Proliferative Versus Degenerative Paradigms in Pulmonary Arterial Hypertension Have We Put the Cart Before the Horse?

作者：Chaudhary Ketul R; Taha Mohamad; Cadete Virgilio J J; Godoy Rafael S; Stewart Duncan J^*

来源：Circulation Research, 2017, 120(8): 1237-1239.

DOI：10.1161/CIRCRESAHA.116.310097

• apoptosis
• endothelial cell
• hemodynamics
• hypertension, pulmonary
• mutations

Pulmonary arterial hypertension is believed to be a proliferative disease, triggered by endothelial cell injury and apoptosis and leading to the formation of occlusive vascular lesions caused by growth-dysregulated "cancerlike" cells. However, the current experimental and clinical evidence is not entirely consistent with this paradigm and suggests an alternate interpretation, specifically that microvascular rarefaction may be due to a degenerative process, driven by sustained endothelial cell apoptosis. The "degenerative" paradigm has important implications, not the least of which is that proliferative lesions may be a secondary manifestation of disease rather than the primary cause of microvascular rarefaction, and that regenerative strategies may be needed to restore the microcirculation in established disease.

• 出版日期2017-4-14