A major and rapidly increasing vascular disease is peripheral artery disease (PAD), caused by atherosclerosis, a build-up of plaque in the arteries of the leg. PAD can cause significant pain and inability to walk as well as potential amputation. PAD affects more than 8 million Americans, requiring hundreds of thousands of surgeries and causing over 80,000 amputations.
The treatments used today to improve blood flow in patients with PAD are surgical bypass or angioplasty/stenting. While often successful initially, these interventions frequently need to be repeated due to re-narrowing of the artery or graft resulting from abnormal scar formation known as restenosis. The failure rates of angioplasty are as high as 50% within 1 – 2 years, whereas vein bypass has a failure rate of 30 – 50% over 5 years. This results in the need for multiple surgeries with additional complications, risks, and costs. Watch this video to learn more.
The initial project of the Vascular Cures Research Network is to discover predictors of the abnormal healing that causes restenosis, identify high-risk patients, and develop appropriate treatments and technologies. Our goal is to develop treatments and technologies to reduce the failure rate of peripheral vascular repairs by 30% within 5 years. This ground-breaking translational program provides the best chance to develop new treatments, by being the first to identify the biological and genetic contributors of PAD restenosis. We will collect and analyze samples from over 2,000 patients - an achievement that has never been possible before.
The Project Details: Genomic and Proteomic Determinants of Peripheral Revascularization
The overall goal of this multicenter collaborative research program is to identify genetic and proteomic risk factors associated with clinical and anatomic failure following lower extremity revascularization procedures. We recently identified a genetic marker. Learn more.
Two independent prospective registry studies are planned - one focused on vein bypass surgery and the other focused on restenosis in arteries treated by endovascular means (angioplasty, atherectomy, stenting). Approximately 1,000 patients will be enrolled for each study, with clinical follow-up for up to two years. Demographic, clinical, and procedural data will be collected as a baseline. Clinical and imaging data will be obtained over the follow up period in accordance with standard post-procedural surveillance practices. Blood samples will be obtained for genomic DNA and plasma biomarkers at 2-3 time points. The genetic and proteomic strategy will be hypothesis-based testing of specific candidate genes/proteins that are considered potential candidates based on other related clinical or basic laboratory investigation. In the vein bypass study, a biopsy sample of the vein conduit will be obtained at the time of initial surgery for potential uses such as immunostaining or transcriptional analysis to examine baseline gene expression patterns.
Advances in genomics are putting the dream of individualized medicine within reach, identifying genetic profiles and biomarkers that predict disease or response to treatment. These discoveries rely on specialized analyses of tissue maintained in a "biobank" from large numbers of patients. Biobanking was included in TIME Magazine's list of “10 Ideas Changing the World Right Now.”