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Research and Reviews: Journal of Medical and Health Sciences Atherosclerosis Gopalarao vuppala1*, Rama Krishna1 and Krishna Murthy1 1Montissory
Siva sivani institute of science and technology, Gurraju palem, Mylavaram, Vijayawada, Andhra Pradesh, India.
Review Article Received: 03/05/2015 Revised: 25/05/2015 Accepted: 01/06/2015 *For Correspondence Montissory Siva sivani institute of science and technology, Gurraju palem, Mylavaram, Vijayawada, Andhra Pradesh, India. . Keywords: Atherosclerosis, chronic disease, Tumor, necrosis.
ABSTRACT Atherosclerosis is a cellular chronic disease characterized by inflammation, lipid deposition, epithelial tissue pathology and Smooth Muscle Cell (SMC) proliferation. The method of inflammation contributes to the progression of induration of the arteries. Many stimuli, like alter oxidized lipoprotein (oxLDL), Tumor necrosis actor alpha (TNFα) or free radicals attributable to smoking, induce a pro-inflammatory makeup of the epithelial tissue, expressing adhesion molecules on its surface and cooperating in unwellness progression [1]. Induration of the arteries is that the major underlying reason behind numerous CVDs including coronary artery diseases (CVD), heart muscle interaction etc. multiple risk factors coordinate in associate Byzantine network for the progression of induration of the arteries. Inflammation has been incontestible to play a serious role within the genesis of induration of the arteries although its pathological process is extraordinarily difficult. it's typically accepted that a posh epithelial tissue pathology induced by free radicals, low-density lipoproteins (LDL), infectious being, shear stress, toxins, cardiovascular disease or a mix of those and alternative factors result in the event of atherosclerosis [2]. And there is another severe action with these, multiple plaque disruptions (PD’s) are common in patients with acute coronary disease (ACD), but many are frequently unrecognized at the time of coronary angiography. The natural history of these PD’s has not been determined, but they are potentially unstable because they are exposed to flowing blood [20]. Many factors contribute to the event of induration of the arteries. Beneath traditional conditions, the vessel wall has its own machinery to keep up tube-shaped structure equilibrium. However, the balance is broken once repetitive metabolic stimuli ensuing from cardiovascular disease, hormone resistance or fat strike the vessel wall. Most of those stimuli disturb equilibrium through the initiation of inflammation that's the achievement of inflammatory cells [3]. It has been foretold that between 1990 and 2020, these diseases to be inflated by a 120% for girls and 137% for men in developing countries as compared with 30–60 % within the developed countries. Induration of the arteries is that the main etiology of vessel diseases [4].
Atherosclerosis Disease and Diagnosis Risk Factors for Atherosclerosis There are several risk factors that reasons to progression of atherosclerosis, these may leads to critical stage of individual with atherosclerosis. Endothelial dysfunction: In the general population the development of atherosclerosis arises from endothelial injury. This results in endothelial dysfunction which permits invasion of sub-endothelial regions by inflammatory cells with subsequent lipid deposition and narrowing of the arterial lumen which following plaque rupture results in thrombosis formation [5].
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Hypertension: Uncontrolled high blood pressure can result in hardening and thickening of your arteries, narrowing the vessels through which blood flows resulting in atherosclerosis. Systemic Lupus Erythematous: Premature carotid and coronary atherosclerosis are common in systemic lupus erythematous (SLE). The highest risk group is young females with 2-fold increase in atherosclerosis above the general population [6]. Obesity: Being overweight or obese does not directly increase your risk of developing atherosclerosis and cardiovascular disease (CVD), but it does lead to related risk factors that do raise your risk [7] Rheumatoid Arthritis: Patients with Rheumatoid Arthritis are also prone to atherosclerosis. Chronic inflammation and immune dysregulation causes atherogenesis which is the first stage of developing atherosclerosis followed by atheroma progression, and the development of thrombosis [8]. Diabetus Milletus: It can also cause atherosclerosis and asymptomatic low grade inflammation occurs prior to unconcealed vascular lesions in these patients. A low grade inflammation can be determined by serum C-reactive protein (CRP). High levels of a protein called C-reactive protein (CRP) in the blood may raise the risk for atherosclerosis and heart attack - high levels of CRP are proof of inflammation in the body which is the body's response to injury or infection - damage to the arteries' inner walls appears to trigger inflammation. Immune system activation: