超声微泡介导VEGF基因转染治疗缺血性疾病研究进展

："治疗性血管新生" 是利用外源性血管生长因子或基因促进缺血部位新生血管形成,达到改善缺血部位血液供应而起到治 疗的目的,该方法为缺血性疾病的治疗提供了新的思路。目前研究的多种与血管生成相关的因子中,血管内皮生长因子（Vascular Endothelial Growth Factor,VEGF）是公认的最具特异性且作用最强的促进血管生长因子。但由于外源性血管生长因子重组蛋白在 体内半衰期短,试验中难以长时间持续给药起到刺激新血管生成及成熟的作用。研究表明通过超声破坏微泡技术可使基因转染 的靶细胞持续表达该基因。因此,应用超声靶向微泡破坏技术使VEGF 基因在缺血部位持续表达,可起到治疗性血管新生的作 用。本文将就超声微泡介导VEGF基因转染治疗缺血性疾病研究进展进行综述。     

超声破裂载基因微泡增强心肌细胞报告基因的转染与表达

目的:通过超声破裂载基因微泡介导报告基因心肌细胞转染,探讨其能否增强心肌细胞外源基因转染与表达.方法:以β-galactosidase质粒为报告基因,将其与自制氟碳气体微泡粘附,制备载基因微泡.利用诊断性超声破裂微泡进行体外心肌细胞基因转染;以磷酸钙共沉淀转染为阳性对照并将其以不同方式与超声破裂微泡技术联合应用,以期进一步增强基因转染效果.分别采用原位染色及酶学定量检测β-galactosidase表达水平,同时进行细胞活性检测.结果:超声破裂载基因氟碳气体微泡(PESDA)转染组心肌细胞β-galactosidase表达水平可达单纯质粒转染组60倍(P＜0.01).磷酸钙共沉淀转染3.67倍(P＜0.01)超声强度、微泡浓度对超声破裂介导基因转染效果有明显影响.超声破裂微泡技术与磷酸钙共沉淀联合应用可进一步提高报告基因的表达(P＜0.05),即使在磷酸钙转染后6 h,超声破裂微泡仍能明显增强报告的基因的表达(P＜0 05).结论:超声破裂微泡技术是一种高效基因转染方法,其不但能增加DNA转染,而且增强入胞后基因的表达.超声破裂微泡与其它基因转染技术联合应用能进一步增加基因转染效率.     

超声微泡介导P53对宫颈癌HeLa细胞转染效率的试验研究

探讨超声微泡介导野生型P53质粒转染人宫颈癌HeLa细胞的最优参数及转染效率,为外源性基因的高效定向转移奠定基础,为宫颈癌的基因治疗提供一条新的思路.将培养的HeLa细胞分别给予超声时间10 s,30 s,60 s,超声强度0.5,0.75,1 W/cm2的组合辐照,以筛选出对HeLa细胞无明显抑制作用的参数组合,再在筛选出的条件下将P53转染入HeLa细胞,24～48 h后,用荧光显微镜观察转染情况.将优化的超声条件用于下步转染,试验分为5组,即空白对照组、质粒组、质粒+微泡组、质粒+超声组、质粒+微泡+超声组,用RT-PCR分析各组转染情况.结果显示:当超声条件为0.5 W/cm2,30 s时,P53在HeLa细胞的转染率较其他试验组高,差异具有统计学意义;超声联合微泡可促进野生型P53质粒转染宫颈癌HeLa细胞,单独超声辐照有较弱的促转染作用.因此,适当的微泡浓度在优化的超声条件下能有效的提高P53质粒在HeLa细胞中的转染效率.     

