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Miao X, Lin J, Li A, Gao T, Liu T, Shen J, Sun Y, Wei J, Bao B, Zheng X. AAV-mediated VEGFA overexpression promotes angiogenesis and recovery of locomotor function following spinal cord injury via PI3K/Akt signaling. Exp Neurol 2024; 375:114739. [PMID: 38401852 DOI: 10.1016/j.expneurol.2024.114739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/09/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024]
Abstract
Spinal cord injury (SCI) is a disorder of the central nervous system resulting from various factors such as trauma, inflammation, tumors, and other etiologies. This condition leads to impairment in motor, sensory, and autonomic functions below the level of injury. Limitations of current therapeutic approaches prompt an investigation into therapeutic angiogenesis through persistent local expression of proangiogenic factors. Here, we investigated whether overexpression of adeno-associated virus (AAV)-mediated vascular endothelial growth factor A (VEGFA) in mouse SCI promoted locomotor function recovery, and whether the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) pathway was mechanistically involved. Three weeks before SCI, AAV-VEGFA was injected at the T10 level to induce VEGFA overexpression. Neurofunctional, histological, and biochemical assessments were done to determine tissue damage and/or recovery of neuromuscular and behavioral impairments. Daily injections of the PI3K/Akt pathway inhibitor LY294002 were made to assess a possible mechanism. AAV-VEGFA overexpression dramatically improved locomotor function and ameliorated pathological injury caused by SCI. Improved motor-evoked potentials in hindlimbs and more spinal CD31-positive microvessels were observed in AAV-VEGFA-overexpressing mice. LY294002 reduced PI3K and Akt phosphorylation levels and attenuated AAV-VEGFA-related improvements. In conclusion, sustained local AAV-mediated VEGFA overexpression in spinal cord can significantly promote angiogenesis and ameliorate locomotor impairment after SCI in a contusion mouse model through activation of the PI3K/Akt signaling pathway.
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Affiliation(s)
- Xin Miao
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Center for Orthopaedics, Shanghai, China
| | - Junqing Lin
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Center for Orthopaedics, Shanghai, China
| | - Ang Li
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Center for Orthopaedics, Shanghai, China
| | - Tao Gao
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Center for Orthopaedics, Shanghai, China
| | - Tiexin Liu
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Center for Orthopaedics, Shanghai, China
| | - Junjie Shen
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Center for Orthopaedics, Shanghai, China
| | - Yi Sun
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Center for Orthopaedics, Shanghai, China
| | - Jiabao Wei
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Center for Orthopaedics, Shanghai, China
| | - Bingbo Bao
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Center for Orthopaedics, Shanghai, China
| | - Xianyou Zheng
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Center for Orthopaedics, Shanghai, China.
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2
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Kumar AS, Kamalasanan K. Drug delivery to optimize angiogenesis imbalance in keloid: A review. J Control Release 2020; 329:1066-1076. [PMID: 33091533 DOI: 10.1016/j.jconrel.2020.10.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 12/12/2022]
Abstract
The wound healing process involves three continuous stages. Where, any imbalance can lead to the formation of unwanted keloids, hypertrophic scar, or tumors. Keloids are any unpleasant, non-compliant comorbidity affecting a major section of people around the globe who acquire it either genetically or by pathological means as a result of a skin injury. Angiogenesis is unavoidable in the healing process after an injury or disruption of skin to promote tissue regeneration. Uncontrolled angiogenesis during the healing process can initiate the unwanted response in the wound that facilitate keloid. Angiogenic therapy is adapted to accelerate healing after an injury. Else ways, there exists a risk of keloid formation due to excessive angiogenesis during the wound healing process. There are numerous strategies to treat keloid. Anti-angiogenic factors are provided to patients post-surgery to prevent the keloid formation; however, they come into the picture after the formation of keloid. The available strategies to treat keloids are steroidal injections, surgical excision of the keloid, radiotherapy, pressure therapy, the use of cryosurgery, and many more. The available treatments are not promising in reducing the recurrent rate of keloids as there are chances of high re-occurrences with similar/larger lesions on the removed keloid site. In this review, we are discussing the importance of controlled angiogenesis with the help of controlled drug delivery strategies enabling the wound healing process without the induction of keloid.
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Affiliation(s)
- Aishwari S Kumar
- Department of Pharmaceutics, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, AIMS Ponekkara PO, Kochi, Kerala, 682041, India
| | - Kaladhar Kamalasanan
- Department of Pharmaceutics, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, AIMS Ponekkara PO, Kochi, Kerala, 682041, India.
