Rubanyi Gabor M
Cardium Therapeutics, San Diego, CA.
J Cardiovasc Pharmacol. 2014 Aug;64(2):109-19. doi: 10.1097/FJC.0000000000000107.
Well-developed coronary collateral vessels in patients with symptomatic coronary artery disease were shown to be associated with reduced future cardiovascular morbidity and mortality. However, the majority of patients with coronary artery disease lack adequate functional coronary collateral circulation. Stimulation of collateral vessel development by angiogenic growth factor therapy (therapeutic angiogenesis) has been tested in many clinical trials in the past, but the potential of this new treatment paradigm has not been realized yet in late stage clinical trials. Mechanistic insights into collateral vessel development and the collective clinical experience in the past decade identified specific obstacles that might have impeded the progress in the field. This review identifies some of the key conceptual, technical, and clinical hurdles and recommends strategies to overcome them in future clinical trials.
有症状冠状动脉疾病患者中发育良好的冠状动脉侧支血管被证明与未来心血管发病率和死亡率降低相关。然而，大多数冠状动脉疾病患者缺乏足够的功能性冠状动脉侧支循环。过去在许多临床试验中已对通过血管生成生长因子疗法（治疗性血管生成）刺激侧支血管发育进行了测试，但这种新治疗模式的潜力在晚期临床试验中尚未实现。对侧支血管发育的机制性见解以及过去十年的总体临床经验确定了一些可能阻碍该领域进展的具体障碍。本综述确定了一些关键的概念、技术和临床障碍，并推荐了在未来临床试验中克服这些障碍的策略。