Immune system, with elements of both innate and adaptive immunity, contributes positively and negatively to the development of complex atherosclerotic plaques. Immune cells may be activated by various endogenous molecules that have undergone chemical and/or structural modification following oxidative or glycation processes. In this way the immune system activation gives rise to low level inflammation leading to the slow development of atherosclerotic disease [9] Other risk factors which cause Atherosclerosis are: Family history of early heart disease, Smoking , Alcohol Consumption, Obesity, Angina, heart attack (Myocardial Infarction), Stroke (Cerebrovascular Accident), Transient Ischemic Attack (TIA) or mini-stroke and Peripheral Vascular Disease (Peripheral Arterial Disease). Pathophysiology of atherosclerosis Most studies on tube-shaped structure inflammation in coronary artery disease have centered on inflammation in hardening of the arteries lesions et al within the membrane, but the Fairing Heart diagnostic test Study (FHBS) disclosed a astonishingly high incidence of pathology and inflammatory cell infiltrates (mainly lymphocytes) within the outer tube-shaped structure and perivascular layers of the arterial of patients with arterial coronary sickness. Inflammatory cell infiltrates within the tunic and media were additional frequent and intensive in patients with response rheumatic diseases than in patients while not response rheumatic diseases. Thus, inflammation within the outer tube-shaped structure layers may well be a typical development in response rheumatic diseases and contribute to the exaggerated vas risk [21] Stages of Atherosclerosis Stages: 1 Endothelium becomes broken (e.g. attributable to high blood pressure, or butt smoke) Stages: 2 Damage causes inflammatory response. White blood cells go into the artery wall, and chemicals (cholesterol) from the blood accumulate. A deposit then builds up an atheroma Stages: 3 Calcium salts and fibrous tissue build up at site and form a tough swelling (plaque), creating the artery lose a number of its electricity (hardens) and inflicting it to slender. Stages : 4 Plaque makes it tough for the guts to pump blood round the body and leads to high force per unit area. feedback results because the enhanced force per unit area makes it a lot of probably that a lot of plaques can kind Symptoms The main symptoms of atherosclerosis are pain or cramps followed by deficiency of oxygen to the muscles. Affected artery becomes narrowed and gets blocked suddenly which leads to pain in its location
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and sometimes results in heart attack or stroke. The other symptom include gangrene of a toe, leg or foot and chest pain (angina pectoris) [10]. Atherosclerosis associated diseases Atherosclerosis in Non-dialysis Chronic Renal Patients The risk of CVD among CKD patients is above within the general population with a high prevalence ofarteria illness (40%) and mortality is ten to twenty times during this population, particularly those that do hemodialysis, accounting for five hundredth of deaths in patients. analysis and analysis for subclinical hardening of the arteries by imaging strategies (calcium score in coronary pictorial representation, ultrasound or angiography) may be used for the identification and stratification of in duration of the arteries risk, considering that the burden of induration of the arteries plaque correlates with the chance of coronary events, particularly in CKD dialysis patients.[22] Type 2 Diabetes and Atherosclerosis Atherosclerosis in polygenic disorder and instituting medical care radio-controlled by rising proof ought to improve outcomes in patients. Clinical manifestations of coronary artery disease occur primarily in three tube-shaped structure beds: coronary arteries, lower extremities, and extracranialarterial blood vessel arteries. polygenic disorder will increase the incidence and accelerates the clinical course of every tube-shaped structure bed. The proof supports aggressive antiatherosclerotic management methods upon diagnosing of sort a pair of polygenic disorder to attenuate the danger of vas morbidity and mortality. Risk factors occur at the same time,, thoughsuch interactions ar tough to quantify[23] Interleukin-18 and Atherosclerosis Clinical associate degreed experimental studies have in contestible an association of elevated IL18 levels with hyperbolic CVD risk. However, question still stay unrequited whether or not this observation is indicative of IL-18 being causative in plaque rupture, or whether or not rupture prone plaques unharness IL-18 into the circulation, or this association is nothing however a co-incident. Summarized the scientific explanation that highlights the importance of Interleukin-18 as biomarker and as a intermediary within the pathophysiology of hardening of the arteries[24] Microparticles in Atherosclerosis Microparticles (MPs) aer membrane vesicles free by numerous cell varieties (platelets, epithelial tissue