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Chan T, Grisch-Chan HM, Schmierer P, Subotic U, Rimann N, Scherer T, Hetzel U, Bozza M, Harbottle R, Williams JA, Steblaj B, Ringer SK, Häberle J, Sidler X, Thöny B. Delivery of non-viral naked DNA vectors to liver in small weaned pigs by hydrodynamic retrograde intrabiliary injection. Mol Ther Methods Clin Dev 2022; 24:268-279. [PMID: 35211639 PMCID: PMC8829443 DOI: 10.1016/j.omtm.2022.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/16/2022] [Indexed: 11/09/2022]
Abstract
Hepatic gene therapy by delivering non-integrating therapeutic vectors in newborns remains challenging due to the risk of dilution and loss of efficacy in the growing liver. Previously we reported on hepatocyte transfection in piglets by intraportal injection of naked DNA vectors. Here, we established delivery of naked DNA vectors to target periportal hepatocytes in weaned pigs by hydrodynamic retrograde intrabiliary injection (HRII). The surgical procedure involved laparotomy and transient isolation of the liver. For vector delivery, a catheter was placed within the common bile duct by enterotomy. Under optimal conditions, no histological abnormalities were observed in liver tissue upon pressurized injections. The transfection of hepatocytes in all tested liver samples was observed with vectors expressing luciferase from a liver-specific promoter. However, vector copy number and luciferase expression were low compared to hydrodynamic intraportal injection. A 10-fold higher number of vector genomes and luciferase expression was observed in pigs using a non-integrating naked DNA vector with the potential for replication. In summary, the HRII application was less efficient (i.e., lower luciferase activity and vector copy numbers) than the intraportal delivery method but was significantly less distressful for the piglets and has the potential for injection (or re-injection) of vector DNA by endoscopic retrograde cholangiopancreatography.
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Affiliation(s)
- Tatjana Chan
- Department of Farm Animals, Division of Swine Medicine of the Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Hiu Man Grisch-Chan
- Division of Metabolism and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp Schmierer
- Department of Small Animal Surgery, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Ulrike Subotic
- Department of Surgery, University Children's Hospital Basel, Basel, Switzerland
| | - Nicole Rimann
- Division of Metabolism and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Tanja Scherer
- Division of Metabolism and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Udo Hetzel
- Department of Pathology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Matthias Bozza
- DNA Vector Laboratory, DKFZ Heidelberg, Heidelberg, Germany
| | | | | | - Barbara Steblaj
- Department of Diagnostics and Clinical Services, Section of Anesthesiology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Simone K Ringer
- Department of Diagnostics and Clinical Services, Section of Anesthesiology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Johannes Häberle
- Division of Metabolism and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Xaver Sidler
- Department of Farm Animals, Division of Swine Medicine of the Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Beat Thöny
- Division of Metabolism and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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Sendra L, Herrero MJ, Montalvá EM, Noguera I, Orbis F, Díaz A, Fernández-Delgado R, López-Andújar R, Aliño SF. Efficacy of interleukin 10 gene hydrofection in pig liver vascular isolated 'in vivo' by surgical procedure with interest in liver transplantation. PLoS One 2019; 14:e0224568. [PMID: 31689315 PMCID: PMC6830756 DOI: 10.1371/journal.pone.0224568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 10/16/2019] [Indexed: 11/19/2022] Open
Abstract
Aim Liver transplantation is the only curative strategy for final stage liver diseases. Despite the great advances achieved during the last 20 years, the recipient immune response after transplantation is not entirely controlled. This results in high rates of acute cell rejection and, approximately, 10% of early mortality. Therapeutic treatment could be improved by efficiently transfecting genes that encode natural immunosuppressant proteins, employing safe procedures that could be transferred to clinical setting. In this sense, interleukin 10 plays a central role in immune tolerance response by acting at different levels. Methods hIL10 gene was hydrofected by retrograde hydrodynamic injection in pig liver with complete vascular exclusion mediated by an ‘in vivo’ surgical procedure. Levels of IL10 DNA, RNA and protein were determined within liver tissue 1 and 10 days after the injection and, more frequently, also the interleukin-10 protein in peripheral blood. Results The procedure was safe for the animals and neither hemodynamic parameters nor liver function determinations showed relevant alterations. The hIL10 hydrofection in watertight liver mediated efficient gene transfer and this was transcribed and translated to protein, achieving up to 110 pg/ml of IL10 in peripheral blood. This value is close to that considered able to reduce the activity of TNFα by half (IL10 IC50 for TNFα = 124 pg/ml). Conclusions Results of this work suggest that IL10 liver hydrofection with vascular exclusion in vivo is a safe and transferable procedure that mediates plasma protein levels with potential clinical interest in immune modulation after transplantation.
