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Arteriosclerosis, Thrombosis, and Vascular Biology. 2004;24:2108-2114
Published online before print September 2, 2004, doi: 10.1161/01.ATV.0000143857.27408.de
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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2004;24:2108.)
© 2004 American Heart Association, Inc.

Vascular Biology

ß3-Integrin Regulates Vascular Endothelial Growth Factor-A–Dependent Permeability

Stephen D. Robinson; Louise E. Reynolds; Lorenza Wyder; Daniel J. Hicklin; Kairbaan M. Hodivala-Dilke

From the Cell Adhesion and Disease/Tumour Biology Laboratory (S.D.R., L.E.R., K.M.H.-D.), Cancer Research UK Clinical Centre, Queen Mary’s School of Medicine & Dentistry at Barts & The London, John Vane Science Centre, Charterhouse Square, London; Novartis Institute for Biomedical Research (L.W.), Angiogenesis Programme, Basel, Switzerland; and ImClone Systems Inc (D.J.H.), New York, NY.

Correspondence to Stephen D. Robinson, Cell Adhesion and Disease/Tumour Biology Laboratory, Cancer Research UK Clinical Centre, Queen Mary’s School of Medicine & Dentistry at Barts & The London, John Vane Science Centre, Charterhouse Square, London EC1M 6BQ, United Kingdom. E-mail s.d.robinson{at}cancer.org.uk


*    Abstract
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 *Abstract
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Objective— ß3-integrin deficiency has been implicated in increasing levels of Flk-1 expression on endothelial cells and enhancing vascular endothelial growth factor (VEGF)-induced angiogenesis. We determined the role of ß3-integrin in mediating VEGF-A–induced blood vessel permeability through Flk-1.

Methods and Results— Using the Miles assay, we demonstrated that VEGF-A–induced plasma leakage was enhanced in ß3-null mice when compared with wild-type controls. This was not caused by any changes in blood vessel structure (as detected by light or electron microscopy) or by changes in endothelial cell–cell adhesion proteins (as determined by Western blot analysis, flow cytometry, and immunofluorescence). Circulating levels of VEGF, baseline blood vessel leakage, and leakage in response to an acute inflammatory stimulus were identical in wild-type and ß3-null mice. However, VEGF-A–induced leakage was abolished in ß3-null mice by the inhibition of Flk-1, indicating that the elevated levels of Flk-1 on ß3-null endothelial cells enhance VEGF-A–induced permeability.

Conclusions— ß3-integrin–deficiency increases the sensitivity of endothelial cells to VEGF-A by elevating Flk-1 expression and, as a consequence, enhances VEGF-A–mediated permeability.

Blood vessels in ß3-integrin–deficient mice are histologically normal and functionally intact. However, they express elevated levels of Flk-1 and are more sensitive than wild-type blood vessels to VEGF-A–induced permeability, but not to permeability induced by acute inflammatory agents.


Key Words: ß3-integrin • VEGF • Flk-1 • permeability • endothelium


*    Introduction
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 *Introduction
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 down arrowDiscussion
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Endothelial cell interactions with the surrounding extracellular matrix (ECM) are mediated primarily by the integrin family of adhesion receptors. These are heterodimeric transmembrane glycoproteins, consisting of {alpha} and ß subunits, possessing both adhesive and signaling properties. Ligand and signaling specificity is conferred by their heterodimeric composition.1 Endothelial cells have been shown to express a variety of integrins including {alpha}vß3, a receptor for fibronectin, vitronectin, osteospontin, von Willebrand factor, laminin, and collagen.2,3

The ability of integrins to act as a bridge between the extracellular and intracellular environments allows them to mediate ECM-induced changes in vascular tone, permeability, and vessel remodeling, and, as such, they have been depicted as key receptors for detecting and responding to vascular injury after damage to the ECM.4 There is mounting evidence that interactions between integrins and the ECM are important in regulating many aspects of vascular biology. For example, we have shown that {alpha}5-integrin and fibronectin are essential for early blood vessel development.5 Several studies demonstrate that endothelial cells must be anchored to the matrix for survival, migration, and proliferation.6–8 Furthermore, changes in the matrix milieu that activate different integrins can regulate the levels of fibroblast growth factor and vascular endothelial growth factor (VEGF) receptors on endothelial cells.9

