New approaches to coronary heart disease - Induction of neovascularisationby growth factors

Currently available approaches for treating human coronary heart disease ai m to relieve symptoms and the risk of myocardial infarction by reducing myo cardial oxygen demand (drugs), preventing further disease progression (drug s), restoring coronary blood flow either pharmacologically (thrombolysis) o r mechanically (angioplasty), or bypassing the stenotic lesions and obstruc ted coronary artery segments (surgery). Direct gene therapy, as well as gen e-derived therapy, especially by angiogenic growth factors, is emerging as a potential new treatment for cardiovascular disease. After extensive exper imental research on angiogenic growth factors, the first clinical studies o n patients with coronary heart disease or peripheral vascular lesions are b eing performed. The polypeptides fibroblast growth factor (FGF) and vascular endothelial gr owth factor seem to be effective in initiating neovascularisation (neo-angi ogenesis) in hypoxic or ischaemic tissues. The first clinical study on pati ents with coronary heart disease treated by local injection of FGF-I into t he 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 tre atment for coronary heart disease in terms of regulation of blood vessel gr owth. Beyond drug therapy, angioplasty and bypass surgery, this therapy may evolve to be a fourth principle of treatment of atherosclerotic cardiovasc ular disease.