Purpose . To study the influence of cytotoxicity of macromolecules,VEGF gene expression, and vascular permeability on the enhancedpermeability and retention (EPR) effect.
Methods . Mice bearing xenografts of A2780 multidrug resistant humanovarian carcinoma were treated by free doxorubicin (DOX) andN-(2-hydroxypropyl)methacrylamide (HPMA) copolymer-bound DOX(P(GFLG)-DOX), Texas Red (P-TR), and FITC (P-FITC). Antitumoractivity, drug distribution in tumor, vascular permeability, VEGF geneexpression, and DNA fragmentation were studied.
Results . The accumulation of free DOX led to the VEGF geneoverexpression and increased the vascular permeability, which in turnenhanced the drug accumulation in the same location. This positivefeedback loop led to a highly inhomogeneous distribution of the drugwithin the tumor. In contrast, P(GFLG)-DOX down-regulated theVEGF gene and decreased vascular permeability. This negativefeedback seemed to prevent additional drug accumulation in dead necrotictissue, resulting in a more uniform drug distribution and enhanced theantitumor activity P(GFLG)-DOX.
Conclusions . The EPR effect significantly differed for macromoleculescontaining DOX when compared to macromolecules without drug. Thecytotoxicity of P(GFLG)-DOX amplified the EPR effect, led to amore homogenous distribution of the drug, increased the average drugconcentration in tumor and augmented its efficacy.