Clinical Application of Novel Therapies for Coronary Angiogenesis: Overview, Challenges, and Prospects

Abstract

Cardiovascular diseases continue to be the leading cause of death worldwide, with ischemic heart disease as the most significant contributor. Pharmacological and surgical interventions have improved clinical outcomes, but are unable to ameliorate advanced stages of end-heart failure. Successful preclinical studies of new therapeutic modalities aimed at revascularization have shown short lasting to no effects in the clinical practice. This lack of success may be attributed to current challenges in patient selection, endpoint measurements, comorbidities, and delivery systems. Although challenges remain, the field of therapeutic angiogenesis is evolving, as novel strategies and bioengineering approaches emerge to optimize delivery and efficacy. Here, we describe the structure, vascularization, and regulation of the vascular system with particular attention to the endothelium. We proceed to discuss preclinical and clinical findings and present challenges and future prospects in the field.

Phase I investigator-initiated study of the safety of MTC001 in patients with chronic ischemic heart failure

“…[ 31 ] These issues have facilitated various cardiac regeneration strategies. [ 32 – 34 ] However, none of the proposed strategies have been widely implemented in clinical practice owing to their limited efficacy. [ 35 ]…”

“…This is rarely complemented by a left ventricular assist device, which is an expensive and invasive option, with a risk of major complications (stroke, bleeding, infection, etc) [31] . These issues have facilitated various cardiac regeneration strategies [32–34] . However, none of the proposed strategies have been widely implemented in clinical practice owing to their limited efficacy [35] …”

Perspectives on Vascular Regulation of Mechanisms Controlling Selective Immune Cell Function in the Tumor Immune Response

“…Tumor cells can release EV that act on EC in a pro-angiogenic manner [100,101]. Additionally, EV can be employed to modulate EC for therapeutic purposes [102]. Inflamed adipocytes generate EV that increase EC VCAM-1 expression that in turn increases IC adhesion [103].…”

Outro Ator no Aumento da Circulação Colateral no Coração – Outro Potencial Alvo Terapêutico na Medicina Cardiovascular?

“…At some point, scientists felt confident they could recapitulate the natural process of vascular growth through hyperexpression of specific angiogenic factors in the new field of gene therapy. 6 Unfortunately, randomized clinical trials with this approach did not succeed as expected, and the early enthusiasm was replaced by disappointment.…”