Influx of [3H,14C]cholesterol-labelled lipoprotein into re-endothelialized and de-endothelialized areas of ballooned aortas in normal-fed and cholesterol-fed rabbits

Effects of injury on apoB kinetics and concentration in rabbit aorta

Endothelial injury or dysfunction and deposition of lipoproteins and cholesterol are key events during the development of atherosclerosis. We have studied the lipoprotein kinetics in arterial tissue in relation to endothelial injury and re-endothelialization. Endothelial injury was induced in rabbits by use of a balloon catheter. With a specific immunoradiometric assay, apoB levels in arterial tissue were measured at different time points for up to 10 weeks after injury. Forty-five minutes before being killed, the rabbits were injected with 125I-LDL, and influx of LDL was calculated from the accumulation of radioactivity in the arterial tissue. The concentration of apoB in the injured arterial tissue was four times higher than that in control arterial tissue (P < .0001). Within the lesion the concentration was as high in nonendothelialized as in re-endothelialized regions. The tissue pool of apoB was divided into a loosely bound fraction and a tightly bound fraction. The increase of apoB in the injured areas was primarily due to an increase in the tightly bound fraction. The influx of apoB was severalfold higher in nonendothelialized tissue than in re-endothelialized tissue or control areas (P < .005). When retention time was calculated, this was found to dramatically increase (by seven times) the tightly bound pool of apoB in the re-endothelialized areas. In addition to the large increase of a tightly bound apoB pool in injured areas, we found a prolonged retention time of apoB in the lesions, but only in the re-endothelialized areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Enhanced incorporation of [14C]glucosamine into glycosaminoglycans of aortic neointima of balloon-injured and cholesterol-fed rabbits in vitro

Glycosaminoglycans (GAG), which form the elementary constituent of extracellular matrix proteoglycans (PG), are implicated in the pathogenesis of atherosclerosis, mainly due to their lipoprotein binding capability and their abundance in a developing lesion during atherogenesis. However, the reasons for the increment of GAG content are poorly understood. In the present study, the influence of two well known atherogenic factors on arterial GAG synthesis were examined by estimating the incorporation of [14C]glucosamine into aortic GAG in an in vitro incubation system. Radioactivity associated with GAG was taken to represent their synthesis. GAG synthesis by neointimal tissue of rabbit aortas, 12 weeks following balloon catheter deendothelialization was measured and compared in rabbits fed a normal or 0.25% cholesterol supplemented diet for the preceding 6 weeks. In normolipaemic rabbits synthesis was found to be 12,438 +/- 173, 17,884 +/- 1390 and 15,960 +/- 1355 dpm/mg dry defatted tissue from uninjured (control), deendothelialized (DEA) and reendothelialized (REA) areas of rabbit aortas, respectively. This incorporation of radioactivity was significantly greater in hypercholesterolaemic rabbits corresponding to 13,426 +/- 239, 32,670 +/- 3077 and 27,496 +/- 3287 in the control, DEA and REA, respectively. The results demonstrated a synergistic effect of cholesterol feeding and arterial endothelial denudation in stimulating GAG synthesis. Although GAG synthesis was found to be stimulated by either cholesterol feeding or arterial injury, the stimulation by cholesterol feeding alone was only marginal. Further, results show a much higher retention of newly synthesized GAG by the tissue from REA. This study provided a possible explanation for increased GAG content in a developing proliferative lesion.

Arterial response to mechanical injury: balloon catheter de-endothelialization

Coronary angioplasty has been used clinically for over a decade. Its initial promise as an alternative to coronary bypass surgery has only partially been fulfilled because of the high rate of post-operative restenosis. A number of animal models have been devised to study this phenomenon and although none is entirely satisfactory, they have, together with recent advances in molecular biology provided an insight into the cellular mechanisms that may contribute to this complication. This knowledge may ultimately lead to a means of therapeutic intervention. This review summarises our present understanding of the pathology of post-angioplasty re-stenosis as revealed by studies using the balloon catheter de-endothelialization model, and discusses some of the intervention strategies that have been attempted.

