The correct development of blood vessels is crucial for all
aspects of tissue growth and physiology in vertebrates. The
formation of an elaborate hierarchically branched network of
endothelial tubes, through either angiogenesis or
vasculogenesis, relies on a series of coordinated morphogenic
events, but how individual endothelial cells adopt specific
phenotypes and how they coordinate their behaviour during
vascular patterning is unclear. Recent progress in our
understanding of blood vessel formation has been driven by
advanced imaging techniques and detailed analyses that have
used a combination of powerful in vitro, in vivo and in silico
model systems. Here, we summarise these models and discuss
their advantages and disadvantages. We then review the
different stages of blood vessel development, highlighting the
cellular mechanisms and molecular players involved at each
step and focusing on cell specification and coordination within
Key words: Angiogenic sprouting, Model systems, Vascular
Blood vessel networks arise either through an assembly process
(vasculogenesis; see Glossary, Box 1) or through the coordinated
expansion of a pre-existing network (angiogenesis; see Glossary, Box
1) (Risau, 1997). Vasculogenesis relies on the local differentiation of
mesoderm-derived angioblasts (see Glossary, Box 1) into endothelial
cells (ECs) that coalesce into a primitive network (Swift and
Weinstein, 2009). Angiogenesis, by contrast, comprises several
morphogenic events during which pre-existing ECs coordinately
sprout, branch, form lumen, make new connections (anastomose) and
rearrange themselves (remodel), resulting in a functional network that
supports and regulates effective blood flow (for a review, see Eilken
and Adams, 2010). During this sprouting process, the ECs migrate,
proliferate, establish junctions and apical-basal polarity, and deposit
a stabilising basement membrane. Some of the most fundamental
questions in vascular biology concern how the ECs coordinate their
individual behaviours during angiogenic sprouting, and how tissue-
level signals regulate collective EC behaviour to build branched,
tubular networks that exhibit tissue-specific patterning and
The deregulation of blood vessel formation generally has major
consequences for normal development, as organogenesis is
critically dependent on blood supply (for a review, see Carmeliet,
2003). The inactivation or mutation of genes involved in blood
vessel development often results in embryonic lethality. Prime
examples are the key angiogenic regulators, vascular endothelial
growth factor (VEGF) and the notch pathway ligand delta-like 4
(DLL4), for which even the loss of a single allele is lethal,
illustrating dose-sensitivity and crucial importance for angiogenic
regulation during development (Carmeliet et al., 1996; Ferrara et
al., 1996; Gale et al., 2004).
Later in life, angiogenesis plays a key role in many diseases
(Carmeliet, 2003). Excess or paucity of blood vessels and their
impaired function contribute to the progression of cancer growth
and metastasis, ischemic retinopathies and stroke, as well as many
Here, we review the individual steps involved in sprouting
angiogenesis, focusing on the molecular players and cellular
mechanisms that govern individual and coordinated EC behaviour
at each step. We also summarise several in vivo, in vitro and in
silico model systems that have delivered key insights and discuss
their major advantages and limitations as models for angiogenic
Angiogenic sprouting models
In vivo models
The mouse retina model
The mouse retina has contributed significantly to our understanding
of mechanisms of angiogenic sprouting (for reviews, see Gariano
and Gardner, 2005; Uemura et al., 2006; Fruttiger, 2007; Stahl et
Development 138, 4569-4583 (2011) doi:10.1242/dev.062323
© 2011. Published by The Company of Biologists Ltd
Coordinating cell behaviour during blood vessel formation
Ilse Geudens1,2and Holger Gerhardt1,2,3,*
1Vascular Patterning Laboratory, Vesalius Research Center, VIB, 3000 Leuven,
Belgium. 2Vascular Patterning Laboratory, Vesalius Research Center, K.U.Leuven,
3000 Leuven, Belgium. 3Vascular Biology Laboratory, London Research Institute –
Cancer Research UK, London WC2A 3LY, UK.
*Author for correspondence (email@example.com)
Box 1. Glossary of terms
Angioblasts. Mesoderm-derived precursors of endothelial cells.
Angiogenesis. The formation of new blood vessels from pre-
existing vessels via sprouting.
Astrocytes (or astrocytic glial cells). Non-neuronal star-shaped
cells in the nervous system that provide support and protection for
ECs and nerve cells.
Diabetic retinopathy. Eye disease associated with diabetes, caused
by damage to the blood vessels in the retina.
Femoral artery. Large artery in the thigh, the main artery providing
blood to the lower limbs.
Mural cells. Cells covering the endothelial cell tube, subdivided into
pericytes in the microvasculature and vascular smooth muscle cells
in larger vessels. Their function is to stabilise nascent vessels, provide
support and guide remodelling.
Optic disc. The location in the retina where axons come together
and leave the eye as the optic nerve and where the blood vessels
enter the eye. Also called the ‘blind spot’ because there are no
photoreceptor cells in this region.
Pericytes. Supportive cells forming a discontinuous layer around
small diameter blood vessels. A type of mural cell.
Retinopathy of prematurity (ROP). Eye disease in premature
babies, caused by a temporal arrest in development of the retinal
vasculature, followed by outgrowth of abnormal vessels.
Vasculogenesis. The formation of new blood vessels from
Vitreal surface. The surface of the retina in contact with the
vitreous, the gel-like substance that fills the eye.
al., 2010). Shortly after birth, blood vessels emerge at the optic disc
(see Glossary, Box 1) and sprout radially just below the vitreal
surface (see Glossary, Box 1) of the retina until they reach the
peripheral margin. The growing vessels are guided by a network of
astrocytes (see Glossary, Box 1), which produce VEGF (Stone et
al., 1995; Dorrell et al., 2002; Ruhrberg et al., 2002; Gerhardt et
al., 2003). In a second phase commencing around postnatal day (P)
6, vascular branches also sprout downwards into the retina to form
additional plexuses (Gerhardt et al., 2003) (for reviews, see
Gariano and Gardner, 2005; Uemura et al., 2006; Fruttiger, 2007;
Stahl et al., 2010). The fact that vascularisation occurs postnatally
in this model makes it accessible to manipulation, drug delivery,
and alterations in oxygen tension. Imaging capabilities are
enhanced by the planar outgrowth of the plexus, which, upon flat-
mounting and immunostaining, can be investigated at high
resolution with excellent contrast (Fig. 1A,B). In addition, the
different stages of angiogenic network formation are visible in a
single sample owing to the spatiotemporal sequence of sprouting,
guidance, remodelling and maturation. However, live imaging of
sprouting retinal vessels in vivo has not been achieved to date, and
we lack information on the true dynamics of vascular development
in this model.
The mouse hindbrain model
Studies on angiogenic sprouting and vascular patterning in the
embryonic mouse hindbrain have provided us with key insights
into angiogenic guidance functions of neuropilin 1 (NRP1), VEGF
(Ruhrberg et al., 2002; Gerhardt et al., 2004), netrin and UNC5B
(Lu et al., 2004). This vascular network forms between E10.5 and
E13.5, and can be visualised by opening up the roofplate and flat-
mounting the neural tube like an open book. The hindbrain vascular
network is ideal for imaging and is used to evaluate the
morphology and density of radial sprouts that emerge from the
perineural plexus, and the branching frequency and vessel diameter
in the subventricular plexus. A major advantage of this model over
the retinal model is the fact that it can be used to study the details
of angiogenic sprouting defects in embryonic lethal mutants, such
as Nrp1 knockouts (Gerhardt et al., 2004). However, live imaging
has also not been achieved in the mouse hindbrain.
Zebrafish as a model for angiogenic sprouting
The zebrafish (Danio rerio) is used as a model for vertebrate
development in many research fields, including vascular biology.
