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4血管内皮生长因子抑制剂
VEGF的阻断剂可溶性VEGF受体嵌合蛋白、反义寡核苷酸和单克隆中和抗体在鼠和猴的视网膜新生血管模型中能明显抑制新生血管生长。目前被临床深入研究的VEGF 抑制剂有2种:(1) Lucentis,它是利用重组DNA技术获得的高亲合力人源化鼠抗体片断,可抑制任何VEGF的同源蛋白质;(2)Macugen,它是化学合成的寡核甘酸链, 折叠成特殊的形状，以抗体形式高亲合力、特异性结合VEGF165。它们均用于玻璃体内注射。这两种药的临床试验表明它们安全、耐受性好, 能稳定和提高渗出型老年性黄斑变性(AMD)患者的视力[35]。对Lucentis的Ⅲ期临床试验正在进行,Macugen已获美国食品及药品管理局(FDA )批准应用于临床治疗AMD的脉络膜新生血管。
综上所述,VEGF在DR的发病机制中起着十分重要的作用,促进内皮细胞迁移、增殖,参与视网膜缺血性病变新生血管的形成。DR的发病机制涉及多个因素、多个环节, 错综复杂。针对VEGF的基因治疗, 虽然尚处在实验研究阶段, 但由于具有高度的特异性及选择性, 且克服了传统激光及冷凝治疗造成的周边视野缩小的缺点, 所以这种抑制VEGF活性的基因治疗方法具有很高的应用研究价值和前景, 为视网膜缺血增殖性病变的防治提供了一个崭新的方向和途径。
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