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Cancer Drug Targets, 2005, 5, 249-266 249
The Chick Embryo Chorioallantoic Membrane as a Model System for the
Study of Tumor Angiogenesis, Invasion and Development of Anti-Angiogenic
Agents
A. Cevik Tufan*,1,3 and N. Lale Satiroglu-Tufan2,3
INTRODUCTION assays currently in use to evaluate this process [5-9]. It is
Angiogenesis is a fundamental process by which new against this background that this review will present a
summary of information available from the literature
blood vessels are formed as extensions from the existing
regarding experimental evaluation of angiogenesis/anti-
vasculature [1]. It plays an essential role in reproduction,
angiogenesis with special emphasis on the chick embryo
development, wound repair and a wide range of pathological
CAM as a model system.
conditions termed “angiogenic diseases”. Under the
physiological conditions, such as reproduction,
development, and wound repair, angiogenesis is highly MOST FREQUENTLY USED ANGIOGENESIS
regulated, i.e. turned on for a specific period of time and then ASSAYS
turned off. However, many diseases are driven by persistent During angiogenesis, new blood vessels emerge and
unregulated angiogenesis. In arthritis new capillary blood grow from preexisting ones through an invasive process that
vessels invade the joint and destroy cartilage, where as in requires proteolysis of the extracellular matrix, migration and
diabetic retinopathy new capillaries in the retina invade the proliferation of endothelial cells, and recruitment of cell
vitreous, bleed, and cause blindness [2]. Among the types, such as pericytes and smooth muscle cells, todifferent
angiogenesis-dependent disease conditions, however, tumor segments of the vasculature [1, 10]. Each of the elements
growth and metastasis are the most dramatic and lethal during this process, i.e., basement membrane disruption,
clinical problems [1-4]. A tumor must continuously cell migration, cell proliferation, and tube formation, can be
stimulate the growth of new capillary blood vessels for the a target for intervention, and each can be tested in vitro.
tumor itself to grow. Furthermore, the new blood vessels However, the critical tests for angiogenesis/anti-angiogenesis
embedded in a tumor provide a gateway for tumor cells to require a more complex assessment, and several in vivo
enter the circulation and to metastasize to distant sites, such assays have been developed that permit a more realistic
as liver, lung, or bone. evaluation of the angiogenic/anti-angiogenic response than
The development of agents that target tumor vasculature can be obtained in vitro. Detailed information regarding
is ultimately dependent on the availability of appropriate available angiogenesis assays can be found in a recent review
preclinical screening assays. One of the most significant by Staton et al. [11]. This review provides a short summary
technical problems in the research field of angiogenesis/anti- of frequently used angiogenesis assays in the context of in
angiogenesis, however, is the accurate interpretation of the vitro and in vivo assays.
highly varied results obtained from the many experimental
In Vitro Assays
*Address correspondence to this author at the Department of Histology Endothelial Cell Culture Assays
and Embryology, and Research Center for Genetic Engineering and In vitro culture of endothelial cells enables the
Biotechnology, Pamukkale University, School of Medicine, Kinikli measurement of essential properties, i.e. cell proliferation,
Kampusu, Morfoloji Binasi, 20020 Kinikli-Denizli-Turkey; Tel: +90 258
213 40 30/ext. 1395; Fax: +90 258 213 28 74; E-mail: cell migration, and tube formation, of these cells during the
actufan@pamukkale.edu.tr process of angiogenesis.
250 Current Cancer Drug Targets, 2005, Vol. 5, No. 4 Tufan and Satiroglu-Tufan
tissues or factors are new vessels, places this system among CAM assay dated 1913. However, its use for the testing of
the most populer in vivo assay systems. The original angiogenic or antiangiogenic substances and tumor
method was developed for rabbit eyes [35], but has been angiogenesis has become popular during the last three
adapted to mice [36, 37], now among the most frequently decades [11, 14, 44-46]. During 2003-2004 over 150
used laboratory animal. It involves the introduction of test publications had used the CAM as their model system to
tissues or substances in to a pocket made in the cornea to evaluate angiogenesis/anti-angiogenesis. CAM assay is an
stimulate the ingrowth of new vessels from the peripheral alternative to animal models and provides a natural
limbal vasculature. If cornea is locally induced by angiogenic environment of growing blood vessels and all the
growth factors (e.g., by FGF, VEGF) or tumor cells, it is components of the complex host interaction. The principal of
also possible to test effects of inhibitors of angiogenesis on the CAM assay is to explant cells/tissues/biomaterials etc.
