Transmyocardial revascularization to enhance myocardial vasculogenesis and hemodynamic function

Abstract

Transmyocardial laser revascularization with the holmium-YAG laser enhances perfusion, with resultant improvement in myocardial contractility.

Transmyocardial Revascularization Enhances Mesenchymal Stem Cell Engraftment in Infarcted Hearts through SCF–c-Kit and SDF-1–CXCR4 Signaling Axes

“…96 In our study, we found that TMR's beneficial effect on LV function is due to increased engraftment of circulating MSCs (discussed below). Therefore, we hypothesize that part of the clinical therapeutic benefit of TMR might be attributable to TMR-induced transmigration and engraftment of circulating progenitor cells, although the source and number of these cells are yet to be clearly delineated.…”

“…This finding is at odds with the evidence presented by Woo and colleagues and Cooley et al of increased vascular densities. 93,96 The trends observed in the capillary densities suggested that the groups that underwent TMR had greater angiogenesis, compared to the ones that did not receive TMR. This is consistent with our previous data, as we saw greater vascular densities in the groups treated with TMR.…”

“…96 Four weeks later, the group that was treated with TMR showed increase in expression of nuclear factor κB (NF-κB), angiopoietin-1. Furthermore, TMR resulted in increased vasculogenesis, perfusion, increased myofilament density, contractility, and global hemodynamic function.…”

“…In addition, TMR enhanced vascular densities and increased the number of circulating endothelial progenitor cells, which are necessary for vasculogenesis. 96 Lastly, in an important study by Yau and colleagues, TMR was combined with cell therapy to demonstrate increased transplanted cell survival in a rat infarct model. 97 Three weeks after an infarct was created, female Lewis rats underwent needle TMR, followed by transplantation of male donor BMCs, BMCs transfected with VEGF, bFGF, and IGF-1 (BMC+VBI), or medium alone.…”

Myocardial Transfection of Adeno-Hypoxia Inducible Factor-1α

“…In reality, the channels are occluded shortly after creation, but interestingly there is maintenance of enhanced perfusion by neovasculature with clinical resolution of angina. 1, 2 Since 1997, with publication of the seminal work defining endothelial progenitor cells (EPCs) by Dr Asahara and colleagues there have been many studies attempting to enhance myocardial perfusion using various EPC mediated strategies. 3 A dichotomy has developed on the approach to enhancing angiogenesis between exogenous administration of EPCs and utilizing the potent EPC chemokines, ie, stromal cell-derived factor (SDF)-1α, vascular endothelial growth factor (VEGF), hepatocyte growth factor, basic fibroblast growth factor (BFGF), and placental growth factor (PlGF), to upregulate and potentiate the preexisting endogenous reparative process.…”