Induction of myocardial neoangiogenesis by human growth factors. A new therapeutic option in coronary heart disease

Currently available approaches for treating human coronary heart disease ai m to relieve symptoms and the risk of myocardial infarction either by reduc ing myocardial oxygen demand, preventing further disease progression, resto ring coronary blood flow pharmacologically or mechanically, or bypassing th e stenotic lesions and obstructed coronary artery segments. Gene therapy, especially using angiogenic growth factors, has emerged recen tly as a potential new treatment for cardio-vascular disease. Following ext ensive experimental research on angiogenic growth factors, the first clinic al studies on patients with coronary heart disease and peripheral vascular lesions have been performed. The polypeptides fibroblast growth factor (FGF ) and vascular endothelial growth factor (VEGF) appear to be particularly e ffective in initiating neovascularization (neoangiogenesis) in hypoxic or i schemic tissues. The first clinical study on patients with coronary heart d isease treated by local intramyocardial injection of FGF-1 showed a 3-fold increase of capillary density mediated by the growth factor. Also, angiogen ic growth factor injection intra myocardially as sole therapy for end-stage coronary disease showed an improvement of myocardial perfusion in the targ et areas as well as a reduction of symptoms and an increase in working capa city. 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 new approac h may evolve into a fourth principle of treatment of atherosclerotic cardio vascular disease.