induced events. The test inhibitors can be administered on CAM or expose a local area on CAM directly to test
orally or systemically, the latter either by bolus injection or, substances implicated in angiogenesis or antiangiogenesis
more effectively, by use of a sustained release method such as mechanisms in order to evaluate alterations in its natural or
implantation of osmotic pumps loaded with the test induced angiogenic capacity. It involves a straightforward
inhibitor [38, 39]. The vascular response can be best procedure of either windowing the eggshell to have access to
monitored by the injection of fluorochrome labeled high- the CAM or preparation of shell-less cultures of avian
molecular weight dextran [40]. Thus, computerized embryos, which increases the CAM area available for
histogram analysis or pixel counts above a specific threshold multiple tests on a single CAM. With its many advantages
would be the easiest method for quantification. The compared to the previously described in vitro and in vivo
advantages of this assay include the ability to monitor assay models, i.e. will be discussed later in this review,
progress of angiogenesis, the absence of an existing CAM assay has the difficulty in standardization of measuring
background vasculature in the cornea, and the ability to use the angiogenic/anti-angiogenic response to an experimental
mice as the experimental animal. The demanding surgical compound/tissue in an objective and quantifiable manner. In
procedures involved in this assay, on the other hand, limit addition, the difficulty in identifying the molecular basis for
the animal number for a given experiment and also the these changes has been the greatest challenge in this field.
practical use of this assay model. In addition, the space From this point onward this review aims to discuss current
available for introducing test material is limited, and knowledge about CAM assay in angiogenesis starting with
inflammatory reactions are difficult to avoid. the embryonic development of the avian CAM.
Matrigel Plug Assay
EMBRYOLOGICAL ORIGIN OF THE CAM, ITS
The principal of this assay is subcutaneous injection of STRUCTURE AND FUNCTION
Matrigel containing test cells or substances where it
solidifies to form a plug [41]. This plug can be recovered Four extraembryonic membranes form during avian
after 7–21 days in the animal and examined histologically to development: the amnion, chorion, allantois, and yolk sac
determine the extent to which blood vessels have entered it. (Fig. (1A)). Two of these membranes, the chorion and
Quantification of the vessels in histologic sections is labor allantois, fuse together and form the chorioallantoic
intensive but accurate [41]. Fluorescence measurement of membrane (Fig. (1J)). The chorion arises from somatopleure
plasma volume can also be achieved using fluorescein (ectoderm and adjacent somatic mesoderm), and the allantois
isothiocyanate (FITC)-labeled dextran 150 [42]. from splanchnopleure (endoderm and adjacent splanchnic
Quantification can also be achieved by measuring the amount mesoderm) [46-50]. The chorion together with amnion
of hemoglobin contained in the plug [41]. However, develops as 4 folds of somatopleure, i.e., head fold, tail fold,
hemoglobin content depends on the blood content, which is and two lateral folds, and these folds ultimately fuse together
directly proportional to the vessel size. Thus, due to to enclose the embryo in an inner covering of amnion and
possible stagnant pools of blood in the tested tissue outer covering of chorion, with its somatic mesoderm
hemoglobin measurement may be misleading. The major towards the amnion and an investing layer of ectoderm (Fig.
advantage of this assay is that it does not require surgical (1J)).
skills, however the evaluation process is demanding The allantois develops as an outgrowth of the hindgut
compared to the corneal angiogenesis assay. appearing at about 60 hours of incubation. On about 4th day
The Sponge/Matrigel Assay of incubation it pushes out of the body of the embryo into
the space between the amnion and chorion, the
This is a modified version of the Matrigel plug assay that extraembryonic coelom. Its proximal portion lies parallel
allows clearer demarcation of neovascularization [39]. In and just caudal to the yolk sac. When the distal portion
brief, Matrigel alone is first introduced subcutaneously into grows clear of the embryo it becomes enlarged. The narrow
the mouse. A sponge soaked with the test material or proximal portion is known as the allantoic stalk, and the
tumoral tissue fragment is then inserted into the plug. New enlarged distal portion as the allantoic vesicle (Fig. (1A)).
vessels can then be measured by injection of FITC-dextran. Fluid accumulation distends the allantois. The allantoic
The greatest disadvantage of the sponge/Matrigel assay, on vesicle enlarges very rapidly between days 4–10 of
the other hand, is that it is more time-consuming than the incubation (Fig. (1)). In this process, the mesodermal layer
standard Matrigel plug assay. of the allantois becomes fused with the adjacent mesodermal
The CAM Assay layer of the chorion to form the CAM.
