1
|
Nasr B, Raux M, Dubosq-Lebaz M, Bamde CC, Coscas R, Gouëffic Y. The specificities of the common femoral artery anatomy, calcification and endovascular treatment. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:330-338. [PMID: 38994547 DOI: 10.23736/s0021-9509.24.13129-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Atherosclerotic lesions of the femoral artery bifurcation are one of the most complex lesion subsets commonly encountered in peripheral artery disease. Common femoral endarterectomy remains the standard of care in this location due to the bulky, eccentric, heavily calcified nature of the plaques, the frequent involvement of the femoral bifurcation, and the risk of compromising future femoral approaches. Recent studies have reported high rates of technical success and low rates of complications with endovascular treatment of the femoral artery bifurcation. This is related to improvements of endovascular equipment and the technical skills of operators. The aim of this manuscript was to provide a comprehensive review of the peculiarities of common femoral artery anatomy, calcification and treatment.
Collapse
Affiliation(s)
- Bahaa Nasr
- Department of Vascular and Endovascular Surgery, CHU Brest, Brest, France
| | - Maxime Raux
- Department of Vascular and Endovascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Maxime Dubosq-Lebaz
- Centre de l'Aorte, Department of Vascular and Endovascular Surgery, CHU Lille, Lille, France
| | - Camil-Cassien Bamde
- Cardio-vascular and Thoracic Surgery Department, Dijon University Hospital, Dijon, France
| | - Raphaël Coscas
- Department of Vascular and Endovascular Surgery, CHU Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne, France
| | - Yann Gouëffic
- Department of Vascular and Endovascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France -
| |
Collapse
|
2
|
Yang B, Hang S, Xu S, Gao Y, Yu W, Zang G, Zhang L, Wang Z. Macrophage polarisation and inflammatory mechanisms in atherosclerosis: Implications for prevention and treatment. Heliyon 2024; 10:e32073. [PMID: 38873669 PMCID: PMC11170185 DOI: 10.1016/j.heliyon.2024.e32073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 05/11/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024] Open
Abstract
Atherosclerosis is a chronic inflammatory disease characterised by plaque accumulation in the arteries. Macrophages are immune cells that are crucial in the development of atherosclerosis. Macrophages can adopt different phenotypes, with the M1 phenotype promoting inflammation while the M2 phenotype counteracting it. This review focuses on the factors that drive the polarisation of M1 macrophages towards a pro-inflammatory phenotype during AS. Additionally, we explored metabolic reprogramming mechanisms and cytokines secretion by M1 macrophages. Hyperlipidaemia is widely recognised as a major risk factor for atherosclerosis. Modified lipoproteins released in the presence of hyperlipidaemia can trigger the release of cytokines and recruit circulating monocytes, which adhere to the damaged endothelium and differentiate into macrophages. Macrophages engulf lipids, leading to the formation of foam cells. As atherosclerosis progresses, foam cells become the necrotic core within the atherosclerotic plaques, destabilising them and triggering ischaemic disease. Furthermore, we discuss recent research focusing on targeting macrophages or inflammatory pathways for preventive or therapeutic purposes. These include statins, PCSK9 inhibitors, and promising nanotargeted drugs. These new developments hold the potential for the prevention and treatment of atherosclerosis and its related complications.
Collapse
Affiliation(s)
- Bo Yang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Sanhua Hang
- Department of Hematology, Affiliated Danyang Hospital of Nantong University, Danyang, 212300, China
| | - Siting Xu
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Yun Gao
- Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Wenhua Yu
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Guangyao Zang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Lili Zhang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, China
| |
Collapse
|
3
|
Hashmi S, Shah PW, Aherrahrou Z, Aikawa E, Aherrahrou R. Beyond the Basics: Unraveling the Complexity of Coronary Artery Calcification. Cells 2023; 12:2822. [PMID: 38132141 PMCID: PMC10742130 DOI: 10.3390/cells12242822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
Coronary artery calcification (CAC) is mainly associated with coronary atherosclerosis, which is an indicator of coronary artery disease (CAD). CAC refers to the accumulation of calcium phosphate deposits, classified as micro- or macrocalcifications, that lead to the hardening and narrowing of the coronary arteries. CAC is a strong predictor of future cardiovascular events, such as myocardial infarction and sudden death. Our narrative review focuses on the pathophysiology of CAC, exploring its link to plaque vulnerability, genetic factors, and how race and sex can affect the condition. We also examined the connection between the gut microbiome and CAC, and the impact of genetic variants on the cellular processes involved in vascular calcification and atherogenesis. We aimed to thoroughly analyze the existing literature to improve our understanding of CAC and its potential clinical and therapeutic implications.