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Affiliation(s)
- Luis Sendra
- Pharmacogenetics Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Gene Therapy Unit, Department of Pharmacology, Universitat de Valencia, Valencia, Spain
| | - María José Herrero
- Pharmacogenetics Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Gene Therapy Unit, Department of Pharmacology, Universitat de Valencia, Valencia, Spain
| | - Eva María Montalvá
- Unit of Experimental Hepatology and Liver Transplantation, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- HPB Surgery and Transplant Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Inmaculada Noguera
- SCSIE, Central Services of Experimental Support, Universitat de Valencia, Valencia, Spain
| | - Francisco Orbis
- HPB Surgery and Transplant Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ana Díaz
- SCSIE, Central Services of Experimental Support, Universitat de Valencia, Valencia, Spain
| | - Rafael Fernández-Delgado
- Pediatrics Unit, Department of Pediatrics, Obstetrics and Gynecology, Universitat de Valencia, Valencia, Spain
| | - Rafael López-Andújar
- Unit of Experimental Hepatology and Liver Transplantation, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- HPB Surgery and Transplant Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Salvador F Aliño
- Pharmacogenetics Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Gene Therapy Unit, Department of Pharmacology, Universitat de Valencia, Valencia, Spain
- Clinical Pharmacology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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3
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Translational Advances of Hydrofection by Hydrodynamic Injection. Genes (Basel) 2018; 9:genes9030136. [PMID: 29494564 PMCID: PMC5867857 DOI: 10.3390/genes9030136] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/20/2018] [Accepted: 02/21/2018] [Indexed: 12/11/2022] Open
Abstract
Hydrodynamic gene delivery has proven to be a safe and efficient procedure for gene transfer, able to mediate, in murine model, therapeutic levels of proteins encoded by the transfected gene. In different disease models and targeting distinct organs, it has been demonstrated to revert the pathologic symptoms and signs. The therapeutic potential of hydrofection led different groups to work on the clinical translation of the procedure. In order to prevent the hemodynamic side effects derived from the rapid injection of a large volume, the conditions had to be moderated to make them compatible with its use in mid-size animal models such as rat, hamster and rabbit and large animals as dog, pig and primates. Despite the different approaches performed to adapt the conditions of gene delivery, the results obtained in any of these mid-size and large animals have been poorer than those obtained in murine model. Among these different strategies to reduce the volume employed, the most effective one has been to exclude the vasculature of the target organ and inject the solution directly. This procedure has permitted, by catheterization and surgical procedures in large animals, achieving protein expression levels in tissue close to those achieved in gold standard models. These promising results and the possibility of employing these strategies to transfer gene constructs able to edit genes, such as CRISPR, have renewed the clinical interest of this procedure of gene transfer. In order to translate the hydrodynamic gene delivery to human use, it is demanding the standardization of the procedure conditions and the molecular parameters of evaluation in order to be able to compare the results and establish a homogeneous manner of expressing the data obtained, as ‘classic’ drugs.
