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Overmars LM, Mekke JM, van Solinge WW, De Jager SC, Hulsbergen-Veelken CA, Hoefer IE, de Kleijn DP, de Borst GJ, van der Laan SW, Haitjema S. Characteristics of peripheral blood cells are independently related to major adverse cardiovascular events after carotid endarterectomy. ATHEROSCLEROSIS PLUS 2023; 52:32-40. [PMID: 37389152 PMCID: PMC10300576 DOI: 10.1016/j.athplu.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023]
Abstract
Background and aims Patients who underwent carotid endarterectomy (CEA) still have a residual risk of 13% of developing a major adverse cardiovascular event (MACE) within 3 years. Inflammatory processes leading up to MACE are not fully understood. Therefore, we examined blood cell characteristics (BCCs), possibly reflecting inflammatory processes, in relation to MACE to identify BCCs that may contribute to an increased risk. Methods We analyzed 75 pretreatment BCCs from the Sapphire analyzer, and clinical data from the Athero-Express biobank in relation to MACE after CEA using Random Survival Forests, and a Generalized Additive Survival Model. To understand biological mechanisms, we related the identified variables to intraplaque hemorrhage (IPH). Results Of 783 patients, 97 (12%) developed MACE within 3 years after CEA. Red blood cell distribution width (RDW) (HR 1.23 [1.02, 1.68], p = 0.022), CV of lymphocyte size (LACV) (HR 0.78 [0.63, 0.99], p = 0.043), neutrophil complexity of the intracellular structure (NIMN) (HR 0.80 [0.64, 0.98], p = 0.033), mean neutrophil size (NAMN) (HR 0.67 [0.55, 0.83], p < 0.001), mean corpuscular volume (MCV) (HR 1.35 [1.09, 1.66], p = 0.005), eGFR (HR 0.65 [0.52, 0.80], p < 0.001); and HDL-cholesterol (HR 0.62 [0.45, 0.85], p = 0.003) were related to MACE. NAMN was related to IPH (OR 0.83 [0.71-0.98], p = 0.02). Conclusions This is the first study to present a higher RDW and MCV and lower LACV, NIMN and NAMN as biomarkers reflecting inflammatory processes that may contribute to an increased risk of MACE after CEA.
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Affiliation(s)
- L. Malin Overmars
- Central Diagnostics Laboratory, Division Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joost M. Mekke
- Department of Vascular Surgery, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wouter W. van Solinge
- Central Diagnostics Laboratory, Division Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Saskia C.A. De Jager
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Cornelia A.R. Hulsbergen-Veelken
- Central Diagnostics Laboratory, Division Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Imo E. Hoefer
- Central Diagnostics Laboratory, Division Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Dominique P.V. de Kleijn
- Department of Vascular Surgery, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Netherlands Heart Institute, Moreelsepark 1, 3511 EP, Utrecht, the Netherlands
| | - Gert J. de Borst
- Department of Vascular Surgery, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sander W. van der Laan
- Central Diagnostics Laboratory, Division Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Saskia Haitjema
- Central Diagnostics Laboratory, Division Laboratories, Pharmacy, and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Mekke JM, Egberts DHJ, Waissi F, Timmerman N, Bot I, Kuiper J, Pasterkamp G, de Borst GJ, de Kleijn DPV. Mast Cell Distribution in Human Carotid Atherosclerotic Plaque Differs Significantly by Histological Segment. Eur J Vasc Endovasc Surg 2021; 62:808-815. [PMID: 34531119 DOI: 10.1016/j.ejvs.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/06/2021] [Accepted: 07/11/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Mast cells (MCs) are important contributors to atherosclerotic plaque progression. For prospective studies on mast cell contributions to plaque instability, the distribution of intraplaque MCs needs to be elucidated. Plaque stability is generally histologically assessed by dividing the plaque specimen into segments to be scored on an ordinal scale. However, owing to competitive use, studies may have to deviate to adjacent segments, yet intersegment differences of plaque characteristics, especially MCs, are largely unknown. Therefore, the hypothesis that there is no segment to segment difference in MC distribution between atherosclerotic plaque segments was tested, and intersegment associations between MCs and other plaque characteristics was investigated. METHODS Twenty-six carotid atherosclerotic plaques from patients undergoing carotid endarterectomy included in the Athero-Express Biobank were analysed. The plaque was divided in 5 mm segments, differentiating between the culprit lesion (segment 0), adjacent segments (-1/+1) and more distant segments (-2/+2) for the presence of MCs. The associations between the intersegment distribution of MCs and smooth muscle cells, macrophage content, and microvessel density in the culprit lesion were studied. RESULTS A statistically significant difference in MCs/mm2 between the different plaque segments (p < .001) was found, with a median of 2.79 (interquartile range [IQR] 1.63 - 7.10) for the culprit lesion, 1.34 (IQR 0.26 - 4.45) for the adjacent segment, and 0.62 (0.14 - 2.07) for the more distant segment. Post hoc analyses showed that intersegment differences were due to differences in MCs/mm2 between the culprit and adjacent segment (p = .037) and between the culprit lesion and the more distant segment (p < .001). MCs/mm2 in multiple different segments were positively correlated with microvessel density and macrophage content in the culprit lesion. CONCLUSION MC numbers reveal significant intersegment differences in human carotid plaques. Future histological studies on MCs should use a standardised segment for plaque characterisation as plaque segments cannot be used interchangeably for histological MC analyses.
