Published Online
on February 12, 2004

A more recent version of this article appeared on March 1, 2004

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Submitted on November 10, 2003
Accepted on November 25, 2003

Gene Therapy and Endovascular Treatment of Intracranial Aneurysms

Edith Ribourtout MSc and Jean Raymond MD^*

From the Department of Radiology (J.R.) and Centre de recherche (E.R.), Centre hospitalier de l’Université de Montréal-Hôpital Notre-Dame, Montreal, Quebec, Canada.

^* To whom correspondence should be addressed. E-mail: dr_jean_raymond{at}hotmail.com.

Background--Endovascular treatment of intracranial aneurysms is safe and effective but too often is followed by recurrences. Gene therapy may improve healing after embolization, and endovascular approaches may offer future in situ delivery systems designed to prevent aneurysm rupture.

Summary of Review--Advances in coil technology have focused on coating strategies designed to modify the biological reaction to the embolic agent. Gene therapy in cardiovascular applications is limited by low efficiency and transient gene expression. Current advances include the potential use of circulating progenitor cells for ex vivo genetic manipulations followed by in vivo delivery. Direct gene transfer may also be enhanced in situ by coils carrying antibody-tethered adenovirus or through the use of cell-specific or radiation-inducible promoters. Candidate genes that may be of value in promoting healing after endovascular treatment include growth factors and metalloproteinase inhibitors. A better understanding of the biology of aneurysm is necessary to conceive strategies designed to control the development of these lesions before their rupture.

Conclusions--Many technical difficulties remain to be solved, but the combination of gene therapy and endovascular techniques offers multiple therapeutic possibilities in the future control of intracranial aneurysms.

Key words: aneurysm, intracranial • endovascular therapy • gene therapy

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