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CARDIAC SURGERY SIMPLIFIED BY DR ABHISHEK, SRIVASTAVA, GENE THERAPY FOR CORONARY ARTERY, DISEASE.... MODULE 29, Many patients with end stage coronary artery, disease do not have revascularization options due, to small vessel disease and are not candidates for, transplantation or mechanical circulatory support., Several vectors can allow entry of genetic material, into cells with modified viruses being the most, commonly utilizes., Multiple route of administration are possible, but, local administration appears to have key, pharmacokinetic advantages over systemic or, intracoronary routes., Local administration can be achieved by direct, Epicardial injection via thoracotomy or catheter, based endocardial injection., INTRODUCTION

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Congestive heart failure is the common end point, for advanced coronary artery disease and the, leading cause of mortality from heart disease., Current therapies for end stage coronary artery, disease in addition to medical therapies include, coronary bypass surgery (CABG), Percutaneous, coronary intervention (PCI), heart transplant, and/or implantation mechanical circulatory, support., Native recovery after acute myocardial infaraction, or acute coronary syndrome may be characterised, by endogenous myocardial revascularization via, the process of collateral vessel formation and, biologic bypass of obstructing coronary lesion and/, or pathologic ventricular remodeling of infarcted, myocardium., Initial strategies to address these biologic, deficiency focused on Administrating exogenous, genes or stem cells to induce new blood vessel, growth into areas of myocardial ischemia or into

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infarct zone to enhance cardiac perfusion and, function respectively., , Gene therapy and stem cell application for cardiac, disease., , Dr. Folkman’s discovered in 1970s that growth, factor, now identified as vascular endothelial, growth factor(VEGF) are associated with

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tumorigenesis and may potentially be useful in, ischemic heart disease and ischemic limbs., , Schematic of direct myocardial administration of, gene vectors or other agents via Epicardial, approach., GENE DELIVERY VECTORS

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Options for gene delivery in cardiac regeneration, include the use of plasmids, integrative, virus(Retrovirus, RV or Lentivirus LV), non, integrative adenovirus, adeno associated virus or, sendai virus, micro RNA or small molucule., , Gene therapy delivery vectors.

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END OF MODULE 29...GENE THERAPY.....