VEGF, also known as vascular permeability factor,10 is unique among growth factors in that it is an important regulator of angiogenesis and a potent vasodilator capable of increasing vascular permeability.11,12 The most widely studied form of VEGF belongs to the VEGF-A family and is a 38-kDa homodimeric peptide (VEGF165 in humans;VEGF164 in mice is henceforth referred to as VEGF-A) belonging to the larger family of VEGFs.13 The biological actions of VEGF are mediated through 2 tyrosine receptor kinases, VEGFR-1 (Flt-1) and VEGFR-2 (Flk-1), and a more recently identified receptor, neuropilin-1, which is believed to be a coreceptor for VEGF acting in concert with VEGFR-2.14

We have shown previously that VEGF-induced angiogenesis is enhanced in mice that are deficient in ß3-integrin and that this response is associated with increased levels of Flk-1.15 In this study we have addressed the role of ß3-integrin in regulating VEGF-A–mediated vascular permeability. By examining the leakage of Evans blue dye from the vascular system, we show that blood vessels in ß3-null mice are more sensitive to VEGF-A–induced permeability. By administering either cells or animals with the monoclonal antibody DC101 directed against Flk-1,16 we show, for the first time to our knowledge, that this enhanced response is mediated by the elevated Flk-1 on ß3-null endothelial cells. We see no morphological defects in ß3-null vessels when compared with wild-type controls, nor is baseline permeability altered, demonstrating that the absence of ß3-integrin does not affect normal blood vessel structure or integrity. These results indicate that ß3-integrin regulates levels of Flk-1 and thereby influences VEGF-A–mediated permeability.


*    Methods
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 *Methods
down arrowResults
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Animals
ß3-integrin–deficient17 and wild-type control mice were 8 to 12 weeks of age. Lectin visualization of blood vessels was performed on mice from a 129sv genetic background, whereas all other studies were performed on mice from a C57/BL6 background. All animals were used in accord with United Kingdom Home Office regulations.

Reagents
For a detailed list of reagent sources, please see http://atvb. ahajournals.org

Miles Assays
Please see http://atvb.ahajournals.org for a detailed protocol of these methods.

Lectin Staining
Please see http://atvb.ahajournals.org for a detailed protocol of these methods.

Morphometric Measurements of Vessels
Vessel area density, vessel number density, and vessel diameters were measured in lectin-stained whole mounts as described by Thurston et al.18

Transmission Electron Microscopy
Ultrastructural analysis of microvessels was from saline-injected skin (as described for the Miles assay). Fifteen minutes after injection, skin surrounding the sites of injection was dissected and processed for electron microscopy.

Western Blotting, Flow Cytometry, and Immunofluorescence
Western blots, flow cytometry, and immunofluorescence were performed as described by Reynolds et al.15

In Vitro Permeability Assay
Transwell permeability assays were performed on monolayers of mouse endothelial cells as described by Wójciak-Stothard.19 VEGF164 (30 ng/mL) in the presence or absence of DC101 (20 µg/mL) was added to both the upper and lower chambers of the transwell concomitant with fluorescein isothiocyanate (FITC)-dextran (1 mg/mL) addition to the upper chamber. Samples were collected and assayed 30 minutes after VEGF stimulation.

In Vivo DC101 Treatments
Pre-experimental treatments were two 0.8-mg intraperitoneal injections of DC101 (100 µL in phosphate-buffered saline [PBS]) or either an equivalent concentration of a rat IgG isotyope control (in PBS) or an equivalent volume of PBS only, on days 0 and 3. VEGF164 intradermal injections and Miles assays were performed on day 6, as described.

Statistical Analysis
Data are presented as means±SEM. Significant differences between means were evaluated by unpaired Student t test. P<0.05 was considered significant.


*    Results
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 *Results
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VEGF-A–Induced Vascular Permeability Is Enhanced in ß3-Integrin–Deficient Mice
To analyze the role of VEGF-A–mediated permeability, we used the Miles assay20 to measure vascular leakage in the skin of ß3-integrin–deficient and wild-type control mice. Mice were injected intravenously with Evans blue dye followed by intradermal injections of either 400 ng VEGF-A or vehicle (saline) alone. Spectrophotometric analysis of specimens from 8-mm biopsy punches performed around the sites of injection (using the point of injection as the center of the punch) showed that within 15 minutes after VEGF-A treatment, blood vessels in ß3-null mice were {approx}2.5-fold more permeable than vessels in wild-type mice (Figure 1A). At this suboptimal concentration of VEGF-A, vessels in wild-type animals exhibited minimal dye leakage when compared with vehicle-only controls. Moreover, a higher (600 ng) dose of VEGF-A was required to induce a significant degree of plasma leakage in wild-type mice, indicating that ß3-null mice are more responsive to VEGF-A.



