1. Growth factor-induced therapeutic neovascularization for ischaemic vascular disease: time for a re-evaluation?
- Author
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Lekas M, Lekas P, Latter DA, Kutryk MB, and Stewart DJ
- Subjects
- Angiogenesis Inducing Agents pharmacology, Animals, Arterial Occlusive Diseases drug therapy, Arteries drug effects, Clinical Trials as Topic, Coronary Disease drug therapy, Fibroblast Growth Factors pharmacology, Humans, Myocardial Ischemia drug therapy, Peripheral Vascular Diseases drug therapy, Randomized Controlled Trials as Topic, Recombinant Proteins therapeutic use, Research Design, Treatment Outcome, Vascular Endothelial Growth Factors pharmacology, Angiogenesis Inducing Agents therapeutic use, Arterial Occlusive Diseases therapy, Coronary Disease therapy, Fibroblast Growth Factors therapeutic use, Genetic Therapy methods, Myocardial Ischemia therapy, Neovascularization, Physiologic drug effects, Neovascularization, Physiologic genetics, Peripheral Vascular Diseases therapy, Vascular Endothelial Growth Factors therapeutic use
- Abstract
Purpose of Review: Therapeutic angiogenesis and arteriogenesis represent an alternative treatment modality for patients with advanced ischaemic coronary or peripheral artery occlusive disease, who are unsuitable for standard revascularization procedures., Recent Developments: Proof-of-concept evidence for therapeutic growth factor, both gene and protein-mediated neovascularization was provided in animal models of chronic myocardial and hindlimb ischaemia. Early human, phase I, trials utilizing the prototypical growth factor families, vascular endothelial growth factor and fibroblast growth factor, documented safety and suggested improvements in anginal symptoms and functional status. Large, randomized, placebo-controlled phase II/III clinical trials have, however, yielded variable results as such studies have suffered from significant limitations in therapeutic approach or design, which limits the ability to draw firm conclusions., Summary: Future trials must incorporate robust delivery strategies and address issues of study design including proper patient selection. Laboratory-based refinements in therapy, including a focus on the promotion of arteriogenesis and the modification of patient 'endotheliopathy', will all further enhance the potential of therapeutic neovascularization strategies.
- Published
- 2006
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