Larger Therapeutic Window for Steroid versus VEGF-A Inhibitor in Inflammatory Angiogenesis: Surprisingly Similar Impact on Leukocyte Infiltration

PURPOSE. The current treatments against inflammatory angiogenesis are steroids and anti-VEGF-A, such as dexamethasone and bevacizumab, respectively. However, the therapeutic windows for dexamethasone and bevacizumab against inflammatory angiogenesis are unknown. METHODS. To investigate the therapeutic windows for dexamethasone and bevacizumab, we used the corneal pocket assay. IL-1 beta pellets were implanted in corneas of BALB/c mice that were then treated with dexamethasone or bevacizumab at different time points. Angiogenesis (area, number of vessels, and sprouting) was quantitated at various time points after implantation. Nuclear Factor-kappa B (NF-kappa B) signaling and leukocyte accumulation in inflammatory angiogenesis were examined by Western blotting, by immunohistochemistry, and in the authors' novel leukocyte transmigration assay. RESULTS. Dexamethasone inhibited IL-1 beta-induced angiogenesis when treatment started 4 days after IL-1 beta implantation, while bevacizumab only inhibited angiogenesis by day 2 after implantation. Both bevacizumab and dexamethasone inhibited angiogenic sprouting. Interestingly, bevacizumab did not affect NF-kappa B activation, which is one of the main signaling targets for steroid action. The authors' new imaging approach revealed that bevacizumab and steroid treatment blocked leukocyte infiltration into implanted corneas. CONCLUSIONS. VEGF-A inhibition affected angiogenic sprouting, while it was not effective against matured vessels. Both dexamethasone and bevacizumab inhibited leukocyte transmigration from angiogenic vessels; however, dexamethasone had a larger therapeutic window. These insights improve the treatment strategy in angiogenic disorders. (Invest Ophthalmol Vis Sci. 2012;53:3296-3302) DOI:10.1167/iovs.11-8114