Therapeutic Angiogenesis for Coronary Artery Disease.

Angiogenesis is a promising new therapy for the treatment of patients with coronary artery disease who are not candidates for standard revascularization techniques. The concept of therapeutic angiogenesis is based upon improving myocardial function by increasing blood flow to ischemic areas of the heart. Angiogenic growth factors, including fibroblast growth factor and vascular endothelial growth factor, have been shown to induce functionally significant angiogenesis in preclinical studies. Both protein and gene formulations are under investigation; currently, protein-based therapy is considered the more practical form of therapy. The delivery of these growth factors is another aspect of angiogenic therapy under development, with several techniques used in clinical trials. However, the optimal method of delivery with regard to tissue specificity and duration of exposure is not yet defined. Despite encouraging preclinical data, the results of clinical trials so far have shown only, if any, modest improvements in cardiac function and clinical outcome. Further randomized, double-blind, placebo-controlled trials are necessary to support angiogenesis as a therapy for ischemic cardiac disease.