VEGF and Other Gene Therapies Improve Flap Survival—A Systematic Review and Meta-Analysis of Preclinical Studies
Surgical flaps are basic tools in reconstructive surgery. Their use may be limited by ischemia and necrosis. Few therapies address or prevent them. Genetic therapy could improve flap outcomes, but primary studies in this field present conflicting results. This systematic review and meta-analysis aim...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-02-01
|
| Series: | International Journal of Molecular Sciences |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1422-0067/25/5/2622 |
| _version_ | 1797264467552108544 |
|---|---|
| author | Wiktor Paskal Mateusz Gotowiec Albert Stachura Michał Kopka Paweł Włodarski |
| author_facet | Wiktor Paskal Mateusz Gotowiec Albert Stachura Michał Kopka Paweł Włodarski |
| author_sort | Wiktor Paskal |
| collection | DOAJ |
| description | Surgical flaps are basic tools in reconstructive surgery. Their use may be limited by ischemia and necrosis. Few therapies address or prevent them. Genetic therapy could improve flap outcomes, but primary studies in this field present conflicting results. This systematic review and meta-analysis aimed to appraise the efficacy of external gene delivery to the flap for its survival in preclinical models. This review was registered with PROSPERO (CRD42022359982). PubMed, Embase, Web of Science, and Scopus were searched to identify studies using animal models reporting flap survival outcomes following any genetic modifications. Random-effects meta-analysis was used to calculate mean differences in flap survival with accompanying 95% CI. The risk of bias was assessed using the SYRCLE tool. Subgroup and sensitivity analyses were performed to ascertain the robustness of primary analyses, and the evidence was assessed using the GRADE approach. The initial search yielded 690 articles; 51 were eventually included, 36 of which with 1576 rats were meta-analyzed. VEGF gene delivery to different flap types significantly improved flap survival area by 15.66% (95% CI 11.80–19.52). Other interventions had smaller or less precise effects: PDGF—13.44% (95% CI 3.53–23.35); VEGF + FGF—8.64% (95% CI 6.94–10.34); HGF—5.61% (95% CI 0.43–10.78); FGF 3.84% (95% CI 1.13–6.55). Despite considerable heterogeneity, moderate risk of bias, and low quality of evidence, the efficacy of VEGF gene therapy remained significant in all sensitivity analyses. Preclinical data indicate that gene therapy is effective for increasing flap survival, but further animal studies are required for successful clinical translation. |
| first_indexed | 2024-04-25T00:29:22Z |
| format | Article |
| id | doaj.art-cb27235d0e924274a31a4e7708e7be4a |
| institution | Directory Open Access Journal |
| issn | 1661-6596 1422-0067 |
| language | English |
| last_indexed | 2024-04-25T00:29:22Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | International Journal of Molecular Sciences |
| spelling | doaj.art-cb27235d0e924274a31a4e7708e7be4a2024-03-12T16:45:40ZengMDPI AGInternational Journal of Molecular Sciences1661-65961422-00672024-02-01255262210.3390/ijms25052622VEGF and Other Gene Therapies Improve Flap Survival—A Systematic Review and Meta-Analysis of Preclinical StudiesWiktor Paskal0Mateusz Gotowiec1Albert Stachura2Michał Kopka3Paweł Włodarski4Department of Methodology, Medical University of Warsaw, 1b Banacha Street, 02-091 Warsaw, PolandDepartment of Methodology, Medical University of Warsaw, 1b Banacha Street, 02-091 Warsaw, PolandDepartment of Methodology, Medical University of Warsaw, 1b Banacha Street, 02-091 Warsaw, PolandDepartment of Methodology, Medical University of Warsaw, 1b Banacha Street, 02-091 Warsaw, PolandDepartment of Methodology, Medical University of Warsaw, 1b Banacha Street, 02-091 Warsaw, PolandSurgical flaps are basic tools in reconstructive surgery. Their use may be limited by ischemia and necrosis. Few therapies address or prevent them. Genetic therapy could improve flap outcomes, but primary studies in this field present conflicting results. This systematic review and meta-analysis aimed to appraise the efficacy of external gene delivery to the flap for its survival in preclinical models. This review was registered with PROSPERO (CRD42022359982). PubMed, Embase, Web of Science, and Scopus were searched to identify studies using animal models reporting flap survival outcomes following any genetic modifications. Random-effects meta-analysis was used to calculate mean differences in flap survival with accompanying 95% CI. The risk of bias was assessed using the SYRCLE tool. Subgroup and sensitivity analyses were performed to ascertain the robustness of primary analyses, and the evidence was assessed using the GRADE approach. The initial search yielded 690 articles; 51 were eventually included, 36 of which with 1576 rats were meta-analyzed. VEGF gene delivery to different flap types significantly improved flap survival area by 15.66% (95% CI 11.80–19.52). Other interventions had smaller or less precise effects: PDGF—13.44% (95% CI 3.53–23.35); VEGF + FGF—8.64% (95% CI 6.94–10.34); HGF—5.61% (95% CI 0.43–10.78); FGF 3.84% (95% CI 1.13–6.55). Despite considerable heterogeneity, moderate risk of bias, and low quality of evidence, the efficacy of VEGF gene therapy remained significant in all sensitivity analyses. Preclinical data indicate that gene therapy is effective for increasing flap survival, but further animal studies are required for successful clinical translation.https://www.mdpi.com/1422-0067/25/5/2622surgical flapsregenerative medicineanimal modelsgene therapygenetic vectors |
| spellingShingle | Wiktor Paskal Mateusz Gotowiec Albert Stachura Michał Kopka Paweł Włodarski VEGF and Other Gene Therapies Improve Flap Survival—A Systematic Review and Meta-Analysis of Preclinical Studies International Journal of Molecular Sciences surgical flaps regenerative medicine animal models gene therapy genetic vectors |
| title | VEGF and Other Gene Therapies Improve Flap Survival—A Systematic Review and Meta-Analysis of Preclinical Studies |
| title_full | VEGF and Other Gene Therapies Improve Flap Survival—A Systematic Review and Meta-Analysis of Preclinical Studies |
| title_fullStr | VEGF and Other Gene Therapies Improve Flap Survival—A Systematic Review and Meta-Analysis of Preclinical Studies |
| title_full_unstemmed | VEGF and Other Gene Therapies Improve Flap Survival—A Systematic Review and Meta-Analysis of Preclinical Studies |
| title_short | VEGF and Other Gene Therapies Improve Flap Survival—A Systematic Review and Meta-Analysis of Preclinical Studies |
| title_sort | vegf and other gene therapies improve flap survival a systematic review and meta analysis of preclinical studies |
| topic | surgical flaps regenerative medicine animal models gene therapy genetic vectors |
| url | https://www.mdpi.com/1422-0067/25/5/2622 |
| work_keys_str_mv | AT wiktorpaskal vegfandothergenetherapiesimproveflapsurvivalasystematicreviewandmetaanalysisofpreclinicalstudies AT mateuszgotowiec vegfandothergenetherapiesimproveflapsurvivalasystematicreviewandmetaanalysisofpreclinicalstudies AT albertstachura vegfandothergenetherapiesimproveflapsurvivalasystematicreviewandmetaanalysisofpreclinicalstudies AT michałkopka vegfandothergenetherapiesimproveflapsurvivalasystematicreviewandmetaanalysisofpreclinicalstudies AT pawełwłodarski vegfandothergenetherapiesimproveflapsurvivalasystematicreviewandmetaanalysisofpreclinicalstudies |