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Progenitor Cells, Bone Marrow-Derived Fibrocytes and Endothelial-to-Mesenchymal Transition: New Players in Vascular Fibrosis.

See related article, pp 461–468 

Tissue fibrosis, defined as an excessive accumulation of extracellular matrix (ECM) components leading to the destruction of organ architecture and impaired function, affects virtually every tissue and organ in the body, including the arteries. Vascular fibrosis of small and large arteries contributes to arterial remodeling, important in the development and complications of hypertension.1 Fibrogenesis is an active process that involves accumulation of structural proteins (collagen and fibronectin) and adhesion proteins (laminin and fibronectin), expression of adhesion molecules and integrins, and remodeling of the ECM.2 Healthy arteries are surrounded by perivascular adventitial tissue comprising collagens I and III in the intima, media, and adventitia, with collagen types I, III, IV, and V in the endothelial and vascular smooth muscle cell basement membranes.3 These fibrillar proteins maintain vascular integrity and normal vascular tone and function. In hypertension, accumulation of collagen and fibronectin and ECM reorganization lead to increased stiffness of the vessel wall.4 Initially, these processes are adaptive and reversible and may compensate for higher blood pressures, but with time and progressive increases in blood pressure, this becomes maladaptive and decompensated, leading to arterial stiffness that contributes to hypertension-associated target organ damage. These events have been demonstrated in many experimental models of hypertension and in hypertensive patients and have been attributed to activation of ERK1/2, p38mitogen-activated protein kinase, transforming growth factor-β, SMAD pathways, oxidative stress, and dysregulation of matrix metalloproteinases.2 Decreased activation of matrix metalloproteinases and increased activity of tissue inhibitors of metalloproteinase leads to reduced collagen turnover and consequent accumulation, with thickening and remodeling of the vascular wall.

Vascular fibrosis is a dynamic and active phenomenon, where a proinflammatory, oxidative milieu, triggered by prohypertensive stimuli, lays the foundation for fibrosis and activation of ECM-producing cells. Until recently the process seemed fairly …