Clinical potential of angiogenic therapy and cellular reprogramming.

You're driving along the freeway during rush hour. You're running late and find yourself in bumper-to-bumper traffic. You have 3 options: (1) do nothing, suffer with anguish inside; (2) find productive ways to pass the time, like listen to a podcast or talk on the phone; or (3) get off on the next exit and find an alternative, roundabout path to your destination. Similarly, patients suffering from coronary artery disease can opt to do nothing; stop progression and treat their symptoms with medical therapy; or undergo revascularization either percutaneously or surgically. There are few options, however, for those who develop chronic coronary artery disease without suitable revascularization strategies. They have missed their exit and are stuck in this metaphorical traffic jam, with no radio and no cell phone. These patients may experience refractory angina or develop ischemic cardiomyopathy and heart failure. Exploring solutions to this increasingly widespread problem is imperative. Chronic heart failure is rising, while the number of organs available for transplantation remains limited. Similarly, bridge therapies such as ventricular assist devices are resource intensive and are typically only performed at select, high-volume institutions. In the following article, the authors explore cardiac regenerative strategies to bridge this therapeutic gap. They delve into a so-called "biologic bypass," which aims to restore perfusion and functionality of ischemic myocardium. Specifically, they review published preclinical data and the potential clinical implementation of cardiac reprogramming of fibrotic tissue into functioning, contractile myocardium, as well as angiogenic therapies aimed at inducing angiogenesis. These innovative and forward-thinking approaches will be necessary to combat the challenges faced by the heart specialists of tomorrow.w Jordan Dozier, MD, and Nahush A. Mokadam, MD.