Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

10-year safety follow-up in patients with local VEGF gene transfer to ischemic lower limb

Abstract

Vascular endothelial growth factor (VEGF)-mediated gene therapy (GT) has shown promising results as a novel method in the treatment of severe cardiovascular diseases. VEGF GT has proved to be safe and well tolerated in short-term studies, but there is only very limited data available on long-term effects. In this study we examined the effects of VEGF GT on patients having received VEGF-A gene transfer for the treatment of symptomatic (that is, claudication or critical lower limb ischemia) peripheral arterial occlusive disease. Out of 54 patients, 25 (46%) were interviewed for this study and 26 (48%) had died during the follow-up. Interviewed patients were treated with adenoviral (n=8, mean age 76 (62.7–90.6) years) or plasmid/liposome (n=8, mean age 84.2 (71.9–94.7) years) vectors compared with a randomized control group (n=10, mean age 80.5 (70.7–88.1) years) using a local balloon catheter device. The follow-up time was 10 years. Causes of death were clarified from hospital records. There were no statistically significant differences between the study groups in the causes of death or in the incidence of cancer (VEGF-Adv 0/10 vs VEGF-p/l 1/8 vs Control 1/7, P=0.5), diabetes (3/10 vs 3/8 vs 2/7, P=1.00) or diabetic retinopathy (0/10 vs 1/8 vs 0/7, P=0.45). In addition, we found no differences in the number of amputations of the treated leg (0/10 vs 3/8 vs 1/7, P=0.17). We conclude that transient VEGF-A-mediated GT did not increase the incidence of cancer, diabetes, retinopathy or any other diseases during the 10-year follow-up time. No significant differences were detected in the number of amputations or causes of death. This study supports our previous findings that local adenovirus and plasmid/liposome-mediated VEGF-A GT is safe and well-tolerated treatment in elderly patients with cardiovascular diseases.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

Accession codes

Accessions

GenBank/EMBL/DDBJ

References

  1. Baumgartner I, Pieczek A, Manor O, Blair R, Kearney M, Walsh K et al. Constitutive expression of phVEGF165 after intramuscular gene transfer promotes collateral vessel development in patients with critical limb ischemia. Circulation 1998; 97: 1114–1123.

    Article  CAS  Google Scholar 

  2. Tongers J, Roncalli J, Losordo D . Therapeutic angiogenesis for critical limb ischemia, microvascular therapies coming of age. Circulation 2008; 118: 9–16.

    Article  Google Scholar 

  3. Hedman M, Hartikainen J, Syvänne M, Stjernvall J, Hedman A, Kivelä A et al. Safety and feasibility of catheter-based local intracoronary vascular endothelial growth factor gene transfer in the prevention of postangioplasty and in-stent restenosis and in the treatment of chronic myocardial ischemia: phase II results of the Kuopio Angiogenesis Trial (KAT). Circulation 2003; 107: 2677–2683.

    Article  CAS  Google Scholar 

  4. Mäkinen K, Manninen H, Hedman M, Matsi P, Mussalo H, Alhava E et al. Increased vascularity detected by digital subtraction angiography after VEGF gene transfer to human lower limb artery: a randomized, placebo-controlled, double-blinded phase II study. Mol Ther 2002; 6: 127–133.

    Article  Google Scholar 

  5. Amano H, Hackett NR, Kaner RJ, Whitlock P, Rosengart TK, Crystal RJ . Alteration of splicing signals in a genomic/cDNA hybrid VEGF gene to modify the ratio of expressed VEGF isoforms enhances safety of angiogenic gene therapy. Mol Ther 2005; 12: 715–724.

    Article  Google Scholar 

  6. Wirth T, Hedman M, Mäkinen K, Manninen H, Immonen A, Vapalahti M et al. Safety profile of plasmid/lipsomes and virus vectors in clinical gene therapy. Curr Drug Saf 2006; 1: 253–257.