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3
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Melly L, Grosso A, Stanciu Pop C, Yu-Hsuan C, Nollevaux MC, Schachtrup C, Marsano A, Di Maggio N, Rondelet B, Banfi A. Fibrin hydrogels promote scar formation and prevent therapeutic angiogenesis in the heart. J Tissue Eng Regen Med 2020; 14:1513-1523. [PMID: 32841501 DOI: 10.1002/term.3118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/04/2020] [Accepted: 08/13/2020] [Indexed: 12/20/2022]
Abstract
Therapeutic angiogenesis is the delivery of factors to promote vascular growth and holds promise for the treatment of ischemic heart conditions. Recombinant protein delivery to the myocardium by factor-decorated fibrin matrices is an attractive approach, thanks to the ability to precisely control both dose and duration of the treatment, the use of a clinically approved material like fibrin, and the avoidance of genetic modification. Here, we investigated the feasibility of inducing therapeutic angiogenesis in the rat myocardium by a state-of-the-art fibrin-based delivery platform that we previously optimized. Engineered versions of murine vascular endothelial growth factor A (VEGF164 ) and platelet-derived growth factor BB (PDGF-BB) were fused with an octapeptide substrate of the transglutaminase coagulation factor fXIIIa (TG) to allow their covalent cross-linking into fibrin hydrogels and release by enzymatic cleavage. Hydrogels containing either 100 μg/mL TG-VEGF alone or in combination with 10 μg/mL TG-PDGF-BB or no factor were injected into rat myocardium. Surprisingly, vascular density was severely reduced in all conditions, both in and around the injection site, where large fibrotic scars were formed. Scar formation was not due to the presence of growth factors, adaptive immunity to human proteins, damage from injection, nor to mechanical trauma from the hydrogel stiffness or volume. Rather scar was induced directly by fibrin and persisted despite hydrogel degradation within 1 week. These results caution against the suitability of fibrin-based platforms for myocardial growth factor delivery, despite their efficacy in other tissues, like skeletal muscle. The underlying molecular mechanisms must be further investigated in order to identify rational targets to prevent this serious side effect.
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Affiliation(s)
- Ludovic Melly
- Cardiac, Vascular and Thoracic Surgery Department, CHU UCL Namur, Yvoir, Belgium
- Cell and Gene Therapy, Department of Biomedicine, Basel University Hospital and University of Basel, Basel, Switzerland
| | - Andrea Grosso
- Cell and Gene Therapy, Department of Biomedicine, Basel University Hospital and University of Basel, Basel, Switzerland
| | | | - Chu Yu-Hsuan
- Institute of Anatomy and Cell Biology, Department of Molecular Embryology, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Christian Schachtrup
- Institute of Anatomy and Cell Biology, Department of Molecular Embryology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Anna Marsano
- Cardiac Tissue Engineering, Department of Biomedicine, Basel University Hospital and University of Basel, Basel, Switzerland
| | - Nunzia Di Maggio
- Cell and Gene Therapy, Department of Biomedicine, Basel University Hospital and University of Basel, Basel, Switzerland
| | - Benoît Rondelet
- Cardiac, Vascular and Thoracic Surgery Department, CHU UCL Namur, Yvoir, Belgium
| | - Andrea Banfi
- Cell and Gene Therapy, Department of Biomedicine, Basel University Hospital and University of Basel, Basel, Switzerland
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4
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Gianni-Barrera R, Di Maggio N, Melly L, Burger MG, Mujagic E, Gürke L, Schaefer DJ, Banfi A. Therapeutic vascularization in regenerative medicine. Stem Cells Transl Med 2020; 9:433-444. [PMID: 31922362 PMCID: PMC7103618 DOI: 10.1002/sctm.19-0319] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/12/2019] [Indexed: 02/06/2023] Open
Abstract
Therapeutic angiogenesis, that is, the generation of new vessels by delivery of specific factors, is required both for rapid vascularization of tissue‐engineered constructs and to treat ischemic conditions. Vascular endothelial growth factor (VEGF) is the master regulator of angiogenesis. However, uncontrolled expression can lead to aberrant vascular growth and vascular tumors (angiomas). Major challenges to fully exploit VEGF potency for therapy include the need to precisely control in vivo distribution of growth factor dose and duration of expression. In fact, the therapeutic window of VEGF delivery depends on its amount in the microenvironment around each producing cell rather than on the total dose, since VEGF remains tightly bound to extracellular matrix (ECM). On the other hand, short‐term expression of less than about 4 weeks leads to unstable vessels, which promptly regress following cessation of the angiogenic stimulus. Here, we will briefly overview some key aspects of the biology of VEGF and angiogenesis and discuss their therapeutic implications with a particular focus on approaches using gene therapy, genetically modified progenitors, and ECM engineering with recombinant factors. Lastly, we will present recent insights into the mechanisms that regulate vessel stabilization and the switch between normal and aberrant vascular growth after VEGF delivery, to identify novel molecular targets that may improve both safety and efficacy of therapeutic angiogenesis.