hVEGF165 和嵌合水蛭肽融合基因的构建、表达和活性检测

根据抗 PTCA 或支架后再狭窄的基因治疗需要多基因治疗的特点,用基因重组技术构建了 hVEGF165 和嵌合水蛭肽 (fused hirudin , FH) 融合基因,并克隆到真核表达载体 pcDNA3.0 中,通过脂质体介导将 pcDNA3.0/hVEGF165 - FH 转染到人内皮细胞株 (ECV304) 中, RT-PCR 及蛋白质印迹证明融合基因 hVEGF165 - FH 在 ECV304 细胞中得到表达 ( 分子质量为 24 ku 左右 ). 通过体外活性检测——— MTT 法检测 hVEGF165 - FH 对 ECV304 细胞增殖的影响,通过体外血管生成分析 hVEGF165 - FH 对内皮细胞株 ECV304 增殖的影响 . 通过体外抗栓活性检测,表明表达产物具有促进内皮细胞株增殖及加快血管生成的作用,同时显著抑制了 ADP 诱导的血小板聚集率 (P < 0.05) 并显著延长 APTT 和 TT (P < 0.05) . 实验结果表明,融合基因在内皮细胞株中得到表达,表达的融合蛋白具有 hVEGF165 和嵌合水蛭肽 (FH) 的双重活性,这为以后的融合基因治疗再狭窄的动物实验打下了良好基础 .     

人VEGF165基因转染成人成肌细胞的实验研究

目的：将人血管内皮生长因子165（hVEGF165）导人原代离体成肌细胞,观察该细胞hVEGF分泌情况,探讨成人自体转基因成肌细胞移植的可行性。方法：采用两步消化法对成人骨骼肌组织消化获取相对较纯的成肌细胞,通过差速贴壁法进行进一步的纯化。以脂质体转染法将pcDNA3．1-hVEGF165导入成肌细胞,通过RT—PCR、ELISA和Western-blot进行hVEGF165定量检测,MTT测定和Mile’s实验检测VEGF165的生物学活性。结果：转基因细胞经RT—PCR扩增出一条VEGF的特异性泳带,ELISA显示转基因细胞培养上清VEGF浓度分别达到18．92±1．77rig／mL、19．04±2．15ng／mL,Western blot检测转基因成肌细胞上清均检测到VEGF蛋白特异性的杂交带,MTT显示转基因细胞上清明显促内皮细胞增殖,Mile’s实验显示转基因细胞上清明显增加毛细血管通透性。结论：质粒pcDNA3．1-hVEGF165能成功转入成人成肌细胞,转基因细胞能分泌有生物活性的VEGF165蛋白。     

低氧环境对高原鼢鼠不同组织VEGF165b基因表达量及微血管密度的影响

目的：探讨高原低氧环境下高原鼢鼠不同组织血管内皮生长因子165b （VEGF_165b）表达量及微血管密度（MVD）的变化。方法：克隆高原鼢鼠VEGF_165b基因并测定其在不同海拔脑、肺和骨骼肌组织内的表达量;免疫组化法观察脑、肺和骨骼肌组织内微血管并测定其在不同海拔组织内的密度。结果：高海拔VEGF_165b表达量显著低于低海拔表达量（P<0.05）;微血管密度随海拔高度升高而增加（P<0.05）。结论：VEGF_165b基因调节动物组织微血管密度是高原动物适应低氧环境的重要机制之一。     

部超声在新生儿呼吸窘迫综合征临床诊断及肺泡表面活性物质治疗效果评估中的应用价值

摘要 目的：研究肺部超声在新生儿呼吸窘迫综合征（NRDS）临床诊断及肺泡表面活性物质（PS）治疗效果评估中的应用价值。方法：将我院于2018年6月～2020年3月期间诊治的80例NRDS患儿纳入研究,记作NRDS组。另取同期80例健康新生儿作为对照组。对所有新生儿进行系统的肺部超声检查并评分,并比较NRDS组和对照组检查结果。将NRDS患儿根据胎龄的不同分成＜30周亚组以及≥30周亚组,比较两组肺部超声检查结果。此外,将所有NRDS患儿按照是否接受PS治疗分成治疗组与非治疗组,比较两组肺部超声评分。结果：NRDS组肺实变、胸膜线异常、支气管充气征、融合B线、肺泡间质综合征、胸腔积液人数占比均高于对照组（均P＜0.05）。胎龄<30周亚组肺泡间质综合征人数占比低于胎龄≥30周亚组患儿,而胸腔积液人数占比高于胎龄≥30周亚组患儿（均P＜0.05）。治疗组治疗后12 h、24 h时的肺部超声评分分别为（15.23±3.15）分、（11.37±2.01）分,均低于非治疗组的（19.45±3.28）分、（16.48±2.83）分（均P＜0.05）。结论：肺部超声作为无创且实时监测手段,诊断NRDS的临床价值较高,且肺部超声评分可作为有效评估NRDS患儿接受PS治疗效果的指标,具有较好的临床应用价值。     