Zebrafish embryos are easy to manipulate, have a rapid generation
time (precursors to all major organs are established within 36
hours) and, because of their transparency, the development of
organs and tissues can be easily imaged and analysed.
Blood vessel development in zebrafish follows a spatiotemporally
conserved pattern (Isogai et al., 2003). The transgenic zebrafish line
Fli1:eGFPy1, expressing green fluorescent protein (GFP) in all ECs
(Lawson and Weinstein, 2002), has been particularly useful for
analysing the dynamics of this process. For example, the formation
of intersegmental vessels (ISVs), which form by sprouting from the
dorsal aorta (DA) and grow along the somite boundaries to connect
Development 138 (21)
A Sprouting angiogenesis
E Computational model
D Embryoid bodies
C Zebrafish ISV
B Mouse retina
Fig. 1. Cell analysis in sprouting angiogenesis models. (A)Schematic illustration of a growing sprout. The sprout is guided by a tip cell (green),
which uses filopodia to scan the environment for attractive and repulsive cues. Stalk cells (purple) proliferate, form a lumen, deposit a basement
membrane (red) and attract pericytes (orange). Both tip and stalk cells are activated endothelial cells (ECs). By contrast, phalanx ECs (grey) represent
quiescent cells that do not proliferate. (B-D)Representative images of vessel networks and sprouts in different model systems, highlighting tip and
stalk cells. (B)The mouse retina at post-natal day (P) 5. Inset shows higher magnification of sprouting front showing tip cells with filopodia and stalk
cells. Red, endothelial nuclei (Erg); green, Isolectin-B4. (C)A growing intersomitic vessel (ISV) in a 28 hours post-fertilisation (hpf) old transgenic
Fli1:eGFPy1zebrafish embryo. (D)Sprouts growing from a mosaic embryoid body in vitro, which comprises DsRed-expressing wild-type (WT) cells
(red) and VEGFR2EGFP/+cells (green). Nuclei are also counterstained (blue). (E)Tip (pink) versus stalk (blue) cell selection simulated in a computational
Development 138 (21)
at the dorsal side of the embryo and form the dorsal longitudinal
anastomosing vessel (DLAV), has been well characterised (Childs et
al., 2002; Isogai et al., 2003; Blum et al., 2008) (Fig. 1C). In contrast
to the mouse retina and hindbrain model systems, zebrafish embryos
allow live time-lapse imaging of blood vessel development over long
periods. Furthermore, as the young embryos can survive several days
without blood flow (Pelster and Burggren, 1996; Stainier et al.,
1996), the flow dependency of angiogenic processes can be studied
in mutants that have no blood flow. One disadvantage of the
zebrafish model is that the species is less closely related to human,
and the duplicated genome sometimes poses problems of redundancy
upon gene silencing (Taylor et al., 2003). However, in rare cases,
knockdown strategies in zebrafish have resulted in more severe
phenotypic effects than knockout of the same gene in mouse (e.g.
synectin; Gipc1 – Mouse Genome Informatics) (Chittenden et al.,
The cornea pocket assay
The cornea pocket assay is an in vivo angiogenesis assay that is
based on the induced vascularisation of the normally avascular
cornea in adult mice (Kenyon et al., 1996). A slow-release pellet
containing angiogenic growth factors, such as VEGF, is placed into
a surgically prepared micropocket in the cornea of adult mice. After
about 5 days, sprouting blood vessels reach the micropellet and the
angiogenic response can be quantified without dissection of the eye.
The exclusive analysis of newly formed blood vessels in a previously
avascular tissue enables the specific effects of individual growth
factors to be studied (Kubo et al., 2002; Kisucka et al., 2006; Kuhnert
et al., 2008; Koch et al., 2011). However, obtaining a standardised
angiogenic response can be difficult, owing to the sensitivity of the
angiogenic response to pellet size, the location of the micropocket
and the released levels of growth factors.
Several disease models have been developed to mimic aspects of
ischemia (inadequate blood supply) and tumour angiogenesis,
enabling experimental studies of the mechanisms of pathological
angiogenesis and the evaluation of anti- or pro-angiogenic
The hindlimb ischemia model
In the hindlimb ischemia model, ligation of the femoral artery (see
Glossary, Box 1) induces tissue ischemia in the leg muscle and the
concomitant neovascularisation response can be assessed (Baffour
et al., 1992; Emanueli et al., 2001; Limbourg et al., 2009). This
ligation method is relatively easy to perform because the femoral
artery is readily accessible. The neovascular response includes
formation of parallel collateral vessels and induction of sprouting
tomography) imaging, which recreates a 3D model based on X-ray-
created cross-sections, can deliver detailed information about the
perfused network in three dimensions (Oses et al., 2009).
Retinal ischemia models
The mouse retinal vasculature is also frequently used as an
ischemia disease model to mimic aspects of human retinopathy of
prematurity (ROP; see Glossary, Box 1) and diabetic retinopathy
(see Glossary, Box 1) (Smith et al., 1994; Stahl et al., 2010). In the
ROP model, mouse pups are exposed to a 75% oxygen-enriched
atmosphere between P7 and P12. The elevated oxygenation causes
vessel regression and suppresses normal vessel formation, leaving
large parts of the central retina avascular. Upon return to normal
atmospheric oxygen levels, the avascular regions become ischemic,
triggering a neovascular response. The new outgrowth of vessels is
poorly organised, causing leakiness and ectopic vessel formation at
the vitreal surface of the retina. Whereas most studies in the past
used histological transverse sections to quantify neo-vessels, recent
studies use retinal flat-mounts and FITC-dextran perfusion, vessel
labelling or Evans Blue to analyse neo-vessel formation and
vascular integrity (Jones et al., 2008; Stahl et al., 2010).
Tumour angiogenesis models
Tumour growth is critically dependent on neovascularisation of the
growing tumour, and several anti-cancer treatment strategies thus
aim to interfere with the tumour-induced angiogenesis process
(reviewed by Carmeliet and Jain, 2011). Tumours can be formed
spontaneously in mice carrying mutations in oncogenes or tumour
suppressor genes, or they can be induced by carcinogen or radiation
treatment. Alternatively, cancerous cells can be transplanted into
different tissues in mice. The transplantation approach has the
advantage that tumour induction is controllable. Furthermore, the
recent development of tumour cells that express luciferase, together
with advanced in vivo imaging techniques, allows the detection of
even small tumour nodules. By contrast, tumour induction by
genetic or chemical approaches, or by radiation, requires close
monitoring of the animals because the unlabelled tumours are only
detectable once they reach a certain size.
The development of intravital imaging techniques has also
enabled the study of dynamic processes between tumour cells,
tumour cells and stroma, and tumour cells and blood vessels during
disease progression. Implantation of specialised imaging
‘windows’ further allows prolonged analysis of tumour growth and
vascularisation without the need for repeated surgery (for reviews,
see Fukumura and Jain, 2008; Lohela and Werb, 2010). Advances
in microscopy techniques, such as the use of infrared two-photon
and second harmonic generation microscopy, allow for deeper
tissue imaging and decreased phototoxicity during intravital
imaging (Andresen et al., 2009).
Tumour models have also been developed in zebrafish during
the last decade. Both chemically induced (Mizgireuv and Revskoy,
2006) and spontaneous zebrafish tumour models (Patton et al.,
2005) as well as transplantation models (Haldi et al., 2006; Nicoli
et al., 2007; Stoletov et al., 2007) have been developed in adult fish
or in embryos. In these models, stimulation of angiogenic sprouting
towards and into tumour masses has been shown (Haldi et al.,
2006; Mizgireuv and Revskoy, 2006; Nicoli et al., 2007), as has the
interaction of tumour cells with blood vessels to induce metastasis
(Stoletov et al., 2007).
