The European Society of Cardiology
Introduction
a Al Virtanen Institute, University of Kuopio, Kuopio, Finland
b Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
* Correspondence to: Ylä Herttuala, Department of Molecular Medicine and Gene Therapy Unit, P.O. Box 1627, Kuopio University Hospital, Puijonlaaksontie 2 (P.O. Box 1777), Kuopio 70210, Finland. Tel.: +358-17-162075; fax: +358-17-163030/163751
seppo.ylaherttuala{at}uku.fi
The development of angiogenic therapy to treat coronary artery disease (CAD) results from the convergence of two major trends over the past few decades: the increasing incidence of cardiovascular disease with its associated patient morbidity, and the availability of genetic techniques for clinical application.
Cardiovascular disease is most common in economically developed countries such as member countries of the European Union and the United States. Factors including smoking, unhealthy diet, physical inactivity and increased life expectancy also contribute to the high prevalence of cardiovascular disease.1 The World Health Organization reports that approximately 7 million deaths from coronary heart disease occur yearly.2 However, the incidences of ischaemia and chest pain are much higher than the mortality rate. Data from population-based studies indicate that 30 patients have stable angina for every patient who is hospitalized with a myocardial infarction, suggesting that 16500000 patients in the United States have stable angina.3 As angina is both an early symptom of CAD and a residual symptom after partially successful therapy, it is, thus, a major concern for both patients and physicians.
While traditional approaches including small molecule drugs and surgery are successful in many patients, the escalating rates of death and disability associated with ischaemic heart disease are considerable, suggesting the need for new therapeutic options. Over the last few decades, biomedical research has developed molecular tools that identify the mechanisms involved in the physiological healing processes and recapitulate them. Gene therapies have been tested in more than 3500 patients in over 630 protocols to date, and are being designed to treat conditions such as cancer, genetic disorders, infectious diseases and cardiovascular diseases.4 The availability of these techniques introduces the possibility of being able to grow new blood vessels in the heart to improve cardiac circulation. Although therapeutic myocardial angiogenesis is not yet routinely available in clinical practice, the experimental results are worthy of review.
This supplement to the European Heart Journal reports on the proceedings of a Symposium entitled "Angiogenic Gene Therapy, a Novel Treatment Paradigm for Coronary Artery Disease", which was held on September 1st, 2003 at the European Society of Cardiology (ESC) meeting in Vienna, Austria. This symposium summarized current options for treating myocardial ischaemia, and explored the feasibility of using Ad5FGF-4 for angiogenic gene therapy to treat CAD. The information provided is intended to enhance readers' knowledge of coronary therapeutic angiogenesis: the rationale for its development; the process used to design a therapy such as Ad5FGF-4; and both preclinical and clinical data on the efficacy and safety of Ad5FGF-4. Future applications for cardiovascular gene therapy are also explored.
Footnotes
1 Dr. Ylä-Herttuala has been a consultant and member of the AGENT Trial Scientific Advisory Committee. 
2 Dr. Dzau has stock ownership in Corgentech Inc.
References
- American Heart Association, International Cardiovascular Disease Statistics, 2002. Available from: www.americanheart.org, accessed October 20, 2003
- World Health Organization, Cardiovascular Diseases, 2004. Available from: www.who.int, accessed January 12, 2004
- Gibbons RJ, Abrams J, Chatterjee K, et al. ACC/AHA 2002 guideline update for the management of patients with stable angina, 2002. Available from: www.acc.org/clinical/guidelines/stable/stable.pdf, accessed January 12, 2004
- Journal of Gene Medicine, Charts and Statistics, 2004. Available from: www.wiley.co.uk/wileychi/genmed/clinical, accessed June 7, 2004
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