Endothelium is an inert lining of the blood vessels which act as highly specialized and metabolically active interface between the blood and the underlying tissues. The basic activities of endothelium encompass mediation of coagulation, platelet adhesion, immune function and control of volume and electrolyte content of the intravascular and extravascular spaces. Endothelium dysfunction can be defined as partial or complete loss of balance between vasodilating and vasoconstricting substances produced by the endothelium.
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Endothelium dysfunction can contribute to several disorders such as hypertension, diabetes, hypercholesterolaemia, Behcet’s disease among others. Endothelium dysfunction is now regarded as an early pivotal event in atherogenesis and has been considered an important event in the development of micro vascular complications in diabetes. Nitric oxide reduction is regarded as one of the prominent features of the endothelial dysfunction. Nitric oxide has following physiological effect which contributes to the inhibition of atherosclerosis which include reduction in LDL oxidation, decrease in platelet aggregation to the endothelium, inhibition of smooth muscles cell proliferation and prevention of leukocyte adhesion and infiltration into the vessel.
The testing and diagnosis method for endothelial dysfunction include angiography with acetylcholine injection, however due to complex and invasive nature of diagnosis till date it has never been used beyond research activities. The non-invasive method to measure endothelial dysfunction comprises percent flow mediated dilation method measured by Brachial Artery Ultrasound Imaging devices. Though the technique is simple yet the acceptance across globe is hampered due to variation in results.
A negative correlation between percent flow mediated dilation and baseline artery size is recognized as a fundamental scaling problem, leading to biased estimates of endothelial function. In 2003, FDA approved device EndoPAT which works by measuring Reactive Hyperemia Index (RHI) during nits clinical trials has shown significant results and up to 80% sensitivity as compared to acetylcoline angiogram. Endothelial function can be improved significantly by exercise, smoke cessation, weight loss in overweight or obese persons, and improved diet. In past few years there has been a significant inclination by leading towards development of variety of novel drugs for treating endothelial dysfunction.
Some of the pipelined and available drugs in the market include maxacalcitol, S-adenosyl methionine, MC-1575 and paricalcitol among others. Some of the prominent drivers to the market include exponential rise in number of obese population, reduced physical activities and diabetes leading to increase in chances of acquiring cardiovascular diseases. Such factors have effectively contributed towards the growth and acceptance of variety of drugs and other therapeutics in past will continue to drive the market in forthcoming years as well. Advances in recombinant and gene therapy are also favoring the growth of endothelial dysfunction drugs uptake and can be an opportunity area for new entrants in the market.
Geographically North America and Europe market is currently the leading market for the endothelial dysfunction products due to high involvement of research and development, advanced medical facilities and broad awareness related to cardiovascular diseases and other related diseases. Lack of government interventions and funds to conduct research and development have affected the growth and revenue share for emerging and developing nations. With the substantial rise in cardiovascular and diabetic case in the Asia-Pacific and Middle East countries in upcoming years the demand for endothelial dysfunction market is likely to grow in these regions in next 5-7 years.
Some of the key players in the market include Abbott Laboratories, Chugai Pharmaceutical Co., Ltd., Johnson & Johnson, Glucox Biotech AB, Stealth Peptides Inc. among other prominent players in the market.
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