Platelet-derived endothelial cell growth factor (PD-ECGF), also known as thymidine phosphorylase (TP), has been reported to possess angiogenic activity and to inhibit apoptosis. This study was performed to determine whether PD-ECGF/TP can be used to ameliorate chronic myocardial ischemia. Myocardial ischemia was created in 40 mongrel dogs by placing an ameroid constrictor on proximal left anterior descending coronary artery (LAD). Plasmid vector encoding human PD-ECGF/TP cDNA (pCIhTP group, n=12), empty vector pCI (pCI group, n=12) or saline (Saline group, n=12) was directly injected into the LAD territory 3-week after ameroid constrictor implantation. Myocardial blood flow was detected using PET at baseline, 3-week after ameroid constrictor implantation and 2-week after therapeutic treatment. At the end of the experiment, the hearts were isolated for biological and histologic analysis. In the pCIhTP group, the transfected heart strongly expressed PD-ECGF/TP. The size of the infarct was smaller in the pCIhTP group than in the pCI or Saline group. The number of apoptotic myocardial cells was decreased in the pCIhTP group compared to the control groups based on triple immunohistochemical staining for von Willebrand factor, -actin smooth muscle cells, and single strand DNA. The level of proapoptotic protein Bax markedly decreased in the pCIhTP group compared to the other groups. Double immunohistochemical staining for von Willebrand factor, -actin smooth muscle cells demonstrated that angiogenesis and arteriogenesis occurred, and paralleled the changes in myocardial blood flow and myocardial function in the pCIhTP group. We conclude that genetic approaches using PD-ECGF/TP to target the myocardium are effective for alleviating chronic myocardial ischemia.