Extract
Basic science is an essential basis of clinical evidence. Ischaemia is the major problem eventually leading to myocardial infarction1 and stroke, which in most parts of the world are still major health problems.2 Ischaemia occurs if a blood vessel supplying vital tissue narrows or occludes in the absence of well-developed collaterals.3 Thus, stimulation of the formation of new blood vessels is one of the strategies to circumvent this fundamental problem. Indeed, most tissue and organs of animals and humans do have such a capacity, although it may not suffice. Therefore, cardiovascular research has focused on understanding and stimulating angiogenesis.
In their review entitled ‘Angiogenic gene therapy in cardiovascular diseases: dream or vision?’ Seppo Ylä-Herttuala and colleagues from the University of Eastern Finland in Kuopio, Finland summarize the current knowledge and the perspectives of such an approach.4 Although current treatment strategies have tremendously improved the management of cardiovascular disease, up to a third of these patients cannot be successfully treated with current treatment approaches, and new treatment strategies are clearly needed. Gene therapy and therapeutic vascular growth may provide a new treatment option for such patients. Several growth factors, such as vascular endothelial growth factors, fibroblast growth factor, and hepatocyte growth factor have been tested in clinical trials. However, apart from the demonstration of increased vascularity, very few clinically relevant results have been obtained. Major problems are gene transfer efficiency, short duration of transgene expression, and suboptimal selection of endpoints and patients. Ongoing gene therapy trials tried to take these issues into account. Better targeted delivery systems and new and more effective growth factors have been brought to clinical testing. Eventually, a combination of future angiogenic therapies and revascularization procedures might be required to achieve optimal tissue function and clinical benefits.