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Affiliation(s)
- Roberto Gianni-Barrera
- Cell and Gene Therapy, Department of Biomedicine, Basel University Hospital and University of Basel, Basel, Switzerland
| | - Nunzia Di Maggio
- Cell and Gene Therapy, Department of Biomedicine, Basel University Hospital and University of Basel, Basel, Switzerland
| | - Ludovic Melly
- Cell and Gene Therapy, Department of Biomedicine, Basel University Hospital and University of Basel, Basel, Switzerland.,Cardiac, Vascular, and Thoracic Surgery, CHU UCL Namur, Yvoir, Belgium
| | - Maximilian G Burger
- Cell and Gene Therapy, Department of Biomedicine, Basel University Hospital and University of Basel, Basel, Switzerland.,Plastic and Reconstructive Surgery, Department of Surgery, Basel University Hospital and University of Basel, Basel, Switzerland
| | - Edin Mujagic
- Cell and Gene Therapy, Department of Biomedicine, Basel University Hospital and University of Basel, Basel, Switzerland.,Vascular Surgery, Department of Surgery, Basel University Hospital and University of Basel, Basel, Switzerland
| | - Lorenz Gürke
- Vascular Surgery, Department of Surgery, Basel University Hospital and University of Basel, Basel, Switzerland
| | - Dirk J Schaefer
- Plastic and Reconstructive Surgery, Department of Surgery, Basel University Hospital and University of Basel, Basel, Switzerland
| | - Andrea Banfi
- Cell and Gene Therapy, Department of Biomedicine, Basel University Hospital and University of Basel, Basel, Switzerland.,Plastic and Reconstructive Surgery, Department of Surgery, Basel University Hospital and University of Basel, Basel, Switzerland.,Vascular Surgery, Department of Surgery, Basel University Hospital and University of Basel, Basel, Switzerland
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5
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Park JS, Bae SH, Jung S, Lee M, Choi D. Enrichment of vascular endothelial growth factor secreting mesenchymal stromal cells enhances therapeutic angiogenesis in a mouse model of hind limb ischemia. Cytotherapy 2019; 21:433-443. [PMID: 30879964 DOI: 10.1016/j.jcyt.2018.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/20/2018] [Accepted: 12/09/2018] [Indexed: 12/18/2022]
Abstract
Critical limb ischemia, a severe manifestation of peripheral artery disease, is emerging as a major concern in aging societies worldwide. Notably, cell-based gene therapy to induce angiogenesis in ischemic tissue has been investigated as treatment. Despite many studies demonstrating the efficacy of this approach, better therapies are required to prevent serious sequelae such as claudication, amputation and other cardiovascular events. We have now established a simplified method to enhance the effects of therapeutic transgenes by selecting for and transplanting only transduced cells. Herein, mesenchymal stromal cells were transfected to co-express vascular endothelial growth factor as angiogenic factor and enhanced green fluorescent protein as marker. Transfected cells were then collected using flow cytometry based on green fluorescence and transplanted into ischemic hind limbs in mice. Compared with unsorted or untransfected cells, purified cells significantly improved blood perfusion within 21days, suggesting that transplanting only cells that overexpress vascular endothelial growth factor enhances therapeutic angiogenesis. Importantly, this approach may prove to be useful in cell-based gene therapy against a wide spectrum of diseases, simply by replacing the gene to be delivered or the cell to be transplanted.
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Affiliation(s)
- Jin Sil Park
- Severance Integrative Research Institute for Cerebral & Cardiovascular Disease, Yonsei University Health System, Seoul, South Korea
| | - Seong-Ho Bae
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
| | - Subin Jung
- Severance Integrative Research Institute for Cerebral & Cardiovascular Disease, Yonsei University Health System, Seoul, South Korea
| | - Minhyung Lee
- Department of Bioengineering, College of Engineering, Hanyang University, Seoul, South Korea
| | - Donghoon Choi
- Severance Integrative Research Institute for Cerebral & Cardiovascular Disease, Yonsei University Health System, Seoul, South Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
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6
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Mousa HSE, Abdel Aal SM, Abbas NAT. Umbilical cord blood-mesenchymal stem cells and carvedilol reduce doxorubicin- induced cardiotoxicity: Possible role of insulin-like growth factor-1. Biomed Pharmacother 2018; 105:1192-1204. [PMID: 30021356 DOI: 10.1016/j.biopha.2018.06.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022] Open
Abstract
In this study, we tried to demonstrate the effects of adding human umbilical cord blood mesenchymal stem cells (hUCB-MSCs) to carvedilol in improving the doxorubicin- induced cardiotoxicity in rats. Rats were randomly divided into four groups: group 1: control group, group 2: doxorubicin untreated group, group 3: rats injected with doxorubicin and received carvedilol, and group 4: rats injected with doxorubicin and received carvedilol and stem cell-treated. Electrocardiography (ECG) was performed to assess cardiac function after animals were sacrificed. Cardiac muscle sections were examined histologically using H&E, Masson trichrome and immunohistochemically using caspase 3 immunostaining. The morphometric and statistical analysis was performed. Levels of malondialdehyde (MDA), superoxide dismutase (SOD), insulin-like growth factor (IGF-1), and vascular endothelial growth factor (VEGF) were measured. We concluded that combination of hUCB-MSCs and carvedilol markedly improves histological and immunohistochemical structure of cardiac muscle fibers and restores cardiac function in doxorubicin- induced cardiotoxicity in rats.
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Affiliation(s)
- Hanaa S E Mousa
- Department of Histology and Cell Biology, Faculty of Medicine ZagazigUniversity, Zagazig, Egypt.
| | - Sara M Abdel Aal
- Department of Histology and Cell Biology, Faculty of Medicine ZagazigUniversity, Zagazig, Egypt
| | - Noha A T Abbas
- Department of clinical Pharmacology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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7
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Bannerman AD, Ze Lu RX, Korolj A, Kim LH, Radisic M. The use of microfabrication technology to address the challenges of building physiologically relevant vasculature. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2018. [DOI: 10.1016/j.cobme.2017.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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8
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Melly L, Cerino G, Frobert A, Cook S, Giraud MN, Carrel T, Tevaearai Stahel HT, Eckstein F, Rondelet B, Marsano A, Banfi A. Myocardial infarction stabilization by cell-based expression of controlled Vascular Endothelial Growth Factor levels. J Cell Mol Med 2018; 22:2580-2591. [PMID: 29478261 PMCID: PMC5908097 DOI: 10.1111/jcmm.13511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/23/2017] [Indexed: 01/24/2023] Open
Abstract
Vascular Endothelial Growth Factor (VEGF) can induce normal or aberrant angiogenesis depending on the amount secreted in the microenvironment around each cell. Towards a possible clinical translation, we developed a Fluorescence Activated Cell Sorting (FACS)-based technique to rapidly purify transduced progenitors that homogeneously express a desired specific VEGF level from heterogeneous primary populations. Here, we sought to induce safe and functional angiogenesis in ischaemic myocardium by cell-based expression of controlled VEGF levels. Human adipose stromal cells (ASC) were transduced with retroviral vectors and FACS purified to generate two populations producing similar total VEGF doses, but with different distributions: one with cells homogeneously producing a specific VEGF level (SPEC), and one with cells heterogeneously producing widespread VEGF levels (ALL), but with an average similar to that of the SPEC population. A total of 70 nude rats underwent myocardial infarction by coronary artery ligation and 2 weeks later VEGF-expressing or control cells, or saline were injected at the infarction border. Four weeks later, ventricular ejection fraction was significantly worsened with all treatments except for SPEC cells. Further, only SPEC cells significantly increased the density of homogeneously normal and mature microvascular networks. This was accompanied by a positive remodelling effect, with significantly reduced fibrosis in the infarcted area. We conclude that controlled homogeneous VEGF delivery by FACS-purified transduced ASC is a promising strategy to achieve safe and functional angiogenesis in myocardial ischaemia.
