Journal of Immunology (ISSN 2995-861X) Hyalinosis : A preliminary communication regarding very interesting and provocative clinical observations. Dr. Med Gernot P. Tilz, H. Becker (in memoriam) and Ch. Tilz The Vascular Diseases of the Brain and the Heart May Have a Different Etiology Corresponding author Dr. med Gernot P. Tilz , Former Head of the Dept. of Clinical Immunology and Jean Dausset Laboratory in A 8036 GRAZ, LKH. Email : gernot.tilz@medunigraz.at Received Date : April 17, 2024 Accepted Date : April 18, 2024 Published Date : May 18, 2024 This is a brief comment on 55 years of clinical experience and some autopsy observations with the late pathologist Prof Hans Becker.. It is now recognized that vascular disease of the brain and coronary vessels may be of two different entities. We encounter patients with advanced disease of coronary and peripheral arteries with no perceptible evidence of “cerebral arteriosclerosis” and conversely people with advanced dementia of vascular origin despite unaffected coronary and peripheral arteries. Some observations at autopsies concerning this matter have come to the conclusion that in general coronary heart disease is mainly sclerotic and inflammatory with all the well - known risk factors of which we are aware, namely high lipids, inflammation, smoking, hypertension. Patients with “cerebral sclerosis” and sometimes renal vascular involvement seem to have often primarily a type of “angiopathy” of their brain vessels and kidneys, due to hypertension sometimes caused by linear deposition (inbibition, or absorption or filtration) of smaller proteins such as prealbumin, transthyretin, free light chains and other smaller molecules. If this hypothesis can be verified, treatment of these two distinct diseases will differ; namely antihypertensive medications for the “cerebral sclerosis” and statins, anti-inflammatory drugs and the antilipideamics for the “peripheral sclerosis”. Further evidence to this “hyalinosis-hypothesis” comes from the description of the “Amyloidosis of the brain” from radiologists. A prospective randomized study focusing specifically on these aspects may yield results that add further to our understanding of the specific etiology of these morbidities and enhances strategies for their management. Acknowledgement I gratefully acknowledge the editorial assistance of Prof. Dr. Günes Ege . FURTHER READING 1. Amano S. Vascular changes in the brain of spontaneously hypertensive rats: hyaline and fibrinoid degeneration. J Pathol. 1977;121(2):119-28. 2. Gychka SG, Shults NV, Nikolaienko SI, Marcocci L, Sariipek NE, Rybka V, et al. Vasa Vasorum Lumen Narrowing in Brain Vascular Hyalinosis in Systemic Hypertension Patients Who Died of Ischemic Stroke. Int J Mol Sci. 2020;21(24). 3. Zhang WW, Badonic T, Hoog A, Jiang MH, Ma KC, Nie JX, et al. Structural and vasoactive factors influencing intracerebral arterioles in cases of vascular dementia and other cerebrovascular disease: a review. Immunohistochemical studies on expression of collagens, basal lamina components and endothelin-1. Dementia. 1994;5(3-4):153-62. 4. Zhang WW, Lempessi H, Olsson Y. Amyloid angiopathy of the human brain: immunohistochemical studies using markers for components of extracellular matrix, smooth muscle actin and endothelial cells. Acta Neuropathol. 1998;96(6):558-63. 5. Ferrer I, Bella R, Serrano MT, Marti E, Guionnet N. Arteriolosclerotic leucoencephalopathy in the elderly and its relation to white matter lesions in Binswanger’s disease, multi-infarct encephalopathy and Alzheimer’s disease. J Neurol Sci. 1990;98(1):37-50. 6. Tilz, G. P., H. Becker ( in memoriam) Originalbeitrag aus eigenen Beobachtungen bei Gefäßprozessen in W.R. Baier und G.P. Tilz (Hrsg: Fortschritte der Klinischen Immunologie -Pionierleistungen in Graz Leykam Verlag 2022 S. 15-26 short communication 1www.directivepublications.org