Antiangiogenesis mediates cisplatin-induced peripheral neuropathy: attenuation or reversal by local vascular endothelial growth factor gene therapy without augmenting tumor growth.
BACKGROUND
Toxic neuropathies induced by cisplatin and other chemotherapeutic agents are important clinical problems because of their high incidence, their lack of effective treatment, and the fact that neuropathy represents a dose-limiting factor for these therapies. The pathogenic basis for toxic neuropathies induced by chemotherapeutic agents has not been completely elucidated.


RESULTS
We investigated the hypothesis that experimental toxic neuropathy results from an antiangiogenic effect of these drugs, resulting in destruction of the vasa nervorum, and accordingly that the neuropathy could be prevented or reversed by locally administered VEGF gene transfer without augmenting tumor growth. In an animal model of cisplatin-induced neuropathy, nerve blood flow was markedly attenuated, and there was a profound reduction in the number of vasa nervorum associated with marked endothelial cell apoptosis, resulting in a severe peripheral neuropathy with focal axonal degeneration characteristic of ischemic neuropathy. After intramuscular gene transfer of naked plasmid DNA encoding VEGF-1 in animals with an established neuropathy, vascularity and blood flow returned to levels similar to those of control rats, peripheral nerve function was restored, and histological nerve architecture was normalized. Gene therapy administered in parallel with cisplatin chemotherapy completely attenuated endothelial cell apoptosis and inhibited destruction of nerve vasculature, deterioration of nerve function, and axonal degeneration. In a rat tumor model, VEGF gene transfer administered locally did not alter tumor growth or vascularity.


CONCLUSIONS
These findings implicate microvascular damage as the basis for toxic neuropathy induced by cisplatin and suggest that local angiogenic gene therapy may constitute a novel prevention or treatment for this disorder without augmenting tumor growth or vascularization.
Kirchmair
Rudolf
R
Division of Cardiovascular Research, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Mass 02135, USA.
Walter
Dirk H
DH
Ii
Masaaki
M
Rittig
Kilian
K
Tietz
Anne B
AB
Murayama
Toshinori
T
Emanueli
Costanza
C
Silver
Marcy
M
Wecker
Andrea
A
Amant
Carole
C
Schratzberger
Peter
P
Yoon
Young-Sup
YS
Weber
Alberto
A
Panagiotou
Eleftheria
E
Rosen
Kenneth M
KM
Bahlmann
Ferdinand H
FH
Adelman
Lester S
LS
Weinberg
David H
DH
Ropper
Allan H
AH
Isner
Jeffrey M
JM
Losordo
Douglas W
DW
D020533:Angiogenesis Inhibitors / Q000009:adverse effects; D000818:Animals; D017209:Apoptosis; D002945:Cisplatin / Q000009:adverse effects*; D004730:Endothelium, Vascular / Q000166:cytology; D015316:Genetic Therapy; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000098:blood supply / Q000150:complications / Q000188:drug therapy; D010523:Peripheral Nervous System Diseases / Q000139:chemically induced / Q000517:prevention & control* / Q000628:therapy; D051381:Rats; D017207:Rats, Sprague-Dawley; D047368:Tumor Burden / Q000187:drug effects; D014471:Umbilical Veins / Q000166:cytology; D014650:Vasa Nervorum / Q000187:drug effects; D042461:Vascular Endothelial Growth Factor A / Q000008:administration & dosage* / Q000627:therapeutic use
D020533:Angiogenesis Inhibitors; D042461:Vascular Endothelial Growth Factor A; D002945:Cisplatin