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Paskal W, Gotowiec M, Stachura A, Kopka M, Włodarski P. VEGF and Other Gene Therapies Improve Flap Survival-A Systematic Review and Meta-Analysis of Preclinical Studies. Int J Mol Sci 2024; 25:2622. [PMID: 38473869 DOI: 10.3390/ijms25052622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/12/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Surgical flaps are basic tools in reconstructive surgery. Their use may be limited by ischemia and necrosis. Few therapies address or prevent them. Genetic therapy could improve flap outcomes, but primary studies in this field present conflicting results. This systematic review and meta-analysis aimed to appraise the efficacy of external gene delivery to the flap for its survival in preclinical models. This review was registered with PROSPERO (CRD42022359982). PubMed, Embase, Web of Science, and Scopus were searched to identify studies using animal models reporting flap survival outcomes following any genetic modifications. Random-effects meta-analysis was used to calculate mean differences in flap survival with accompanying 95% CI. The risk of bias was assessed using the SYRCLE tool. Subgroup and sensitivity analyses were performed to ascertain the robustness of primary analyses, and the evidence was assessed using the GRADE approach. The initial search yielded 690 articles; 51 were eventually included, 36 of which with 1576 rats were meta-analyzed. VEGF gene delivery to different flap types significantly improved flap survival area by 15.66% (95% CI 11.80-19.52). Other interventions had smaller or less precise effects: PDGF-13.44% (95% CI 3.53-23.35); VEGF + FGF-8.64% (95% CI 6.94-10.34); HGF-5.61% (95% CI 0.43-10.78); FGF 3.84% (95% CI 1.13-6.55). Despite considerable heterogeneity, moderate risk of bias, and low quality of evidence, the efficacy of VEGF gene therapy remained significant in all sensitivity analyses. Preclinical data indicate that gene therapy is effective for increasing flap survival, but further animal studies are required for successful clinical translation.
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Affiliation(s)
- Wiktor Paskal
- Department of Methodology, Medical University of Warsaw, 1b Banacha Street, 02-091 Warsaw, Poland
| | - Mateusz Gotowiec
- Department of Methodology, Medical University of Warsaw, 1b Banacha Street, 02-091 Warsaw, Poland
| | - Albert Stachura
- Department of Methodology, Medical University of Warsaw, 1b Banacha Street, 02-091 Warsaw, Poland
- Doctoral School, Medical University of Warsaw, 81 Żwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Michał Kopka
- Department of Methodology, Medical University of Warsaw, 1b Banacha Street, 02-091 Warsaw, Poland
- Doctoral School, Medical University of Warsaw, 81 Żwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Paweł Włodarski
- Department of Methodology, Medical University of Warsaw, 1b Banacha Street, 02-091 Warsaw, Poland
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Improvement of Flap Necrosis in a Rat Random Skin Flap Model by In Vivo Electroporation-Mediated HGF Gene Transfer. Plast Reconstr Surg 2017; 139:1116e-1127e. [PMID: 28445365 DOI: 10.1097/prs.0000000000003259] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite great understanding of underlying mechanisms for flap necrosis and advances in surgical techniques, flap necrosis remains a critical issue. In the present study, the authors investigated the efficacy of electroporation-mediated hepatocyte growth factor (HGF) gene delivery to random dorsal skin flaps (McFarlane) to accelerate wound healing and reduce flap necrosis. METHODS Fifteen male Wistar rats (290 to 320 g) were divided randomly into three groups. Group a, the control group (n = 5), underwent surgery and received no gene transfer. Group b received electroporation-mediated HGF gene delivery 24 hours after surgery as a treatment. Group c received electroporation-mediated HGF gene delivery 24 hours before surgery as prophylaxis (n = 5). Planimetry, laser Doppler imaging, and immunohistochemistry were used to assess the efficacy of HGF gene therapy among the groups. RESULTS Electroporation-mediated HGF gene delivery significantly decreased flap necrosis percentage compared with the control group in prophylactic and treatment groups (p = 0.0317 and p = 0.0079, respectively) and significantly increased cutaneous perfusion compared with the control group (p = 0.0317 and p = 0.0159, respectively). Moreover, Spearman rank correlation showed a significant negative correlation between flap necrosis percentage and laser index (p = 0.0213 and r = -0.5964, respectively). Furthermore, significantly higher mean CD31 vessel density was detected in treatment and prophylactic groups (p = 0.0079 and p = 0.0159, respectively). In addition, quantitative image analysis revealed significantly higher HGF protein expression in groups b and c (p = 0.0079 and p = 0.0079, respectively). CONCLUSION These findings suggested in vivo electroporation-mediated HGF gene delivery enhanced viability and vascularity of the ischemic skin flap.
