Fig. 2

Limb salvage after gene therapy in a 33-year-old woman. (Left top) Nonhealing wound on the medial aspect of the calf and ischemic necrosis involving the great toe. (Left middle) Ingrowth of granulation tissue in calf wound, healing of great toe. (Left bottom) Three months after gene transfer, healing of split-thickness skin graft at wound site, and full resolution of great toe necrosis. (Right) Evidence of phVEGF₁₆₅ bioavailability documented by an increase in venous VEGF blood levels, and bioactivity expressed as an increase in antebrachial index. The ankle-brachial index progressively increased from 0.28 before to 0.56 after gene therapy (weeks refer to time post-transfection). This was associated with the development of a phasic pulse volume recording (PVR) compared with the nonphasic tracing recorded at baseline. Vertical arrows indicate timing of each of the two intramuscular phVEGF₁₆₅ injections.