Eibel Bruna, Rodrigues Clarissa G, Giusti Imarilde I, Nesralla Ivo A, Prates Paulo R L, Sant'Anna Roberto T, Nardi Nance B, Kalil Renato A K
Programa de Pós-Graduação, Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brasil.
Rev Bras Cir Cardiovasc. 2011 Oct-Dec;26(4):635-46. doi: 10.5935/1678-9741.20110056.
Severe ischemic heart disease with refractory angina, occurs in increasing incidence. Alternative forms of treatment, in an attempt to reduce myocardial ischemia and relief of symptoms has been studied. In this context, gene therapy is an option, for the possibility of inducing angiogenesis, establish collateral circulation and reperfuse ischemic myocardium. Several clinical trials have been conducted and, except for specific cases of adverse effects, there is indication of safety, feasibility and potential effectiveness of therapy. The clinical benefit, however, is not yet well established. In this article we review the clinical trials of gene therapy for patients with ischemic heart disease. The approach includes: (1) myocardial ischemia and angiogenesis on the pathophysiological aspects involved, (2) growth factors, dealing with specific aspects and justifying the use in cardiac patients with no option for conventional therapy, (3) controlled clinical trials, where a summary of the main studies involving gene therapy for severe ischemic heart disease is presented, (4) our experience, especially on preliminary results of the first gene therapy clinical trial in Brazil and (5) future prospects.
严重缺血性心脏病伴难治性心绞痛的发病率日益增加。人们已经研究了各种替代治疗方法，试图减轻心肌缺血并缓解症状。在此背景下，基因治疗是一种选择，因为它有可能诱导血管生成、建立侧支循环并使缺血心肌再灌注。已经进行了多项临床试验，除了特定的不良反应病例外，有迹象表明该治疗具有安全性、可行性和潜在有效性。然而，临床益处尚未得到充分证实。在本文中，我们回顾了针对缺血性心脏病患者的基因治疗临床试验。内容包括：（1）涉及的病理生理方面的心肌缺血和血管生成，（2）生长因子，探讨其具体方面并说明在无常规治疗选择的心脏病患者中使用的理由，（3）对照临床试验，介绍了涉及严重缺血性心脏病基因治疗的主要研究总结，（4）我们的经验，特别是巴西首个基因治疗临床试验的初步结果，以及（5）未来展望。
