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Resilience of the Internal Mammary Artery to Atherogenesis: Shifting From Risk to Resistance to Address Unmet Needs

Kraler, Simon, Libby, Peter, Evans, Paul C., Akhmedov, Alexander, Schmiady, Martin O., Reinehr, Michael, Camici, Giovanni G., Lüscher, Thomas F.·2021·Arteriosclerosis, Thrombosis, and Vascular Biology
DOI 10.1161/atvbaha.121.316256PMC PMC8299999
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Abstract

Fueled by the global surge in aging, atherosclerotic cardiovascular disease reached pandemic dimensions putting affected individuals at enhanced risk of myocardial infarction, stroke, and premature death. Atherosclerosis is a systemic disease driven by a wide spectrum of factors, including cholesterol, pressure, and disturbed flow. Although all arterial beds encounter a similar atherogenic milieu, the development of atheromatous lesions occurs discontinuously across the vascular system. Indeed, the internal mammary artery possesses unique biological properties that confer protection to intimal growth and atherosclerotic plaque formation, thus making it a conduit of choice for coronary artery bypass grafting. Its endothelium abundantly expresses nitric oxide synthase and shows accentuated nitric oxide release, while its vascular smooth muscle cells exhibit reduced tissue factor expression, high tPA (tissue-type plasminogen activator) production and blunted migration and proliferation, which may collectively mitigate intimal thickening and ultimately the evolution of atheromatous plaques. We aim here to provide insights into the anatomy, physiology, cellular, and molecular aspects of the internal mammary artery thereby elucidating its remarkable resistance to atherogenesis. We propose a change in perspective from risk to resilience to decipher mechanisms of atheroresistance and eventually identification of novel therapeutic targets presently not addressed by currently available remedies.

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Metadata

Authors
Kraler, S., Libby, P., Evans, P. C., Akhmedov, A., Schmiady, M. O., Reinehr, M., Camici, G. G., & Lüscher, T. F.
Affiliations
  • Center for Molecular Cardiology, University of Zürich, Switzerland (S.K., A.A., G.G.C., T.F.L.).
  • Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (P.L.).
  • Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, United Kingdom (P.C.E.).
  • Clinic for Cardiac Surgery (M.O.S.), University Hospital Zurich, Switzerland.
  • University Heart Centre, Institute of Pathology and Molecular Pathology (M.R.), University Hospital Zurich, Switzerland.
ORCID
Venue
Arteriosclerosis, Thrombosis, and Vascular Biology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2021-08
Volume
41
Issue
8
Pages
2237-2251
ISSN
  • 1079-5642
  • 1524-4636
DOI
10.1161/atvbaha.121.316256
PMC
PMC8299999
Cited by
65
References
11
Language
en

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