Gene Therapy vs Pharmacotherapy.

Recent progress in molecular and cellular biology has developed numerous effective cardiovascular drugs. However, there are still number of diseases for which no known effective therapy exists, such as peripheral arterial disease, ischemic heart disease, restenosis after angioplasty, vascular bypass graft occlusion, and transplant coronary vasculopathy. Currently, gene therapy is emerging as a potential strategy for the treatment of cardiovascular disease to treat such diseases despite this limitation. The first human trial in cardiovascular disease started in 1994 to treat peripheral vascular disease, using vascular endothelial growth factor (VEGF). Since then, many different potent angiogenic growth factors have been clinically tested to treat peripheral arterial disease. In addition, therapeutic angiogenesis using VEGF gene was applied to treat ischemic heart disease from 1997. The results from these clinical trials appear to exceed expectations. Improvement of clinical symptoms in peripheral arterial disease and ischemic heart disease has been reported. Many different potent angiogenic growth factors have been tested in clinical trials to treat peripheral arterial disease or ischemic heart disease. In addition, another strategy for combating disease processes, to target to transcriptional process, has been tested in a human trial. Transfection of cis-element double-stranded (ds) oligodeoxynucleotides (ODN) (decoy) is an especially powerful tool in a new class of antigene strategies for gene therapy. Transfection of ds ODN, corresponding to the cis sequence, will result in the attenuation of authentic cis-trans interaction, leading to the removal of transfactors from the endogenous cis-elements with subsequent modulation of gene expression. Genetically modified vein grafts transfected with decoy against E2F, an essential transcription factor in cell cycle progression, revealed apparent long-term potency in human patients. This review focuses on the future potential of gene therapy for the treatment of cardiovascular disease. [ABSTRACT FROM AUTHOR]