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Luo S, Ma X, Wu W, Lin S, Li M, Zhang Z, Zhu P, Song Z. Continuous Hypobaric Hypoxia may Promote Atherosclerosis Progression in Apolipoprotein E-deficient Mice. Int J Med Sci 2023; 20:849-857. [PMID: 37324194 PMCID: PMC10266041 DOI: 10.7150/ijms.78362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/07/2023] [Indexed: 06/17/2023] Open
Abstract
Background: Intermittent normobaric hypoxia can promote the progression of atherosclerotic plaques. However, the effect of continuous hypobaric hypoxia (CHH), which is a major feature of high-altitude environment, on atherosclerosis has not been investigated thoroughly. Materials and Methods: After eight weeks of high-cholesterol diet, 30 male ApoE-/- mice were randomly divided into control and CHH groups. Mice in the CHH group lived in a hypobaric chamber with an oxygen content of 10% and air pressure of 364 mmhg (equal to 5,800 m altitude above sea level) for 4 weeks, while mice in the control group lived in normoxia condition. Then all mice were euthanized and the atherosclerotic lesion size and plaque stability in the aortic root were assessed. Intraplaque angiogenesis was characterized by immunostaining of CD31 and endomucin, which are identified as specific markers of vascular endothelial cells. Immunohistochemistry and qRT-PCR were performed to measure inflammatory cytokines. Results: Four weeks of CHH exposure promoted the growth of atherosclerotic lesions (p=0.0017) and decreased the stability of atherosclerotic plaques. In CHH group, plaque smooth muscle cells and collagen contents decreased, while plaque macrophages and lipids contents increased significantly (p<0.001). The contents of CD31 (p=0.0379) and endomucin (p=0.0196) in the plaque was higher in the CHH group and correlated with angiogenesis progression. Further, the content of monocyte chemotactic protein-1 (p=0.0376) and matrix metalloproteinase-2 was significantly higher (p=0.0212) in the CHH group. Conclusions: CHH may accelerate atherosclerosis progression in ApoE-/- mice by promoting angiogenesis and inflammation.
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Affiliation(s)
- Shouming Luo
- Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaogen Ma
- Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Weiqiang Wu
- Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shu Lin
- Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Group of Neuroendocrinology, Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
- The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Mindian Li
- Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhihui Zhang
- Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ping Zhu
- Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhiyuan Song
- Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Norda S, Papadantonaki R. Regulation of cells of the arterial wall by hypoxia and its role in the development of atherosclerosis. VASA 2023; 52:6-21. [PMID: 36484144 DOI: 10.1024/0301-1526/a001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The cell's response to hypoxia depends on stabilization of the hypoxia-inducible factor 1 complex and transactivation of nuclear factor kappa-B (NF-κB). HIF target gene transcription in cells resident to atherosclerotic lesions adjoins a complex interplay of cytokines and mediators of inflammation affecting cholesterol uptake, migration, and inflammation. Maladaptive activation of the HIF-pathway and transactivation of nuclear factor kappa-B causes monocytes to invade early atherosclerotic lesions, maintaining inflammation and aggravating a low-oxygen environment. Meanwhile HIF-dependent upregulation of the ATP-binding cassette transporter ABCA1 causes attenuation of cholesterol efflux and ultimately macrophages becoming foam cells. Hypoxia facilitates neovascularization by upregulation of vascular endothelial growth factor (VEGF) secreted by endothelial cells and vascular smooth muscle cells lining the arterial wall destabilizing the plaque. HIF-knockout animal models and inhibitor studies were able to show beneficial effects on atherogenesis by counteracting the HIF-pathway in the cell wall. In this review the authors elaborate on the up-to-date literature on regulation of cells of the arterial wall through activation of HIF-1α and its effect on atherosclerotic plaque formation.