cells, monocytes) in circulation, that play inevitable role in occlusion and tube inflammation. Literatures thus far instructed MPs as biomarkers of tube injury and inflammation and conjointly contribute to the initiation and development of arteriosclerosis and its connected manifestations. Arteriosclerosis is that the major underlying pathophysiology for the assorted cardio tube diseases (CVDs). Additionally, most up-to-date knowledge recommend a possible prognostic role of current MPs. gift article summarizes in brief regarding {the different |the numerous} MPs and their importance as markers to envision the tube health in various CVDs [25] Atherosclerosis in Systemic Autoimmune Disease Systemic response diseases (SADs) area unit related to considerably increased vas (CV) morbidity and mortality owing to a cluster of risk factors. Among them we discover ancient markers of CV risk however additionally specific risk factors in the main associated with inflammation and pathology. Therefore, CV involvement assessment in those diseases is additional and additional necessary and several other authors are learning for the last years that development[26] Angiogenesis in Atherosclerosis Angiogenesis is that the formation of latest blood vessels from preceding vasculature that involves epithelial tissue cell proliferation, migration, tube and lumen formation, and infrequently the accomplishment of sleek muscle cells and alternative membrane cells. In coronary-artery disease, a rise in pro‐ angiogenic factors and/or a decrease in anti-angiogenic factors stimulate maturation, this is often referred to as the angiogenic switch. In human coronary-artery disease, there's AN increased expression of angio statin, AN anti-angiogenic issue that causes a discount in collateral vessel formation whereas increased expression of living substance issue four is related to plaque maturation[28] Atherosclerosis and Cancer Cancer (IARC) has determined that individuals UN agency are overweight or corpulent are at enlarged risk of developing many cancer sorts. The planned mechanisms are chronic hyperinsulinemia coupled to the hypoglycaemic agent resistance obesity-related, enlarged current levels of insulin-like
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growth factor-1 and oestrogens adiposity-related. The arteriosclerosis Risk in Communities studies (ARIC study) shows that avoirdupois is risk for the event of artery intima-media thickness: this is often associate degree index of generalized arteriosclerosis. The planned mechanisms are some immunomudolatry cytokines/chemokines and adipokine dysregulation obesity-related. The aim of the study is to counsel a general hypothesis in pathogenetic mechanism of the enlarged risk for arteriosclerosis and cancer obesity-related [29] Coronary Artery Disease in Patients with HIV In the treatment of Human immunological disorder Virus (HIV) have crystal rectifier to improved survival for patients with HIV. Before the appearance of combined combination antiretroviral medical aid (cART), patients were at a big risk of dying untimely from expedient infections and internal organ sickness, as well as failure. cART has dramatically altered prognosis, with near-normal lifespan, although is currently related to a high rate of internal organ complications as well as severe heart condition. Patients with HIV have the next calculated risk of upset compared to AN aged match HIV-negative population, that is part thanks to AN atherogenic macromolecule profile, hormone resistance from chronic cART, and the next incidence of ancient risk factors for upset, as well assmoking, dyslipidemia and polygenic disease. Additionally, HIV itself probably will increase the danger of coronary cardiovascular disease, part thanks to the chronic inflammatory surroundings, with even those on antiretroviral medical aid showing elevated inflammatory markers. The item of this review is to explore the potential risks for HIV-associated coronary sickness and supply a management strategy for these patients at high risk [30] Atherosclerosis in Primary Antiphospholipid Syndrome The incidence of blood vessel or phlebothrombosis and continual miscarriages within the presence and persistence of Antiphospholipid Antibodies (aPL) detected by immunoassays or activity tests defines the Antiphospholipid Syndrome (APS) . Early observations suggesting that aPL contributed to coronary artery disease in general autoimmune disorder (SLE) result in testing the coronary artery disease hypothesis in primary APS (PAPS) through the activity of membrane Media Thickness (IMT) in massive enough PAPS series. This review can survey the pathways related to premature coronary artery disease in PAPS as they temporally appeared within the scientific literature, and can discuss however these reports support the thought of coronary artery disease as a coffee grade inflammatory and immune method [31] AMD and Atherosclerosis The findings that the hypofunction of the Retinal Pigment epithelial tissue (RPE) induce