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  		Figure 1. VEGF-A–induced vascular permeability is enhanced in ß3-null mice. A, Permeability of skin vessels after intradermal injections of VEGF-A. Values are presented as the ratio of VEGF-induced Evans blue leakage/vehicle alone-induced Evans blue leakage (±SEM), n=6 to 9 animals per genotype. The photographs illustrate enhanced leakage of Evans blue dye in ß3-null skin in response to 400 ng of VEGF-A; nsd=no significant difference. Scale bar=5 mm. B, Circulating levels of VEGF. The bars represent serum concentrations of VEGF (±SEM), n=6 mice per genotype. C, Baseline vascular permeability in the skin of ears. Bars represent ng of Evans blue leakage per mg weight of ear (±SEM), n=8 to 9 animals per genotype. The photographs show minimal Evans blue dye leakage in whole ears in the absence of an inflammatory stimulus. Scale bar=10 mm. D, Mustard oil-induced permeability in the skin of ears. Bars represent ng of Evans blue leakage per mg weight of ear (±SEM), n=8 to 9 animals per genotype. The inserted graph represents fold stimulation of treated/vehicle alone in wild-type and ß3-null mice. The photographs illustrate extensive Evans blue dye leakage in inflamed ears of wild-type and ß3-null mice. Scale bar=10 mm.

The extravasated Evans blue measured in this type of experiment is caused by both vessel permeability and vessel dilation. Although we cannot distinguish between the two, vessel dilation usually accounts for <0.01% of leakage in the type of assay described.21,22

Baseline Permeability and Inflammation-Induced Permeability Are not Affected by ß3-Integrin Deficiency
Because VEGF-A-mediated vessel permeability was enhanced in ß3-null mice, we then asked if ß3-integrin–deficiency affected baseline vessel permeability. To address this, we first examined circulating VEGF levels in wild-type and ß3-null mice. Enzyme-linked immunosorbent assay results measuring serum levels of VEGF are presented in Figure 1B. No significant differences in VEGF levels were observed between wild-type and ß3-null mice, indicating that in a young, healthy population of mice, circulating levels of VEGF are not affected by the absence of ß3-integrin. In addition, no evidence of edema was observed in the ß3-null mice (data not shown).

We next compared vascular leakage in ear skin under baseline conditions. Mice were injected intravenously with Evans blue dye followed by topical application of mineral oil (a noninflammatory agent used as the vehicle in subsequent inflammatory assays) to the epidermis of the ear. Spectrophotometric analysis of dissected ears showed that within the 30-minute time frame of the experiment, no significant difference was observed in dye leakage between wild-type and ß3-null mice (Figure 1C).

We next investigated vascular leakage in ear skin in response to mustard oil, an inflammatory agent that induces acute plasma leakage in the skin.23 Mice were injected intravenously with Evans blue dye, followed by topical application of mustard oil to the epidermis of the ear, as described (for the baseline assays). Spectrophotometric analysis of dissected ears showed that 30 minutes after Evans blue administration, mustard oil treatment induced {approx}2.5-fold increase in dye leakage (when compared with baseline levels) in vessels from both wild-type and ß3-null mice; no difference was observed when comparing levels of leaked dye between the 2 genotypes (Figure 1D). Although the data presented are from samples collected 30 minutes after initial mustard oil treatment, we have not seen any differences in vascular leakage between ß3-null and wild-type vessels at either earlier (15 minutes) or later (60 minutes) time points (data not shown). Taken together, these data indicate that baseline permeability and inflammation induced permeability of vessels in ß3-null mice is equivalent to that of vessels in wild-type mice.

Blood Vessels in the Skin of ß3-Null Mice Are Morphologically Normal
The vessels in the skin of ß3-null mice appeared normal. The skin was not reddened and we saw no overt signs of edema (data not shown). We have shown previously that there are no differences between wild-type and ß3-null mice in the number of platelet and endothelial cell adhesion molecule (PECAM)-positive vessels in normal back skin.15 The architecture of the microvasculature was examined in whole-mount preparations of ear skin from wild-type and ß3-null mice in which vessels were visualized with biotin-labeled BS-1 lectin, which binds to the luminal surface of endothelial cells.24 The vessels throughout the skin of the ear appeared normal (Figure 2A). A quantitative analysis revealed no differences in vessel area density (reflecting the overall number, length, and size of vessels per unit area), vessel number density (reflecting the total number of vessels traversing the ear per unit area, independent of vessel size), or in the average diameter of microvessels (Figure 2B).