Ex vivo and in vitro models
Retinal explant cultures
Recent ex vivo studies of retinal explants in short-term culture
suggest that the dynamic analysis of ongoing retinal vascular
sprouting might be feasible (Murakami et al., 2006; Sawamiphak
et al., 2010; Unoki et al., 2010b). In this approach, retinas are
dissected, placed on a filter and covered with a collagen matrix.
VEGF is then used to induce sprouting of the retinal vessels
(Murakami et al., 2006). In this model, the normal endogenous
tissue gradient of VEGF is likely to be disrupted, and directional
guidance and balanced EC proliferation might not be comparable
with the in vivo situation. Furthermore, because these explant
models lack vascular perfusion, flow- and shear stress-dependent
remodelling, as well as any tissue response feedback mechanisms,
cannot be studied.
The aortic ring assay
In this assay, rings are cut from mouse or rat aorta and embedded in
a collagen matrix. They begin forming angiogenic sprouts in
response to the injury induced by the dissection procedure (Nicosia
and Ottinetti, 1990; Masson et al., 2002). Within a few days, sprouts
emerging from the ring form a microvascular network forms that
undergoes maturation and recruits mural cells (see Glossary, Box 1)
from the aortic wall (Iurlaro et al., 2003). This model has been used
to study dynamic sprout outgrowth, tissue invasion and mural cell
recruitment (Gerhardt et al., 2003; Chun et al., 2004; Franco et al.,
2008; Graupera et al., 2008; Aplin et al., 2010).
Such ex vivo vascular explants reproduce the natural
environment of outgrowing vessel branches more accurately than
isolated ECs; however, influences of blood flow and blood pressure
are not present. Rat aortic rings, unlike mouse explants, can be
cultured without addition of serum to the medium (Nicosia and
Ottinetti, 1990; Masson et al., 2002), enabling the evaluation of
pro- or anti-angiogenic compounds in a chemically defined
environment. By using transgenic animals as the source of tissue
for the aortic ring assay, the effects of gene knockout, mutations
and overexpression of genes of interest can be studied.
Embryoid body sprouting assay
Embryoid bodies (EBs) are clusters of embryonic stem cells (ESCs)
cultured in vitro to differentiate into multiple cell lineages, including
ECs. When embedded in a collagen matrix and stimulated with
VEGF, EBs form capillary-like structures in a manner comparable
with vasculogenesis and angiogenesis (Jakobsson et al., 2007). A
branched 3D network of sprouts forms after one week (Fig. 1D). The
EC sprouts are surrounded by mural cells and a basement membrane,
and become lumenised (Jakobsson et al., 2007). The EB endothelium
also undergoes arterial/venous differentiation (Muller-Ehmsen et al.,
2006), but the lack of blood flow precludes shear stress-dependent
remodelling (Nguyen et al., 2006).
EBs are ideal for studying gene function as they can be
constructed using genetically manipulated ESCs that overexpress or
lack a gene of interest. Indeed, the inactivation of angiogenesis-
regulating genes, such as those encoding vascular endothelial growth
factor receptor 2 (VEGFR2; KDR – Mouse Genome Informatics) or
VE-cadherin (CDH5 – Mouse Genome Informatics), gives rise to
phenotypes that are similar to those observed in in vivo models
(Vittet et al., 1997; Jakobsson et al., 2006). Furthermore, by mixing
different genotypes of ESCs, EBs can be used as a cell competition
assay to investigate quantitative and cell-autonomous gene function
in sprouting (Fig. 1D) (Jakobsson et al., 2010). Time-lapse imaging
of EBs delivers dynamic information on EC behaviour during the
Other in vitro models of angiogenesis
The in vitro models described above are best suited to studying the
process of angiogenic sprout outgrowth. However, numerous other
methods have been used to induce in vitro tubule formation by ECs
that have not been described here owing to space limitations. These
many examples have been discussed previously by Staton et al.
(Staton et al., 2004).
In silico models
Increasingly, computational models are being used to predict the
outcome of biological processes. The predictions can then be tested
in the laboratory and, based on discrepancies or new observations,
the computational model can be refined, leading to a deeper
understanding of the process.
Computational and mathematical models of angiogenesis have
focused mainly on tumour angiogenesis, addressing the qualitative
migratory response of individual ECs to angiogenic factors, and
quantitatively predicting sprout densities during vascular network
formation (for a review, see Chaplain et al., 2006). Recent studies
have simulated various signalling, mechanical and flow-related
aspects of tumour angiogenesis, utilising a variety of modelling
approaches (for reviews, see Peirce, 2008; Mac Gabhann et al.,
Recently, computational modelling has also entered the field of
developmental angiogenesis. Based on simulations of the feedback
loop between VEGF and notch signalling, the initial sprouting
process could be accurately replicated in silico, indicating that
VEGF/notch regulation is sufficient to pattern this process (Bentley
et al., 2008; Bentley et al., 2009) (Fig. 1E). This computational
model also predicted that the balance between VEGFR1 (FLT1 –
Mouse Genome Informatics) and VEGFR2 expression levels in
ECs affects their potential to become the tip cell in a growing
sprout (Jakobsson et al., 2010), and illustrated the effects of notch
signalling dynamics on tip cell selection and branching (Guarani et
al., 2011). As a caveat, it should be noted that the value of
computational modelling crucially depends on the availability of
quantitative biology data that can inform the process, and that the
value will greatly increase with iterations of predictions and
experimental testing. Evidence is mounting that better integration
of computational models, and their testing in parallel with
biological models, will lead to a much better understanding of
Sprouting angiogenesis: the key cell types
The concept of behavioural coordination during angiogenesis rests
on the observation that not all ECs behave the same; functional
specification and heterogeneity allows for effective job-share and
teamwork. The prototypical example is the ‘tip-stalk’ concept in
angiogenic sprouting, which describes two distinct cell phenotypes
based on their gene expression profiles and the functional
specifications of ECs within a newly formed sprout. The leading cell,
called the tip cell, is migratory and polarised. This cell extends long
filopodia that scan the environment for attractant or repellent signals,
and hence serves to guide the new blood vessel in a certain direction
(Fig. 1A) (Ruhrberg et al., 2002; Gerhardt et al., 2003; Lu et al.,
2004; De Smet et al., 2009). Adjacent to the tip cell, the following
cells, termed stalk cells, proliferate during sprout extension and form
the nascent vascular lumen (Fig. 1A) (Gerhardt et al., 2003). Tip cell
migration can occur without stalk proliferation and vice versa.
However, only a regulated balance between both processes
establishes adequately shaped nascent sprouts (Ruhrberg et al., 2002;
Gerhardt et al., 2003; Ruhrberg, 2003).
The tip and stalk cell phenotypes characterise the ‘activated
endothelium’. Once lumenised connections and blood flow have
been established, the migratory activity and proliferation of ECs
ceases (Bussmann et al., 2011) and they eventually adopt a
‘quiescent phenotype’. Quiescent ECs are characterised by a more
regular ‘cobblestone’ appearance, which resembles a phalanx
formation of ancient Greek soldiers, leading Mazzone and
Carmeliet to coin the term ‘phalanx cells’ (Fig. 1A) (Mazzone et
al., 2009). Where, when and how the activated endothelium transits
to quiescence is poorly understood. Although tip and stalk cells are
defined by neighbourhood relationships, no clear positional
relationship can be assigned to stalk and phalanx cells in the
developing plexus. Both the proliferative stalk cells and the
quiescent phalanx cells are covered by supporting pericytes (see
Development 138 (21)
Development 138 (21)
Glossary, Box 1) (Betsholtz et al., 2005; Mazzone et al., 2009),
connected by adhesion and tight junctions, and embedded in
basement membrane (Fig. 1A).
