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The genesis of cardiovascular risk in inflammatory arthritis: insights into glycocalyx shedding, endothelial dysfunction, and atherosclerosis initiation

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Abstract

This narrative review provides a comprehensive examination of the complex interplay between inflammatory arthritis (IA) and cardiovascular pathology. It particularly illuminates the roles of atherosclerosis initiation, endothelial dysfunction, and glycocalyx shedding. IA not only provokes tissue-specific inflammatory responses, but also engenders a considerable degree of non-specific systemic inflammation. This review underscores the accelerating influence of the chronic inflammatory milieu of IA on cardiovascular disease (CVD) progression. A focal point of our exploration is the critical function of the endothelial glycocalyx (EG) in this acceleration process, which possibly characterizes the earliest phases of atherosclerosis. We delve into the influence of inflammatory mediators on microtubule dynamics, EG modulation, immune cell migration and activation, and lipid dysregulation. We also illuminate the impact of microparticles and microRNA on endothelial function. Further, we elucidate the role of systemic inflammation and sheddases in EG degradation, the repercussions of complement activation, and the essential role of syndecans in preserving EG integrity. Our review provides insight into the complex and dynamic interface between systemic circulation and the endothelium.

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Authors and Affiliations

  1. Medical Faculty, Medical University - Sofia, Sofia, 1431, Bulgaria

    Alexander Krasimirov Angelov & Mariana Ivanova

  2. Clinic of Rheumatology, University Hospital St. Ivan Rilski - Sofia, Sofia, 1431, Bulgaria

    Alexander Krasimirov Angelov & Mariana Ivanova

  3. Faculty of Medicine, Medical University - Varna, Varna, 9002, Bulgaria

    Miroslav Markov & Tsvetoslav Georgiev

  4. Clinic of Internal Medicine, University Hospital St. Marina - Varna, Varna, 9010, Bulgaria

    Miroslav Markov

  5. Clinic of Rheumatology, University Hospital St. Marina - Varna, Varna, 9002, Bulgaria

    Tsvetoslav Georgiev

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All authors have played a substantial role in shaping the study’s conception and design. They have actively engaged in acquiring and analyzing the data, as well as interpreting the results. Furthermore, the authors have collectively contributed to both the initial draft and subsequent critical revisions of the manuscript, providing their invaluable insights. Each author has granted their final approval for the manuscript’s submission to this journal, demonstrating their commitment to taking responsibility for all aspects of the work and being accountable for any potential concerns that may arise. Lastly, all contributing authors have meticulously reviewed and endorsed the final version of the manuscript and take full responsibility for the integrity and accuracy of all aspects of the work.

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Angelov, A.K., Markov, M., Ivanova, M. et al. The genesis of cardiovascular risk in inflammatory arthritis: insights into glycocalyx shedding, endothelial dysfunction, and atherosclerosis initiation. Clin Rheumatol 42, 2541–2555 (2023). https://doi.org/10.1007/s10067-023-06738-x

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