Therapeutic Arteriogenesis Has Arrived

Abstract

The report by Seiler et al1 on a clinical trial using granulocyte-macrophage colony-stimulating factor (GM-CSF) to stimulate the growth of coronary collateral vessels is the temporary culminating point of a long history of research that started in the early 1940s with the observation that the pressure measured in the distal stump of an occluded canine coronary (or femoral or carotid) artery rose as a function of time and was caused by the development of a collateral circulation.2,3 Strandness4 and Schoop and Jahn5 were probably the first to measure the pressure in the distal stump of a peripheral artery in the leg of patients for an estimation of residual perfusion. See p 2012 Almost 30 years after Gregg, my group presented the first systematic analysis of peripheral coronary pressure (PCP), provided a theoretical framework, and described the influence of coronary collateral growth and of collateral blood flow on PCP.6 This led to the formulation of an electrical analog of the coronary arterial system that was later refined by Scheel et al7 and Harrison et al.8 The electrical analog could be displayed on an Apple Macintosh computer and served as a great educational aid for training young cardiologists and physiologists. This was necessary because the complex network of coronary resistances sometimes behaved counterintuitively, but the program helped solve problems of interpretation. A classic case of confusion to the uninitiated is the fall in PCP with increasing collateral blood flow and vice …