Topical colchicine selection of keratinocytes transduced with the multidrug resistance gene (MDR1) can sustain and enhance transgene expression in vivo.

For skin gene therapy, achieving prolonged high-level gene expression in a significant percentage of keratinocytes (KC) is difficult because we cannot selectively target KC stem cells. We now demonstrate that topical colchicine treatment can be used to select, in vivo, KC progenitor cells transduced with the multidrug resistance gene (MDR1). When human skin equivalents containing MDR1-transduced KC were grafted onto immunocompromised mice, topical colchicine treatments significantly increased (7-fold) the percentage of KC expressing MDR1, compared to vehicle-treated controls, for up to 24 wk. Topical colchicine treatment also significantly enhanced the amount of MDR1 protein expressed in individual KC. Furthermore, quantitative real-time PCR analysis of MDR1 transgene copy number demonstrates that topical colchicine treatment selects and enriches for KC progenitor cells in the skin that contain and express MDR1. For clinical skin gene therapy applications, this in vivo selection approach promises to enhance both the duration and expression level of a desired therapeutic gene in KC, by linking its expression to the MDR1 selectable marker gene.

A genetically engineered, nonthrombogenic cellular lining for LVADs: in vitro preconditioning before in vivo implantation.

Because of the clinical success of left ventricular assist devices (LVADs) used for short-term "bridge to transplant" and the limited availability of donor organs, heart assist devices are being considered for long-term implantation as an alternative to heart transplantation. In an effort to improve biocompatibility, our laboratory has developed a nonthrombogenic cellular lining from genetically engineered smooth muscle cells (GE-SMC) for the Thermocardiosystems Heartmate LVAD. Smooth muscle cells have been transduced with the gene for endothelial nitric oxide synthase (NOS III) and produce NO at concentrations that reduce platelet deposition and smooth muscle cell proliferation when tested in vitro. In this investigation, the adhesive capabilities of GE-SMC linings were examined. An in vitro circulatory loop was designed to expose cell lined LVADs to in vivo operating conditions. Cumulative cell loss from cell lined LVADs was less than 10% after 24 hours of flow. Using a protocol for "preconditioning" the cell lining within the mock circulatory loop, the first implantation of an LVAD containing a genetically engineered SMC lining was successfully implemented in a bovine model. Results from this 24 hour study indicate that the flow-conditioned cellular lining remained intact with no evidence of thromboembolization and only minimal changes in coagulation studies.

Nonthrombogenic, adhesive cellular lining for left ventricular assist devices.

BACKGROUND: The textured, blood-contacting surfaces of the Thermocardiosystems HeartMate left ventricular assist device (LVAD) promote the passivation of the biomaterial caused by the accumulation of an integral coagulum. Commonly, acute, postimplantation thrombocytopenia causes significant bleeding, requiring surgery or blood transfusions. Chronic complications include thromboembolic microevents that can affect central nervous system function. Pumps, explanted during donor organ transplantation, are often found to have an extensive cellular panus associated with the blood-contacting surfaces of the device. This natural cellular lining suggests a possible strategy for improving the blood biocompatibility of the HeartMate. Therefore, seeding of LVADs with cells genetically engineered to enhance their antithrombotic properties before implantation was investigated as a means to improve biocompatibility for long-term use. METHODS AND RESULTS: Bovine vascular smooth muscle cells genetically engineered to produce nitric oxide were seeded on LVAD biomaterials and exposed to elevated shear stresses to determine cell-adhesive capabilities. Comparative studies were performed with vascular endothelial cells isolated from the same vessel. To assess the thrombogenic potential of the genetically engineered smooth muscle cells, monolayers were exposed to whole blood in parallel plate flow chambers and were platelet-adhesion quantified. This procedure used scanning electron microscopy and computer image-capture software. Endothelial cell monolayers and mock-transduced smooth muscle cells were assayed in a comparative manner. LVADs were seeded with genetically engineered smooth muscle cells and maintained under cell culture conditions for 96 hours. Thereafter, seeded LVADs were incorporated into in vitro flow loops. Cell retention within the pump was determined by sampling the effluent culture medium downstream of the pump and cell counting in a Coulter counter. After 18 hours of in vitro flow, a seeded pump was implanted into the abdominal cavity of a calf and anastomosed to the apex of the heart and to the descending aorta. More genetically engineered smooth muscle cells were retained on the surface of LVAD biomaterials when they were subjected to shear stresses up to 75 dyne/cm than endothelial cells assayed in the identical manner. Adherence of platelets to the surface of smooth muscle cells was significantly reduced after their transduction with nitric oxide synthase with GTP cyclohydrolase genes. Platelet deposition on the genetically modified myocyte layers was similar to that associated with endothelial cell layers. Cell loss from cell-seeded LVADs incorporated into in vitro flow loops remained < 5% of the total cell number seeded regardless of the duration of flow. CONCLUSIONS: LVADs seeded with smooth muscle cells, transduced with the genes to optimize nitric oxide production, adhered well to the pump surface under in vitro and in vivo flow conditions.

Annular elastolytic giant cell granuloma.

A 49-year-old woman had large annular lesions with raised erythematous borders and atrophic, hypopigmented central regions on her neck, trunk, and proximal upper extremities. Examination of a biopsy specimen demonstrated a granulomatous infiltrate in the upper dermis that surrounded areas lacking elastic fibers; elastic fibers were present within the multinucleated giant cells. The clinical presentation and pathologic findings were consistent with a diagnosis of annular elastolytic giant cell granuloma (AEGCG). The clinical description and pathologic differential diagnosis of AEGCG are reviewed.

