The new angiotherapy

Abstract

The new angiotherapy Tai-Ping D. Fan, Elise C. Kohn; Totowa, NJ; 2002; Humana Press; 609 pages; $150.00. During the past decade there has been an explosion of interest in angiogenesis at the level of both laboratory research and clinical investigation. Classically defined, angiogenesis is the sprouting of new blood vessels from preexisting vessels, whereas vasculogenesis is de novo formation of such vessels during embryogenesis. As several of the contributors in this text point out, such mutually exclusionary categorization is oversimplification, with the probability that vasculogenesis may also occur later, in adulthood. Both of these processes are dynamic and complex, with positive and negative modulators, which have been likened to a multidimensional coagulation cascade. Vasculogenesis and angiogenesis are involved in a multitude of disease states, ranging from arteriovenous malformation, hemangioma, atherosclerosis, venous and arterial ulceration, and scleroderma, to diabetic retinopathy, rheumatoid arthritis, wound healing, and neoplasms. We are just beginning to gain a rudimentary understanding of angiogenesis, and its mechanisms and regulation. Angiotherapy, broadly defined, is the targeting of blood vessels for intervention, during differentiation, maintenance, or homeostasis, in either normal or disease processes. A textbook on this topic is timely and provides a useful summary of present knowledge. The New Angiotherapy is written by an international group of experts in the field of angiogenesis, with many contributors who are colleagues of the two editors at the University of Cambridge and the National Institutes of Health. Each chapter is clearly written, succinct, and extensively referenced. The first chapter clarifies the distinction and relationship between vasculogenesis and angiogenesis. The subsequent half dozen chapters describe and explain our current understanding of the molecular and cellular biology of angiogenesis as derived from previous and recent in vitro and in vivo studies. These are followed by descriptions of the various components of angiogenesis, including the angiopoietins, extracellular matrix proteins, vascular endothelial growth factor, fibroblast growth factor, and other cytokines and vasoactive peptides. Following these descriptions of the basic science of angiogenesis, 8 chapters effectively connect the basic pathophysiologic features with a variety of clinical diseases. These chapters educate the reader about the pathogenesis of these disease processes, including wound healing and repair, rheumatoid arthritis, neoplasms and metastases, and coronary and peripheral arterial occlusive diseases, and highlight the mechanistic associations with angiogenesis. Each of these chapters also contains a thorough literature review of relevant preclinical and clinical studies for therapeutic angiogenesis in these disease states. The last chapter in this section, “Contact-guided angiogenesis and tissue engineering,” describes the emerging therapeutic concept of tissue-engineered blood vessels from cultured endothelial cells, tagging them with growth factors, and implanting them in vivo to stimulate angiogenesis. If there is angiogenesis, there is also anti-angiogenesis. The book devotes ane entire section to anti-angiogenesis and expounds on possible anti-angiogenic targets. Of interest is Chapter 19, which gives an overview of some of these modulators, including cyclosporin A, antimicrobial agents, and steroids that have angiostatic effects. Possible targets discussed at length are the tyrosine kinase receptors, endothelial monocyte-activating polypeptide II, and CD105. There are also 2 excellent chapters that review the possible methods of gene therapy for therapeutic anti-angiogenesis and vascular targeting with monoclonal antibodies. The last section of the book identifies the vast potential for clinical application of angiogenesis and anti-angiogenesis, and defines some of the cutting-edge strategies that may be used in these processes. Several helpful tables list key clinical published studies. One chapter describes in depth the newest members of the anti-angiogenesis family, angiostatin and endostatin, which are endogenous molecules that may have substantial future therapeutic applicability. These chapters also provide recommendations for conducting appropriate clinical trials in angiotherapy. Overall, this is a well-written, concise, and evidence-based textbook that deals with both the facts and concepts of angiogenesis and possibilities for future angiotherapy. I recommend it in particular to academic physicians and investigators in vascular surgery, cardiovascular medicine and surgery, oncology, dermatology, and rheumatology.