Gene Therapy for Cardiovascular Disorders - Applications of Biotechnology in Cardiovascular Therapeutics - page 222

Table 8.2 Catheter-based systems for vector delivery to the cardiovascular system

Catheter Advantages Disadvantages/limitations

Gene transfer to the vessel wall
Double balloon Prolonged contact of vector with vessel

wall

Occlusion of the vessel

Minimal systemic spread of the vector Vector escape via side

branches

Enables withdrawal of vector after gene
transfer

Transduction efficacy low

Porous balloon Transfer to deeper layers of vessel wall Damage to the vessel wall

from high pressure
delivery

Short occlusion time
Enables simultaneous PTCA and gene
transfer

Gel-coated balloon Short vessel occlusion time Low gene transfer efficacy

Enables simultaneous PTCA and gene
transfer

Dispatch Catheter Allows distal blood flow Vector escape via side

branches Prolonged contact of vector with vessel

wall
Efficient gene delivery
Minimal systemic spread of the vector

Angioplasty balloon Transfer to deeper layers of vessel wall Damage to the vessel wall

from multiple injections Short occlusion time

Enables simultaneous PTCA and gene
transfer
Minimal systemic spread of the vector
Gene transfer to the myocardium
NOGA Enables percutaneous access to

myocardial muscle

High cost
Difficult and time
consuming Gene transfer to viable ischemic

myocardium
High gene transfer efficacy
Minimal systemic spread of the vector
Gene transfer to vessel wall as well as the myocardium
Micro-Infusion
Catheter

Percutaneous procedure
Direct delivery to vessel wall and
myocardium
Perivascular delivery enables gene to be
retained at treatment site and not lost
in blood circulation

Approved only for delivery
into the vessel wall or
perivascular area
Research in progress for
vessels 2-8 mm in
diameter

© Jain PharmaBiotech

Adenoviral Vectors for Cardiovascular Diseases

Adenoviral vectors are considered to be the most effective agents for gene transfer
for vascular disease. Gene transfer of vasoactive molecules is an effective method
of vascular protection. Clinical trials in humans followed the success of intracoro-
nary injection of adenoviral vectors encoding VEGF in pigs with coronary occlu-
sion. Revascularization takes place by a process of angiogenesis. Such vectors have