title: Gene-based therapies in patients with critical limb ischemia.
abstract: Critical limb ischemia (CLI) constitutes a life-limiting and life-threatening disease. Revascularization, either endovascular or surgical, remains the best treatment option accompanied by medication and risk factor modification. Patients unable to undergo revascularization, referred as 'no-option patients', have been the center of interest the last few years, subjected to treatment therapies based on proteins (mainly growth factors) involved in angiogenesis via gene delivery to the ischemic tissue. Areas covered: This review focuses on these growth factors, gives an update of the studies available, discusses the possible problems that influence outcomes and describes future perspectives including possible new technologies that will improve them. Additionally, the authors attempt to place therapeutic angiogenesis to the bigger frame of tailored therapy in CLI. Expert opinion: Although encouraging in the beginning, growth factor therapy results have been equivocal and inconclusive. And while it would be misleading to approach gene therapy as panacea, its effect on the micro-circulatory level activating angiogenesis and arteriogenesis could act as an important adjunct in personalized treatment.
authors.affiliation: a Department of Interventional Radiology , Patras University Hospital , Rio , Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kitrou
authors.affiliation: a Department of Interventional Radiology , Patras University Hospital , Rio , Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Karnabatidis
authors.affiliation: b 2nd Department of Radiology, Division of Interventional Radiology , Attikon University General Hospital , Athens , Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Brountzos
authors.affiliation: a Department of Interventional Radiology , Patras University Hospital , Rio , Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Katsanos
authors.affiliation: b 2nd Department of Radiology, Division of Interventional Radiology , Attikon University General Hospital , Athens , Greece.
authors.forename: Lazaros
authors.initials: L
authors.lastname: Reppas
authors.affiliation: b 2nd Department of Radiology, Division of Interventional Radiology , Attikon University General Hospital , Athens , Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Spiliopoulos
mesh_terms: D000818:Animals; D002986:Clinical Trials as Topic / Q000379:methods; D005121:Extremities / Q000098:blood supply* / Q000473:pathology; D018014:Gene Transfer Techniques; D015316:Genetic Therapy / Q000379:methods*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000235:genetics* / Q000628:therapy*; D018919:Neovascularization, Physiologic / Q000502:physiology; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000235:genetics / Q000628:therapy; D033581:Stem Cell Transplantation / Q000379:methods / Q000639:trends
keywords: Angiogenesis; Growth factor; critical limb ischemia; fibroblast growth factor; gene therapy; hepatocyte growth factor; hypoxia inducible growth factor; no-option CLI patients; stromal derived growth factor; vascular endothelial growth factor