Pathophysiology of Angiogenesis and Its Role in Vascular Disease

Angiogenesis is the process in which new blood vessels, in particular capillaries, are formed from the pre-existing vascular network, Angiogenesis plays a critical role in normal postnatal growth and development. It is crucial in providing nourishment to granulation tissue during wound healing, as well as in the formation of collateral vessels as part of an adaptive response to vascular occlusion and ischaemia. Failure of adequate angiogenesis plays an important role in conditions including ischaemic heart disease, peripheral arterial disease (PAD), delayed wound healing and ischaemic stroke. Conversely, excessive pathological angiogenesis driven by inflammation is a key contributor to the development and progression of malignant cancers, atherosclerotic plaques, proliferative retinal disease and inflammatory arthritides, among many other pathologies. Diseases associated with angiogenesis are highly prevalent globally, with cardiovascular-related disorders and cancer being the leading causes of mortality worldwide. However, current therapies that target angiogenesis remain limited though, as anti-angiogenic agents can delay physiological angiogenic processes, causing severe side effects while pro-angiogenic therapies may cause inadvertent tumourigenesis. The intricate balance between desirable physiological angiogenesis and unwanted pathological angiogenesis involves the regulation of a suite of signalling pathways, regulatory factors and cell-to-cell interactions.