Measuring levels of proteins in eye fluid may accurately predict need for lifelong macular degeneration therapy (VEGF & angiopoietin-like 4)

Medical Xpress / Johns Hopkins University School of Medicine ^ | June 29, 2022 | Yu Qin et al

[ConservativeMind]

Researchers say they have found that levels of a specific protein appears to help accurately predict whether people with the wet form of age-related macular degeneration may need lifelong, frequent eye injections to preserve vision or if they can be safely weaned off the treatments.

Standard treatment of wet age-related macular degeneration requires monthly or twice-monthly eye injections of so-called anti-VEGF drugs that slow or stop the growth of leaky blood vessels and, in most cases, stave off further vision loss.

Sodhi's team found that relatively higher levels of angiopoietin-like 4 (higher than 4.22 ng/mL) accurately predicted actual clinical outcomes in the patient population, identifying with 91% sensitivity those patients who would continue to require monthly eye injections to preserve their vision.

To improve the accuracy of the prediction model, they paired measurements of angiopoietin-like 4 with VEGF, the protein specifically targeted by current wet macular degeneration treatments. With both proteins, the researchers were able to correctly identify with 76% sensitivity and 85% specificity patients who likely need monthly eye injections; this group of wet macular degeneration patients could benefit from newer longer acting anti-VEGF therapies.

…Mice that received either the angiopoietin-like 4-blocking RNAi treatment or the VEGF-blocking RNAi treatment, both had lower levels of abnormal blood vessel growth than mice which received control treatment. However, in mice that received RNAi targeting both VEGF and angiopoietin-like 4, the treatment showed an additive effect, with even lower abnormal blood vessel growth than RNAi targeting either protein alone.

As an alternative to using RNAi as a therapy, the researchers tested a naturally-found protein called soluble neuropilin, which the researchers have previously shown have a quenching effect on VEGF and angiopoietin-like 4 in studies in diabetes. The test yielded similar results as the RNAi, effectively treating the growth of the abnormal blood vessels..

[ConservativeMind]

These two testable items can immediately help target treatment, and one or two future (not apparently available) treatment options are now known (angiopoientin-like 4 and neuropilin).

[ConservativeMind]

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[Dr. Sivana]

I didn’t think there was much in the way of treatment for the wet variation of macular degeneration.

[chronicles]

I have been getting eye injections for over 10 years. At first they were about 1 to 2 months apart, but about 2 years ago the eye was stable enough that they started spacing the injections out.
Now they are about 4 months apart. Over the years, there has been a half dozen times that the doctor also inserted an Ozurdex pellet in the eye in addition to the Lucentis shot.
This current treatment is expensive and slow, it would be a great savings for Medicare if a more effective drug was developed.

[exnavy]

I was diagnosed two years ago, no one metioned the “wet” variation?

[MayflowerMadam]

That’s wonderful — that you’ve been about to manage it.