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Aronovich EL, Hyland KA, Hall BC, Bell JB, Olson ER, Rusten MU, Hunter DW, Ellinwood NM, McIvor RS, Hackett PB. Prolonged Expression of Secreted Enzymes in Dogs After Liver-Directed Delivery of Sleeping Beauty Transposons: Implications for Non-Viral Gene Therapy of Systemic Disease. Hum Gene Ther 2017; 28:551-564. [PMID: 28530135 DOI: 10.1089/hum.2017.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The non-viral, integrating Sleeping Beauty (SB) transposon system is efficient in treating systemic monogenic disease in mice, including hemophilia A and B caused by deficiency of blood clotting factors and mucopolysaccharidosis types I and VII caused by α-L-iduronidase (IDUA) and β-glucuronidase (GUSB) deficiency, respectively. Modified approaches of the hydrodynamics-based procedure to deliver transposons to the liver in dogs were recently reported. Using the transgenic canine reporter secreted alkaline phosphatase (cSEAP), transgenic protein in the plasma was demonstrated for up to 6 weeks post infusion. This study reports that immunosuppression of dogs with gadolinium chloride (GdCl3) prolonged the presence of cSEAP in the circulation up to 5.5 months after a single vector infusion. Transgene expression declined gradually but appeared to stabilize after about 2 months at approximately fourfold baseline level. Durability of transgenic protein expression in the plasma was inversely associated with transient increase of liver enzymes alanine transaminase and aspartate transaminase in response to the plasmid delivery procedure, which suggests a deleterious effect of hepatocellular toxicity on transgene expression. GdCl3 treatment was ineffective for repeat vector infusions. In parallel studies, dogs were infused with potentially therapeutic transposons. Activities of transgenic IDUA and GUSB in plasma peaked at 50-350% of wildtype, but in the absence of immunosuppression lasted only a few days. Transposition was detectable by excision assay only when the most efficient transposase, SB100X, was used. Dogs infused with transposons encoding canine clotting factor IX (cFIX) were treated with GdCl3 and showed expression profiles similar to those in cSEAP-infused dogs, with expression peaking at 40% wt (2 μg/mL). It is concluded that GdCl3 can support extended transgene expression after hydrodynamic introduction of SB transposons in dogs, but that alternative regimens will be required to achieve therapeutic levels of transgene products.
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Affiliation(s)
- Elena L Aronovich
- 1 Department of Genetics, Cell Biology and Development and Center for Genome Engineering, University of Minnesota , Minneapolis, Minnesota
| | | | - Bryan C Hall
- 1 Department of Genetics, Cell Biology and Development and Center for Genome Engineering, University of Minnesota , Minneapolis, Minnesota
| | - Jason B Bell
- 1 Department of Genetics, Cell Biology and Development and Center for Genome Engineering, University of Minnesota , Minneapolis, Minnesota
| | - Erik R Olson
- 2 Discovery Genomics, Inc. , Minneapolis, Minnesota
| | - Myra Urness Rusten
- 3 Department of Radiology, University of Minnesota , Minneapolis, Minnesota
| | - David W Hunter
- 3 Department of Radiology, University of Minnesota , Minneapolis, Minnesota
| | | | - R Scott McIvor
- 1 Department of Genetics, Cell Biology and Development and Center for Genome Engineering, University of Minnesota , Minneapolis, Minnesota.,2 Discovery Genomics, Inc. , Minneapolis, Minnesota
| | - Perry B Hackett
- 1 Department of Genetics, Cell Biology and Development and Center for Genome Engineering, University of Minnesota , Minneapolis, Minnesota.,2 Discovery Genomics, Inc. , Minneapolis, Minnesota
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Sendra Gisbert L, Miguel Matas A, Sabater Ortí L, Herrero MJ, Sabater Olivas L, Montalvá Orón EM, Frasson M, Abargues López R, López-Andújar R, García-Granero Ximénez E, Aliño Pellicer SF. Efficacy of hydrodynamic interleukin 10 gene transfer in human liver segments with interest in transplantation. Liver Transpl 2017; 23:50-62. [PMID: 27783460 DOI: 10.1002/lt.24667] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/29/2016] [Indexed: 12/15/2022]
Abstract
Different diseases lead, during their advanced stages, to chronic or acute liver failure, whose unique treatment consists in organ transplantation. The success of intervention is limited by host immune response and graft rejection. The use of immunosuppressant drugs generally improve organ transplantation, but they cannot completely solve the problem. Also, their management is delicate, especially during the early stages of treatment. Thus, new tools to set an efficient modulation of immune response are required. The local expression of interleukin (IL) 10 protein in transplanted livers mediated by hydrodynamic gene transfer could improve the organ acceptance by the host because it presents the natural ability to modulate the immune response at different levels. In the organ transplantation scenario, IL10 has already demonstrated positive effects on graft tolerance. Hydrodynamic gene transfer has been proven to be safe and therapeutically efficient in animal models and could be easily moved to the clinic. In the present work, we evaluated efficacy of human IL10 gene transfer in human liver segments and the tissue natural barriers for gene entry into the cell, employing gold nanoparticles. In conclusion, the present work shows for the first time that hydrodynamic IL10 gene transfer to human liver segments ex vivo efficiently delivers a human gene into the cells. Indexes of tissue protein expression achieved could mediate local pharmacological effects with interest in controlling the immune response triggered after liver transplantation. On the other hand, the ultrastructural study suggests that the solubilized plasmid could access the hepatocyte in a passive manner mediated by the hydric flow and that an active mechanism of transportation could facilitate its entry into the nucleus. Liver Transplantation 23:50-62 2017 AASLD.
