[Gene therapy in cardiovascular diseases].

Neoangiogenesis, congestive heart failure and prevention of reoclusion after PCI represent the main targets of gene therapy (GT) in cardiology. Therapeutic angiogenesis can be used in advanced myocardial ischemia and in angina pectoris not suitable for the revascularization by cardiosurgery or by catheterization techniques. Heart failure is another indication of GT in cardiology. Modulation of calcium homeostasis, beta-adrenergic receptors and resistance of myocytes against apoptosis belongs to main forms of GT in this indication. Prevention of restenosis after PCI (with or without stent implantation) represents the third possible indication of GT. Conversion of ventricular myocytes into pacemaker cells using the gene potassium channel was described. Some benefit of GT can be expected in systemic and pulmonary hypertension. An optimal vector should be defined, as well as the optimal access (probably transmyocardial supplemented with intravenous application) and doses. GT seems to be safe and well tolerated by patients. Randomized, placebo control studies should be initiated for the final clinical assessment of this method.