posterior segment neovascularization ( nv ) is the vision - threatening pathology responsible for the two most common causes of acquired blindness in developed countries : exudative age - related macular degeneration ( amd ) and proliferative diabetic retinopathy . currently the only approved treatments for posterior segment nv that occurs in exudative amd is laser photocoagulation or photodynamic therapy with visudyne ; both therapies involve occlusion of affected vasculature which results in localized laser - induced damage to the retina . surgical interventions with vitrectomy and membrane removal are the only options currently available for patients with proliferative diabetic retinopathy . no strictly pharmacologic treatment has been approved for use against posterior segment nv . in addition to changes in the retinal microvasculature induced by hyperglycemia in diabetic patients leading to macular edema , proliferation of neovascular membranes is also associated with vascular leakage and edema of the retina . where edema involves the macula , visual acuity worsens . in diabetic retinopathy , macular edema is the major cause of vision loss . like angiogenic disorders laser photocoagulation is used to stabilize or resolve the edematous condition . unfortunately , laser photocoagulation is a cytodestructive procedure , that while preventing further edema to develop , will alter the visual field of the affected eye . an effective pharmacologic therapy for posterior segment nv and edema would likely provide substantial efficacy to the patient , thereby avoiding invasive surgical or damaging laser procedures . effective treatment of the nv would improve the patient &# 39 ; s quality of life and productivity within society . also , societal costs associated with providing assistance and health care to the blind could be dramatically reduced . amfenac is an nsaid that is known to potently inhibit the activity of cox - 1 and cox - 2 enzymes . unexpectedly , amfenac was found to inhibit both vegf - induced cell proliferation and capillary tube formation in a dose - response fashion using a bovine retinal microvascular endothelial cell assay . to our knowledge , this blockade on vegf effects by nsaids that occurs independently of cox inhibition , i . e ., the ability to block the proangiogenic signal normally elicited by vegf , is unique with regard to amfenac versus other nsaids . this unique activity may help explain , in part , our previous findings that topical nepafenac ( the prodrug of amfenac ) inhibited choroidal nv in a mouse model , where topical voltaren ® and acular ® had no effect . if this novel antiangiogenic activity occurs in man , amfenac ( and topical nepafenac ) could be used to more effectively treat diseases that involve vegf signaling and in disease states where other nsaids would likely be less effective . ophthalmic disorders associated with upregulation of vegf that are potential indications for amfenac ( topical nepafenac ) would include exudative age - related macular degeneration , proliferative diabetic retinopathy , retinal vein occlusion , proliferative vitreoretinopathy , neovascular glaucoma , corneal angiogenesis , retinal microvasculopathy and retinal ( macular ) edema . again , because amfenac is the active metabolite of nepafenac , which has the ability to reach the posterior segment following topical corneal application in preclinical models , it is possible to treat these vegf - mediated ocular disorders using topical ocular administration of nepafenac . according to the present invention , a therapeutically effective amount of a nepafenac is administered topically to an eye whereas local or systemic administration of amfenac would be used to treat and / or prevent vegf mediated vascular disorders . the doses of amfenac or nepafenac used in the treatment or prevention of vegf medicated vascular abnormalities will depend on the type of abnormality to be prevented or treated , the age and body weight of the patient , and the form of preparation / route of administration . compositions intended for topical ophthalmic administration will typically contain nepafenac in an amount of from about 0 . 001 to about 4 . 0 % ( w / v ), preferably from about 0 . 01 to about 0 . 