Vascular plaques

The concentration of t-PA in human blood is 2—5 ng/mL, ie, 2—5 ppb. Plasminogen activation is accelerated in the presence of a clot, but the rate is slow. The dissolution of a clot requites a week or more during normal repair of vascular damage (17). Prevention of irreversible tissue damage during a heart attack requires that a clot, formed by mpture of an atherosclerotic plaque, be dissolved in a matter of hours. This rapid thrombolysis (dissolution of the clot) must be achieved without significant tibrinogenolysis elsewhere in the patient. 

Vascular grafts are tubular devices implanted throughout the body to replace blood vessels which have become obstmcted by plaque, atherosclerosis, or otherwise weakened by an aneurysm. Grafts are used most often in peripheral bypass surgery to restore arterial blood flow in the legs. 

The calcification of atherosclerotic plaques may be induced by osteopontin expression, since osteopontin is a protein with a well-characterized role in bone formation and calcification. Vascular smooth muscle cell migration on osteopontin is dq endent on the integrin av 33 and antagonists of av 33 prevent both smooth muscle cell migration and restenosis in some animal model [8]. 

Furthermore, there is some evidence for pleiotrophic effects (e.g., effects on hemostasis, vascular function, anti-inflammatory effects, and stabilizing effects on atherosclerotic plaques) of statins. The clinical relevance of this (and the potential difference between the various statins) is at present uncertain but subject to intense investigation. 

Atherosclerosis A disease process of the arteries involving fatty plaque formation and inflammation in the vascular wall. 

Increased CCL2 has been detected in macrophage-rich human atherosclerotic lesions (26) and in the blood of patients with acute coronary syndrome (implying an unstable plaque) (27,28). It is found in the arteries of primates on a high-cholesterol diet (29) and is upregulated in vascular endothelial cells and... 

Growing clinical data also points to the importance of IL-8 in atherogenesis. IL-8 has been found in atheromatous lesions from patients with atherosclerotic disease including carotid artery stenosis (103), CAD (118), abdominal aortic aneurysms (AAA) (103,104,114), and peripheral vascular disease (PVD) (104). Furthermore, studies using plaque explant samples have yielded more direct evidence for IL-8 involvement. Media from cultured AAA tissue induced IL-8-dependent human aortic endothelial cell (HAEC) chemotaxis (122). Homocysteine, implicated as a possible biomarker for CAD, is also capable of inducing IL-8 (123-125) by direct stimulation of endothelial cells (123,124) and monocytes (125). When patients with hyperhomocysteinemia were treated with low-dose folic acid, decreases in homocysteine levels correlated with decreases in IL-8 levels (126). Statins significantly decrease serum levels of IL-6, IL-8, and MCP-1, as well as expression of IL-6, IL-8, and MCP-1 mRNA by peripheral blood monocytes and HUVECs (127). Thus, IL-8 may be an underappreciated factor in the pathogenesis of atherosclerosis. 

Release of markers bound to the endothelial cell such as thrombomodulin is indicative of vascular damage. Increased levels of soluble thrombomodulin in plasma are diagnostic (93). Other endothelium-derived markers such as 6-keto-prostaglandin F a, which is a metabolite of prostacyclin, are useful in the assessment of endothelial function, with lower levels indicative of inability to synthesize this marker due to defective or damaged endothelium through plaque formation (93). 

Atherosclerosis, a disease of the vascular wall, is the substrate for the arterial forms of CVD. Atherosclerotic plaques exhibit a focal distribution along the arterial tree as a consequence of local conditions that favor their initiation and progression. Low or reversed shear stress, for example, contributes to plaque development, a process in which the regulation of several genes may be involved (Resnick and Gimbrone 1995). 

Prelli, F., Castano, E., Glenner, G. G., and Frangione, B. (1988). Differences between vascular and plaque core amyloid in Alzheimer s disease./ Neurochem. 51, 648-651. 

Okura, Y., Brink, M., Itabe, H., Scheidegger, K.J., Kalangos, A., and Delafontaine, P., 2000, Oxidized low-density lipoprotein is associated with apoptosis of vascular smooth muscle cells in human atherosclerotic plaques. Circulation 102 2680-2686. 

---