Therapeutic angiogenesis for critical limb ischemia

Abstract

The use of angiogenic factors to effect therapeutic angiogenesis may be an attractive treatment modality for a substantial number of patients who have diffuse peripheral artery disease and who are not candidates for traditional revascularization procedures. Delivery of angiogenic factors as a protein or gene encoding for the respective protein product has been shown to induce angiogenesis in numerous animal models, and the expression of a functioning product has been demonstrated. Various early clinical trials of therapeutic angiogenesis have shown reduction in critical limb ischaemia (CLI) symptoms and increases in exercise time, as well as objective evidence of improved perfusion, and angiographic appearance following such angiogenic treatments. Initial phase I and II clinical trial results are encouraging and reflect the potential success of therapeutic angiogenesis as a clinical modality for the treatment of CLI. This review discusses the role of the most well-known growth factors under examination in therapeutic angiogenesis, along with the problems and considerations of this approach as a treatment strategy.