老年高血压合并2 型糖尿病患者血清同型半胱氨酸、血尿酸水平 变化及临床意义

目的：探讨老年高血压合并2 型糖尿病患者血清同型半胱氨酸（Homocysteine, Hcy）、血尿酸（Serum uric acid, SUA）水平变 化及其临床意义。方法：2012 年9 月至2013 年9 月期间,我院诊治的40 例单纯高血压和40 例高血压合并2 型糖尿病患者,分别 作为对照组和研究组,检测两组血清Hcy、SUA水平。结果：两组患者收缩压、舒张压比较无统计学差异（P>0.05）。研究组空腹血 糖、餐后2h 血糖、血清Hcy、SUA 均显著高于对照组（P<0.05）。研究组中血管并发症患者血清Hcy、SUA为（25.0± 5.0）umol/L 和 （390.0± 65.0）mmol/L显著高于无血管并发症患者（17.0± 4.0）umol/L 和（330.0± 55.0）mmol/L,血管并发症患者FBG、餐后2h 血 糖与无血管并发症患者比较无统计学差异（P>0.05）。结论：高血压合并2 型糖尿病患者血清Hcy、SUA异常升高,且存在慢性血 管并发症患者两者水平更高,血清Hcy、SUA是老年高血压合并2 型糖尿病的危险因素。     

载多西紫杉醇脂质微泡对人肝癌HepG2细胞抑制作用的体外研究

目的：观察自制载多西紫杉醇脂质微泡联合超声对人肝癌HepG2细胞的抑制作用。方法：通过薄膜分散法制备载多西紫杉醇脂质微泡,观察其形态,测定粒径大小、包封率、载药量及稳定性等性质;将人肝癌HepG2细胞随机分为5组,对照组、多西紫杉醇组（DOC组）、多西紫杉醇联合超声组（DOC＋US组）、载多西紫杉醇脂质微泡组（DLLM组）、载多西紫杉醇脂质微泡联合超声组（DLLM＋US组）,CCK-8法检测细胞毒性,倒置显微镜观察细胞凋亡的形态,DAPI荧光染色法观察凋亡细胞核的改变。结果：载多西紫杉醇脂质微泡形态光滑圆整,无黏连;粒径分布范围为170~590 nm,平均粒径为350 nm;Zeta电位为-5.2 mV;微泡的包封率为80.0%,载药量为18.5%;4℃条件下保存14天性质稳定;DLLM＋US组较其他各组对肿瘤细胞有更为明显的抑制增殖及诱导凋亡效应（P〈0.01）。结论：自制载多西紫杉醇脂质微泡粒径小,包封率高,稳定性好,此微泡联合超声对人肝癌HepG2细胞有明显抑制作用,载多西紫杉醇脂质微泡有望成为一种新型抗肿瘤给药途径。     

