Results of a double-blind, placebo-controlled study to assess the safety of intramuscular injection of hepatocyte growth factor plasmid to improve limb perfusion in patients with critical limb ischemia.
BACKGROUND
The Study to Assess the Safety of Intramuscular Injection of Hepatocyte Growth Factor Plasmid to Improve Limb Perfusion in Patients With Critical Limb Ischemia (HGF-STAT trial) determined the effect of hepatocyte growth factor (HGF) plasmid on safety and limb tissue perfusion as measured by transcutaneous oxygen tension (TcPo(2)) in patients with critical limb ischemia (CLI).


RESULTS
Randomized patients with rest pain or ischemic ulcers and TcPo(2) <40 mm Hg and/or toe pressure <50 mm Hg received placebo or HGF-plasmid intramuscular injection as follows: 0.4 mg at days 0, 14, and 28 (low dose); 4.0 mg at days 0 and 28 (middle dose); or 4.0 mg at days 0, 14, and 28 (high dose). Patients were evaluated for safety, changes in TcPo(2) and ankle and toe pressure, amputation, and wound healing. Ninety-three of 104 treated patients were evaluated for safety (mean age 70 years, 63% male, 53% diabetic, 64% with tissue loss, mean ankle-brachial index 0.41, and mean toe pressure 26 mm Hg). Adverse events occurred in 86% of the patients, most of which were related to CLI or comorbid conditions and were not different between groups. TcPo(2) (mean+/-SE) increased at 6 months in the high-dose group (24.0+/-4.2 mm Hg, 95% CI 15.5 to 32.4 mm Hg) compared with the placebo (9.4+/-4.2 mm Hg, 95% CI 0.9 to 17.8), low-dose (11.1+/-3.7 mm Hg, CI 3.7 to 18.7 mm Hg), and middle-dose (7.3+/-4.8 mm Hg, CI -2.2 to 17.0 mm Hg) groups (ANCOVA P=0.0015). There was no difference between groups in secondary end points, including ankle-brachial index, toe-brachial index, pain relief, wound healing, or major amputation.


CONCLUSIONS
Intramuscular injection of HGF plasmid was safe and well tolerated. Larger studies to determine whether HGF plasmid can improve wound healing and limb salvage in patients with CLI are warranted.
Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756, USA. Richard.J.Powell@Hitchcock.org
Richard J
RJ
Powell
Michael
M
Simons
Farrel O
FO
Mendelsohn
George
G
Daniel
Timothy D
TD
Henry
Minako
M
Koga
Ryuichi
R
Morishita
Brian H
BH
Annex
D000328:Adult; D000368:Aged; D001785:Blood Gas Monitoring, Transcutaneous / Q000379:methods; D004311:Double-Blind Method; D064420:Drug-Related Side Effects and Adverse Reactions; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D015316:Genetic Therapy / Q000379:methods; D017228:Hepatocyte Growth Factor / Q000008:administration & dosage* / Q000009:adverse effects / Q000235:genetics; D006801:Humans; D007273:Injections, Intramuscular; D007511:Ischemia / Q000628:therapy*; D007866:Leg / Q000098:blood supply*; D007871:Leg Ulcer / Q000628:therapy*; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000188:drug therapy; D010919:Placebos; D010957:Plasmids / Q000008:administration & dosage* / Q000009:adverse effects; D011237:Predictive Value of Tests
D010919:Placebos; D017228:Hepatocyte Growth Factor