Gene Therapy for Cardiovascular Disorders - Applications of Biotechnology in Cardiovascular Therapeutics - page 254

for both protection and rescue of the myocardium. Availability of genomic screening
technologies will help in the identification of novel therapeutic targets and detec-
tion of disease-causing polymorphisms, which may lead to the design of individual-
ized gene and cell-based therapies (Melo et al. 2004 ). Particular attention should be
paid to the following aspects:

• Gene therapy, though feasible for the treatment of dyslipoproteinimia and

atherosclerosis, would have a limited impact on multifactorial diseases.
Gene transfer methods need to be refined and adopted for use for various targets •

in the cardiovascular system.

By the year 2015, new technology using stable gene integration may lead to the
development of more effective and lifelong therapy for diabetes, familial homozy-
gous hypercholesterolemia, and other acquired diseases. It is unlikely that these
gene therapy applications will be used routinely in clinical practice within the next
few years because of the time taken for the regulatory process to be completed and
for physicians to adopt the technologies in their daily practice. However, by 2015,
some of the studies will have resulted in products that would enter regular clinical
use. It is possible, for example, that FGF-4 will be used in conditions such as
chronic stable angina refractory to medical therapy and in patients with evidence
of coronary occlusion. New trials of gene- and cell-based therapy will be in
progress, and many that will provide important treatment directions for the future
will be completed. Between 2010 and 2015, there is expected to be an emphasis
on aggressive reduction in risk factors, which will be achieved by the introduction
of new drugs. The trend will be toward earlier coronary interventional therapy.
New surgical techniques may also have emerged. Within this time frame, it is
conceivable that angiogenic gene therapy will be used in selected populations.
Small molecules, DNA-decoy techniques, or gene-based therapy will be used to
inhibit the cell cycle in order to prolong the functional life of bypass grafts.
Autologous endothelial cell harvesting may even be used to produce an engineered
graft. Further research will provide a rationale for using cell-based therapy to
repair vascular and myocardial tissue. Long-term myocardial protection from
ischemia and/or reperfusion using preemptive gene therapy will be in the advanced
phase of investigation. Parallel developments in the field of genetic biomarkers,
genomics, and proteomics will help to pinpoint drug targets and identify patient
populations to be treated by these technologies within the framework of personal-
ized medicine.