A novel bFGF-GH injection therapy for two patients with severe ischemic limb pain

First-in-Man Clinical Pilot Study Showing the Safety and Efficacy of Intramuscular Injection of Basic Fibroblast Growth Factor With Atelocollagen Solution for Critical Limb Ischemia

BACKGROUND

Therapeutic angiogenesis with basic fibroblast growth factor (bFGF) with atelocollagen was confirmed in a study using a limb ischemia mouse model. Because the number of elderly patients with critical limb ischemia (CLI) is increasing, particularly that caused by arteriosclerosis obliterans (ASO), the development of less invasive angiogenesis therapies desired.

METHODS AND RESULTS

This first-in-man clinical study was designed to assess the safety and efficacy of i.m. injection of bFGF with atelocollagen. Human recombinant bFGF (200 μg), combined with 4.8 mL 3% atelocollagen solution, was prepared and injected into the gastrocnemius muscle of the ischemic leg. The primary endpoint was safety, evaluated on all adverse events over 48 weeks after this treatment. The secondary endpoint was efficacy, evaluated by improvement of ischemic symptoms. No serious procedure-related adverse events were observed during the follow-up period. Visual analogue scale (VAS) score was significantly improved at 4, 24 and 48 weeks compared with baseline (P<0.05), and 7 patients became pain free during the follow-up period. Fontaine classification was improved in 4 of 10 patients at 48 weeks. Cyanotic lesions disappeared in 2 patients at 4 weeks.

CONCLUSIONS

I.m. injection of bFGF with atelocollagen is safe and feasible in patients with CLI. Randomized controlled trials are therefore needed to confirm these results.

Optimization and scale-up of Wharton's jelly-derived mesenchymal stem cells for clinical applications

MSCs are promising candidates for stem cell therapy and regenerative medicine. Umbilical cord is the easiest obtainable biological source of MSCs and the Wharton's jelly of the umbilical cord is a rich source of fetus-derived stem cells. However, the use of MSCs for therapeutic application is based on their subsequent large-scale in vitro expansion. A fast and efficient protocol for generation of large quantities of MSCs is required to meet the clinical demand and biomedical research needs. Here we have optimized conditions for scaling up of WJ-MSCs. Low seeding density along with basic fibroblast growth factor (bFGF) supplementation in the growth medium, which is DMEM-KO, resulted in propagation of more than 1 x 10(8) cells within a time period of 15 days from a single umbilical cord. The upscaled WJ-MSCs retained their differentiation potential and immunosuppressive capacity. They expressed the typical hMSC surface antigens and the addition of bFGF in the culture medium did not affect the expression levels of HLA-DR and CD 44. A normal karyotype was confirmed in the large-scale expanded WJ-MSCs. Hence, in this study we attempted rapid clinical-scale expansion of WJ-MSCs which would allow these fetus-derived stem cells to be used for various allogeneic cell-based transplantations and tissue engineering.

Fibroblast growth factor and insulin-like growth factor rescue growth cones of sensory neurites from collapse after tetracaine-induced injury

BACKGROUND

Basic fibroblast growth factor (bFGF) and insulin-like growth factor (IGF)-1 have multiple effects on cells, including proliferation, differentiation, and survival. In this study, we investigated the effects of different concentrations of IGF and bFGF on the morphology of growth cones of the developing sensory neurons after tetracaine-induced injury in vitro.

METHODS

Dorsal root ganglia were isolated from chick embryos on embryonic day 7 or 8 and cultured for 24 hours. Tissues were then exposed to 100 mumol/L tetracaine for 60 minutes. The media were replaced by tetracaine-free media containing different concentrations of IGF, bFGF, or combination of IGF 50 ng/mL and bFGF 5 ng/mL and incubated for a further 24 hours. Growth cone collapse assays were then performed to assess regeneration of neurons.

RESULTS

Exposure of dorsal root ganglia explants to tetracaine 100 mumol/L for 1 hour caused significant growth cone collapse 24 hours after washing out tetracaine (P < 0.01). It was found that adding bFGF (5, 10, 20, and 50 ng/mL) or IGF (50 and 100 ng/mL) to the replacement media significantly decreased growth cone collapse percentage at 24 hours after washout (P < 0.01); however, the low concentrations of bFGF (2 ng/mL) or IGF (25 ng/mL) did not cause significant change. Growth cone collapse after simultaneous addition of 5 ng/mL bFGF and 50 ng/mL IGF was statistically lower than the values after adding 5 ng/mL bFGF (P < 0.01), and it was marginally lower than 50 ng/mL IGF.

CONCLUSION

bFGF and bIGF decreased growth cone collapse after tetracaine-induced injury in vitro.