Angiogenesis

, Volume 15, Issue 1, pp 1–22

Therapeutic angiogenesis for myocardial ischemia revisited: basic biological concepts and focus on latest clinical trials

  • Sofoclis Mitsos
  • Konstantinos Katsanos
  • Efstratios Koletsis
  • George C. Kagadis
  • Nikolaos Anastasiou
  • Athanasios Diamantopoulos
  • Dimitris Karnabatidis
  • Dimitris Dougenis
Review Paper

Abstract

Therapeutic angiogenesis is based on the premise that the development of new blood vessels can be augmented by exogenous administration of the appropriate growth factors. Over the last years, successful preclinical studies and promising results of early clinical trials have created great excitement about the potential of therapeutic angiogenesis for patients with advanced ischemic heart disease. The authors provide an overview of the biology of angiogenesis, the basic characteristics of angiogenic factors, and the different routes of their delivery. They discuss experimental studies in animal models of myocardial ischemia and outline available clinical studies on therapeutic angiogenesis for myocardial ischemia. Related safety issues are also addressed followed by a critical perspective about the future of proangiogenic therapies for ischemic cardiovascular disorders. Despite the established proof of concept and reasonable safety, however, results of the latest trials on therapeutic angiogenesis for myocardial ischemia have provided inconsistent results and the definite means of inducing clinically useful therapeutic angiogenesis remain elusive. More studies are required to gain further insights into the biology of angiogenesis and address pharmacological limitations of current approaches of angiogenic therapy. The authors hope and envisage that in the not-too-distant future, these investigative efforts will lead to important new strategies for treatment of myocardial ischemic syndromes. Means of non-invasive individualized pharmacological therapeutic neovascularization may be the next major advance in the treatment of ischaemic heart disease.

Keywords

Myocardial ischemia Therapeutic angiogenesis Arteriogenesis Neovascularization Growth factors Gene therapy 

Abbreviations

EPC

Endothelial precursor cell

VEGF

Vascular endothelial growth factor

FGF

Fibroblast growth factor

VEGFR

Vascular endothelial growth factor receptor

NP/NRP

Neuropilin

FGFR

Fibroblast growth factor receptor

HLGAG

Heparin-like glycosaminoglycans

RTK

Receptor tyrosine kinase

MCP-1

Monocyte chemotactic protein-1

GM-CSF

Granulocyte-macrophage colony-stimulating factor

HGF

Hepatocyte growth factor

PDGF

Platelet derived growth factor

TGF-a/TGF-b

Transforming growth factor-a/-b

TNF-a

Tumour necrosis factor-a

BDNF

Brain-derived neurotrophic factor

CAD

Coronary artery disease

EMI

Experimental myocardial iscehima

MRI

Magnetic resonance imaging

G-CSF

Granulocyte colony stimulating factor

GM-CSF

Granulocyte macrophage colony stimulating factor

CABG

Coronary artery bypass graft

SPECT

Single photon emission computed tomography

LV

Left ventricular

LVEF

Left ventricular ejection fraction

CPC

Cardiac progenitor cell

BM

Bone marrow

BMC

Bone marrow cell

MSC

Mesenchymal stem cell

BM-MNC

Bone marrow mononuclear cell

AMI

Acute myocardial infarction

TMR

Transmyocardial laser revascularization

PMR

Percutaneous myocardial revascularization

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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Sofoclis Mitsos
    • 1
  • Konstantinos Katsanos
    • 2
  • Efstratios Koletsis
    • 3
  • George C. Kagadis
    • 4
  • Nikolaos Anastasiou
    • 5
  • Athanasios Diamantopoulos
    • 2
  • Dimitris Karnabatidis
    • 2
  • Dimitris Dougenis
    • 3
  1. 1.Department of Cardiothoracic SurgeryOnassion Cardiac Surgery CenterAthensGreece
  2. 2.Department of Interventional Radiology, School of MedicinePatras University HospitalRionGreece
  3. 3.Department of Cardiothoracic Surgery, School of MedicinePatras University HospitalRionGreece
  4. 4.Department of Medical Physics, School of MedicineUniversity of PatrasPatrasGreece
  5. 5.Department of Thoracic Surgery1st IKA HospitalMelissia, AthensGreece

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