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[The molecular bypass: an established method for revascularisation of non-operable PAD patients or merely a future
J Herold1, S Said1, R Braun-Dullaeus1
1Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland.
Insights
Arteriogenesis promotes natural collateral vessel growth to restore blood flow. Research explores cell and growth factor therapies to enhance this process for treating vascular diseases when traditional methods fail.
Area of Science:
- Vascular Biology and Medicine
- Cardiovascular Research
- Regenerative Medicine
Context:
- Peripheral arterial disease (PAD) and coronary artery disease often limit treatment options.
- Existing therapies like bypass grafts or angioplasty are not suitable for all patients.
- Physiological collateral circulation compensates for vascular stenosis but varies individually.
Purpose:
- To review the physiology and pathophysiology of vascular stenoses and their compensatory mechanisms.
- To explore current and novel therapeutic strategies for improving revascularization, particularly for non-operable PAD patients.
- To highlight the role of arteriogenesis, cell-based therapies, and growth factors in promoting collateral vessel growth.
Summary:
- Collateral circulation compensates for arterial blockages, but true neovascularization (vasculogenesis) occurs in specific adult conditions.
- Arteriogenesis, the enhancement of natural collateral growth, is a key research area.
- Monocytes, stem cells, and growth factors (e.g., VEGF, MCP-1) are investigated for their therapeutic potential in promoting vessel growth.
Impact:
- Provides an overview of current treatment approaches for vascular stenosis and PAD.
- Discusses promising cell and growth factor-related studies for therapeutic angiogenesis.
- Evaluates outcomes of interventions like balloon dilatation, stenting, and bypass surgery for revascularization.
Abstract:
Collateral vessel growth is a physiological process that is not equally pronounced in all people. After the development of a haemodynamically relevant stenosis in vascular systems, blood flow is directed through a collateral circulation to supply ischaemic tissue. This collateral circulation exists on the capillary level and by definition, is not composed of real new vessels. Postnatal vasculogenesis (true neovascularisation) occurs in the adult organism in tumour vascularisation, wound healing, in the endometrium, and in the context of chronic diseases such as rheumatoid arthritis and psoriasis. Reopening of the occluded vessel or use of artificial bypass grafts are the most attractive therapeutic approaches for treating peripheral arterial and coronary artery disease. These strategies have been exhausted in many patients; therefore augmentation of arteriogenesis can be more useful. Arteriogenesis, the promotion of natural collateral growth, is a hot topic in vascular research. Monocytes play a key role in arteriogenesis by "homing" to areas of collateral vessel growth and locally secrete multiple essential growth factors. Furthermore, stem cells of different origins, endothelial progenitor cells or mononuclear cells are currently being used to promote vessel growth. Also, the application of growth factors such as VEGF, MCP-1, GM-CSF have been already used in clinical trials. This review article describes the physiology and pathophysiology of vascular stenoses and their compensation mechanisms. The review also gives an overview of current treatment approaches and new strategies for non-operable PAD patients. The article presents the current cell and growth factor-related studies, as well as results of balloon dilatation and stent implantation or bypass surgery studies for improvement of revascularisation.
