From the Klinik für Thorax-, Herz und Gefäßchirurgie,
Klinikum Fulda, Germany, and Chirurgische Forschung (B.U.v.S.),
Universitätsklinik Freiburg, Germany.
Correspondence to B. Schumacher, MD, Klinik für Thorax-, Herz und Gefäßchirurgie, Klinikum Fulda, Pacelliallee 4, D-36043 Fulda, Germany.
Background—The
present article is a report of our animal experiments and also of
the first clinical results of a new treatment for coronary
heart disease using the human growth factor FGF-I (basic fibroblast
growth factor) to induce neoangiogenesis in the ischemic
myocardium.
Methods and Results—FGF-I was obtained from strains
of Escherichia coli by genetic engineering, then
isolated and highly purified. Several series of animal experiments
demonstrated the apathogenic action and neoangiogenic potency of this
factor. After successful conclusion of the animal experiments, it was
used clinically for the first time. FGF-I (0.01 mg/kg body weight) was
injected close to the vessels after the completion of internal mammary
artery (IMA)/left anterior descending coronary artery (LAD)
anastomosis in 20 patients with three-vessel coronary disease.
All the patients had additional peripheral stenoses
of the LAD or one of its diagonal branches. Twelve weeks later, the IMA
bypasses were selectively imaged by intra-arterial digital
subtraction angiography and quantitatively evaluated. In all the animal
experiments, the development of new vessels in the ischemic
myocardium could be demonstrated angiographically. The
formation of capillaries could also be demonstrated in humans and was
found in all cases around the site of injection. A capillary network
sprouting from the proximal part of the coronary artery could
be shown to have bypassed the stenoses and rejoined the distal
parts of the vessel.
Conclusions—We believe that the use of FGF-I for
myocardial revascularization is in principle a new
concept and that it may be particularly suitable for patients with
additional peripheral stenoses that cannot be
revascularized surgically.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Induction of Neoangiogenesis in Ischemic Myocardium by Human Growth Factors
First Clinical Results of a New Treatment of Coronary Heart Disease
Key Words: growth substances • angiogenesis • coronary disease
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