Summary Angiogenesis is the formation of new blood vessels from the existing vasculature. Vascular endothelial growth factor (VEGF) is an endothelium-specific angiogenic factor strongly implicated in pathological angiogenesis. In this study, the mRNA and protein expression of the four alternatively spliced VEGF isoforms (121, 165, 189 and 206 amino acids) were examined in normal and malignant breast tissues. Three VEGF transcripts were detected in both (121>165>189), whereas only VEGF165 protein was detected. The tumours expressed more VEGF mRNA (P = 0.02) and protein (P < 0.0001), with eight-fold more VEGF protein generated per mRNA unit (P = 0.009). To examine this further, the expression of elF-4E, a translation initiation factor, was examined. Increased elF-4E mRNA levels were detected in the tumours (P < 0.0001) that correlated with VEGF mRNA (P = 0.0002), implying co-regulation of these genes. VEGF mRNA expression was elevated in tumours expressing the epidermal growth factor receptor (P < 0.01), but there was no difference according to oestrogen receptor status (P = 0.9), node status (P = 0.09) or between differing histologies (P = 0.4). These data suggest that elevated VEGF protein expression, by both enhanced transcription and translation, is a potential means by which tumour angiogenesis is induced in breast carcinomas. VEGF expression is also significantly associated with factors correlating with a poor outcome, implying a role in progression of this disease.Keywords: angiogenesis; vascular endothelial growth factor; elF-4E translation; breast cancer; GAPDH Angiogenesis is the formation of new blood vessels from the existing vasculature. It is a complex process involving degradation of the basement membrane, endothelial proliferation, migration, tube formation and the initiation of blood flow. Angiogenesis occurs in a wide range of biological events, including the female reproductive cycle, embryonic development and wound healing (Folkman and Shing, 1992). In the pathological setting, it is an important component of many diseases including rheumatoid arthritis and diabetic retinopathy, and is a critical, although not the only, step necessary for the growth and metastasis of tumours (Folkman, 1990). Under physiological conditions, angiogenesis is regulated strictly by a balance of stimulation and inhibition, but in the neoplastic state there appears to be a loss of control (Liotta et al, 1991).Although several types of angiogenic factors, including lipids and peptides, have been identified (reviewed Folkman and Klagsbrun, 1987;Bicknell and Harris, 1991;Bouck, 1993;Scott and Harris, 1994), the focus has remained on the polypeptide growth factors. Of these, the angiogenic growth factor most strongly implicated in tumour angiogenesis is vascular endothelial growth factor (VEGF).In addition to being the most selective endothelial mitogen known (Leung et al, 1989), VEGF elicits other effects on endothelial cells, including chemotaxis (Kock et al, 1994), increased permeability (Keck et al, 1989)