Prevention of vein graft failure: potential applications for gene therapy

The use of gene therapy in the clinical setting is believed to be a realistic option for the future. Many clinical trials are underway for treatment of disorders as diverse as cancer, peripheral vascular disease, and numerous monogenic diseases. However, gene therapy for vein graft failure may be more distant due to the highly complex, multifactorial aetiology of the disease. Although many of the cellular mechanisms involved in vein graft failure have been reported, important barriers still need to be overcome before gene therapy could become a clinical reality. Further understanding of the molecular mechanisms involved in graft failure will lead to the identification of appropriate therapeutic genes. Moreover, limitations in the current delivery systems need to be overcome to allow efficient, safe delivery and expression of transgenes for the required length of time in vivo. However, currently available gene delivery vectors are extremely useful tools to help in our understanding of vein graft failure. In this review, we address the issues surrounding gene therapy with particular emphasis on its future potential to ameliorate long term vein graft occlusion. (C) 1997 Elsevier Science B.V.