.-In resistance-sized arteries, a chronic increase in blood flow leads to increases in arterial structural luminal diameter and arterial wall mass. In this review, we summarize recent evidence that outward remodeling of resistance arteries 1) can help maintain and restore tissue perfusion, 2) is not intimately related to flowinduced vasodilatation, 3) involves transient dedifferentiation and turnover of arterial smooth muscle cells, and 4) is preceded by increased expression of matricellular proteins, which have been shown to promote disassembly of focal adhesion sites. Studies of experimental and physiological resistance artery remodeling involving differential gene expression analyses and the use of knockout and transgenic mouse models can help unravel the mechanisms of outward remodeling.flow-induced vasodilatation; matricellular protein; gene expression microarray analysis IN ARTERIES, TRANSMURAL PRESSURE and blood flow influence wall thickness and structural luminal diameter (13,16,28,29,49). Mathematical modeling, cell and molecular biological approaches, and experiments in genetically modified animals are beginning to shed light on the mechanisms that underlie these arterial remodeling responses. Here, we summarize recent observations concerning flow-induced outward remodeling of resistance arteries. Exploration of this type of arterial structural response might lead to pharmacological treatments to 1) improve collateral perfusion and 2) reverse the inward arterial remodeling in essential hypertension.
TERMINOLOGYRemodeling is frequently used to describe any alteration of arterial structure. In agreement with others (4, 38), we find it useful to note the differences among several types of arterial remodeling: 1) neointima formation, 2) alteration of the arterial structural luminal diameter (outward or inward), and 3) alteration of tunica media mass (hypertrophic, eutrophic, and hypotrophic). Although this classification is helpful, it also highlights gaps in current knowledge, such as the manner in which media, adventitia, and ultrastructural wall components, such as extracellular matrix, focal adhesion sites, and cytoskeleton, determine the diameter. Arterial structural diameter refers to the maximally dilated diameter and results from the elastic properties of the arterial wall. The diameter of an arterial segment in vivo obviously depends on this structural diameter and on the degree of vasomotor tone or smooth muscle contractile activity.Resistance arteries are small (300 -100 m diameter) muscular arteries that are situated between large elastic conduit arteries and arterioles. In contrast to the large arteries, resistance arteries 1) not only respond to, but also influence, local mean arterial pressure and blood flow, 2) rarely, if ever, develop a neointima, and 3) do not display hypertrophy but, rather, exhibit inward eutrophic remodeling during chronic hypertension (37). In resistance arteries, circumferential wall stress and wall shear stress are maintained at higher values than in arterioles (43)...