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Affiliation(s)
- Ludovic Melly
- Cell and Gene Therapy, Departments of Biomedicine and Surgery, University and University Hospital Basel, Basel, Switzerland.,Cardiac Surgery and Engineering, Departments of Biomedicine and Surgery, University and University Hospital Basel, Basel, Switzerland.,Department of Cardiac Vascular and Thoracic Surgery, CHU UCL Namur, Yvoir, Belgium
| | - Giulia Cerino
- Cardiac Surgery and Engineering, Departments of Biomedicine and Surgery, University and University Hospital Basel, Basel, Switzerland
| | - Aurélien Frobert
- Department of Cardiology, University of Fribourg, Fribourg, Switzerland
| | - Stéphane Cook
- Department of Cardiology, University of Fribourg, Fribourg, Switzerland
| | | | - Thierry Carrel
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Hendrik T Tevaearai Stahel
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Friedrich Eckstein
- Cardiac Surgery and Engineering, Departments of Biomedicine and Surgery, University and University Hospital Basel, Basel, Switzerland
| | - Benoît Rondelet
- Department of Cardiac Vascular and Thoracic Surgery, CHU UCL Namur, Yvoir, Belgium
| | - Anna Marsano
- Cardiac Surgery and Engineering, Departments of Biomedicine and Surgery, University and University Hospital Basel, Basel, Switzerland
| | - Andrea Banfi
- Cell and Gene Therapy, Departments of Biomedicine and Surgery, University and University Hospital Basel, Basel, Switzerland
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9
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Gaudiello E, Melly L, Cerino G, Boccardo S, Jalili-Firoozinezhad S, Xu L, Eckstein F, Martin I, Kaufmann BA, Banfi A, Marsano A. Scaffold Composition Determines the Angiogenic Outcome of Cell-Based Vascular Endothelial Growth Factor Expression by Modulating Its Microenvironmental Distribution. Adv Healthc Mater 2017; 6. [PMID: 28994225 DOI: 10.1002/adhm.201700600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/25/2017] [Indexed: 01/22/2023]
Abstract
Delivery of genetically modified cells overexpressing Vascular Endothelial Growth Factor (VEGF) is a promising approach to induce therapeutic angiogenesis in ischemic tissues. The effect of the protein is strictly modulated by its interaction with the components of the extracellular matrix. Its therapeutic potential depends on a sustained but controlled release at the microenvironmental level in order to avoid the formation of abnormal blood vessels. In this study, it is hypothesized that the composition of the scaffold plays a key role in modulating the binding, hence the therapeutic effect, of the VEGF released by 3D-cell constructs. It is found that collagen sponges, which poorly bind VEGF, prevent the formation of localized hot spots of excessive concentration, therefore, precluding the development of aberrant angiogenesis despite uncontrolled expression by a genetically engineered population of adipose tissue-derived stromal cells. On the contrary, after seeding on VEGF-binding egg-white scaffolds, the same cell population caused aberrantly enlarged vascular structures after 14 d. Collagen-based engineered tissues also induced a safe and efficient angiogenesis in both the patch itself and the underlying myocardium in rat models. These findings open new perspectives on the control and the delivery of proangiogenic stimuli, and are fundamental for the vascularization of engineered tissues/organs.
