Innate and adaptive immunity: the understudied driving force of heart valve disease

被引:62
作者
Bartoli-Leonard, Francesca [1 ]
Zimmer, Jonas [1 ]
Aikawa, Elena [1 ,2 ,3 ]
机构
[1] Harvard Med Sch, Ctr Interdisciplinary Cardiovasc Sci, Brigham & Womens Hosp, Dept Med, Boston, MA 02115 USA
[2] Harvard Med Sch, Ctr Excellence Vasc Biol, Brigham & Womens Hosp, Dept Med, Boston, MA 02115 USA
[3] Sechenov First Moscow State Med Univ, Dept Human Pathol, Moscow, Russia
基金
美国国家卫生研究院;
关键词
Calcific aortic valve; disease; Inflammation; Immunity; Calcification; Clonal; haematopoiesis; VALVULAR INTERSTITIAL-CELLS; CD4(+)CD28(NULL) T-CELLS; PROMOTES OSTEOBLASTIC DIFFERENTIATION; NEUTROPHIL EXTRACELLULAR TRAPS; II-INDUCED HYPERTENSION; TOLL-LIKE RECEPTORS; AORTIC-STENOSIS; MAST-CELLS; CLONAL HEMATOPOIESIS; DENDRITIC CELLS;
D O I
10.1093/cvr/cvab273
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Calcific aortic valve disease (CAVD), and its clinical manifestation that is calcific aortic valve stenosis, is the leading cause for valve disease within the developed world, with no current pharmacological treatment available to delay or halt its progression. Characterized by progressive fibrotic remodelling and subsequent pathogenic mineralization of the valve leaflets, valve disease affects 2.5% of the western population, thus highlighting the need for urgent intervention. Whilst the pathobiology of valve disease is complex, involving genetic factors, lipid infiltration, and oxidative damage, the immune system is now being accepted to play a crucial role in pathogenesis and disease continuation. No longer considered a passive degenerative disease, CAVD is understood to be an active inflammatory process, involving a multitude of pro-inflammatory mechanisms, with both the adaptive and the innate immune system underpinning these complex mechanisms. Within the valve, 15% of cells evolve from haemopoietic origin, and this number greatly expands following inflammation, as macrophages, T lymphocytes, B lymphocytes, and innate immune cells infiltrate the valve, promoting further inflammation. Whether chronic immune infiltration or pathogenic clonal expansion of immune cells within the valve or a combination of the two is responsible for disease progression, it is clear that greater understanding of the immune systems role in valve disease is required to inform future treatment strategies for control of CAVD development.
引用
收藏
页码:2506 / 2524
页数:19
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