title: Antiangiogenesis mediates cisplatin-induced peripheral neuropathy: attenuation or reversal by local vascular endothelial growth factor gene therapy without augmenting tumor growth.
abstract: 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.
authors.affiliation: Division of Cardiovascular Research, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Mass 02135, USA.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kirchmair
authors.forename: Dirk H
authors.initials: DH
authors.lastname: Walter
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ii
authors.forename: Kilian
authors.initials: K
authors.lastname: Rittig
authors.forename: Anne B
authors.initials: AB
authors.lastname: Tietz
authors.forename: Toshinori
authors.initials: T
authors.lastname: Murayama
authors.forename: Costanza
authors.initials: C
authors.lastname: Emanueli
authors.forename: Marcy
authors.initials: M
authors.lastname: Silver
authors.forename: Andrea
authors.initials: A
authors.lastname: Wecker
authors.forename: Carole
authors.initials: C
authors.lastname: Amant
authors.forename: Peter
authors.initials: P
authors.lastname: Schratzberger
authors.forename: Young-Sup
authors.initials: YS
authors.lastname: Yoon
authors.forename: Alberto
authors.initials: A
authors.lastname: Weber
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Panagiotou
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Rosen
authors.forename: Ferdinand H
authors.initials: FH
authors.lastname: Bahlmann
authors.forename: Lester S
authors.initials: LS
authors.lastname: Adelman
authors.forename: David H
authors.initials: DH
authors.lastname: Weinberg
authors.forename: Allan H
authors.initials: AH
authors.lastname: Ropper
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Isner
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Losordo
mesh_terms: 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
chemical_list: D020533:Angiogenesis Inhibitors; D042461:Vascular Endothelial Growth Factor A; D002945:Cisplatin