1. Volume 141, Issue 1, Pages 178-190 (April 2010)
Further Pharmacological and Genetic Evidence for the Efficacy of PlGF Inhibition in Cancer and Eye Disease 
Sara Van de Veire, Ingeborg Stalmans, Femke Heindryckx, Hajimu Oura, Annemilaï Tijeras-Raballand, Thomas Schmidt, Sonja Loges, Imke Albrecht, Bart Jonckx, Stefan Vinckier, Christophe Van Steenkiste, Sònia Tugues, Charlotte Rolny, Maria De Mol, Daniela Dettori, Patricia Hainaud, Lieve Coenegrachts, Jean-Olivier Contreres, Tine Van Bergen, Henar Cuervo, Wei-Hong Xiao, Carole Le Henaff, Ian Buysschaert, Behzad Kharabi Masouleh, Anja Geerts, Tibor Schomber, Philippe Bonnin, Vincent Lambert, Jurgen Haustraete, Serena Zacchigna, Jean-Marie Rakic, Wladimiro Jiménez, Agnes Noël, Mauro Giacca, Isabelle Colle, Jean-Michel Foidart, Gerard Tobelem, Manuel Morales-Ruiz, José Vilar, Patrick Maxwell, Stanley A. Vinores, Geert Carmeliet, Mieke Dewerchin, Lena Claesson-Welsh, Evelyne Dupuy, Hans Van Vlierberghe, Gerhard Christofori, Massimiliano Mazzone, Michael Detmar, Désiré Collen, Peter Carmeliet 
Cell 
Volume 141, Issue 1, Pages (April 2010)
DOI: /j.cell
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2. Figure 1 Reduced Papilloma Formation and HCC upon PlGF Blockage
(A–D) Skin papillomas from external (A and C) or internal view (B and D) in PlGF−/− (C and D) and WT mouse (A and B). Asterisks and arrowheads indicate corresponding anatomical tumor locations.
(E–H) Incidence (E and G) and number of papillomas per mouse (F and H) (n = 19–20; p < 0.01).
(I) Echographic measurement of liver volume in healthy mice and in HCC mice, untreated or treated with PlGF-specific or control siRNA (mean ± SEM; n = 6–8; ∗p < 0.05); healthy liver volumes: 0.74 ± 0.05, 0.8 ± 0.1, 0.88 ± 0.06, and 0.72 ± 0.05 cm3 at 8, 10, 12, and 14 weeks (n = 6).
(J–M) Micrograph of livers from healthy (J) or HCC mice (K–M), untreated (K), control siRNA-treated (L), or PlGF-specific siRNA-treated (M).
See also Figure S1.
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3. Figure 2 Mechanisms of Anti-HCC Activity by PlGF Blockage
(A–D) Micro-angiography of hepatic arterial supply in healthy (A), untreated HCC (B), control siRNA-treated HCC (C), and PlGF-silenced HCC (D) mice.
(E) Quantification of hepatic arterial network in healthy (white bar), untreated HCC (dark gray), control siRNA-treated HCC (light gray), and PlGF-silenced HCC (blue) mice (AU: absolute pixel unit, ‰) (n = 4; ∗p < 0.05).
(F–H) SMA staining, revealing a portal triad with paired hepatic artery in a healthy liver (F), large, smooth muscle cell-coated unpaired arteries (asterisks) in HCC mice treated with IgG (G), and a portal triad and small unpaired artery (asterisk) in HCC liver after 5D11D4 (H). Black arrowhead (bile duct); blue arrowhead (hepatic paired artery); PV (portal vein).
(I–K) Immunostaining for the endothelial marker endoglin, showing portal vein (PV) and central vein (CV) amidst a sinusoidal network in healthy liver (I); black arrowhead (bile duct); blue arrowhead (hepatic paired artery). In IgG-treated HCC nodules, the capillary network is chaotically organized, with tortuous vessels and cords, laying at large distances from each other (J), in contrast to the more regular pattern, size, and shape of capillaries and shorter intercapillary distances in 5D11D4-treated HCC (K).
(L–N) Immunostaining for SMA, showing undetectable expression in HSCs around sinusoids in healthy liver (L). In HCC, tumor capillaries (red arrowhead) are surrounded by strongly SMA+-stained HSCs in IgG-treated mice (M) but not in 5D11D4-treated mice (N).
(O) Histogram of intercapillary distances, showing shorter distances in 5D11D4-treated HCC; values in healthy liver are shown for comparison.
(P) Mac-3+ macrophage infiltration in tumors of HCC mice treated with control (gray) or PlGF-specific siRNA (blue) (n = 8; ∗p < 0.05).
