IL-6 trans-signaling: an overlooked driver of retinal neovascularization?

BACKGROUND: Vascular endothelial growth factor (VEGF) is regarded as the essential promoter of vitreoretinal vascular diseases that threaten eyesight, such as proliferative diabetic retinopathy (PDR). Therefore, VEGF is the primary therapeutic target in these diseases, but not all patients respond adequately to VEGF inhibition. This raises the question if other factors contribute to disease modulation. PDR evolves in an interplay of pathological processes including inflammation, barrier integrity loss, aberrant angiogenesis, and metabolic dysregulation. Interleukin-6 (IL-6), recognized for its pro-inflammatory properties, was the focus of this study. AIM: Investigate IL-6 mediated angiogenic potential and disease-relevant mechanisms in the context of VEGF driven vitreoretinal disorder. METHODS: Levels of IL-6 and soluble IL-6 receptor (sIL-6R) were quantified in patient samples using ELISA. In vitro, the functional effect and downstream signaling patterns of IL-6, sIL-6R and VEGF on vascular endothelial cells were analyzed with western blot, spheroid sprouting-, migration-, seahorse assays and LC-MS/MS. RESULTS: Vitreous samples from PDR patients showed elevated levels of IL-6 and its corresponding soluble IL-6 receptor (sIL-6R) compared to clinical control groups. In vitro, IL-6 trans-signaling (IL-6 + sIL-6R) leads to a pro angiogenic phenotype in human vascular endothelial cells demonstrated in migration and spheroid sprouting assays, mirroring the effects of VEGF. Interestingly, IL-6 trans- and VEGF-signaling differ in their effects on barrier integrity and metabolic profile. IL-6 trans-signaling disrupts endothelial barrier function and shows an increased mitochondrial oxygen consumption rate in the Seahorse assay, as well as lower produced lactate levels compared to VEGF. Tocilizumab, an IL-6R antibody, showed additive treatment effects to anti-VEGF therapeutics regarding angiogenesis and VEGF induced metabolic drive in vitro. CONCLUSION: IL-6 trans-signaling functions as an independent promoter of vitreoretinal vascular disease and therapeutic targeting of its pathway could beneficially complement current anti-VEGF treatment protocols.