A bioengenharia tecidual tem sido aplicada na Endodontia na busca de tratamentos mais biológicos. A revascularização pulpar tem sido observada em dentes com ápice aberto, porém há poucos estudos direcionados aos dentes com ápice formado. A angiogênese é primordial para a nutrição celular durante a regeneração tecidual. O objetivo deste estudo foi analisar o efeito do fator de crescimento endotelial (VEGF) na angiogênese após pulpectomia de canais radiculares de rato com apicigênese completa. A câmara pulpar dos primeiros molares superiores de 12 ratos machos Wistar com 13 semanas foi acessada. A polpa radicular do canal mésio vestibular foi removida e o canal instrumentado até a lima K25. Com uma lima K20, além do limite foraminal, foi induzido o sangramento periapical para o canal radicular. Os dentes do lado direito da arcada foram preenchidos com coágulo sanguíneo (GS), e nos dentes do lado esquerdo foi utilizado VEGF165 recombinante (Prospec, Israel) adicionado ao coágulo (GV). Os dentes foram selados com ionômero de vidro fotopolimerizável, e 60 dias depois os animais foram sacrificados. A maxila foi dissecada, fixada, descalcificada e incluída em parafina. Cortes transversais seriados foram feitos e corados com hematoxilina-eosina para avaliação morfológica ou incubados com anticorpo de coelho anti-fator VIII (Bioss, EUA) para análise da angiogênese. A análise histológica demonstrou canais preenchidos por tecido conjuntivo sem presença de odontoblastos nos dois grupos. A imuno-histoquímica demonstrou positividade para o anticorpo no tecido neoformado em ambos os grupos. No grupo 1 foi predominante a marcação difusa, e no grupo 2 foi a marcação definida. Pode-se concluir que o uso de VEGF acelera a angiogênese que ocorre em canais pulpectomizados de molares com apicigênese completa. / The tissue engineering has been applied in Endodontics in search of more biological treatments. The pulp revascularization has been observed in immature teeth, but there are few studies directed to the closed-apex teeth. Angiogenesis is essential for cellular nutrition during tissue regeneration. The aim of this study was to analyze the effect of vascular endothelial growth factor (VEGF) in angiogenesis after pulp removal in rats with mature teeth. The pulp chamber of upper first molars of 12 male Wistar rats with 13-weeks-old was accessed. The pulp of the mesiobuccal root canal was removed, and the root canal was shaped up to 25K-file. Then, a 20K-file was introduced beyond the apex to induce bleeding. The teeth on the right side of the arch are filled using blood clot alone (GS) and the teeth on the left side was filled using blood clot + VEGF165 recombinant (Prospec, Israel) (GV). The teeth were coronally sealed using light-curing glass ionomer, and the animals were sacrificed after 60 days. The samples were dissected, fixed, decalcified and included in paraffin. Transverse serial sections were made, and stained using hematoxylin-eosin to morphological evaluation or expressed by immunostaining using anti-Factor VIII rabbit antibody (BIOSs, USA) to angiogenesis analysis. Morphological analysis showed root canals filled by connective tissue without the presence of odontoblasts in both groups. Immunohistochemistry showed positivity for the antibody in the new tissue in both groups, with marking defined in group 2. Diffuse marking was predominant in the group 1, and the well-maked type was predominant in the group 2. It can be concluded that the use of VEGF accelerates angiogenesis that occurs in root canal of closed-apex molars after pulpectomy.

The hamster estrous cycle lasts four days and is considered to be a physiological model for angiogenesis. Angiogenesis is the formation of new capillaries from preexisting vessels, and it occurs extensively during corpus luteum formation in the estrous cycle. Von Willebrand Factor (vWF) is a glycoprotein that is secreted uniquely in endothelial cells and megakaryocytes. It is frequently used as an endothelial cell marker and it is able to detect vessels within tissues when it is used in immunohistochemical staining techniques. This study explores von Willebrand Factor expression within Golden Hamster ovarian tissue. In particular, this study uses cage control and antiorthostatic cage suspension tissue. Antiorthostatic cage suspension is a model developed to mimic and study the physiological effects caused by microgravity, such as that experienced in space flight. It is hypothesized that simulated microgravity caused by antiorthostatic cage suspension would result in lower levels of vasculature and expression of vWF within ovarian tissue. Due to financial considerations, conclusive data was not obtained due to a lack of statistics. However, our study indicates that vasculature and vWF expression may be increased in antiorthostatic cage suspension tissue.