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Roh TS, Jung BK, Yun I, Lew DH, Kim YS. Effect of botulinum toxin A on vasoconstriction and sympathetic neurotransmitters in a murine random pattern skin flap model. Wound Repair Regen 2017; 25:75-85. [DOI: 10.1111/wrr.12501] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/29/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Tai Suk Roh
- Department of Plastic and Reconstructive Surgery; Institute for Human Tissue Restoration, Gangnam Severance Hospital, Yonsei University College of Medicine; Seoul Republic of Korea
| | - Bok Ki Jung
- Department of Plastic and Reconstructive Surgery; Institute for Human Tissue Restoration, Gangnam Severance Hospital, Yonsei University College of Medicine; Seoul Republic of Korea
| | - Insik Yun
- Department of Plastic and Reconstructive Surgery; Institute for Human Tissue Restoration, Gangnam Severance Hospital, Yonsei University College of Medicine; Seoul Republic of Korea
| | - Dae Hyun Lew
- Department of Plastic and Reconstructive Surgery; Institute for Human Tissue Restoration, Gangnam Severance Hospital, Yonsei University College of Medicine; Seoul Republic of Korea
| | - Young Seok Kim
- Department of Plastic and Reconstructive Surgery; Institute for Human Tissue Restoration, Gangnam Severance Hospital, Yonsei University College of Medicine; Seoul Republic of Korea
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Rah DK, Yun IS, Yun CO, Lee SB, Lee WJ. Gene therapy using hepatocyte growth factor expressing adenovirus improves skin flap survival in a rat model. J Korean Med Sci 2014; 29 Suppl 3:S228-36. [PMID: 25473214 PMCID: PMC4248010 DOI: 10.3346/jkms.2014.29.s3.s228] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/02/2014] [Indexed: 01/08/2023] Open
Abstract
Hepatocyte growth factor (HGF) is a potent angiogenic factor that can stimulate the production of blood vessels in ischemic tissue. We investigated whether gene therapy using HGF-expressing adenovirus could enhance skin flap survival. Sprague-Dawley rats were randomly divided into three groups. Rats were subdermally injected with HGF-expressing adenovirus (HGF virus group), recombinant HGF (rhHGF group), or phosphate buffered saline (PBS group) 2 days before and immediately after 3 × 9 cm caudal flap elevation. The survival area of the skin flap, the ratio of blood flow, CD31-positive vessels and, VEGF expression were examined. Skin flap viability was significantly increased in the HGF virus group compared to the rhHGF and PBS groups (71.4% ± 5.9%, 63.8%± 6.4%, and 39.2% ± 13.0%, respectively) (P = 0.025). Furthermore, the blood flow ratio was significantly increased in the HGF virus group. In the HGF virus group, the number of CD31-positive vessels and vascular endothelial growth factor (VEGF) expression were significantly increased. Gene therapy using HGF-expressing adenovirus increase VEGF expression, the number of viable capillaries, and blood flow to the flap, thereby improving skin flap survival.
