Pro- and anti-angiogenic therapy and atherosclerosis with special emphasis on vascular endothelial growth factors

INTRODUCTION: Atherosclerosis is a complex, progressive disease affecting nearly half of the population in Western countries. Although several treatment methods are already available, they may not be applicable to all patients suffering from advanced cardiovascular diseases, such as end-stage myocardial ischemia or difficult peripheral ischemia and potential new treatment methods are under intensive investigation. AREAS COVERED: VEGFs are major angiogenic molecules controlling vascular growth and function, vascular homeostasis, permeability and vasodilatation. Therefore, they have been regarded as potential new treatment agents for ischemic heart and peripheral vascular disease and several pro-angiogenic clinical trials have been conducted. In contrast, VEGFs also take part in pathological states by inducing microvessel growth in, for example tumors and atherosclerotic lesions. In this review, the biological basis of atherosclerosis and VEGF biology are presented as well as the latest results from pre-clinical research and clinical trials of pro- and anti-angiogenic therapy. EXPERT OPINION: Even though pro-angiogenesis has been shown to be safe and well-tolerated in clinical trials, efficacy of the treatment has not been satisfactory. In the expert opinion section of the review, we discuss the major obstacles to cardiovascular gene therapy and some future prospects.