Previously, we cloned Heat shock protein A12B (HspA12B), the newest member of a recently defined subfamily of proteins distantly related to the Hsp70 family that are enriched in atherosclerotic lesions. We have found that HspA12B is predominantly expressed in vascular endothelium, and that it is involved in angiogenesis which we probed by in vitro angiogenesis assays (Matrigel), migration assays and Directed In Vivo Angiogenesis Assay (DIVAA). Hsp70s are molecular chaperones that are inducible by stress and have been found to be anti-apoptotic (Li et al. 2000; Nylandsted et al. 2000; Garrido et al. 2001). Because of its homology to Hsp70, we propose that it is the first endothelial-specific chaperone that is required for angiogenesis and interacts with known angiogenesis regulators. To begin to understand the molecular mechanisms underlying the role of HspA12B in angiogenesis, we turned our attention to identifying proteins that are involved in angiogenesis and also interact with HspA12B. Through the use of a yeast two-hybrid (Y2H) system HspA12B was found to interact with a known angiogenesis regulator, A Kinase Anchoring Protein 12 (AKAP12). This interaction was confirmed by co-immunoprecipitation and by colocalization. In primary human umbilical vein endothelial cells (HUVECs), shRNA mediated HspA12B knockdown increased AKAP12 levels and decreased VEGF by more than 75%, whereas HspA12B over-expression decreased AKAP12 and more than doubled VEGF levels. We further identified a 32-Amino Acid (32-AA) domain in AKAP12 that mediates interaction with HspA12B. Over-expression of this 32-AA domain in HUVECs disrupted the HspA12B-AKAP12 interaction and decreased VEGF expression suggesting the importance of the HspA12B-AKAP12 interaction in regulating VEGF. This is the first evidence that HspA12B promotes angiogenesis resulting in up-regulation of VEGF by suppressing AKAP12. Consistent with the proposed role in angiogenesis, HspA12B was also found to be increased in endothelial cells (ECs) by angiogenic stresses including hypoxia and shearing stress while knockdown of HspA12B abolished hypoxia-induced tubule formation. This work provides new insight into the mechanisms controlling angiogenesis by providing the first example of an EC-specific molecular chaperone that acts as a regulator of angiogenesis and lays the foundation for future studies of HspA12B-derived therapeutics for angiogenesis related diseases.

Angiogenesis, the formation of new vessels from a preexisting vasculature, is critical for supplying a healing myocardium with oxygen and nutrients to sustain metabolism post myocardial infarction (MI). Interleukin-1β (IL-1β), a proinflammatory cytokine increased in the heart post-MI, is considered essential for angiogenesis in tumor growth and metastasis, arthritis, endometriosis, and wound healing. Matrix metalloproteinases (MMPs) are implicated in angiogenesis because of their ability to selectively degrade components of the extracellular matrix. Vascular endothelial growth factors (VEGFs) play a vital role in angiogenesis because of their involvement in the recruitment and proliferation of endothelial cells. The current study explores IL-1β-stimulated regulation of angiogenic genes in cardiac microvascular endothelial cells (CMECs), the signaling mechanisms involved, and the implications in the processes of angiogenesis. DNA microarray analysis indicated IL-1β modulates the expression of numerous angiogenesis-related genes, notably upregulating MMP-2 and downregulating VEGF-D expression. RT-PCR and Western blot analyses confirmed the differential expression in response to IL-1β. In-gel zymographic analysis demonstrated IL-1β-stimulated increase in MMP-2 activity. IL-1β activated ERK1/2 and JNKs, not p38 kinase, and activated PKCα/β1 independent of MAPKs. IL-1β inactivated GSK3β via ERK1/2. Pharmacological inhibition of these signaling cascades indicated IL-1β-stimulated regulation of MMP-2 and VEGF-D occurs via ERK1/2, JNKs, and PKCα/β1-dependent mechanisms. In addition, inactivation of GSK3β inhibited basal VEGF-D expression. H2O2 significantly increased MMP-2 protein levels while IL-1β-induced VEGF-D downregulation was further potentiated by ROS scavenging compounds and inhibition of NF-κB. Phalloidin-FITC stain indicated a sharp reduction in fibrillar actin in the cytoskeleton of IL-1β-stimulated cells. Wounding assays revealed that IL-1β induced CMEC migration but prevented cell-to-cell contact and restoration of the monolayer. Flow cytometric analysis revealed a G0/G1 phase cell cycle arrest in IL-1β-stimulated cells, indicative of decreased proliferation. IL-1β inhibited three-dimensional in vitro tube formation by CMECs. Lastly, IL-1β inhibited microvessel sprouting from aortic rings, an assay examining the collective response of multiple cell types. Collectively, the data presented in this study provide evidence that IL-1β differentially regulates important angiogenesis-related genes in CMECs. This differential regulation may lead to interruptions in the processes of angiogenesis, ultimately creating a dysfunctional phenotype for myocardial vessel formation.

