Angiogenesis: a Future Treatment Approach for Coronary Heart Disease

Coronary artery disease is a leading cause of morbidity and mortality in Canada and the western world. Despite increased awareness, better management of risk factors, and improved non-surgical and surgical treatment modalities, coronary artery disease can sometimes involve the vessels of some patients so severely that medications, angioplasty and coronary artery bypass grafting may be unsuccessful at alleviating heart symptoms and preventing complications. However, patients may in the future benefit from a biologically-based therapy called therapeutic angiogenesis, which recreates the highly potent physiologic processes that occur during growth and development in every animal and human being, with the goal of forming new blood vessels in the adult heart. What is angiogenesis? Angiogenesis is the formation of new blood vessels from preexisting ones. This process occurs somewhat naturally in the heart of patients who progressively develop coronary disease over a number of months to years, yet to a degree that is usually insufficient to completely alleviate cardiac symptoms and prevent subsequent complications. The sequence of events leading to angiogenesis is depicted in Figure 1. Angiogenesis is a very complex process, and it is believed that the actions of growth factors and of a locally produced gas called nitric oxide interplay to detach, multiply, rearrange, and recruit cells in order to creat