Preventing Blood Vessel Growth As Treatment

[Tricia]

There was a very interesting article in the November 13 issue of Forbes magazine. It talked about breakthrough treatments for macular degeneration which in the its severe form is abnormal blood vessels leaking fluid in the back of the eye.

One drug called Lucentis halts blood vessel growth when injected in to the side of the eye. In two large scale trials it stopped vision loss in 95% of patients which researchers are calling miraculous.

Some doctors are using Avastin with great success. This is the cancer treatment form of the drug and is currently on the market and which insurance will cover most of the price.

Not only is this good news for rosacea sufferers with eye problems but it has great potential (in my mind) as an overall solution to prevent blood vessel re-growth in any area of the skin. If it can be injected safely in to the eye, why not the cheeks or nose? How great would this therapy be to use after laser treatments?

This is the kind of testing I'd like to see done. Is it possible to get a study started in using tese types of angiogenesis prevention drugs to complement exisiting rosacea therapy? The drugs are already on the market so it seems the next step og implememting a study wouldn't be too difficult. Although what do I know?

What does the board think?

Tricia

[Robert T. Brodell, MD]

As with any new drug the issue is whether the benefits outweight the risks. Is there anywhere in the body where one wishes to have new blood vessel growth? In the setting of a heart attack....turning off new blood vessel growth might be disasterous. In preventing blindness the risk/benefit ratio is more heavily weighted to the benefit. Soooooo, since blood vessels in rosacea are worn on the outside of the body where they are easily attacked with vascular lesion lasers, the benefit here is reletively small...I would go slow on the risk side!

Dr. Bob Brodell

[mboes]

Tricia,

for a PhD trained investigator like myself it is difficult to judge how safe it would be to inject the drugs you mention in skin (to prevent regrowth of blood vessels). I think you make a very good argument though. Before wondering whether it would be a safe treatment, one should find out if your idea has merit. One can test your hypothesis in a model situation (i.e. in skin explants from afflicted human skin; systemic concerns, of what side-effects the drugs have on blood vessels elsewhere in the body are there by taken out of consideration) and see if bloodvessel growth is inhibited after treatment. it would be exciting to find out whether this is the case or not. In the event of positive outcome, safety should be tested for, which can initially be done in animal models that harbor pieces of human skin. eventually one has to test in human skin of afflicted rosacea individuals obviously, which is a long, very long road to go, but that is true for all new treatments.

best,

Marianne Boes

[dfries2003]

Hi Doctors,

Thanks so much for your explanations. I found them very interesting. But I'm curious. Along these lines, given recent studies like the following which suggest that "vascular endothelial growth factor (VEGF) protein is a key biomarker for sepsis", in addition to other studies that suggest that elevated MMPs are also the rule with sepsis, why wouldn't medical researchers immediately suspect the potential involvement of any bacteria (such as C. pneumoniae) known to persist in the blood vessels themselves in all diseases that involve increased VEGF production, leaking blood vessels and destruction of surrounding tissues (i.e. Macular Degeneration, MS, Crohn's Disease, Interstitial Cystitis, and Rosacea)?

New Study Finds Key Role For VEGF In Onset Of Sepsis

FYI, I had an interesting discussion about this (posting as Red) with Dr Wheldon, Microbiologist and FCRPATH (posting as DW) on Cpnhelp starting at the following link:

http://www.cpnhelp.org/?q=multiple_scleros...ge#comment-9230

It seems so obvious to me. Am I missing something?

Dan

[Tricia]

Thanks Dr. Brobell and Boes for your responses and I agree any testing on this theory would have to be done with safety as an utmost priority.

As far as blood vessels being able tp be "zapped" by lasers. I agree with this to an extent but think there could be better therapies following a laser session that target the re-growth of vessels that inevitably occurs in that sensitive time frame between days 7-21 . Injecting something like Avastin directly in to the areas that have been zapped "may" help prevent the feeder vessels from re-forming and drastically improve the treatment. Of course it may do nothing at all or have disasterous effects but I'd sure love to see researchers look in to this.

Rosacea has its own devastating effects on sufferers. I can't compare it to the threat of blindness but I do know I'd be willing to put up with some pretty serious risks if a good chance of treatment success were offered.

Dan, as far as an answer your question, I have no idea but it's a good one!

Tricia