Arteriogenesis: Angiogenesis within Unstable Atherosclerotic Plaque-- Interactions with Extracellular Matrix.

Vascularization is an exciting and complex mechanism involving angiogenesis and arteriogenesis. The role of homeostasis in the extracellular matrix (ECM) cannot be overemphasized. The delicate balance of metalloproteinases and their inhibitors is of utmost importance during vascularization within the unstable plaques. ECM degradation initiates the cascades of angiogenesis, especially near the thin fibrous cap, which can lead to rupture and intraplaque hemorrhages and acute coronary syndromes. The constant injury and response to injury to the vessel wall causes this natural repair and healing process to go awry with devastating clinical outcomes. With gene transfer it is now possible to have a positive impact on the treatment of those for whom traditional revascularization procedures have failed, and we are witnessing the benefits of many years of basic scientific research.