Molecular and cell based therapies for protection, rescue and repair of ischemic myocardium: reasons for cautious optimism

Despite the significant therapeutic advances of the past 25
years, coronary ischemic artery disease (CAD) remains the
predominant cause of premature death. The prevalence of the
disease imposes enormous financial strain on the healthcare
system calling for new approaches for treatment of CAD. The
availability of cardiotropic vectors capable of long-term and
stable protein expression and the recent isolation of progenitor
cells with regenerative and angiogenic potential may provide
opportunities for the design of novel therapies for protection and
rescue of the myocardium from ischemia and failure. Cardioprotective gene therapy strategies have been effective in animal models of myocardial ischemia and reperfusion injury, and gene transfer of proangiogenic cytokines has been used as a
strategy for rescuing ischemic myocardium. Transplantation of
autologous progenitor cells is emerging as a potential option for
the revascularization and repair of ischemic and infarcted myocardium. Notwithstanding these promising findings, there is pressing need for the development of safer and more effective vectors and the optimization and standardization of gene- and cell-based therapies.
In this article, we discuss the current preclinical and clinical advances in gene- and cell-based therapies for protection,
rescue, and repair of the ischemic myocardium, with emphasis on strategies for protection of the myocardium from ischemia and reperfusion injury and for neovascularization and regeneration of ischemic and infarcted myocardium.