Atherogenesis and inflammation

Following endothelial injury monocytes attach to the subendothelium and penetrate into the vessel wall forming macrophagelfoam cells by accumulating lipids. Macrophages release various products such as interleukins complement factor fragments tumour necrosis factors oxidized cholesterol and oxygen free radicals leading to further endothelial injury and cytolysis. Platelets at the site of vascular injury monocytes endothelial cells and smooth muscle cells release mitogenic factors which stimulate smooth muscle cell proliferation and migration. This smooth muscle cell proliferation together with organization of thrombus and extracellular matrix synthesis leads to the development of atheromatous plaques. Macrophages by releasing proteases such as collagenase and elastase form an abscess in the plaque which is covered by a thin fibrous cap. When this cap ruptures a local thrombus is formed and depending upon the degree and duration of thrombus and the degree of collateral development the fate of this thrombotic process is determined.