Tendon Vasculature in Health and Disease

Herbert Tempfer, Andreas Traweger, Herbert Tempfer, Andreas Traweger

Abstract

Tendons represent a bradytrophic tissue which is poorly vascularized and, compared to bone or skin, heal poorly. Usually, a vascularized connective scar tissue with inferior functional properties forms at the injury site. Whether the increased vascularization is the root cause of tissue impairments such as loss of collagen fiber orientation, ectopic formation of bone, fat or cartilage, or is a consequence of these pathological changes remains unclear. This review provides an overview of the role of tendon vasculature in healthy and chronically diseased tendon tissue as well as its relevance for tendon repair. Further, the nature and the role of perivascular tendon stem/progenitor cells residing in the vascular niche will be discussed and compared to multipotent stromal cells in other tissues.

Keywords: lymphatics; tendinopathy; tendon regeneration; tendon stem/progenitor cells; tendon vasculature.

Figures

Figure 1
Figure 1
Embryonic tendons show a high density of tendon cells producing VEGF, ultimately resulting in a pronounced angiogenic response in developing tendons (A). In healthy adult tendons the relative cell density decreases and tenocytes produce the antiangiogenic factor endostatin in response to physiological mechanical load, thus limiting neo-angiogenesis (B). In diseased tendons, tenocytes produce HIF-1 in response to mechanical overload and/ or hypoxia. HIF-1 in turn induces the expression of VEGF, promoting neoangiogenesis. Hemorrhage due to vascular injury also leads to an increase in VEGF and to the production of matrix metalloproteinases (MMPs), resulting in a further weakening and degradation of the tendon matrix (C).

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