According to a recent publication [43] the first evidence In this double layer of mesoderm an extremely rich
of the tumor-induced angiogenesis in vivo by using the vascular network, which is connected to embryonic
252 Current Cancer Drug Targets, 2005, Vol. 5, No. 4 Tufan and Satiroglu-Tufan
Fig. (1). The development of CAM in shell-less culture. A) Schematic diagram of a day 4/5 chick embryo in ovo. B-I) CAM
development in shell-less culture from day 4 trough day 10. J) Schematic diagram of a day 9/10 chick embryo in ovo.
overlying chorionic epithelial cells and mediating gas exchange with the outer environment [47, 49]. Parallel
to days 10 to 14 [57]. Hyaluronic acid is important in the
this there is continues rapid growth in the surface area of the formation, alignment, and migration of the capillary plexus,
CAM until day 9 [48, 52] (Figure-1). The endothelial cell while heparan sulfate, chondroitin sulfate, and dermatan
mitotic index declines rapidly after day 11 [47-49]. The sulfate are implicated in the differentiation and development
fused CAM covers the entire surface of the inner shell of arterial and venous vessels of the CAM [57].
membrane of the chicken by day 12 of incubation. Thus,
approximately 6 cm2 surface area of CAM on day 6 of THE MECHANISMS AND MAJOR SIGNALING
incubation reaches to almost 65 cm2 surface area on day 14 EVENTS INVOLVED IN ANGIOGENESIS PROCESS
[53]. At day 14, the capillary plexus is located at the surface Two distinct mechanisms, vasculogenesis and
of the ectoderm adjacent to the shell membrane. The
angiogenesis establish the formation of the vascular network
ultrastructural morphology of the capillary system of 16 day
in the CAM. While vasculogenesis refers to in situ
CAM was described as a dense plexus consisting of a single
differentiation and growth of blood vessels from mesodermal
network of capillaries lined by a continuous endothelium
derived hemangioblasts, angiogenesis comprises two
with some pericytes embedded in the chorionic epithelium
different mechanisms: endothelial sprouting and IMG [65].
[54]. The vascular system attains its final arrangement on
The sprouting process is based on endothelial cell
day 18, just before hatching (on day 21) [55].
migration, proliferation and tube formation. IMG divides
Schlatter et al. [48] have demonstrated that by means of existing vessel lumens by formation and insertion of tissue
morphometric analysis CAM angiogenesis undergoes three folds and columns of interstitial tissue into the vessel lumen.
phases of development. In an early phase, from day 5 to day The latter are termed interstitial or inter-vascular tissue
7, the major mechanism of capillary network growth is structures and tissue pillars or posts. Intussusception also
sprouting. In an intermediate phase, from day 8 to day 12, includes the establishment of new vessels by in situ loop
intussusceptive microvascular growth (IMG) is dominating, formation in the wall of large veins.
and at days 13 and 14, CAM structure is undergoing Numerous inducers of angiogenesis have been identified,
expansion with only a small increase in complexity. By this
including members of the fibroblast growth factor (FGF)
time chorionic artery undergoes 6-7 generations of branching
family, vascular permeability factor/vascular endothelial
[56]. These findings are important in view of experimental
growth factor (VPF/VEGF), angiogenin, transforming
protocols using the CAM as a model for testing angiogenetic
factors. Indeed, care has to be taken not to misinterpret growth factor alpha and beta (TGF- and -), platelet-
normal age-dependent alterations of the CAM vascular derived growth factor (PDGF), platelet-derived endothelial
cell growth factor (PDECGF), tumor necrosis factor alpha
architecture as specific responses to tested agents.
(TNF-), interleukins, chemokines, and angiopoietins [66].