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Affiliation(s)
- Luis Sendra Gisbert
- Pharmacogenetics Unit, Instituto de Investigación Sanitaria La Fe and Hospital Universitario y Politécnico La Fe, Av. Fernando Abril Martorell 106, 46026 Valencia
- Gene Therapy Unit, Pharmacology Department, Medicine Faculty, Universidad de Valencia, Valencia, Spain
| | - Antonio Miguel Matas
- Gene Therapy Unit, Pharmacology Department, Medicine Faculty, Universidad de Valencia, Valencia, Spain
| | - Luis Sabater Ortí
- General and Digestive Surgery Department, Hospital Clínico Universitario, Valencia, Spain
| | - María José Herrero
- Pharmacogenetics Unit, Instituto de Investigación Sanitaria La Fe and Hospital Universitario y Politécnico La Fe, Av. Fernando Abril Martorell 106, 46026 Valencia
| | | | - Eva María Montalvá Orón
- Hepatobiliopancreatic Surgery and Transplantation Unit, General Surgery Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Matteo Frasson
- Coloproctology Unit, General Surgery Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Rafael López-Andújar
- Hepatobiliopancreatic Surgery and Transplantation Unit, General Surgery Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Salvador Francisco Aliño Pellicer
- Pharmacogenetics Unit, Instituto de Investigación Sanitaria La Fe and Hospital Universitario y Politécnico La Fe, Av. Fernando Abril Martorell 106, 46026 Valencia
- Gene Therapy Unit, Pharmacology Department, Medicine Faculty, Universidad de Valencia, Valencia, Spain
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Sendra L, Miguel A, Pérez-Enguix D, Herrero MJ, Montalvá E, García-Gimeno MA, Noguera I, Díaz A, Pérez J, Sanz P, López-Andújar R, Martí-Bonmatí L, Aliño SF. Studying Closed Hydrodynamic Models of "In Vivo" DNA Perfusion in Pig Liver for Gene Therapy Translation to Humans. PLoS One 2016; 11:e0163898. [PMID: 27695064 PMCID: PMC5047531 DOI: 10.1371/journal.pone.0163898] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 09/18/2016] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Expressing exogenous genes after naked DNA delivery into hepatocytes might achieve sustained and high expression of human proteins. Tail vein DNA injection is an efficient procedure for gene transfer in murine liver. Hydrodynamic procedures in large animals require organ targeting, and improve with liver vascular exclusion. In the present study, two closed liver hydrofection models employing the human alpha-1-antitrypsin (hAAT) gene are compared to reference standards in order to evaluate their potential clinical interest. MATERIAL AND METHODS A solution of naked DNA bearing the hAAT gene was retrogradely injected in 7 pig livers using two different closed perfusion procedures: an endovascular catheterization-mediated procedure (n = 3) with infrahepatic inferior vena cava and portal vein blockage; and a surgery-mediated procedure (n = 4) with completely sealed liver. Gene transfer was performed through the suprahepatic inferior cava vein in the endovascular procedure and through the infrahepatic inferior vena cava in the surgical procedure. The efficiency of the procedures was evaluated 14 days after hydrofection by quantifying the hAAT protein copies per cell in tissue and in plasma. For comparison, samples from mice (n = 7) successfully hydrofected with hAAT and healthy human liver segments (n = 4) were evaluated. RESULTS Gene decoding occurs efficiently using both procedures, with liver vascular arrest improving its efficiency. The surgically closed procedure (sealed organ) reached higher tissue protein levels (4x10^5- copies/cell) than the endovascular procedure, though the levels were lower than in human liver (5x10^6- copies/cell) and hydrofected mouse liver (10^6- copies/cell). However, protein levels in plasma were lower (p<0.001) than the reference standards in all cases. CONCLUSION Hydrofection of hAAT DNA to "in vivo" isolated pig liver mediates highly efficient gene delivery and protein expression in tissue. Both endovascular and surgically closed models mediate high tissue protein expression. Impairment of protein secretion to plasma is observed and might be species-related. This study reinforces the potential application of closed liver hydrofection for therapeutic purposes, provided protein secretion improves.
