Inflamação e aterosclerose: novos biomarcadores e perspectivas terapêutica

Atualmente a aterosclerose e considerada uma doenca inflamatoria cronica, provavelmente iniciada por disfuncao endotelial associada a fatores inerentes a ativacao do sistema imunologico. A disfuncao endotelial pode ser causada por diversos fatores, como colesterol alto, presenca de radicais livres, associada a fatores externos, hipertensao, diabetes mellitus, alteracoes geneticas, dentre outros. No local onde o endotelio se torna disfuncional ocorre uma resposta inflamatoria, que estimula a migracao e a proliferacao de celulas musculares lisas, que se agregam a area de inflamacao, formando uma lesao mais complexa. Alem disso, ocorre o recrutamento de leucocitos e adesao de plaquetas ao endotelio na regiao da placa de ateroma. Apesar da indubitavel utilidade do perfil lipidico na avaliacao do risco aterosclerotico, esse dado fornece um panorama incompleto do paciente, uma vez que varios eventos cardiovasculares ocorrem em individuos com concentracoes plasmaticas de colesterol e LDL consideradas adequadas. Considerando o papel de destaque dado ao processo inflamatorio no desenvolvimento da aterosclerose, se faz necessaria a observacao de novos biomarcadores para uma melhor previsao de risco cardiovascular. Este trabalho resume aspectos importantes relacionados as metaloproteinases (MMP), proteina C-reativa (PCR), moleculas de adesao, TNF-α, interleucinas (IL) e adiponectina. O conhecimento destes possiveis marcadores constitui-se de vital importância para o direcionamento eficiente de novas abordagens terapeuticas, representando um novo horizonte no tratamento da aterosclerose. Atherosclerosis is currently considered as a chronic inflammatory disease, probably caused by an endothelial dysfunction associated with factors inherent to the activation of the immune system. Endothelial dysfunction may be caused by several factors such as high cholesterol, free radicals, associated with external factors, hypertension, diabetes mellitus, genetic disorders and others. An inflammatory response occurs at the location where the endothelium becomes dysfunctional, stimulating the migration and proliferation of smooth muscle cells, clumping in the inflammation area and forming a more complex lesion, together with the recruitment of leukocytes and platelet adhesion to the endothelium in the atheromatous plaque region. Despite the undoubted utility of the lipid profile in atherosclerotic risk assessment, these data provide an incomplete overview of the patient, as many cardiovascular events occur in patients with cholesterol and LDL plasma concentrations rated as adequate. Considering the prominent role assigned to the inflammatory process for the development of atherosclerosis, it is necessary to observe new biomarkers in order to predict cardiovascular risk more effectively. This paper summarizes important aspects related to matrix metalloproteinases (MMPs), C-reactive protein (CRP), adhesion molecules, TNF-α, interleukins (ILs) and adiponectin. Knowledge of these potential markers is of vital importance for efficiently targeting new therapeutic approaches, opening up a new horizon for atherosclerosis treatment.