The distinct tip and stalk EC phenotypes display differential gene
expression profiles, suggesting that their specification is determined
genetically. Several recent studies have analysed and compared the
expression profiles of tip and stalk cells (del Toro et al., 2010;
Strasser et al., 2010). These studies have identified a list of genes
with which tip cells are enriched, which includes VEGFR2, platelet-
derived growth factor B (PDGFB), the netrin receptor unc-5
homolog B (UNC5B), the notch ligand DLL4, EC-specific molecule
1 (ESM1), the peptide ligand apelin (APLN) and the membrane-
inserted matrix metalloprotease 14 (MMP14) (Gerhardt et al., 2003;
Lu et al., 2004; Hellstrom et al., 2007; Yana et al., 2007; del Toro et
al., 2010; Strasser et al., 2010). However, a single unique gene or
protein that can be used reliably and unambiguously as a molecular
marker for tip cells has not been identified.
A key pathway regulating the specification of tip and stalk cells
is the notch signalling pathway. Notch signalling is an
communication mechanism best known for its role in instructing
differential fate decisions between neighbouring cells during
development (Chitnis, 1995; Lewis, 1998) (Box 2). Furthermore,
in epithelial cells, presentation on filopodia of notch ligands has
been shown to extend the effective range of notch-signal induction
from a single cell to beyond its immediate neighbours (De
Joussineau et al., 2003). During angiogenesis, activated notch
signalling inhibits tip cell formation and promotes the stalk cell
phenotype (Hellstrom et al., 2007; Leslie et al., 2007; Lobov et al.,
2007; Siekmann and Lawson, 2007; Suchting et al., 2007). Genetic
and pharmacological inactivation of notch in mouse and zebrafish
illustrated that tip cell formation is the default response of the
activated endothelium, whereas the lumen-forming stalk cell
phenotype is acquired through notch activation (Hellstrom et al.,
2007; Leslie et al., 2007; Siekmann and Lawson, 2007; Suchting
et al., 2007). Recent observations challenge the idea that tip and
stalk cells resemble fully differentiated cell fates. Instead, their
specification is surprisingly dynamic and transient, relying on
continued competition between the cells (Jakobsson et al., 2010).
As a consequence, tip cells are overtaken, and exchanged, as
neighbouring cells take their place.
Sprouting angiogenesis: a multistep process
Upon induction of angiogenic sprouting, ECs exposed to
angiogenic stimuli become activated and compete for the tip cell
position (Jakobsson et al., 2010). This process limits the number of
outgrowing sprouts. Networks are then formed by fusion
(anastomosis) of sprouts, stabilisation and remodelling of newly
It has been noted that vascular sprouts morphologically resemble
the growth cones of developing axons and the tip cells of growing
tracheal tubes in Drosophila (Kater and Rehder, 1995; Ribeiro et
al., 2002). In addition, the functional similarities between blood
vessel development and pulmonary tubulogenesis, kidney ureteric
duct formation, mammary gland branching and neuronal wiring
indicate a remarkable degree of evolutionary conservation in the
process of branching morphogenesis (see Box 3).
When nutritional and oxygen demands within a tissue exceed the
supply provided by existing blood vessels, the tissue sends out
signals that stimulate the formation of new blood vessels (for
reviews, see Germain et al., 2010; Carmeliet and Jain, 2011). A key
angiogenesis-promoting signal is VEGF. VEGF activates the
endothelium through stimulation of VEGFR2. This leads to the
selection of a tip cell, tip cell branching, vessel sprouting, EC
proliferation and lumen formation (Fig. 2).
Tip cell selection
Although apparently all ECs exposed to VEGF become activated,
not all ECs respond by directed migration (Gerhardt et al., 2003).
Instead, a fine-tuned feedback loop between VEGF and
notch/DLL4 signalling establishes a ‘salt and pepper’ distribution
of tip and stalk cells within the activated endothelium (Hellstrom
et al., 2007; Leslie et al., 2007; Lobov et al., 2007; Siekmann and
Box 2. Notch-mediated lateral inhibition
Notch signalling is an evolutionarily conserved, contact-dependent,
cell-cell communication pathway that controls multiple cell fate
decisions, stem cell renewal and differentiation during embryonic
and adult life. Activation of the notch receptor by delta- or jagged-
type ligands on neighbouring cells induces release of the
intracellular domain of the notch receptor, which in turn activates
the transcription of notch target genes. Notch signalling is best
known for its ability to spatially pattern cell differentiation by a
process called ‘lateral inhibition’. In this process, a cell adopts a
particular fate within a pool of cells and inhibits its immediate
neighbours from acquiring the same fate. Initially, all progenitor cells
are equivalent (panel A) and express both notch ligands (blue) and
notch receptors (red). Owing to stochastic variations and intrinsic or
extrinsic factors, one cell starts expressing higher levels of ligand
than its neighbours. Lateral inhibition utilises a feedback mechanism
in which the activation of the notch receptor reduces ligand
expression, thereby amplifying the (initially) small differences in
levels of ligand expression between the cells. Although signalling
initially occurs bi-directionally, the amplification eventually
establishes ‘signal-sending’ cells that express higher levels of the
ligand (panel B; dark green cells), and ‘signal-receiving’ cells that
express low levels of the ligand (panel B; light green cells). The latter
remain under the control of the signals sent by the initial
differentiating cells (Artavanis-Tsakonas et al., 1999). Activation of
the notch receptor in the ‘signal-receiving’ cells induces expression
of transcriptional repressors that prevent expression of
differentiation-inducing factors. Thus, only the ‘signal-sending’ cells
adopt a differentiated state, whereas the differentiation pathway is
suppressed by notch signalling in the surrounding cells.
A Uniform signalling
B Lateral inhibition and cell-fate
notch receptorDLL4 ligand
Lawson, 2007; Suchting et al., 2007; Bentley et al., 2008). The
resulting cell-fate specification mechanism is reminiscent of a
classical notch-mediated lateral inhibition process (Muskavitch,
1994; Lewis, 1998), in which a cell adopts a particular fate and
prevents (by lateral inhibition) its immediate neighbours from
acquiring the same fate (Box 2). Although activated ECs would be
assumed to initially express similar levels of notch and DLL4, and
thus undergo a balanced reciprocal notch activation, stochastic
differences in local VEGF concentrations, in filopodia elongation
(and thus VEGF exposure) or in transcription rate lead to small
imbalances: one cell will express slightly higher DLL4 levels and,
thus, will dominate its neighbours by activating more notch
signalling. The cell with more DLL4, and less notch activity, will
be selected as the tip cell. Activation of notch inhibits VEGFR2,
indirectly inhibiting DLL4 expression levels, thereby reinforcing
the dominance of the selected tip cell and limiting the number of
tip cells induced by VEGF (Fig. 2A,B) (Williams et al., 2006;
Hellstrom et al., 2007; Leslie et al., 2007; Lobov et al., 2007;
Suchting et al., 2007). Currently, an open question in the field is
whether and how DLL4 might activate notch in cells that are not
in direct contact with a tip cell. Given that the precise shape of tip
and stalk cells is poorly defined, it is unclear whether long-range
lateral inhibition, possibly mediated by long cellular processes (De
Joussineau et al., 2003), is active and necessary to explain tip cell
spacing. A recent study suggests that, at least in tumour
angiogenesis, DLL4 exosomes might affect long-range signalling,
but signalling between ECs via exosomes has not been
demonstrated (Sheldon et al., 2010).
