Korean Circ J.  2008 Feb;38(2):73-79. 10.4070/kcj.2008.38.2.73.

Therapeutic Angiogenesis: The Pros and Cons and the Future

• Ryu JK

• KMID: 2225838
• DOI: http://doi.org/10.4070/kcj.2008.38.2.73

Abstract

Despite the improvements in medical, surgical and endovascular therapies, vascular disease is still a significant, critical clinical problem. The advances in understanding the mechanisms of neovascularization and the accumulated experiences of successful therapeutic application in animal models have raised expectations for therapeutic angiogenesis as a promising treatment option. However, the large, double-blinded, controlled clinical trials using therapeutic agent in the form of protein, naked DNA or viral gene therapy have failed to show clinical benefit. Nevertheless, by this time, cell based therapeutic angiogenesis has raised a promising option for the treatment of ischemic diseases. This article summarizes the essential preclinical research and major clinical trials on therapeutic angiogenesis, and it deals with several issues related to the failure of the clinical trials. Future directions in the realm of therapeutic angiogenesis are also described with focusing on cell based therapy.

Keyword

Neovascularization; Angiogenesis; Clinical trial; Cell therapy

MeSH Terms

DNA
Genes, Viral
Models, Animal
Tissue Therapy
Vascular Diseases
DNA

Figure

• 

  Fig. 1 Scheme showing neovascularization mechanisms. A: vasculogenesis; According to this idea, endothelial tubes are produced as a first step (a). Maturation to arterioles proceeds by the recruitment of smooth muscle cells or progenitors (b). B: angiogenesis describes the growth of capillaries from pre-existing vessels. It proceeds either by sprouting of endothelial cell or by intussusception. The initial trigger is hypoxia. C: arteriogenesis is induced after stenosis or occlusion of a major artery (indicated by the gray spot). Fluid shear stress, caused by altered blood flow (thick arrows) through pre-existing collateral anastomosis (slim arrows) serves as initial trigger. Growth of collaterals proceeds by remodeling of pre-existent arterioles. EPC: endothelial progenitor cells.

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