accumulation of lipids within the Bruch’s membrane have contributed to the understanding of the physiopathogenesis of the Age-Related Macular illness (AMD). it's been attainable to conclude that the interactions that occur within the formation of the arterial sclerosis plaques may occur within the sclerachoroid-retina advanced, that is, the alter low-density lipoprotein induces the assembly of the white blood corpuscle chemotactic protein-1 (MCP-1) and will increase the expression of the living thing Adhesion Molecule-1 (ICAM-1) and Vascular Cell Adhesion Molecule- one (VCAM-1) by the activated epithelium cells. These molecules attract the current monocytes and promote adhesion to the vascular wall. Once the recruited monocytes enter the vascular wall membrane, they ingest the alter low-density lipoprotein and differentiate into macrophages. These cells secrete inflammatory cytokines, enzymes and vascular growth factors and should induce the formation of the Choroidal Neovascularization (CNV)[32] T Cells and Atherosclerosis The role of Treg cells within the suppression of the proatherogenic T cell reponse has been documented. The role of natural Tregs in experimental arterial sclerosis was ab initio reported by AitOufella et al. in 2006, demonstrating that depletion of peripheral Tregs by anti- CD25 being antibodies magnified coronary-artery disease lesion size and vulnerability in atherogenic mouse model apolipoprotein E cistron deficient (ApoE-/-) mice. Given the importance of Tregs within the suppression of the reaction in several response diseases and therefore the proven fact that arterial sclerosis may be a chronic disease with immunological activity in each stage, Tregs square measure presently one amongst the foremost active topics in vessel analysis. [33] Inflammation and Atherosclerosis
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The vulnerable and damaged plaque is characterized by a chronic “active” inflammation. The “active” inflammation is principally painted by T-lymphocytes and macrophages that square measure activated towards a pathway of inflammatory response and secrete cytokines and lytic enzymes that successively cause fibrous cap dilution predisposing the plaque to rupture. Moreover, some pathologic, clinical and angiographic observations appear to counsel the chance that the principal reason behind coronary instability isn't to be found within the vulnerability of one coronary-artery disease plaque, however within the presence of multiple vulnerable plaques within the entire coronary tree, related to a widespread inflammatory method consisting of macrophagic cells and activated T lymphocytes [34] Role of Fcγ Receptors Atherosclerosis Atherosclerosis square measure wide thought of to be AN immune mediate method. Fcγ receptors (FcγRs) contribute to the regulation of immune and inflammatory responses and are concerned in human vessel lesions. Major cell sorts concerned within the pathological process of the diseases categorical FcγRs and their ligands like immune complexes and CRP are shown to activate FcγRs signal pathway. This review summarizes recent vital progress addressing the varied roles of FcγRswithin the malady pathological process that comes from the studies of FcγRs deficient animal models, clinical investigations and in vitro molecular and cellular studies. These new findings facilitate U.S.A. appreciate the rising role of FcγRs in vessel diseases, and counsel FcγRs as a possible therapeutic target for the diseases. [35] Role of B Cells in Atherosclerosis B cells play a vital role in each body substance and adaptation immune responses and square measure detectable in murine and human coronary-artery disease arteries. Recent findings from mouse models square measure setting out to re-define the complicated role(s) of B-cells within the arterial sclerosis. We are going to discuss the involvement of various B-cell subsets in tube-shaped structure pathology and the way B cells can be targeted for therapeutic utility. [36] Treatment and Management Recent research findings on atherosclerosis have marked significant development in development of several treatment methods. One of the treatment methods carried out by Hadi et al. in atherosclerosis model of hypercholesterolemic rabbit have shown that the increase in inflammatory markers such as hs.CRP, TNFα have been significantly reduced on treatment with Vildagliptin and resulted in inhibition of inflammation caused due to high atherogenic diet [11-13]. The other treatment methods may include modulation of vascular inflammation in arteriosclerosis is by autoimmune responses against selfantigens like alter LDL within the vascular wall (ox-LDL) [14], ROCK matter fasudil reduced the overactivation of ROCK in patients with arteriosclerosis [15]. The use of human gamma globulin, montelukast have resulted in good result for treatment of atherosclerosis by reducing progression of the disease [16,17]. Significant research has resulted in better management strategies for atherosclerosis. Few of the