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Jing J, Guo J, Dai R, Zhu C, Zhang Z. Targeting gut microbiota and immune crosstalk: potential mechanisms of natural products in the treatment of atherosclerosis. Front Pharmacol 2023; 14:1252907. [PMID: 37719851 PMCID: PMC10504665 DOI: 10.3389/fphar.2023.1252907] [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: 07/04/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023] Open
Abstract
Atherosclerosis (AS) is a chronic inflammatory reaction that primarily affects large and medium-sized arteries. It is a major cause of cardiovascular disease and peripheral arterial occlusive disease. The pathogenesis of AS involves specific structural and functional alterations in various populations of vascular cells at different stages of the disease. The immune response is involved throughout the entire developmental stage of AS, and targeting immune cells presents a promising avenue for its treatment. Over the past 2 decades, studies have shown that gut microbiota (GM) and its metabolites, such as trimethylamine-N-oxide, have a significant impact on the progression of AS. Interestingly, it has also been reported that there are complex mechanisms of action between GM and their metabolites, immune responses, and natural products that can have an impact on AS. GM and its metabolites regulate the functional expression of immune cells and have potential impacts on AS. Natural products have a wide range of health properties, and researchers are increasingly focusing on their role in AS. Now, there is compelling evidence that natural products provide an alternative approach to improving immune function in the AS microenvironment by modulating the GM. Natural product metabolites such as resveratrol, berberine, curcumin, and quercetin may improve the intestinal microenvironment by modulating the relative abundance of GM, which in turn influences the accumulation of GM metabolites. Natural products can delay the progression of AS by regulating the metabolism of GM, inhibiting the migration of monocytes and macrophages, promoting the polarization of the M2 phenotype of macrophages, down-regulating the level of inflammatory factors, regulating the balance of Treg/Th17, and inhibiting the formation of foam cells. Based on the above, we describe recent advances in the use of natural products that target GM and immune cells crosstalk to treat AS, which may bring some insights to guide the treatment of AS.
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Affiliation(s)
- Jinpeng Jing
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jing Guo
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Rui Dai
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chaojun Zhu
- Institute of TCM Ulcers, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Surgical Department of Traditional Chinese Medicine, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhaohui Zhang
- Institute of TCM Ulcers, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Surgical Department of Traditional Chinese Medicine, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Grievink HW, Smit V, Verwilligen RAF, Bernabé Kleijn MNA, Smeets D, Binder CJ, Yagita H, Moerland M, Kuiper J, Bot I, Foks AC. Stimulation of the PD-1 Pathway Decreases Atherosclerotic Lesion Development in Ldlr Deficient Mice. Front Cardiovasc Med 2021; 8:740531. [PMID: 34790707 PMCID: PMC8591266 DOI: 10.3389/fcvm.2021.740531] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: Signaling through the coinhibitory programmed death (PD)-1/PD-L1 pathway regulates T cell responses and can inhibit ongoing immune responses. Inflammation is a key process in the development of atherosclerosis, the underlying cause for the majority of cardiovascular diseases. Dampening the excessive immune response that occurs during atherosclerosis progression by promoting PD-1/PD-L1 signaling may have a high therapeutic potential to limit disease burden. In this study we therefore aimed to assess whether an agonistic PD-1 antibody can diminish atherosclerosis development. Methods and Results: Ldlr−/− mice were fed a western-type diet (WTD) while receiving 100 μg of an agonistic PD-1 antibody or control vehicle twice a week. Stimulation of the PD-1 pathway delayed the WTD-induced monocyte increase in the circulation up to 3 weeks and reduced T cell activation and proliferation. CD4+ T cell numbers in the atherosclerotic plaque were reduced upon PD-1 treatment. More specifically, we observed a 23% decrease in atherogenic IFNγ-producing splenic CD4+ T cells and a 20% decrease in cytotoxic CD8+ T cells, whereas atheroprotective IL-10 producing CD4+ T cells were increased with 47%. Furthermore, we found an increase in regulatory B cells, B1 cells and associated atheroprotective circulating oxLDL-specific IgM levels in agonistic PD-1-treated mice. This dampened immune activation following agonistic PD-1 treatment resulted in reduced atherosclerosis development (p < 0.05). Conclusions: Our data show that stimulation of the coinhibitory PD-1 pathway inhibits atherosclerosis development by modulation of T- and B cell responses. These data support stimulation of coinhibitory pathways as a potential therapeutic strategy to combat atherosclerosis.
