Therapeutic Angiogenesis for Tissue Repair and Regeneration

Therapeutic angiogenesis modalities represent a broad range of interventions that generate

new blood vessel growth to promote neovascularization and tissue repair. Presently, there are
three major indications for which angiogenic therapies are in clinical use: 1) chronic wounds
(e.g. diabetic lower extremity ulcers, venous leg ulcerations, pressure ulcers, arterial ulcers);
2) peripheral arterial disease; and 3) ischemic heart disease. In such conditions, the
therapeutic goal is to stimulate angiogenesis to improve perfusion, deliver survival factors to
sites of tissue repair, mobilize regenerative stem cell populations, and ultimately, restore form
and function to the tissue.
Therapeutic Angiogenic Drugs:

Growth factor-based therapies include the only FDA-approved recombinant protein

drug rhPDGF (becaplermin, REGRANEX 0.01% gel) which is indicated for diabetic
neuropathic lower extremity ulcers.

Growth factors can also be delivered through autologous isolates of patient platelets
such as Autologel, SmartPReP.

Currently, there are no FDA-approved angiogenic drugs for the treatment of ischemic
cardiovascular disease.

Some early stage clinical trials of therapeutic angiogenic agents have demonstrated
reductions in symptoms of angina, increase in ability to exercise, and objective
evidence of improved perfusion and left ventricular function following therapy.

Therapeutic Angiogenesis Promoting Devices:

Negative pressure wound therapy (NPWT) such as the Vacuum Assisted Closure
(V.A.C.) system induces angiogenesis through tissue microdeformations and
mechanochemical coupling and signal transduction.

MIST ultrasound is a low-frequency and low-intensity non-contact device that results

in cell stimulation and increased wound perfusion.

Hyperbaric Oxygen (HBO) promotes angiogenesis and wound healing by increasing

VEGF expression and recruiting edothelial progenitor cells.

Cell-Based Therapies:

Tissue engineered products approved by the FDA include the bilayered skin substitute
Grafstkin (Apligraf) and the fibroblast dermal skin substitute Dermagraft. These

products contain living or cryopreserved cells on a matrix capable of secreting and

releasing multiple angiogenic growth factors into the wound bed.

CD34+ endothelial progenitor cells (EPC) derived from bone marrow or from
peripheral blood have been found to enhance angiogenesis in ischemic tissues,
increase transcutaneous oyxgen, improve ankle-brachial index (ABI), increase
collateral vessels by angiography and improve healing of leg ulcers.