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Affiliation(s)
- Joost M Mekke
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Daan H J Egberts
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Farahnaz Waissi
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Nathalie Timmerman
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ilze Bot
- Division of BioTherapeutics, LACDR, Leiden University, Leiden, the Netherlands
| | - Johan Kuiper
- Division of BioTherapeutics, LACDR, Leiden University, Leiden, the Netherlands
| | - Gerard Pasterkamp
- Laboratory of Clinical Chemistry and Haematology, Division Laboratories and Pharmacy, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Dominique P V de Kleijn
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands.
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3
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Paraskevas KI. Prevention and treatment of strokes associated with carotid artery stenosis: a research priority. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1260. [PMID: 33178792 PMCID: PMC7607067 DOI: 10.21037/atm-2020-cass-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kosmas I Paraskevas
- Department of General and Vascular Surgery, Central Clinic of Athens, 24, Alex. Papagou Street, N. Iraklio 14122, Athens, Greece
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4
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Waissi F, Dekker M, Timmerman N, Hoogeveen RM, van Bennekom J, Dzobo KE, Schnitzler JG, Pasterkamp G, Grobbee DE, de Borst GJ, Stroes ES, de Kleijn DP, Kroon J. Elevated Lp(a) (Lipoprotein[a]) Levels Increase Risk of 30-Day Major Adverse Cardiovascular Events in Patients Following Carotid Endarterectomy. Stroke 2020; 51:2972-2982. [DOI: 10.1161/strokeaha.120.030616] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background and Purpose:
General population studies have shown that elevated Lp(a) (lipoprotein[a]) levels are an emerging risk factor for cardiovascular disease and subsequent cardiovascular events. The role of Lp(a) for the risk of secondary MACE in patients undergoing carotid endarterectomy (CEA) is unknown. Our objective is to assess the association of elevated Lp(a) levels with the risk of secondary MACE in patients undergoing CEA.
Methods:
Lp(a) concentrations were determined in preoperative blood samples of 944 consecutive patients with CEA included in the Athero-Express Biobank Study. During 3-year follow-up, major adverse cardiovascular events (MACE), consisting of myocardial infarction, stroke, and cardiovascular death, were documented.
Results:
After 3 years follow-up, Kaplan-Meier cumulative event rates for MACE were 15.4% in patients with high Lp(a) levels (>137 nmol/L; >80th cohort percentile) and 10.2% in patients with low Lp(a) levels (≤137 nmol/L; ≤80th cohort percentile; log-rank test:
P
=0.047). Cox regression analyses adjusted for conventional cardiovascular risk factors revealed a significant association between high Lp(a) levels and 3-year MACE with an adjusted hazard ratio of 1.69 (95% CI, 1.07–2.66). One-third of MACE occurred within 30 days after CEA, with an adjusted hazard ratio for the 30-day risk of MACE of 2.05 (95% CI, 1.01–4.17). Kaplan-Meier curves from time point 30 days to 3 years onward revealed no significant association between high Lp(a) levels and MACE. Lp(a) levels were not associated with histological carotid plaque characteristics.
Conclusions:
High Lp(a) levels (>137 nmol/L; >80th cohort percentile) are associated with an increased risk of 30-day MACE after CEA. This identifies elevated Lp(a) levels as a new potential risk factor for secondary cardiovascular events in patients after carotid surgery. Future studies are required to investigate whether Lp(a) levels might be useful in guiding treatment algorithms for carotid intervention.
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Affiliation(s)
- Farahnaz Waissi
- Division of Surgical Specialties, Department of Vascular Surgery (F.W., M.D., N.T., J.v.B., G.J.d.B., D.P.V.d.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands (F.W., M.D., D.P.V.d.K.)
- Department of Cardiology (F.W., M.D.), Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - Mirthe Dekker
- Division of Surgical Specialties, Department of Vascular Surgery (F.W., M.D., N.T., J.v.B., G.J.d.B., D.P.V.d.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands (F.W., M.D., D.P.V.d.K.)
