Endothelial regrowth after arterial injury: from vascular repair to therapeutics.

Abstract

Time for primary review 32 days. Interventional strategies for patients with coronary artery disease such as percutaneous transluminal coronary angioplasty or coronary stent implantation invariably result in a marked degree of vascular injury (deendothelialization, mechanical damage to the medial and adventitial layers) [1–3]. The loss of the endothelial monolayer is associated with a variety of deleterious consequences such as thrombus formation, neointimal thickening, and abnormal responses to endothelium-dependent agonists [3–5]. These effects may contribute to each of the known limitations of these techniques (vessel occlusion, restenosis, coronary spasm). The objective of the present review will be to present applied reendothelialization as a possible treatment for patients with coronary artery disease undergoing mechanical revascularization. Our aim will be twofold: first, to summarize current knowledge on the beneficial effect of endothelial regrowth after arterial injury; second, to discuss the potential role of growth factors or other compounds to accelerate reendothelialization. Occupying a strategically important location between circulating blood and tissues and having the ability to respond to changes in its physical, chemical, and humoral environment by the production of bioactive substances, the normal endothelium controls the tone and the proliferative state of the underlying vascular smooth muscle cells (VSMCs) and maintains a non-adhesive luminal surface. Modulation of VSMC tone is mediated by the synthesis and release of endothelium-derived relaxing and contracting factors. The proliferative state of VSMCs is controlled through these endothelium-derived factors and through the secretion of matrix proteins. Anticoagulant, fibrinolytic, and antithrombotic properties of the endothelium contribute to the maintenance of the fluidity of the blood. ### 1.1 Endothelium-dependent vasomotion #### 1.1.1 Relaxing factors Prostacyclin (PGI2), a potent vasorelaxant and platelet-inhibitory metabolite of arachidonic acid was the first endothelium-derived vasoactive factor discovered [6]. After the seminal observation of Furchgott and Zawadski in 1980 [7]that an intact endothelial layer was required for acetylcholine-induced vasorelaxation, … * Corresponding author. Service de Cardiologie B, Hopital Cardiologique, Boulevard du Professeur J. Leclercq, 59037 Lille Cedex, France. Tel. (+33-3) 2044 5302; Fax (+33-3) 2053 5874; E-mail: cbauters@chru-lille.fr