As the major component of the double-layered mesoderm In this review the molecular regulation of angiogenesis
the extracellular matrix of the CAM expresses fibronectin, mechanisms is discussed in respect to the best-characterized
laminin, collagen type I, collagen type IV, bone positive regulators, i.e. VEGF and its receptors flk-1 (KDR)
morphogenic protein receptor Type II (BMPR II), and and flt-1, FGF signaling, the Angiopoietin/TIE system, and
specific glycosaminoglycans (GAGs) in its composition the ephrin-B/EpH-B system.
favoring the angiogenic process [46, 57, 58]. At early stages VEGF is a heparin-binding angiogenic molecule with
of development, when the subepithelial capillary plexus is
endothelial target specificity in the CAM [67]. VEGF, also
not yet formed, fibronectin appears in the extracellular matrix
termed VEGF-A, belongs to the VEGF–PDGF supergene
beneath the chorion, and may promote the migration of
family. Alternative exon splicing of the VEGF gene yields 5
endothelial cells merging by sprouting from the mesodermal
isoforms, i.e., VEGF-A, VEGF-B, VEGF-C, VEGF-D, and
blood vessels [58]. Fibronectin has also been implicated in
VEGF-E [68]. They display differential interactions with
the vasoproliferative processes induced by angiogenic stimuli
three related receptor tyrosine kinases, i.e., VEGFR-1/Flt-1,
in the CAM [59, 60]. Laminin, on the other hand, is present
VEGFR-2/Flk-1/KDR, and VEGFR-3/Flt-4 [69]. However,
during all stages of vessel formation in CAM development
the angiogenic effects of VEGF are initiated via its binding
[58] and is implicated in the early formation and later
to two of these receptor tyrosine kinases, i.e., VEGFR-1 and
differentiation of the subendothelial basement membrane
VEGFR-2 [68, 69], that are found primarily on vascular
[60]. Maximum collagen synthesis is seen between days 7
endothelial cells. Although VEGFR-1 binds VEGF with
and 10 with a decrease at day 12, when vascular density is
higher affinity than does VEGFR-2, VEGFR-1 is thought to
considered to have reached a plateau. Collagen-degrading
act primarily as an intermediate receptor on endothelial cells,
enzyme activity peaks at days 8-10, which coincides with
modulating the availability of VEGF to VEGFR-2, the
the maximum angiogenesis [61]. BMPR II, which is
principal receptor for VEGF signaling [68, 70]. As an
involved in the interaction of endothelial cells and collagen
endogenous angiogenic ligand VEGF promotes endothelial
type I, is expressed during days 1-10 and is down- regulated
cell proliferation and migration, stromal degradation,
by day 18 [62]. Collagen type IV appears in the late stages
increased vascular permeability, and possibly the formation
of CAM vascular development and may play an important
of an extravascular fibrin substrate for endothelial and tumor
role in the terminal differentiation of endothelial cells, i.e.,
cell growth [68, 70-72]. VEGF also acts as a crucial survival
progressive slow down of microvascular endothelial cell
factor for endothelial cells in newly formed vessels by
proliferation, gradual reduction in endothelial migration,
inhibiting apoptosis [68, 73].
establishment of cell polarity, lumen formation, and
maturation of the basement membrane [58, 63, 64]. The The two most extensively investigated proteins of the
distribution of hyaluronic acid and sulfated GAGs peaks at FGF family implicated in angiogenesis, on the other hand,
are FGF-1 (acidic FGF) and FGF-2 (basic FGF) [49]. They
254 Current Cancer Drug Targets, 2005, Vol. 5, No. 4 Tufan and Satiroglu-Tufan
are structurally related, having a 53% absolute sequence homology [74]. They stimulate endothelial cell mitosis a
nd ERK-independent survival mechanism preventing stress-
migration in vitro, are among the most potent angiogenic mediated death based on Raf coupling to the mitochondria,
proteins in vivo, have high affinity for heparin and heparan whereas the v5 pathway prevents receptor-mediated death
sulfate, are stored in the extracellular matrix, but lack a in an ERK-dependent manner [73, 80] (Fig. (2)).
signal sequence for secretion [49, 75]. FGF-2 exists in four Another family of growth factors specific for the vascular
forms, one low-molecularweight (18 kDa) and three high- endothelium is Angiopoietins [81-87]. Similar to VEGF,
molecular-weight forms, resulting from alternative initiations the specificity of the Angiopoietins for the vascular
of translation [49, 66]. FGF-2 has been isolated from a endothelium results from the restricted distribution of their
variety of tissues and cell lines [76]. receptors, TIE-1 and TEI-2, to these cells. Thus, the
Synergistic angiogenesis of VEGF and FGF-2 has been receptor tyrosine kinases with immunoglobulin and
demonstrated both in vitro and in vivo [77-79]. The epidermal growth factor homology domains (TIE)-1 and
coordination of signals from these two important classes of TIE-2 have critical roles in angiogenesis process [88]. TIE-2
angiogenic growth factors requires the interaction of them has at least four known ligands, Angiopoietin-1,
with the extracellular matrix (ECM), i.e., integrin ligation, Angiopoietin-2, Angiopoietin-3 and Angiopoietin-4.
