Inflammation during the life cycle of the atherosclerotic plaque
2021/09/20 by Peter Libby · 413 citations
Biochemistry, Genetics and Molecular Biology · Immunology and Microbiology · Medicine · #Atheroma #Atherosclerosis and Cardiovascular Diseases #Biology #Cardiology #Cell Adhesion Molecules Research #Cell biology #Extracellular matrix #Fatty streak #Fibrous cap #Inflammation #Internal medicine #Lesion #Medicine #Pathology #Protease and Inhibitor Mechanisms #Thrombosis
paper · pdf · doi:10.1093/cvr/cvab303
published in Cardiovascular Research 117(13), 2525-2536 (Oxford University Press)
openalex publication_date 2021/09/20 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/31
Abstract
Inflammation orchestrates each stage of the life cycle of atherosclerotic plaques. Indeed, inflammatory mediators likely link many traditional and emerging risk factors with atherogenesis. Atheroma initiation involves endothelial activation with recruitment of leucocytes to the arterial intima, where they interact with lipoproteins or their derivatives that have accumulated in this layer. The prolonged and usually clinically silent progression of atherosclerosis involves periods of smouldering inflammation, punctuated by episodes of acute activation that may arise from inflammatory mediators released from sites of extravascular injury or infection or from subclinical disruptions of the plaque. Smooth muscle cells and infiltrating leucocytes can proliferate but also undergo various forms of cell death that typically lead to formation of a lipid-rich 'necrotic' core within the evolving intimal lesion. Extracellular matrix synthesized by smooth muscle cells can form a fibrous cap that overlies the lesion's core. Thus, during progression of atheroma, cells not only procreate but perish. Inflammatory mediators participate in both processes. The ultimate clinical complication of atherosclerotic plaques involves disruption that provokes thrombosis, either by fracture of the plaque's fibrous cap or superficial erosion. The consequent clots can cause acute ischaemic syndromes if they embarrass perfusion. Incorporation of the thrombi can promote plaque healing and progressive intimal thickening that can aggravate stenosis and further limit downstream blood flow. Inflammatory mediators regulate many aspects of both plaque disruption and healing process. Thus, inflammatory processes contribute to all phases of the life cycle of atherosclerotic plaques, and represent ripe targets for mitigating the disease.
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