Arterial dissections: Common features and new perspectives

Area of Science:

• Cardiovascular Science
• Vascular Biology
• Genetics

Background:

• Arterial dissections are catastrophic vascular events affecting diverse arteries, often studied in isolation due to varied clinical outcomes.
• Commonly occurring in young to middle-aged individuals, often with hypertension or migraine, suggesting a generalized vasculopathy.

Purpose of the Study:

• To review shared and unique features of arterial dissections across different vascular beds.
• To provide a comprehensive understanding of these arteriopathies by considering them collectively.

Main Methods:

• Review of genetic, cellular, and molecular investigations of various arterial dissection types.
• Analysis of common pathophysiological pathways, including intimal tear, vasa vasorum dysfunction, and signaling pathway disruptions.

Main Results:

• Striking similarities in pathophysiology across dissection types, involving TGF-β signaling, extracellular matrix, cytoskeleton, and metabolism.
• Identification of mutations in genes like LRP1, collagen, fibrillin, and TGF-β receptors.
• Phenotype switching in endothelial and smooth muscle cells from quiescent to proliferative states.

Conclusions:

• Arterial dissections represent a collective pathology with shared molecular mechanisms, despite distinct clinical presentations.
• Understanding these commonalities, particularly genetic and cellular pathways, offers therapeutic targets.
• Leveraging knowledge from well-characterized dissections can inform the management of rarer forms.