disease. Clinical improvements observed consist of improved muscle function and regression of rest pain or angina. However, direct evidence for improved vascularization, as evaluated by angiography, is weak. We here report an unexpected effect that occurred in ischaemic hind limb muscle of mice treated with intramuscular adenoviral gene transfer of VEGF-A, namely the increase of myoglobin. Myoglobin is a hemecontaining protein, expressed in cardiomyocytes and skeletal myocytes, that ameliorates oxygen storage in and supply to muscle cells. Both the number of myoglobin-stained muscle fibers and active myoglobin concentration were increased in calf muscle of Ad.VEGFversus Ad.LacZ-treated mice (18±4.3 versus 7.0±4.1% and 64±6.8 versus 43±3.9 mg myoglobin/ mg dry-weight respectively, N = 6). Another effect of Ad.VEGF treatment was an increase of capillaries (409±74 vs. 185±24 capillaries/mm2, N = 6), however no increase of collateral arteries was observed as compared to Ad.LacZ (angiographic Rentrop scores 1.9±0.4 versus 1.9±0.3, N = 6). To study whether VEGF can act directly on muscle cells to enhance myoglobin expression, we performed an experiment with VEGF protein in differentiated murine C2C12 myoblasts in culture. Indeed, a 3-fold increase of myoglobin mRNA was shown in VEGFversus PBS-treated myoblasts, using Real Time RT-PCR analysis. In addition, co-expression of VEGF and myoglobin was observed in ischaemic muscle tissue of 15 limb amputation patients, suggesting a correlation between both proteins. Moreover, an increased level of ischaemia was correlated with an increase in both VEGF and myoglobin expression (Signs-test p = .018 and .047 respectively). In conclusion, VEGF (gene) therapy results in enhanced myoglobin expression in skeletal muscle in vitro and in vivo. Furthermore, we show correlated expression of VEGF and myoglobin in muscle from limb amputation patients. The increased myoglobin expression in VEGF-treated muscle implies an improved muscle oxygenation, which may, partly, explain the previously observed clinical improvements, such as regression of claudication or angina, in VEGF-treated patients. Poster Abstracts / Cardiovascu S134
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