Prof. Johannes Waltenberger,
Therapeutic angiogenesis is on its way into clinical practice! Good news from basic science. It was only a few years ago that therapeutic angiogenesis – i.e. induction of new blood vessels as well as the growth of existing vessels, also called arteriogenesis – was proposed to revolutionize cardiovascular medicine. It was hoped that the application of either angiogenic growth factors, related genes or vascular cells could trigger vascular growth and repair leading to better perfusion of ischemic tissues.
This concept is of utmost importance for treating patients with chronic myocardial ischemia, also known as chronic refractory angina. Although preclinical data were extremely encouraging, it turned out to be challenging to repeat therapeutic success in patients. In addition, animal data show conflicting data, raising the question whether an angiogenic-stimulating strategy might even have negative side effects on the underlying atherosclerotic disease. These open questions have triggered novel basic science projects that were enthusiastically discussed during a State-of-the-Art basic science symposium. Dr. I. Zachary, London, UK, focused on the role of the angiogenic growth factor VEGF in the vessel wall. Of note, it turned out that VEGF can either stabilize or destabilize plaques in a concentration-dependent manner. VEGF may therefore act as a hero or a villain. The situation is similar for bone marrow-derived endothelial and smooth muscle progenitor cells as discussed by Dr. J.-S. Sylvestre, Paris, F. The role of the angiogenic VEGF is of special importance in diabetic patients, who have elevated VEGF levels. Dr. S. Ylä-Herttuala, Kuopio, FI, highlighted the relevance of novel genetic animal models, which better resemble the human situation compared to previously available models. Another level of complexity in atherosclerosis research was raised by Dr. I. Hoefer, Utrecht, NL. Patient-related characteristics seem to prime the immunological reaction that may stimulate angiogenesis. It will therefore be important for future studies to correctly stratify patients based on novel molecular diagnostic tools.
The field of therapeutic angiogenesis has recently advanced by significant contributions from basic science laboratories. It was possible to define mechanisms and requirements of physiological and pathological neovascularization related to coronary artery disease. This knowledge will greatly support the translation of therapeutic angiogenesis into clinical practice within the coming years.
Breakthrough or aberration? Neovascularisation in cardiovascular disease
This congress report accompanies a presentation given at the ESC Congress 2008. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.
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