A pro-inflammatory and fibrous cap thinning transcriptome profile accompanies carotid plaque rupture leading to stroke

Molecular Pathways of Vulnerable Carotid Plaques at Risk of Ischemic Stroke: A Narrative Review

The concept of vulnerable carotid plaques is pivotal in understanding the pathophysiology of ischemic stroke secondary to large-artery atherosclerosis. In macroscopic evaluation, vulnerable plaques are characterized by one or more of the following features: microcalcification; neovascularization; lipid-rich necrotic cores (LRNCs); intraplaque hemorrhage (IPH); thin fibrous caps; plaque surface ulceration; huge dimensions, suggesting stenosis; and plaque rupture. Recognizing these macroscopic characteristics is crucial for estimating the risk of cerebrovascular events, also in the case of non-significant (less than 50%) stenosis. Inflammatory biomarkers, such as cytokines and adhesion molecules, lipid-related markers like oxidized low-density lipoprotein (LDL), and proteolytic enzymes capable of degrading extracellular matrix components are among the key molecules that are scrutinized for their associative roles in plaque instability. Through their quantification and evaluation, these biomarkers reveal intricate molecular cross-talk governing plaque inflammation, rupture potential, and thrombogenicity. The current evidence demonstrates that plaque vulnerability phenotypes are multiple and heterogeneous and are associated with many highly complex molecular pathways that determine the activation of an immune-mediated cascade that culminates in thromboinflammation. This narrative review provides a comprehensive analysis of the current knowledge on molecular biomarkers expressed by symptomatic carotid plaques. It explores the association of these biomarkers with the structural and compositional attributes that characterize vulnerable plaques.

Omics Approaches Unveiling the Biology of Human Atherosclerotic Plaques

Atherosclerosis is a chronic inflammatory disease of the arterial wall, characterized by the buildup of plaques with the accumulation and transformation of lipids, immune cells, vascular smooth muscle cells, and necrotic cell debris. Plaques with collagen-poor thin fibrous caps infiltrated by macrophages and lymphocytes are considered unstable because they are at the greatest risk of rupture and clinical events. However, the current histologic definition of plaque types may not fully capture the complex molecular nature of atherosclerotic plaque biology and the underlying mechanisms contributing to plaque progression, rupture, and erosion. The advances in omics technologies have changed the understanding of atherosclerosis plaque biology, offering new possibilities to improve risk prediction and discover novel therapeutic targets. Genomic studies have shed light on the genetic predisposition to atherosclerosis, and integrative genomic analyses expedite the translation of genomic discoveries. Transcriptomic, proteomic, metabolomic, and lipidomic studies have refined the understanding of the molecular signature of atherosclerotic plaques, aiding in data-driven hypothesis generation for mechanistic studies and offering new prospects for biomarker discovery. Furthermore, advancements in single-cell technologies and emerging spatial analysis techniques have unveiled the heterogeneity and plasticity of plaque cells. This review discusses key omics-based discoveries that have advanced the understanding of human atherosclerotic plaque biology, focusing on insights derived from omics profiling of human atherosclerotic vascular specimens.

MgCl2 Attenuates ox-LDL-Induced Vascular Smooth Muscle-Derived Foam Cells Pyroptosis by Downregulating the TLR4/NF-κB Signaling Pathway

Pyroptosis is a type of programmed cell death that is generally upregulated during atherosclerosis (AS). Magnesium, an important cation in the body, has exhibited an antiatherosclerotic effect. We collected AS model datasets from the Gene Expression Omnibus (GEO) and explored the correlation between pyroptosis and AS through a series of bioinformatics methods. We next investigated the impact of oxidized low-density lipoprotein (ox-LDL) on primary cultured vascular smooth muscle cells (VSMCs) foaminess and pyroptosis. Finally, foam cells were preconditioned with different concentrations of MgCl2 to explore its influence on ox-LDL-induced VSMCs pyroptosis. NLRP3-mediated pyroptosis plays a core role in regulating AS progression as shown by bioinformatic analysis. Ox-LDL (50/75/100 mg/L) increased CE/TE ratio (> 50%) in VSMCs and prompted VSMC-derived foam cell formation, and (75/100 mg/L) ox-LDL-induced pyroptosis. Compared to 1 mmol/L MgCl2, 10 mmol/L MgCl2 significantly downregulated the expression of pyroptosis related molecules in VSMCs induced by 75 mg/L ox-LDL, including NLRP3, ASC, caspase-1, and GSDMD. The secretion of IL-1β, IL-18, and LDH was also inhibited by MgCl2. According to CCK-8 and Hoechst 33,342/PI staining, the damage to VSMCs viability induced by ox-LDL was ameliorated by MgCl2. In addition, MgCl2 attenuated the upregulation of TLR4, IKKβ, and p65 and the downregulation of IκBα in VSMCs induced by ox-LDL. The present study demonstrated that pyroptosis-related genes were the core genes in AS. We also revealed the effect and underlying mechanism of MgCl2 on ox-LDL-induced VSMCs pyroptosis, suggesting that MgCl2 has promising clinical applications for AS pyroptosis prevention and treatment.

Differential Expression of Peripheral Circulating MicroRNA-146a Between Patients with Atherosclerotic Vulnerable Plaque and Stable Plaque

Atherosclerotic plaque rupture and subsequent cardiovascular complications threaten the population's health worldwide. The polymorphism of miR-146a rs2910164 was significantly associated with the risk of vulnerable plaques. However, it remains unclear whether the circulating miR-146a is differentially expressed in stable and vulnerable plaques and thus, serves as a potential biomarker.This study aims to analyze the differential expression of circulating miR-146a between patients with stable and vulnerable plaques to explore the potential molecular mechanisms.Public databases were searched from their inception up to November 2022. A study reporting the specific circulating miR-146a levels between patients with stable and vulnerable plaques was included. The study quality was assessed using the modified genetic 8-stars Newcastle-Ottawa scale. The differential expression levels of miR-146a were evaluated using the standardized mean difference (SMD).Eight studies with 978 patients were included and analyzed. The results showed that miR-146a expression levels were significantly higher in the vulnerable plaque population than in the stable plaque population (SMD: 1.91; 95% confidence interval: 1.35, 2.47; P < 0.01). A similar statistical significance was found in subgroup analyses regarding sample source, disease type, and vulnerable plaque characteristics. Sensitivity analysis suggested the robustness of the results. Analysis of downstream genes suggested that miR-146a-targeted regulation of ACTN4, SARM1, and ULK2 may affect intraplaque hemorrhage.Patients with vulnerable plaque have higher circulating miR-146a levels than those with stable plaque. However, based on the limitations of this study, high-quality studies are still needed to confirm the results.