    Article  CAS  Google Scholar 

  7. Kim H-J, Jang S, Park J-I, Buyn J, Kim D-I, Do S-Y . Vascular endothelial growth factor induced gene therapy in patients with peripheral arterial disease. Exp Mol Med 2004; 36: 336–344.

    Article  CAS  Google Scholar 

  8. Noguchi P . Risks and benefits of gene therapy. New Engl J Med 2003; 348: 193–194.

    Article  Google Scholar 

  9. Isner J, Vale P, Symes J, Losordo D . Assessement of risks associated with cardiovascular gene therapy in human subjects. Circ Res 2001; 89: 389–400.

    Article  CAS  Google Scholar 

  10. Hacein-Bey-Abina S, Garrigue A, Wang GP, Soulier J, Lim A, Morillon E et al. Insertional ocogenesis in 4 patients after retrovitus-mediated gene therapy of SCID-X1. J Clin Invest 2008; 118: 3132–3142.

    Article  CAS  Google Scholar 

  11. Dettweiler U, Simon P . Points to consider for ethics committees in human gene therapy trials. Bioethics 2001; 15: 491–500.

    Article  CAS  Google Scholar 

  12. Gaffney MM, Hynes SO, Barry F, O’Brien T . Cardiovascular gene therapy: current status and therapeutic potential. Br J Pharmacol 2007; 152: 175–188.

    Article  CAS  Google Scholar 

  13. Isner M, Baumgartner I, Rauh G, Schainfeld R, Blair R, Manor O et al. Treatment of thromboangiitis obliterans (Buerger's disease) by intramuscular gene transfer of vascular endothelial growth factor: preliminary clinical results. J Vasc Surg 1998; 28: 964–975.

    Article  CAS  Google Scholar 

  14. Kastrup J, Jørgensen E, Rück A, Tägil K, Glogar D, Ruzyllo W et al. Direct intramyocardial plasmid vascular endothelial growth factor-A165 gene therapy in patients with stable severe angina pectoris: a randomized double-blind placebo-controlled study: the Euroinject One Trial. J Am Coll Cardiol 2005; 45: 982–988.

    Article  CAS  Google Scholar 

  15. Chen Y . Orthopedic applications of gene therapy. J Orthop Sci 2001; 6: 199–207.

    Article  CAS  Google Scholar 

  16. Kastrup J, Jørgensen E, Fuchs S, Nikol S, Bøtker HE, Gyöngyösi M et al. A randomised, double-blind, placebo-controlled, multicentre study of the safety and efficacy of BIOBYPASS (AdGVVEGF121.10NH) gene therapy in patients with refractory advanced coronary artery disease: the NOVA trial. Eurointervention 2011; 6: 813–818.

    Article  Google Scholar 

  17. Hedman M, Muona K, Hedman A, Kivelä A, Syvänne M, Eränen J et al. Eight-year safety follow-up of coronary artery disease patients after local intracoronary VEGF gene transfer. Gene Therapy 2009; 16: 629–634.

    Article  CAS  Google Scholar 

  18. Fontaine R, Kim M, Kieny R . Die chirurgische Behandlung der peripheren Durchblutungsstörungen. Helv Chir Acta 1954; 21: 499–533.

    CAS  PubMed  Google Scholar 

  19. Kannel WB, McGee DL . Update on some epidemiologic features of intermittent claudication: the Framingham Study. J Am Geriatr Soc 1985; 33: 13–18.

    Article  CAS  Google Scholar 

  20. Norgren L . Non-surgical treatment of critical limb ischaemia. Eur J Vasc Surg 1990; 4: 463–467.

    Article  CAS  Google Scholar 

  21. Lepäntalo M, Mätzke S . Outcome of unreconstructed chronic crtical limb ischaemia. Eur J Vasc Endovasc Surg 1996; 11: 153–157.

    Article  Google Scholar 

  22. Morishita R, Aoki M, Hashiya N, Makino H, Yamasaki K, Atsuma J . Safety evaluation of clinical gene therapy using using hepatocyte growth factor to treat peripheral arterial disease. Hypertension 2004; 44: 203–209.