- Department of Cardiology (F.W., M.D.), Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - Nathalie Timmerman
- Division of Surgical Specialties, Department of Vascular Surgery (F.W., M.D., N.T., J.v.B., G.J.d.B., D.P.V.d.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Renate M. Hoogeveen
- Department of Vascular Medicine (R.M.H., E.D.G.S.), Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - Joelle van Bennekom
- Division of Surgical Specialties, Department of Vascular Surgery (F.W., M.D., N.T., J.v.B., G.J.d.B., D.P.V.d.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Kim E. Dzobo
- Department of Experimental Vascular Medicine (K.E.D., J.G.S., J.K.), Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - Johan G. Schnitzler
- Department of Experimental Vascular Medicine (K.E.D., J.G.S., J.K.), Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - Gerard Pasterkamp
- Laboratory of Experimental Cardiology, Division Laboratories and Pharmacy, Department of Clinical Chemistry and Hematology (G.P.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care (D.E.G.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Gert J. de Borst
- Division of Surgical Specialties, Department of Vascular Surgery (F.W., M.D., N.T., J.v.B., G.J.d.B., D.P.V.d.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Erik S.G. Stroes
- Department of Vascular Medicine (R.M.H., E.D.G.S.), Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - Dominique P.V. de Kleijn
- Division of Surgical Specialties, Department of Vascular Surgery (F.W., M.D., N.T., J.v.B., G.J.d.B., D.P.V.d.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands (F.W., M.D., D.P.V.d.K.)
| | - Jeffrey Kroon
- Department of Experimental Vascular Medicine (K.E.D., J.G.S., J.K.), Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
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de Borst GJ. A Farewell to Classic Qualitative Microscope Histology Assessment. Eur J Vasc Endovasc Surg 2019; 59:488. [PMID: 31601469 DOI: 10.1016/j.ejvs.2019.09.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 09/19/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Gert J de Borst
- Department of Vascular Surgery, UMC Utrecht, Utrecht, the Netherlands.
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Spanos K, Karathanos C, Lachanas VA, Drakou A, Stamoulis K, Koutsias S, Giannoukas AD. Real-world experience of extracranial carotid artery interventions for atherosclerotic disease during a 10-year period. INT ANGIOL 2018; 37:465-470. [PMID: 30418006 DOI: 10.23736/s0392-9590.18.04043-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to assess the long-term outcome of carotid disease treatment with endarterectomy or stenting (CEA or CAS) in a real-world setting during a 10-year period. METHODS A single center retrospective study with prospectively collected data including patients (symptomatic or asymptomatic) being treated with CEA or CAS. Survival, restenosis, stroke and major adverse cardiac events (MACE) were the outcomes. RESULTS A total of 413 patients (mean age of 69±3.5 years; 80%, 333/413 males) were treated with CEA (83.7%, 346/413) or CAS (16.3%, 67/413). Most of the patients were asymptomatic (60%, 248/413). The incidence of in-hospital stroke and death was 0.5% (2/413) and 0.7% (3/413), respectively. The survival rate at 1, 3 and 5 years was 98%, 94.7% and 90.6%, respectively. The freedom of re-stenosis at 1, 3 and 5 years was 99%, 98% and 90.5%, respectively. The freedom of any stroke at 1, 3 and 5 years was 99%, 97% and 94.8%, respectively. The freedom of MACE at 1, 3 and 5 years was 97.6%, 91.5% and 86.3%, respectively. Symptomatic presentation was associated with higher rates of restenosis after CEA and higher rate of mortality (P=0.025) and MACE (P=0.022) after CAS. CONCLUSIONS Carotid interventions remain durable treatment methods of carotid disease. Long-term outcomes regarding mortality, restenosis, and risk of stroke or MACE are similar between CAS and CEA for asymptomatic patients. Symptomatic presentation may be associated with higher rates of restenosis after CEA and higher rate of mortality and MACE after CAS, however larger studies are needed to clarify this issue.
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Affiliation(s)
- Konstantinos Spanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece -
| | - Christos Karathanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Vasileios A Lachanas
- Department of Otorhinolaryngology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Aikaterini Drakou
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Stamoulis
- Department of Anesthesiology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Stylianos Koutsias
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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7
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Pothof AB, van Koeverden ID, Pasterkamp G, Schermerhorn ML, de Borst GJ. Overtreatment or Undertreatment of Carotid Disease: A Transatlantic Comparison of Carotid Endarterectomy Patient Cohorts. Circ Cardiovasc Qual Outcomes 2018; 11:e004607. [PMID: 29654001 DOI: 10.1161/circoutcomes.118.004607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/09/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Alexander B Pothof
- Department of Vascular Surgery (A.B.P., I.D.v.K., G.J.d.B.), Department of Experimental Cardiology (I.D.v.K.), and Department of Clinical Chemistry and Hematology (G.P.), University Medical Center Utrecht, The Netherlands. Department of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (A.B.P., M.L.S.)
