Ann Thorac Surg 2000;69:1161
© 2000 The Society of Thoracic Surgeons
ORIGINAL ARTICLES: CARDIOVASCULAR
Invited commentary
Frank W. Sellke, MDa
a Division of Cardiothoracic Surgery, Beth Israel Deaconess Medical Center, 110 Francis St, LMOB 2A, Boston, MA 02215, USA
e-mail: fsellke{at}caregroup.harvard.edu
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Kawasuji and colleagues describe the effects of intramyocardial injection of the angiogenic growth factor basic fibroblast growth factor on myocardial perfusion, function, and vascular density in a canine model of acute myocardial ischemia. Basic fibroblast growth factor increased regional blood flow, reduced thinning, and increased capillary and arteriolar densities in the myocardium subtended by the occluded left anterior descending artery. This is one of several recently published studies that have demonstrated the physiologic effects of administration of one of several angiogenic proteins, or genes encoding the proteins, on myocardial perfusion and function in acute and chronic models of ischemia. Although the findings are provocative and interesting, the study has several limitations. First, a canine model of acute ischemia was examined. As acknowledged by the authors, it is well known that the dog has extensive native collateral vessels that may prevent infarction after ligation of a major coronary artery. This is generally not the case in other species such as the pig or in humans. Second, the method of administration would probably not be clinically applicable, as we would not consider the transthoracic injection of a substance in a patient suffering a large myocardial infarction. However, the intra-coronary, intravenous, or catheter-based injection may be a consideration. Although the ability to increase perfusion in acutely and chronically ischemic myocardium with angiogenic growth factors has been shown both in animals and in humans, the clinical usefulness is still in doubt and large blinded randomized trials will need to be performed. Several such trials are underway. Even if patients are unable to be completely revascularized with coronary bypass operation or angioplasty, these procedures may provide effective treatment for the relief of angina and other ischemic symptoms. The questions requiring further study are whether adjuvant gene therapy or growth factor protein therapy will improve the results of these standard procedures in patients with incomplete revascularization, whether therapeutic angiogenesis will become established as sole therapy, and what role angiogenesis will play in the overall treatment of patients.
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Therapeutic angiogenesis with intramyocardial administration of basic fibroblast growth factor
- Michio Kawasuji, Hiroshi Nagamine, Masahiro Ikeda, Naoki Sakakibara, Hirofumi Takemura, Susumu Fujii, and Yoh Watanabe
Ann. Thorac. Surg. 2000 69: 1155-1161.
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