Orientador: Willian Fernando Zambuzzi / Resumo: Com o aumento progressivo da expectativa de vida da população, defeitos ósseos se tornou um problema de saúde pública. Por sua vez, o sistema esquelético abriga um conjunto de células que, de maneira hierárquica, sustentam a formação do osso ao longo da vida, sendo sua capacidade regenerativa comprometida durante o processo de envelhecimento. Com o aumento da expectativa de vida, a população idosa vem crescendo nos últimos anos e com ela o aumento eminente de fraturas ósseas. Sabe-se que o desenvolvimento e regeneração ósseos são eventos complexos e controlados por mecanismos parácrinos de sinalização intercelulares, destacando que a osteogênese está acoplada, principalmente, à angiogênese. Embora relatado, este mecanismo de comunicação entre células endoteliais e células osteoprogenitoras não está bem elucidado, sobretudo considerando o repertório de moléculas tróficas envolvidas. A fim de compreender melhor estes mecanismos, o objetivo deste trabalho foi desenvolver metodologias capazes de mimetizar o microambiente endotelial-ósseo, bem como desvendar eventos acoplados entre os diferentes tipos celulares envolvidos no processo, sobretudo gerando tecido endotelial in vitro, equivalente ao original. Para isso, fizemos uso de células humanas primárias, as quais foram submetidas a diferentes protocolos experimentais, onde a mesma densidade de células endoteliais arterial (HCAEC) e venosa (HUVEC) e de musculatura lisa (AoSMC) (cultivo misto) foi plaqueada em tubos cônicos sem tr... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: With the progressive increase in the life expectancy of the population, bone defects became a public health problem. In turn, the skeletal system houses a set of cells that, in a hierarchical way, support the formation of the bone throughout life, and its regenerative capacity is compromised during the aging process. With the increase in life expectancy, the elderly population has been increasing in recent years and with it the eminent increase of bone fractures. It is known that bone development and regeneration are complex events and controlled by paracrine mechanisms of intercellular signaling, emphasizing that osteogenesis is mainly coupled with angiogenesis. Although reported, this mechanism of crosstalk between endothelial cells and osteoprogenitor cells is not well elucidated, especially considering the repertoire of involved trophic molecules. In order to better understand these mechanisms, the objective of this work was to develop methodologies capable of mimicking the endothelial-bony microenvironment, as well as unveiling the coupled events between the different cell types involved in the process, especially generating endothelial tissue in vitro, equivalent to the original one. For this, we used primary human cells, which were submitted to different experimental protocols, where the same density of arterial (HCAEC) and venous (HUVEC) endothelial cells and smooth muscle cell (AoSMC) (mixed culture) were plated in tubes (s), and after 72 hours the generated spheroid... (Complete abstract click electronic access below) / Mestre

Development of an in vitro model for the early stages of cardiovascular disease is a current necessity. Cardiovascular disease is the leading cause of death in the United States and throughout the world. Oxidative stress and reactive oxygen species have been implicated in cardiovascular disease development. An in vitro model of these processes will improve our understanding of cardiovascular disease development and allow for the development of additional treatments. Atherosclerosis is an inflammatory disease and increased levels of H2O2 are associated with inflammation. The model focuses on H2O2-induced oxidative stress under static and shear conditions. Previous studies have documented increased O2.- and increased cytotoxicity in smooth muscle cells exposed to H2O2. Under static culture, endothelial cells exposed to H2O2, exhibited increased O2.- over basal levels via NOS and NAPDH oxidase pathways. Increased O2.- was attenuated by MnSOD adenoviral-mediated upregulation and endothelial cell exposure to Tiron. This suggests NOS and NADPH oxidase as sources of increased O2.- under H2O2-induced oxidative stress. Endothelial cell cytotoxicity was increased with H2O2 exposure. The increase in cytotoxicity was diminished upon exposure to Tiron or L-NAME. Under shear conditions (8.2 dynes/cm2), endothelial cells exposed to H2O2 exhibited increased O2.- compared to control via an L-NAME (specific inhibitor NOS) and Apocynin (NADPH oxidase inhibitor) inhibitable mechanism. This suggests NOS and NADPH oxidase as sources of increased O2.- under H2O2-induced oxidative stress. The increased O2.- was attenuated with MnSOD adenoviral-mediated upregulation and endothelial cell exposure to Tiron (an O2.-scavenger). Endothelial cell attachment under shear with exposure to H2O2 was improved with MnSOD adenoviral-mediated upregulation as observed by decreased loss of the endothelial cell monolayer compared with H2O2 exposed endothelial cells. Endothelial cells exposed to H2O2 exhibit increased O2.-, suggesting that H2O2-induced oxidative stress may be a reasonable model for atherosclerosis. NOS and NADPH oxidase co-inhibition under shear and static culture demonstrated that NOS and NADPH oxidase inhibition is non-additive under static culture, yet additive under shear. Co-inhibition results suggest a complex relationship between the two enzymes that requires additional experimentation to deconvolve.

