Ola Didrik Saugstad
Department of Pediatric Research, Rikshospitalet Medical Center, University of Oslo, Norway
ROP Phase 1
With premature birth, normal vascular development that would occur in utero ceases and there is loss of some developing vessels. In utero VEGF is growing at front of vessels. VEGF is, however, dependent on insulin like growth factor-1 (IGF-1) which is transported across the placenta. IGF-1 is therefore a non-hypoxic regulating factor critical to the development of ROP. In ROP phase 1, triggered by premature birth, IGF-1 is not maintained at in utero levels, and IGF-1 drops dramatically. IGF-1 consequently is low after preterm birth and being initially lowest in those who later develop ROP. Oxygen therapy after birth leading to hyperoxia of the immature retina suppresses VEGF. Because both VEGF and IGF-1 are low in this phase vascular growth ceases.
My conclusion, Iplex restores the Phase 1 infants normal range of IGF1/IGFBP3, allowing the eyes to develop more normally. Future use of Iplex for ROP is only the tip of the iceburg, and many indications will come on board.