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See article by Boengler et al. [2] (pages 573–581) in this issue. Our understanding of the initial steps in blood vessel formation has been advanced through studies employing transgenic and knock-out mouse models [1] as well as isolated cells cultivated under conditions of altered oxygen level and shear stress. From the standpoint of identifying basic biological controls, examination of the tumor vascularization process also has provided insight concerning the molecular pathways required to form and sustain the microvasculature. However, much remains to be discovered about the far slower, adaptive process of arteriogenesis whereby pre-existing arterioles adopt new structural features required for sustaining blood flow around vascular obstructions. Especially fascinating are molecular events that occur in the vicinity of obstruction points where oxygen levels are near normal but flow rates significantly altered. An interesting report by Boengler and colleagues, appearing in this issue of Cardiovascular Research [2], has helped in this regard by identifying links between biomechanical stress and expression of specific transcription factors in the arterial wall. Importantly, two of these factors, the cardiac ankyrin repeat protein (CARP) and Egr-1, previously have been implicated in cardiovascular diseases associated with both vascular and myocardial tissue remodeling [1,3].Arteriogenesis is proposed to consist of two phases [4,5]. The initiating event appears to be endothelial cell damage produced by high fluid … *Tel.: +1-614-292-3147; fax: +1-614-292-4888.

Building better blood vessels: new insight on the molecular control of arteriogenesis