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Gene Therapy for Atherosclerotic Cardiovascular Disease

      To the Editor: The review of gene therapy for atherosclerotic disease by O'Brien and Simari
      • O'Brien T
      • Simari RD
      Gene iherapy for atherosclerotic cardiovascular disease: a time for optimism and caution.
      beautifully summarizes the current state of the art and state of the science. I am slightly perplexed, however, by the omission of intrapericardial therapy, which deposits appropriate agents, including genes and angiogenic factors, directly on the coronary arteries and myocardium. Intrapericardial therapy has worked extremely well under a variety of experimental circumstances (Table 1 and described in detail elsewhere
      • Spodick DH
      Intrapcricardial therapeutics and diagnostics [editorial].
      ). The material would have been within the scope of the authors' concise presentation, and I wonder if they had any newer caveats to explain the omission.
      Table 1Intrapericardial Therapy via Normal Pericardium (Experimental)
      Modified from Spodick.2
      TypeTargets (cardiac diseases)
      GeneVessels: mcsothclium; conduction tissues
      Apolipoprotein A-MilanoVessels: intima;advcntitia
      OxygenDamaged/ischemic myocardium
      Nitric oxideVessels: lumen; walls
       DonorsPlatelets
       Precursor (i.-arginine)
      Voltage sensitiveDamaged (depolarized) cells
      HypothermicDamaged/ischemic myocardium
      Ami arrhythmicMyocardium/conduction tissues
       Procainamide
       Amiodarone
       L-Arginine (via nitric oxide)
      Ami arrhythmic/antibodyMyosin of damaged cells
      Calcium-avidIncreased cell calcium
      * Modified from Spodick.
      • Spodick DH
      Intrapcricardial therapeutics and diagnostics [editorial].

      REFERENCES

        • O'Brien T
        • Simari RD
        Gene iherapy for atherosclerotic cardiovascular disease: a time for optimism and caution.
        Mayo Clin Proc. 2000; 75: 831-834
        • Spodick DH
        Intrapcricardial therapeutics and diagnostics [editorial].
        AmiCardiol. 2000; 85: 1012-1014

      Linked Article

      • Gene Therapy for Atherosclerotic Cardiovascular Disease: In Response
        Mayo Clinic ProceedingsVol. 75Issue 11
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          We thank Dr Spodick for pointing out that genes may be delivered to the heart via the pericardium. We agree with his comments on the use of pericardial delivery for pharmacological agents and also as a potential medium for gene delivery. How ever, the focus of our article was to discuss progress in approaches to gene therapy of atherosclerosis in humans, and therefore we did not describe animal models. Thus, while pericardial delivery has worked well under a variety of experimental circumstances, we considered this to be beyond the scope of our article.
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