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(Circulation Research. 2008;102:1458.)
© 2008 American Heart Association, Inc.

Reviews

Gene Therapy in Heart Failure

Leif Erik Vinge, Philip W. Raake, Walter J. Koch

From the Center for Translational Medicine and the George Zallie and Family Laboratory for Cardiovascular Gene Therapy, Thomas Jefferson University, Philadelphia, Pa.

Correspondence to Walter J. Koch, PhD, W.W. Smith Professor of Medicine, Thomas Jefferson University, 1025 Walnut St, Room 317, Philadelphia, PA 19107. E-mail walter.koch{at}jefferson.edu

This Review is part of a thematic series on Cardiovascular Gene Therapy, which includes the following articles:

Gene Therapy in Heart Failure

Human Studies of Angiogenic Gene Therapy Gene Therapy for Cardioprotection Gene Therapy for Arrhythmias New Vectors for Gene Transfer Gene Correction Strategies

The Editors of Circulation Research

With increasing knowledge of basic molecular mechanisms governing the development of heart failure (HF), the possibility of specifically targeting key pathological players is evolving. Technology allowing for efficient in vivo transduction of myocardial tissue with long-term expression of a transgene enables translation of basic mechanistic knowledge into potential gene therapy approaches. Gene therapy in HF is in its infancy clinically with the predominant amount of experience being from animal models. Nevertheless, this challenging and promising field is gaining momentum as recent preclinical studies in larger animals have been carried out and, importantly, there are 2 newly initiated phase I clinical trials for HF gene therapy. To put it simply, 2 parameters are needed for achieving success with HF gene therapy: (1) clearly identified detrimental/beneficial molecular targets; and (2) the means to manipulate these targets at a molecular level in a sufficient number of cardiac cells. However, several obstacles do exist on our way to efficient and safe gene transfer to human myocardium. Some of these obstacles are discussed in this review; however, it primarily focuses on the molecular target systems that have been subjected to intense investigation over the last decade in an attempt to make gene therapy for human HF a reality.

Key Words: gene therapy • heart failure • cardiomyocyte • myocardial contractility