Vascular endothelial growth factor in patients with critical limb ischemia before and after amputation.
BACKGROUND
It is known that levels of vascular endothelial growth factor (VEGF) in biological fluids increase with inflammation and vascular proliferation. Theraputic angiogenesis by injection of VEGF or genes encoding for it may be a promising strategy for treatment of critical limb ischemia. However growth factors are also implicated in the development of vascular disease by smooth muscle cell proliferation.


METHODS
We have previously shown VEGF levels to be increased in juvenile diabetic subjects with no clinical evidence of vascular disease. We have measured serum VEGF using an enzyme linked immunosorbent assay and cellular VEGF expression using flow cytometry in patients with critical limb ischemia prior to and 6 months postamputation to determine whether removal of the ischemic limb leads to changes in systemic endothelial cell function.


RESULTS
Baseline VEGF levels were significantly increased in the patient group compared to controls with levels returning to control levels at 6 months postsurgery. Monocyte and neutrophil VEGF expression was significantly reduced in the patient group. Platelet expression of VEGF was also reduced but this failed to reach statistical significance.


CONCLUSIONS
The results suggest that it may be useful to determine the balance between VEGF production and cellular receptor expression prior to treatment.
Department of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom. m.mclaren@dundee.ac.uk
M
M
McLaren
D J
DJ
Newton
F
F
Khan
J J F
JJ
Belch
D000368:Aged; D000671:Amputation, Surgical; D016022:Case-Control Studies; D016228:Endothelial Growth Factors / Q000097:blood*; D004730:Endothelium, Vascular / Q000502:physiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000097:blood*; D007511:Ischemia / Q000097:blood* / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008222:Lymphokines / Q000097:blood*; D008297:Male; D020033:Protein Isoforms / Q000097:blood; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors
D016228:Endothelial Growth Factors; D036341:Intercellular Signaling Peptides and Proteins; D008222:Lymphokines; D020033:Protein Isoforms; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors