Researchers grow new blood vessels in the heart

BMJ 1998; 316 doi: (Published 28 February 1998) Cite this as: BMJ 1998;316:645
  1. Hilary Bower
  1. London

    German doctors have grown new blood vessels in human hearts using genetically engineered human growth factor. This is a clinical first that could transform treatment for ischaemic heart disease.

    In a randomised controlled trial, researchers from the Fulda medical centre in Germany injected human growth factor FGF-I into the heart muscle of 20 patients undergoing bypass surgery for three vessel coronary artery disease (Circulation 1998;97:645-50). All participants also had stenoses in peripheral branches that could not be treated with surgery, and the injection was targeted close to these sites. A control group received inactivated FGF-I in the same way.

    After only four days new capillary growth, radiating outward from the point of injection and bypassing stenoses, was clearly visible in an angiogram in all 20 patients. At 12 weeks, blood flow to the heart had increased by two to three times, and over the following three years the team found that the average ejection fraction improved from 50.3% to 63.8%. Controls showed an improvement of 7-8%.

    In addition, 10 of the 20 patients who received the growth factor now take no drugs except aspirin, and the remainder take substantially fewer and lower doses of cardiovascular drugs than controls. None have experienced any negative side effects.

    Research leader, Professor Thomas-Joseph Stegmann, said that angiogenesis offered a new therapeutic concept for diffuse coronary artery disease. “We can bypass the bigger vessels, but this does nothing for the additional lesions in the smaller vessels. For the first time we have been able to demonstrate that FGF-I can induce neoangiogenesis in situ in the ischaemic human heart. In our opinion this opens up new possibilities for treatment.” Professor Stegmann said that it was not yet known whether growth factors could be effective enough to combat blockages of the larger arteries. His next focus is to find a way to deliver growth factor without surgery—for example, through a catheter.

    Professor Brian Pentecost, the medical director of the British Heart Foundation, said that the results were extremely encouraging. But researchers have yet to prove that the capillary vessels grown really make a functional difference, he noted.

    Embedded Image

    Surgery cannot correct multiple small vessel narrowing


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