Extracellular Matrix in Calcific Aortic Valve Disease: Architecture, Dynamic and Perspectives

• Main Authors: Anna Di Vito, Annalidia Donato, Ivan Presta, Teresa Mancuso, Francesco Saverio Brunetti, Pasquale Mastroroberto, Andrea Amorosi, Natalia Malara, Giuseppe Donato
• Format: Article
• Language: English
• Published: MDPI AG 2021-01-01
• Series: International Journal of Molecular Sciences
• Subjects: calcific aortic valve disease; extracellular matrix; extracellular vesicles; collagen; elastic fibers; tenascin-C
• Online Access: https://www.mdpi.com/1422-0067/22/2/913

Calcific Aortic Valve Disease (CAVD) is the most common valvular heart disease in developed countries and in the ageing population. It is strongly correlated to median age, affecting up to 13% of the population over the age of 65. Pathophysiological analysis indicates CAVD as a result of an active and degenerative disease, starting with sclerosis and chronic inflammation and then leaflet calcification, which ultimately can account for aortic stenosis. Although CAVD has been firstly recognized as a passive event mostly resulting from a degenerative aging process, much evidences suggests that calcification arises from different active processes, involving both aortic valve-resident cells (valve endothelial cells, valve interstitial cells, mesenchymal stem cells, innate immunity cells) and circulating cells (circulating mesenchymal cells, immunity cells). Moreover, a role for the cell-derived “matrix vesicles” and extracellular matrix (ECM) components has also been recognized. The aim of this work is to review the cellular and molecular alterations occurring in aortic valve during CAVD pathogenesis, focusing on the role of ECM in the natural course of the disease.