Immunologic Arterial Injury and Atherogenesis
Inflammation and atherogenesis share major pathogenic features. Inflammation is a reaction to injury in which there is increased permeability of endothelium of the microcirculation, accumulation of protein-rich fluid in the intersitium, migration of leukocytes, and repair characterized by proliferation of mesenchymal cells and increased connective tissue synthesis. Similarly, necrosis of arterial smooth muscle cells, increased permeability of endothelium, migration of leukocytes, proliferation of mesenchymal cells and increased connective tissue synthesis are all features of atherosclerosis (Joris and Majno 1978).
Immunological vascular injury and atherosclerosis also share pathogenic features. Increased endothelial permeability resulting from IgE mediated release of vasoactive amines from basophils and platelets is believed to be essential for localization of immune complexes in the arterial wall. Such IgE mediated increases in endothelial permeability may enhance transport of other macromolecules, e.g., lipoproteins, into the arterial wall (Henson and Cochrane 1971). Alterations in endothelium are also important in other types of immunological injury such as graft rejection (Alonso et al. 1977).
Premature atherosclerosis or atherosclerosis of increased severity has been found in human in association with arterial diseases that have a major inflammatory or immunological components. Saphir et al. (1950) noted evidence of healed arteritis in hearts of humans with premature atherosclerosis and ischemic heart disease. Syphilis, rheumatic heart disease, lupus erythematosus and organ transplantation may be associated with vascular injury, arteritis and premature or unusually severe atherosclerosis (Zeek et al. 1932; Bulkley and Roberts 1975; Rider et al. 1975). There is evidence to indicate that arterial injury in syphilis, rheumatic heart disease, lupus erythematosus and organ transplantation are immunologically mediated.
KeywordsRheumatic Heart Disease Arterial Injury Premature Atherosclerosis Arterial Smooth Muscle Cell Serum Sickness
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