Collapse
Affiliation(s)
- Satwat Hashmi
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi 74800, Pakistan;
| | - Pashmina Wiqar Shah
- Institute for Cardiogenetics, Universität zu Lübeck, 23562 Lübeck, Germany; (P.W.S.); (Z.A.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, University Heart Centre Lübeck, 23562 Lübeck, Germany
| | - Zouhair Aherrahrou
- Institute for Cardiogenetics, Universität zu Lübeck, 23562 Lübeck, Germany; (P.W.S.); (Z.A.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, University Heart Centre Lübeck, 23562 Lübeck, Germany
| | - Elena Aikawa
- Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Rédouane Aherrahrou
- Institute for Cardiogenetics, Universität zu Lübeck, 23562 Lübeck, Germany; (P.W.S.); (Z.A.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, University Heart Centre Lübeck, 23562 Lübeck, Germany
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, FI-70211 Kuopio, Finland
| |
Collapse
|
4
|
Xu S, Wang F, Mai P, Peng Y, Shu X, Nie R, Zhang H. Mechanism Analysis of Vascular Calcification Based on Fluid Dynamics. Diagnostics (Basel) 2023; 13:2632. [PMID: 37627891 PMCID: PMC10453151 DOI: 10.3390/diagnostics13162632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Vascular calcification is the abnormal deposition of calcium phosphate complexes in blood vessels, which is regarded as the pathological basis of multiple cardiovascular diseases. The flowing blood exerts a frictional force called shear stress on the vascular wall. Blood vessels have different hydrodynamic properties due to discrepancies in geometric and mechanical properties. The disturbance of the blood flow in the bending area and the branch point of the arterial tree produces a shear stress lower than the physiological magnitude of the laminar shear stress, which can induce the occurrence of vascular calcification. Endothelial cells sense the fluid dynamics of blood and transmit electrical and chemical signals to the full-thickness of blood vessels. Through crosstalk with endothelial cells, smooth muscle cells trigger osteogenic transformation, involved in mediating vascular intima and media calcification. In addition, based on the detection of fluid dynamics parameters, emerging imaging technologies such as 4D Flow MRI and computational fluid dynamics have greatly improved the early diagnosis ability of cardiovascular diseases, showing extremely high clinical application prospects.
Collapse
Affiliation(s)
- Shuwan Xu
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518033, China; (S.X.); (F.W.); (P.M.)
| | - Feng Wang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518033, China; (S.X.); (F.W.); (P.M.)
| | - Peibiao Mai
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518033, China; (S.X.); (F.W.); (P.M.)
| | - Yanren Peng
- Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510120, China; (Y.P.); (X.S.)
| | - Xiaorong Shu
- Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510120, China; (Y.P.); (X.S.)
| | - Ruqiong Nie
- Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510120, China; (Y.P.); (X.S.)
| | - Huanji Zhang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518033, China; (S.X.); (F.W.); (P.M.)
