An Introduction to Vascular Biology: From Basic Science to Clinical Practice
Authors: Richard Donnelly
Journal: Journal of the Royal Society of Medicine (2003)

The revised and updated second edition of An Introduction to Vascular Biology is broader in scope than its predecessor and more clinically oriented. The extent to which vascular biology and pathophysiology impacts upon clinical medicine is perfectly illustrated by the varied departmental affiliations of the four editors—haematology, rheumatology, obstetrics and vascular surgery. The book includes nineteen short, digestible chapters grouped under basic science, pathophysiology and clinical practice. Contributors include respected names such as Peter Weissberg, Patrick Vallance, Caroline Savage, Allun Hughes and John Tooke. Each chapter has a list of useful up-to-date references, but the illustrations would have benefited from a splash of colour (especially the clinical photographs and histological sections).

The basic science section is comprehensive, with useful introductory chapters on topical subjects such as angiogenesis, vascular cell apoptosis, and the biology of wound healing. The whole area of angiogenesis is particularly relevant clinically. Sprouting of new blood vessels from existing vascular structures plays an important part in collateral vessel formation, tumour growth and tissue remodelling and regeneration. This chapter describes the regulation of endothelial cell migration and proliferation, with connective tissue expansion and the gradual creation of new vascular architecture. Numerous growth factors stimulate angiogenesis while other anti-angiogenic molecules inhibit new vessel formation. The basic science is outlined in a clinical context with reference to conditions in which therapeutic manipulation of angiogenic pathways has potential benefits. This might be achieved, for example, by gene therapy whereby DNA for a powerful angiogenic growth factor, VEGF, is administered locally in the leg or the heart to enhance new vessel formation in patients with critical ischaemia. Conversely, there is a rationale for inhibition of angiogenesis as a way to block tumour growth in primary or metastatic disease. The chapter on angiogenesis will appeal to many different clinical and research specialties.

The section on pathophysiology also includes topical updates in fields that are rapidly changing—for example, the status of candidate genes for hypertension, the many aspects of endothelial dysfunction, and the growing importance of nitric oxide in health and disease. Imaging of the cardiovascular system has undergone enormous change over the past ten years, particularly with techniques such as spiral CT and MR. Alan Moody (radiologist) has written a chapter illustrating the versatility of these techniques not simply in arterial disease but also in assessing patients with venous disease and venous thrombosis. CT and MR angiography are becoming especially useful in the assessment of patients with carotid and renovascular disease. It is a pity that the images have not reproduced well, but in other respects the chapter is excellent.

The third section becomes more focused on therapeutic strategies for improving symptoms and prognosis in patients with assorted vascular conditions, including the cardiovascular complications of diabetes, aortic aneurysms, pulmonary hypertension, and the different forms of vasculitis. Each of these chapters is well illustrated with simple, practical guides to diagnosis and treatment based on a clear understanding of the pathophysiological processes.

Beverley Hunt and her co-editors have succeeded in putting together a collection of varied chapters in which the underlying structural and functional abnormalities in blood vessels are described scientifically in the context of clinical disorders. Individual chapters are easy to read and should provide helpful guidance to clinicians and those interested in the pathophysiological basis of vascular medicine.