Endothelial dysfunction sustains immune response in atherosclerosis: potential cause for ineffectiveness of prevailing drugs

Abstract

Vascular endothelial dysfunction (ED) forms the cornerstone in the development of atherosclerotic lesions that clinically manifest as ischemia, myocardial infarction, stroke or peripheral arterial disease. ED can be triggered by various risk factors including hypercholesterolemia, hypertension, hyperhomocystenemia and chronic low-grade inflammation. These risk factors also activate immune response systemically. Current drugs used for managing atherosclerosis not only aid in subsiding the risk factor but also suppress the immune activation. Nonetheless, their effectiveness in treating ED is still questionable. Here, we discuss how pathologic molecules and processes pertaining to ED can activate innate and adaptive arms of the immune system leading to disease progression even in the absence of cardiovascular risk factors and the potential of the current drugs, used in the management of atherosclerotic patients, in reversing them. We mainly focus on activated endothelium, endothelial microparticles, mechanically stretched endothelial cells, endothelial mesenchymal transition and endothelial glycocalyx sheds.

Keywords:

• Endothelial dysfunction
• endothelial microparticles
• endothelial cyclical stretch
• endothelial mesenchymal transition
• endothelial glycocalyx sheds
• immune activation

Acknowledgement

We thank Santosh Kurra for helping us in figure preparation.

Declaration of Interest

None declared

Consent for publication

All authors have given consent for publication in the present form.

Authors contribution

Shamima Akhtar, had the idea for the article, performed the literature search and drafted the manuscript. Alpana Sharma critically revised the work.

Additional information

Funding

This work was supported by National-Postdoctoral Fellowship from Science and Engineering Research Board (SERB), Department of Science and Technology and Indian Council for Medical Research (ICMR) grant (61/2/IMM/2019-BMS) to Dr. Alpana Sharma.