Cardiovascular Medicine

Ischaemic heart disease, cardiomyopathy, and heart failure, including patients who have exhausted revascularisation. These patients share a problem that bypass and stenting do not solve: tissue that remains ischaemic because the microvasculature is inadequate, in people who are no longer candidates for a further mechanical intervention.

Angiogenic gene therapy addresses that microvascular deficit rather than the named lesion, and is delivered where perfusion is controlled — intramyocardially, intra-arterially, or in the operative field. Non-viral formats are used preferentially: plasmid and minicircle constructs express for a bounded period and can be repeated, which suits an indication where a defined window of angiogenic signalling is the objective and where permanent unregulated angiogenic signalling would itself be the safety concern.