| |
Collapse
|
5
|
Corti A, Khalil D, De Paolis A, Cardoso L. Size and proximity of micro-scale hard-inclusions increase the risk of rupture in fibroatheroma-like laboratory models. J Mech Behav Biomed Mater 2023; 141:105749. [PMID: 36924613 PMCID: PMC10081969 DOI: 10.1016/j.jmbbm.2023.105749] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/08/2023]
Abstract
Increased mechanical stresses of the fibroatheroma cap tissue is a crucial risk factor on the pathogenesis of asymptomatic coronary artery disease events. Moreover, both numerical and analytical studies have shown that microcalcifications (μCalcs) located in the fibrous cap can multiply the cap tissue stress by a factor of 2-7. This stress amplification depends on the ratio of the gap between particles (h) and their diameter (D) when they are aligned along the tensile axis. However, the synergistic effect of cap stiffness and uCalcs on the ultimate stress and rupture risk of the atheroma cap has not been fully investigated. In this context, we studied the impact of micro-beads (μBeads) of varying diameters and concentration on the rupture of silicone-based laboratory models mimicking human fibroatheroma caps of different stiffness (shear moduli μsoft = 40 kPa, μstiff = 400 kPa) and thickness (650 μm and 100 μm). A total of 145 samples were tested under uniaxial tension up to failure and the true stress and strain response of each model was derived by means of Digital Image Correlation (DIC). Before testing, samples were scanned using high-resolution Micro-CT, to perform morphometry analyses of the embedded micro-beads and determine the number of closely spaced particles (h/D<0.5). The micro-beads structural and spatial features were then compared to the case of 29 non-ruptured human atheroma fibrous caps presenting μCalcs. Samples with and without μBeads exhibited a distinct hyperelastic behavior typical of arterial tissues. Regardless of the sample stiffness, large μBeads (>80 μm) significantly reduced the ultimate tensile stress (UTS) of the thick cap models with the effect being more pronounced as the particle diameter increases. Stiff models experienced early rupture in the presence of μBeads with 40 μm diameter. Smaller μBeads of 6 μm and 20 μm didn't affect the ultimate strength of the thick cap models. However, when 6 μm μBeads where introduced in thinner cap models, we observed more than 20% drop in UTS. Increasing the μBeads concentration was also positively correlated with lower stresses at rupture as more clusters formed resulting in lower values of h/D. Morphometry analyses of cap models and human atheroma show that the 6 μm μBeads groups present very similar size distributions to μCalcs and that human μCalcs occupy an average volume ratio of 0.79 ± 0.85%. Our results clearly capture the influence of μBeads on the rupture threshold of a vascular tissue mimicking material. This effect appears to be dependent on the μBeads-to-cap thickness size ratio as well as their proximity. These findings support previous numerical and analytical studies suggesting that μCalcs located within the fibroatheroma cap may be responsible for significantly increasing the risk of cap rupture that precedes myocardial infarction and sudden death.
Collapse
Affiliation(s)
- Andrea Corti
- City College of the City University of New York, Department of Biomedical Engineering, New York, NY, 10029, USA
| | - Daniel Khalil
- City College of the City University of New York, Department of Biomedical Engineering, New York, NY, 10029, USA
| | - Annalisa De Paolis
- City College of the City University of New York, Department of Biomedical Engineering, New York, NY, 10029, USA
| | - Luis Cardoso
- City College of the City University of New York, Department of Biomedical Engineering, New York, NY, 10029, USA.
| |
Collapse
|
6
|
Azeez M, Laivuori M, Tolva J, Linder N, Lundin J, Albäck A, Venermo M, Mäyränpää MI, Lokki ML, Lokki AI, Sinisalo J. High relative amount of nodular calcification in femoral plaques is associated with milder lower extremity arterial disease. BMC Cardiovasc Disord 2022; 22:563. [PMID: 36564714 PMCID: PMC9783794 DOI: 10.1186/s12872-022-02945-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/09/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Clinical implications of different types of vascular calcification are poorly understood. The two most abundant forms of calcification, nodular and sheet calcification, have not been quantitatively analyzed in relation to the clinical presentation of lower extremity arterial disease (LEAD). METHODS The study analyzed 51 femoral artery plaques collected during femoral endarterectomy, characterized by the presence of > 90% stenosis. Comprehensive clinical data was obtained from patient records, including magnetic resonance angiography (MRA) images, toe pressure and ankle brachial index measurements and laboratory values. The plaques were longitudinally sectioned, stained with Hematoxylin and Eosin and digitized in a deep learning platform for quantification of the relative area of nodular and sheet calcification to the plaque section area. A deep learning artificial intelligence algorithm was designed and independently validated to reliably quantify nodular calcification and sheet calcification. Vessel measurements and quantity of each calcification category was compared to the risk factors and clinical presentation. RESULTS On average, > 90% stenosed vessels contained 22.4 ± 12.3% of nodular and 14.5 ± 11.8% of sheet calcification. Nodular calcification area proportion in lesions with > 90% stenosis is associated with reduced risk of critically low toe pressure (< 30 mmHg) (OR = 0.910, 95% CI = 0.835-0.992, p < 0.05), severely lowered ankle brachial index (< 0.4) (OR = 0.912, 95% CI = 0.84-0.986, p < 0.05), and semi-urgent operation (OR = 0.882, 95% CI = 0.797-0.976, p < 0.05). Sheet calcification did not show any significant association. CONCLUSIONS Large amount of nodular calcification is associated with less severe LEAD. Patients with nodular calcification may have better flow reserves despite local obstruction.