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Affiliation(s)
- Dong Kyun Rah
- Institute for Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - In Sik Yun
- Department of Plastic & Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chae-Ok Yun
- Department of Bioengineering, College of Engineering, Hanyang University, Seoul, Korea
| | - Sae Bin Lee
- Institute for Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jai Lee
- Institute for Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Shimamura M, Nakagami H, Taniyama Y, Morishita R. Gene therapy for peripheral arterial disease. Expert Opin Biol Ther 2014; 14:1175-84. [PMID: 24766232 DOI: 10.1517/14712598.2014.912272] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Gene therapy has emerged as a novel therapy to promote angiogenesis in patients with critical limb ischemia (CLI) caused by peripheral artery disease. Researchers working in this area have focused on pro-angiogenic factors, such as VEGF, fibroblast growth factor (FGF) and hepatocyte growth factor (HGF). Based on the elaborate studies and favorable results of basic research using naked plasmid DNA (pDNA) encoding these growth factors, some clinical Phase I and Phase II trials have been performed. The results of these studies demonstrate the safety of these approaches and their potential for symptomatic improvement in CLI patients. However, the Phase III clinical trials have so far been limited to HGF gene therapy. Because one pitfall of the Phase III trials has been the limited transgene expression achieved using naked pDNA alone, the development of more efficient gene transfer systems, such as ultrasound microbubbles and the needleless injector, as well as the addition of other genes will make these novel therapies more effective and ease the symptoms of CLI. AREAS COVERED This study reviews the previously published basic research and clinical trials that have studied VEGF, FGF and HGF gene therapies for the treatment of CLI. Adjunctive therapies, such as the addition of prostacyclin synthase genes and the development of more efficient gene transfer techniques for pDNA, are also reviewed. EXPERT OPINION To date, clinical studies have demonstrated the safety of gene therapy in limb ischemia but the effectiveness of this treatment has not been determined. Larger clinical studies, as well as the development of more effective gene therapy, are needed to achieve and confirm beneficial effects.
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Affiliation(s)
- Munehisa Shimamura
- Osaka University, Kanazawa University and Hamamatsu University School of Medicine, United Graduate School of Child Development, Division of Vascular Medicine and Epigenetics, Department of Child Development , Suita , Japan
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Lee WJ, Yun CO, Yun IS, Kim YO, Choi IK, Yun TJ, Rah DK. Augmentation of rat skin flap viability by relaxin-expressing adenovirus. Wound Repair Regen 2011; 19:709-17. [DOI: 10.1111/j.1524-475x.2011.00733.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 08/15/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Won Jai Lee
- Institute for Human Tissue Restoration; Department of Plastic and Reconstructive Surgery; Yonsei University; Seoul; Korea
| | | | - In Sik Yun
- Institute for Human Tissue Restoration; Department of Plastic and Reconstructive Surgery; Yonsei University; Seoul; Korea
| | - Yong-Oock Kim
- Institute for Human Tissue Restoration; Department of Plastic and Reconstructive Surgery; Yonsei University; Seoul; Korea
| | | | | | - Dong Kyun Rah
- Institute for Human Tissue Restoration; Department of Plastic and Reconstructive Surgery; Yonsei University; Seoul; Korea
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Wang XT, Avanessian B, Ma Q, Durfee H, Tang YQ, Liu PY. Enhancement of flap survival and changes in angiogenic gene expression after AAV2-mediated VEGF gene transfer to rat ischemic flaps. Wound Repair Regen 2011; 19:498-504. [DOI: 10.1111/j.1524-475x.2011.00705.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Use of gene-modified keratinocytes and fibroblasts to enhance regeneration in a full skin defect. Langenbecks Arch Surg 2011; 396:543-50. [DOI: 10.1007/s00423-011-0761-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 02/21/2011] [Indexed: 12/28/2022]
