Inflammatory mechanisms, arteriosclerosis and ischemic stroke:: Clinical data and perspectives

Objective. The atherosclerosis is the most common cause of death and disability in developed countries by causing ischemic cardiopathic and stroke. The ischemic atherotrombotic stroke is the most frequent form of the last one. In this sense we review herein the mechanisms underlying the artherosclerotic process. Development It is understood as an inflammatory disease, by taking into account the widely accepted hypothesis by Ross: it was firstly stated in structural terms, as macrophages and T/B linfocities were present in the arterial wall from the first stages of the disease (fatty streak) to the last and complicated ones. The starting point is a functional endothelial damage, secondary to mechanical or vascular risk factors and called,response-to-injury hypothesis'. The next step is an inflammatory cascade that involves humoral (citokines, growth factors) and cellular (increased quintiotaxis, adherece and infiltration of inflamatory cells) mechanisms. They interact among them, outbalanced and in a progresssive way that leads to the final fibroproliferative response. Every stage has his own inflammatory components and interactive pathways. The following elements are outstanding in this process: 1) Adhesion molecules, including E-selectin, ICAM-1 and VCAM-1, that are increased locally in the plaques and as circulating elements; plaquetary receptors Of the type IIb/IIIa are integrins which belong to the same family; 2) Citokines with either proinflammatory activity-like IL-1, the TNF-alpha and linfocitary ligands like the CD-40, or with antiinflammatory activity like the gamma interpheron; 3) Growth factors, with plaquetary (PDGF) and fibroblastic (FGF) variants as the cornerstone; 4) Markers of systemic inflammation, overall plasma Creactive protein and fibrinogen, that predict the risk of stroke and cardiovascular death; IL-6, complement, thrombin and heat shock proteins (HSP) would act in a similar but less conclusive way. Conclusions. The evidences of the pivotal role of the inflammation in the stroke allow to develop therapeutical strategies to prevent the disease: fostering natural antiinflamatory mechanisms, or inhibiting inflammatory elements by selective (monoclonal antibodies) or non-selective (II&IIIa receptors, antiinflammatory drugs) pathways are distinctily glimpsed, ongoing or fully developed.