ABSTRACT
Sleeping Beauty (SB) transposons have been effective in delivering therapeutic genes to treat certain diseases in mice. Hydrodynamic gene delivery of integrating transposons to 5-20% of the hepatocytes in a mouse results in persistent elevated expression of the therapeutic polypeptides that can be secreted into the blood for activity throughout the animal. An alternative route of delivery is ex vivo transformation with SB transposons of hematopoietic cells, which then can be reintroduced into the animal for treatment of cancer. We discuss issues associated with the scale-up of hydrodynamic delivery to the liver of larger animals as well as ex vivo delivery. Based on our and others' experience with inefficient delivery to larger animals, we hypothesize that impulse, rather than pressure, is a critical determinant of the effectiveness of hydrodynamic delivery. Accordingly, we propose some alterations in delivery strategies that may yield efficacious levels of gene delivery in dogs and swine that will be applicable to humans. To ready hydrodynamic delivery for human application we address a second issue facing transposons used for gene delivery regarding their potential to "re-hop" from one site to another and thereby destabilize the genome. The ability to correct genetic diseases through the infusion of DNA plasmids remains an appealing goal.
Subject(s)
DNA Transposable Elements/genetics , Gene Transfer Techniques , Genetic Therapy/methods , Animals , Disease Models, Animal , Dogs , Genetic Therapy/adverse effects , Genetic Vectors , Hydrodynamics , Liver Diseases/therapy , Mice , Neoplasms/therapy , Safety , Swine , Transposases/genetics , Treatment OutcomeABSTRACT
PURPOSE: Nitinol, a nickel-titanium alloy, is a valuable material in the construction of interventional endoluminal devices because of its biocompatibility, super elasticity, high resiliency and shape memory. The possibility of nickel toxicity has been raised with devices constructed of Nitinol. Our investigation examines the long-term corrosive behavior of this alloy in experimental and biological environments. METHODS: We performed three levels of study. Microscopic examination was made of 64 devices of various sizes, randomly selected from 240 Amplatzer Septal Occluders that had been exposed to saline solution at 37 degrees C for fourteen months. All samples were studied by electron microscopy ranging from 50 to 5000 times magnification. We also studied microscopically 3 Amplatzer devices explanted 18-36 months after implantation in dogs, and 2 Amplatzer Septal Occluders removed from patients 18 months (cardiac transplant) and 19 months (died of causes unrelated to device placement) after implantation, which were examined grossly and by electron microscopy up to 5000 times magnification. We then measured the levels of nickel in the blood using inductive plasma mass spectroscopy in 19 patients with implanted Amplatzer devices, making measurements before and 6 months after implantation. RESULTS: Electron microscopy showed an intact titanium oxide layer with no evidence of corrosion in vitro and in vivo. One explanted device in direct contact with the platinum leads of a pacemaker for eighteen months showed minor pitting of the titanium oxide layer believed to be galvanic in nature. No wire fractures were found in vitro after cycle testing with 400 million cycles, nor in devices taken from the animals and humans. Biochemical studies showed no significant elevation of levels of nickel levels after implantation. CONCLUSION: Nitinol wire of Amplatzer septal occlusion devices is resistant to corrosion when exposed to physiologic saline solution, and in experimental animals as well as humans. A device in contact with a platinum pacemaker electrode developed minimal pitting of the titanium oxide layer, believed to be galvanic in nature and of no structural or clinical significance. There is no increase of concentrations of nickel in the blood of patients who have received Amplatzer nitinol devices. These favorable testing results reveal that nickel-titanium is an inert, corrosion resistant alloy.
Subject(s)
Alloys/toxicity , Balloon Occlusion/adverse effects , Balloon Occlusion/instrumentation , Corrosion , Postoperative Complications , Vascular Diseases/surgery , Adolescent , Adult , Alloys/analysis , Animals , Child , Child, Preschool , Disease Models, Animal , Dogs , Equipment Failure , Humans , Male , Models, Biological , Time Factors , Vascular Diseases/bloodABSTRACT
A nitinol shunt device was applied in six minipigs to create a precise intra-atrial shunt. This self-expanding shunt device consists of two retention disks of 2-8 mm, a 4 mm connecting waist with a 10 mm eccentric hole. It requires a 7 Fr introducer sheath. The device is attached to the delivery cable with a microscrew. Placement technique is identical to that of Amplatzer septal occluder. Balloon dilation was performed immediately and 1 month after placement. One animal died from general anesthesia before device placement. Left atrial angiography showed a patent intra-atrial shunt in 5/5 pigs immediately and 4/4 in 1- to 3-month follow up. Postmortem examination demonstrated patent shunts partially or completely neoendothelialized. The shunt device was found to be an effective and safe way to create a permanent atrial communication.
