ABSTRACT
Several studies show that portions of intramyocardial coronary arteries are spared of arteriosclerosis, involving morphological, embryological, biochemical and pathophysiological aspects. Endothelial function is significantly affected in the segment of transition, as estimated by the vasoactive response to Ach. These findings suggest that myocardial bridge can provide protection against arteriosclerosis by counteracting the negative effects of endothelial dysfunction. The intramyocardial portion's protection phenomenon deserves further scientific research on all research fronts. Improved morphological, biomechanical and especially physiological and embryological knowledge may be the key to a future window of opportunity for chronic arterial disease therapy and prevention. In addition, this review discusses possible therapeutic approaches for symptomatic coronary ischemia caused by myocardial bridges.
Diversos estudos demonstram que as porções intramiocárdicas das artérias coronárias são poupadas da arteriosclerose, envolvendo aspectos morfológicos, embriológicos, biomecânicos e aspectos fisiopatológicos. A função endotelial é significativamente afetada no segmento de transição, tal como estimado pela resposta vasoativa para acetilcolina (Ach). Esses achados sugerem que ponte miocárdica pode fornecer proteção contra a arteriosclerose, por contrariar os efeitos negativos da disfunção endotelial. O fenômeno dessa proteção da porção intramiocárdica merece maior investigação científica em todas as frentes de pesquisa. Maiores conhecimentos sobre os aspectos morfológicos, biomecânicos e, principalmente, fisiológicos e embriológicos podem ser a chave para uma futura janela de oportunidades de terapia e prevenção da doença arterial crônica. Nessa revisão, discutem-se, também, possíveis abordagens terapêuticas para fenômenos coronarianos isquêmicos causados por pontes miocárdicas.
Subject(s)
Humans , Coronary Artery Disease/prevention & control , Endothelium, Vascular/physiopathology , Myocardial Bridging/pathology , Adipose Tissue/metabolism , Coronary Circulation/physiology , Coronary Vessels/anatomy & histology , Coronary Vessels/embryology , Endothelin-1/metabolism , Paracrine Communication/physiology , Peptidyl-Dipeptidase A/metabolismABSTRACT
The cirrhosis represents the final stage of several chronic hepatic diseases and it is characterized by the presence of fibrosis and morphologic conversion from the normal hepatic architecture into structurally abnormal nodules. In the evolution of the disease there is loss of the normal vascular relationship and portal hypertension. There are also regenerative hepatocelular alterations that become more prominent with the progression of the disease. The liver transplantation continues to be the only therapeutic option in cases of disease in terminal phase. The hepatic stellate cells (HSC) are perisinusoidal cells that store vitamin A and produce growth factors, citocins, prostaglandins and other bioactive substances. They can suffer an activation process that convert them to cells with a phenotype similar to myofibroblasts. When activated, they present increased capacity of proliferation, mobility, contractility and synthesis of collagen and other components of extracelular matrix. They possess cytoplasmic processes adhered to sinusoids and can affect the sinusoidal blood flow. HSC are important in pathogenesis of fibrosis and portal hypertension.
A cirrose representa o estágio final de diversas doenças hepáticas crônicas e é caracterizada pela presença de fibrose e conversão da arquitetura hepática normal em nódulos estruturalmente anormais. Na evolução da doença ocorre perda da relação vascular normal e hipertensão portal. Há também alterações regenerativas hepatocelulares que se tornam mais proeminentes com a progressão da doença. O transplante hepático permanece como a única opção terapêutica nos casos de doença em fase terminal. As células estreladas hepáticas (CEH) são células perisinusoidais que armazenam vitamina A e produzem fatores de crescimento, citocinas, prostaglandinas e outras substâncias bioativas. Podem sofrer um processo de ativação para um fenótipo semelhante a miofibroblastos. Quando ativadas apresentam maior capacidade de proliferação, motilidade, contractilidade, síntese de colágeno e componentes da matriz extracelular. Possuem processos citoplasmáticos aderidos aos sinusóides e podem afetar o fluxo sangüíneo sinusoidal. As CEH são importantes na patogênese da fibrose e hipertensão portal.
Subject(s)
Humans , Adult , Hepatocytes/metabolism , Kupffer Cells/metabolism , Liver Cirrhosis/physiopathology , Liver/metabolism , Cell Proliferation , Disease Progression , Extracellular Matrix/metabolism , Hepatocyte Growth Factor/metabolism , Hepatocytes/cytology , Hypertension, Portal/complications , Kupffer Cells/cytology , Liver Cirrhosis/etiology , Liver Cirrhosis/metabolism , Liver Failure/complications , Liver/cytology , Myocytes, Smooth Muscle/metabolism , Paracrine Communication/physiology , Platelet-Derived Growth Factor/metabolismABSTRACT
Synchronous attainment of maternal endometrial receptivity allows implantation-stage adhesive blastocyst to undertake apposition, attachment and invasion. In the present essay, we propose a model according to which luteal phase progesterone induces a basic drive in endometrium toward receptivity and as a result, adequately primed endometrium differentiates through certain steps in a fixed action pattern. The implantation-stage embryo senses such endometrial responsiveness circumstantially by the factors secreted by maternal endometrium and undertakes differentiation to implant by secreting factors which act on maternal endometrial cells to further potentiate them to implantation stage-specific changes. Such a dynamic temporo-spatial manner of interaction involving a set of specific factors acting synchronously leads to the activation of innate releasing process in both compartments towards embryo attachment followed by successful intrusion and controlled invasion of trophoblast cells into maternal endometrium. In the present review we discuss the potential role of various endocrine and paracrine factors in the process of blastocyst implantation in the human.