to support endothelial cell proliferation and migration [73]. Ligands for the TIE-1 have not been well characterized up to
Integrins can directly associate with growth factor receptors, date. The function of TIE-1 is related to endothelial cell
thereby regulating the capacity of integrin–growth-factor- differentiation and the establishment of blood vessel
receptor complexes to propagate downstream signaling. It integrity, i.e. vasculagenesis related events [89], where as
has recently been shown that this synergy involves FGF- TIE-2 appears to play a role in hematopoiesis and
2/v3 and VEGF/v5 interactions differentiallyactivating angiogenesis [90]. Angiopoietin-1 and Angiopoietin-2 are
Ras-Raf-ERK signaling (Fig. (2)). ERK is likely playing a secreted glycoproteins that share 60% amino acid identity
general role in both pathways of angiogenesis because it and bind with similar affinity to TIE-2. Angiopoietin-1
regulates gene transcription, cell cycle progression, and cell induces autophosphorylation of TIE-2, which is naturally
migration, which are critical to the growth anddifferentiation blocked by Angiopoietin-2. Angiopoietin-1 mediates
of new blood vessels [73, 80]. However, in this proposed reciprocal interactions between the endothelium, surrounding
model each of these signaling pathways also accounts for matrix and mesenchyme inducing endothelial cells to recruit
protection of endothelial cell from distinct mediators of pericytes and smooth muscle cells to become incorporated in
apoptosis [68, 73, 80]. The v3 pathway promotes an the vessel wall [91]. Angiopoietin-2 blocks the TIE-2
receptor and acts to repel pericytes and smooth muscle cells.
Fig. (2). Sinergy of VEGF and FGF signaling pathways in angiogenesis. This synergy involves FGF-2/v3 and VEGF/v5
interactions differentially activating Ras-Raf-ERK signaling. ERK is likely playing a general role in both pathways of angiogenesis
because it regulates gene transcription, cell cycle progression, and cell migration, which are critical to the growth and differentiation
of new blood vessels. However, in this proposed model each of these signaling pathways also accounts for protection of endothelial
cell from distinct mediators of apoptosis. ECM, extracellular matrix; PM, plasma membrane; EC, endothelial cell.
The Chick Embryo Chorioallantoic Membrane Current Cancer Drug Targets, 2005, Vol. 5, No. 4 255
Thus, function of the Angiopoietin/TIE -2 pathway seems to involves remodeling and maturation of the vascular networ
be restricted to later stages of vascular development and k.
For example, VE-cadherins mediate endothelial barrier
A receptor tyrosine kinase family recently implicated in function, angiogenesis and can also support cross-talk with
neovascularization consists of the Eph family of receptor VEGF receptors [95, 96]. The role of VE-cadherins in
tyrosine kinases that play a prominent role in endothelial angiogenesis has recently been reviewed [97-99].
cell assembly and migration [85]. The Eph family of receptor
tyrosine kinases and their membrane-tethered ligands, known Signals from phosphoinositide (PI) 3-kinase and its
as ephrins, constitute the largest receptor tyrosine kinase target AKT are also implicated as regulators of angiogenesis
sub-family, with at least 14 receptors and 9 ligands [92, 93]. [100]. Activated PI 3-kinase and AKT are strong inducers of
This family is subdivided into class A receptors that bind neovascularization and endothelial cell proliferation [100].
GPI-tethered A class ephrins, and B class receptors that bind Inhibition of PI 3-kinase signaling interferes with
transmembrane-tethered B class ephrins [94]. Gene targeting angiogenesis [100]. PI 3-kinase signaling also mediates
studies have established several class B Eph family VEGF expression in endothelial cells [101]. AKT signaling
members, i.e., EphB-mediated signaling, as key regulators plays also a role in FGF-1-stimulated angiogenesis in vivo
of embryonic angiogenesis [85, 94]. Class A Eph receptors, [102]. Thus, the AKT pathway may also serve as a
on the other hand, have been shown to regulate post-natal therapeutic target for angiogenesis-associated diseases.
angiogenesis in adults [94].