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Affiliation(s)
- Emanuele Gaudiello
- Department of Biomedicine; University of Basel; Hebelstrasse 20 CH-4031 Basel Switzerland
- Department of Surgery; University Hospital Basel; Spitalstrasse 21 CH-4031 Basel Switzerland
| | - Ludovic Melly
- Department of Biomedicine; University of Basel; Hebelstrasse 20 CH-4031 Basel Switzerland
- Department of Surgery; University Hospital Basel; Spitalstrasse 21 CH-4031 Basel Switzerland
| | - Giulia Cerino
- Department of Biomedicine; University of Basel; Hebelstrasse 20 CH-4031 Basel Switzerland
- Department of Surgery; University Hospital Basel; Spitalstrasse 21 CH-4031 Basel Switzerland
| | - Stefano Boccardo
- Department of Biomedicine; University of Basel; Hebelstrasse 20 CH-4031 Basel Switzerland
- Department of Surgery; University Hospital Basel; Spitalstrasse 21 CH-4031 Basel Switzerland
| | - Sasan Jalili-Firoozinezhad
- Department of Biomedicine; University of Basel; Hebelstrasse 20 CH-4031 Basel Switzerland
- Department of Surgery; University Hospital Basel; Spitalstrasse 21 CH-4031 Basel Switzerland
| | - Lifen Xu
- Department of Biomedicine; University of Basel; Hebelstrasse 20 CH-4031 Basel Switzerland
| | - Friedrich Eckstein
- Department of Biomedicine; University of Basel; Hebelstrasse 20 CH-4031 Basel Switzerland
- Department of Surgery; University Hospital Basel; Spitalstrasse 21 CH-4031 Basel Switzerland
| | - Ivan Martin
- Department of Biomedicine; University of Basel; Hebelstrasse 20 CH-4031 Basel Switzerland
- Department of Surgery; University Hospital Basel; Spitalstrasse 21 CH-4031 Basel Switzerland
| | - Beat A. Kaufmann
- Department of Biomedicine; University of Basel; Hebelstrasse 20 CH-4031 Basel Switzerland
| | - Andrea Banfi
- Department of Biomedicine; University of Basel; Hebelstrasse 20 CH-4031 Basel Switzerland
- Department of Surgery; University Hospital Basel; Spitalstrasse 21 CH-4031 Basel Switzerland
| | - Anna Marsano
- Department of Biomedicine; University of Basel; Hebelstrasse 20 CH-4031 Basel Switzerland
- Department of Surgery; University Hospital Basel; Spitalstrasse 21 CH-4031 Basel Switzerland
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10
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Xu HL, Yu WZ, Lu CT, Li XK, Zhao YZ. Delivery of growth factor-based therapeutics in vascular diseases: Challenges and strategies. Biotechnol J 2017; 12. [PMID: 28296342 DOI: 10.1002/biot.201600243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 01/27/2017] [Accepted: 02/09/2017] [Indexed: 12/18/2022]
Abstract
Either cardiovascular or peripheral vascular diseases have become the major cause of morbidity and mortality worldwide. Recently, growth factors therapeutics, whatever administrated in form of exogenous growth factors or their relevant genes have been discovered to be an effective strategy for the prevention and therapy of vascular diseases, because of their promoting angiogenesis. Besides, as an alternative, stem cell-based therapy has been also developed in view of their paracrine-mediated effect or ability of differentiation toward angiogenesis-related cells under assistance of growth factors. Despite of being specific and potent, no matter growth factors or stem cells-based therapy, their full clinical transformation is limited from bench to bedside. In this review, the potential choices of therapeutic modes based on types of different growth factors or stem cells were firstly summarized for vascular diseases. The confronted various challenges such as lack of non-invasive delivery method, the physiochemical challenge, the short half-life time, and poor cell survival, were carefully analyzed for these therapeutic modes. Various strategies to overcome these limitations are put forward from the perspective of drug delivery. The expertised design of a suitable delivery form will undoubtedly provide valuable insight into their clinical application in the regenerative medicine.
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Affiliation(s)
- He-Lin Xu
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Wen-Ze Yu
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Cui-Tao Lu
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Xiao-Kun Li
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou City, Zhejiang Province, China.,Collaborative Innovation Center of Biomedical Science by Wenzhou University & Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
| | - Ying-Zheng Zhao
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou City, Zhejiang Province, China
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11
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Boccardo S, Gaudiello E, Melly L, Cerino G, Ricci D, Martin I, Eckstein F, Banfi A, Marsano A. Engineered mesenchymal cell-based patches as controlled VEGF delivery systems to induce extrinsic angiogenesis. Acta Biomater 2016; 42:127-135. [PMID: 27469308 DOI: 10.1016/j.actbio.2016.07.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/19/2016] [Accepted: 07/23/2016] [Indexed: 12/26/2022]
Abstract
UNLABELLED Therapeutic over-expression of Vascular Endothelial Growth Factor (VEGF) by transduced progenitors is a promising strategy to efficiently induce angiogenesis in ischemic tissues (e.g. limb muscle and myocardium), but tight control over the micro-environmental distribution of the dose is required to avoid induction of angioma-like tumors. Therapeutic VEGF release was achieved by purified transduced adipose mesenchymal stromal cells (ASC) that homogeneously produce specific VEGF levels, inducing only normal angiogenesis after injection in non-ischemic tissues. However, the therapeutic potential of this approach mostly in the cardiac field is limited by the poor cell survival and the restricted area of effect confined to the cell-injection site. The implantation of cells previously organized in vitro in 3D engineered tissues could overcome these issues. Here we hypothesized that collagen sponge-based construct (patch), generated by ASC expressing controlled VEGF levels, can function as delivery device to induce angiogenesis in surrounding areas (extrinsic vascularization). A 7-mm-thick acellular collagen scaffold (empty), sutured beneath the patch, provided a controlled and reproducible model to clearly investigate the ongoing angiogenesis in subcutaneous mice pockets. VEGF-expressing ASC significantly increased the capillary in-growth inside both the patch itself and the empty scaffold compared to naïve cells, leading to significantly improved survival of implanted cells. These data suggest that this strategy confers control (i) on angiogenesis efficacy and safety by means of ASC expressing therapeutic VEGF levels and (ii) over the treated area through the specific localization in an engineered collagen sponge-based patch. STATEMENT OF SIGNIFICANCE Development of efficient pro-angiogenic therapies to restore the micro-vascularization in ischemic tissues is still an open issue. Although extensively investigated, the promising approach based on injections of progenitors transduced to over-express Vascular Endothelial Growth Factor (VEGF) has still several limitations: (i) need of a tight control over the microenvironmental VEGF dose to avoid angioma-like tumor growth; (ii) poor implanted cell survival; (iii) effect area restricted mainly to the injection sites. Here, we aimed to overcome these drawbacks by generating a novel cell-based controlled VEGF delivery device. In particular, transduced mesenchymal cells, purified to release a sustained, safe and efficient VEGF dose, were organized in three-dimensional engineered tissues to improve cell survival and provide a uniform vascularization throughout both the mm-thick implanted constructs themselves and the surrounding area.