In der vorliegenden Arbeit wurde die Expression unterschiedlicher Marker für die Vaskularisation in verschiedenen Modifikationen zur Unterkieferaugmentation mit autologem kortikospongiösen Beckenkammtransplantaten in-vivo am Schafmodell untersucht. Wie schon aus Voruntersuchungen bekannt, zeigte vor allem die Modifikation des Transplantatlagers in der Kombination einer resorbierbaren Bio-Gide® Membran mit dem Knochenersatzmaterial (KEM) Bio-Oss® und einem kortikospongiösen Transplantat die geringsten Resorptionsraten. Dieser Konditionierung wurden verschiedene andere Modikifationen des Transplantatlagers gegenübergestellt und jeweils die Expression der Vaskularisationsmarker untersucht und verglichen. Sowohl die Untersuchungen zur Expression von Bone Morphogenetic Protein-2 (BMP-2), Vascular Endothelial Growth Factor (VEGF) und seinen Rezeptor-Isoformen VEGF-Rezeptor 1 und VEGF-Rezeptor 2, sowie den NOS-Isoformen eNOS und iNOS zeigen alle eine signifikant vermehrte Expression in der Konditionierung mit Bio-Oss® als KEM und einer resorbierbaren Bio-Gide® Membran. Lediglich die Expression des von-Willebrand-Faktors (vWF) als Marker des Endothels zeigte keine signifikant vermehrte Expression in der mit Bio-Oss® und Bio-Gide® modifizierten Gruppe. Hier wäre die Tatsache, dass der vWF auch als Marker der endothelialen Dysfunktion beschrieben wird und in den klinisch stärker atrophierten Modifikation vermehrt exprimiert wird, eine Erklärungsmöglichkeit. Die Untersuchungen zur Expression der Vaskularisationsmarker hinsichtlich der Regionen im Augmentat zeigen sowohl bei BMP-2 wie auch bei VEGF und seinen Rezeptorisoformen VEGF-R1 und VEGF-R2 eine signifikant vermehrte Expression im Bereich des Transplantates in der Bio-Oss® Modifikation. Diese Ergebnisse stützen den klinischen Aspekt der guten Vaskularisierung des Transplantates und unterstreichen die Bedeutung der Wachstumsfaktoren für die Vaskularisierung im Transplantat. Bei den Färbungen auf NOS findet sich eine signifikant vermehrte Expression im Transplantatlager. Diese Ergebnisse stellen die Bedeutung von NOS für die Regulation der Osteogenese und die direkten Wirkungen auf Osteoblasten und Osteoklasten. Die Tatsache, dass gerade in der Bio-Oss® Modifikation, in der klinisch die geringste Resorption zu beobachten war, signifikant mehr Vaskularisationsmarker exprimiert wurden, ist Nachweis der besseren Vaskularisation dieser Konditionierung und unterstreicht sowohl den Nutzen von KEM wie Bio-Oss® bei Transplantationen autologen Knochens, wie auch die Möglichkeiten der therapeutischen Verwendung einzelner Wachstumsfaktoren wie z. B. BMP-2. / In this study the expression of various markers for vascularization in different modifications of alveolar ridge augmentation procedures on the mandible with autogenous bone grafts from the iliac crest was analyzed with the help of an in-vivo sheep model. As preliminary investigations suggested, especially the modification of the host side as a combination of a resorbable Bio-Gide® membrane according to the concept of Guided Bone Regeneration (GBR) with Bio-Oss® as a bovine bone substitute, showed the least resorption in clinical findings. This modification of the host side was compared with a control group, in which other modifications of the host side were being used and which showed a way higher rate of resorption during the surveillance period and until the euthanasia of the sheep after 16 weeks. The expression of different vascularization markers was compared between these two groups. The data concerning the expression of Bone Morphogenetic Protein-2 (BMP-2), Vascular Endothelial Growth Factor (VEGF) and its receptor-isoforms VEGF-Receptor 1 and VEGF-Receptor 2, as well as the Nitric Oxide Synthase (NOS) isoforms, the endothelial NOS (eNOS) and the inducible NOS (iNOS) all showed a significantly higher expression within the modification of the host side using GBR and Bio-Oss®. Only the expression of the von-Willebrand-Factor (vWF) as a marker of the endothelium showed no significantly higher expression within this modification but a higher expression within the control group. Hypothetically, the fact that vWF is also a marker of endothelial dysfunction could explain the higher expression within the control group. Taking the different regions of the graft in consideration, BMP-2, VEGF, VEGFR-1 and VEGFR-2 all showed a significantly