Abstract 550: Vascular And Muscle Recovery In Pre-clinical Model Of Peripheral Vascular Disease Using Intramuscular Estrogen Related Receptor Gamma Gene Therapy

Abstract

Peripheral arterial disease (PAD) and critical limb ischemia (CLI) are caused by occlusion of blood vessels and characterized by muscle ischemia, weakness, and limb myopathy. Over 8-12 million Americans are affected by PAD, resulting in impaired mobility, increased cardiovascular risk, and limb amputation. Therapeutic strategies for simultaneously restoring blood flow, metabolism, and muscle recovery are currently lacking for PAD. We have previously shown in a transgenic mouse model that nuclear receptor Estrogen-related receptor gamma (ERRγ) is a central regulator of muscle metabolism and angiogenesis. Here, we investigated intramuscular (IM) gene therapy for PAD using AAV9-Esrrg in unilateral hindlimb ischemia (HLI) pre-clinical model. We first established in hindlimb muscles of C57Bl6/J mice that a single IM injection of 1X10^11 AAV9-Esrrg viral particles robustly increased ERRγ protein expression, resulting in induction of angiogenic and oxidative genes, higher capillary (CD31 immunostaining) density and SDH oxidative metabolic activity over AAV9-GFP injected control muscles. Subsequently, AAV9-Esrrg injection, 24 hours after HLI, increased ischemic neo-angiogenesis, markers of endothelial activation, and significantly improved blood flow recovery measured by laser Doppler flowmetry over AAV9-GFP injected controls. Moreover, ERRγ overexpression increased mitochondrial respiratory complex protein expression, which resulted in restored SDH oxidative metabolic capacity in ischemic muscle. More critically, AAV9-Esrrg restored myofibrillar size and mitigated ischemia-induced myopathy as revealed by myofiber size to number ratio quantification. In conclusion, we demonstrate that post-ischemic IM AAV9-Esrrg gene delivery rescues ischemic pathology by boosting metabolism and angiogenesis, underscoring Esrrg gene therapy or pharmacological activation as a highly promising strategy for treating PAD/CLI-related myopathy.