5 Therapeutic angiogenesis for ischemic heart disease (Topics on Heart Failure Therapy)

There are several methods of neovascularization therapy for ischemic heart disease: gene ther-apy with angiogenic factors, cell therapy with endothelial progenitor cells, and cytokine therapy with granulocyte colony stimulating factor(G-CSF). However, from the viewpoint of efficacy and safety, cell therapy is thought to be the best approach for regeneration therapy. There has been some scepticism about the efficacy of gene therapy with a single angiogenic factor because angiogenesis is considered to involve several angiogenic factors. It was initially reported that G-CSF therapy caused a high incidence of myocardial infarction or in-stent coronary artery restenosis. Subsequently, intracoronary infusion or intramyocardial injection of bone marrow mononuclear cells or peripheral blood endothelial progenitor cells was shown to be effective in patients with acute myocardial infarction or in those after myocardial infarction. Recently, we found that erythropoietin enhanced angiogenesis induced by implantation of bone marrow mononuclear cells in a murine model of limb ischemia. With the aim of applying this combination therapy for human ischemic heart disease, we are now investigating its effect on the heart