Therapeutic Angiogenesis for the Treatment of Cardiovascular Disease

The development of blood vessels may be considered in several contexts. Vasculogenesis and angiogenesis are the processes responsible for the development of the circulatory system, the first functional unit in the developing embryo (1). Pathologic angiogenesis includes the role of post-natal neovascularization in the pathogenesis of arthritis, diabetic retinopathy, and, most notably, tumor growth and metastasis (2). Therapeutic angiogenesis involves the development of collateral blood vessels supplying ischemic tissues, either endogenously or in response to administered growth factors. The purpose of this review is to consider the mechanisms responsible for therapeutic angiogenesis, which develops endogenously, as well as novel strategies, which have been devised to augment this response. Because recapitulation of the embryonic paradigm forms the conceptual basis for therapeutic, as well as pathologic angiogenesis, selected aspects of embryonic blood-vessel development are included. While pathologic angiogenesis is beyond the scope of the current paper, certain principles which have emerged from studies of pathologic neovascularization are considered for the implications they may have for cardiovascular disease.