New approaches to coronary heart disease: induction of neovascularisation by growth factors.
Currently available approaches for treating human coronary heart disease aim to relieve symptoms and the risk of myocardial infarction by reducing myocardial oxygen demand (drugs), preventing further disease progression (drugs), restoring coronary blood flow either pharmacologically (thrombolysis) or mechanically (angioplasty), or bypassing the stenotic lesions and obstructed coronary artery segments (surgery). Direct gene therapy, as well as gene-derived therapy, especially by angiogenic growth factors, is emerging as a potential new treatment for cardiovascular disease. After extensive experimental research on angiogenic growth factors, the first clinical studies on patients with coronary heart disease or peripheral vascular lesions are being performed. The polypeptides fibroblast growth factor (FGF) and vascular endothelial growth factor seem to be effective in initiating neovascularisation (neo-angiogenesis) in hypoxic or ischaemic tissues. The first clinical study on patients with coronary heart disease treated by local injection of FGF-1 into the compromised underperfused myocardial tissue showed a 3-fold increase of capillary density mediated by the growth factor. Angiogenic therapy of the human myocardium introduces a new modality of treatment for coronary heart disease in terms of regulation of blood vessel growth. Beyond drug therapy, angioplasty and bypass surgery, this therapy may evolve to be a fourth principle of treatment of atherosclerotic cardiovascular disease.
Stegmann
T J
TJ
Department of Thoracic and Cardiovascular Surgery, Fulda Medical Center, Fulda, Germany. heart.stegmann@klinikum-fulda.de