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Affiliation(s)
- Stephen Norda
- Department of Cardiovascular Medicine, University Hospital Münster, Germany
| | - Rosa Papadantonaki
- Emergency Department, West Middlesex University Hospital, Chelsea and Westminster NHS Trust, London, United Kingdom
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Lin CC, Chen WJ, Sun YK, Chiu CH, Lin MW, Tzeng IS. Effects of continuous positive airway pressure on resolvin and matrix metalloproteinase-9 in patients with obstructive sleep apnea. Respir Physiol Neurobiol 2020; 285:103603. [PMID: 33348057 DOI: 10.1016/j.resp.2020.103603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Resolvin is a checkpoint controller in inflammation. Matrix metalloproteinase-9 (MMP-9) is an airway remodeling regulator. We evaluated the levels of resolvin and MMP-9 protein in the serum and exhaled breath condensate (EBC) before and after continuous positive airway pressure (CPAP) treatment. METHOD We enrolled 20 non-OSA snorers and 40 patients with moderate to severe OSA scheduled for CPAP treatment. ELISA was used to assess resolvin and MMP-9 levels in the serum and EBC. All patients underwent sleep assessment at baseline and 3 months after CPAP. RESULTS There was no between-group difference; moreover, there were no differences in the pre- and post-treatment serum levels of resolvin and MMP-9 in patients with OSA. Compared with non-OSA snorers, patients with OSA had lower resolvin and higher MMP-9 levels in the EBC. After CPAP treatment, the EBC levels of resolvin and MMP-9 in patients with OSA returned to normal. CONCLUSIONS Successful OSA treatment by CPAP can normalize EBC levels of resolvin and MMP-9.
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Affiliation(s)
- Ching-Chi Lin
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
| | - Wei-Ji Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Lukang Christian Hospital, Changhua, Taiwan
| | - Yi-Kun Sun
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chung-Hsin Chiu
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Mei-Wei Lin
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
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Pizarro-Montaner C, Cancino-Lopez J, Reyes-Ponce A, Flores-Opazo M. Interplay between rotational work shift and high altitude-related chronic intermittent hypobaric hypoxia on cardiovascular health and sleep quality in Chilean miners. ERGONOMICS 2020; 63:1281-1292. [PMID: 32449502 DOI: 10.1080/00140139.2020.1774079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
Mining activities expose workers to diverse working conditions, rotational shifts and high altitude-related hypobaric hypoxia. Separately, each condition has been reported having a negative impact on miners' health risk; however, the combination of both stressors has been poorly explored. The present study aimed to analyse the effects of exposure to rotational work shift (RWS) alone or in combination with high altitude-related chronic intermittent hypobaric hypoxia (CIHH) on cardiometabolic, physical activity and sleep quality related markers in copper miners from Los Pelambres mine in Chile. One hundred and eleven male miners working in RWS with or without CIHH were included. Anthropometrics measures, sleep quality assessment, physical activity level (PAL) and handgrip strength were evaluated. Exposure to CIHH exacerbated the detrimental effects of RWS as miners exposed to the combination of RWS and CIHH where more obese and had a wider neck circumference, reduced PAL at work and worsened sleep quality. Practitioner summary: The purpose was to assess cardiometabolic health and sleep quality markers associated with the combined effects of rotational shift work and high altitude-related intermittent hypobaric hypoxia in miners. Findings showed a wider neck circumference, lower physical activity level and higher prevalence of poor sleep quality in exposed miners. Abbreviations: ANOVA: analysis of variance; BM: body mass; BMI: body mass index; CI: confidence intervals; CIHH: chronic intermittent hypobaric hypoxia; CV: cardiovascular; CVR: cardiovascular risk; HA: high altitude; HACE: high-altitude cerebral edema; HGS: handgrip strength; IPAQ-SF: International Physical Activity Questionnaire - Short Form; LSD: Fisher's least standardized difference; MANCOVA: multivariate general lineal model; MET: metabolic equivalent; PAL: physical activity level; PSQI: Pittsburg sleep quality index; RWS: rotational work shift; WHR: waist-to-hip ratio.
