Therapeutic perspectives in vascular remodeling in asthma and chronic obstructive pulmonary disease.
In chronic inflammatory airway diseases such as asthma and chronic obstructive pulmonary disease (COPD), changes in bronchial microvasculature are present and contribute to airway wall remodeling. Angiogenesis and vascular leak seem to be prevalent in asthma, while vasodilatation and vascular leak seem to be prevalent in COPD. The functional meaning of bronchial vascular remodeling is not completely known. The increase in vessel number and size as well as the vascular leakage may concur to the thickening of the airway wall and to the narrowing of the bronchial lumen. Accordingly, pharmacological control of bronchial vascular remodeling may be crucial for symptom control in asthma and COPD. In asthmatic airways, steroids can downregulate vascular remodeling by acting on proangiogenic factors, whereas long-acting β2-agonists seem to be mostly effective in decreasing vascular permeability. In COPD, there is less available experimental evidence on the effect of the currently used drugs on airway microvascularity changes. Importantly, vascular endothelial growth factor, the most specific grow factor for vascular endothelium, is crucially involved in the pathophysiology of the airway vascular remodeling, both in asthma and COPD. The inhibition of vascular endothelial growth factor and its receptors has the potential for the treatment of the vascular changes in the airway wall.
Clinical Science Department, University of Parma, Parma, Italy.
Dario
D
Olivieri
Alfredo
A
Chetta
D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D056151:Airway Remodeling / Q000187:drug effects*; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001249:Asthma; D001980:Bronchi / Q000187:drug effects / Q000378:metabolism / Q000473:pathology; D002199:Capillary Permeability / Q000187:drug effects; D005786:Gene Expression Regulation; D006801:Humans; D009389:Neovascularization, Pathologic / Q000517:prevention & control*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism / Q000473:pathology; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors* / Q000235:genetics / Q000378:metabolism; D015398:Signal Transduction; D013256:Steroids / Q000627:therapeutic use; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors* / Q000235:genetics / Q000378:metabolism
D058666:Adrenergic beta-2 Receptor Agonists; D020533:Angiogenesis Inhibitors; D000893:Anti-Inflammatory Agents; D013256:Steroids; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D040262:Receptors, Vascular Endothelial Growth Factor