Angiogenesis in the Normal Adrenal Fetal Cortex and Adrenocortical Tumors
Abstract
:Simple Summary
Abstract
1. Introduction
2. Angiogenesis Regulation
- (1)
- Sprouting angiogenesis, one the most well characterized mechanism leading to angiogenesis, relies on endothelial cells function specification into either tip or stalk cells. Tip cells are derived from the parent vessel, degrade the basement membrane, extend large filopodia which can sense angiogenic factor gradients, such as vascular endothelial growth factor (VEGF), and migrate along the chemotactic paths. In contrast, stalk cells proliferate behind tip cells to form the sprout body, start the process of lumen formation, and connect with neighboring vessels [5,6,7].
- (2)
- Intussusceptive angiogenesis is a process that consists in the splitting of pre-existing vessels into two new vessels. It starts with the formation of transluminal tissue pillars through the invagination of opposing capillary endothelial cells into the vascular lumen, creating a zone of contact. Commonly, intussusceptive and sprouting angiogenesis are complementary mechanisms [5,8].
- (3)
- Recruitment of endothelial progenitor cells and vasculogenesis, a process through which endothelial progenitor cells are recruited in response to several growth factors, cytokines and/or hypoxia-inducible factors. Endothelial progenitor cells differentiate into mature endothelial cells and are incorporated into the angiogenic sprout, thus contributing to new blood vessel formation [4,9].
- (4)
2.1. VEGF Pathway in Angiogenesis Regulation
2.2. Ang-Tie Pathway in Angiogenesis Regulation
3. Angiogenesis in Normal Adrenal Cortex
3.1. Fetal Adrenal Cortex
3.2. Adult Adrenal Cortex
4. Angiogenesis in Adrenocortical Tumors
5. Anti-Angiogenic Agents’ Efficacy in Adrenocortical Carcinomas Treatment
Anti-Angiogenic Drug | Mechanism of Action | Study Type | Patient Population | Results | Ref. |
---|---|---|---|---|---|
Bevacizumab (+capecitabine) | Monoclonal anti-VEGF antibody | Observational retrospective cohort study | Patients with refractory ACC (n = 10) | PFS: 59 days OS: 124 days | [71] |
Thalidomide | Immunomodulatory agent that targets TNF-α, ILs, VEGF, bFGF | Observational retrospective cohort study | Patients with refractory ACC (n = 27) | PFS: 11.2 weeks (4.4–22.8 weeks) OS: 36.4 weeks (5.1–111.1 weeks) | [75] |
Lenvatinib (+pembrolizumab) | Multi-TKI that inhibits VEGFR-1, VEGFR-2 and VEGFR-3, FGFRs, PDGFR-α, KIT, RET | Observational retrospective cohort study | Patients with recurrent and/or metastatic ACC (n = 8) | PFS: 5.5 months OS: NA | [76] |
Cabozatinib | TKI that targets VEGFR-2 and c-Met | Observational retrospective cohort study | Patients with refractory metastatic ACC (n = 16) | PFS: 16.2 weeks (2.8–61 weeks) OS: 56 weeks (5.6–83.1 weeks) | [77] |
Sorafenib (+paclitaxel) | Multi-TKI inhibitor that VEGFR-2 VEGFR-3, PDGFR and RAF-1 | Phase II, single-arm, open label clinical trial | Patients with refractory metastatic ACC (n = 10) | Trial interrupted due disease progression in all enrolled patients | [72] |
Sunitinib | Multi-TKI that inhibits VEGFR-1 and VEGFR-2, c-KIT, FLT3 and PDGFR | Phase II, single-arm, open label clinical trial | Patients with advanced ACC after mitotane or others cytotoxic drugs (n = 35) | PFS: 2.8 months (5.6–11.2 months) OS: 5.4 months (14.0–35.5 months) | [73] |
Axitinib | Selective inhibitor of VEGFR-1, VEGFR-2 and VEGFR-3 | Phase II, single-arm, open label clinical trial | Patients with metastatic ACC previously treated with at least one chemotherapy regimen (n = 13) | PFS: 5.48 months (1.8–10.92 months) OS: 13.7 months | [74] |
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Patient Group Comparisons | Results | |
---|---|---|
VEGF | Patients with ACT vs. Healthy individuals | ↑ VEGF serum levels in patients with ACT [59,60] |
Aldosterone secreting ACA vs. Non-functioning ACA | ↑ VEGF tumor expression in aldosterone producing ACA [61] | |
Cortisol secreting ACA vs. Aldosterone secreting ACA | ↑ VEGF serum levels patients with cortisol secreting ACA [60] | |
ACC vs. Normal adrenal glands | ↑ VEGF expression in ACC [61,62] | |
ACC vs. ACA | ↑ VEGF serum levels in ACC ↑ VEGF tumor expression in ACC [59,61,63,64] | |
Patients with recurrent ACC vs. Patients with non-recurrent ACC | ↑ VEGF serum levels in recurrent ACC ↑ VEGF tumor expression in recurrent ACC [60,63] | |
Localized ACC vs. Invasive ACC | No difference in VEGF tumor expression [63] | |
VEGF-R2 | ACC vs. Normal adrenal glands | ↑ VEGF-R2 tumor expression in ACC [62] |
ACC vs. ACA | ↑ VEGF-R2 tumor expression in ACC [64] |
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Pereira, S.S.; Oliveira, S.; Monteiro, M.P.; Pignatelli, D. Angiogenesis in the Normal Adrenal Fetal Cortex and Adrenocortical Tumors. Cancers 2021, 13, 1030. https://doi.org/10.3390/cancers13051030
Pereira SS, Oliveira S, Monteiro MP, Pignatelli D. Angiogenesis in the Normal Adrenal Fetal Cortex and Adrenocortical Tumors. Cancers. 2021; 13(5):1030. https://doi.org/10.3390/cancers13051030
Chicago/Turabian StylePereira, Sofia S., Sofia Oliveira, Mariana P. Monteiro, and Duarte Pignatelli. 2021. "Angiogenesis in the Normal Adrenal Fetal Cortex and Adrenocortical Tumors" Cancers 13, no. 5: 1030. https://doi.org/10.3390/cancers13051030