Ultrastructure of the afferent arteries of experimental femoral arteriovenous fistulae in rabbits

Elastic Lamina Defects Are an Early Feature of Aortic Lesions in the Apolipoprotein E Knockout Mouse

The aortae from male apolipoprotein E knockout (apoE-/-) mice were examined by serial section immunohistochemistry and electron microscopy to determine the continuity of the internal elastic lamina (IEL) and its association with developing intimal lesions. While in this model, defects in the elastic laminae have previously been described beneath advanced xanthomatous lesions, this study demonstrates that disruption of the IEL may be a primary factor in the localization and pathogenesis of intimal lesions in the apoE-/- mouse. IEL defects were found beneath early lesions in animals as young as 8 weeks of age. Small defects without associated intimal alteration were also observed. The elastic tissue defects beneath early intimal lesions were usually transversely orientated with abrupt "break" edges. Regions consistent with direct enzymatic digestion of the IEL were relatively rare and only observed beneath advanced plaques, particularly in the brachiocephalic artery. The presence of IEL defects around branch sites of old C57BL/6J control mice along with their matching localization and morphology in apoE-/- appears consistent with biomechanical fatigue rather than direct enzymatic degradation. In conclusion, disruption of the IEL appears to be a prominent early, if not initial, feature of the apoE-/- model of atherosclerosis and may act as the nidus upon which intimal lesions develop.

Coronary heart disease, hypercholesterolemia, and atherosclerosis. I. False premises

Lipid-rich caseous debris of advanced lesions stimulated interest in the role of cholesterol and lipids in atherosclerosis. Lipid-containing arterial lesions in cholesterol-overfed animals (cholesterolosis) and xanthomatous vascular lesions in subjects with familial hypercholesterolemia were then misrepresented as being atherosclerotic and led to the development of the hypercholesterolemic/lipid hypothesis. It is untenable that cholesterol, an essential multifunctional metabolite, is pathogenic at all blood levels and hypercholesterolemia is not prerequisite for human or experimental atherosclerosis. Serum cholesterol levels display a poor correlation with atherosclerosis at autopsy and with unreliable national coronary heart disease (CHD) mortality in each sex. Atherosclerosis topography and its iatrogenic production in humans and experimentally in herbivores by hemodynamic means both support a biomechanical causation and preclude causality by any circulating humoral factor. CHD, not a specific disease, is a nonspecific complication of many diseases including atherosclerosis and cannot be equated with coronary atherosclerosis due to differences in pathology and pathogenesis. Thus, extrapolations from CHD risk factors or correlations with fallacious vital statistics to atherosclerosis are invalid. It follows that the hypercholesterolemic/lipid hypothesis evolving from false premises, misuse of CHD, scientific misrepresentation, and fallacious data has no legitimate basis.

The elusive local factor in atherosclerosis

Recent evidence confirms that local haemodynamic stresses account for the initiation, topographical localization and complications of atherosclerosis. These causative stresses are vibratory and associated with pulse pressure and the lesser vibrations of greater frequency generated by blood flow at predilection sites. This bioengineering fatigue hypothesis is further substantiated by analogous effects of repetitive stresses on erythrocytes and in the musculoskeletal system. The mechanism underlying fatigue is cumulative molecular scissions of the mural constituents which ultimately result in failure of the wall as a whole. Free radicals and oxidation products are by-products of this molecular scission in atherogenesis. This theory which explains the progressive inexorable loss of mural cohesion, its pathogenesis and complications is completely substantiated by the iatrogenic and experimental reproduction of the disease by haemodynamic means.