Stimulation of arteriogenesis; a new concept for the treatment of arterialocclusive disease

After birth two forms of vessel growth can be observed; angiogenesis and ar teriogenesis. Angiogenesis refers to the formation of capillary networks. A rteriogenesis refers to the growth of preexistent collateral arterioles lea ding to formation of large conductance arteries that are well capable to co mpensate for the loss of function of occluded arteries. The process of arte riogenesis is initiated when shear stresses increase in the preexistent col lateral pathways upon narrowing of a main artery. The increased shear stres s leads to an upregulation of cell adhesion molecules for circulating monoc ytes, which. accumulate subsequently around the proliferating arteries and provide the several required cytokines and growth factors. Several strategi es are currently tested for their potential to stimulate the process of art eriogenesis. These strategies focus either at sheer stress, at direct stimu lation of endothelial and smooth muscle cell growth or at the monocytic pat hway and promising results were obtained From experimental studies. However , some important questions remain to be answered before arteriogenesis can be brought from bench to bedside. (C) 2001 Elsevier Science B.V, All rights reserved.