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Affiliation(s)
- Stefano Boccardo
- Department of Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedicine, University of Basel, Basel, Switzerland; Musculoskeletal Disease Area, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Emanuele Gaudiello
- Department of Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Ludovic Melly
- Department of Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Giulia Cerino
- Department of Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Davide Ricci
- CTNSC, Istituto Italiano di Tecnologia, Ferrara, Italy
| | - Ivan Martin
- Department of Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Friedrich Eckstein
- Department of Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Andrea Banfi
- Department of Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Anna Marsano
- Department of Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedicine, University of Basel, Basel, Switzerland.
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12
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Rai R, Tallawi M, Frati C, Falco A, Gervasi A, Quaini F, Roether JA, Hochburger T, Schubert DW, Seik L, Barbani N, Lazzeri L, Rosellini E, Boccaccini AR. Bioactive electrospun fibers of poly(glycerol sebacate) and poly(ε-caprolactone) for cardiac patch application. Adv Healthc Mater 2015; 4:2012-25. [PMID: 26270628 DOI: 10.1002/adhm.201500154] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/31/2015] [Indexed: 12/21/2022]
Abstract
Scaffolds for cardiac patch application must meet stringent requirements such as biocompatibility, biodegradability, and facilitate vascularization in the engineered tissue. Here, a bioactive, biocompatible, and biodegradable electrospun scaffold of poly(glycerol sebacate)-poly(ε-caprolactone) (PGS-PCL) is proposed as a potential scaffold for cardiac patch application. The fibers are smooth bead free with average diameter = 0.8 ± 0.3 μm, mean pore size = 2.2 ± 1.2 μm, porosity = 62 ± 4%, and permeability higher than that of control biological tissue. For the first time, bioactive PGS-PCL fibers functionalized with vascular endothelial growth factor (VEGF) are developed, the approach used being chemical modification of the PGS-PCL fibers followed by subsequent binding of VEGF via amide bonding. The approach results in uniform immobilization of VEGF on the fibers; the concentrations are 1.0 μg cm(-2) for the PGS-PCL (H) and 0.60 μg cm(-2) for the PGS-PCL (L) samples. The bioactive scaffold supports the attachment and growth of seeded myogenic and vasculogenic cell lines. In fact, rat aortic endothelial cells also display angiogenic features indicating potential for the formation of vascular tree in the scaffold. These results therefore demonstrate the prospects of VEGF-functionalized PGS-PCL fibrous scaffold as promising matrix for cardiac patch application.
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Affiliation(s)
- Ranjana Rai
- Institute of Biomaterials Department of Materials Science and Engineering; University of Erlangen-Nuremberg; 91058 Erlangen Germany
| | - Marwa Tallawi
- Institute of Biomaterials Department of Materials Science and Engineering; University of Erlangen-Nuremberg; 91058 Erlangen Germany
| | - Caterina Frati
- Department of Medicine and Pathology; University of Parma; 12-I 43126 Parma Italy
| | - Angela Falco
- Department of Medicine and Pathology; University of Parma; 12-I 43126 Parma Italy
| | - Andrea Gervasi
- Department of Medicine and Pathology; University of Parma; 12-I 43126 Parma Italy
| | - Federico Quaini
- Department of Medicine and Pathology; University of Parma; 12-I 43126 Parma Italy
| | - Judith A. Roether
- Institute of Polymeric Materials; Department of Materials Science and Engineering; University of Erlangen-Nuremberg; 91058 Erlangen Germany
| | - Tobias Hochburger
- Institute of Polymeric Materials; Department of Materials Science and Engineering; University of Erlangen-Nuremberg; 91058 Erlangen Germany
| | - Dirk W. Schubert
- Institute of Polymeric Materials; Department of Materials Science and Engineering; University of Erlangen-Nuremberg; 91058 Erlangen Germany
| | - Lothar Seik
- Ibt - Immunological and Biochemical Testsystems GmbH Wiesenstr. 17; 88521 Binzwangen Germany
| | - Niccoletta Barbani
- Department of Civil and Industrial Engineering; Largo Lucio Lazzarino; 56126 Pisa Italy
| | - Luigi Lazzeri
- Department of Civil and Industrial Engineering; Largo Lucio Lazzarino; 56126 Pisa Italy
| | - Elisabetta Rosellini
- Department of Civil and Industrial Engineering; Largo Lucio Lazzarino; 56126 Pisa Italy
| | - Aldo R. Boccaccini
- Institute of Biomaterials Department of Materials Science and Engineering; University of Erlangen-Nuremberg; 91058 Erlangen Germany
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13
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Yu M, Jie X, Xu L, Chen C, Shen W, Cao Y, Lian G, Qi R. Recent Advances in Dendrimer Research for Cardiovascular Diseases. Biomacromolecules 2015; 16:2588-98. [DOI: 10.1021/acs.biomac.5b00979] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Maomao Yu
- Peking
University Institute of Cardiovascular Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Xu Jie
- School
of Pharmacy, Shihezi University, Shihezi 832000, China
| | - Lu Xu
- Peking
University Institute of Cardiovascular Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Cong Chen
- Peking
University Institute of Cardiovascular Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Wanli Shen
- School
