Gregor P
III. interní-kardiologická klinika-Kardiocentrum 3. LF UK a FNKV, Praha.
Cas Lek Cesk. 2003;142(9):519-22.
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.
新生血管生成、充血性心力衰竭以及预防经皮冠状动脉介入治疗（PCI）后的再闭塞是心脏病学中基因治疗（GT）的主要目标。治疗性血管生成可用于晚期心肌缺血以及不适合通过心脏手术或导管技术进行血运重建的心绞痛。心力衰竭是心脏病学中基因治疗的另一个适应症。调节钙稳态、β-肾上腺素能受体以及心肌细胞对凋亡的抗性是该适应症中基因治疗的主要形式。预防PCI术后（无论是否植入支架）的再狭窄是基因治疗的第三个可能适应症。有人描述了利用基因钾通道将心室肌细胞转化为起搏细胞的方法。在系统性和肺动脉高压方面有望从基因治疗中获得一些益处。应确定最佳载体、最佳给药途径（可能是经心肌给药并辅以静脉给药）和剂量。基因治疗似乎对患者是安全且耐受性良好的。应为该方法的最终临床评估开展随机、安慰剂对照研究。