Myointimal hyperplasia: pathogenesis and implications. 2. Animal injury models and mechanical factors

Arterial wall injury either by balloon catheter, drying, or scraping results in a denudation of endothelial cells (EC) and a subsequent proliferation of smooth-muscle cells (SMC). The degree of SMC proliferation appears to be dependent on the degree of initial injury and not to the loss of the overlying endothelium. Successful reendothelialization of denuded areas depends on the size of the denuded segment as well as SMC-EC interactions. Prolonged exposure of SMC to serum substances results in inhibition of EC regrowth, the production of prostacyclin by SMC, and the development of a thromboresistant surface. Heparin appears to inhibit SMC proliferation in vivo (as well as in vitro), an effect that is independent of platelet SMC interaction. EC-derived heparin in vivo may also result in inhibition of SMC proliferation. Platelets may play an important role in the early response to arterial injury and development of myointimal hyperplasia (MIH), but their long-term role appears to be minor. Antiplatelet agents have widely varying species-dependent effects on platelets and platelet-vessel wall interactions, but in specific circumstances they may inhibit MIH. The precise role of steroid drugs and immunosuppression on MIH in arterial injury models awaits further study. The role of lipoproteins in MIH is unclear; however, the inhibition of MIH by omega-3 fatty acids in vivo as well as their inhibition of platelet-derived growth factor production by EC in vitro implies a regulatory role. Acute hypertension results in a marked proliferation of EC and SMC in vivo and enhances the proliferative response to injury as well. Low wall shear stress, turbulence, and boundary layer separation all increase EC turnover, a likely influence on EC growth factor production. The compliance mismatch resulting from graft-artery anastomoses, injury, and endarterectomy results in locally increased cyclical stretch, which may predispose to SMC proliferation.

The arterial barrier to lipoprotein influx in the hypercholesterolemic rabbit. 2. Long-term studies in deendothelialized and reendothelialized aortas

These studies consider whether a mild aortic injury that does not increase cholesteryl ester influx during the first few days promotes atheromatosis in the hypercholesterolemic rabbit. The cholesteryl ester influx in uninjured, deendothelialized, and reendothelialized aorta was also measured in order to account for the different cholesteryl ester contents in these areas. By 32-33 days after localized aortic injury which was made after 5-7 days of cholesterol feeding, uninjured (control) areas of the thoracic aortas had accumulated 48 micrograms/cm2 each of esterified and nonesterified cholesterol due to continued cholesterol feeding. However, the previously injured deendothelialized and reendothelialized areas of the aortas had accumulated 6 and 10 times as much esterified cholesterol, and 2 and 5 times as much nonesterified cholesterol, respectively, as the adjacent uninjured areas. Esterified cholesterol influx was low during the second day after injury but increased with time so that 30-31 days later the esterified cholesterol influx in deendothelialized and reendothelialized aorta was respectively 44 and 7 times as great as the 0.1 microgram/h/cm2 in the adjacent uninjured aorta. However, expressed per mg aortic cholesteryl ester, cholesteryl ester influx in reendothelialized aorta was no greater than in noninjured aorta. These studies suggest that an injury that does not initially increase cholesteryl ester influx can promote atheromatosis and that the higher rate of cholesteryl ester influx that develops with time in reendothelialized areas is closely related to its increased cholesteryl ester content.

The arterial barrier to lipoprotein influx in the hypercholesterolemic rabbit. 1. Studies during the first two days after mild aortic injury

These studies examine the hypothesis that removal of aortic endothelium eliminates a barrier to lipoprotein cholesterol influx. The aortas of rabbits fed a cholesterol-rich diet from 7 to 16 days before balloon injury were studied 1 or 2 days after deendothelialization of specific areas of the aorta. By this design the aortic sterol content was near normal on the day of injury, but areas of injured and noninjured aorta were exposed to identical levels of elevated plasma cholesterol. Measuring the arterial [3H]- and [14C] cholesterol fractions accumulated during 2 different intervals after dosage in the same animals permitted calculation of total influx and fractional loss of aortic cholesterol. During the first 2 days after deendothelialization, total (unidirectional) cholesteryl ester influx in deendothelialized aorta was similar to that in adjacent uninjured aorta, but total influx of nonesterified cholesterol was increased. The calculated increase in influx of nonesterified cholesterol was not a result of an increase in hydrolysis of entered cholesteryl ester but probably represents increased exchange of labeled cholesterol between artery and plasma. These results suggest that subendothelial layers of the aorta of short-term cholesterol-fed rabbits function as significant barriers to lipoprotein influx and that processes other than increased permeation by lipoproteins initiate injury-induced lesions.

