Adenoviral intramyocardial VEGF-DΔNΔC gene transfer increasesmyocardial perfusion reserve in refractory angina patients: a phase I/IIa study with 1-year follow-up

Aims We evaluated for the first time the effects of angiogenic and lymphangiogenic AdVEGF-D-Delta N Delta C gene therapy in patients with refractory angina. Methods and results Thirty patients were randomized to AdVEGF-D-Delta N Delta C (AdVEGF-D) or placebo (control) groups. Electromechanical NOGA mapping and radiowater PET were used to identify hibernating viable myocardium where treatment was targeted. Safety, severity of symptoms, quality of life, lipoprotein(a) [Lp(a)] and routine clinical chemistry were measured. Myocardial perfusion reserve (MPR) was assessed with radiowater PET at baseline and after 3- and 12-months follow-up. Treatment was well tolerated. Myocardial perfusion reserve increased significantly in the treated area in the AdVEGF-D group compared with baseline (1.00 +/- 0.36) at 3 months (1.31 +/- 0.46, P = 0.045) and 12 months (1.44 +/- 0.48, P = 0.009) whereas MPR in the reference area tended to decrease (2.05 +/- 0.69, 1.76 +/- 0.62, and 1.87 +/- 0.69; baseline, 3 and 12 months, respectively, P = 0.551). Myocardial perfusion reserve in the control group showed no significant change from baseline to 3 and 12 months (1.26 +/- 0.37, 1.57 +/- 0.55, and 1.48 +/- 0.48; respectively, P = 0.690). No major changes were found in clinical chemistry but anti-adenovirus antibodies increased in 54% of the treated patients compared with baseline. AdVEGF-D patients in the highest Lp(a) tertile at baseline showed the best response to therapy (MPR 0.94 +/- 0.32 and 1.76 +/- 0.41 baseline and 12 months, respectively, P = 0.023). Conclusion AdVEGF-D-Delta N Delta C gene therapy was safe, feasible, and well tolerated. Myocardial perfusion increased at 1 year in the treated areas with impaired MPR at baseline. Plasma Lp(a) may be a potential biomarker to identify patients that may have the greatest benefit with this therapy.