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Affiliation(s)
- Camila Pizarro-Montaner
- Master in Physical Activity and Sports Nutrition program, Universidad Mayor, Santiago, Chile
| | - Jorge Cancino-Lopez
- Laboratory of Exercise and Physical Activity Sciences, School of Physiotherapy, Universidad Finis Terrae, Santiago, Chile
| | - Alvaro Reyes-Ponce
- Faculty of Rehabilitation Sciences, School of Physiotherapy, Universidad Andres Bello, Viña del Mar, Chile
| | - Marcelo Flores-Opazo
- Laboratory of Exercise and Physical Activity Sciences, School of Physiotherapy, Universidad Finis Terrae, Santiago, Chile
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Abstract
The anoxemia theory proposes that an imbalance between the demand for and supply of oxygen in the arterial wall is a key factor in the development of atherosclerosis. There is now substantial evidence that there are regions within the atherosclerotic plaque in which profound hypoxia exists; this may fundamentally change the function, metabolism, and responses of many of the cell types found within the developing plaque and whether the plaque will evolve into a stable or unstable phenotype. Hypoxia is characterized in molecular terms by the stabilization of hypoxia-inducible factor (HIF) 1α, a subunit of the heterodimeric nuclear transcriptional factor HIF-1 and a master regulator of oxygen homeostasis. The expression of HIF-1 is localized to perivascular tissues, inflammatory macrophages, and smooth muscle cells adjacent to the necrotic core of atherosclerotic lesions and regulates several genes that are important to vascular function including vascular endothelial growth factor, nitric oxide synthase, endothelin-1, and erythropoietin. This review summarizes the effects of hypoxia on the functions of cells involved in atherogenesis and the evidence for its potential importance from experimental models and clinical studies.
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Affiliation(s)
- Gordon A A Ferns
- 1 Department of Medical Education, Brighton & Sussex Medical School, Brighton, United Kingdom
| | - Lamia Heikal
- 1 Department of Medical Education, Brighton & Sussex Medical School, Brighton, United Kingdom
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Luft FC. Hypoxemia as a model for high altitude and cardiovascular risk reduction. J Mol Med (Berl) 2016; 94:247-9. [PMID: 26915418 DOI: 10.1007/s00109-016-1390-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Friedrich C Luft
- Experimental and Clinical Research Center, Max-Delbrück Center and Charité Medical Faculty, Berlin, Germany.
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Suxiaojiuxin pill enhances atherosclerotic plaque stability by modulating the MMPs/TIMPs balance in ApoE-deficient mice. J Cardiovasc Pharmacol 2015; 64:120-6. [PMID: 24621651 DOI: 10.1097/fjc.0000000000000095] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: Suxiaojiuxin pill (SX) is a famous Chinese formulated product, which has been used to treat coronary heart disease and angina pectoris in China. This study was carried out to investigate the effect and possible mechanism of SX on the stability of atherosclerotic plaque in ApoE-deficient mice. ApoE-/- mice of 6-8 weeks old were fed with high-fat diet for developing artherosclerosis. After oral administration of SX for 8 weeks, histopathology of aortic plaque was performed by Sudan III and hematoxylin-eosin staining, and muscle protein was detected by Western blotting (WB). The mRNA and proteins associated with aortic plaque stability were detected by reverse transcription-polymerase chain reaction and WB, respectively. SX treatment could not only reduce serum triglyceride level and plaque area but also increase fibrous cap thickness and collagen content compared with the model group. WB results showed that SX could increase α-smooth muscle actin, tissue inhibitor of metalloproteinase 1 (TIMP-1), and TIMP-2 protein expression, whereas decrease matrix metalloproteinase 2 (MMP-2) and MMP-9 protein expression. Moreover, SX could upregulate the expression of α-smooth muscle actin mRNA and downregulate the expression of vascular endothelial growth factor mRNA. These results showed that SX could enhance atherosclerotic plaque stability in ApoE-deficient mice. The mechanism may be associated with modulating the MMPs/TIMPs balance.