of Pharmacy, Shihezi University, Shihezi 832000, China
| | - Yini Cao
- Peking
University Institute of Cardiovascular Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Guan Lian
- School
of Pharmacy, Shihezi University, Shihezi 832000, China
| | - Rong Qi
- Peking
University Institute of Cardiovascular Sciences, Peking University Health Science Center, Beijing 100191, China
- School
of Pharmacy, Shihezi University, Shihezi 832000, China
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14
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Martino MM, Brkic S, Bovo E, Burger M, Schaefer DJ, Wolff T, Gürke L, Briquez PS, Larsson HM, Gianni-Barrera R, Hubbell JA, Banfi A. Extracellular matrix and growth factor engineering for controlled angiogenesis in regenerative medicine. Front Bioeng Biotechnol 2015; 3:45. [PMID: 25883933 PMCID: PMC4381713 DOI: 10.3389/fbioe.2015.00045] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/19/2015] [Indexed: 01/22/2023] Open
Abstract
Blood vessel growth plays a key role in regenerative medicine, both to restore blood supply to ischemic tissues and to ensure rapid vascularization of clinical-size tissue-engineered grafts. For example, vascular endothelial growth factor (VEGF) is the master regulator of physiological blood vessel growth and is one of the main molecular targets of therapeutic angiogenesis approaches. However, angiogenesis is a complex process and there is a need to develop rational therapeutic strategies based on a firm understanding of basic vascular biology principles, as evidenced by the disappointing results of initial clinical trials of angiogenic factor delivery. In particular, the spatial localization of angiogenic signals in the extracellular matrix (ECM) is crucial to ensure the proper assembly and maturation of new vascular structures. Here, we discuss the therapeutic implications of matrix interactions of angiogenic factors, with a special emphasis on VEGF, as well as provide an overview of current approaches, based on protein and biomaterial engineering that mimic the regulatory functions of ECM to optimize the signaling microenvironment of vascular growth factors.
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Affiliation(s)
- Mikaël M Martino
- Host Defense, Immunology Frontier Research Center, Osaka University , Osaka , Japan
| | - Sime Brkic
- Cell and Gene Therapy, Department of Biomedicine, Basel University , Basel , Switzerland ; Department of Surgery, Basel University Hospital , Basel , Switzerland
| | - Emmanuela Bovo
- Cell and Gene Therapy, Department of Biomedicine, Basel University , Basel , Switzerland ; Department of Surgery, Basel University Hospital , Basel , Switzerland
| | - Maximilian Burger
- Cell and Gene Therapy, Department of Biomedicine, Basel University , Basel , Switzerland ; Department of Surgery, Basel University Hospital , Basel , Switzerland ; Plastic, Reconstructive, Aesthetic and Hand Surgery, Department of Surgery, Basel University Hospital , Basel , Switzerland
| | - Dirk J Schaefer
- Plastic, Reconstructive, Aesthetic and Hand Surgery, Department of Surgery, Basel University Hospital , Basel , Switzerland
| | - Thomas Wolff
- Cell and Gene Therapy, Department of Biomedicine, Basel University , Basel , Switzerland ; Department of Surgery, Basel University Hospital , Basel , Switzerland ; Vascular Surgery, Department of Surgery, Basel University Hospital , Basel , Switzerland
| | - Lorenz Gürke
- Vascular Surgery, Department of Surgery, Basel University Hospital , Basel , Switzerland
| | - Priscilla S Briquez
- Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL) , Lausanne , Switzerland
| | - Hans M Larsson
- Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL) , Lausanne , Switzerland
| | - Roberto Gianni-Barrera
- Cell and Gene Therapy, Department of Biomedicine, Basel University , Basel , Switzerland ; Department of Surgery, Basel University Hospital , Basel , Switzerland
| | - Jeffrey A Hubbell
- Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL) , Lausanne , Switzerland ; Institute for Molecular Engineering, University of Chicago , Chicago, IL , USA ; Argonne National Laboratory, Materials Science Division , Argonne, IL , USA
| | - Andrea Banfi
- Cell and Gene Therapy, Department of Biomedicine, Basel University , Basel , Switzerland ; Department of Surgery, Basel University Hospital , Basel , Switzerland
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15
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Montgomery M, Zhang B, Radisic M. Cardiac Tissue Vascularization: From Angiogenesis to Microfluidic Blood Vessels. J Cardiovasc Pharmacol Ther 2014; 19:382-393. [PMID: 24764132 DOI: 10.1177/1074248414528576] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Myocardial infarction results from a blockage of a major coronary artery that shuts the delivery of oxygen and nutrients to a region of the myocardium, leading to massive cardiomyocytes death and regression of microvasculature. Growth factor and cell delivery methods have been attempted to revascularize the ischemic myocardium and prevent further cell death. Implantable cardiac tissue patches were engineered to directly revascularize as well as remuscularize the affected muscle. However, inadequate vascularization in vitro and in vivo limits the efficacy of these new treatment options. Breakthroughs in cardiac tissue vascularization will profoundly impact ischemic heart therapies. In this review, we discuss the full spectrum of vascularization approaches ranging from biological angiogenesis to microfluidic blood vessels as related to cardiac tissue engineering.
