Smart Nicola
Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, UK.
Microcirculation. 2017 Jan;24(1). doi: 10.1111/micc.12335.
Neovascularization of the ischemic myocardium postinfarction is necessary to restore blood flow to vulnerable cardiomyocytes and will be indispensable for prospective regenerative strategies, to perfuse newly formed myocardium. Therapeutic attempts to enhance new vessel formation have, to date, yielded modest clinical benefits, and innovative approaches are now needed. Intrinsic mechanisms are initiated by the heart in an attempt to rebuild injured vessels, but these are poorly understood. Insight into the underlying mechanisms may reveal targets for therapeutically augmenting this low-level neovascular response. Starting from a limited number of descriptive studies, this review summarizes what is known of coronary neovascularization and explores putative mechanisms and cellular sources which may endogenously contribute, or that may be pharmacologically triggered, to support vasculo- or angiogenesis. As injury responses in the adult frequently recapitulate embryological processes, a particular focus is placed on the developmental mechanisms of coronary vessel formation. An understanding of the cellular sources and the regulatory pathways used by the embryo may reveal novel targets for reactivating coronary vessel and myocardial regeneration.
心肌梗死后缺血心肌的新生血管形成对于恢复脆弱心肌细胞的血流是必要的，并且对于灌注新形成的心肌的前瞻性再生策略而言将是不可或缺的。迄今为止，增强新血管形成的治疗尝试仅产生了适度的临床益处，因此现在需要创新方法。心脏会启动内在机制来尝试重建受损血管，但对这些机制了解甚少。深入了解潜在机制可能会揭示增强这种低水平新生血管反应的治疗靶点。从有限数量的描述性研究出发，本综述总结了已知的冠状动脉新生血管形成情况，并探讨了可能内源性促成或可通过药理学触发以支持血管生成或血管新生的假定机制和细胞来源。由于成体中的损伤反应常常重现胚胎发育过程，因此特别关注冠状动脉形成的发育机制。了解胚胎所使用的细胞来源和调控途径可能会揭示重新激活冠状动脉和心肌再生的新靶点。