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Wang Q, Ma S, Li D, Zhang Y, Tang B, Qiu C, Yang Y, Yang D. Dietary capsaicin ameliorates pressure overload-induced cardiac hypertrophy and fibrosis through the transient receptor potential vanilloid type 1. Am J Hypertens 2014; 27:1521-9. [PMID: 24858305 DOI: 10.1093/ajh/hpu068] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Dietary capsaicin plays a protective role in hypertension, atherosclerosis, obesity, and hyperlipidemia through activating the transient receptor potential vanilloid type 1 (TRPV1), a nonselective cation channel. This study was designed to investigate the role of capsaicin in cardiac hypertrophy and fibrosis in a pressure overload model. METHODS TRPV1 knockout (KO) mice and their wild-type (WT) littermates, aged 8 weeks, were randomly divided into sham and aortic banding surgery groups and were fed with chow or chow plus capsaicin for 10 weeks. RESULTS Dietary capsaicin significantly attenuates pressure overload-induced increase in heart weight index, enlargement of ventricular volume, decrease in cardiac function, and increase in cardiac fibrosis in WT mice. However, these effects of capsaicin were absent in TRPV1 KO mice. Additionally, capsaicin blunted pressure overload-induced upregulation of transforming growth factor β, connective tissue growth factor, and the phosphorylation of Smad2/3 in WT mice but not in TRPV1 KO mice. Moreover, capsaicin attenuated pressure overload-induced overexpression of metalloproteinase (MMP)-2, MMP-9 and MMP-13 in WT mice but not in TRPV1 KO mice. Capsaicin also attenuated angiotensin II-induced proliferation of cardiac fibroblasts from mice with the TRPV1 channel. CONCLUSIONS Our results suggest that dietary capsaicin protects against cardiac hypertrophy and fibrosis in pressure overload mice through TRPV1.
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Affiliation(s)
- Qiang Wang
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, PR China
| | - Shuangtao Ma
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, PR China
| | - De Li
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, PR China
| | - Yan Zhang
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, PR China
| | - Bing Tang
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, PR China
| | - Chenming Qiu
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, PR China
| | - Yongjian Yang
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, PR China
| | - Dachun Yang
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, PR China.
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Tuleta I, França CN, Wenzel D, Fleischmann B, Nickenig G, Werner N, Skowasch D. Hypoxia-induced endothelial dysfunction in apolipoprotein E-deficient mice; effects of infliximab and L-glutathione. Atherosclerosis 2014; 236:400-10. [PMID: 25150938 DOI: 10.1016/j.atherosclerosis.2014.08.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 08/01/2014] [Accepted: 08/04/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Obstructive sleep apnoea (OSA) has been implicated as a risk factor for atherosclerosis. The aim of our study was to examine the effects of chronic intermittent hypoxia in apoE-/- mice serving as model of OSA on endothelial dysfunction and oxidative stress and to evaluate the reversibility of hypoxia-induced changes under anti-inflammatory infliximab and anti-oxidative l-glutathione. METHODS ApoE-/- mice were divided into 4 groups (n = 9 each): 1. intermittent hypoxia 8 h/day for 6 weeks, 2. intermittent hypoxia + injections of infliximab, 3. intermittent hypoxia + injections of l-glutathione, 4. normoxia = control. RESULTS Endothelial function was impaired under hypoxia compared to control. Application of infliximab and l-glutathione improved it to a level of control. The percentage of endothelial microparticles increased under hypoxia compared to other groups. Levels of NADPH oxidase 2-derived reactive oxygen species were approximately 9 times higher in the hypoxia group. The number of sca-1/flk-1+ endothelial progenitor cells was higher in bone marrow and lower in blood under hypoxia vs. other groups. Stromal cell derived factor-1alpha- and matrix metalloproteinase-9-dependent release of these cells from bone marrow was attenuated under hypoxia. The number of DilacLDL+/lectin + early outgrowth progenitor cells and that of colony forming units from these cells were higher under hypoxia. Atherosclerotic plaques in the aorta were more frequent under hypoxia and control in comparison with both drug groups. CONCLUSION Intermittent hypoxia contributes to endothelial dysfunction by the local increase in reactive oxygen species and reduction of the peripheral repair capacity. Infliximab and l-glutathione prevent hypoxia-induced vascular and extravascular changes.
