Abstract-Development of the coronary vascular system is an interesting model in developmental biology with major implications for the clinical setting. Although coronary vessel development is a form of vasculogenesis followed by angiogenesis, this system uses several unique developmental processes not observed in the formation of other blood vessels. This review summarizes the literature that describes the development of the coronary system, highlighting the unique aspects of coronary vessel development. It should be noted that many of the basic mechanisms that govern vasculogenesis in other systems have not been analyzed in coronary vessel development. In addition, we present recent advances in the field that uncover the basic mechanisms regulating the generation of these blood vessels and identify areas in need of additional studies.
A Brief Description of Coronary Vessel DevelopmentCoronary vessel development is an example of vasculogenesis followed by angiogenesis with unique variations specific to heart development. Vasculogenesis has been described as the de novo generation of blood vessels, whereas angiogenesis can be thought of as the generation of capillaries, veins, and arteries from preexisting vessels. The process begins with the delivery of vasculogenic cell types to the surface of the heart after beating has begun. These cells must then disperse throughout the heart; differentiate into endothelial cells, smooth muscle cells, pericytes, and fibroblasts; subsequently form arteries, veins, and capillaries; and finally connect to the aorta and coronary sinus. Delivery of a population of cells to an existing organ requires dynamic cellular events, and coordination of cell movement with the precise timing of delivery, commitment, and differentiation is critical for proper vessel formation and organ development. Originally, researchers thought that coronary vascular progenitors were derived from the cardiac mesoderm, like the other cell types in the myocardium and endocardium. 1,2 These data were first challenged by Manasek, 3 who demonstrated that the heart tube is initially composed of only endocardium and myocardium and that the epicardium arises from extracardiac regions. In more recent years, several studies have determined that progenitors of the epicardium and coronary vascular system are derived from extracardiac tissue, the proepicardial organ (PEO; Figure 1). Although the earliest location of these progenitors is still in debate, they appear to arise from splanchnic mesoderm. 4 -6 The PEO is associated with the septum transversum that grows from the dorsal body wall ventrally to divide the embryonic coelom into the pleuropericardial and peritoneal cavities and forms a portion of the diaphragm. 4,[7][8][9] However, the PEO is a transient structure that consists of a single epithelial layer folded into a shape resembling a grapelike cluster. In chicken (HH stage 17) and mouse (E9.5) embryos, the PEO migrates to and then over the surface of the heart to form the primitive epicardium (Figures 1 th...