Effects of a single intracoronary injection of basic fibroblast growth factor in stable angina pectoris

We sought to evaluate safety, tolerability, pharmacokinetics, and pharmacodynamics of basic fibroblast growth factor (bFGF), administered as a single intracoronary injection, to subjects with stable angina pectoris secondary to coronary artery disease. bFGF, an angiogenic growth factor, has been shown to enhance collateral development in animal models of progressive coronary occlusion. To our knowledge, this study represents the initial introduction of parenteral bFGF into humans. This was a phase 1, randomized, dose-escalation trial of bFGF in 25 subjects with coronary artery disease and stable angina. Subjects were randomized 2:1 to a single dose of bFGF or placebo, injected into the left main coronary artery. bFGF doses ranged from 3 to 100 μg/kg, increasing in half-log increments. bFGF was generally well tolerated at doses of 3 to 30 μg/kg. Plasma clearance was 20 ± 2 ml/kg/min, with an elimination half-life of 85 ± 11 minutes. bFGF caused acute hypotension (≈10%) that did not appear to be dose-related through the dose range studied. Of the 9 subjects who received 30 to 100 μg/kg bFGF, 2 had sustained hypotension, mild to moderate in severity, lasting 1 to 3 days, and 3 subjects developed bradycardia hours to days after bFGF administration. bFGF dilated epicardial coronary arteries (7.4 ± 2.5% mean diameter increase, p <0.02). Transient mild thrombocytopenia and proteinuria were observed in some subjects in the 30-μg/kg cohort. No subject had signs suggesting systemic angiogenesis. Thus, intracoronary bFGF, at doses of 3 to 30 μg/kg, was generally well tolerated in subjects with stable angina.