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Basic principles of angiogenesis for the interventional cardiologist
1Rapapport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Insights
Therapeutic angiogenesis offers a novel treatment for residual myocardial ischemia when standard therapies fail. This approach stimulates the growth of collateral blood vessels to bypass blockages in coronary arteries.
Area of Science:
- Cardiovascular Medicine
- Regenerative Medicine
- Molecular Biology
Background:
- Coronary artery disease (CAD) management has advanced, yet many patients experience persistent myocardial ischemia.
- A significant patient group remains symptomatic despite conventional treatments like medications, angioplasty, and bypass surgery.
- Therapeutic angiogenesis presents a potential alternative for patients with extensive ischemia unresponsive to current interventions.
Purpose of the Study:
- To review the physiological basis of angiogenesis and its significance in both development and adulthood.
- To explore the regulatory mechanisms governing angiogenesis.
- To provide an update on clinical trials investigating angiogenic cytokine administration for therapeutic angiogenesis.
Main Methods:
- Review of the physiology of angiogenesis, including its regulation and response to ischemia/hypoxia.
- Discussion of gene therapy principles for stimulating angiogenesis.
- Analysis of current clinical trial data on angiogenic cytokine administration.
Main Results:
- Angiogenesis is a critical process for developing collateral circulation, essential for bypassing stenotic lesions in coronary arteries.
- Ischemia and hypoxia are potent stimuli for angiogenesis.
- Gene therapy and angiogenic cytokines are being investigated as methods to promote collateral growth in humans.
Conclusions:
- Therapeutic angiogenesis holds promise as a treatment strategy for refractory coronary artery disease.
- Further research and clinical trials are necessary to optimize angiogenic therapies.
- Stimulating endogenous collateral vessel formation could significantly improve outcomes for patients with extensive myocardial ischemia.
Abstract:
Despite tremendous advances in the management of coronary artery disease, there is a growing population of patients who remain symptomatic with residual myocardial ischemia. Therapeutic angiogenesis, designed to promote the development of endogenous conduits forming collateral blood vessels that serve to bypass coronary artery stenotic lesions, may constitute an alternative treatment strategy for patients with extensive tissue ischemia in whom contemporary therapies-antianginal medications, angioplasty, bypass surgery-have failed or are not feasible. Intensive investigation is now focused on methods that would have the potential to stimulate the development of collaterals in humans. In this review we summarize the physiology of angiogenesis and its role in development and adult life, its regulation, the effects of ischemia and hypoxia, the principles of gene therapy for angiogenesis, and an update on the current available trials data of angiogenic cytokines administration.
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