Stimulation of growth and migration of vascular endothelial cells by vascular endothelial growth factor transduced smooth muscle cells in co-culture.

Vascular endothelial growth factor (VEGF) is a secreted mitogen with high specificity toward endothelial cells. Expression of VEGF by smooth muscle cells in vivo may be an important stimulus for the regrowth of the endothelium after damage caused by interventions such as angioplasty. The levels of VEGF secreted by cultured smooth muscle cells minimally stimulated growth of endothelial cells in co-culture. Full length cDNA for the 165 amino acid residue, bovine VEGF (VEGF165), was isolated from calf liver total RNA by reverse transcriptase polymerase chain reaction (RT-PCR) techniques, and used to generate plasmid constructs for transfection. Bovine aortic smooth muscle cells (BSMC), stably transfected with VEGF165 plasmid DNA, secreted mitogen into conditioned culture medium at levels that are physiologically relevant (2-4 ng/ml). Transformed BSMC stimulated growth of bovine aortic endothelial cells (BAEC) in co-culture, to a significantly greater extent than mock transfected BSMC. Migration of BAEC was also enhanced by the presence of VEGF transduced BSMC. These data suggest that smooth muscle cells, genetically engineered to produce VEGF, may provide biologic linings in cardiovascular prostheses that could promote the growth of endogenous endothelial cells.

Liposomal induction of NO synthase expression in cultured vascular smooth muscle cells.

Transfection of bovine smooth muscle cells with plasmid constructs containing the full coding sequence for endothelial NO synthase (NOS3) using liposome mediated gene transfer gave rise to cells that produced high levels of NO. Western analysis indicated that transfected cells were indeed expressing NOS3 protein, but in addition expression of inducible NO synthase (NOS2) was detected. The latter accounted for the high levels of NO produced by transfectants. Treatment of bovine or rat smooth muscle cells or 3T3 fibroblasts with only liposome preparations resulted in the induction of NOS2 expression and NO production. All liposomal reagents were shown to be endotoxin free. Direct induction of gene expression by liposomes alone suggests caution in interpretation of data for which gene transfer is mediated by liposomal preparations.

Genetically engineered smooth muscle cells as linings to improve the biocompatibility of cardiovascular prostheses.

BACKGROUND: The seeding of the blood-contacting surfaces of cardiovascular prostheses with autologous endothelial cells to improve their biocompatibility has had little success. In most instances, cells have sloughed off under flow conditions. The performance of left ventricular assist devices (LVADs) designed to stabilize patients awaiting donor hearts for transplantation has been remarkably good. After prolonged implantation, pump surfaces become covered with a pannus of smooth muscle-like cells (myofibroblasts). Occasional islands of endothelial cells have been identified on top of such cell layers. Therefore, in an attempt to accelerate the beneficial conditioning and improve biomaterial-blood compatibility of LVAD internal surfaces, their seeding with autologous, genetically engineered smooth muscle cells (SMCs) was investigated. METHODS AND RESULTS: Since routine testing of the Thermocardiosystems HeartMate LVAD is carried out in calves, SMCs were isolated from calves, propagated in culture, and transduced with NO synthase genes to yield stable production of NO. Previous studies had demonstrated that SMCs attached strongly to the biomaterials that compose the internal surfaces of LVADs. Transduction of NO synthase gene expression in the SMCs was achieved by electroporation and antibiotic (G418) selection. Inhibition of smooth muscle cell proliferation by NO has been documented, and the same molecule has been shown to inhibit platelet adhesion to cell surfaces. Cells transduced with NO synthase expressed enzyme protein at consistently high levels for several passages in culture; however, NO production was dependent on the supplementation of culture medium with a source of tetrahydrobiopterin (sepiapterin). Under such conditions, transduced cells were growth-inhibited compared with mock-transfected controls. Induction of GTP cyclohydrolase (the rate-limiting enzyme for the production of tetrahydrobiopterin) expression also resulted in NO production by NO synthase-transduced cells. CONCLUSIONS: Preliminary studies have shown that SMCs form strong attachments to the surface materials of LVADs and that their proliferation rates could be controlled after transformation with NO synthase under conditions that support production of NO. Therefore, genetically engineered SMCs may provide an improved blood biomaterial interface for cardiovascular prostheses.

Pressure wave fidelity in catheter introducers.

Pressure waveform fidelity was examined in two sizes of the Bard catheter introducer. The purpose of this endeavor was to determine whether accurate blood pressure measurements could be achieved directly via the catheter introducers. The introducers were incorporated into a mock circulatory system for the study. The effects of supporting dilators and catheters within the introducer sheath during pressure measurements were also considered. Parameters used to explain pressure waveform response within the catheter introducers included the damping coefficient and the natural frequency of the catheter introducer, and the effects of impedance mismatching between the transducer and the mock circulatory system. Overall, the pressure measurements obtained from the catheter introducer were distorted. Mean pressure levels measured in the introducers were up to 15 mmHg higher than the true mean pressure. The distortion in the pressure measurements can be attributed for the most part to impedance mismatching. In sum, the pressure measurements obtained from catheter introducer-manometer systems should be used only referentially, and not as an absolute standard.