The use of gene therapy in the clinical setting is believed to be a re
alistic option for the future. Many clinical trials are underway for t
reatment of disorders as diverse as cancer, peripheral vascular diseas
e, and numerous monogenic diseases. However, gene therapy for vein gra
ft failure may be more distant due to the highly complex, multifactori
al 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 therapeu
tic genes. Moreover, limitations in the current delivery systems need
to be overcome to allow efficient, safe delivery and expression of tra
nsgenes for the required length of time in vivo. However, currently av
ailable gene delivery vectors are extremely useful tools to help in ou
r 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 Else
vier Science B.V.