Dilemma of Angiogenesis

An old specter haunted the 72nd annual sessions of the American Heart Association in Atlanta last November—the awful nothingness of the placebo effect. No one could prove whether it was or it was not there, but its presence cast a pall over some sessions that dealt with one of the most promising therapies to date—angiogenesis.The prospect of growing a new network of blood vessels to feed starving heart muscles energized the American Heart Association meetings 2 years ago. However, there appears to be a dichotomy. Patients report improvement; scientists cannot prove it exists.“What are we trying to do?” asked Michael Simons, MD, director of the Angiogenesis Research Center at Beth Israel Medical Center in Boston. He identified various types of blood vessel growth as angiogenesis, arteriogenesis, and vasculogenesis. “Which of these processes are we trying to induce? One of them or all of them?”“How does the process work?” he asked. “What are the appropriate targets for the therapy?”The discussion at the meeting convened by the Angiogenesis Foundation, a nonprofit organization based in Cambridge, MA, dealt with the following new therapies thought to enhance angiogenesis: gene therapy, application of growth factors to stimulate growth, and transmyocardial or direct myocardial revascularization using lasers to punch holes in the myocardium. Founded in 1994, the Foundation has participated in activities involving the therapeutic potential of antiangiogenesis for the past 5 years.The Foundation convened the 1999 Consensus Meeting: Clinical Trials in Coronary …