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J Thorac Cardiovasc Surg 2001;121:0206-0216
© 2001 The American Association for Thoracic Surgery

Basic Science Lecture

Gene therapy and genomic strategies for cardiovascular surgery: The emerging field of surgiomics

Victor J. Dzau, MD, Michael J. Mann, MD, Afshin Ehsan, MD, Daniel P. Griese, MD

From the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Mass.

Received for publication Aug 18, 2000. Accepted for publication Aug 31, 2000. Address for reprints: Victor J. Dzau, MD, Tower 1, Office of the Chairman, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, 75 Francis St, Boston, MA 02115.

Over the past decade, with the advent of molecular technologies, our understanding of the complex mechanisms behind cardiovascular diseases has expanded exponentially. From the identification of inherited single gene disorders to multigenic acquired pathology, the fundamental genetic contributions of these diseases are unquestionable. These developments have led to an enhanced interest in gene-based therapeutic strategies. The ability to alter patterns of gene expression or function in an effort to correct or prevent disease processes forms the basis for "gene therapy." The delivery of genetic agents and successful manipulation of gene expression in living tissues has been crucial to the potential realization of this exciting technology.

The application of this technology not only will affect the overall approach to medical therapies, but likely will improve our ability to treat patients surgically. Complications that limit the long-term efficacy of traditional surgical cardiovascular therapies, such as transplantation and bypass grafting, will greatly benefit from advances in both our understanding and treatment of the genetic and molecular basis of these problems. In this review, we will present the state of gene therapy strategies and the range of methods for genetic intervention that currently exist. We will review the progress and application of this technology toward the improvement of surgical cardiac revascularization, as it applies to molecular neovascularization of the myocardium and the enhancement of bypass graft patency. We will discuss the potential impact gene transfer and genetic engineering principles and technologies may have on cardiovascular surgery and on surgical outcomes. Finally, rapid progress in human genome sequencing and mapping is likely to affect cardiovascular therapeutics and surgery. We believe the integration of the disciplines of gene therapy and genomics and cardiovascular surgery should result in the emergence of a new field of therapy that we term surgiomics.

Gene therapy strategies and delivery systems

Gene therapy is defined as any manipulation . . . [Full Text of this Article]






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