Vascular endothelial growth factor gene transfer therapy for coronary artery disease: A systematic review and meta-analysis.

Abstract

AIM:

It is not clear whether treatment by vascular endothelial growth factor (VEGF) gene transfer can improve myocardial ischemia through a proangiogenesis mechanism and is effective against coronary artery disease (CAD). We aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared VEGF gene therapy and standard treatments in CAD.

METHODS:

We systematically searched the PubMed, Embase, and Cochrane databases and relevant references for RCTs (published up to May 2018; no language restrictions) and performed meta-analysis using both fixed and random effects models. Our primary outcome measures were mortality and serious cardiac events. The secondary outcome measures were follow-up left ventricular ejection fraction (LVEF), change in LVEF (ΔLVEF), and angina outcomes. The registration number is CRD42017058430.

RESULTS:

Of 524 identified studies, 14 were eligible and were included in our analysis. At a mean follow-up of 6 months, VEGF gene therapy demonstrated a decreased risk of serious cardiac events (11.7% vs 21.2%, relative risk: 0.56; 95% confidence interval (CI): 0.37, 0.84; P = 0.005) and a slight improvement in follow-up LVEF (weighted mean difference: 1.95; 95%CI: 1.28, 2.62). Furthermore, VEGF gene therapy using adenoviral vectors showed more potential benefit in terms of the risk of serious cardiac events, ΔLVEF, and Canadian Cardiovascular Society angina class. Nevertheless, mortality and angina frequency scores were not different.

CONCLUSIONS:

Vascular endothelial growth factor gene therapy appears to be safe and effective regarding serious cardiac events, with greater benefit when using adenoviral vectors. This meta-analysis highlights the need for further exploration in these areas.

• Authors: Rong Yuan, Qiqi Xin, Weili Shi, Wei Liu, Simon-M Lee, Puiman Hoi, Lin Li, Jun Zhao, Weihong Cong, Keji Chen
• Journal: Cardiovascular therapeutics (Cardiovasc Ther) Vol. 36 Issue 5 Pg. e12461 (Oct 2018) ISSN: 1755-5922 [Electronic] England
• PMID: 30035366 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: © 2018 John Wiley & Sons Ltd.

Chemical References

• Vascular Endothelial Growth Factor A

Topics

• Aged
• Coronary Artery Disease (genetics, metabolism, physiopathology, therapy)
• Female
• Gene Expression Regulation
• Gene Transfer Techniques
• Genetic Therapy (methods)
• Humans
• Male
• Middle Aged
• Neovascularization, Physiologic
• Randomized Controlled Trials as Topic
• Treatment Outcome
• Vascular Endothelial Growth Factor A (biosynthesis, genetics)