Collapse
Affiliation(s)
- Mae Azeez
- grid.7737.40000 0004 0410 2071Transplantation Laboratory, Department of Pathology, University of Helsinki, Haartmaninkatu 3, FIN-00014 Helsinki, Finland
| | - Mirjami Laivuori
- grid.15485.3d0000 0000 9950 5666Department of Vascular Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, PL 340, FIN-00029 HUS, Helsinki, Finland
| | - Johanna Tolva
- grid.7737.40000 0004 0410 2071Transplantation Laboratory, Department of Pathology, University of Helsinki, Haartmaninkatu 3, FIN-00014 Helsinki, Finland
| | - Nina Linder
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland, HILIFE, University of Helsinki, FIN-00014 Helsinki, Finland
| | - Johan Lundin
- grid.7737.40000 0004 0410 2071Institute for Molecular Medicine Finland, HILIFE, University of Helsinki, FIN-00014 Helsinki, Finland ,grid.4714.60000 0004 1937 0626Present Address: Department of Public Health Sciences, Global Health/IHCAR, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Anders Albäck
- grid.15485.3d0000 0000 9950 5666Department of Vascular Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, PL 340, FIN-00029 HUS, Helsinki, Finland
| | - Maarit Venermo
- grid.15485.3d0000 0000 9950 5666Department of Vascular Surgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, PL 340, FIN-00029 HUS, Helsinki, Finland
| | - Mikko I. Mäyränpää
- grid.7737.40000 0004 0410 2071Department of Pathology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 3, FIN-00014 Helsinki, Finland
| | - Marja-Liisa Lokki
- grid.7737.40000 0004 0410 2071Transplantation Laboratory, Department of Pathology, University of Helsinki, Haartmaninkatu 3, FIN-00014 Helsinki, Finland
| | - A. Inkeri Lokki
- grid.7737.40000 0004 0410 2071Transplantation Laboratory, Department of Pathology, University of Helsinki, Haartmaninkatu 3, FIN-00014 Helsinki, Finland ,grid.7737.40000 0004 0410 2071Translational Immunology Research Program, Research Programs Unit, University of Helsinki, Haartmaninkatu 8, FIN-00014 Helsinki, Finland ,grid.15485.3d0000 0000 9950 5666Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, PL 340, FIN-00029 HUS Helsinki, Finland
| | - Juha Sinisalo
- grid.15485.3d0000 0000 9950 5666Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, PL 340, FIN-00029 HUS Helsinki, Finland
| |
Collapse
|
7
|
Roy P, Orecchioni M, Ley K. How the immune system shapes atherosclerosis: roles of innate and adaptive immunity. Nat Rev Immunol 2022; 22:251-265. [PMID: 34389841 PMCID: PMC10111155 DOI: 10.1038/s41577-021-00584-1] [Citation(s) in RCA: 216] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 02/07/2023]
Abstract
Atherosclerosis is the root cause of many cardiovascular diseases. Extensive research in preclinical models and emerging evidence in humans have established the crucial roles of the innate and adaptive immune systems in driving atherosclerosis-associated chronic inflammation in arterial blood vessels. New techniques have highlighted the enormous heterogeneity of leukocyte subsets in the arterial wall that have pro-inflammatory or regulatory roles in atherogenesis. Understanding the homing and activation pathways of these immune cells, their disease-associated dynamics and their regulation by microbial and metabolic factors will be crucial for the development of clinical interventions for atherosclerosis, including potentially vaccination-based therapeutic strategies. Here, we review key molecular mechanisms of immune cell activation implicated in modulating atherogenesis and provide an update on the contributions of innate and adaptive immune cell subsets in atherosclerosis.
