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Sara Weis, Satoshi Shintani, Alberto Weber, Rudolf Kirchmair, Malcolm Wood, Adrianna Cravens, Heather McSharry, Atsushi Iwakura, Young-sup Yoon, Nathan Himes, Deborah Burstein, John Doukas, Richard Soll, Douglas Losordo, David Cheresh
Published in Volume 113, Issue 6
J Clin Invest. 2004; 113(6):885–894 doi:10.1172/JCI20702
Abstract | Full text | PDF
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Figure 9

Sequence of cellular and molecular events following MI. The link between edema and poor clinical outcome following myocardial infarction has remained poorly understood. We propose a pathway in which hypoxia-driven VEGF expression following MI leads to edema and cardiac damage. Upon VEGF stimulation, Src activity is required for the disruption of a preformed Flk-cadherin-catenin complex, which loosens EC-cell contacts and permits extravasation of serum and blood cells. The resulting edema and inflammation increase interstitial pressure, which reduces local blood flow and causes further hypoxia. Endothelial gaps also expose basal lamina, attracting platelets that adhere, become activated, and could release VEGF locally. Platelet aggregates form microthrombi that can limit blood flow through smaller vessels, thereby increasing hypoxia and contributing to the expansion of cardiac damage and infarcted tissue that is associated with poor clinical outcome. Src blockade delivered within the first few hours following vessel occlusion could prevent VEGF-induced dissociation of the Flk-cadherin-catenin complex and preserve endothelial barrier integrity, thereby eliminating the further damage and infarct expansion beyond the initial ischemic boundary.