gms | German Medical Science

Malignant glioma represent the prototoype of an angiogenic tumors. The fact that this angiogenic activity cannot be observed in low-grade glioma suggests that tumor angiogenesis is crucial for the process of glioma development and progression. This view is further supported by the identification of tumor vessel density as an independent prognostic parameter for human astroglial tumors. Over the past years, the mechanisms underlying glioma angiogenesis have been increasingly understood. Consequently, it has become apparent that glioma angiogenesis is a complex and multistep process involving endothelial cell activation, endotelial cell proliferation, angiogenic sprouting and vascular morphogenesis. In addition, the increasing insight into this process has led to the identification of various molecular and cellular signaling pathways mediating individual steps of glioma angiogenesis. After experimental evidence has been provided that glioma growth is dependent on angiogenesis each of these pathways represents a putative target for future anti-glioma therapies. The current challenge is now to translate these lessons learned from basic science into a clinical application and to evaluate the role of anti-angiogenesis in the treatment of malignant glioma. This, however, not only affords a thorough clinical evaluation of anti-angiogenic therapies, alone or in combination with alternative strategies, but also the development of novel techniques to image and monitor their therapeutic efficacy. This presentation will provide an insight into the mechanisms of glioma angiogenesis, discuss the potentials and limitations of anti-angiogenic therapy, and outline current activities with respect to its translation into clinical application.