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Review: Vascular remodeling: implications for small artery function and target organ damageCardiovascular Research Group, Division of Cardiovascular and Endocrine Sciences, University of Manchester, United Kingdom
Cardiovascular Research Group, Division of Cardiovascular and Endocrine Sciences, University of Manchester, United Kingdom, Wellcome Trust Clinical Research Facility, Manchester Royal Infirmary, Manchester, United Kingdom
Cardiovascular Research Group, Division of Cardiovascular and Endocrine Sciences, University of Manchester, United Kingdom
Cardiovascular Research Group, Division of Cardiovascular and Endocrine Sciences, University of Manchester, United Kingdom
Cardiovascular Research Group, Division of Cardiovascular and Endocrine Sciences, University of Manchester, United Kingdom, Wellcome Trust Clinical Research Facility, Manchester Royal Infirmary, Manchester, United Kingdom, tony.heagerty@ manchester.ac.uk
At the level of the small artery, essential hypertension is associated with eutrophic inward remodeling. This involves reduction in lumen diameter by an increase in wall thickness. Previously thought to involve either hypertrophy or hyperplasia of the vascular smooth muscle cells in the media, it is now felt to be mediated by a functional property of the wall: myogenic tone. This is the ability of an artery to contract in response to an increase in intraluminal pressure. This autoregulatory function is also vital to ensure stabilisation of distal capillary pressures and so prevent, or limit, organ damage. Indeed in any animal model studied, when myogenic autoregulation is affected, target organ damage ensues. We have also observed, in two studies, that when myogenic autoregulation is damaged in the context of hypertension, eutrophic remodeling is replaced by an outward growth of the arterial wall with preservation of lumen diameter. This is called hypertrophic remodeling and, independently, has been observed by a number of groups in small arteries from patients with type 2 diabetes. We believe that this is a key reason for the unique propensity to hypertensive injury seen in patients with diabetes. We also discuss the significance of integrins, transmembrane proteins with wide ranging functions; from initiation of cell migration to intracellular signalling. Two particular integrins,
Key Words: hypertension • small artery • diabetes • target organ damage • eutrophic remodeling • hypertrophic remodeling • myogenic tone
Therapeutic Advances in Cardiovascular Disease, Vol. 1, No. 2,
129-137 (2007) |
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5β1 and 
β3, have been found to be necessary for both normal myogenic autoregulation and eutrophic remodeling and the possibility that damage to these may occur in diabetes is examined.