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Affiliation(s)
- Hendrika W Grievink
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, Netherlands.,Centre for Human Drug Research, Leiden, Netherlands
| | - Virginia Smit
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, Netherlands
| | - Robin A F Verwilligen
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, Netherlands
| | - Mireia N A Bernabé Kleijn
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, Netherlands
| | - Diede Smeets
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph J Binder
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Hideo Yagita
- Department of Immunology, Juntendo University, Tokyo, Japan
| | - Matthijs Moerland
- Centre for Human Drug Research, Leiden, Netherlands.,Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - Johan Kuiper
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, Netherlands
| | - Ilze Bot
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, Netherlands
| | - Amanda C Foks
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research (LACDR), Leiden University, Leiden, Netherlands
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Juega J, Palacio-Garcia C, Rodriguez M, Deck M, Rodriguez-Luna D, Requena M, García-Tornel Á, Rodriguez-Villatoro N, Rubiera M, Boned S, Muchada M, Ribo M, Pinana C, Hernandez D, Coscojuela P, Diaz H, Sanjuan E, Hernandez-Perez M, Dorado L, Quesada H, Cardona P, De-La-Torre C, Tomasello A, Gallur L, Sanchez M, Gonzalez-Rubio S, Camacho J, Ramon-Y-Cajal S, Álvarez-Sabin J, Molina CA, Pagola J. Monocyte-to-Lymphocyte Ratio in Clot Analysis as a Marker of Cardioembolic Stroke Etiology. Transl Stroke Res 2021; 13:949-958. [PMID: 34586594 DOI: 10.1007/s12975-021-00946-w] [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: 02/23/2021] [Revised: 09/01/2021] [Accepted: 09/10/2021] [Indexed: 11/24/2022]
Abstract
The aim of the study was to find markers of high-risk cardioembolic etiology (HRCE) in patients with cryptogenic strokes (CS) through the analysis of intracranial clot by flow cytometry (FC). A prospective single-center study was designed including patients with large vessel occlusion strokes. The percentage of granulocytes, monocytes, lymphocytes, and monocyte-to-lymphocyte ratio (MLr) were analyzed in clots extracted after endovascular treatment (EVT) and in peripheral blood. Large arterial atherosclerosis (LAA) strokes and high-risk cardioembolic (HRCE) strokes were matched by demographics and acute reperfusion treatment data to obtain FC predictors for HRCE. Multilevel decision tree with boosting random forest classifiers was performed with each feature importance for HRCE diagnosis among CS. We tested the validity of the best FC predictor in a cohort of CS that underwent extensive diagnostic workup. Among 211 patients, 178 cases underwent per-protocol workup. The percentage of monocytes (OR 1.06, 95% CI 1.01-1.11) and MLr (OR 1.83, 95% CI 1.12-2.98) independently predicted HRCE diagnosis when LAA clots (n = 28) were matched with HRCE clots (n = 28). Among CS (n = 82), MLr was the feature with the highest weighted importance in the multilevel decision tree as a predictor for HRCE. MLr cutoff point of 1.59 yield sensitivity of 91.23%, specificity of 44%, positive predictive value of 78.79%, and negative predictive value of 68.75 for HRCE diagnosis among CS. MLr ≥ 1.6 in clot analysis predicted HRCE diagnosis (OR, 6.63, 95% CI 1.85-23.71) in a multivariate model adjusted for age. Clot analysis by FC revealed high levels of monocyte-to-lymphocyte ratio as an independent marker of cardioembolic etiology in cryptogenic strokes.
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Affiliation(s)
- Jesús Juega
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Carlos Palacio-Garcia
- Hematology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Maite Rodriguez
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Matias Deck
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - David Rodriguez-Luna
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Álvaro García-Tornel
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Noelia Rodriguez-Villatoro
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Sandra Boned
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Marian Muchada
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Carlos Pinana
- Department of Neuroradiology, Valld'Hebron University Hospital, Barcelona, Spain
| | - David Hernandez
- Department of Neuroradiology, Valld'Hebron University Hospital, Barcelona, Spain
| | - Pilar Coscojuela
- Department of Neuroradiology, Valld'Hebron University Hospital, Barcelona, Spain
| | - Humberto Diaz
- Department of Neuroradiology, Valld'Hebron University Hospital, Barcelona, Spain
| | - Estela Sanjuan
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Maria Hernandez-Perez
- Stroke Unit, Department of Neurology, Germans Trias I Pujol University Hospital, Badalona, Spain
| | - Laura Dorado
- Stroke Unit, Department of Neurology, Germans Trias I Pujol University Hospital, Badalona, Spain
| | - Helena Quesada
- Stroke Unit Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Pere Cardona
- Stroke Unit Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Carolina De-La-Torre
- Stroke Unit Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - Alejandro Tomasello
- Department of Neuroradiology, Valld'Hebron University Hospital, Barcelona, Spain
| | - Laura Gallur
- Hematology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Maria Sanchez
- Hematology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Sara Gonzalez-Rubio
- Hematology Department, Vall d'Hebron University Hospital, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Jessica Camacho
- Department of Pathology Vall d, Hebron University Hospital, Barcelona, Spain
| | | | - José Álvarez-Sabin
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Jorge Pagola
- Stroke Unit, Department of Neurology, Medicine Department, Vall d'Hebron Research Institute, Valld'Hebron University Hospital, Autonomous University of Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
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