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Affiliation(s)
- Luis Sendra
- Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| | - Antonio Miguel
- Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| | - Daniel Pérez-Enguix
- Servicio de Radiología y Grupo de Investigación Biomédica en Imagen GIBI239, IIS La Fe y Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María José Herrero
- Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
- Unidad de Farmacogenética, IIS La Fe y Área Clínica del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- * E-mail:
| | - Eva Montalvá
- Unidad de Cirugía Hepatobiliopancreática y Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Inmaculada Noguera
- Servicio Central de Soporte a la Investigación Experimental (SCSIE), Universidad de Valencia, Valencia, Spain
| | - Ana Díaz
- Servicio Central de Soporte a la Investigación Experimental (SCSIE), Universidad de Valencia, Valencia, Spain
| | - Judith Pérez
- Servicio de Anatomía Patológica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pascual Sanz
- CIBER e Instituto de Biomedicina de Valencia, CSIC, Valencia, Spain
| | - Rafael López-Andújar
- Unidad de Cirugía Hepatobiliopancreática y Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Luis Martí-Bonmatí
- Servicio de Radiología y Grupo de Investigación Biomédica en Imagen GIBI239, IIS La Fe y Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Salvador F. Aliño
- Departamento de Farmacología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
- Unidad de Farmacogenética, IIS La Fe y Área Clínica del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Unidad de Farmacología Clínica, Área Clínica del Medicamento, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Yokoo T, Kanefuji T, Suda T, Kamimura K, Liu D, Terai S. Site-Specific Impact of a Regional Hydrodynamic Injection: Computed Tomography Study during Hydrodynamic Injection Targeting the Swine Liver. Pharmaceutics 2015; 7:334-43. [PMID: 26389943 PMCID: PMC4588204 DOI: 10.3390/pharmaceutics7030334] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 08/28/2015] [Accepted: 09/03/2015] [Indexed: 02/06/2023] Open
Abstract
A hemodynamic study of hydrodynamic gene delivery (HGD) from the tail vein in rodents has inspired a mechanism and an approach to further improve the efficacy of this procedure. However, there is no report on the hemodynamics of a regional HGD, which is an inevitable approach in large animals. Here, we report the hemodynamics of a regional hydrodynamic injection in detail based on 3D volume data and the dynamism of tissue intensity over time by using computed tomography (CT) both during and after a regional hydrodynamic injection that targeted the liver of a pig weighing 15.6 kg. Contrast medium (CM) was injected at a steady speed of 20 mL/s for 7.5 s under the temporal balloon occlusion of the hepatic vein (HV). A retrograde flow formed a wedge-shaped strong enhancement area downstream of the corresponding HV within 2.5 s, which was followed by drainage into another HV beginning from the target area and the portal vein (PV) toward a non-target area of the liver. After the injection, the CM was readily eliminated from the PV outside the target area. These data suggest that an interventional radiology approach is effective in limiting the hydrodynamic impacts in large animals at a target area and that the burden overflowing into the PV is limited. A further investigation that simultaneously evaluates gene delivery efficiency and hemodynamics using CT is needed to establish feasible parameters for a regional HGD in large animals.
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Affiliation(s)
- Takeshi Yokoo
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata 950-8510, Japan.
| | - Tsutomu Kanefuji
- Department of Gastroenterology & Hepatology, Uonuma Institute of Community Medicine, Niigata University, 4132 Urasa, Minami Uonuma, Niigata, 949-7392, Japan.
| | - Takeshi Suda
- Department of Gastroenterology & Hepatology, Uonuma Institute of Community Medicine, Niigata University, 4132 Urasa, Minami Uonuma, Niigata, 949-7392, Japan.
| | - Kenya Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata 950-8510, Japan.
| | - Dexi Liu
- Department of Pharmaceutical and Biochemical Sciences, University of Georgia, College of Pharmacy, 250 W. Green street, Athens, GA 30602, USA.
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata 950-8510, Japan.
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