Restenosis: is there a pharmacologic fix in the pipeline?
One of the most frustrating aspects of restenosis is that it is the result of advances in medical care (there was no restenosis before the days of balloon angioplasty), yet it seems to be resistant to all that science has to offer. Still we believe there is reason to be optimistic. We are at last beginning to see some promise from clinical trials, and data being generated confirm some of the hypotheses previously generated from animal experiments. Thus the effects seen with the GP IIb/IIIa antibody 7E3 suggest that thrombosis may be as important in its long-term sequelae as it is for acute reocclusion. The jury is still out on whether antiproliferative approaches will be a therapeutic option, but local delivery paradigms using novel formulations delivered by catheter or impregnated in stents may allow the concept to be tested without the risk of systemic toxicity. Plans are also underway for gene therapy trials, although we may have to wait for better vector technology before taking these into the coronary bed. Perhaps we should move away from the "single pill" approach and accept that, like many infections, malignancies, or even heart failure, a multifaceted approach with combination therapy will provide the first glimmer of that brighter tomorrow.
Keiser
J A
JA
Parke-Davis Pharmaceutical Research, Warner Lambert Company, Ann Arbor, Michigan 48105, USA.
Uprichard
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AC
D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary; D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D015316:Genetic Therapy; D006131:Growth Inhibitors / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D010789:Phototherapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000276:immunology; D012008:Recurrence
D000911:Antibodies, Monoclonal; D005343:Fibrinolytic Agents; D006131:Growth Inhibitors; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D006493:Heparin; D000077284:Abciximab