THE USE OF CAM ASSAY
Culture Methods Used in CAM Assay
In addition, regulation of cell–cell adhesion by vascular
shell-less culture [48]. Each of these methods has benefits
Fig. (3). The sequence of events during the preparation of shell-less cultures of the chick embryo. A) Collection and preincubation of
fertilized eggs at 37°C in a humidified egg incubator. B) Cleaning and cooling of eggs prior to explantation. C-E) Explantation of
embryos in to the presterilized culture containers at aseptic conditions. F) Incubation of shell-less cultures at 37°C in a humidified
incubator for the desired amont of time.
256 Current Cancer Drug Targets, 2005, Vol. 5, No. 4 Tufan and Satiroglu-Tufan
Table 1. Assays Used in Testing Angiogenesis
Shell-less chick embryo CAM model Mammalian models
1. Cost efficient (eggs, time, labor, etc.) 1. Moderate to high cost (laboratory animals, per diem, time, labor, etc.)
2. In vivo assay 2. In vivo assay
3. No mature immune system Carrier 3. Mature immune system [Referance]
4. No surgery required to test materials 4. Complex surgery to place implants (i.e., requires anesthesia, operating
1. Methyl cellulose discs room, etc.) [132, 151]
2. Elvax™ polymer (Elvax-40, ethylene acetate copolymer, 40%vinyl acetate content)
5. Allows multiple tests on individual CAMs 5. One animal per test [151]
3. Matrigel
6. Allows direct and continuous visualization and recording of test site [152]
6. Usually does not allow visualization of implant or test site
4. Agarose discs or agarose beads
7. Animals do not need to be restrained 7. Animals often have to be restrained [122]
5. External gels (collagen gel inside parallel nylon meshes)
8. Implantation and test time is limited with days 8. Implantation and test time is longer [153, 154]
6. Gelatin sponges
9. Tissue and blood sampling is easily done [133]
9. Tissue and blood samples are available in larger quantity but require
7. Filter discs (e.g. Millipore dics soaked in the solution) more invasive procedures [110, 121, 155]
10. Biology/physiology of this model is well known 10. Biology/physiology of these models are also well known, but are also
8. Plastic cover slips (e.g. Thermanox cover slips onto which the stimulant had been dried) [156, 157]
more complex
9. Rings composed of silactic, teflon, or glass [158-160]
11. Cost-effective model for utilization of expensive and limited reagents 11. Cost-ineffective model for utilization of expensive and limited reagents
(e.g., cytokines, antibodies)
10. Flooding the surface (e.g., cytokines, antibodies) [161, 162]
12. Easily reproducible
11. Direct inoculation into the cavity of the allantoic vesicle 12. Reproducibility is expensive and requires more time and labor
[163]
13. Allows large-scale screening
12. Direct application of cells and tissues 13. Large-scale screening is difficult [164]
Table 2. Comparison Between the Shell-Less Chick Embryo CAM Model and Mammalian Models for Testing Angiogenesis
258 Current Cancer Drug Targets, 2005, Vol. 5, No. 4 Tufan and Satiroglu-Tufan
THE IMPORTANCE OF STANDARDIZATION OF In studies of inhibition of angiogenesis, on the other
THE CAM hand, there are two approaches, which differ fundamentally in
It is difficult to quantify an angiogenic or anti-angiogenic the target vessels, i.e. those which examine the response in
the rapidly growing CAM [104, 132] and those that evaluate
response with reasonable speed, ease and accuracy,especially
the inhibition of growth induced by a known stimulant, such
in an in vivo system like CAM [44, 124-127]. Even though
as FGF-2 [133]. It is important to remember that inhibition
the pitfalls, including non-specific responses have been
has rarely been described in studies of CAMs older than 8
adequately described [123, 128, 129], their importance is not
days other than those in which a stimulus such as FGF-2
generally acknowledged either. Furthermore, a wide range of
was used.
methodologies is employed in culturing the CAM. Some of
the decisions to be made before starting the assay include the There have been a variety of application methods or
choice of avian CAM, i.e. chicken or quail CAM, the carriers described in the literature to test angiogenic or anti-
method of CAM assay, i.e., in ovo or shell-less culture (if in angiogenic activity of relevant substances and some of the
ovo, dropped CAM or small hole; if shell-less, age to crack, most frequently used are previously discussed during the
and container for culture), the method of application of a test description of most frequently used assay methods. In
material/tissue, i.e., carriers for interventions, the choice of addition, a more comprehensive list of these carriers is given
age of the CAM at which the intervention is applied and the in Table 3. However, The CAM may also be used to test
duration of the intervention, as well as the methods for the growth and invasiveness of a variety of tumors by
quantification of responses. implanting them onto the CAM and by comparing tumor
As described earlier, we achieved high survival rates with growth and vascularization with or without the
the use of a chick embryo shell-less culture technique administration of an anti-angiogenic substance [127, 134-
involving the described modified culture containers allowing 136].
