Recent efforts in drug discovery on vascular inflammation and consequent atherosclerosis

ABSTRACT

Introduction: Preservation of vascular endothelium integrity and maintenance of its full functionality are fundamental aspects in order to avoid both cardiovascular and non-cardiovascular diseases.

Areas covered: Although a massive endothelial disruption is a rare condition, caused by acute and uncontrolled inflammatory responses (e.g. the cytokine storm induced by SARS-CoV-2 infection), more frequently the vascular tree is the first target of slowly progressive inflammatory processes which affect the integrity of endothelium and its ‘barrier’ function, supporting the onset of atherosclerotic plaque and spreading inflammation. This endothelial dysfunction leads to decrease NO biosynthesis, impaired regulation of vascular tone, and increased platelet aggregation. Such chronic subclinic inflammation leads to macrophage infiltration in atherosclerotic lesions. Therefore, many efforts should be addressed to find useful approaches to preserve vascular endothelium from inflammation. In this review, the authors have evaluated the most recent strategies to counteract this pathological condition.

Expert opinion: The therapeutic and nutraceutical approaches represent useful tools to treat or prevent different phases of vascular inflammation. In particular, the pharmacological approach should be used in advanced phases characterized by clinical signs of vascular disease, whilst the nutraceutical approach may represent a promising preventive strategy to preserve the integrity of the endothelial tissue.

KEYWORDS:

• Atherosclerosis
• endothelial dysfunction
• nutraceutical approach
• therapeutic strategies
• SARS-CoV-2
• vascular inflammation

Article highlights

• Preservation of vascular endothelium integrity and maintenance of its full functionality are of fundamental importance both to avoid cardiovascular (e.g. atherosclerosis) and non-cardiovascular (e.g. COVID19) diseases.

• The vascular tree is the first target of slowly progressive inflammatory processes which affect the integrity of endothelium and its ‘barrier’ function, supporting the onset of atherosclerotic plaque and spreading inflammation.

• Vascular inflammation condition is prodromal for the onset of atherosclerosis because it induces endothelial dysfunction associated with decreased NO biosynthesis, vasoconstriction, increased platelet aggregation, and macrophage infiltration.

• Several efforts should be addressed to find therapeutic and nutraceutical approaches to preserve the endothelium from vascular inflammation.

• Among these two types of approach, both efficient, probably the classic therapeutic one (e.g. synthetic and biological drugs) should be used in the acute phase (e.g. SARS-CoV-2 cytokines storm) while the nutraceutical/natural one (e.g. resveratrol, polysulfides and isothiocyanates), could be considered more suitable as a preventive chronic strategy to preserve the integrity of the endothelial tissue.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.