title: Imbalance between pro-angiogenic and anti-angiogenic factors in rheumatic and mixomatous mitral valves.
abstract: BACKGROUND
  A balance between angiogenic and anti-angiogenic factors is critical in tissue development, tissue repair and homeostasis. Aberrant angiogenesis has been implicated in several pathologic conditions, including valvular heart disease. The aim of this study was to ascertain the pathogenetic role of angiogenesis in rheumatic and mixomatous mitral valve diseases.
  
  
  METHODS
  Leaflets from mixomatous (n=20) and rheumatic (n=20) mitral valves removed from surgical patients, and normal mitral valve (n=6) obtained at autopsy were collected. Immunohistochemical studies were performed on sequential valve sections, evaluating CD31, CD34, α smooth muscle actin (α-SMA), vascular endothelial growth factor (VEGF), VEGF receptor-1 (VEGFR1), VEGF receptor-2 (VEGFR-2), and chondromodulin-I (Chm-I).
  
  
  RESULTS
  Immunohistochemistry revealed significant differences among groups in CD31 (p=0.001), CD34 (p<0.001), α-SMA (p<0.001), VEGF (p<0.001), VEGFR1 (p=0.007), VEGFR2 (p=0.011), and Chm-I (p<0.001) expressions. Rheumatic valves demonstrated a severe up-regulation and down-regulation in pro-angiogenic and anti-angiogenic factors, respectively, compared with mixomatous and normal mitral valves. On the contrary, mixomatous valves showed a significant up-regulation of anti-angiogenic factors with respect to rheumatic and normal valves.
  
  
  CONCLUSIONS
  These findings provide evidence that an imbalance between pro-angiogenic and anti-angiogenic factors is implicated in mitral valve disease. Pro-angiogenic factors are up-regulated in rheumatic disease, while anti-angiogenic ones in mixomatous mitral valves.
authors.affiliation: Department of Surgical Sciences, Cardiac Surgery Unit, Varese University Hospital, University of Insubria, Varese, Italy. giovannimariscalco@yahoo.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.forename: Fausto
authors.initials: F
authors.lastname: Sessa
authors.forename: Vito Domenico
authors.initials: VD
authors.lastname: Bruno
authors.forename: Gabriele
authors.initials: G
authors.lastname: Piffaretti
authors.forename: Maciej
authors.initials: M
authors.lastname: Banach
authors.forename: Paolo
authors.initials: P
authors.lastname: Cattaneo
authors.forename: Giuseppe Paolo
authors.initials: GP
authors.lastname: Cozzi
authors.forename: Andrea
authors.initials: A
authors.lastname: Sala
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018952:Antigens, CD34 / Q000096:biosynthesis; D005260:Female; D006349:Heart Valve Diseases / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000378:metabolism* / Q000473:pathology; D009389:Neovascularization, Pathologic / Q000378:metabolism* / Q000473:pathology; D012214:Rheumatic Heart Disease / Q000378:metabolism* / Q000473:pathology; D040301:Vascular Endothelial Growth Factor Receptor-2 / Q000096:biosynthesis
chemical_list: D018952:Antigens, CD34; D040301:Vascular Endothelial Growth Factor Receptor-2