Vascular growth factors and angiogenesis in cardiac surgery.
Therapeutic angiogenesis, in the form of growth factor protein administration or gene therapy, has emerged as a new method of treatment for patients with severe, inoperable coronary artery disease. Improved myocardial perfusion and function after administration of angiogenic growth factors has been demonstrated in animal models of chronic myocardial ischemia. Recently, preliminary clinical trials using growth factor proteins or genes encoding these angiogenic factors have demonstrated clinical and other objective evidence of relevant angiogenesis. A recent study reported beneficial long-term effects of therapeutic angiogenesis using fibroblast growth factor (FGF)-2 protein in terms of freedom from angina and perfusion on single-photon emission computed tomographic imaging. Thus, therapeutic angiogenesis has the potential to extend treatment options to patients who are not optimal candidates for conventional methods of myocardial revascularization. However, endogenous antiangiogenic influences, intrinsic lack of response of patients with severe endothelial dysfunction, and other limitations will need to be overcome before angiogenesis becomes a standard therapy for the treatment of patients with severe coronary disease.
Sellke
Frank W
FW
Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA. fsellke@caregroup.harvard.edu
Ruel
Marc
M
D043925:Angiogenesis Inducing Agents / Q000502:physiology*; D000818:Animals; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D016503:Drug Delivery Systems; D016228:Endothelial Growth Factors / Q000008:administration & dosage / Q000627:therapeutic use*; D016220:Fibroblast Growth Factor 1 / Q000008:administration & dosage; D016222:Fibroblast Growth Factor 2 / Q000008:administration & dosage / Q000627:therapeutic use*; D015316:Genetic Therapy; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D008222:Lymphokines / Q000008:administration & dosage / Q000627:therapeutic use*; D018919:Neovascularization, Physiologic / Q000502:physiology*; D020033:Protein Isoforms / Q000008:administration & dosage / Q000627:therapeutic use*; D015899:Tomography, Emission-Computed, Single-Photon; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors
D043925:Angiogenesis Inducing Agents; D016228:Endothelial Growth Factors; D036341:Intercellular Signaling Peptides and Proteins; D008222:Lymphokines; D020033:Protein Isoforms; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors; D016222:Fibroblast Growth Factor 2; D016220:Fibroblast Growth Factor 1