diffusion of air through the material [103-105]. In terms of quantification of responses an outline of most
The age of CAM at the time of application and the frequently used methods can be given as follows:
duration of application of the intervention plays a critical role Scoring
when it comes to evaluation of angiogenic responses of test
agents or tumor material, since CAM itself undergoes rapid Evaluation may be made by direct observation of the
changes during the course of its maturation. The window of presence or absence of a feature, or based on an arbitrary
testing should preferentially be a period during which score, i.e. + to 4+ or 0 to 3 or as “positive”, “negative” or
neovascularization due to tested application can be “questionable”. The features evaluated for alteration in
distinguished from natural process. The application time angiogenesis include vessel density, new vessel formation,
reported in the literature varies from as early as day 3 [130] vessels tortuosity (bending or looping and corkscrew), vessel
to as late as day 15 [131]. However, as discussed earlier the disorganization, characteristics of vessel branching, number
rapid growth of the surface area of the CAM continues until of intersepts of vessels with a series of concentric circles, and
day 9 [48, 52] and the endothelial cell mitotic index declines the size, surface area, number etc. of an avascular zone, where
rapidly after day 11 [47-49]. In addition, at days 13 and 14, angiogenesis is inhibited [46, 137-141]. The scoring method
CAM structure is undergoing expansion with only a small is considered as a “semiquantitative” evaluation of the
increase in complexity [48]. Thus, the period starting from response. An example of its use in testing of the inhibition
day 9/10 up to day 14/15 is generally considered to be a of angiogenesis, most important in anti-cancer research, is
suitable window of application. that where two independent observers determine the radius of
Table 3. Carriers for Testing Interventions on CAM
The Chick Embryo Chorioallantoic Membrane Current Cancer Drug Targets, 2005, Vol. 5, No. 4 259
the growth inhibition zone as 0 to 4 grades of vessel growth sections fixed at regular intervals after implantation. The
from the center of each intervention application point to the total number of vessels in 6 randomly chosen fields is
furthest contiguous area in which tertiary vessels are absent. counted. Vessel density is evaluated planimetrically with a
Zones with a radius greater than 1 mm are interpreted as 12-line by 12-line reticule inserted in the eyepiece of a
evidence of significant inhibition of angiogenesis [141]. photomicroscope. The total number of intersection points in
Morphometric Evaluation of Vessel Response 6 randomly chosen fields occupied by transversally sectioned
microvessels 3 to 10 mm in diameter are counted. Vessel
Length, diameter, area, branching patterns, and/or branch number and density are determined by two independent
points of vessels can be determined under this category. observers and processed statistically. Quantitative assays of
Ribatti et al. [142] described a method for the Quantitative agiogenesis for CAM are also reviewed recently [143].
evaluation of a vasoproliferative response using Finally, angiographic techniques are developed to evaluate
morphomertic parameters. According to them, vessel density the morphometric parameters of treated CAMs. In such a
is quantified by morphometric evaluation of histologic CAM study the fluorescence intensity of FITC-dextran injected
Table 4. Substances that Inhibit Angiogenesis
Pharmacological Growth Factor-Related
amiloride [165] anti-bFGF antibody [203]
anthracyclines and titanocene bichloride [166] VEGI, (a protein of the TNF superfamily) [144]
doxorubicin [162]
bleomycin [162] VEGF- diphtheria toxin conjugate [121, 159]
DFMO (inhibitor of ornithine decarboxylase) [159] TGF 1 [204]
suramin and suramin anlogues [167, 175] anti-VEGF antibody [205]
retinoids [168, 158] PDGF-AA and PDGF –BB [206]
synthetic retinoid:fenretinide [169] hepatocyte growth factor-like basic peptides [207]
aminopeptidase-N antagonists [170]
purine analogue [171] Anti-PlGF-1 antibody [208]
cyclosporin [172]
protamine [173] Cell Biology-Related
somatostatin and somatostatin analogue [174] Anti-angiogenin antibody [209-213]
kininostat [176] angiostatin [214]