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Affiliation(s)
- Izabela Tuleta
- Department of Internal Medicine II - Cardiology, Pulmonology, University of Bonn, Bonn, Germany.
| | - Carolina Nunes França
- Department of Internal Medicine II - Cardiology, Pulmonology, University of Bonn, Bonn, Germany
| | - Daniela Wenzel
- Department of Physiology I, University of Bonn, Bonn, Germany
| | | | - Georg Nickenig
- Department of Internal Medicine II - Cardiology, Pulmonology, University of Bonn, Bonn, Germany
| | - Nikos Werner
- Department of Internal Medicine II - Cardiology, Pulmonology, University of Bonn, Bonn, Germany
| | - Dirk Skowasch
- Department of Internal Medicine II - Cardiology, Pulmonology, University of Bonn, Bonn, Germany
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ZHENG XI, WANG QIANG, ZHANG YAN, YANG DACHUN, LI DE, TANG BING, LI XIUCHUAN, YANG YONGJIAN, MA SHUANGTAO. Intermittent cold stress enhances features of atherosclerotic plaque instability in apolipoprotein E-deficient mice. Mol Med Rep 2014; 10:1679-84. [DOI: 10.3892/mmr.2014.2464] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 04/08/2014] [Indexed: 11/06/2022] Open
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Zhang Y, Wang Q, Yang D, Li D, Tang B, Yang Y, Ma S. Expression of mammalian target of rapamycin in atherosclerotic plaques is decreased under diabetic conditions: a mechanism for rapamycin resistance. Mol Med Rep 2014; 9:2388-92. [PMID: 24737099 DOI: 10.3892/mmr.2014.2141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 03/13/2014] [Indexed: 11/06/2022] Open
Abstract
Our previous study demonstrated that diabetes increases in-stent restenosis following rapamycin-eluting stent placement, which was defined as rapamycin resistance. However, the underlying mechanisms of rapamycin resistance remain to be determined. In the present study, male apolipoprotein E-deficient (ApoE-/-) mice were randomly divided into control and diabetic groups. Diabetes was induced by injecting streptozocin (STZ). The hyperglycemic state, defined as a fasting plasma glucose level >13 mmol/l, was maintained for 8 weeks. At the end of the administration, the plasma levels of triglycerides (TG) and total cholesterol (TC) were significantly elevated in the diabetic group compared with the control mice (all P<0.01). The present study revealed that diabetes increased the atherosclerotic plaque size of the aortic root (P<0.01) and the content of vascular smooth muscle cells (VSMCs) in the atherosclerotic lesion (P<0.01). Furthermore, the protein expression and phosphorylation of mammalian target of rapamycin (mTOR), 4E-binding protein 1 and ribosomal S6 kinase 1 (P<0.01) were significantly decreased in the diabetic mice compared with the control group. The decrease in the expression and phosphorylation of mTOR and its downstream kinases may be one of the molecular mechanisms underlying rapamycin resistance.
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Affiliation(s)
- Yan Zhang
- Department of Cardiology, General Hospital of PLA Chengdu Military Area Command, Chengdu, Sichuan 610083, P.R. China
| | - Qiang Wang
- Department of Cardiology, General Hospital of PLA Chengdu Military Area Command, Chengdu, Sichuan 610083, P.R. China
| | - Dachun Yang
- Department of Cardiology, General Hospital of PLA Chengdu Military Area Command, Chengdu, Sichuan 610083, P.R. China
| | - De Li
- Department of Cardiology, General Hospital of PLA Chengdu Military Area Command, Chengdu, Sichuan 610083, P.R. China
| | - Bing Tang
- Department of Cardiology, General Hospital of PLA Chengdu Military Area Command, Chengdu, Sichuan 610083, P.R. China
| | - Yongjian Yang
- Department of Cardiology, General Hospital of PLA Chengdu Military Area Command, Chengdu, Sichuan 610083, P.R. China
| | - Shuangtao Ma
- Department of Cardiology, General Hospital of PLA Chengdu Military Area Command, Chengdu, Sichuan 610083, P.R. China
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