higher expression within the bone graft of the modification using GBR and Bio-Oss®. These results underline the clinical aspect of the good vascularization of the graft within this modification. NOS showed a significantly higher expression in the region of the host side and could explain the importance of NOS for osteogenesis and its effect on osteoblasts and osteoclasts. In summary, the significantly higher expression of vascularization markers and clincally the lowest rate of atrophy and resorption within the modification of the host side using GBR and Bio-Oss®, underlines the better vascularization of this modification and emphasizes the use of GBR and bone substitues during the transplantation of autogenous bone grafts and suggests the therapeutical use of certain growth factors such as BMP-2 within this modification.

There are not enough donor lungs available to meet the increasing demand for lung transplantation. To compound the problem, transplant recipients have a projected survival time of only 5.7 years despite life-long immunosuppression. An alternative approach for acquiring transplantable lungs and reducing post-operative complications may be possible through tissue engineering. Perfusion-decellularization generates natural, three-dimensional extracellular matrix (ECM) scaffolds of an organ that are apt for tissue engineering. Decellularization of the heart, lung, liver, kidney, and pancreas has been reported in animal models and from human tissue. Decellularization of fibrotic and emphysematic lungs indicated that this technique can efficiently remove cells from diseased tissue—a potential source of materials for engineering of transplantable lung tissue. Pulmonary hypertension (PHT) is a vascular disease characterized by increased pulmonary vascular resistance leading to right heart failure and death. Lungs damaged by PHT are unsuitable for transplantation; however, decellularization of these organs may provide scaffolds appropriate for ex vivo lung engineering. Monocrotaline-induced PHT (MCT-PHT) is a well-established model of this disease in rats closely resembling the clinical presentation of PHT in humans. Thus, decellularization and recellularization of hypertensive lungs was evaluated using the MCT-PHT model. Decellularization of control and MCT-PHT Sprague-Dawley rat lungs was accomplished by treating the lungs with Triton X-100, sodium deoxycholate (SDC), NaCl, and DNase. The resulting acellular matrices were extensively characterized by molecular, mechanical, and structural analyses revealing that decellularization was able to remove cells while leaving the ECM components and lung ultrastructure intact; however, the vasculature of MCT-PHT acellular lung scaffolds was narrower than control scaffolds—a hallmark of PHT. To evaluate the effect of narrowed vasculature on the use of hypertensive lungs for tissue engineering, an optimal vascular recellularization technique was developed. Gravity-based seeding of endothelial cells followed by bioreactor-based whole-organ culture resulted in efficient vascular recellularization of control lung scaffolds. However, this method led to heterogeneous re-endothelialization of the vasculature of MCT-PHT matrices suggesting that additional manipulation or optimization is required. / acase@tulane.edu

Angiotensin II (Ang II) promotes vascular disease and hypertension, in part, by activating the interleukin-6 (IL-6)/signal transducer and activator of transcription 3 (STAT3) signaling pathway. Extensive studies have demonstrated that SOCS3 plays an important role in suppressing the IL-6/STAT3 pathway in the immune system and in cancer biology. In contrast, the functional importance of SOCS3 in cardiovascular disease is largely unknown. Thus, the overall goal of these studies was to investigate the role of SOCS3 in models of Ang II-dependent vascular disease and hypertension. To examine direct effects of Ang II on the vessel wall, carotid arteries from SOCS3 haplodeficient (SOCS3+/-) mice and wild-type littermates (SOCS3+/+) were incubated with the peptide or vehicle for 22 hrs, followed by examination of endothelial function using acetylcholine. Relaxation to acetylcholine was similar in all arteries incubated with vehicle. A low concentration of Ang II (1 nmol/L) did not affect acetylcholine-induced vasodilation in SOCS3+/+ mice, but reduced responses in arteries