At the cellular level, PAD is driven by several factors:
Endothelial Dysfunction: The endothelial cells lining the arteries lose their ability to regulate vascular tone and permeability, leading to increased adhesion of inflammatory cells and lipids. Lipid Accumulation: Low-density lipoprotein (LDL) particles accumulate within the intima, becoming oxidized and triggering an inflammatory response. Smooth Muscle Cell Proliferation: Smooth muscle cells migrate from the media to the intima and proliferate, contributing to intimal thickening and plaque formation. Extracellular Matrix Remodeling: The balance between matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) is disrupted, leading to excessive degradation and deposition of extracellular matrix components.
