Angiogenesis

T he concept of modulating blood vessel growth-stimu- lation or inhibition-to serve a desired clinical goal has an enormous intellectual appeal.It can be used to relieve ischemia in tissues with compromised arterial blood supply, improve edema in areas of impaired lymphatic drainage, and inhibit the growth of tumors.Other applications involve facilitating reendothelialization and inhibiting neointima formation after vascular injury, preventing the progression of atherosclerotic plaque, and promoting "vascular health" in general.The least-explored application of this concept involves modulating body and organ size by regulating the endothelial cell mass.All of these areas received a significant, albeit varied, amount of attention in past decades but only recently have we begun approaching clinical applications.Indeed, the first antiangiogenic agent has been approved by the US Food and Drug Administration for the treatment of certain types of cancer, and it is hoped that the emergence of therapeutically useful angiogenesis-promoting agents is not far behind.This article examines some of our current understanding of the regulation of blood vessel growth in mature adult tissues and the various therapeutic applications of this knowledge.Obviously, a review of this size cannot cover such a vast field in any amount of detail, and the author regrets not citing primary references for many of the facts and concepts that are mentioned.