from SOCS3+/- mice by ~50% (P<0.05). This Ang II-induced endothelial dysfunction in SOCS3+/- mice was prevented by inhibitors of NF-êB or STAT3, an IL-6 neutralizing antibody, or a scavenger of superoxide. Responses to nitroprusside, an endothelium-independent vasodilator, were similar in all groups. To test the importance of SOCS3 in vivo, mice were infused systemically with a pressor dose of Ang II (1.4 mg/kg per day) or vehicle for 14 days via osmotic mini-pumps. Acetylcholine-induced vasodilation in carotid and resistance arteries in brain from SOCS3+/- mice was reduced by ~60% (P<0.05). Surprisingly, genetic deficiency in SOCS3 prevented the majority of Ang II-induced endothelial dysfunction without affecting the pressor response to Ang II. To investigate potential mechanisms underlying divergent results when studying effects of local versus systemic effects of Ang II, we performed bone marrow transplantation followed by infusion of vehicle or Ang II for two weeks. Lethally irradiated WT (CD45.1) mice reconstituted with SOCS3+/- bone marrow were protected from Ang II-induced endothelial dysfunction (P<0.05), while reconstitution of irradiated SOCS3+/- mice with WT (CD45.1) bone marrow exacerbated Ang II-induced vascular dysfunction (P<0.05). WT (CD45.1) into SOCS3+/+ and SOCS3+/- into SOCS3+/- bone marrow chimeras exhibited vascular function consistent with non-irradiated controls. In addition, the pressor response to Ang II was reduced by ~50% in WT mice reconstituted with bone marrow from SOCS3+/- mice (P<0.05). These data suggest that SOCS3 exerts divergent or context-dependent effects depending on whether vascular dysfunction was due to local versus systemic administration of Ang II. SOCS3 deficiency in the vessel wall enhanced local detrimental effects of Ang II on vascular function. In contrast, bone marrow-derived cells that are haplodeficient in SOCS3 protect against systemically administered Ang II and the resulting vascular dysfunction and hypertension. To my knowledge, these are the first experimental studies that begin to define the importance of SOCS3 in Ang II-induced hypertension and endothelial dysfunction. Results obtained from these experiments provide new insight into mechanisms which regulate oxidative stress and inflammation within the vasculature. The studies also revealed that bone marrow-derived cells that are haplodeficient in SOCS3 protect against pressor and endothelial effects of Ang II. These findings may eventually contribute to the development of novel therapeutic approaches for hypertension and hypertension associated end-organ damage.

For over a century, there have been suggestions of a link between what is currently called bipolar disorder and cardiovascular mortality. In the contemporary epidemiological literature, this risk has been confirmed and approximates twice that expected based on age and gender. To date, however, this information has come primarily from clinical samples, which carry considerable risk of selection bias. The studies contained in this dissertation sought to assess this relationship using methods less vulnerable to selection bias and to determine the role that course of illness and treatments for illness may play in the development of vascular disease. In a nationally representative sample, we confirmed a link between mood disorders and vascular disease, which was particularly pronounced in women with bipolar disorder. In subsequent studies, a dose-response relationship between the duration of clinically significant hypomanic or manic symptoms and both cardiovascular mortality and endothelial function was seen. While medication exposure did not appear related to mortality or endothelial function, first generation antipsychotics were associated with arterial stiffness, an effect apparently mediated by elevations in blood pressure. In cross-sectional samples, our data suggests that vasculopathy is not present early in the course of bipolar disorder although is much greater than expected later in the course of illness. This dissertation purports that vasculopathy develops over the long-term course of bipolar disorder, is proportional to symptom burden, and is influenced by health behaviors and treatments. These findings may provide opportunities for clinicians and those afflicted to intervene to address this excess risk of vascular morbidity and mortality.