Bars: 100 μm (F–K); 20 μm (L–N). Data are mean ± SEM. See also Figure S2 and Table S1.
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4. Figure 3
Resistance of Rip1Tag2 Tumors and Evidence for Specificity of 5D11D4
(A–D) The number (A and C) or total volume (B and D) of tumors per mouse were not affected by loss (A and B) or inhibition of PlGF by 5D11D4 (50 mg/kg; 3×/week) (C and D) (n = 7–8); tumor growth in PlGF+/−:Rip1Tag2 and PlGF+/+:Rip1Tag2 mice was not different.
(E–I) Intramuscular AAV-PlGF gene transfer-induced angiogenesis (F), which is blocked by 5D11D4 (G) but not by DC101 (H); panel E: control; panel I: quantification of the microvascular density (mean ± SEM; n = 5; ∗p < 0.05 versus control; #p < 0.05).
(J–N) Intramuscular AAV-VEGF gene transfer-induced angiogenesis (K), which is not affected by 5D11D4 (L) but is reduced by DC101 (M); panel J: control; panel N: quantification of the microvascular density (mean ± SEM; n = 3; ∗p < 0.05 versus control; #p < 0.05).
Bars: 50 μm. See also Figure S3.
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5. Figure 4 Mechanisms of PlGF Blockage in Rip1Tag2 Tumors
(A and B) Quantification of intratumoral vessel density of tumors from Rip1Tag2:PlGF+/− and Rip1Tag2:PlGF−/− mice (n = 7) (A) and of tumors from Rip1Tag2 mice, treated with control IgG or 5D11D4 (n = 7) (B).
(C and D) Quantification of neutrophil infiltration in tumors from Rip1Tag2:PlGF+/− and Rip1Tag2:PlGF−/− mice (n = 7) (C) and in tumors from Rip1Tag2 mice, treated with control IgG or 5D11D4 (n = 7) (D). Data are mean ± SEM (C and D).
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6. Figure 5 Inhibition of CNV by Anti-PlGF or PlGF Deficiency
In all panels, analysis was 14 days after lasering; mAb (3×/week) was started 3 hr after lasering until sacrifice.
(A) Dose-dependent inhibition of CNV by 5D11D4 (n = 12/group; ∗p < 0.05).
(B and C) FITC-dextran flatmounts, revealing fewer choroidal neovessels after 5D11D4 (C) than control IgG (B).
(D) CNV was reduced in PlGF−/− mice, but 5D11D4 treatment (25 mg/kg) did not further reduce CNV in PlGF−/− mice (n = 10/group; ∗p < 0.05 versus WT, control IgG).
(E) Flt-TK deficiency reduced CNV but 5D11D4 (25 mg/kg) did not further reduce CNV (n = 6/group; ∗p < 0.05 versus WT, IgG).
(F) Inhibition of CNV by anti-PlGF mAb 3C7A8, whereas 12H6B6 only exhibited a tendency (25 mg/kg) (n = 6/group; ∗p < 0.05).
(G) Delivery of human PlGF-2 (10 μg/week) stimulated CNV in PlGF−/− mice; hPlGF-driven CNV was blocked by 16D3 (25 mg/kg) (n = 5/group; ∗p < 0.05 versus hPlGF-2 without 16D3).
Data are mean ± SEM. See also Figure S4.
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7. Figure 6 5D11D4 Enhances Inhibition of CNV by VEGF Inhibitors
In all panels, analysis was 14 days after lasering; mAb (3×/week) was started 3 hr after lasering until sacrifice.
(A) Dose-dependent inhibition of CNV by DC101 (n = 12/group; ∗p < 0.05).
(B and C) FITC-dextran choroidal flatmounts, revealing fewer perfused neovessels after DC101 (C) than control IgG (B).
(D) Partial replacement of DC101 with 5D11D4 yielded similar anti-CNV effect as maximal DC101 dose alone (n = 12/group; ∗p < 0.05 versus control; #p < 0.05 versus monotherapy); dose (mg/kg) of 5D11D4 and DC101 is indicated below each bar.
(E) Combination of 5D11D4 (25 mg/kg) plus gene transfer of sFlk1 (hydroporation 2 days before lasering) inhibited CNV more than either monotherapy (n = 8–11; ∗p < 0.05 versus control; #p < 0.05 versus monotherapy).
Data are mean ± SEM.
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8. Figure 7 Mechanisms of CNV Inhibition by PlGF Blockage
Analysis at days 14 (A–J) or 5 (K–M) after lasering; mAb treatment (3×/week) started 3 hr after lasering until sacrifice.
