在多细胞生物中，血管生成是从既有血管形成新的血管的必要过程，它有助于生长和发育。不同的机制，如血管发生、萌发、套入、合并血管生成，以及血管共用、血管发生类仿真和淋巴管生成等，都参与了新血管的形成。在许多病理条件下，如癌症、动脉硬化、关节炎、牛皮癣、子宫内膜异位症、肥胖症和SARS-CoV-2（COVID-19）等，发展性血管生成过程被重现，但通常缺乏正常的反馈机制来调节血管形成的空间和时间模式。因此，病理性血管生成提出了设计基于血管定向疗法的新挑战和新机会。在这里，我们概述了对血管发展的最新见解，并突出了促进或抑制血管生成过程以稳定、逆转甚至停止疾病进展的新型治疗策略。在我们的评论中，我们还将探讨几个额外的方面（血管生成转换、低氧、血管细胞内分泌信号、内皮可塑性、血管正常化和内皮细胞无力）与规范的血管生成机制并行运作，推测这些过程如何被抗血管生成或基于血管定向的治疗所针对。 ©2023. 作者。

In multicellular organisms, angiogenesis, the formation of new blood vessels from pre-existing ones, is an essential process for growth and development. Different mechanisms such as vasculogenesis, sprouting, intussusceptive, and coalescent angiogenesis, as well as vessel co-option, vasculogenic mimicry and lymphangiogenesis, underlie the formation of new vasculature. In many pathological conditions, such as cancer, atherosclerosis, arthritis, psoriasis, endometriosis, obesity and SARS-CoV-2(COVID-19), developmental angiogenic processes are recapitulated, but are often done so without the normal feedback mechanisms that regulate the ordinary spatial and temporal patterns of blood vessel formation. Thus, pathological angiogenesis presents new challenges yet new opportunities for the design of vascular-directed therapies. Here, we provide an overview of recent insights into blood vessel development and highlight novel therapeutic strategies that promote or inhibit the process of angiogenesis to stabilize, reverse, or even halt disease progression. In our review, we will also explore several additional aspects (the angiogenic switch, hypoxia, angiocrine signals, endothelial plasticity, vessel normalization, and endothelial cell anergy) that operate in parallel to canonical angiogenesis mechanisms and speculate how these processes may also be targeted with anti-angiogenic or vascular-directed therapies.© 2023. The Author(s).