Percutaneous approaches for efficient cardiac gene delivery

Gene therapy for heart failure treatment is currently being optimized and validated. The results to date are encouraging but challenges remain before it becomes a therapeutic approach in clinical cardiology. Much effort is dedicated to improve gene transduction efficiency by improving the vectors and the delivery methods. Successful translation from the benchtop to the bedside requires teams including biologists focusing on vector modification and cardiologists refining delivery methods. Two key components for translation to the clinic include safety and efficacy. Transduction efficiency is closely linked to invasiveness in most delivery methods. However, current candidates for cardiac gene therapy are patients without effective treatment option and are in advanced heart failure, thus a less invasive approach is preferred. This review focuses on injection methods of gene delivery with emphasis on percutaneous and endovascular approaches to summarize currently available percutaneous gene delivery methods and their features.