Collapse
Affiliation(s)
- Payel Roy
- Division of Inflammation Biology, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Marco Orecchioni
- Division of Inflammation Biology, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Klaus Ley
- Division of Inflammation Biology, La Jolla Institute for Immunology, La Jolla, CA, USA.
- Department of Bioengineering, University of California, San Diego, San Diego, CA, USA.
| |
Collapse
|
8
|
Brel NK, Gruzdeva OV, Kokov AN, Masenko VL, Dyleva YA, Belik EV, Barbarash OL. Relationship of visceral obesity and coronary calcinosis in ischemic heart disease. TERAPEVT ARKH 2022; 93:1428-1434. [DOI: 10.26442/00403660.2021.12.201277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Indexed: 11/22/2022]
Abstract
Aim. To assess the relationship between the prevalence of visceral obesity (VO) and the severity of coronary calcification (CC) in patients with verified coronary artery disease (CAD).
Materials and methods. 125 patients with CAD were examined. Assessment of the morphometric characteristics of visceral adipose tissue (VAT) and CC was perform using multislice computed tomography (MSCT). The calcium index (CI) of the coronary arteries (CA) was determine by the Agatston method. Statistical analysis was perform using Statistica 10.0.
Results. VO was detect in 82 (65.6%) patients with CAD. In the presence of VO, higher CC values were observed in the projection of the envelope (p=0.00014), right coronary (p=0.00002) arteries, total CI (p=0.0003), and the prevalence of massive CC. Correlation analysis showed the relationship between the area of VAT and the CC of all the studied localizations. According to the ROC analysis, VO is a significant predictor of massive CC (area under the ROC curve AUC 0.72, 95% CI 0.560.89), in contrast to body mass index BMI (AUC 0.56, 95% CI 0.310.82).
Conclusion. The index of the ratio of VAT to subcutaneous adipose tissue (VAT/SAT), but not BMI, had a direct correlation with CC. Morphology of VAT may be a significant diagnostic sign of massive CC in patients with CAD, as a factor affecting treatment and prognosis.
Collapse
|
9
|
Imaging Inflammation in Patients and Animals: Focus on PET Imaging the Vulnerable Plaque. Cells 2021; 10:cells10102573. [PMID: 34685553 PMCID: PMC8533866 DOI: 10.3390/cells10102573] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/18/2021] [Accepted: 09/23/2021] [Indexed: 02/07/2023] Open
Abstract
Acute coronary syndrome (ACS) describes a range of conditions associated with the rupture of high-risk or vulnerable plaque. Vulnerable atherosclerotic plaque is associated with many changes in its microenvironment which could potentially cause rapid plaque progression. Present-day PET imaging presents a plethora of radiopharmaceuticals designed to image different characteristics throughout plaque progression. Improved knowledge of atherosclerotic disease pathways has facilitated a growing number of pathophysiological targets for more innovative radiotracer design aimed at identifying at-risk vulnerable plaque and earlier intervention opportunity. This paper reviews the efficacy of PET imaging radiotracers 18F-FDG, 18F-NaF, 68Ga-DOTATATE, 64Cu-DOTATATE and 68Ga-pentixafor in plaque characterisation and risk assessment, as well as the translational potential of novel radiotracers in animal studies. Finally, we discuss our murine PET imaging experience and the challenges encountered.
