The regulation of vascular endothelial growth factor A (VEGF) is critical
to neovascularization in numerous tissues under physiological and pathological
conditions. VEGF has multiple isoforms, created by alternative splicing or
proteolytic cleavage, and characterized by different receptor-binding and
matrix-binding properties. These isoforms are known to give rise to a spectrum
of angiogenesis patterns marked by differences in branching, which has
functional implications for tissues. In this review, we detail the extensive
extracellular regulation of VEGF and the ability of VEGF to dictate the vascular
phenotype. We explore the role of VEGF-releasing proteases and soluble carrier
molecules on VEGF activity. While proteases such as MMP9 can
‘release’ matrix-bound VEGF and promote angiogenesis, for
example as a key step in carcinogenesis, proteases can also suppress
VEGF’s angiogenic effects. We explore what dictates pro- or
anti-angiogenic behavior. We also seek to understand the phenomenon of VEGF
gradient formation. Strong VEGF gradients are thought to be due to decreased
rates of diffusion from reversible matrix binding, however theoretical studies
show that this scenario cannot give rise to lasting VEGF gradients in vivo. We
propose that gradients are formed through degradation of sequestered VEGF.
Finally, we review how different aspects of the VEGF signal, such as its
concentration, gradient, matrix-binding, and NRP1-binding can differentially
affect angiogenesis. We explore how this allows VEGF to regulate the formation
of vascular networks across a spectrum of high to low branching densities, and
from normal to pathological angiogenesis. A better understanding of the control
of angiogenesis is necessary to improve upon limitations of current angiogenic
therapies.