Beyond Impressions
نویسندگان
چکیده
Atherosclerotic lesions form preferentially in arterial regions characterized by slow and irregular patterns of blood flow such as those found on the inner curvature of bifurcation branch points. Because of this nonrandom distribution, extensive research has focused on the role of shear stress or the mechanical drag force exerted on the endothelial lining of blood vessels. Blood flow that follows a high shear stress, unimpeded laminar pattern encourages homeostatic mechanisms in the endothelium and protects against atherosclerosis. The transition from laminar to disturbed flow elicits changes in endothelial cell behavior that include increased inflammatory signaling through the activation of NF-κB, increased expression of leukocyte adhesion receptors, and the recruitment of immune cells. Focal areas exposed to detrimental shear stress, together with the synergistic effects of dyslipidemia, age, and hyperglycemia, initiate and promote the growth of atherosclerotic lesions. The mechanisms by which endothelial cells sense and respond to these changes in flow have been intensively studied, but gaps in our knowledge remain.
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