Sind die Gen- oder Stammzelltherapie eine therapeutische Option?

The aim of cardiovascular gene and stem cell therapy concepts is regeneration of vascular and myocardial cells in ischaemically damaged areas. Despite the wealth of more or less valid study results, two main directions for clinical investigation can be distinguished. Gene therapy with angiogenic growth factors in the form of repetitive intramuscular injections of naked plasmid DNA (pDNA) is simple to perform and is principally applied in clinical investigations in the field of peripheral arterial occlusive disease (“therapeutic angiogenesis”). Anumber of parallel phase II studies with nonviral pDNA for fibroblast growth factor-1 (FGF-1) are ongoing in the USA and Europe (TALISMAN studies). In ischaemic heart disease stem cell-based concepts are showing first clinical results. Adult stem cells are obtained by bone marrow puncture or ex-vivo expansion in blood of circulating stem cells also deriving from the patient’s bone marrow. After intracoronary administration what is hoped for is intensified neovascularisation of ischaemic myocardium through release of angiogenic growth factors from mononuclear bone marrow cells, and regeneration of infarcted myocardium by transdifferentiation of mesenchymal stem cells into myocardial cells. In this context the German multicentre study Transplantation Of adult Progenitor Cells in Ischaemic Heart Disease (TOPCARE-AMI study) and Bone Marrow Transfer to Enhance ST-Elevation Infarct Regeneration (BOOST study) will shortly widen our knowledge still further.