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People suffering from heart disease may soon be able to have a genetically engineered coronary bypass. Doctors in Britain and the United States have been working on a way of preventing veins used in heart surgery from blocking up, making a further operation necessary.
By-pass surgery is one of the commonest types of operation performed, with surgeons taking veins from patients' legs to graft round diseased and blocked arteries in the heart.
Unfortunately, the procedure often has to be repeated, sometimes only a few years after the first operation. The main problem is that the veins used to by-pass the heart are not as strong as the diseased arteries they replace, and they tend to react badly to the sort of blood pressure intended only for arteries. As a result, the vein grows a thick layer of muscle to protect itself against damage. But this can result in narrowing, which makes the vein more likely to clog than the artery.
Now doctors have succeeded making the veins used in a by-pass to behave more like an artery. After removing the vein from the patient's leg ready for implantation, they inject it with human DNA designed to alter the genetic make-up of the muscle cells to slow down the narrowing of the vein.
In a preliminary trial on 42 patients, 17 were given the new gene therapy vein by-pass operation and the rest given conventional grafts. Patients who had the pioneering surgery fared much better, with only 20 pc suffering blockages within the first year of surgery, compared to 60pc for those having normal by-pass treatment.
Besides cost and risk to patients of repeated surgery, there are only a limited number of veins that can be used in the operation, and supply can become almost exhausted if a patient needs several veins per operation.
Dr Keith Channon of Oxford University and the city's John Radcliffe Hospital is also using gene therapy to treat heart by-pass patients. Instead of using human DNA, he is modifying viruses, first making them safe, so they can infect the cells making up the vein. The virus prevents the chain of events which leads to the unwanted build-up of extra muscle. 'This is a huge problem in modern medicine,' he says. 'What we are trying to do is to make the original by-pass last as long as possible.'