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Affiliation(s)
- Miles Montgomery
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Boyang Zhang
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Milica Radisic
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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16
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Erekat NS, Al-Jarrah MD, Al Khatib AJ. Treadmill Exercise Training Improves Vascular Endothelial Growth Factor Expression in the Cardiac Muscle of Type I Diabetic Rats. Cardiol Res 2014; 5:23-29. [PMID: 28392871 PMCID: PMC5358275 DOI: 10.14740/cr314w] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2013] [Indexed: 12/31/2022] Open
Abstract
Background Vascular endothelial growth factor (VEGF) expression is a potent mitogen for endothelial cells that is involved in angiogenesis. Cardiac VEGF is decreased in many pathologic conditions, including diabetes mellitus and aging. Exercise training has improved VEGF expression in the aging heart. Thus, the aim of our study is to illustrate the impact of treadmill exercise training on the cardiac VEGF expression in type I diabetic rats. Methods Twenty normal Sprague-Dawley rats and Sprague-Dawley rats with streptozotocin-induced diabetes were divided into the following equal groups: sedentary control (SC), exercised control (EC), sedentary diabetic rats (SD) and exercised diabetic rats (ED). Immunohistochemistry was used to investigate VEGF expression in the cardiac tissue in each of the four different groups. Results Cardiac VEGF expression was significantly (P < 0.05) lower in SD compared with that in SC. However, exercise training significantly (P < 0.01) enhanced VEGF expression in the cardiac tissue in ED compared with that in SD. Conclusion Our present data suggest that treadmill exercise training improved diabetes-induced downregulation in the cardiac VEGF expression.
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Affiliation(s)
- Nour S Erekat
- Department of Anatomy, Faculty of Medicine, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Muhammed D Al-Jarrah
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, JUST, Irbid, Jordan
| | - Ahed J Al Khatib
- Department of Pathology, Faculty of Medicine, JUST, Irbid, Jordan
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17
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Abstract
Heart failure is a devastating condition, the progression of which culminates in a mismatch of oxygen supply and demand, with limited options for treatment. Heart failure has several underlying causes including, but not limited to, ischaemic heart disease, valvular dysfunction, and hypertensive heart disease. Dysfunctional blood vessel formation is a major problem in advanced heart failure, regardless of the aetiology. Vascular endothelial growth factor (VEGF) is the cornerstone cytokine involved in the formation of new vessels. A multitude of investigations, at both the preclinical and clinical levels, have garnered valuable information on the potential utility of targeting VEGF as a treatment option for heart failure. However, clinical trials of VEGF gene therapy in patients with coronary artery disease or peripheral artery disease have not, to date, demonstrated clinical benefit. In this Review, we outline the biological characterization of VEGF, and examine the evidence for its potential therapeutic application, including the novel concept of VEGF as adjuvant therapy to stem cell transplantation, in patients with heart failure.
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18
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Mechanistic, technical, and clinical perspectives in therapeutic stimulation of coronary collateral development by angiogenic growth factors. Mol Ther 2013; 21:725-38. [PMID: 23403495 DOI: 10.1038/mt.2013.13] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Stimulation of collateral vessel development in the heart by angiogenic growth factor therapy has been tested in animals and humans for almost two decades. Discordance between the outcome of preclinical studies and clinical trials pointed to the difficulties of translation from animal models to patients. Lessons learned in this process identified specific mechanistic, technical, and clinical hurdles, which need to be overcome. This review summarizes current understanding of the mechanisms leading to the establishment of a functional coronary collateral network and the biological processes growth factor therapies should stimulate even under conditions of impaired natural adaptive vascular response. Vector delivery methods are recommended to maximize angiogenic gene therapy efficiency and reduce side effects. Optimization of clinical trial design should include the choice of clinical end points which provide mechanistic proof-of-concept and also reflect clinical benefits (e.g., surrogates to assess increased collateral flow reserve, such as myocardial perfusion imaging). Guidelines are proposed to select patients who may respond to the therapy with high(er) probability. Both short and longer term strategies are outlined which may help to make therapeutic angiogenesis (TA) work in the future.
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19
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Melly L, Boccardo S, Eckstein F, Banfi A, Marsano A. Cell and gene therapy approaches for cardiac vascularization. Cells 2012; 1:961-75. [PMID: 24710537 PMCID: PMC3901132 DOI: 10.3390/cells1040961] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 10/16/2012] [Accepted: 10/25/2012] [Indexed: 12/16/2022] Open
Abstract
Despite encouraging preclinical results for therapeutic angiogenesis in ischemia, a suitable approach providing sustained, safe and efficacious vascular growth in the heart is still lacking. Vascular Endothelial Growth Factor (VEGF) is the master regulator of angiogenesis, but it also can easily induce aberrant and dysfunctional vascular growth if its expression is not tightly controlled. Control of the released level in the microenvironment around each cell in vivo and its distribution in tissue are critical to induce stable and functional vessels for therapeutic angiogenesis. The present review discusses the limitations and perspectives of VEGF gene therapy and of different cell-based approaches for the implementation of therapeutic angiogenesis in the treatment of cardiac ischemia.
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Affiliation(s)
- Ludovic Melly
- Cell and Gene Therapy, Department of Biomedicine and Department of Surgery, Basel University Hospital, Basel 4031, Switzerland.
| | - Stefano Boccardo
- Department of Robotics, Brain & Cognitive Sciences, Istituto Italiano di Tecnologia, Genova 16163, Italy.
| | - Friedrich Eckstein
- Cardiac Surgery, Department of Surgery, Basel University Hospital, Basel 4031, Switzerland.
| | - Andrea Banfi
- Cell and Gene Therapy, Department of Biomedicine and Department of Surgery, Basel University Hospital, Basel 4031, Switzerland.
| | - Anna Marsano
- Cell and Gene Therapy, Department of Biomedicine and Department of Surgery, Basel University Hospital, Basel 4031, Switzerland.
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