Stegmann T J, Hoppert T, Schneider A, Gemeinhardt S, Köcher M, Ibing R, Strupp G
Klinik für Thorax-, Herz- und Gefässchirurgie Fulda.
Herz. 2000 Sep;25(6):589-99. doi: 10.1007/pl00001972.
Currently available approaches for treating human coronary heart disease aim to relieve symptoms and the risk of myocardial infarction either by reducing myocardial oxygen demand, preventing further disease progression, restoring coronary blood flow pharmacologically or mechanically, or bypassing the stenotic lesions and obstructed coronary artery segments. Gene therapy, especially using angiogenic growth factors, has emerged recently as a potential new treatment for cardiovascular disease. Following extensive experimental research on angiogenic growth factors, the first clinical studies on patients with coronary heart disease and peripheral vascular lesions have been performed. The polypeptides fibroblast growth factor (FGF) and vascular endothelial growth factor (VEGF) appear to be particularly effective in initiating neovascularization (neoangiogenesis) in hypoxic or ischemic tissues. The first clinical study on patients with coronary heart disease treated by local intramyocardial injection of FGF-1 showed a 3-fold increase of capillary density mediated by the growth factor. Also, angiogenic growth factor injection intramyocardially as sole therapy for end-stage coronary disease showed an improvement of myocardial perfusion in the target areas as well as a reduction of symptoms and an increase in working capacity. Angiogenic therapy of the human myocardium introduces a new modality of treatment for coronary heart disease in terms of regulation of blood vessel growth. Beyond drug therapy, angioplasty and bypass surgery, this new approach may evolve into a fourth principle of treatment of atherosclerotic cardiovascular disease.
目前治疗人类冠心病的方法旨在通过降低心肌需氧量、防止疾病进一步发展、通过药物或机械手段恢复冠状动脉血流，或绕过狭窄病变和阻塞的冠状动脉节段来缓解症状和降低心肌梗死风险。基因治疗，尤其是使用血管生成生长因子的基因治疗，最近已成为心血管疾病潜在的新治疗方法。在对血管生成生长因子进行广泛的实验研究之后，已经对冠心病和周围血管病变患者进行了首批临床研究。成纤维细胞生长因子（FGF）和血管内皮生长因子（VEGF）这两种多肽在低氧或缺血组织中启动新血管形成（新生血管生成）方面似乎特别有效。对通过局部心肌内注射FGF-1治疗的冠心病患者进行的首次临床研究表明，生长因子介导的毛细血管密度增加了3倍。此外，将血管生成生长因子心肌内注射作为终末期冠心病的唯一治疗方法，显示出目标区域心肌灌注得到改善，症状减轻，工作能力增强。就血管生长调节而言，人类心肌的血管生成治疗为冠心病引入了一种新的治疗方式。除了药物治疗、血管成形术和搭桥手术之外，这种新方法可能会发展成为动脉粥样硬化性心血管疾病治疗的第四项原则。
