Robert A. Brenes, MD, Caroline C

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Presentation transcript:

Toward a mouse model of hind limb ischemia to test therapeutic angiogenesis Robert A. Brenes, MD, Caroline C. Jadlowiec, MD, Mackenzie Bear, BSc, Peter Hashim, BA, Clinton D. Protack, MD, Xin Li, MD, Wei Lv, MD, Michael J. Collins, MD, Alan Dardik, MD, PhD Journal of Vascular Surgery Volume 56, Issue 6, Pages 1669-1679 (December 2012) DOI: 10.1016/j.jvs.2012.04.067 Copyright © 2012 Terms and Conditions

Fig 1 Methods. A, Modified hind limb ischemia model. The arrow (↓) denotes the site of femoral ligation, and the asterisks (*) denote length of superficial femoral artery excision. B, Representative image of digit gangrene (black arrow). C, D, Expression of bone marrow mononuclear cell (BM-MNC) markers. E, F, Expression of endothelial progenitor cell markers. G, H, Coexpression of mononuclear cell and endothelial progenitor cell markers. CD, Cluster of differentiation; FSC, fluorophore-conjugated secondary antibody; VEGFR, vascular endothelial growth factor receptor. The error bars show the standard error of the mean. Journal of Vascular Surgery 2012 56, 1669-1679DOI: (10.1016/j.jvs.2012.04.067) Copyright © 2012 Terms and Conditions

Fig 2 Mononulear cell (MNC) treatment (5 × 105) improves hind limb ischemia (MNC-treated, n = 21; control, n = 20). A, MNC-treated mice showed improved functional outcomes according to Tarlov score (*P = .0004). B, MNC-treated mice had greater improvement of ischemia as shown by ischemia score (P = .0002). C, No significant differences were observed for the modified ischemia score (P = .4587). Invasive Doppler measurements show MNC-treated mice had improved (D) proximal flow (*P < .0001) and (E) distal flow (*P < .0001). F, Representative laser Doppler images show improved perfusion in MNC-treated mice. The arrows show improved perfusion in MNC-treated mice at days 7 and 14. P values represent statistical analysis by analysis of variance. The error bars show the standard error of the mean. Journal of Vascular Surgery 2012 56, 1669-1679DOI: (10.1016/j.jvs.2012.04.067) Copyright © 2012 Terms and Conditions

Fig 3 Gastrocnemius muscle histology in mice treated with mononuclear cells (MNCs; n = 3) and in controls (n = 3). A, Histologic comparison of control (left) and MNC-treated (right) mice over 28 days (stained with hematoxylin and eosin; original magnificiation, ×40). B, MNC-treated mice demonstrated increased muscle fiber area at days 7, 14, and 28 (*P = .0053). C, MNC-treated mice showed decreased number of muscle fibers (*P < .0001). D, MNC-treated mice demonstrated higher capillary density at day 14 (*P < .0001). P values represent statistical analysis by analysis of variance. The error bars show the standard error of the mean. Journal of Vascular Surgery 2012 56, 1669-1679DOI: (10.1016/j.jvs.2012.04.067) Copyright © 2012 Terms and Conditions

Fig 4 Mononuclear cell (MNC) dose–response (n = 4 to 6 per group). A, Quantification of representative laser Doppler perfusion images showed no differences between MNC-treated groups at day 7 (P = .7501, analysis of variance [ANOVA]). B, MNC-treated mice show increased perfusion (day 7) compared with control mice (P = .0018, ANOVA); 5 × 105 and 1 × 106 MNC groups showed increased distal flow vs control (*P < .05, post hoc test; **P > .05 vs other groups). C, No significant differences between MNC-treatment groups and control were seen in functional outcomes (P = .5520, ANOVA). D, Capillary density was increased at day 14 in MNC-treated mice vs control mice (n = 3; P < .0001, ANOVA; *P < .05 vs control, post hoc test; **P < .05 vs control, post hoc test; P > .05 vs each other, post hoc test). E, Gastrocnemius muscle fiber area was increased at day 14 in MNC-treated mice vs control mice (P < .0001, ANOVA; *P < .05 vs control, post hoc test; **P < .05 vs control, post hoc test; P > .05 vs each other, post hoc test). The error bars show the standard error of the mean. Journal of Vascular Surgery 2012 56, 1669-1679DOI: (10.1016/j.jvs.2012.04.067) Copyright © 2012 Terms and Conditions

Fig 5 Comparison of response to proximal vs distal mononuclear cell (MNC) injection (n = 21) vs control (n = 6). A, Functional measurements with the Tarlov scale (day 7) showed no difference between control and MNC-treated groups (P = .9821). B, Functional measurements with the ischemia scale (day 7) showed no difference between groups (P = .6594). C, Increased semimembranosus flow with MNC-treated mice (P = .0041, analysis of variance [ANOVA]); there was no significant difference in flow between proximal and distal treatment (P > .05, post hoc test; *P < .05 vs control, post hoc test). D, Distal flow was increased in proximally and distally treated mice vs control (P = .0086, ANOVA). There was no significant difference in flow between proximal and distal MNC treatment (P > .05, post hoc test; *P < .05 vs control, post hoc test, n = 3). E, MNC-treated mice showed increased capillary density compared with control and baseline (P < .0001, ANOVA); there was no significant difference in capillary density between proximally and distally treated mice (P > .05, post hoc test; *P < .05 vs control, post hoc test, n = 3). F, MNC-treated mice showed increased gastrocnemius muscle fiber area compared with control mice (P < .0001, ANOVA). The difference between proximal and distal injection was significant (P < .05, post hoc test; *P < .05 vs control, post hoc test, n = 3.) G, MNC-treated mice showed decreased gastrocnemius muscle fiber number compared with control mice (P = .002, ANOVA); the difference between proximal and distal injection was not significant (P > .05, post hoc test; *P < .05 vs control, post hoc test, n = 3). Journal of Vascular Surgery 2012 56, 1669-1679DOI: (10.1016/j.jvs.2012.04.067) Copyright © 2012 Terms and Conditions