Ref-1 in Retinal Neovascularization - PROJECT SUMMARY
Retinal neovascularization impairs visual function and is a hallmark of several neovascular eye diseases,
including retinopathy of prematurity (ROP) and proliferative diabetic retinopathy (PDR). Diabetic retinopathy
(DR) is the leading cause of vision-loss in working age adults, and ROP is the leading cause of preventable
blindness in children. Current treatments include intravitreal (IVT) injections of anti-vascular endothelial growth
factor (VEGF) biologics. However, these therapeutics are often accompanied by high treatment burden and
resistance to therapy. Previous research indicates that VEGF alone is not sufficient for induction of
neovascularization, suggesting that multiple disease-relevant pathways may be targeted to increase
therapeutic response. Thus, there is a critical need to develop novel therapies that modulate multiple disease-
relevant pathways and circumvent the issues with IVT injections. Prior studies indicate that APE1/Ref-1, a
multifunctional protein with both endonuclease (APE1) and redox activity (Ref-1), regulates multiple
transcription factors that are linked to retinal neovascularization. Preliminary data in the laser-induced choroidal
neovascularization model demonstrated upregulation of Ref-1 during neovascularization, and oral
administration of a small molecule Ref-1 redox inhibitor decreased disease severity. RNA-seq of human retinal
endothelial cells revealed that a Ref-1 redox inhibitor downregulated Wnt signaling genes, implying that Ref-1
redox function modulates neovascularization through the Wnt signaling. But, the underlying molecular
mechanisms of the novel Ref-1 target in retinal neovascularization have yet to be elucidated. Identifying the
molecular mechanism underlying Ref-1 in retinal neovascularization is critical in developing novel therapies to
reduce vision loss. The hypothesis of this proposal is that Ref-1 redox activity promotes induction of retinal
neovascularization via activation of the Wnt signaling pathway, and reducing Ref-1 redox activity with a novel
Ref-1 redox inhibitor will exhibit potent therapeutic effects via inhibition of the Wnt signaling pathway. Aim 1 will
analyze the spatiotemporal expression of Ref-1 in retinal neovascularization in the oxygen-induced retinopathy
(OIR) mouse model, the Vldlr-/- mouse model, and in human PDR tissue. Aim 2 will analyze the mechanism of
Ref-1 regulation of the Wnt pathway in retinal endothelial cells through functional in vitro assays. Aim 3 will
assess anti-angiogenic effects of a Ref-1 inhibitor in vivo by administering oral Ref-1 inhibitor in the OIR mouse
model and evaluating changes in neovascularization. Effects on the Wnt signaling pathway will also be
assessed using immunofluorescence. Completion of this study will bolster understanding of Ref-1 in
neovascular eye diseases and provide a novel therapeutic strategy to combat vision loss and blindness due to
these diseases.