategy of targeting pericytes

摘要:

随着人口老龄化程度的加剧，湿性年龄相关性黄斑变性(wARMD)的发病率逐渐上升，新生血管的形成导致黄斑区反复出血，是中老年人失明的主要原因之一。目前临床治疗以玻璃体腔注射抗血管内皮生长因子(VEGF)为一线治疗方法，但仍有部分患者对抗VEGF药物应答不良或无应答，导致临床治疗效果欠佳甚至无效，分析其具体影响因素将有利于指导临床制定方案。本文综述了高龄、疗程、注射次数、新生血管病灶特征、黄斑区结构、眼内房水细胞因子水平及遗传等因素对抗VEGF药物治疗应答的影响。此外，周细胞作为一种微血管壁的成分细胞，近年来发现其可影响抗VEGF药物治疗的敏感性，本文就周细胞在抗VEGF应答不良或不应答中的作用机制及靶向周细胞的解决策略研究现状进行综述。

Abstract:

With the increasing aging population, the incidence of wet age-related macular degeneration(wARMD)is gradually rising. The formation of neovascularization leads to recurrent hemorrhage in the macular region, which is one of the main causes of blindness in the elderly. Currently, the primary clinical treatment for wARMD is intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs. However, there are still some patients who have poor or no response to anti-VEGF drugs, resulting in suboptimal or ineffective clinical outcomes. Analyzing the specific influencing factors will be beneficial in guiding clinical decision-making. This article reviews the impact of factors such as advanced age, treatment duration, number of injections, characteristics of neovascular lesions, macular structure, intraocular cytokine levels, and genetics on the response to anti-VEGF therapy. In addition, recent studies have found that pericytes, as cellular components of microvascular walls, can influence the sensitivity to anti-VEGF therapy. This review summarizes the current research on the mechanisms of pericytes in poor or non-response to anti-VEGF therapy and discusses targeted strategies focusing on pericytes.