Angiogenesis: a "breakthrough" technology in cardiovascular medicine.

The identification of angiogenic growth factors has generated the opportunity for novel therapies in the treatment of a variety of diseases. Antibodies and/or naturally occurring angiogenesis inhibitors are being investigated clinically to antagonize key angiogenic factors. The strategy is designed to eliminate the vascular infrastructure and thereby minimize the extent of pathological consequences to the patient. A complementary strategy is likely to emerge for the treatment of cardiovascular diseases. Clinical trials of therapeutic angiogenesis have already been initiated in patients with myocardial ischemia and peripheral vascular disease. These include trials of recombinant protein therapy as well as gene transfer. While preliminary applications of gene therapy have established proof of the concept that angiogenic growth factors can augment collateral artery development in human subjects, many questions remain to be answered.