Fewer Circulating Endothelial Progenitor Cells in Newly Diagnosed Neovascular AMD Patients

Abstract: Objective: Patients with age-related macular degeneration (AMD) exhibit pathologic neovascularization under the retina, with choroidal neovascularization (CNV) suggestive of defective angiogenesis. The endothelial progenitor cells (EPCs) present in the peripheral blood contribute to angiogenesis and vasculogenesis, and their regulation is altered in several vascular disorders. We investigated whether the numbers and functional properties of EPCs may be disordered in newly diagnosed neovascular AMD. Methods Fifteen suitable AMD patients and 10 controls matched for age, risk factors for atherosclerosis and use of medication that could influence the circulating pool of EPCs were studied. Circulating EPCs were assayed by the colony-forming unit (CFU) method. The EPCs' adhesive capacity was studied by evaluating their ability to attach to fibronectin and cultured endothelial cells. Serum levels of vascular endothelial growth factor (VEGF) were studied and correlated with EPC numbers. Results: The patients had significantly fewer circulating EPCs(16.5±2.8) compared to their controls (31±4.6; p=0.0085). The functional properties of both groups' EPCs were similar. Conclusions: The peripheral circulating pool of endothelial stem cells is altered in patients with newly diagnosed neovascular AMD, suggesting that pathologic angiogenesis may result from or influence the regulation of endothelial precursor circulation

Biosimilars in ophthalmology: "Is there a big change on the horizon?"

Retinal disease management has witnessed remarkable advances in posterior segment pharmacotherapy with the development of anti-VEGF molecules such as Lucentis® (ranibizumab), Eylea® (aflibercept), and off-label bevacizumab (Avastin). The US patents for ranibizumab and aflibercept will expire in 2020 (though Regeneron has indicated that it might attempt to extend its US patent to June 2023 with additional patent claims), and their European patents will expire in 2022 and 2025. Aflibercept comes off patent in 2022 in People's Republic of China and Japan. As soon as each patent expires, biosimilar molecules could potentially come in the mainstream clinical practice as a more cost-efficient choice in the form of generic biosimilars. It is difficult to predict how significant this shift would be in terms of more cost-effective clinical management and how it will impact the care in developed and developing world. It is important for clinicians to have a clear understanding about ophthalmic biosimilars before the industry brings these molecules to the mainstream clinical use globally

Biosimilars in ophthalmology: "Is there a big change on the horizon?"

Retinal disease management has witnessed remarkable advances in posterior segment pharmacotherapy with the development of anti-VEGF molecules such as Lucentis® (ranibizumab), Eylea® (aflibercept), and off-label bevacizumab (Avastin). The US patents for ranibizumab and aflibercept will expire in 2020 (though Regeneron has indicated that it might attempt to extend its US patent to June 2023 with additional patent claims), and their European patents will expire in 2022 and 2025. Aflibercept comes off patent in 2022 in People's Republic of China and Japan. As soon as each patent expires, biosimilar molecules could potentially come in the mainstream clinical practice as a more cost-efficient choice in the form of generic biosimilars. It is difficult to predict how significant this shift would be in terms of more cost-effective clinical management and how it will impact the care in developed and developing world. It is important for clinicians to have a clear understanding about ophthalmic biosimilars before the industry brings these molecules to the mainstream clinical use globally