Arterial dissections: Common features and new perspectives.
Arterial dissections: Common features and new perspectives.
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DOI：
10.3389/fcvm.2022.1055862
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发表时间：
2022
影响因子：
3.6
通讯作者：
中科院分区：
文献类型：
--
作者：
动脉夹层是指大动脉壁突然撕裂，导致血管内血液积聚，是一种灾难性疾病，可导致严重的、可能致命的后遗症。涉及多种血管床，包括主动脉或冠状动脉、颈动脉、肺动脉和内脏动脉，每种类型的夹层都以其自身的方式具有破坏性。传统上，由于在不同解剖位置（如中风、心肌梗死和肾衰竭）进行解剖的不同临床后果，它们一直是单独研究，而不是集体研究。在这里，我们回顾了这些动脉病变的共同和独特的特征，以提供更好的理解这一家族的疾病。动脉夹层常见于青年至中年，常与高血压和/或偏头痛合并；后者提示它们是全身性血管病变的一部分。遗传学研究以及动脉夹层的细胞和分子研究揭示了夹层类型之间惊人的相似性，特别是它们的病理生理学，包括是否存在内膜撕裂和血管功能障碍作为壁内出血的原因。所有类型解剖常见的通路扰动包括TGF-β信号、细胞外基质、细胞骨架或代谢的破坏，这可以通过在调节这些过程的关键基因中发现突变来证明，这些基因包括LRP1、胶原基因、纤维蛋白和TGF-β受体，或它们的偶联途径。这些连接信号通路的扰动导致受影响动脉的内皮和血管平滑肌细胞的表型转换，在这种情况下，它们的生理静止状态被增殖激活的表型所取代。有趣的是，不同解剖位置的解剖与不同的性别和年龄偏好相关，表明基因和环境相互作用参与疾病发病机制。重要的是，这些细胞机制具有潜在的治疗靶向性。将动脉夹层作为一种集体病理学来考虑，可以从更有特征的夹层类型（如涉及胸主动脉的夹层）中获得洞察力，从而为不太常见的夹层形式提供信息，包括应用已知的治疗干预措施的潜力。
Arterial dissections, which involve an abrupt tear in the wall of a major artery resulting in the intramural accumulation of blood, are a family of catastrophic disorders causing major, potentially fatal sequelae. Involving diverse vascular beds, including the aorta or coronary, cervical, pulmonary, and visceral arteries, each type of dissection is devastating in its own way. Traditionally they have been studied in isolation, rather than collectively, owing largely to the distinct clinical consequences of dissections in different anatomical locations – such as stroke, myocardial infarction, and renal failure. Here, we review the shared and unique features of these arteriopathies to provide a better understanding of this family of disorders. Arterial dissections occur commonly in the young to middle-aged, and often in conjunction with hypertension and/or migraine; the latter suggesting they are part of a generalized vasculopathy. Genetic studies as well as cellular and molecular investigations of arterial dissections reveal striking similarities between dissection types, particularly their pathophysiology, which includes the presence or absence of an intimal tear and vasa vasorum dysfunction as a cause of intramural hemorrhage. Pathway perturbations common to all types of dissections include disruption of TGF-β signaling, the extracellular matrix, the cytoskeleton or metabolism, as evidenced by the finding of mutations in critical genes regulating these processes, including LRP1, collagen genes, fibrillin and TGF-β receptors, or their coupled pathways. Perturbances in these connected signaling pathways contribute to phenotype switching in endothelial and vascular smooth muscle cells of the affected artery, in which their physiological quiescent state is lost and replaced by a proliferative activated phenotype. Of interest, dissections in various anatomical locations are associated with distinct sex and age predilections, suggesting involvement of gene and environment interactions in disease pathogenesis. Importantly, these cellular mechanisms are potentially therapeutically targetable. Consideration of arterial dissections as a collective pathology allows insight from the better characterized dissection types, such as that involving the thoracic aorta, to be leveraged to inform the less common forms of dissections, including the potential to apply known therapeutic interventions already clinically available for the former.
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影响因子：
3.7
作者：
Boucher, Philippe;Li, Wei-Ping;Matz, Rachel L.;Takayama, Yoshiharu;Auwerx, Johan;Anderson, Richard G. W.;Herz, Joachim
通讯作者：
Herz, Joachim
影响因子：
3.9
作者：
Bartstra JW;Spiering W;van den Ouweland JMW;Mali WPTM;Janssen R;de Jong PA
通讯作者：
de Jong PA
DOI：
10.1016/j.bbrc.2009.11.145
发表时间：
2010-01-01
影响因子：
3.1
作者：
Amirak, Emre;Zakkar, Mustafa;Evans, Paul C.;Kemp, Paul R.
通讯作者：
Kemp, Paul R.
影响因子：
1.7
作者：
Bianconi, Eva;Piovesan, Allison;Canaider, Silvia
通讯作者：
Canaider, Silvia
影响因子：
64.5
作者：
Bergmann, Olaf;Zdunek, Sofia;Frisen, Jonas
通讯作者：
Frisen, Jonas