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Catheter-based stem cell and gene therapy for refractory myocardial ischemia

Nature Clinical Practice Cardiovascular Medicine volume 4, pages S89–S95 (2007)Cite this article

Abstract

Intramyocardial delivery of genes and cells derived from bone marrow has been evaluated in several small studies of 'no-option' symptomatic patients with chronic ischemic coronary artery disease. Clinical experience with intramyocardial gene delivery is limited to genes encoding isoforms of vascular endothelial cell growth factor. In the largest study (Euroinject One), 80 patients were randomized to receive a plasmid encoding vascular endothelial cell growth factor 165 or placebo. The results of this study suggested no beneficial therapeutic effect of this strategy. The experience with stem cells is limited to use of autologous, nonexpanded, nonmanipulated bone-marrow-derived cells; thus, the number of injected stem cells reflects their natural proportion within the bone marrow. The results of these preliminary studies suggest this approach is feasible and has a high safety profile. Although no conclusion can yet be made regarding efficacy, the improved myocardial perfusion in all four studies described in this Review is encouraging. Data from assessments of individual patients, however, suggests a wide variability in response, underscoring the need for further bench and clinical investigations.

Key Points

  • Catheter-based transendocardial cell and gene delivery for therapeutic angiogenesis has so far been studied in only a small number of patients

  • Studies have so far involved only autologous, nonexpanded, nonmanipulated bone-marrow-derived cells and gene encoding vascular endothelial growth factor

  • Nonfluoroscopic electromechanical mapping-guided myocardial navigation can help locate the most vulnerable ischemic territory

  • Although some complications have been reported, overall, transendocardial injection seems to be safe

  • No predictors of a favorable response to therapy have yet been clearly identified

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Authors and Affiliations

  1. A Battler is Director of Cardiology Departments and R Kornowski is Director of International Cardiology at the Rabin Medical Center, S Fuchs is Director of the Cardiac Catheterization Service, Petah Tikva, Israel.,

    Shmuel Fuchs, Alexander Battler & Ran Kornowski

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  1. Shmuel Fuchs
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  2. Alexander Battler
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  3. Ran Kornowski
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Corresponding author

Correspondence to Shmuel Fuchs.

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Competing interests

Shmuel Fuchs receives consultation fees from Biologics Delivery Systems Group and Cordis Corporation. Alexander Battler and Ran Kornowski declared no competing interests.

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Fuchs, S., Battler, A. & Kornowski, R. Catheter-based stem cell and gene therapy for refractory myocardial ischemia. Nat Rev Cardiol 4 (Suppl 1), S89–S95 (2007). https://doi.org/10.1038/ncpcardio0762

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