Collapse
|
10
|
Nuotio K, Koskinen SM, Mäkitie L, Tuimala J, Ijäs P, Heikkilä HM, Saksi J, Vikatmaa P, Sorto P, Kasari S, Paakkari I, Silvennoinen H, Valanne L, Mäyränpää MI, Soinne L, Kovanen PT, Lindsberg PJ. Warfarin Treatment Is Associated to Increased Internal Carotid Artery Calcification. Front Neurol 2021; 12:696244. [PMID: 34322086 PMCID: PMC8311519 DOI: 10.3389/fneur.2021.696244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/18/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Long-term treatment with the vitamin K antagonist warfarin is widely used for the prevention of venous thrombosis and thromboembolism. However, vitamin K antagonists may promote arterial calcification, a phenomenon that has been previously studied in coronary and peripheral arteries, but not in extracranial carotid arteries. In this observational cohort study, we investigated whether warfarin treatment is associated with calcification of atherosclerotic carotid arteries. Methods: Overall, 500 consecutive patients underwent carotid endarterectomy, 82 of whom had received long-term warfarin therapy. The extent of calcification was assessed with preoperative computed tomography angiography, and both macroscopic morphological grading and microscopic histological examination of each excised carotid plaque were performed after carotid endarterectomy. Results: Compared with non-users, warfarin users had significantly more computed tomography angiography-detectable vascular calcification in the common carotid arteries (odds ratio 2.64, 95% confidence interval 1.51–4.63, P < 0.001) and even more calcification in the internal carotid arteries near the bifurcation (odds ratio 18.27, 95% confidence interval 2.53–2323, P < 0.001). Histological analysis revealed that the intramural calcified area in plaques from warfarin users was significantly larger than in plaques from non-users (95% confidence interval 3.36–13.56, P = 0.0018). Conclusions: Long-lasting warfarin anticoagulation associated with increased calcification of carotid atherosclerotic plaques, particularly in locations known to be the predilection sites of stroke-causing plaques. The clinical significance of this novel finding warrants further investigations.
Collapse
Affiliation(s)
- Krista Nuotio
- Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Suvi M Koskinen
- Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.,Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura Mäkitie
- Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | | | - Petra Ijäs
- Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Hanna M Heikkilä
- Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Jani Saksi
- Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Pirkka Vikatmaa
- Abdominal Center, Vascular Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Pia Sorto
- Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Sonja Kasari
- Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Ilari Paakkari
- Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Heli Silvennoinen
- Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leena Valanne
- Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko I Mäyränpää
- Pathology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Lauri Soinne
- Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| | - Petri T Kovanen
- Wihuri Research Institute, Biomedicum Helsinki 1, Helsinki, Finland
| | - Perttu J Lindsberg
- Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland
| |
Collapse
|
11
|
Extracellular Matrix in Calcific Aortic Valve Disease: Architecture, Dynamic and Perspectives. Int J Mol Sci 2021; 22:ijms22020913. [PMID: 33477599 PMCID: PMC7831300 DOI: 10.3390/ijms22020913] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/18/2022] Open
Abstract
Calcific Aortic Valve Disease (CAVD) is the most common valvular heart disease in developed countries and in the ageing population. It is strongly correlated to median age, affecting up to 13% of the population over the age of 65. Pathophysiological analysis indicates CAVD as a result of an active and degenerative disease, starting with sclerosis and chronic inflammation and then leaflet calcification, which ultimately can account for aortic stenosis. Although CAVD has been firstly recognized as a passive event mostly resulting from a degenerative aging process, much evidences suggests that calcification arises from different active processes, involving both aortic valve-resident cells (valve endothelial cells, valve interstitial cells, mesenchymal stem cells, innate immunity cells) and circulating cells (circulating mesenchymal cells, immunity cells). Moreover, a role for the cell-derived "matrix vesicles" and extracellular matrix (ECM) components has also been recognized. The aim of this work is to review the cellular and molecular alterations occurring in aortic valve during CAVD pathogenesis, focusing on the role of ECM in the natural course of the disease.
Collapse
|
12
|
Molecular Aspects and Prognostic Significance of Microcalcifications in Human Pathology: A Narrative Review. Int J Mol Sci 2020; 22:ijms22010120. [PMID: 33374380 PMCID: PMC7795544 DOI: 10.3390/ijms22010120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 12/17/2022] Open
Abstract
The presence of calcium deposits in human lesions is largely used as imaging biomarkers of human diseases such as breast cancer. Indeed, the presence of micro- or macrocalcifications is frequently associated with the development of both benign and malignant lesions. Nevertheless, the molecular mechanisms involved in the formation of these calcium deposits, as well as the prognostic significance of their presence in human tissues, have not been completely elucidated. Therefore, a better characterization of the biological process related to the formation of calcifications in different tissues and organs, as well as the understanding of the prognostic significance of the presence of these calcium deposits into human tissues could significantly improve the management of patients characterized by microcalcifications associated lesions. Starting from these considerations, this narrative review highlights the most recent histopathological and molecular data concerning the formation of calcifications in breast, thyroid, lung, and ovarian diseases. Evidence reported here could deeply change the current point of view concerning the role of ectopic calcifications in the progression of human diseases and also in the patients’ management. In fact, the presence of calcifications can suggest an unfavorable prognosis due to dysregulation of normal tissues homeostasis.
