A bstract : Efforts to therapeutically stimulate or inhibit vessel growth have been primarily focused on vascular endothelial growth factor (VEGF) and its receptor VEGFR‐2 (Flk‐1), while little attention has been devoted to the therapeutic potential for angiogenic disorders of placental growth factor (PlGF), a VEGF family member, and its receptor VEGFR‐1 (Flt‐1). However, recent developments and insights could shift that focus to P1GF and Flt‐1. Indeed, PlGF stimulated angiogenesis and collateral growth in ischemic heart and limb with at least a comparable efficiency to VEGF and did not cause side effects associated with VEGF, such as edema or hypotension. An anti‐Flt‐1 antibody suppressed neovascularization in tumors and ischemic retina, and angiogenesis and inflammatory joint destruction in arthritis. The anti‐Flt‐1 antibody also reduced atherosclerotic plaque growth and vulnerability, but the atheroprotective effect was not due to reduced plaque neovascularization. The anti‐inflammatory effects of the anti‐Flt‐1 antibody were attributable to a reduced mobilization of bone marrow‐derived myeloid progenitors into the peripheral blood, a reduced mobilization/differentiation (and impaired infiltration) of Flt‐1‐expressing leukocytes into inflamed tissues, and a defective activation of myeloid cells. Thus, PlGF and Flt‐1 constitute potential candidates for therapeutic modulation of angiogenesis and inflammation.
2][3] Apart from a role in the progression of atherosclerotic lesions, MMPs have also been involved in plaque destabilization and rupture and in the development of aneurysms.Despite intense research efforts during the last decade, it has been challenging to formulate a unifying model on the specific role of MMPs in atherosclerosis.In fact, mouse genetic studies have yielded controversial insights, highly dependent on genetic background, dietary regimen, and arterial site of analysis, whereas human genetic association studies do not prove causality of MMPs in atherosclerosis.Moreover, the lack of specific inhibitors precluded pharmacological dissection of the role of MMPs in vivo.There is thus a need for alternative strategies to decipher the MMP puzzle in atherosclerosis.In this issue of Circulation, Liang et al 4 used a novel approach: They generated transgenic rabbits to study the role of MMP-12, also known as macrophage elastase, in atherosclerosis.Their results indicate that MMP-12 causes media destruction and pseudoaneurysm formation and, more surprisingly, accelerates plaque growth in an animal model that more closely resembles atherosclerosis in humans.