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  		Figure 2. Blood vessel morphology is normal in ß3-null mice. A, BS-1 lectin visualization of microvessel morphology near the margin of the ear (art, arteriole; cap, capillary; ven, venule). Scale bar=100 µm. B, Morphometric quantitation of blood vessels in BS-1 lectin-stained ear whole mounts. Values represent mean (±SEM) of 3 to 6 microscope fields per ear and 5 ears per genotype. C, Ricin lectin visualization of exposed basement membrane surrounding mustard oil-treated blood vessels near the margin of the ear. Arrowheads indicate sites of leakage. Scale bar=30 µm.

The amount of plasma leakage in inflammation depends, at least in part, on the number and size of sites for leakage in the endothelium.25 These leakage sites expose the underlying endothelial basement membrane and can therefore be visualized in whole-mount preparations with ricin lectin, which binds more avidly to components of the basement membrane than the endothelium.26 In untreated vessels, rhodamine-labeled ricin lectin binding to the endothelial luminal surface was weak and uniform in both genotypes (data not shown). In mustard oil-treated ears, ricin lectin bound very strongly to focal sites of exposed basement membrane in vessels presumed to be venules based on vessel diameter and various models of acute inflammation.27 The degree of ricin lectin binding was comparable in both genotypes. We did not see any differences in the number (data not shown) or location of exposed basement membrane sites in wild-type versus ß3-null vessels (Figure 2C).

Analysis by transmission electron microscopy confirmed an intact microvascular network in the skin of untreated ß3-null mice. ß3-null vessels, including capillaries, were unaltered in size and showed normal pericyte recruitment and cell–cell contacts between endothelial cells and supporting cells (Figure 3A and data not shown).



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  		Figure 3. Cell–cell and cell–ECM associations appear normal in ß3-null blood vessels. A, Upper panel shows transmission electron microscopy of vessels in the skin (e, endothelial cell nucleus; s, supporting cell body). Scale bar=2 µm. Lower panel shows higher magnifications of similar sections to those in upper panel. Arrowheads indicate electron-dense endothelial cell–cell junctions. Scale bar=200 nm. B, Western blot analysis of occludin levels in lung endothelial cells. Blotting for HSC 70 provides a loading control. The bar chart represents averaged densitometry results (means±SEM) from multiple independent experiments that show wild-type and ß3-null endothelial cells express equivalent levels of occludin. C, The panels show representative flow cytometric analyses of PECAM and VECAD levels on lung endothelial cells. D, The micrographs show immunofluorescence for PECAM (upper panels) and VECAD (lower panels) in both blood vessels from skin and in cultured lung endothelial cells. Positive, bright staining is concentrated at the borders between endothelial cells in both genotypes. Scale bar=5 µm in skin sections and 3 µm in cultured cells.

Endothelial cell-to-cell junctions are complex structures formed by different adhesive molecules.28 Endothelial cells possess adherens junctions and tight junctions similar to those described in epithelial cells. Adherens junctions are ubiquitous along the vascular tree and are formed by transmembrane proteins belonging to the cadherin superfamily. Endothelial cells express a cell-specific cadherin known as vascular endothelial cell cadherin (VECAD). Tight junctions comprise 3 types of transmembrane proteins, occludins, claudins and junctional adhesion molecule. In addition, other adhesive proteins, such as PECAM, and endoglin are concentrated at intercellular contacts in the endothelium. As a measure of the molecular architecture of junctions in wild-type and ß3-null endothelial cells, we performed Western blot analysis for occludin (Figure 3B) on lung endothelial cells derived from wild-type and ß3-null animals; flow cytometry for PECAM and VECAD (Figure 3C) on lung endothelial cells derived from wild-type and ß3-null animals; and immunofluorescence (Figure 3D) on both frozen skin sections and isolated lung endothelial cells from both genotypes. Wild-type and ß3-null endothelial cells showed equivalent expression of all 3 cell–cell adhesion molecules, suggesting that adherens junctions, tight junctions, and other cell adhesions are normal in ß3-null cells.