Enhanced accumulation and turnover of esterified cholesterol in injured rabbit aorta

Arterial injury exacerbates experimental atherogenesis. This report evaluates cholesteryl ester influx and loss during the first 5 days after arterial injury. Selected areas of aortas from rabbits made hypercholesterolemic by 12 to 16 days of cholesterol feeding were injured with a balloon catheter. This allowed measurements and a relatively precise comparison of cholesterol and cholesteryl ester influx into the uninjured and injured arterial wall within the same animal. The animals received oral doses of 3H- or 14C-cholesterol either just before injury or 1 day later. Most animals were given the other isotope of cholesterol 1 day before sacrifice, which took place 2 to 5 days after injury. Measurement of accumulated labelled esterified cholesterol within the same animal during two different time periods allowed the estimation of total influx and fractional loss of entered esterified cholesterol within the artery. Between 2 and 5 days after injury, total influx into areas of injured artery averaged 30 to 60 times the total influx into the adjacent uninjured areas. By the fifth day after injury, the esterified cholesterol content was about 10 times greater in injured areas than in adjacent, uninjured areas. The nonesterified cholesterol content of injured areas was about 70% greater than that of adjacent noninjured areas. Total influx and fractional loss of arterial cholesteryl ester calculated from radioactivity data could account for 117 +/- 6 (mean +/- SEM) percent of the cholesteryl ester mass that accumulated during the interval from injury to sacrifice. The total influx rates and daily increments in cholesteryl ester content of injured areas were positively related.

Proteoglycan composition of rabbit arterial wall under conditions of experimentally induced atherosclerosis

The concentration and composition of proteoglycans (PG) of the neointima developed following balloon catheter removal of aortic endothelium in rabbits, were assessed. PG were extracted from the aortic intimal-medial tissues with 4 M guanidinium chloride in the presence of protease inhibitors and purified subsequently by cesium chloride gradient ultracentrifugation and fractionation by high-performance liquid chromatography (HPLC). PG so obtained was analysed for its protein, cholesterol and glycosaminoglycan (GAG) content. For the characterization of the GAG moiety, an exhaustive proteolytic digestion was done. The GAG were then recovered by ethanolic precipitation and their relative distribution was determined after a selective enzymatic digestion using specific enzymes. Results show a significant increase in the amount of PG in the areas of the injured arterial wall covered by regenerated endothelium. In addition, changes in the composition of GAG were also found in the PG isolated from experimental animals when compared to PG isolated from normal aorta. A marked increase in the content of chondroitin sulfates and dermatan sulfate of injured tissue was seen. Hyaluronic acid content also changed in response to de-endothelialization and cholesterol feeding, but only moderately. The content of heparan sulfate remained unaffected in experimental tissues. Furthermore, cholesterol feeding aggravated the injury-induced increment of GAG. These findings are consistent with previously reported morphological observations, and correlate well with reports that arterial injury and cholesterol feeding act synergistically in the evolution of the atherosclerotic lesion and provide further evidence that the interaction of lipid and PG of the arterial wall may be of particular importance to our comprehension of the pathogenesis of atherosclerosis.

Pathogenesis of atherosclerosis

There is abundant evidence that changes in diet and various types of vessel wall injury can independently induce the growth of arterial lesions in experimental animals. These lesions closely resemble those found in humans with atherosclerosis. Whether endothelial injury or accumulation of lipoprotein in the arterial intima is the initial event, the progression of the disease is characterized by changes in the neointima that favor the deposition of lipid. The metabolism of proteoglycans may be especially important in this process; this is relevant to diabetes because changes in proteoglycan metabolism are associated with this disease. Insulin and growth hormone may favor the proliferation of smooth muscle cells in the arteries of diabetic patients. Many agents, which are potentially injurious to the endothelium, accentuate the response of the vessel wall to injury. Modifications of the thrombotic process, such as increased production of thromboxane by platelets, decreased production of prostacyclin by the endothelium, and increased production of von Willebrand factor further enhance the thrombotic process and may be important in the initiation and subsequent progression of atherosclerosis in diabetics. Alterations in lipoprotein metabolism may also facilitate the development of endothelial injury.