钙网蛋白参与缺血后处理减轻大鼠骨骼肌缺血/再灌注损伤

本实验分别在整体和细胞水平观察缺血后处理（ischemic postconditioning,I-postC）对骨骼肌缺血／再灌注（ischemia／reperfusion,I／R）损伤的影响,并探讨钙网蛋白（calreticulin,CRT）介导的信号转导机制。（1）整体实验：健康雄性Wistar大鼠48只,无创动脉夹夹闭右侧股动脉4h,松夹再灌注12h或24h建立大鼠右后肢I／R损伤模型,随机分为I／R组、缺血预处理（ischemic preconditioning,IPC）组（5min缺血／5min再灌,3个循环）和I-postC组（1min再灌／1min缺血,3个循环）（n=16）,大鼠左后肢做对照处理。再灌注结束时测定血浆乳酸脱氢酶（1actate dehydrogenase,LDH）活性、骨骼肌湿干重比值（wet／dryweightratio,W／D）;电镜观察骨骼肌超微结构变化：Westernblot检测骨骼肌CRT、钙调神经磷酸酶（calcineurin,CaN）的表达。（2）细胞培养实验：原代培养Sprague-Dawley乳鼠骨骼肌细胞,随机分为6组：正常对照组、缺氧／复氧（hypoxia／reoxygenation,H／R）组、缺氧预处理（hypoxic preconditioning,HPC）组、缺氧后处理（hypoxic postconditioning,H-postC）组、CaN抑制剂环孢素A（cyclosporine,CsA）＋H／R组和CsA＋H-postC组。台盼蓝排斥实验、流式细胞仪检测细胞损伤情况：Westernblot检测骨骼肌细胞CRT和CaN的表达。结果显示：（1）在整体动物实验中,I-postC可显著降低血浆LDH活性和组织水肿,骨骼肌超微结构损伤减轻,无细胞核凋亡现象,与IPC组相比无显著差异。I-postC再灌注12h和24hCRT表达分别较I／R12h和24h组高4．39倍和1．02倍（P〈0．05）,CaN表达分别增高1．96倍和0．63倍（尸〈0．05）。相关分析显示CRT表达与CaN表达呈正相关（r-0．865,P〈0．01）。（2）在细胞培养实验中,H-postC可减轻H／R诱导的骨骼肌细胞凋亡,增加细胞存活率,与HPC组相比无显著差异,CsA可抑制H-postC的保护作用;H-postC可上调CRT和CaN的表达,分别较H／R组增加31．8％（P〈0．05）和6．02％,加入CsA后CaN表达降低44．02％（P〈0．05vsH-postC）。上述整体实验和细胞培养实验结果提示,I-postC与IPC保护作用相似,可显著减轻I／R损伤;CRT上调介导的CaN表达增加可能参与了I-postC的保护作用,抑制CaN表达可降低I-postC的保护作用。     

Superior neovascularization and muscle regeneration in ischemic skeletal muscles following VEGF gene transfer by rAAV1 pseudotyped vectors

Recombinant adeno-associated virus serotype 2 (rAAV2) vector has been widely employed for gene therapy. Recent progress suggests that the new serotypes of AAV showed a better performance than did AAV2 in normal tissues. Here, we evaluate the potential role of human vascular endothelial growth factor (VEGF) gene transfer using rAAV vector pseudotyped with serotype 1 capsid proteins (rAAV1) in the treatment of muscle ischemia. In ischemic skeletal muscles, the rAAV1-LacZ vector allowed higher level, broader distribution, and long-lasting gene expression compared with the rAAV2-LacZ vector. Muscle VEGF165 production following the rAAV1-VEGF165 vector injection was 5-10 times higher than that following the rAAV2-VEGF165 vector injection. VEGF165 production mediated by the rAAV1-VEGF165 vector stimulated a large set of neovascularization with relatively mature vascular structures and enhanced muscle regeneration in the ischemic skeletal muscles. Thus, the rAAV1-VEGF165 vector mediated gene transfer may be a therapeutic approach to peripheral vascular diseases.     

Hypoxic response elements control expression of human vascular endothelial growth factor(165) genes transferred to ischemia myocardium in vivo and in vitro

BACKGROUND: Vascular endothelial growth factor (VEGF) gene transfer with recombinant adeno-associated viral (rAAV) vector for ischemia heart disease therapy is being increasingly studied. However, uncontrolled long-term expression of VEGF may cause some side effects. Therefore, an attempt to develop an effective gene control system for safeguarding against such side effects should be made. Pathphysiologically, an ideal control system for VEGF gene expression is letting it respond to hypoxia. We used nine copies of hypoxic response element (HRE) to regulate expression of hVEGF(165) in the myocardium, and tried to elucidate the feasibility and safety of the application of the HIF-1-HRE system. METHODS: Cardiomyocytes of neonatal Sprague Dawley rats were cultured and incubated with rAAV-9HRE-hVEGF(165), and pig ischemic heart models were established and rAAV-9HRE-hVEGF(165) was injected into ischemia myocardium. RT-PCR, Western blot, ELISA, and immunohistochemistry were used to determine hVEGF(165) expressions of cultured cardiomyocytes and myocardium under hypoxic and reoxygenation conditions. RESULTS: The results of RT-PCR and ELISA determinations revealed that, in cultured cardiomyocytes, expressions of hVEGF(165)mRNA and protein were up-regulated under hypoxic conditions. After 4 h of reoxygenation, hVEGF(165)mNRA expression was decreased, and disappeared following 8 to 12 h of reoxygenation (P < 0.01). RT-PCR and Western blot also showed that, under myocardial ischemia, hVEGF(165) expression was increased significantly (P < 0.01). Following myocardial reperfusion, both hVEGF(165)mRNA and protein expressions were inhibited (P < 0.01). The new vessels in the reperfusion condition were decreased. CONCLUSIONS: This study suggested that 9HRE can effectively control hVEGF(165) gene expression in vivo and in vitro. It has feasibility for using the HIF-1-HRE system for regulation of angiogenic factor expression in ischemia heart.     

