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Background/aims: Urea cycle disorders (UCDs) are rare inborn errors of urea synthesis. US and European consensus statements on the diagnosis and treatment of UCDs were last published in 2001 and 2019, respectively. Recommendations are based primarily on case reports and expert opinion and there is limited agreement or consistency related to long-term management approaches. A clinician survey was conducted to assess current real-world practices and perspectives on challenges and unmet needs., Methods: A 14-item multiple-choice survey was administered to physicians in 2017. Clinicians who reported actively managing at least 1 patient with UCD were eligible to participate. Descriptive statistics were calculated for each survey item (frequencies for categorical variables; means, standard deviations, medians, and ranges for continuous variables)., Results: Sixty-six US clinicians completed the survey (65 geneticists; 1 pediatric neurologist). Over 90% of responders agreed or strongly agreed that even modest elevations in ammonia could cause physiological and functional brain damage; >80% of respondents agreed that asymptomatic UCD patients are at risk of brain damage over time due to mild/subclinical elevations in ammonia. Eighty-six percent of clinicians agreed or strongly agreed with recommending genetic testing for female relatives when a patient is diagnosed with ornithine transcarbamylase deficiency. Ninety-four percent of respondents agreed that patients have better disease control when they are more adherent to their UCD therapy. Nearly 90% indicated that clinicians and patients would benefit from updated UCD management guidance. More than half (53%) of respondents rated the symptoms of UCDs as extremely or very burdensome to the everyday lives of patients and their families; only 8% rated UCD symptoms as slightly or not at all burdensome. The majority of clinicians agreed (48%) or strongly agreed (32%) that caring for a child or family member with a UCD has a negative impact on the quality of life and/or health of family members/guardians (e.g. stress, relationships, ability to work)., Conclusions: This self-reported survey suggests a need for updated and expanded clinical guidance on the long-term treatment and management of UCD patients., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Microvascular network formation is required for the success of many therapies in regenerative medicine. The process of vessel assembly is fundamentally altered, however, in many people within the potential patient population, including the elderly and people with diabetes. Significant research has been performed to determine how cellular dysfunction contributes to this inadequate neovascularization, but alterations in the extracellular matrix (ECM) may also influence this process. Glycation of ECM proteins, specifically type I collagen, increases as people age and is accelerated due to uncontrolled diabetes. This glycation results in increased ECM stiffness and resistance to degradation. The goal of this research is to determine whether collagen glycation consistent with changes in aged (defined as people older than 80 years old) and diabetic individuals influences neovascularization. Collagen gels that were incubated in glucose-6-phopshate (G6P) for varying times exhibited cross-linking (26.2+/-8.1% and 31.3+/-5.6% for incubation in 375 mM G6P for 5 and 8 days, respectively), autofluorescence, and advanced glycation end product levels (666+/-481 and 2122+/-501 pmol/mg protein for 5 and 8 days of 375 mM G6P, respectively) consistent with aged and diabetic populations. Three-dimensional culture models showed that sprouting angiogenesis was delayed in collagen gels with high levels of glycation. When implanted in vivo, glycated gels were degraded (44.4+/-4.2% and 49.5+/-11.7% nondegraded gel remaining for gels incubated for 5 and 8 days in 375 mM G6P, respectively) and vascularized (75.5+/-32.0 and 73.7+/-23.6 vessels/mm(2)) more slowly than controls (22.3+/-9.9% gel remaining and 133.3+/-31.0 vessels/mm(2)). These results suggest that glycation of collagen can alter neovascularization and may contribute to alterations in vessel assembly observed as people age and due to diabetes., (Published by Elsevier Inc.)

The use of growth factors for the therapeutic stimulation of neovascularization in regenerative medicine has been extensively investigated, but the inability to control their temporal delivery may limit clinical success. A strategy that delivers continuous therapeutic concentrations of growth factors may increase the protein's efficacy. The present study investigates the ability of sustained delivery of fibroblast growth factor-1 (FGF-1), to induce neovascularization in vivo. Alginate microbeads were synthesized to release active FGF-1 for three weeks. Microbeads loaded with FGF-1 (total amount 150 ng) were implanted into a surgically created omentum pouch in rats and were compared to control empty microbead implants and a single bolus injection of 150 ng of FGF-1 with empty microbead implant. Animals were sacrificed at either 3 or 6 weeks post implantation and omenta were analyzed for vascular density and mural cell interactions. Vascular area for bolus FGF-1 and FGF-1 loaded microbeads was higher than control at 3 weeks. At 6 weeks, vascular density in the group with FGF-1 loaded microbeads was significantly higher than the group with bolus administration of FGF-1, primarily due to an increase in the number of vessels less than 20 microm in diameter. Vascular density in omenta of the group receiving the bolus FGF-1 returned to control levels by 6 weeks. Staining for smooth muscle actin showed that 50% of vessels had associated mural cells. There was a trend of increased mural cell staining at 6 weeks for the FGF-1 loaded beads compared to bolus FGF-1 and control levels. Results in these studies suggest that sustained release of FGF-1 increases the duration of the vascular response in contrast to a bolus injection of FGF-1.