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Camacho M, Rodríguez C, Guadall A, Alcolea S, Orriols M, Escudero JR, Martínez-González J, Vila L. Hypoxia upregulates PGI-synthase and increases PGI₂ release in human vascular cells exposed to inflammatory stimuli. J Lipid Res 2011; 52:720-31. [PMID: 21296955 DOI: 10.1194/jlr.m011007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Hypoxia affects vascular function and cell metabolism, survival, growth, and motility; these processes are partially regulated by prostanoids. We analyzed the effect of hypoxia and inflammation on key enzymes involved in prostanoid biosynthesis in human vascular cells. In human vascular smooth muscle cells (VSMC), hypoxia and interleukin (IL)-1β synergistically increased prostaglandin (PG)I₂ but not PGE₂ release, thereby increasing the PGI₂/PGE₂ ratio. Concomitantly, these stimuli upregulated cyclooxygenase-2 (COX-2) expression (mRNA and protein) and COX activity. Interestingly, hypoxia enhanced PGI-synthase (PGIS) expression and activity in VSMC and human endothelial cells. Hypoxia did not significantly modify the inducible microsomal-PGE-synthase (mPGES)-1. Hypoxia-inducible factor (HIF)-1α-silencing abrogated hypoxia-induced PGIS upregulation. PGIS transcriptional activity was enhanced by hypoxia; however, the minimal PGIS promoter responsive to hypoxia (-131 bp) did not contain any putative hypoxia response element (HRE), suggesting that HIF-1 does not directly drive PGIS transcription. Serial deletion and site-directed mutagenesis studies suggested several transcription factors participate cooperatively. Plasma levels of the stable metabolite of PGI₂ and PGIS expression in several tissues were also upregulated in mice exposed to hypoxia. These data suggest that PGIS upregulation is part of the adaptive response of vascular cells to hypoxic stress and could play a role in counteracting the deleterious effect of inflammatory stimuli.
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Affiliation(s)
- Mercedes Camacho
- Angiology, Vascular Biology, and Inflammation Laboratory, Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain
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Abstract
Rheologically active pharmacotherapy is of high importance in many dermato-logical diseases. The intravenous administration of iloprost belongs to the most effective systemic therapeutic agents that serve this pharmacodynamic approach and additionally substantial knowledge on the safety and efficacy exists. We review the dermatologically relevant data in order to offer an easy, thematically focused overview to practicing dermatologists.
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Affiliation(s)
- Johannes Wohlrab
- Department of Dermatology and Venereology, University of Halle-Wittenberg, Halle (Saale), Germany.
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Mueller CK, Thorwarth MW, Schultze-Mosgau S. Angiogenic Gene-Modified Fibroblasts for Induction of Localized Angiogenesis. J Surg Res 2010; 160:340-8. [DOI: 10.1016/j.jss.2008.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 11/23/2008] [Accepted: 12/03/2008] [Indexed: 11/17/2022]
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Aizawa K, Sato S, Terakawa M, Saitoh D, Tsuda H, Ashida H, Obara M. Accelerated adhesion of grafted skin by laser-induced stress wave-based gene transfer of hepatocyte growth factor. JOURNAL OF BIOMEDICAL OPTICS 2009; 14:064043. [PMID: 20059281 DOI: 10.1117/1.3253325] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Gene therapy using wound healing-associated growth factor gene has received much attention as a new strategy for improving the outcome of tissue transplantation. We delivered plasmid DNA coding for human hepatocyte growth factor (hHGF) to rat free skin grafts by the use of laser-induced stress waves (LISWs); autografting was performed with the grafts. Systematic analysis was conducted to evaluate the adhesion properties of the grafted tissue; angiogenesis, cell proliferation, and reepithelialization were assessed by immunohistochemistry, and reperfusion was measured by laser Doppler imaging as a function of time after grafting. Both the level of angiogenesis on day 3 after grafting and the increased ratio of blood flow on day 4 to that on day 3 were significantly higher than those in five control groups: grafting with hHGF gene injection alone, grafting with control plasmid vector injection alone, grafting with LISW application alone, grafting with LISW application after control plasmid vector injection, and normal grafting. Reepithelialization was almost completed on day 7 even at the center of the graft with LISW application after hHGF gene injection, while it was not for the grafts of the five control groups. These findings demonstrate the validity of our LISW-based HGF gene transfection to accelerate the adhesion of grafted skins.
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Affiliation(s)
- Kazuya Aizawa
- Keio University, Department of Electronics and Electrical Engineering, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa 223-8522, Japan
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