The dynamic interaction between VEGF and notch signalling was
unravelled independently by several groups while studying the
process of angiogenic sprouting in the postnatal mouse retina
(Hellstrom et al., 2007; Lobov et al., 2007; Siekmann and Lawson,
2007; Suchting et al., 2007). They all observed DLL4 expression in
ECs at the leading front of the vascular plexus and found that
inhibition of DLL4/notch signalling results in increased vascular
density due to excessive sprouting. Similar findings were described
in the zebrafish ISV sprouting model. Inhibition of the Notch
pathway induces hyperbranching of the ISVs and leads to an
increased number of ECs in the ISVs (Leslie et al., 2007; Siekmann
and Lawson, 2007). By contrast, overexpression of the activated
Notch receptor blocks sprouting of the ISVs (Siekmann and Lawson,
2007). Besides downregulating VEGFR2, notch signalling also
affects VEGFR1 and VEGFR3 (FLT4 – Mouse Genome
Informatics) expression. Notch activation leads to increased levels of
VEGFR1 and soluble (s)VEGFR1 (Fig. 2B,C) (Harrington et al.,
2008; Funahashi et al., 2010; Krueger et al., 2011). This dampens the
angiogenic sprouting response to VEGF, as both receptor variants act
as a decoy for the VEGF ligand and limit VEGFR2 activation (Fong
et al., 1995; Hiratsuka et al., 1998). During both mouse and zebrafish
angiogenesis, VEGFR3 is most strongly expressed in the leading tip
cells and is downregulated by notch signalling in the stalk cells
(Shawber et al., 2007; Siekmann and Lawson, 2007). Blocking
VEGFR3 signalling counteracts the hyperbranching phenotype upon
notch inhibition (Tammela et al., 2008). Surprisingly, a recent study
suggests that, during angiogenesis, VEGFR3 acts independently of
its kinase activity and ligand-binding capabilities, and modulates
VEGFR2-mediated signalling by forming VEGFR2-VEGFR3
heterodimers (Nilsson et al., 2010). Notch signalling also
downregulates the expression of NRP1, which is a positive regulator
of VEGFR2 signalling (Williams et al., 2006). Collectively, these
molecular regulatory processes lead to increased responsiveness of
the tip cell to VEGF and decreased sensitivity of stalk cells to VEGF.
Computational modelling illustrated that the feedback loop
between VEGF and DLL4/notch signalling is, in principle,
sufficient to pattern ECs into tip and stalk cells, but only in a
narrow window of VEGF concentration. This lack of robustness of
a simple VEGF/DLL4 feedback loop was confirmed by in vivo
studies, which identified that Jagged 1, an additional notch ligand,
also participates in specification by antagonising notch activation
through DLL4 (Benedito et al., 2009). As Jagged 1 is expressed
predominantly in stalk cells, it can effectively prevent DLL4-
mediated reciprocal activation of notch in tip cells, thereby greatly
enhancing the efficacy of the lateral-inhibition process (Fig. 2B).
Thus, DLL4 and Jagged 1 coordinately control the process of
angiogenic sprouting and confer robustness to the crucial event of
Tip cell branching
Tip ECs extend branch-like filopodia through remodelling of the
actomyosin and microtubule cytoskeleton, similar to the way in
which neurite extensions protrude from neuronal cell bodies (Kater
and Rehder, 1995; Gerhardt et al., 2003). The cytoskeletal
dynamics that regulate cellular branching are dependent on myosin
II contractility, which is partly determined by the physical
properties, and hence stiffness, of the extracellular matrix (ECM)
(Fischer et al., 2009; Myers et al., 2011). Local downregulation of
myosin II contraction within a cell allows lamellipodia formation
and initiation of EC branching (Fischer et al., 2009). EC
polarisation, and hence the directionality of filopodia extension,
during migration or upon exposure to shear stress is dependent on
CDC42 activity, a small GTPase of the Rho family (Etienne-
Manneville, 2004). The directionality of filopodia extension is
further determined by the distribution of heparin-binding VEGF
isoforms (VEGF165and VEGF188) in the local environment
(Ruhrberg et al., 2002). Recent work showed that VEGF-induced
Development 138 (21)
Box 3. Sprouting and cellular competition in other
Branched tubular networks in many organs and organisms show
mechanistic similarities and a remarkable degree of evolutionary
conservation. Cellular competition for the lead position during
branching morphogenesis has been discovered in several systems.
As in the vertebrate vascular system, a newly formed airway
tracheal branch in Drosophila is guided by a leading tip cell, and
extension of the sprout involves cell intercalation and proliferation
of stalk cells. Tracheal branching in Drosophila is regulated by FGF
signalling, and the FGF ligand Branchless (BNL) forms the tracheal
counterpart of VEGF in angiogenic sprouting (Sutherland et al.,
1996). BNL signalling through the FGF receptor Breathless (BTL)
induces filopodia formation and initiation of sprouting. Cells with
the highest BTL levels competitively acquire the lead position and
form the tracheal tip cell (Ghabrial and Krasnow, 2006).
Branching processes in the vertebrate lung, mammary gland and
kidney ureteric duct are similarly regulated by FGF signalling, with
additional roles played by TGF- signalling and other pathways
(Horowitz and Simons, 2008; Lu et al., 2008). Whereas competition
in Drosophila tracheal branching and angiogenesis establishes one
or two leading cells, competition in branching of lung, ureteric
epithelium and mammary gland leads to clustering of cells that
collectively form the bud tip. In all cases, competition involves
differential growth factor receptor levels. However, Notch-mediated
lateral inhibition appears to be integrated only in the tracheal and
angiogenic competition mechanisms, in which selection of single
tip cells is crucial for sprouting (Ikeya and Hayashi, 1999; Ghabrial
and Krasnow, 2006; Jakobsson et al., 2010).
Development 138 (21)
filopodial extension is dependent on ephrinB2-mediated
internalisation of VEGFR2 (Sawamiphak et al., 2010), but whether
and how localised VEGFR activation might lead to localised
filopodia formation remains unclear.
Sprout elongation: orchestrating tubular morphogenesis
Once the tip cell has been selected, it guides the growing sprout
towards a gradient of VEGF and other attractive guidance cues
(Gerhardt et al., 2003). The stalk cells that form the body of the
sprout then proliferate to deliver the necessary building blocks for
the growing sprout (Fig. 2A) (Gerhardt et al., 2003). As the vessel
elongates, the stalk cells create a lumen, produce a basement
membrane and associate with pericytes.
Over the past few years, a growing number of ligand-receptor
interactions involved in neuronal guidance (e.g. Eph-ephrin,
netrins-Unc, Robo-Slit, semaphorins-plexins, semaphorins-
neuropilins) have also been found to regulate vascular patterning
and EC guidance (for reviews, see Carmeliet and Tessier-Lavigne,
2005; Larrivee et al., 2009). Given that the major blood vessels and
nerve fibres within the body are strikingly aligned, questions of co-
patterning by common pathways and mutual interactions between
ECs and nerve cells have received increasing attention.
The initial outgrowth of the sprout from the parent vessel is
regulated by a combination of extrinsic guidance cues (Eichmann et
al., 2005; Holderfield and Hughes, 2008) and a local vessel-derived
C VEGF signalling during sprouting
B VEGF-notch signalling during
A Initiation of vessel formation
Fig. 2. Sprout induction. (A)The initiation of blood vessel formation. The presence of VEGF (blue gradient) activates the endothelium (yellow cells)
of existing blood vessels. A VEGF/notch-dependent regulatory mechanism ensures the selection of a limited number of tip cells (green) by blocking
tip cell formation in the immediate neighbours (via lateral inhibition). Tip cells sprout towards the VEGF gradient, and the adjacent stalk cells follow
the guiding tip cell and proliferate to support sprout elongation. (B)VEGF/notch regulatory feedback during tip cell selection. The activation of
VEGFR2 (pink) by VEGF (blue circles) induces the expression of the notch ligand DLL4 (D; blue). The subsequent activation of notch (N; red) by DLL4
in contacting cells reduces their expression of VEGFR2 and DLL4, thereby making them less sensitive to VEGF-mediated activation and limiting their
ability to activate notch signalling in neighbouring cells. The expression of other tip cell-enriched genes, such as UNC5B and PDGFB is reduced in
stalk cells, whereas the expression of the non-signalling VEGF decoy receptors VEGFR1 and soluble (s) VEGFR1 is increased, further reducing the
likelihood of VEGFR2 activation in these cells. Furthermore, jagged1 (J1; yellow), which is selectively expressed in stalk cells, competes with DLL4 in
cis for binding to notch receptors on tip cells. Jagged1 binds, but does not activate the notch receptor, thereby preventing notch activation in the
tip cells. (C)VEGF signalling during sprouting. Soluble VEGFR1 (sVEGFR1; brown) produced by the cells immediately next to the outgrowing vessel
branch sequesters VEGF molecules, thereby creating a corridor of higher VEGF levels perpendicular to the parent vessel. This corridor might act to
optimise spreading of the vascular network and to avoid contact with nearby emerging sprouts.
