Calcific Aortic Valve Disease: a Developmental Biology Perspective

Abstract

Purpose of review: This review aims to highlight the past and more current literature related to the multifaceted pathogenic programs that contribute to calcific aortic valve disease (CAVD) with a focus on the contribution of developmental programs.

Recent findings: Calcification of the aortic valve is an active process characterized by calcific nodule formation on the aortic surface leading to a less supple and more stiffened cusp, thereby limiting movement and causing clinical stenosis. The mechanisms underlying these pathogenic changes are largely unknown, but emerging studies have suggested that signaling pathways common to valvulogenesis and bone development play significant roles and include Transforming Growth Factor-β (TGF-β), bone morphogenetic protein (BMP), Wnt, Notch, and Sox9. This comprehensive review of the literature highlights the complex nature of CAVD but concurrently identifies key regulators that can be targeted in the development of mechanistic-based therapies beyond surgical intervention to improve patient outcome.

Keywords: Calcification; Cell signaling; Extracellular matrix; Heart valve; Valvulogenesis.

Fig. 1

Overview of conserved mature heart valve structure. Pentachrome staining to show extracellular matrix organization within the aortic valve structure of mice (a) and sheep (b). Note more defined stratification in the larger animal model. F = Fibrosa S = Spongiosa V = Ventricularis