Multifactorial basis for coronary collateralization: a complex adaptive response to ischemia

Angiogenesis and vasculogenesis are adaptive responses of the coronary coll ateral circulation to myocardial ischemia. This review focuses on the conce rted action of growth factors, growth factor receptors. extracellular matri x, and inflammatory cellular responses to regulate angiogenesis and vasculo genesis in response to myocardial ischemia and alterations in sheer stress, Therapeutic angiogenesis represents a novel approach to increase myocardia l perfusion in patients with coronary artery disease and provides an opport unity to further clarify the mechanisms that regulate collateral developmen t. Impairment of angiogenic adaptive responses to ischemia during disease s tates is an important subject for future investigation. (C) 1999 Elsevier S cience B.V. All rights reserved.