and VEGFR1-dependent mechanism of guidance (Chappell et al.,
2009). The production of soluble VEGFR1 (sVEGFR1) by the cells
immediately adjacent to the emerging sprout leads to a local
depletion of VEGF and the formation of a ‘corridor’ of higher VEGF
levels ahead of the newly forming sprout (Fig. 2C). The purpose of
this local integration of guidance regulations is probably to optimise
efficient spreading of the vascular network and to avoid premature
contact with nearby emerging sprouts.
Recent time-lapse imaging studies have revealed a dynamic
shuffling of tip and stalk cells at the leading front of growing
sprouts (Jakobsson et al., 2010). This was shown both in vitro (in
EB sprouting assays) and in vivo (in mice and zebrafish),
challenging the idea of stable tip and stalk cell selection. The
positional exchange also suggests that cells constantly have to re-
evaluate the VEGF/notch signalling loop when they meet new
neighbours. ECs compete for the tip cell position based on their
relative levels of VEGFR1 and VEGFR2, the activities of which
gauge the expression level of the DLL4 ligand; lower expression
levels of VEGFR1 or higher levels of VEGFR2, compared with
neighbouring cells, result in higher levels of DLL4 expression and,
hence, an increased ability of a cell to suppress its neighbouring
cells from becoming tip cells (Jakobsson et al., 2010).
Conceptually, this suggests that the leader of the team, the tip cell,
is constantly challenged by cells within the stalk region to
demonstrate its dominance in terms of VEGFR levels. If the
challenging stalk cell is ‘better equipped’, it takes over the
leadership and becomes the new tip cell. The surprisingly
competitive behaviour of ECs ensures that the cell with the best
guiding capacities will lead the sprout. Accordingly, the guidance
of a growing sprout is not entirely determined at the level of a
single tip cell, as was originally hypothesised (Gerhardt et al.,
2003), but rather is the consequence of team play in a population
of cells. By coupling competition to the relative sensitivity to
environmental VEGF, this collective cell behaviour should,
theoretically, enhance the ability of ECs to determine the direction
of the VEGF gradient and, thus, might provide robustness to the
patterning process. Similar cellular competition mechanisms have
also been described in other branching processes (Box 3).
Stalk cell proliferation drives sustained elongation
Proliferation contributes to the sustained growth of a newly
forming vessel. Tip cells rarely proliferate (Gerhardt et al., 2003),
although division of the leading cell of ISV sprouts in zebrafish has
been observed (Siekmann and Lawson, 2007; Blum et al., 2008).
By contrast, stalk cells are strongly proliferative and, thus, support
sustained elongation of the growing sprout (Fig. 2A) (Gerhardt et
al., 2003). However, experimental observations indicate that stalk
cell proliferation does not push the tip cell forward, but rather that
the tip cells themselves interact with the surrounding substrate to
pull the growing sprout further in the direction of growth
(Ausprunk and Folkman, 1977; Caussinus et al., 2008; Phng et al.,
2009). In Drosophila tracheal tubes, sprouting tip cells were also
shown to exert a pulling force that allows new stalk cells to
intercalate into the stem of the growing sprout (Caussinus et al.,
2008). Furthermore, Ausprunk and Folkman identified that blood
vessel sprouting can initially progress without cell division
(Ausprunk and Folkman, 1977), indicating that a similar pulling
force of the vascular tip cell is likely to be present. However,
sustained sprouting and further outgrowth of the vessel branch
requires proliferation of the stalk cells (Ausprunk and Folkman,
1977), and decreased stalk proliferation correlates with branch
regression (Phng et al., 2009).
The orientation of stalk cell divisions
In addition to the frequency of cell division, the orientation of the
division plane is important for tubular morphogenesis during sprout
outgrowth. De-regulation or randomisation of division orientation
leads to abnormal vessel morphologies, because the orientation of
cell division determines whether a vessel becomes longer or wider
(Zeng et al., 2007). Similar to findings in other tubular structures,
the plane of EC divisions in a growing sprout is mostly
perpendicular to the long axis of the vessel, supporting lengthening
of the tube (Fig. 2A) (Fischer et al., 2006; Zeng et al., 2007).
Intriguingly, this regular behaviour of dividing ECs is also
influenced by VEGF gradients, adding another level of complexity
to the multiple regulatory roles of this angiogenic factor (Zeng et
al., 2007). It is noteworthy that VEGF-dependent determination of
the EC division plane occurs in the absence of blood flow. In
perfused vessels, EC polarity is linked to the direction of shear
stress produced by blood flow, which is sensed by the
transmembrane proteins PECAM1, VE-cadherin and VEGFR2 and
transduced by CDC42-dependent signalling (Tzima et al., 2003;
Noria et al., 2004; Gomes et al., 2005; Tzima et al., 2005). It is
tempting to speculate that ECs within blind-ended and non-
perfused sprouts are able to orientate their division in the direction
of sprout elongation through pulling forces exerted by the tip cell
in a VEGF gradient.
A second important role of the stalk cells within a newly forming
blood vessel is to establish a vascular lumen. Various mechanisms
have been proposed to exist in different model systems and even in
different vascular beds (Ellertsdottir et al., 2010; Wang et al.,
2010). In larger capillaries that remain constantly perfused, the
lumen of a newly forming sprout remains continuous with that of
the parent vessel. This suggests that the stalk cells retain their
apical-basal polarity when they bud off from the parent vessel. This
mechanism has also been described in the zebrafish brain
vasculature (Huisken and Stainier, 2009; Ellertsdottir et al., 2010).
By contrast, zebrafish ISVs appear to be formed by another
mechanism as the initial primary ISVs are not lumenised when they
sprout from the dorsal aorta. To explain how lumens form in this
situation, Kamei et al. first proposed a model (Fig. 3A) in which
the vascular lumen of ISVs is formed by fusion of intracellular
vacuoles, which ultimately fuse across the ECs of a newly formed
sprout to form a continuous lumen (Kamei et al., 2006). Later,
Blum et al. analysed the arrangement of EC junctions in the ISVs
and DLAV and found that cell-cell junctions are present over the
entire length of the vessel, even across the presumptive lumen-
forming cells. This is inconsistent with the model of simple vacuole
fusion, which would result in a head-to-tail arrangement of ECs
and seamless vessels. Therefore, it was proposed that the lumenal
space of ISVs is formed between cells by exocytosis of vacuoles
to form an intercellular space (Fig. 3B) (Blum et al., 2008; Wang
et al., 2010). More recently, aortic lumenisation in mouse and
zebrafish was shown to similarly occur extracellularly. However,
in these studies, vacuoles were not observed and lumen formation
was associated with relocalisation of junctional proteins and cell-
shape changes (Fig. 3C) (Strilic et al., 2009; Wang et al., 2010).
