title: VEGF gene delivery to myocardium: deleterious effects of unregulated expression.
abstract: BACKGROUND
  Vascular endothelial growth factor (VEGF) is being investigated for therapeutic angiogenesis in ischemic myocardium. Primarily, transient delivery systems have been tested. The goal of this study was to investigate the effects of continuous expression of VEGF in myocardium by use of myoblast-mediated delivery.
  
  
  RESULTS
  Primary murine myoblasts (5 x 10(5) cells in 10 microL of PBS with 0.5% BSA) expressing both the murine VEGF gene and the beta-galactosidase (beta-gal) gene from a retroviral promoter were implanted in the ventricular wall of immunodeficient mice (n=11) via a subdiaphragmatic approach. Control immunodeficient mice (n=12) were injected with the same number of myoblasts expressing only the beta-gal gene. Between days 14 and 16, surviving mice were euthanized and the hearts processed for histology. In the experimental group, 11 of 11 mice demonstrated failure to thrive by day 13; 5 deaths occurred between days 8 and 15. There were no complications in the control mice. Histochemistry documented successful implantation of myoblasts (positive beta-gal reaction product) in 6 of 6 surviving experimental mice and 12 of 12 controls. Histology disclosed intramural vascular tumors resembling hemangiomas in the VEGF-myoblast-injected myocardium in 6 of 6 surviving mice. beta-Gal-expressing cells were present at the site of the vascular tumors. Immunohistochemistry localized abundant endothelial nitric oxide synthase and CD31 (platelet and endothelial cell adhesion molecule) within the lesion, consistent with the presence of endothelial cells.
  
  
  CONCLUSIONS
  In this model, unregulated continuous expression of VEGF is associated with (1) a high rate of failure to thrive/death and (2) formation of endothelial cell-derived intramural vascular tumors in the implantation site. These results underscore the importance of regulating VEGF expression for therapeutic angiogenesis.
authors.affiliation: Department of Medicine and the Cardiovascular Research Institute, University of California, San Francisco, USA. lee@ep4.ucsf.edu
authors.forename: R J
authors.initials: RJ
authors.lastname: Lee
authors.forename: M L
authors.initials: ML
authors.lastname: Springer
authors.forename: W E
authors.initials: WE
authors.lastname: Blanco-Bose
authors.forename: R
authors.initials: R
authors.lastname: Shaw
authors.forename: P C
authors.initials: PC
authors.lastname: Ursell
authors.forename: H M
authors.initials: HM
authors.lastname: Blau
mesh_terms: D000818:Animals; D017690:Cell Transplantation; D016228:Endothelial Growth Factors / Q000096:biosynthesis* / Q000235:genetics*; D005786:Gene Expression Regulation; D018014:Gene Transfer Techniques / Q000009:adverse effects*; D006338:Heart Neoplasms / Q000235:genetics* / Q000378:metabolism / Q000473:pathology; D006391:Hemangioma / Q000235:genetics* / Q000378:metabolism / Q000473:pathology; D008222:Lymphokines / Q000096:biosynthesis* / Q000235:genetics*; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D016513:Mice, SCID; D018482:Muscle, Skeletal / Q000166:cytology / Q000378:metabolism / Q000502:physiology; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors
chemical_list: D016228:Endothelial Growth Factors; D008222:Lymphokines; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors