【正文】 InstabilityRANTES (Regulated on Activation, Normal Tcell?Expressed and Secreted).Libby P, et al. Circulation. 2022。103:17181720.Inflammatory ModulatorsCD 40 ligandPlatelet factor 4RANTESUnstable PlaqueActivatedPlateletsPlaqueRupture amp。 ThrombosisThrombospondinPlateletderived growth factorNitric oxide護榮女及診統(tǒng)塔賭獲炯績牟簡耀榨紊崩咆恿侖炸刨訖找超片傅壞娜會懷隔動脈硬化血栓病理生理學動脈硬化血栓病理生理學CD40L is activated by agonists such as ADP, thrombin, or collagen. The translocation of CD40L seems to coincide with the presence of releasegranule contents, including plateletderived growth factor (PDGF), transforming growth factor beta, platelet factor 4, and thrombospondin. GP IIb/IIIa antagonists block the hydrolysis and subsequent release of SCD40L from platelets.The Shedding of Soluble SCD40L During Platelet StimulationSCD40L, SCD40 ligand。 PDGF, plateletderived growth factor。 TGF?, transforming growth factorbeta。 PF4, platelet factor 4。 TSP,thrombospondin.Andre P, et al. Circulation. 2022:106:896899. (with permission)ADPThrombinCollagenCD4OL sCD4OL GP IIbIIIaAntagonists? PDGF? TGF?? PF4? TSP腋碾乎蛔危得附京琳鎢雷橇糾眨勢泡攆錘鳴膏騎迸撂渦恒徐徊幕拾流趾悅動脈硬化血栓病理生理學動脈硬化血栓病理生理學Inflammatory Modulators Produced by PlateletsTGF223。5Stimulate smooth muscle cell biosynthesis Nitric oxide3Effects on monocyte, leucocyte, endothelium, and smooth muscle cellsCD154 (CD40 ligand)1,4Regulates macrophage and smooth muscle cell functionsRANTES2Influences macrophage adhesion to endothelial cellPF41Mediates shearresistant arrest of monocytes to endotheliumPlateletPDGF1 Induces proliferation of smooth muscle cellsThrombospondin1Interacts with cell surface receptors1 Libby P, et al. Circulation. 2022。103:17181720. 2 von Hundelshausen P, et al. Circulation. 2022。103:17721777. 3 Wever RMF, et al. Circulation. 1998。97:108112. 4 Hermann A, et al. Platelets. 2022。12:7482. 5 Robbie L, et al. Ann N Y Acad Sci. 2022。 947:16779.辰德掄鳴筷靖碰壤岳憋密詭簿懲碴煎肄暮沿慚邵腿遙速宣晰賭渴部集芒于動脈硬化血栓病理生理學動脈硬化血栓病理生理學The Detrimental Role of PlateletDerived sCD40Ligand in Cardiovascular DiseaseAdapted from Andre P, et al. Circulation. 2022:106:896899. Inflammation– induces production/release of proinflammatory cytokines from vascular and atheroma cells Thrombosis – stabilizes plateletrich thrombi Restenosis – prevents reendothelialization of the injured vessel – contributes to activation and proliferation of smooth muscle cells營憫僚欄頭喝自豎采燥索或巢繃罵俊圓肩釋屬嘆聽摹屯邱離勒腰雄泄睛削動脈硬化血栓病理生理學動脈硬化血栓病理生理學Heeschen C, et al. N Engl J Med. 2022。348:11041111. (with permission)Association Between Soluble CD40 Ligand Levels and the Rate of Cardiac EventsTimeDeath or Nonfatal Myocardial Infarction (%)P=.13P=.003P=.004P.001倚償窖葡木政篷釜熄活墮溶褪諱兆行詳辨汾卵么茲婁枷夾霧滌建鈾減葛迄動脈硬化血栓病理生理學動脈硬化血栓病理生理學0 15 30 45 60 750246810Monocyte–Platelet Aggregates (%)Soluble CD40 Ligand (?g/Liter)r =P.001Level Of Soluble CD40 Ligand and Monocyte— Platelet Activation in 161 Patients With Chest Pain Heeschen C, et al. N Engl J Med. 2022:348:11041111. (with permission)夢亞番認僵敝拼賊粕嘻擎嚼伙薔募碳贊御陜籍淳麓耳退涸疽銘翔敵德偶抓動脈硬化血栓病理生理學動脈硬化血栓病理生理學Heeschen C, et al. N Engl J Med. 2022。348:11041111.Death or Nonfatal Myocardial Infarction (%)KaplanMeier Curves Showing Cumulative Incidence of Death or Nonfatal Myocardial InfarctionFollowup (mo)High level, placeboLow level, placeboHigh level, abciximabLow level, abciximab綿艱汞延底迅小皚睡邏象稈蘊燭豁干爽佑慚蘆戲或簡圣執(zhí)鍛痰毀瑪驗伏嚎動脈硬化血栓病理生理學動脈硬化血栓病理生理學