Collapse
|
13
|
Quaglino D, Boraldi F, Lofaro FD. The biology of vascular calcification. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2020; 354:261-353. [PMID: 32475476 DOI: 10.1016/bs.ircmb.2020.02.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Vascular calcification (VC), characterized by different mineral deposits (i.e., carbonate apatite, whitlockite and hydroxyapatite) accumulating in blood vessels and valves, represents a relevant pathological process for the aging population and a life-threatening complication in acquired and in genetic diseases. Similarly to bone remodeling, VC is an actively regulated process in which many cells and molecules play a pivotal role. This review aims at: (i) describing the role of resident and circulating cells, of the extracellular environment and of positive and negative factors in driving the mineralization process; (ii) detailing the types of VC (i.e., intimal, medial and cardiac valve calcification); (iii) analyzing rare genetic diseases underlining the importance of altered pyrophosphate-dependent regulatory mechanisms; (iv) providing therapeutic options and perspectives.
Collapse
Affiliation(s)
- Daniela Quaglino
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy.
| | - Federica Boraldi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | |
Collapse
|
14
|
|
15
|
Immune-Mediated Inflammation in Vulnerable Atherosclerotic Plaques. Molecules 2019; 24:molecules24173072. [PMID: 31450823 PMCID: PMC6749340 DOI: 10.3390/molecules24173072] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 01/16/2023] Open
Abstract
Atherosclerosis is a chronic long-lasting vascular disease leading to myocardial infarction and stroke. Vulnerable atherosclerotic (AS) plaques are responsible for these life-threatening clinical endpoints. To more successfully work against atherosclerosis, improvements in early diagnosis and treatment of AS plaque lesions are required. Vulnerable AS plaques are frequently undetectable by conventional imaging because they are non-stenotic. Although blood biomarkers like lipids, C-reactive protein, interleukin-6, troponins, and natriuretic peptides are in pathological ranges, these markers are insufficient in detecting the critical perpetuation of AS anteceding endpoints. Thus, chances to treat the patient in a preventive way are wasted. It is now time to solve this dilemma because clear results indicate a benefit of anti-inflammatory therapy per se without modification of blood lipids (CANTOS Trial, NCT01327846). This fact identifies modulation of immune-mediated inflammation as a new promising point of action for the eradication of fatal atherosclerotic endpoints.
Collapse
|
16
|
Wang Z, Zhang L, Sun Z, Shao C, Li Y, Bao Z, Jing L, Geng Y, Gu W, Pang Q, Li L, Yan J. Mechanisms of Matrix Vesicles Mediating Calcification Transition in Diabetic Plaque. Heart Lung Circ 2019; 29:112-117. [PMID: 31230870 DOI: 10.1016/j.hlc.2019.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/06/2019] [Accepted: 04/22/2019] [Indexed: 01/11/2023]
Abstract
Vascular calcification is a key character of advanced plaque in diabetic atherosclerosis. Microcalcification induces plaque rupture, whereas macrocalcification contributes to plaque stability. However, there is still no clear explanation for the formation and transition of these two types of calcification. Based on existing work and the latest international progress, this article provides a brief review of four aspects: calcification transition in plaque; matrix vesicle-mediated calcification transition in plaque; regulation mechanism of matrix vesicle-mediated calcification transition in diabetic plaque; and proposal of a new hypothesis, which may offer a new perspective on the study of the mechanism of calcification transition in plaque.
Collapse
Affiliation(s)
- Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China.
| | - Lili Zhang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
| | - Zhen Sun
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
| | - Chen Shao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
| | - Yukun Li
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
| | - Zhengyang Bao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
| | - Lele Jing
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
| | - Yue Geng
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
| | - Wen Gu
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
| | - Qiwen Pang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
| | - Lihua Li
- Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China.
| | - Jinchuan Yan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China.
| |
Collapse
|