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Vessel co-option and resistance to anti-angiogenic therapy


Vessel co-option is a non-angiogenic mechanism of tumour vascularisation in which cancer cells utilise pre-existing blood vessels instead of inducing new blood vessel formation. Vessel co-option has been observed across a range of different tumour types, in both primary cancers and metastatic disease. Importantly, vessel co-option is now implicated as a major mechanism that mediates resistance to conventional anti-angiogenic drugs and this may help to explain the limited efficacy of this therapeutic approach in certain clinical settings. This includes the use of anti-angiogenic drugs to treat advanced-stage/metastatic disease, treatment in the adjuvant setting and the treatment of primary disease. In this article, we review the available evidence linking vessel co-option with resistance to anti-angiogenic therapy in numerous tumour types, including breast, colorectal, lung and pancreatic cancer, glioblastoma, melanoma, hepatocellular carcinoma, and renal cell carcinoma. The finding that vessel co-option is a significant mechanism of resistance to anti-angiogenic therapy may have important implications for the future of anti-cancer therapy, including (a) predicting response to anti-angiogenic drugs, (b) the need to develop therapies that target both angiogenesis and vessel co-option in tumours, and (c) predicting the response to other therapeutic modalities, including immunotherapy.

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Fig. 1

These images were first published in Bridgeman et al. [114] and are reproduced here with the permission of the copyright holder. Scale bar = 50 μm

Fig. 2

This figure is adapted from Kuczynski et al. [10] with the permission of the copyright holder

Fig. 3

This figure is adapted from Kuczynski et al. [10] with the permission of the copyright holder

Fig. 4

This figure is adapted from Kuczynski et al. [10] with the permission of the copyright holder


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Kuczynski, E.A., Reynolds, A.R. Vessel co-option and resistance to anti-angiogenic therapy. Angiogenesis 23, 55–74 (2020). https://doi.org/10.1007/s10456-019-09698-6

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  • Vessel co-option
  • Angiogenesis
  • Drug resistance
  • Biomarker
  • Invasion
  • Metastasis
  • Anti-angiogenic therapy
  • Immunotherapy