title: Safety and feasibility of high-pressure transvenous limb perfusion with 0.9% saline in human muscular dystrophy.
abstract: We evaluated safety and feasibility of the transvenous limb perfusion gene delivery method in muscular dystrophy. A dose escalation study of single limb perfusion with 0.9% saline starting with 5% of limb volume was carried out in adults with muscular dystrophies under intravenous analgesia/anesthesia. Cardiac, vascular, renal, muscle, and nerve functions were monitored. A tourniquet was placed above the knee with inflated pressure of 310 mm Hg. Infusion was carried out with a clinically approved infuser via an intravenous catheter inserted in the saphenous vein with a goal infusion rate of 80 ml/minute. Infusion volume was escalated stepwise to 20% limb volume in seven subjects. No subject complained of any post procedure pain other than due to needle punctures. Safety warning boundaries were exceeded only for transient depression of limb tissue oximetry and transient elevation of muscle compartment pressures; these were not associated with nerve, muscle, or vascular damage. Muscle magnetic resonant imaging (MRI) demonstrated fluid accumulation in muscles of the perfused lower extremity. High-pressure retrograde transvenous limb perfusion with saline up to 20% of limb volume at above infusion parameters is safe and feasible in adult human muscular dystrophy. This study will serve as a basis for future gene transfer clinical trials.
authors.affiliation: Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. zhengfan@med.unc.edu
authors.forename: Zheng
authors.initials: Z
authors.lastname: Fan
authors.forename: Keith
authors.initials: K
authors.lastname: Kocis
authors.forename: Robert
authors.initials: R
authors.lastname: Valley
authors.forename: James F
authors.initials: JF
authors.lastname: Howard
authors.forename: Manisha
authors.initials: M
authors.lastname: Chopra
authors.forename: Hongyu
authors.initials: H
authors.lastname: An
authors.forename: Weili
authors.initials: W
authors.lastname: Lin
authors.forename: Joseph
authors.initials: J
authors.lastname: Muenzer
authors.forename: William
authors.initials: W
authors.lastname: Powers
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008279:Magnetic Resonance Imaging; D008297:Male; D018482:Muscle, Skeletal / Q000378:metabolism; D009136:Muscular Dystrophies / Q000175:diagnosis / Q000628:therapy*; D010101:Oxygen Consumption; D010477:Perfusion / Q000009:adverse effects / Q000379:methods*; D011312:Pressure; D012965:Sodium Chloride / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D012965:Sodium Chloride