Inflammatory Growth Factors and In-Stent Restenosis: Effect of Cytokines and Growth Factors

Following stent implantation and vascular injury, restenosis is one of the prominent clinical problems due to the synergism effects of inflammatory cytokines and growth factors. Restenosis development is accompanied by increased proliferation and migration of vascular smooth muscle cells (VSMCs) into the intimal region. The content has been obtained from PubMed database and the Google Scholar search engine through searching English-language articles (1989–2019) using keywords “Vascular injury,” “Restenosis,” “Growth factors,” “Cytokines,” and “Smooth muscle cells.” After the vascular injury, the secretion of inflammatory factors can stimulate inflammatory cells, which lead to the release of growth factors. This can stimulate the migration of VSMCs and neointimal hyperplasia, and, as a result, lead to restenosis. Inflammatory cytokines, such as transforming growth factor-beta (TGFβ), often stimulate growth factors such as platelet-derived growth factor (PDGF) and fibroblast growth factor (FGF), which can accelerate the restenosis process. Other cytokines such as tumor necrosis factor-α (TNF-α) and interleukin-1 (IL-1) in the initial inflammation inhibit restenosis by affecting insulin-like growth factor binding proteins (IGFBPs). Considering the synergism effects of inflammatory cytokines and growth factors in the pathogenesis of restenosis, it is expected that these factors can be used as prognostic markers with therapeutic purposes.