Cell-cell adhesion between ECs is mediated via tight junctions and
adherens junctions (Dejana et al., 2009). These intercellular
junctions are formed by homophilic interactions of adhesive
proteins that further interact with intracellular partners and with the
actin cytoskeleton. At tight junctions, adhesion can be mediated by
claudins, occludin, members of the junctional adhesion molecule
Development 138 (21)
Development 138 (21)
(JAM) family, or by EC selective adhesion molecule (ESAM). EC
adherens junctions are predominantly formed by vascular
endothelial (VE)-cadherin (for a review, see Dejana et al., 2009).
During lumen formation in the mouse aorta, VE-cadherin is
required for establishing the initial apical-basal cell polarity of
aortic ECs and localising CD34-sialomucins to the cell-cell contact
site (Fig. 3C) (Strilic et al., 2009). The negative charge of the sialic
acids in CD34-sialomucin in turn induces electrostatic repulsion of
the apposing EC surfaces, leading to the initiation of lumen
formation (Fig. 3C) (Strilic et al., 2010). During cell separation and
extension of the lumen, the VE-cadherin-expressing junctions are
relocalised to the lateral cell contact sites (Fig. 3C). CD34-
sialomucins further recruit F-actin to the lumenal cell surface
(Strilic et al., 2009). VEGF-dependent localisation of non-muscle
myosin II to this apically enriched F-actin cytoskeleton induces EC
shape changes and further separation of the adjacent ECs, fully
establishing the aortic lumen (Strilic et al., 2009).
Because the stalk cells proliferate even when a lumen is already
present, it is important that proliferation is tightly coordinated with
EC junction formation in order to maintain patent and sealed
vessels; however, the mechanism by which these two processes are
coordinated remains unclear.
Sprout anastomosis: connecting the vascular network
When the tip cell of a growing sprout contacts other sprouts, new
cell-cell junctions are established and the sprouts become
connected in a process called anastomosis. Recently, it was found
that VE-cadherin is present not only at cell-cell junctions but also
at the tips of EC filopodia (Fig. 4) (Almagro et al., 2010). Its
presence there probably facilitates the early establishment of new
cell-cell junctions. Anastamosis can also be observed in zebrafish
as the ISVs reach the dorsal roof, branch horizontally and make
contact with neighbouring sprouts to form the DLAV. During this
event, VE-cadherin in tip cells was shown to localise to tip-tip
contact sites immediately upon contact with neighbouring sprouts
(Blum et al., 2008). As the tip cells of the two sprouts crawled over
each other, the VE-cadherin contacts expanded.
How the tip cells meet to establish new contacts is not fully
understood. Recent descriptions of macrophage-tip cell
interactions, in particular at sites where two tip cells make
contact via their filopodia, raised the hypothesis that
macrophages might act as ‘bridge cells’ that facilitate the contact
and possibly stabilise nascent connections (Fig. 4) (Checchin et
al., 2006; Fantin et al., 2010; Schmidt and Carmeliet, 2010;
Rymo et al., 2011). It is important to note, however, that
anastomosis in the complete absence of macrophages is normal,
albeit less frequent (Checchin et al., 2006; Kubota et al., 2009;
Fantin et al., 2010; Rymo et al., 2011), illustrating that the basic
mechanism is likely to be EC-autonomous and that the
macrophages might be involved in modulating and refining the
connection process. A similar phenomenon has been described in
the Drosophila tracheal system in which tracheal tip cells, which
are similar to vascular tip cells, extend filopodia to explore their
environment (Wolf et al., 2002; Schmidt and Carmeliet, 2010).
During branch fusion, the tracheal tip cells extend their filopodia
along the surface of specialised mesodermal bridge cells to help
them to position correctly (Wolf et al., 2002). This tip-bridge cell
interaction in Drosophila is dependent on FGF signalling,
whereas the molecular basis for macrophage-tip cell interactions
remains to be elucidated. Possible receptor-ligand candidates that
mediate this interaction are notch-DLL4, TIE2 (TEK – Mouse
Genome Informatics)-angiopoietin-2 (ANG2) or chemokine
receptor CXCR4-stromal cell-derived factor-1 (SDF1; CXCL12
– Mouse Genome Informatics) (Fig. 4). The notch, TIE2 and
CXCR4 receptors are expressed in macrophages (De Palma et al.,
2007; Fung et al., 2007; Lima e Silva et al., 2007; Fantin et al.,
2010), whereas their respective ligands DLL4, ANG2 and SDF1
are expressed in tip cells (Ridgway et al., 2006; Hellstrom et al.,
2007; Strasser et al., 2010; Unoki et al., 2010a), although
CXCR4 has also been described as a tip cell enriched gene
(Strasser et al., 2010). Several recent publications illustrate that
macrophages also promote angiogenic branching in the retina and
in aortic ring cultures (Checchin et al., 2006; Kubota et al., 2009;
Fantin et al., 2010; Rymo et al., 2011). Surprisingly, in the deeper
retinal vessel plexus, macrophages negatively regulate vessel
density by producing sVEGFR1 (Stefater et al., 2011).
Observations in the aortic ring assay, hint towards a two-way
communication between blood vessels and macrophages (Fig. 4),
whereby blood vessels attract macrophages, which in turn secrete
soluble pro-angiogenic factors (Rymo et al., 2011). Considering
A Intracellular vacuole
B Intercellular vacuole
C Lumenal repulsion
Fig. 3. Models of lumen formation during sprout
outgrowth. (A)Intracellular vacuole coalescence.
Endothelial cells (ECs) can form a lumen by forming
intracellular vacuoles that coalesce and connect with each
other and with vacuoles in neighbouring cells.
(B)Intercellular vacuole exocytosis. ECs can form a lumen
by producing exocytotic vacuoles that are released into the
intercellular space. (C)Luminal repulsion. Alternatively, an
intercellular lumen can be created by apical membrane
(lumenal) repulsion. VE-cadherin (purple) establishes the
initial apical-basal polarity in the ECs and localises CD34-
sialomucins (orange) to the cell-cell contact sites. The
negative charge of the sialomucins induces electrostatic
repulsion and initial separation of the apical membranes,
thereby relocalising the junctional proteins to the lateral
membranes. Further separation and establishment of the
lumen is based on F-actin-mediated cell-shape changes
the breadth of literature on various influences of macrophages on
the vasculature during both developmental and pathological
angiogenesis, it is clear that ECs and macrophages engage in
multiple interactions, the outcome of which will probably be
highly context dependent.
Network formation: remodelling and maturation
After the establishment of new connections within the vascular
network, significant remodelling occurs; some branches are
stabilised whereas others regress. One important factor regulating
remodelling is oxygen, as elevated oxygen levels induce vascular
pruning, ensuring that vascular density is correctly adapted to
tissue oxygenation (Claxton and Fruttiger, 2005). Nevertheless,
the processes of vascular remodelling, regression and stabilisation
are far from being completely understood. Pericytes play an
important part in vascular stabilisation. Whether the actual
presence of pericytes protects vessels from regression is
controversial (von Tell et al., 2006). Early studies suggested that
recruitment of smooth-muscle actin-positive pericytes marks the
end of a plasticity time-window in vascular development during
which pruning can occur (Benjamin et al., 1998). In addition,
pericyte coverage correlated with vessel protection against
regression in the retina during development and disease (Chan-
Ling et al., 2004). By contrast, other studies showed that tumour
vessels abundantly covered by pericytes were not protected from
regression upon VEGF inhibition (Inai et al., 2004). Thus, the
exact mechanisms and conditions of vascular stabilisation by
pericytes remain to be unravelled. The factors that are involved
in pericyte recruitment include angiopoietin-1 (ANG1)-TIE2,
platelet-derived growth factor
transforming growth factor-1 (TGFB1)-activin receptor-like
kinase 5 (ALK5; TGFBR1 – Mouse Genome Informatics) and
notch signalling components (Jain, 2003; Scehnet et al., 2007).