    Article  CAS  Google Scholar 

  23. Patel SR, Lee LY, Mack CA, Polce DR, El-Sawy T, Hackett NR et al. Safety of direct myocardial administration of an adenovirus vector encoding vascular endothelial growth factor 121. Hum Gene Ther 1999; 10: 1331–1348.

    Article  CAS  Google Scholar 

  24. Viita H, Kinnunen K, Eriksson E, Lähteenvuo J, Babu M, Kalesnykas G et al. Intravitreal adenoviral 15-lipoxygenase-1 gene transfer prevents vascular endothelial growth factor A-induced neovascularization in rabbit eyes. Hum Gen Ther 2009; 20: 1679–1686.

    Article  CAS  Google Scholar 

  25. Ylä-Herttuala S, Alitalo K . Gene transfer as a tool to induce therapeutic vascular growth. Nat Med 2003; 9: 694–701.

    Article  Google Scholar 

  26. Rutanen J, Rissanen TT, Markkanen JE, Gruchala M, Kivelä A, Hedman A et al. Adenoviral catheter-mediated intramyocardial VEGF-DNC gene transfer induces transmural angiogenesis in porcine heart. Circulation 2004; 109: 1029–1035.

    Article  CAS  Google Scholar 

  27. Perrin LA, June JE, Rosebury W, Robertson A, Kovesdi I, Bruder JT et al. Increased revascularization efficacy after administration of adenovirus encoding VEGF121 . Gene Therapy 2004; 11: 512–521.

    Article  CAS  Google Scholar 

  28. Stewart DJ, Kutryk M, Fitchett D, Freeman M, Camack N, Su Y . VEGF gene therapy fails to improve perfusion of ischemic myocardium in patients with advanced coronary disease: results of the NORTHERN TRIAL. Mol Ther 2009; 17: 1109–1115.

    Article  CAS  Google Scholar 

  29. Hattan N, Chilian WM, Rocic P . Restoration of coronary collateral growth in the Zucker obese rat: impact of VEGF and ecSOD. Basic Res Cardiol 2007; 102: 217–223.

    Article  CAS  Google Scholar 

  30. Fujii H, Sun Z, Li SH, Wu J, Fazel S, Weisel RD et al. Ultrasound-targeted gene delivery induces angiogenesis after a myocardial infarction in mice. JACC Cardiovasc imaging 2009; 2: 880–882.

    Article  Google Scholar 

  31. Tang J, Wang J, Zheng F, Kong X, Guo L, Yang J et al. Combination of chemokine and angiogenic factor genes and mesenchymal stem cells could enhance angiogenesis and improve cardiac function after acute myocardial infarction in rats. Mol Cell Biochem 2010; 339: 107–118.

    Article  CAS  Google Scholar 

  32. Laitinen M, Mäkinen K, Manninen H, Matsi P, Kossila M, Agrawal RS et al. Adenovirus-mediated gene transfer to lower limb artery of patients with chronic critical leg ischemia. Hum Gene Ther 1998; 9: 1481–1486.

    Article  CAS  Google Scholar 

  33. Laitinen M, Hartikainen J, Hiltunen MO, Eränen J, Kiviniemi M, Närvänen O et al. Catheter-mediated vascular endothelial growth factor gene transfer to human coronary arteries after angioplasty. Hum Gene Ther 2000; 11: 263–270.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study was supported by grants from Finnish Academy, University of Eastern Finland spearhead project funds, Clinigene EU Network of Excellence and The Finnish Medical Foundation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S Ylä-Herttuala.

Ethics declarations

Competing interests

The authors declare no conflict of interest

Rights and permissions

Reprints and permissions

About this article

Cite this article

Muona, K., Mäkinen, K., Hedman, M. et al. 10-year safety follow-up in patients with local VEGF gene transfer to ischemic lower limb. Gene Ther 19, 392–395 (2012). https://doi.org/10.1038/gt.2011.109

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/gt.2011.109

Keywords

This article is cited by

Search

Quick links