Oxidative stress is implicated in lipid infiltration, inflammation, and fibro-calcification in degenerative aortic stenosis, though targeted medical therapies have yet to demonstrate clinical benefit.
This review highlights the role of oxidative stress in aortic stenosis pathophysiology and discusses potential therapeutic targets, noting the current gap between preclinical success and clinical efficacy.
Despite the elucidation of the pathways behind the development of aortic stenosis (AS), there remains no effective medical treatment to slow or reverse its progress. Instead, the gold standard of care in severe or symptomatic AS is replacement of the aortic valve. Oxidative stress is implicated, both directly as well as indirectly, in lipid infiltration, inflammation and fibro-calcification, all of which are key processes underlying the pathophysiology of degenerative AS. This culminates in the breakdown of the extracellular matrix, differentiation of the valvular interstitial cells into an osteogenic phenotype, and finally, calcium deposition as well as thickening of the aortic valve. Oxidative stress is thus a promising and potential therapeutic target for the treatment of AS. Several studies focusing on the mitigation of oxidative stress in the context of AS have shown some success in animal and in vitro models, however similar benefits have yet to be seen in clinical trials. Statin therapy, once thought to be the key to the treatment of AS, has yielded disappointing results, however newer lipid lowering therapies may hold some promise. Other potential therapies, such as manipulation of microRNAs, blockade of the renin-angiotensin-aldosterone system and the use of dipeptidylpeptidase-4 inhibitors will also be reviewed.
Phua et al. (Sat,) conducted a review in Aortic stenosis. Oxidative stress is implicated in lipid infiltration, inflammation, and fibro-calcification in degenerative aortic stenosis, though targeted medical therapies have yet to demonstrate clinical benefit.