Inhibition of Flk-1 Function Abrogates VEGF-A–Induced Permeability in ß3-Null Mice
Given that no differences in either vessel structure or junctional protein levels were observed when comparing wild-type and ß3-null blood vessels, but that VEGF-A–mediated permeability and Flk-1 levels (Figure 4A) were significantly elevated in ß3-null mice, we asked if elevated Flk-1 levels were directly responsible for the enhanced VEGF-A–mediated vessel permeability response. To address this in vitro, we cultured monolayers of wild-type and ß3-null endothelial cells in transwell chambers and measured the flux of FITC-dextran across the monolayers in response to treatment with either VEGF-A alone or VEGF-A in combination with the neutralizing anti–Flk-1 antibody DC10116 (Figure 4B). To address this in vivo, we administered DC101 to wild-type and ß3-null mice and measured VEGF-A–induced vessel leakage using the Miles assay (Figure 4C). Both analyses revealed that by inhibiting the function of Flk-1, VEGF-A–induced permeability was completely abolished in ß3-null endothelium. These results indicate that increased levels of Flk-1 in ß3-null mice are directly responsible for an increased sensitivity to VEGF-A–mediated blood vessel permeability.



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  		Figure 4. Elevated VEGF-A–induced blood vessel permeability in ß3-null mice is via Flk-1. A, Western blot analysis of Flk-1 levels in lung endothelial cells. Blotting for HSC 70 provides a loading control. The bar chart represents averaged densitometry results (means±SEM) from multiple independent experiments that show ß3-null endothelial cells express 2- to 3-fold more Flk-1 than wild-type controls. B, Effect of ß3-integrin deficiency in endothelial barrier function in vitro. VEGF-mediated permeability is inhibited by DC101 in ß3-null endothelial monolayers when compared with wild-type controls. Bars show the percentage of FITC-dextran flux across the monolayer in comparison to untreated controls (±SEM), n=4 independent wells per genotype/per treatment. C, Permeability of skin vessels in vivo after intradermal injections of suboptimal doses of VEGF-A in mice pretreated with DC101 or control (rat isotype matched IgG or PBS, collectively shown as control treatment). DC101 inhibits VEGF-A–induced vascular leakage in ß3-null mice. Bars show the ratio of VEGF-induced Evans blue leakage/vehicle alone-induced Evans blue leakage (±SEM), n=6 to 14 animals per genotype/per treatment.


*    Discussion
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 up arrowAbstract
 up arrowIntroduction
 up arrowMethods
 up arrowResults
 *Discussion
down arrowReferences
 
The establishment and maintenance of a vascular network is critical for normal embryological development and has significant implications for pathological processes such as wound healing and tumorgenesis. Numerous investigations have demonstrated that interactions between integrins and the ECM are important to these processes.2,6,29–32

A major focus of these studies has been on the roles played by {alpha}vß3-integrin and {alpha}vß5-integrin in angiogenesis.33–37 During angiogenesis, {alpha}vß3 expression is upregulated.38 Furthermore, its expression is linked to cell migration, invasion, and cell survival.38–40 Given these collective data, it is surprising that genetic ablation of {alpha}v-integrin elicits only minor vessel defects.41 Although most {alpha}v-deficient mice die soon after birth, a complex embryonic vascular network develops. In addition, ß3-deficient mice are viable and fertile and appear to produce a vascular network without obvious defects.17,42 A detailed morphological examination of skin blood vessels in ß3-null mice, presented here, indicates that the vasculature is intact and indistinguishable from that of wild-type mice, reinforcing the conclusion that ß3-integrin is not necessary for establishing a normal vasculature.

Endothelial cells attach to the ECM to form a semi-permeable barrier restricting movement of solutes across the vascular wall. Evidence that integrins are involved in maintaining this barrier comes from studies showing that treating endothelial monolayers or isolated coronary venules with RGD peptides (small molecules that disrupt interactions between integrins and the ECM) increase their permeability.43–45 The fact that the increased permeability in these in vitro studies is prevented by the addition of soluble fibronectin or vitronectin suggests that interactions between integrins and the ECM influence vessel permeability. From the data we present here, however, we are able to conclude that ß3-integrin is not essential for maintaining an intact and functional endothelial barrier. These data are as follows: (1) baseline vessel permeability is not altered in ß3-deficient mice; (2) a molecular comparison of the endothelial cell-to-cell contacts between the 2 genotypes revealed no differences in the expression of PECAM, VECAD, or occludin; and (3) wild-type and ß3-null blood vessels respond equally to mustard oil-induced plasma leakage. Collectively, these data indicate that ß3-integrin is not necessary for maintaining baseline integrity of the endothelial barrier.