| | - Ian D van Koeverden
- Department of Vascular Surgery (A.B.P., I.D.v.K., G.J.d.B.), Department of Experimental Cardiology (I.D.v.K.), and Department of Clinical Chemistry and Hematology (G.P.), University Medical Center Utrecht, The Netherlands. Department of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (A.B.P., M.L.S.)
| | - Gerard Pasterkamp
- Department of Vascular Surgery (A.B.P., I.D.v.K., G.J.d.B.), Department of Experimental Cardiology (I.D.v.K.), and Department of Clinical Chemistry and Hematology (G.P.), University Medical Center Utrecht, The Netherlands. Department of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (A.B.P., M.L.S.)
| | - Marc L Schermerhorn
- Department of Vascular Surgery (A.B.P., I.D.v.K., G.J.d.B.), Department of Experimental Cardiology (I.D.v.K.), and Department of Clinical Chemistry and Hematology (G.P.), University Medical Center Utrecht, The Netherlands. Department of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (A.B.P., M.L.S.)
| | - Gert J de Borst
- Department of Vascular Surgery (A.B.P., I.D.v.K., G.J.d.B.), Department of Experimental Cardiology (I.D.v.K.), and Department of Clinical Chemistry and Hematology (G.P.), University Medical Center Utrecht, The Netherlands. Department of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA (A.B.P., M.L.S.).
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8
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Jin H, Li DY, Chernogubova E, Sun C, Busch A, Eken SM, Saliba-Gustafsson P, Winter H, Winski G, Raaz U, Schellinger IN, Simon N, Hegenloh R, Matic LP, Jagodic M, Ehrenborg E, Pelisek J, Eckstein HH, Hedin U, Backlund A, Maegdefessel L. Local Delivery of miR-21 Stabilizes Fibrous Caps in Vulnerable Atherosclerotic Lesions. Mol Ther 2018; 26:1040-1055. [PMID: 29503197 PMCID: PMC6080193 DOI: 10.1016/j.ymthe.2018.01.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/08/2018] [Accepted: 01/12/2018] [Indexed: 01/22/2023] Open
Abstract
miRNAs are potential regulators of carotid artery stenosis and concordant vulnerable atherosclerotic plaques. Hence, we analyzed miRNA expression in laser captured micro-dissected fibrous caps of either ruptured or stable plaques (n = 10 each), discovering that miR-21 was significantly downregulated in unstable lesions. To functionally evaluate miR-21 in plaque vulnerability, miR-21 and miR-21/apolipoprotein-E double-deficient mice (Apoe-/-miR-21-/-) were assessed. miR-21-/- mice lacked sufficient smooth muscle cell proliferation in response to carotid ligation injury. When exposing Apoe-/-miR-21-/- mice to an inducible plaque rupture model, they presented with more atherothrombotic events (93%) compared with miR-21+/+Apoe-/- mice (57%). We discovered that smooth muscle cell fate in experimentally induced advanced lesions is steered via a REST-miR-21-REST feedback signaling pathway. Furthermore, Apoe-/-miR-21-/- mice presented with more pronounced atherosclerotic lesions, greater foam cell formation, and substantially higher levels of arterial macrophage infiltration. Local delivery of a miR-21 mimic using ultrasound-targeted microbubbles into carotid plaques rescued the vulnerable plaque rupture phenotype. In the present study, we identify miR-21 as a key modulator of pathologic processes in advanced atherosclerosis. Targeted, lesion site-specific overexpression of miR-21 can stabilize vulnerable plaques.
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Affiliation(s)
- Hong Jin
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Daniel Y Li
- Department of Vascular and Endovascular Surgery, Technical University Munich, Munich, Germany; German Center for Cardiovascular Research (DZHK), Munich, Germany
| | | | - Changyan Sun
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Albert Busch
- Department of Vascular and Endovascular Surgery, Technical University Munich, Munich, Germany; German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Suzanne M Eken
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Hanna Winter
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Greg Winski
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Uwe Raaz
- University Heart Center, Göttingen, Germany
| | | | - Nancy Simon
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Renate Hegenloh
- Department of Vascular and Endovascular Surgery, Technical University Munich, Munich, Germany; German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Ljubica Perisic Matic
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Maja Jagodic
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Ewa Ehrenborg
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Jaroslav Pelisek
- Department of Vascular and Endovascular Surgery, Technical University Munich, Munich, Germany; German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Hans-Henning Eckstein
- Department of Vascular and Endovascular Surgery, Technical University Munich, Munich, Germany; German Center for Cardiovascular Research (DZHK), Munich, Germany
| | - Ulf Hedin
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | | | - Lars Maegdefessel
- Department of Medicine, Karolinska Institute, Stockholm, Sweden; Department of Vascular and Endovascular Surgery, Technical University Munich, Munich, Germany; German Center for Cardiovascular Research (DZHK), Munich, Germany.
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