5 % ( w / v ), with 1 - 2 drops once to several times a day . likewise , representative doses for other forms of preparations are approximately 1 - 100 mg of amfenac / day / adult for injections or local administration and approximately 10 - 1000 mg of amfenac / adult for oral preparations , each administered once to several times a day . additional therapeutic agents may be added to supplement the use of nepafenac or amfenac . the following examples are presented to illustrate various aspects of the present invention , but are not intended to limit the scope of the invention in any respect . the percentages are expressed on a weight / volume basis . the following formulations are representative of the topical compositions useful in the present invention . formulation 1 nepafenac 0 . 01 - 0 . 5 % polysorbate 80 0 . 01 % benzalkonium chloride 0 . 01 % + 10 % excess disodium edta 0 . 1 % monobasic sodium phosphate 0 . 03 % dibasic sodium phosphate 0 . 1 % sodium chloride q . s . 290 - 300 mosm / kg ph adjustment with naoh and / or hcl ph 4 . 2 - 7 . 4 water q . s . 100 % formulation 2 nepafenac 0 . 01 - 0 . 5 % hydroxypropyl methylcellulose 0 . 5 % polysorbate 80 0 . 01 % benzalkonium chloride 0 . 01 % + 5 % excess disodium edta 0 . 01 % dibasic sodium phosphate 0 . 2 % sodium chloride q . s . 290 - 300 mosm / kg ph adjustment with naoh and / or hcl ph 4 . 2 - 7 . 4 water q . s . 100 % formulation 3 nepafenac 0 . 1 + 6 % excess carbopol 974p 0 . 08 % tyloxapol 0 . 01 % glycerin 2 . 4 % disodium edta 0 . 01 % benzalkonium chloride 0 . 01 % ph adjustment with naoh and / or hcl ph 7 . 5 ± 0 . 2 water q . s . 100 % effect of al06295a ( amfenac ) on brmec ( bovine retinal microvascular endothelial cell ) proliferation vegf - induced brmec proliferation was measured using a modified mtt assay , brmec were plated at 3 × 10 3 onto a fibronectin / hyaluronic acid matrix in 96 - well plates ( coming ). growth medium was added for two days , followed by serum free medium ( sfm ) overnight , then by test medium containing 0 or 25 ng / ml vegf in 100 μl of sfm . after 24 hours at 37 ° c ./ 5 % co 2 , 25 μl of mtt ( 3 -( 4 , 5 - dimethylthiazol - 2 - yl )- 2 , 5 - diphenyl tetrazolium bromide ) was added to each well and incubated for 4 hours . 100 μl of lysis buffer ( 20 % sds in 50 : 50 dmf : h 2 o + 2 . 0 % acetic acid and 0 . 05 % hcl ) was then added to each well , and the plates were incubated overnight at 37 ° c . and read ( spectramax 190 , molecular devices ; sunnyvale , calif .) at 570 nm . for experiments utilizing al06295 , 25 ng / ml vegf was combined with the compound at 0 . 1 , 0 . 3 , 1 . 0 or 3 μm . the results show that the 1 and 3 μm doses of amfenac significantly reduce vegf induced brmec proliferation , see fig1 . a mixture of 8 vol of vitrogen 100 ( cohesion ; palo alto , calif . ), 1 vol . of 0 . 2n naoh , and 1 vol . of 10 × rpmi - 1640 medium containing 5 μg / ml fibronectin and 5 μg / ml laminin was prepared and 400 μl was added to each well of a 24 - well plate . after incubating for 3 hrs at 37 ° c . to solidify the gel , 10 4 brmec were added to each well and incubated in growth medium for 3 days . then the medium was carefully aspirated and 200 μl of the gel solution was layered on top of the cells and incubated at 37 ° c . for 1 hr . following addition of growth medium for 24 hrs , 2 ml of test medium containing serum - free ( sf ) medium plus vegf or sf medium plus vegf and al06295a were added to each well . the gels were assessed 24 hrs later . for quantitative analysis , six fields per treatment group were chosen from areas containing tubes ; seven wells were used for each treatment . the lengths of the tubes were measured in digitized images , and the data are expressed in fig2 as the total length per field of view in μm . the results show that all doses of amfenac significantly and potently inhibit vegf induced capillary tube formation in brmecs . this invention has been described by reference to certain preferred embodiments ; however , it should be understood that it may be embodied in other specific forms or variations thereof without departing from its special or essential characteristics . the embodiments described above are therefore considered to be illustrative in all respects and not restrictive , the scope of the invention being indicated by the appended claims rather than by the foregoing description .
the use of amfenac and derivatives , including nepafenac , to treat vascular endothelial growth factor mediated vascular disorders .