In marked contrast to the lack of an apparent phenotype in vessel structure and baseline integrity, we see an increase in the sensitivity of ß3-null vessels to subthreshold doses of VEGF-A treatment. Changes in matrix composition and integrin activation can influence levels of, and signaling through, VEGF and fibroblast growth factor receptors on cultured microvascular endothelial cells.9,46,47 We show that the absence of ß3-integrin is associated with an increase in the levels of Flk-1 expressed on endothelial cells and, for the first time to our knowledge, that this increase in Flk-1 leads to an increased sensitivity to VEGF-A–mediated permeability in vitro and in vivo. Previously, we were able to draw correlations between only elevated Flk-1 levels and enhanced VEGF-mediated angiogenesis.15 With respect to permeability, however, we show that by inhibiting signaling through Flk-1, we abolish the enhanced VEGF-A response seen in ß3-null vessels. This demonstrates that the increased Flk-1 is functional and is entirely responsible for the elevated sensitivity to VEGF-A–induced permeability.

Conventional treatment of vascular leakage is rather aspecific and includes treatments such as the administration of glucocorticoids or nonsteroidal inflammatory drugs and antihistaminergic compounds. Recently, VEGF antagonists48 and VEGF receptor inhibitors49 have been used with some success in treating the increased vessel leakiness associated with macular degeneration, diabetic retinopathy, and ischemia–reperfusion injury. By genetically ablating ß3-integrin function, we have altered blood vessel sensitivity to VEGF-A–induced plasma leakage, indicating that integrins might be additional useful targets for clinically manipulating vessel permeability.

Antagonists of {alpha}vß3 and {alpha}vß5, some of which are in clinical trials,50 have been shown to block angiogenesis, suggesting that these integrins are required for angiogenesis. However, we have shown that ß3-integrin–deficient mice support enhanced pathological angiogenesis.15 The data we present here and in our previous studies suggest that ß3-integrin acts as a transdominant inhibitor of VEGF-mediated vascular functions, with its presence being enough to downregulate levels of Flk-1. We have previously demonstrated that the reintroduction of ß3-integrin into null endothelial cells restores Flk-1 levels to those seen in wild-type cells,15 suggesting that ß3-integrin can regulate Flk-1 expression. Hence, eliminating ß3-integrin interactions with the ECM might alter the response of endothelial cells to VEGF. The antagonist of {alpha}vß3-integrin, LM609, has been shown to enhance vascular permeability.51 If inhibition of {alpha}vß3-integrin has the potential of elevating Flk-1 levels in endothelial cells, both angiogenesis and permeability of tumor vessels could be increased, especially if, as many are,52 the tumor is a source of VEGF production. This might prove detrimental to the treatment of the tumor. We do not question the efficacy of {alpha}vß3 antagonists as potentially useful therapeutic agents, but our results suggest we need a more thorough understanding of the interactions between integrins and other molecules that are involved in regulating angiogenesis and permeability.

Many vascular disorders are accompanied by alterations in production and/or degradation of ECM components and by alterations in integrin expression.4 Because of this, integrins are obvious therapeutic targets for treating a host of vascular diseases such as hypertension, diabetes mellitus, and restenosis.53–56 This idea is exciting and should be explored, but with the thought in mind that manipulating integrin expression might lead to an increase in growth factor receptor levels expressed by endothelial cells. As we show here, genetically ablating ß3-integrin function elevates Flk-1 levels on endothelial cells. This has the potential of affecting vessel growth and vessel permeability, both of which have important implications for current and future therapeutics. Vessel leakiness, for example, is known to contribute to the abnormal microenvironment of tumors and can affect tumor growth, metastasis, and therapeutic drug delivery.57 As long as we exercise caution, though, integrins may provide us with useful targets for treating a range of vascular disorders.


*    Acknowledgments
 
We thank Garry Saunders, Sue Watling, Colin Wren, and Stephen Gschmeissner for their technical assistance, and Ian Hart, Francesco Conti, Andrew Reynolds, and the other members of the Department of Tumor Biology for their support and criticism during this study. We also thank Mark Karaczun for his critical reading of the manuscript.

Received April 8, 2004; accepted August 3, 2004.


*    References
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 *References
 

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