title: Angiogenic gene therapy for refractory angina.
abstract: BACKGROUND
  Stimulation of coronary collateral vessel growth by therapeutic angiogenesis (TA) offers an alternative treatment option for patients with refractory angina. Several TA modalities, including delivery to the heart of angiogenic growth factors (proteins or genes) and cells have been tested in clinical trials in the past two decades, but so far none of them resulted in significant therapeutic efficacy in large scale studies. This review attempts to identify the main obstacles hindering clinical success and recommends measures to overcome them in the future.
  
  
  METHODS
  After stating the medical need and rational for TA, and listing and briefly discussing past and current TA clinical trials, three main areas of obstacles are described: conceptual questions, technical limitations and clinical design uncertainties. Based on scientific and technical advances and lessons learned in past clinical trials, potential solutions to overcome some of these obstacles are proposed.
  
  
  CONCLUSIONS
  Several success criteria are identified, which apply to any TA approach of choice. It is emphasized, that each of these criteria needs to be met in future clinical trials to have a chance of therapeutic success.
authors.affiliation: a Angionetics, Inc ., San Diego , CA , USA.
authors.forename: Gabor M
authors.initials: GM
authors.lastname: Rubanyi
mesh_terms: D000256:Adenoviridae; D000787:Angina Pectoris / Q000628:therapy*; D064987:Cell- and Tissue-Based Therapy; D003097:Collateral Circulation / Q000235:genetics*; D005346:Fibroblast Growth Factors / Q000235:genetics; D015316:Genetic Therapy / Q000379:methods*; D006801:Humans; D018919:Neovascularization, Physiologic / Q000235:genetics*; D033581:Stem Cell Transplantation; D042461:Vascular Endothelial Growth Factor A / Q000235:genetics
chemical_list: D042461:Vascular Endothelial Growth Factor A; D005346:Fibroblast Growth Factors
keywords: Adenovirus; angina pectoris; angiogenesis; arteriogenesis; cell therapy; clinical trial design; coronary collaterals; fibroblast growth factor; gene therapy; myocardial ischemia