(A and B) PlGF deficiency and 5D11D4 (25 mg/kg) reduced CD31+ area (A) and vessel density (B) (n = 10; ∗p < 0.05 versus control). The antiangiogenic effect of DC101 (25 mg/kg) is shown for comparison.
(C–J) SEM micrographs of CNV in WT (C and D), PlGF−/− (E and F), 5D11D4-treated WT (G and H), and DC101-treated WT (I and J) mice. Dashed line: border between laser-induced necrotic center (black hole) and adjacent healthy choroid, from where neovessels sprout. In WT mice, vessels of irregular size and shape sprouted into the wound. By contrast, in PlGF−/− and 5D11D4-treated WT mice, neovessels only formed aborted stumps, despite numerous spiky protrusions. After DC101, neovessels appeared immobilized (“frozen”) and exhibited signs of pruning with few sprouts. Bars: 50 μm (C, E, G, and I); 10 μm (D, F, H, and J).
(K) Absence of PlGF or 5D11D4 (25 mg/kg) inhibits accumulation of F4/80+ macrophages in CNV, whereas DC101 is ineffective (n = 10/group; ∗p < 0.05).
(L and M) F4/80 immunostaining of CNV lesions, showing reduced macrophage infiltration after 5D11D4 (25 mg/kg) (L) as compared to IgG (M). Dashed lines: borders of CNV lesion.
Data are mean ± SEM. See also Figure S5.
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9. Figure S1 Role of PlGF in Human Xenograft Models, Related to Figure 1
(A) Dose-dependent increase in 16D3 plasma concentrations (injected 2×/week).
(B–D) Inhibition by 16D3 (25 mg/kg) of human DanG tumor growth in nu/nu mice (n = 10/group; ∗p ≤ versus control). Panels C and D: micrographs of DanG tumor-bearing mice, treated with control IgG (C; note cachexia) or 16D3 (D).
Bars: 1 cm. Data are mean ± SEM.
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10. Figure S2 Role of PlGF in HCC, Related to Figure 2
(A) Endothelial staining for CD31, revealing comparable capillary area within tumor nodules of control and PlGF-silenced HCC in transgenic SV40 T-Ag mice (n = 5–8; p = NS).
(B) Endothelial staining for endoglin, revealing comparable capillary density in tumor nodules of control and PlGF-blocked HCC in the DEN-induced HCC model (n = 5–8; p = NS).
Data are mean ± SEM.
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11. Figure S3 Role of PlGF in Rip1Tag2 Model, Related to Figure 3
(A) Comparable staging of tumors in normal/hyperplastic islets, adenoma, or carcinoma in Rip1Tag2:PlGF+/− (n = 6) and Rip1Tag2:PlGF−/− mice (n = 6). Data are mean ± SEM.
(B) Immunoblotting, revealing detectable levels of PlGF in placenta and pancreatic tumor from a 12-week-old Rip1Tag2 mouse; actin immunoblotting was used as control for loading.
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12. Figure S4
5D11D4 and 16D3 Inhibit CNV in Wild-Type or Humanized Mice, Related to Figure 5
(A) Double-immunostaining of CNV cross-sections for Flt1 (red) and CD31 (green), revealing expression of Flt1 in endothelial cells of neovessels.
(B) Staining of CNV cross-sections for streptavidin, revealing localization of biotinylated 5D11D4 in CNV lesions.
(C) Adenoviral delivery of human PlGF-2 (Ad.hPlGF-2) stimulated CNV lesion formation in PlGF−/− mice; this hPlGF-driven CNV lesion formation was blocked by systemic delivery of the murine anti-human PlGF mAb 16D3 (mean ± SEM; n = 5; ∗p < 0.05 versus Ad.hPlGF2 without 16D3; middle gray bar).
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13. Figure S5
5D11D4 Inhibits Choroidal Vessel Leakage in CNV, Related to Figure 7
(A and B) Leakage from permeable neovessels contributes to vision loss in AMD. Vessel leakiness was assessed by coinjection of a low molecular weight Texas Red-conjugated dextran (which extravasates from leaky vessels in the perivascular matrix) together with a high-molecular weight FITC-labeled lectin (which binds to the endothelium). Since mice were saline perfused before dissection of choroids to remove all intravascular red dextran, vessels with a tight barrier are green, while leaky vessels are yellow. Confocal image through CNV lesion, showing yellow leaky vessels in a mouse treated with control IgG (A), while neovessels in 5D11D4-treated mice appear green (B). When measuring the perivascular Texas Red+ area, 5D11D4 inhibited leakage by 46% ± 5% (n = 6; p < 0.05), comparable to 52% ± 7% in PlGF−/− mice (n = 5; p < 0.05), while DC101 suppressed leakage by 49% ± 8% (n = 6; p < 0.05; not shown).
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