Abstract
P 068
Effect of Lucentis therapy on endothelial progenitor cells in patients with neovascular AMD
Michelle Berna-Thill
Universitäts-Augenklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg
Objective
Endothelial Progenitor Cells from bone-marrow seem to form a substantial part of experimental choroidal neovascularization. We have recently shown that the number of Endothelial Progenitor Cells in the peripheral blood of patients with neovascular AMD (nvAMD) is significantly increased compared to age-matched control or patients with dry AMD. VEGF may act as recruiting factor. This study therefore investigates the effect of anti-VEGF therapy using ranibizumab (Lucentis®) on Endothelial Progenitor Cells from patients with nvAMD.
Methods
32 ml of blood was taken from patients with newly diagnosed, previously untreated nvAMD immediately preceding the first, second and third intravitreal injection of Lucentis and 4 weeks after the last injection. Mononuclear cells were separated using a Ficoll-based system and transferred to complete pro-angiogenic medium (EGM-2MV, Lonza) on fibronectin-coated culture vessels. After 7 days, cultures were observed daily for appearance of cell clusters of Late Outgrowth Endothelial Progenitor Cells (OECs). The day of first appearance as well as the final number of clusters were noted. A complete ophthalmological exam including fluorescein angiography and Optical Coherence Tomography were performed before and after Lucentis therapy.
Results
Complete blood samples were obtained from 15 patients. On average, time to first appearance of OEC clusters was 11.4, 13, 14.3 and 9.7 days at the start of therapy, before the second and third Lucentis injection and 4 weeks after the third injection. OEC clusters were significantly slower to appear before the third injection as compared to pre-treatment. Mean number of OEC clusters/20 ml blood was 3.5, 3.8, 2.4 und 11.6 preceding the first, second and third Lucentis injection and 4 weeks after the last injection. The difference in number of OEC clusters at different time points was not statistically significant. 2 patients had highly elevated numbers of OEC clusters before the start of therapy and had a marked decrease of OEC clusters during Lucentis therapy, while their clinical condition stabilized or improved.
Conclusions
First results seem to demonstrate a possible inhibitory influence of anti-VEGF therapy on the number of endothelial progenitor cells in patients with nvAMD. More patients are currently recruited in order to analyze the relationship between the clinical appearance of nvAMD, circulating endothelial progenitor cells and the influence of Lucentis therapy.
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