Arteriogenesis

Arteriogenesis refers to an increase in the diameter of existing arterial vessels.

Mechanically, arteriogenesis is linked to elevated pressure, which increases radial wall stress, and elevated flow, which increases endothelial surface stress. The vessel increases in diameter until the stress is normalized (Prior et al., 2004). Arteriogenesis does not occur every time there is an increase in flow, however. Most vessel networks can handle increased flow without increasing diameter because flow is related to vessel diameter by a power of four. Initial experiments demonstrated this phenomenon in that mature vessels are unlikely to respond to increased flow by increasing diameter, but will respond to decreased flow by decreasing diameter (Brownlee & Langille, 1991). Another experiment showed that increasing shear stress caused an immediate increase in vessel expansion followed by a rapid decrease, as well as demonstrating that the mature vessels do indeed respond more favorably to decreased stress (Tuttle et al., 2001).

Chemically, arteriogenesis is related to upregulation of cytokines and cell adhesion receptors. More specifically, mechanical stresses cause endothelial cells to produce chemical facilitators that begin the process of increasing diameter. An increase in shear stress causes an increase in the number of monocyte chemoattractant protein-1 (MCP-1) molecules expressed on the surface of vessel walls as well as increased levels of TNF-α, bFGF, and MMP. MCP-1 increases the tendency of monocytes to attach to the cell wall. TNF-α provides an inflammatory environment for the cells to develop while bFGF helps induce mitosis in the endothelial cells. Finally, MMPs remodel the space around the artery to provide the space for expansion (Van Royen et al., 2001). Another potent chemical signal is nitric oxide (NO), demonstrated to be a major factor in increasing vessel diameter in response to increased flow until the shear stress is restored to the normal level (Tronc et al., 1996).

bFGF is known to increase both arteriogenesis and angiogenesis in vivo. However, it is not sufficient as a monotherapy to increase arteriogenesis. In a placebo study determining the effects of bFGF on arteriogenesis, patients were treated with one bolus of bFGF. The treatment helped reduce anginal symptoms but did not significantly affect arteriogenesis. Thus, it is speculated that other growth factors work in tandem with bFGF to produce the desired response and that growth factors must be administered at varying time points throughout the duration of the experiment (Van Royen et al., 2001). This finding is important because it shows that arteriogenesis is the result of a combination of signaling cascades and growth factors as opposed to being tied to a single chemical.

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