Cellular adhesion molecules and cardiovascular disease. Part II. Their association with conventional and emerging risk factors, acute coronary events and cardiovascular risk prediction.

The role of cellular adhesion molecules in the patho-genesis of atherosclerosis has now been clearly demonstrated. Plasma levels of adhesion molecules, which have been shed from the cell surface, have also been associated with the presence of clinical atherosclerotic disease, cardiovascular risk factors and acute coronary syndromes. However, there is little consensus in the literature, including between the large well-designed population studies. This may be explained either by unrecognized confounding factors or, alternatively, by the unpredictable relationship between cell surface expression and activity of cellular adhesion molecules and their shedding into the plasma under different circumstances. Probably for the latter reasons, there is at present little evidence that the measurement of circulating adhesion molecules is likely to offer any additional benefit for individual patients above the assessment of conventional cardiovascular risk factors in the assessment of either the extent of, or future risk from, cardiovascular disease.

Cellular adhesion molecules and cardiovascular disease. Part I. Their expression and role in atherogenesis.

Atherosclerosis is now recognized to be an inflammatory disease, and several inflammatory markers have been shown to be associated with both the presence and future risk of symptomatic cardiovascular disease. Cellular adhesion molecules, particularly members of the selectin family and immunoglobulin superfamily, are intimately involved in the recruitment of leucocytes to sites of inflammation, including developing atherosclerotic lesions. Their role in the pathogenesis of atherosclerosis has been clearly demonstrated using knockout mice models. Plasma levels of adhesion molecules, which have been shed from the cell surface, have been associated with the presence of clinical atherosclerotic disease, although published studies differ in their findings. This limited consensus in the literature may be explained either by unrecognized confounding factors, or perhaps by the unpredictable relationship between cell surface expression and activity of cellular adhesion molecules and their shedding into the plasma. While cell surface activity of adhesion molecules appears critical in the development of atherosclerotic lesions, the measurement of plasma levels of soluble adhesion molecules may offer little additional benefit for individual patients in the prediction of the extent of atherosclerotic disease above the assessment of conventional cardiovascular risk factors.

Percutaneous transluminal septal myocardial ablation: a new catheter-based therapy for patients with hypertrophic obstructive cardiomyopathy.

Hypertrophic obstructive cardiomyopathy is a complex disorder with serious clinical implications. Percutaneous transluminal septal myocardial ablation is a promising new addition to existing therapies for this condition. It is a catheter-based approach that involves instilling alcohol into the septal branches of the left anterior descending artery to induce a 'controlled' septal myocardial infarct. The result is a decrease in thickness of the hypertrophied interventricular septum and a reduction of the left ventricular outflow tract gradient. To date, the results from several series have been promising, with improvements in haemodynamic and clinical parameters without prohibitive complication rates. In this article, the indications, technique and outcomes of this procedure are reviewed.

Factors influencing the differentiation of embryonal carcinoma and embryo-derived stem cells.

The effects of aggregation, retinoic acid, and medium conditioned by Buffalo rat liver (BRL) cells, alone and in combination, on the differentiation of PSA4TG12 embryonal carcinoma and E14 embryonal stem cells are reported. The observations indicate that BRL-conditioned medium has more than one effect on the differentiation process, that retinoic acid has at least two effects which operate in different concentration ranges, and that both agents influence the choice of differentiation pathway as well as the extent of differentiation.