Osteogenic differentiation effects on rat bone marrow-derived mesenchymal stromal cells by lentivirus-mediated co-transfection of human BMP2 gene and VEGF165 gene

We proposed a novel combined gene therapy of human vascular endothelial growth factor 165 gene (hVEGF165) and human bone morphogenetic protein 2 gene (hBMP2) for bone regeneration by lentivirus-mediated co-transfection of both genes into rat bone marrow-derived mesenchymal stromal cells (MSCs). Both genes were successfully co-expressed in MSCs confirmed by real-time PCR and ELISA. And the alkaline phosphatase activity of MSCs was significantly augmented by the co-transfection with both genes than any single gene transfection (P < 0.01). These results demonstrated the feasibility of the combined gene therapy by using MSCs lentivirally co-transfected with hVEGF165 and hBMP2 for bone regeneration.     

竞争性PCR检测MLC_2-糜酶融合基因在转基因小鼠中的组织特异性表达

 用竞争性 Ｐ Ｃ Ｒ 方法定量检测了大鼠肌球蛋白轻链 ２ 启动子（ｍ ｙｏｓｉｎ ｌｉｇｈｔ ｃｈａｉｎ ２ ｐｒｏｍ ｏｔ ｅｒ, Ｍ Ｌ Ｃ２） 糜酶（ｃｈｙｍ ａｓｅ）融合基因在转基因小鼠不同组织中的表达情况,发现 Ｍ Ｌ Ｃ２ ｃｈｙｍ ａｓｅ融合基因在转基因小鼠的心脏中有较高水平的表达,在骨骼肌中表达水平较低,在肾脏中有微弱表达;而在肝脏和肺中未检测到．表明 Ｍ Ｌ Ｃ２ ｃｈｙｍ ａｓｅ 融合基因改变了野生型 ｃｈｙｍ ａｓｅ 在生物体内的表达特性,不仅提高了表达效率,而且赋予了一定的心脏组织特异性,为进一步研究 ｃｈｙｍ ａｓｅ 基因在心脏中的功能奠定了基础．     

Dietary glutamine supplementation enhances endothelial progenitor cell mobilization in streptozotocin-induced diabetic mice subjected to limb ischemia

Diabetes is a metabolic disorder with increased risk of vascular diseases. Tissue ischemia may occur with diabetic vascular complications. Bone marrow-derived endothelial progenitor cells (EPCs) constitute a reparative response to ischemic injury. This study investigated the effects of oral glutamine (GLN) supplementation on circulating EPC mobilization and expression of tissue EPC-releasing markers in diabetic mice subjected to limb ischemia. Diabetes was induced by a daily intraperitoneal injection of streptozotocin for 5 days. Diabetic mice were divided into 2 nonischemic groups and 6 ischemic groups. One of the nonischemic and 3 ischemic groups were fed the control diet, while the remaining 4 groups received diets with identical components except that part of the casein was replaced by GLN. The respective diets were fed to the mice for 3 weeks, and then the nonischemic mice were sacrificed. Unilateral hindlimb ischemia was created in the ischemic groups, and mice were sacrificed at 1, 7 or 21 days after ischemia. Their blood and ischemic muscle tissues were collected for further analyses. Results showed that plasma matrix metallopeptidase (MMP)-9 and the circulating EPC percentage increased after limb ischemia in a diabetic condition. Compared to groups without GLN, GLN supplementation up-regulated plasma stromal cell-derived factor (SDF)-1 and muscle MMP-9, SDF-1, hypoxia-inducible factor-1 and vascular endothelial growth factor gene expression. The CD31-immunoreactive intensities were also higher in the ischemic limb. These findings suggest that GLN supplementation enhanced circulating EPC mobilization that may promote endothelium repair at ischemic tissue in diabetic mice subjected to limb ischemia.     

