Related Experiment Video
Updated: May 1, 2026
Large Animal Model for Evaluating the Efficacy of the Gene Therapy in Ischemic Heart
Published on: September 2, 2021
Identifying and overcoming obstacles in angiogenic gene therapy for myocardial ischemia
1Cardium Therapeutics, San Diego, CA.
Insights
Well-developed coronary collateral vessels reduce cardiovascular events in coronary artery disease patients. Therapeutic angiogenesis faces hurdles, but overcoming them may unlock its potential for improving collateral circulation.
Area of Science:
- Cardiovascular Medicine
- Regenerative Medicine
- Vascular Biology
Background:
- Coronary artery disease (CAD) patients with good coronary collateral vessel (CCV) development exhibit reduced cardiovascular morbidity and mortality.
- However, many CAD patients lack sufficient functional CCV, limiting their prognosis and treatment options.
- Therapeutic angiogenesis, aimed at stimulating CCV growth, has shown limited success in late-stage clinical trials.
Purpose of the Study:
- To review the mechanistic insights and clinical experiences in therapeutic angiogenesis for CAD.
- To identify key conceptual, technical, and clinical obstacles hindering progress in stimulating collateral vessel development.
- To propose strategies for overcoming these hurdles in future clinical trials.
Main Methods:
- Review of existing literature on coronary collateral vessel development in CAD.
- Analysis of clinical trial data and mechanistic studies on therapeutic angiogenesis.
- Identification and categorization of challenges encountered in the field.
Main Results:
- Established association between well-developed CCV and improved cardiovascular outcomes in symptomatic CAD.
- Identified significant obstacles in therapeutic angiogenesis, including conceptual, technical, and clinical challenges.
- Highlighted the need for refined strategies to effectively promote collateral circulation.
Conclusions:
- Despite challenges, enhancing CCV remains a promising therapeutic strategy for CAD.
- Overcoming identified hurdles is crucial for realizing the full potential of therapeutic angiogenesis.
- Future trials require optimized approaches to improve collateral vessel development and patient outcomes.
Abstract:
Well-developed coronary collateral vessels in patients with symptomatic coronary artery disease were shown to be associated with reduced future cardiovascular morbidity and mortality. However, the majority of patients with coronary artery disease lack adequate functional coronary collateral circulation. Stimulation of collateral vessel development by angiogenic growth factor therapy (therapeutic angiogenesis) has been tested in many clinical trials in the past, but the potential of this new treatment paradigm has not been realized yet in late stage clinical trials. Mechanistic insights into collateral vessel development and the collective clinical experience in the past decade identified specific obstacles that might have impeded the progress in the field. This review identifies some of the key conceptual, technical, and clinical hurdles and recommends strategies to overcome them in future clinical trials.
