Clinical application of angiogenic therapy for ischemic heart disease

血管生成治疗作为缺血性心脏病的一种新的治疗方法而受到关注，由于血管生成生长因子的施用继发于侧支发展，血管生成治疗增加了流向缺血心肌的血流量。虽然在几个犬实验中报告了这种治疗的有效性，但临床应用已在德国和美国启动。我们发现，显着的冠状动脉侧支的发展是由植入bFGF浸渍的酸性明胶水凝胶微球到急性冠状动脉闭塞的狗的梗死心肌诱导。我们还发现，局部室壁运动异常被治疗减弱，这种治疗是有益的缺血心肌的保护。作为未来的临床应用，我们有一个血管生成治疗计划，使用bFGF浸渍的酸性明胶水凝胶微球治疗药物治疗难治性患者，并且不适合经皮或手术血运重建。EECP（增强型体外反搏）以及IABP（主动脉内气囊泵送）增加主动脉舒张压，并降低主动脉收缩压，导致冠状动脉血流量和心输出量增加。我们报道了一名劳力型心绞痛患者，经5,000 U肝素预处理后，进行35小时的EECP可减轻心绞痛发作。可以想象，EECP联合肝素预处理作为心绞痛患者的无创治疗具有很大的潜力。

Angiogenic therapy is noticed as a new treatment for ischemic heart disease, which increases blood flow to the ischemic myocardium as a result of collateral development secondary to the administration of angiogenic growth factors. While the effectiveness of this treatment is reported in several canine experiments, clinical applications have been launched out in Germany and U.S.A..We found that significant coronary collateral development is induced by the implantation of bFGF-impregnated acidic gelatin hydrogel microspheres into the infarct myocardium of dogs with acute coronary occlusion. We also found that regional wall motion abnormality is attenuated by the treatment and this treatment is useful for the preservation of ischemic myocardium. As a future clinical application, we have a plan of angiogenic therapy with use of bFGF-impregnated acidic gelatin hydrogel microspheres for patients who are refractory to medical therapy and are not a candidate for percutaneous or surgical revascularization.EECP (enhanced external counterpulsation) as well as IABP (intra-aortic balloon pumping) increases the aortic diastolic pressure, and decreases the aortic systolic pressure resulting in the augmentation of coronary blood flow and cardiac output. We reported that 35 hours of EECP with the 5,000 U of heparin pretreatment alleviated anginal attack in a patient with effort angina. It is conceivable that EECP combined with heparin pretreatment has great potential as noninvasive treatment of angina patients.