Combined transfer of human VEGF165 and HGF genes renders potent angiogenic effect in ischemic skeletal muscle

Increased interest in development of combined gene therapy emerges from results of recent clinical trials that indicate good safety yet unexpected low efficacy of "single-gene" administration. Multiple studies showed that vascular endothelial growth factor 165 aminoacid form (VEGF165) and hepatocyte growth factor (HGF) can be used for induction of angiogenesis in ischemic myocardium and skeletal muscle. Gene transfer system composed of a novel cytomegalovirus-based (CMV) plasmid vector and codon-optimized human VEGF165 and HGF genes combined with intramuscular low-voltage electroporation was developed and tested in vitro and in vivo. Studies in HEK293T cell culture, murine skeletal muscle explants and ELISA of tissue homogenates showed efficacy of constructed plasmids. Functional activity of angiogenic proteins secreted by HEK293T after transfection by induction of tube formation in human umbilical vein endothelial cell (HUVEC) culture. HUVEC cells were used for in vitro experiments to assay the putative signaling pathways to be responsible for combined administration effect one of which could be the ERK1/2 pathway. In vivo tests of VEGF165 and HGF genes co-transfer were conceived in mouse model of hind limb ischemia. Intramuscular administration of plasmid encoding either VEGF165 or HGF gene resulted in increased perfusion compared to empty vector administration. Mice injected with a mixture of two plasmids (VEGF165+HGF) showed significant increase in perfusion compared to single plasmid injection. These findings were supported by increased CD31+ capillary and SMA+ vessel density in animals that received combined VEGF165 and HGF gene therapy compared to single gene therapy. Results of the study suggest that co-transfer of VEGF and HGF genes renders a robust angiogenic effect in ischemic skeletal muscle and may present interest as a potential therapeutic combination for treatment of ischemic disorders.     

Mesenchymal stem cells improve survival in ischemic diabetic random skin flap via increased angiogenesis and VEGF expression

Random skin flaps (RSFs) are cutaneous flaps. Despite the negative impact of diabetes mellitus (DM) on RSF viability, they are commonly used in diabetic patients. In this study, we have assessed bone marrow mesenchymal stem cell (BMMSC) treatment on RSF survival, tensiometrical parameters, angiogenesis, and mast cells (MCs) count in an ischemic RSF model in rats with type 1 DM (T1DM). We induced T1DM in 30 Wistar adult male rats. The animals were assigned to three groups of 10 rats per group as follows: group 1 (control); group 2 (placebo), and group 3 (BMMSCs). A 30 × 80 mm RSF was created in each rat. On day 7, we measured the viable portion of each RSF. A sample was taken for histological and immunohistochemistry studies, fibroblasts, MCs, angiogenesis, collagen bundle density, and the presence of vascular endothelial growth factor (VEGF)+ cells. An additional sample was taken to evaluate the flap's incision strength. Treatment with BMMSCs (17.8 ± 0.37) significantly increased RSF survival compared with the control (13.3 ± 0.35) and placebo (16.1 ± 0.27) groups (one-way analysis of variance, P = .000; least significant difference, P = .000, P = .002). There was a significant improvement in angiogenesis, as confirmed by stereologic examination. Assessment of VEGF+ cells showed prominent neovascularization in BMMSC-treated RSFs compared with the control and placebo groups. Subdermal injection of BMMSC significantly increased ischemic RSF survival as a result of stimulated neovascularization in T1DM rats. Treatment of diabetic RSF with BMMSCs showed no beneficial effects in the fibroblast number and biomechanical parameters for the repair of ischemic wounds in the rat model. Treatment with BMMSCs significantly increased collagen bundle density.