management strategies include yoga along with conventional therapy in patients have significantly reduced the early atherosclerosis, Insulin administration prevented regression of coronary atherosclerosis [18,19] etc. CONCLUSION As we know atherosclerosis is a slow poisonous disease with results of severe attack to the heart, atherosclerosis is results of our lifestyle, habits, obesity, mental stress and our health history. Where in our routine life the dangerous habits like smoking and drinking are plays a vital role in progression of atherosclerosis. Where in our daily lifestyle small changes can protect our heart from atherosclerosis those changes like daily exercise, stress free, avoiding fatty foods and frequent doctor consultation. Improved treatments have reduced the amount of deaths from atherosclerosis-related diseases. These treatments even have improved the standard of life for individuals that have these diseases. However, hardening of the arteries remains a typical ill health. You may be ready to stop or delay hardening of the arteries and also the diseases it will cause. Life style changes and obtaining in progress care will assist you avoid the problem of atherosclerosis and live an extended, healthy life. REFERENCES
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1. Esther SerranoPertierra, Lorena Benavente, Miguel Aacutengel BlancoGelaz, Joseacute Luis FernaacutendezMartiacuten, Carlos H Lahoz, et. al. Lysophosphatidylcholine Induces Vascular Smooth Muscle Cell Membrane Vesiculation: Potential Role in Atherosclerosis through Caveolin-1 Regulation. J Proteomics Bioinform. 2014 Vol.7.10 332-339 2. Kunal Mahajan, Interleukin-18 and Atherosclerosis: Mediator or Biomarker. J Clin Exp Cardiolog 2014, 5:352. 3. Marcello Camici, Fabio Galetta and Angelo Carpi, Obesity and Increased Risk for Atherosclerosis and Cancer. Intern Med 2014, 4: 154. 4. Kunal Mahajan, Microparticles in Atherosclerosis: Biomarkers of Disease. J Clin Exp Cardiolog 2015, 5: 356. 5. Maya Mattar, Bochra Jandali, Charles J Malemud and Ali D Askari, Atherosclerosis and Rheumatic Diseases. Rheumatology (Sunnyvale) 2015, 1000147. 6. Paola C Roldan, Michelle Ratliff, Richard Snider, Leonardo Macias, Rodrigo Rodriguez, et. al. Aortic Atherosclerosis in Systemic Lupus Erythematosus. Rheumatology (Sunnyvale) 2014, S5-006. 7. Marcello Camici, Fabio Galetta and Angelo Carpi, Obesity and Increased Risk for Atherosclerosis and Cancer. Intern Med 2014, 4: 154. 8. Min Wu, FanFang Zeng, Run Wang, WaiKey Seto, Pearl Pai, et. al. Atherosclerosis in Patients with Rheumatoid Arthritis. Rheumatology (Sunnyvale) 2014, S5-002. 9. R Businaro, M Digregorio, R Rigano et al. Morphological analysis of cell subpopulations within carotid atherosclerotic plaques. Italian Journal of Anatomy and Embryology. 2005, 110: 109–115. 10. http://www.pfizer.ca/local/files/en/yourhealth/Atherosclerosis.pdf 11. Najah R Hadi, Hussain Abdulkadhim, Ahmad Almudhafer and Sahar A Majeed. Effect of Vildagliptin on Atherosclerosis Progression in High Cholesterol–Fed Male Rabbits. J Clin Exp Cardiolog 2013, 4:249. 12. Korosoglou G, Weiss RG, Kedziorek DA, Walczak P, Gilson WD, et. al. Noninvasive detection of macrophage-rich atherosclerotic plaque in hyperlipidemic rabbits using “positive contrast― magnetic resonance imaging. J Am Coll Cardiol. 2008, 52: 483-491. 13. Bolli G, Dotta F, Rochotte E, Cohen SE Efficacy and tolerability of vildagliptin vs. pioglitazone when added to metformin: a 24-week, randomized, double-blind study. Diabetes Obes Metab. 2008, 10: 82-90. 14. Jahaira Lopez Pastrana, Xiaojin Sha, Anthony Virtue, Jietang Mai, Ramon Cueto, et. al. Regulatory T Cells and Atherosclerosis. J Clin Exp Cardiolog. 2012, S12-002. 15. Suowen Xu, Rock the Rock of Atherosclerosis. J Vasc Med Surg 2013, 1:e101. 16. Chiharu Kishimoto and Zuyi Yuan, The Role of Fcγ Receptors in Myocardial Diseases and Atherosclerosis. J Clin Cell Immunol 2012, S10: 004. 17. Najah R Hadi, Bassim I Mohammad, Ahmad Almudhafer, Naser Yousif and Ahmed M Sultan, Monteleucast and Zileuton Retard the Progression of Atherosclerosis via Down Regulation of the Inflammatory and Oxidative Pathways. J Clin Exp Cardiolog 2013, 4:250. 18. Manchanda SC, Mehrotra UC, Makhija A, Mohanty A, Dhawan S and Sawhney JPS, et. al. Reversal of Early Atherosclerosis in Metabolic Syndrome by Yoga – A Randomized Controlled Trial. J Yoga Phys Ther 2013, 3:132. 19. Roever L, Casella-Filho A, Dourado PMM, Resende ES, Chagas ACP (2014) Insulin Resistance, Type 2 Diabetes and Atherosclerosis. J Diabetes Metab 5:464.
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20. Jacek Jawien, Mouse Experimental Models of Atherosclerosis in Pharmacology. J Clin Exp Cardiolog 2011, S1-001. 21. Maya Mattar, Bochra Jandali, Charles J Malemud and Ali D Askari, Atherosclerosis and Rheumatic Diseases. Rheumatology (Sunnyvale) 2015, 1000147. 22. Wagner Ramos Borges, Andre Mauricio Souza Fernandes, Andre Rodrigues Duraes, Roque Aras Junior and Joao Lima,
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