Endothelial production of ANG1 initially regulates pericyte
recruitment through induction of expression of the chemokine
MCP-1 (monocyte chemotactic protein-1; CCL2 – Mouse
Genome Informatics) (Aplin et al., 2010). The recruited pericytes
prevent regression of newly formed blood vessels by delivering
vascular stabilisation factors, such as tissue inhibitor of
metalloproteinase 3 (TIMP3) and, again, ANG1 (Fig. 5)
(Sundberg et al., 2002; Saunders et al., 2006). Thus, the current
literature collectively suggests that the process of vascular
remodelling and maturation is strongly dependent on the ANG-
ligand–TIE-receptor signalling mechanism.
ANG1 induces vessel stabilisation via signalling through the
TIE2 receptor (Suri et al., 1996). ANG2 was initially considered to
be an antagonist for ANG1/TIE2 signalling that inhibited vessel
stabilisation and favoured vascular regression (Maisonpierre et al.,
1997). However, later findings have shown that ANG2 can also
activate the TIE2 receptor, albeit weakly and in a context-
dependent manner (Kim et al., 2000; Teichert-Kuliszewska et al.,
2001; Daly et al., 2006). Furthermore, ANG1 can have opposing
roles either by inducing vascular quiescence or stimulating
angiogenesis; differential gene expression profiles are induced in
TIE2-expressing ECs depending on whether ANG1 stimulation
occurs in the presence or absence of cell-cell contact (Fukuhara et
al., 2008; Saharinen et al., 2008).
DLL4/notch signalling also plays a crucial role in the vascular
stabilisation process by affecting both ECs and pericytes. The
activation of DLL4/notch signalling in ECs has a vessel stabilising
effect via inhibition of angiogenic sprouting (Hellstrom et al., 2007;
Leslie et al., 2007; Lobov et al., 2007; Siekmann and Lawson,
2007; Suchting et al., 2007). Notch signalling also promotes
vascular stabilisation more directly through the induction of notch-
regulated ankyrin repeat protein (NRARP) expression (Phng et al.,
2009) and via the production of ECM components (Benedito et al.,
2008; Trindade et al., 2008; Zhang et al., 2011). NRARP limits
notch signalling and promotes WNT/CTNNB1 signalling in stalk
cells, which supports vascular stability and prevents EC retraction
by inducing proliferation and improving intercellular junctions
(Fig. 5) (Phng et al., 2009). Additionally, it has been suggested that
notch signalling can stabilise newly formed blood vessels by
affecting pericytes. For example, pericyte marker expression in
cells cultured from bone marrow increases with notch signalling
(Stewart et al., 2011), and a recent study suggested that the
stabilising effect of ANG1/TIE2 signalling between pericytes and
ECs is mediated via induction of DLL4 expression in ECs (Fig. 5)
(Zhang et al., 2011). However, the full relevance of these
observations for pericyte-mediated stability in vivo remains
unclear, as previous studies reported no defects in pericyte
recruitment in DLL4-deficient mice.
In addition to the establishment of a quiescent and stable
vasculature, DLL4/notch signalling also appears to be important
for further maintenance of the quiescent state. EC-specific
inducible deletion of RBPJ, the downstream transcriptional
regulator of all canonical notch signalling, triggers spontaneous
angiogenesis in multiple tissues in adult mice (Dou et al., 2008).
Also, specific blockade of DLL4-mediated notch signalling in mice
using a DLL4-specific antibody resulted in liver pathologies
characterised by abnormal activation of ECs (Yan et al., 2010).
Development 138 (21)
Fig. 4. Current concepts of anastomosis. Schematic illustration of tip
cell fusion. For simplicity, the vascular lumen is not illustrated. The
formation of new connections between growing vessels is facilitated by
vessel interactions with macrophages (blue) that can act as bridge cells
that promote filopodia contact between tip cells (green). Upon contact,
adhesion junctions are formed by VE-cadherin, first at the tips of
filopodia and later also along the extending interface of the contacting
cells. The precise role of macrophages and the molecular regulation of
anastomosis are not understood. Possible candidate pathways involved
are the notch, TIE2 and CXCR4 signalling pathways; the notch
receptors (red), the TIE2 receptor (green) and the CXCR4 receptor
(yellow) are expressed on macrophages and their cognate ligands are
expressed on tip cells (not shown). A two-way interaction between ECs
and macrophages through (unknown) soluble factors (pink) has been
Development 138 (21)
These findings indicate that DLL4/notch signalling is essential for
repressing angiogenesis in established blood vessels and for
maintaining quiescence in the endothelium.
Angiogenesis research has moved into an exciting phase of in
vivo cell biology, with numerous new tools and methods
enabling researchers to address questions of vascular patterning
at the single-cell level. Dynamic high resolution imaging,
sophisticated genetic tools for single cell labelling and cell-
autonomous gene-function analysis have established new
concepts of EC competition and cooperation and will continue
to define the precise molecular control of the individual steps in
the angiogenic sprouting process.
Despite exciting progress, many basic questions remain
unanswered. For example, what are the specific roles of newly
identified tip and stalk cell genes and how do they integrate with
the fundamental VEGF/notch regulatory feedback loop? What is
the biological function of the dynamic tip and stalk cell exchange?
How does this fit with the concept of functional specialisation?
How do stalk cells that take over the tip cell position overcome the
notch-mediated inhibitory instructions of the tip cell that initially
prevented them from becoming a tip cell? What is the molecular
identity of the phalanx cell phenotype, and how different are
phalanx cells from stalk cells? What is the cellular mechanism of
vessel remodelling and how do intrinsic forces (blood flow) and
tissue response (hypoxia/VEGF) integrate into coordinated EC
behaviour? Finally, what determines the abnormal development of
blood vessels in pathologies, and how different is EC behaviour
and its regulation in disease?
We anticipate that, in the coming years, detailed combinatorial
analyses that bring together the knowledge of cell biologists,
developmental biologists, computational biologists and clinicians
will fuel progress in this field. These combined efforts, using
genetics, quantitative biology, cell culture models and pre-clinical
models, aided by rapidly developing imaging technology methods
and approaches to analysis of signalling in vivo, will greatly
advance our understanding of the key processes in angiogenesis.
Note added in proof
A paper appearing in this issue (Arima et al., 2011) confirms the
recently discovered dynamic shuffling of endothelial cells along the
extending sprout and frequent exchange of cells at the tip position
(Jakobsson et al., 2010). Using time-lapse imaging in the aortic
ring assay, and a combination of labelling techniques that allow
nuclear tracking of EC and stochastic mosaic labeling of individual
cells by low titre viral transduction, Arima and colleagues were
able to undertake a comprehensive analysis of cell movements and
their relative contribution to sprout elongation. Accordingly,
effective elongation of the sprout appears to be driven by the
velocity, orientation and directionality of endothelial cell migration
under VEGF stimulation. Dll4/Notch signalling counteracts several
of these parameters. Interestingly, the authors observe that mural
cell recruitment to the advancing sprout promotes collective EC
cell behavior that culminates in the ‘elongation drive’. Whether all
of these observations hold true in vivo remains to be shown.
However, the systemic analysis of single and collective cell
behavior to extract critical parameters will certainly continue to
drive insights into the fundamental principals of blood vessel
We apologise to authors whose work we could not cite because of the limit on
the number of references. We are grateful to Irene Aspalter, Claudio Franco,
Giovanni Mariggi and Katie Bentley for supplying the micrographs for Fig. 1.
H.G. is supported by Cancer Research UK, the Lister Institute of Preventive
Medicine, the EMBO Young Investigator Programme and the Foundation
Leducq Transatlantic Network ARTEMIS.
Competing interests statement
The authors declare no competing financial interests.
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