Edinburgh Research Explorer Endothelial to Mesenchymal Transition in Cardiovascular Disease: Key Mechanisms and Clinical Translation Opportunities

Endothelial to mesenchymal transition (EndMT) is a process whereby an endothelial cell undergoes a series of molecular events that lead to a change in phenotype toward a mesenchymal cell (e.g., myo fi broblast, smooth muscle cell). EndMT plays a fundamental role during development, and mounting evidence indicates that EndMT is involved in adult cardiovascular diseases (CVDs), including atherosclerosis, pulmonary hypertension, valvular disease, and fi broelastosis. Therefore, the targeting of EndMT may hold therapeutic promise for treating CVD. However, the fi eld faces a number of challenges, including the lack of a precise functional and molecular de fi nition, a lack of understanding of the causative pathological role of EndMT in CVDs (versus being a “ bystander-phenomenon ” ), and a lack of robust human data corroborating the extent and causality of EndMT in adult CVDs. Here, we review this emerging but exciting fi eld, and propose a framework for its systematic advancement at the molecular and translational levels. (J Am Coll Cardiol 2019;73:190 –