Novel approach to ischemic skin ulcer in systemic lupus erythematosus: therapeutic angiogenesis by controlled-release basic fibroblast growth factor.

摘要

Systemic lupus erythematosus (SLE) frequently involves the vascular system, and the acquired inflammatory process is known to accelerate atherosclerosis. We report a 65-year-old woman with SLE complicated by an ischemic skin ulcer of the superior portion of the right lateral malleolus which was untreatable by local therapy. The ankle-brachial index was reduced to 0.72 in the right leg, and transcutaneous oxygen tension (TCPO2) at the dorsum of the right foot was 1.0 mmHg (normal limit: >30 mmHg) with no increase after pure oxygen inhalation. Angiography revealed total occlusions of all the below-the-knee arteries with poor distal collateral circulation, indicating an Inter-Society Consensus type D lesion. Because the patient's SLE disease activity index was 11 points under the administration of prednisolone and methotrexate, invasive therapy by percutaneous or surgical revascularization was not preferable. Thus, we decided to perform therapeutic angiogenesis by administration of controlled-release basic fibroblast growth factor (bFGF)-incorporated biodegradable gelatin hydrogel. Four weeks after the therapy, there was no significant improvement in ankle-brachial index (ABI) and angiographic findings. Instead, basal TCPO2 was increased to 10 mmHg with an additional increase up to 39 mmHg by oxygen inhalation. Furthermore, the ulcer healed completely without any complications. This result suggests that bFGF protein therapy using the drug delivery system can be a promising approach to intractable skin ulcers complicating SLE.