| Abstract | PURPOSE: Thromboangiitis obliterans (TAO), or Buerger's disease, a distinct form of vascular occlusive disease that afflicts the peripheral arteries of young smokers, is often characterized by an inexorable downhill course even in patients who discontinue smoking once a stage of critical limb ischemia associated with ulceration or gangrene is reached. As part of a phase I clinical trial to document the safety and efficacy of intramuscular gene transfer of naked plasmid DNA-encoding vascular endothelial growth factor (phVEGF165) in the treatment of critical limb ischemia, we treated TAO in 6 patients. METHODS: Seven limbs in 6 patients (3 men, 3 women; mean age, 33 years; range, 33 to 51 years) who satisfied the criteria for TAO and had signs or symptoms of critical limb ischemia were treated twice, 4 weeks apart, with 2 or 4 mg of phVEGF165, which was administered by direct intramuscular injection at 4 arbitrarily selected sites in the ischemic limb. The gene expression was documented by enzyme-linked immunosorbent assay that was performed on peripheral blood samples. RESULTS: The ulcers that were nonhealing for more than 1 month healed completely in 3 of 5 limbs after the intramuscular phVEGF165 gene therapy. Nocturnal rest pain was relieved in the remaining 2 patients, although both continue to have claudication. The evidence of the improved perfusion to the distal ischemic limb included an increase of more than 0.1 in the ankle brachial index in 3 limbs, an improved flow shown with magnetic resonance imaging in 7 of the 7 limbs, and newly visible collateral vessels shown with serial contrast angiography in 7 of the 7 limbs. The adverse consequences of the phVEGF165 gene transfer were limited to transient ankle or calf edema in 3 of the 7 limbs. Two patients with advanced distal forefoot gangrene ultimately required below-knee amputation despite the evidence of improved perfusion. A histologic section disclosed the classic pathologic findings of TAO. CONCLUSION: Therapeutic angiogenesis with phVEGF165 gene transfer, if instituted before the development of forefoot gangrene, may provide a novel therapy for patients with advanced Buerger's disease that is unresponsive to standard medical or surgical treatment methods. |
| Authors | J M Isner, I Baumgartner, G Rauh, R Schainfeld, R Blair, O Manor, S Razvi, J F Symes
(Affiliation: Division of Cardiovascular Research and the Departments of Medicine, Radiology, and Surgery, St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Mass 02135, USA.)
|
| Journal | Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
(J Vasc Surg)
Vol. 28
Issue 6
Pg. 964-73; discussion 73-5
(Dec 1998)
ISSN: 0741-5214 UNITED STATES |
| PMID | 9845647
(Publication Type: Journal Article)
|
| Chemical References |
- Endothelial Growth Factors
- Lymphokines
- Vascular Endothelial Growth Factor A
- Vascular Endothelial Growth Factors
|
| Topics |
- Adult
- Angiography, Digital Subtraction
- Endothelial Growth Factors
(blood, genetics)
- Enzyme-Linked Immunosorbent Assay
- Female
- Gene Therapy
(adverse effects)
- Gene Transfer Techniques
(adverse effects)
- Hemodynamics
- Humans
- Injections, Intramuscular
- Ischemia
(diagnosis, etiology)
- Leg
(blood supply)
- Lymphokines
(blood, genetics)
- Magnetic Resonance Angiography
- Male
- Middle Aged
- Neovascularization, Physiologic
- Thromboangiitis Obliterans
(complications, therapy)
- Vascular Endothelial Growth Factor A
- Vascular Endothelial Growth Factors
|
