ARVO celebrates 75 years with a look back at the impact of one discovery

FORT LAUDERDALE, Fla. — Translating research into clinical practice can be difficult, but the effort can reap copious rewards in the long term, according to a renowned cancer researcher speaking here.

Judah Folkman, MD, a professor of cell biology and pediatric surgery at Harvard Medical School, delivered the keynote address at the annual meeting of the Association for Research in Vision and Ophthalmology (ARVO), which began here Sunday.

Credited with inventing the field of angiogenesis research, Dr. Folkman had plenty of experience to draw on as he described the challenges faced by researchers trying to break into uncharted scientific territory.

Alluding to the unwillingness of many to break with long-held beliefs, Dr. Folkman recalled a lesson he refused to heed in his early years: “The only experts are those of the past; there are no experts of the future.”

Largely because of Dr. Folkman’s career-long dedication to the subject, the process of angiogenesis is now recognized as an important control point in a number of cancer types, and angiogenesis inhibitors have emerged as a new class of drugs, not only in cancer research, but in ophthalmology and other fields of medicine.

But Dr. Folkman can still vividly recall a time when “no one believed that tumors could recruit new cells.” He pioneered the idea that some tumors grow by recruiting their own network of blood vessels.

“It was very hard to make the case that tumors were dependent on angiogenesis,” Dr. Folkman said.

By the mid-1980s, it had been shown and corroborated many times over that tumors can produce new cells. This led to a greatly enhanced understanding of how cancer grows and how this growth can be inhibited, Dr. Folkman said.

For example, researchers were able to determine that endostatin is an effective angiogenesis inhibitor. As a result, endostatin is now an important component in many experimental cancer treatment regimens, he said.

In the field of ophthalmology, the concept of angiogenesis has had wide-ranging implications, not only for ocular tumors, but also for diseases such as macular degeneration, diabetic retinopathy and Knobloch syndrome, as well as for endothelial disorders, Dr. Folkman said.

“We think of this switch to the angiogenic phenotype as a balance between stimulators and inhibitors, and that is especially true in the cornea,” Dr. Folkman said.

He said angiogenesis provides an underlying principle for many types of diseases that are dominated by the same pathologic process — even though they are treated by different specialists.

“Thus the ophthalmologist who is trying to stop angiogenesis in the eye is treating the same process as the rheumatologist trying to keep new vessels from invading joint cartilage, as the gynecologist trying to arrest angiogenesis in endometriosis and as the urologist who would like to turn off the angiogenic switch in benign prostate, malignant prostate and bladder cancers,” he said.

“The take home message is: If you should happen to drain the Pacific Ocean, you should not be surprised if the islands are connected,” Dr. Folkman quipped.

Dr. Folkman was also awarded the 75th Anniversary Award, in honor of ARVO’s 75 years in existence. In bestowing the award, Robert N. Weinreb, MD, president of ARVO, praised Dr. Folkman for his “overwhelming body of work that will undoubtedly lead to the treatment and cure of many diseases.”