Preconditioning of surgical pedicle flaps with DNA plasmid expressing hypoxia-inducible factor-1α (HIF-1α) promotes tissue viability

Kai Hua Chang, Pouria Shoureshi, Frank Lay, Raul Sebastian, Zahra Alikhassy Habibabady, Louis J. Born, Guy P. Marti, Stephen J. Meltzer, John M. Abraham, John W. Harmon

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Ischemic necrosis of surgical flaps after reconstruction is a major clinical problem. Hypoxia-inducible factor-1α (HIF-1α) is considered the master regulator of the adaptive response to hypoxia. Among its many properties, it regulates the expression of genes encoding angiogenic growth factors, which have a short half-life in vivo. To achieve a continuous application of the therapeutic, we utilized DNA plasmid delivery. Transcription of the DNA plasmid confirmed by qRT-PCR showed significantly increased mRNA for HIF-1α in the transfected tissue compared to saline control tissue. Rats were preconditioned by injecting with either HIF-1α DNA plasmid or saline intradermally in the designated flap region on each flank. Seven days after preconditioning, each rat had two isolated pedicle flaps raised with a sterile silicone sheet implanted between the skin flap and muscle layer. The flaps preconditioned with HIF-1α DNA plasmid had significantly less necrotic area. Angiogenesis measured by CD31 staining showed a significant increase in the number of vessels per high powered field in the HIF-1α group (p < 0.05). Our findings offer a potential therapeutic strategy for significantly promoting the viability of surgical pedicle flaps by ischemic preconditioning with HIF-1α DNA plasmid.

Original languageEnglish (US)
Pages (from-to)319-328
Number of pages10
JournalGene Therapy
Issue number6
StatePublished - Jun 2021

ASJC Scopus subject areas

  • Molecular Medicine
  • Molecular Biology
  • Genetics


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