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Rolle der Angiogenese und ihrer Inhibitoren in der Gynäkologie

Von der Embryonalentwicklung bis zur Tumorgenese und Metastasierung

The role of angiogenesis and its inhibitors in gynecology

From physiological embryonic development to tumorigenesis and metastasis

  • Gynäkologie aktuell
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Die Angiogenese bezeichnet die Neubildung von Blutgefäßen, die durch Sprossungs- oder Spaltungsvorgänge des Gefäßsystems entstehen. Solide Tumoren sind in ihrem Wachstum von einem sie umgebenden mitwachsenden Kapillarnetz abhängig, das den Tumor mit Nährstoffen und Sauerstoff versorgt. Die pathophysiologische Rolle der Angiogenese ist für viele benigne (Endometriose, Menorrhagie, Leiomyomatose, ovarielles Überstimulationssyndrom, Präeklampsie und plazentares Hypoperfusionssyndrom) und maligne (vor allem das metastasierte und therapierefraktäre Mammakarzinom, das Ovarialkarzinom, das Tubenkarzinom sowie das primäre peritoneale Karzinom) gynäkologischen Erkrankungen nachgewiesen. Angiogeneseabhängige Erkrankungen können mit Hilfe antiangiogenetisch wirksamer Therapeutika behandelt werden. Aufgrund der substantiellen Nebenwirkungen dieser oft nur in Kombination mit einer klassischen Chemotherapie wirksamen Medikamente ist der Einsatz etablierter Angiogeneseinhibitoren ausgewählten, meist malignen Ekrankungsbildern vorbehalten. Zu diesen zählen vor allem das metastasierte und therapierefraktäre Mammakarzinom, das Ovarialkarzinom, das Tubenkarzinom und das primäre peritoneale Karzinom. Die Arbeit gewährt einen Überblick über den Kenntnisstand in der antiangiogenetischen Behandlung in der Gynäkologie und über potenzielle weitere Einsatzmöglichkeiten neuer Medikamente in diesem Zusammenhang.

Abstract

Angiogenesis describes the neoformation of blood vessels which develop by budding and sprouting of the existing vessel system. Solid tumor growth is dependent on the surrounding growing capillary network providing the tumor with essential nutrients and oxygen. The pathophysiological role of angiogenesis could be shown for multiple benign (endometriosis, menorrhagia, leiomyomatosis, ovarian hyperstimulation syndrome, preeclampsia and placental hypoperfusion syndrome) and malignant (especially metastasized and therapy-refractory breast cancer, ovarian cancer, cancer of the fallopian tube and the primary peritoneal cancer) diseases. Diseases that are very much dependent on (neo) angiogenesis can be treated with various anti-angiogenic agents. Due to the broad spectrum of side effects of established angiogenesis inhibitors which are mostly given in combination with chemotherapeutic agents, this therapeutic approach is mostly limited to malignant diseases, such as breast cancer, ovarian cancer, cancer of the fallopian tube and primary peritoneal carcinoma. This review provides an overview of the current state of knowledge in the anti-angiogenic therapy of gynecological diseases and will give a perspective of potential future implications of new therapeutic agents.

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Danksagung

Die Autoren bedanken sich bei Mathias Podlovics für die Abbildung 2.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller Strasse 3, Haus 24, 24105, Kiel, Deutschland

    I. Alkatout, W. Jonat, C. Mundhenke &  C. Schem MaHM

  2. Frauenklinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Deutschland

    N. Maass

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  1. I. Alkatout
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Correspondence to C. Schem MaHM.

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Alkatout, I., Maass, N., Jonat, W. et al. Rolle der Angiogenese und ihrer Inhibitoren in der Gynäkologie. Gynäkologe 46, 56–62 (2013). https://doi.org/10.1007/s00129-012-3091-9

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