aspirin [168] angiotensinogen and cleaved derivatives [215]
sulindac derivatives [168] cortisone and heparin [161, 166]
thalidomide [168] steroids [216, 217]
Tamoxifen [168] homocysteine [218]
motuporanines (extract of marine sponge) [177] Endostatin [219]
1,4-Pheylwnebis (methylene) selenocyanate [178] Protamine sulfate [116, 217]
NAMI-A (ruthenium red based compound) [179] Platelet factor-4 [220]
kininogen and kininogen derived polypeptides [180] Heparanase inhibitors [221]
indinavir and saquinavir (HIV protease inhibitors) [181] Antagonists of adhesion molecules [222]
thymidine phosporylase inhibitor [223]
a-Thymosin peptides [182] prothrombin fragments 1 and 2 [224]
2-aroylindole derivatives (Synthetic tubulin inhibitors) [183] PAI-1 [225]
dominant-negative p65 PAK peptide [226]
pentosan polysulfate (inhibitor of HIV-1 Tat) [184] Interleukin-2 [227]
apomorphine: a dopamine receptor inhibitor [185]
non- or low-sulfated saccharides [186] Connective Tissue-Related
lactacystin inhibition of the proteasome [187] Matrix metalloproteinase (MMP) inhibitors [228]
p38 MAP kinase [188]
goniodomin A (an antifungal polyeter macrolide) [189] MMP-3 [228]
inhibitors of collagen deposition [229]
GM 1474 [190] Heparan sulfate [230]
Inhibitor of arylsulfatase [191]
Alpha, beta, gamma-cyclodextrin [192] Cartilage-Related
Spironolactone [193] squalamine [231]
Tyrosine kinase inhibitors [194-197] U-995, Shark Cartilagederived peptide [229]
Nitric oxide [198-202] growth plate chondrocytes conditioned medium [232]
metastatin(a hyaluronanbinding protein from cartilage) [233]
260 Current Cancer Drug Targets, 2005, Vol. 5, No. 4 Tufan and Satiroglu-Tufan
into the CAM circulation was evaluated as an index of cells must be located near blood vessels in order to survi
angiogenesis [144]. ve
Biochemical Evaluation of Angiogenesis and grow. In 1971, Folkman [148] proposed
that
In this group collagen production, DNA and/or protein neovascularization of a tumor was required to provi
synthesis, BrdU/3H-thymidine uptake, size of CAM, and de
alterations in the expression patterns of signaling molecules essential nutrients beyond the limit of simple diffusion a
involved in the angiogenesis process, such as FGF-2, nd
VEGF, integrins etc. [previously discussed in this rewiev], to allow for growth beyond 1 to 2 mm. The growth a
can be evaluated [46]. nd
This outline of quantification methods can be further metastatic capacity of malignant tumors have been shown
extended, however, it is a fact that all recently suggested to
methods of quantification are based on these classical be highly dependent on the ability to develop new blo
techniques with some modifications [145-147]. od
vessels. Thus, this process has long been evaluated as
a
ANTI-ANGIOGENIC AGENTS DEVELOPED BY candidate target for treating primary tumors and reduci
THE USE OF CAM MODEL ng
Development of a vascular supply is critical for most their metastases. Angiogenesis inhibitors are described
normal physiologic as well as neoplastic processes. Most as
specific/semi-specific (class-1) and non-specific (class-2), ABBREVIATIONS
depending on whether they inhibit proliferation and/or BMPR II = Bone morphogenic protein receptor Type II
migration of endothelial cells only (non-specific), or are also
toxic for tumor cells (specific) [149]. CAM = Chorioallantoic membrane
As a complex, and multistep process angiogenesis ECM = Extracellular matrix
presents several key target mechanisms for therapeutic FGF = Fibroblast growth factor
interventions. These include interference with angiogenic
GAGs = Glycosaminoglycans
stimulators, angiogenic receptors, the extracellular matrix,
the control of angiogenesis by hypoxic signaling, IMG = Intussusceptive microvascular growth
proteolysis, and vascular targeting. Among many PDGF = Platelet-derived growth factor
interventions that are proposed for clinical testing some
inhibitors are currently being tested in human trials, i.e., in PDECGF = Platelet-derived endothelial cell growth
phase I, II, or III clinical studies [150]. Some of these factor
substances developed by the use of CAM assay are TGF- = Transforming growth factor alpha
summarized in Table 4.
VE = Vascular endothelial
VEGFR = Vascular endothelial growth factor receptor
VPF/VEGF = Vascular permeability factor/vascular
endothelial growth factor
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