Understanding Atherosclerosis

disease which the investigators recognize as a basis on which to build an understanding of the disease.

The major issues are: 1) the role of the multifunctional smooth muscle cell to produce the fibrous tissue important to the repair process. 2) the idea that the development of the plaque in the intima space is caused by a failure in the function of the endothelial cells lining the lumen of the artery as a barrier to the infiltration of lipid into the intima space to form the characteristic lipid center of the mature plaque. This idea is supported by Ross and refuted by Campbell; 3) the idea that the fatty streak which is composed of fatfilled cells occupying the intima space is the precursor of the mature plaque development.

This idea is supported by Ross but refuted by Velican; 4) the idea that there is a group of necrotic cells developing in the intima space, which results in a foci of necrosis in the intima, which is the precursor to the plaque development. This idea is supported by Velican (16); 5) the fact is, that as the intima thickens with age, and the thickening is speeded up by the risk factors for atherosclerosis, the conditions for cell injury are enhanced.

The healthy life process of the cells in the thickened intima is diminished by the lack of adequate nourishment and oxygen support. Thereby the SMC of the intima succumbs to the other cell death (OCD) process and contributes to the characteristic fat and cellular debris in the lesion center of the fibrous plaque.

Russell Ross dedicated his studies to understanding the disease process of Atherosclerosis. The listed issues will be supported or refuted by the evidence reported by the references selected. Two of the issues listed, however, are not supported by the facts. These two issues are: 1) the idea that atherosclerosis is caused by the dysfunction of the endothelial cells, (refuted by Campbell and Campbell); and 2) the idea that the fatfilled cell of the fatty streak is a predecessor to the fibrous plaque (refuted by the work of Velican).

Review Objective The purpose of this review is to support the concept that the other cell death (OCD) is the key to understanding the degenerative processes that result in the decrease in healthy function of the vital organs, and including the cause for the disease process of atherosclerosis. In the case of atherosclerosis, the main investigators are Russell Ross, the Velicans, and the Campbells.

Ross recognized atherosclerosis as a healing response to injury of the artery wall. It became the “injury and repair� theory of atherosclerosis (17) (18). He worked to understand the process of SMC migration from the media to the intima and described the proliferation of the synthetic capabilities of the SMC in the intima to produce fibrous tissue to preserve the structural integrity of the artery wall. This process became recognized as a repair process that evolved to prevent a lesion which would have ended in perforation of the artery wall, resulting in loss of the integrity of the arterial system and subsequent bleeding.

It will be noted that the degenerative processes and injury to tissues occur more intensely as the tissues are a greater distance from the heart, which is the source of oxygenated blood. A major example is the fact that the atherosclerotic lesions develop to a larger degree in the abdomen, and to a lesser degree in the thoracic area (19) (20).

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