Experimental atherosclerosis in swine

Animal models of spontaneous plaque rupture: the holy grail of experimental atherosclerosis research

Throughout the history of atherosclerosis research we have sought animal models of the disease process that exhibit high frequencies of the features that make human plaque a clinical risk: plaque rupture, mural thrombosis, and intra-plaque hemorrhage. This type of model is needed to determine the mechanisms by which plaques rupture and to design and test therapeutic interventions for stabilizing plaques. Studies of domestic and exotic animals have shown that most species will spontaneously develop fatty streaks and in some cases atheromatous lesions with sufficient time, but that rupture and thrombosis is exceedingly rare. Even with addition of fat and cholesterol to the diet, lesion development is accelerated but does not increase the frequency with which plaques rupture in most animal models. However, recently we have observed high frequencies of intra-plaque hemorrhage in the innominate/brachiocephalic arteries of older, chow-fed, hyperlipidemic, apolipoprotein E-deficient mice, and high frequencies of plaque rupture with mural thrombus in younger apolipoprotein E-deficient mice fed a high-fat diet. This suggests that plaque rupture and secondary thrombosis are frequent and reproducible occurrences at specific sites in apolipoprotein E-deficient mice, and that the timing and pathobiology of the ruptures are influenced by lipid status in this murine model.

The biologic behavior of balloon hyperinflation-induced arterial lesions in hypercholesterolemic pigs depends on the presence of foam cells

Lack of a large-animal model of accelerated atherosclerosis has limited study of the biologic behavior of atherosclerotic lesions. We hypothesized that mechanical vascular trauma combined with diet-induced hypercholesterolemia would result in rapid development of complex atherosclerosis-like lesions. Accordingly, we induced deep injury to a carotid artery by repetitive balloon hyperinflations in minipigs that were fed either an atherogenic diet (n = 30) or a standard diet (controls, n = 4) and examined the resultant lesions 1 month later. The neointimal lesions that evolved in 23 patent vessels from cholesterol-fed animals were complex, exhibiting infiltration of smooth muscle and foam cells and evidence of organized thrombus, recent thrombus, hemorrhage, and calcification. Lesions were separable histologically into two groups: foam-cell rich (n = 12), with 33 +/- 10 foam cells per high-power field, and foam-cell poor (n = 11), with 4 +/- 1 foam cells per high-power field. Minipigs with foam cell-rich lesions had higher serum cholesterol levels than those with foam cell-poor lesions (712 +/- 178 vs 468 +/- 240 mg/dL, P < .02). The incidence of intralesional thrombus was also significantly greater in foam cell-rich than in foam cell-poor lesions (50% vs 9%, P < .04). In addition, the degree of luminal stenosis was greater in the presence of lesions containing thrombus compared with those without thrombus (60 +/- 38% vs 30 +/- 29%, P = .05). Lesions in the control animals were fibrocellular and lacked foam cells and thrombus. Thus, hypercholesterolemia appeared to affect lesion composition and behavior.(ABSTRACT TRUNCATED AT 250 WORDS)

Fish oil and the prevention and regression of atherosclerosis

Epidemiological studies in the seventies have put forward that dietary rather than genetic factors are responsible for the lower incidence of ischemic heart disease in Greenland Inuit and have generated a large body of both in vitro and in vivo experimental studies, exploring the putative favorable effects of fish (oil) on atherogenesis and its risk factors. The first part of this report reviews the in vivo animal studies, concentrating on the hypercholesterolemic models and the arterialized vein graft model. In the hypercholesterolemic animal studies, the results are inconclusive as the studies reporting a protective effect are matched by the number of studies showing no effect or an adverse effect. The diversity in species, dose of fish oil, duration of study, type of vessel studied and type of fish oil preparation (content of n-3 fatty acids, unesterified n-3 fatty acids, ethylesters or triglycerides) could all contribute. Furthermore, the definitions and criteria used in the literature to evaluate atherogenesis are diverse and it appears that while one parameter is affected, another is not necessarily modified in the same direction, stressing the importance of extending the analysis of the effects on atherogenesis to more than one parameter. We also believe that it is time to reach a consensus as to which animal model mimics most closely a particular human situation. Only in appropriate models, investigating more than one atherosclerosis variable, can the effects of a putative anti-atherogenic drug or diet be verified. In the veno-arterial autograft model, mimicking the patient after coronary bypass grafting, dietary fish oil has been consistently effective in preventing accelerated graft intima proliferation. It could therefore be of interest to evaluate the effects of fish oil on graft patency in patients after coronary bypass surgery after a period of years. The results from studies on restenosis after percutaneous transluminal angioplasty are also reviewed and it is concluded that the two large scale trials, that are currently underway, might reliably answer the question whether fish oil is effective as a non-pharmacological adjuvants in the prevention of restenosis. Lastly, the studies on the effects of fish oil on the regression of experimental atherosclerosis are reviewed. In view of the small number of studies (i.e., four) investigating the effects of fish oil on the regression of atherosclerosis, it is premature to draw any conclusion, and therefore further experimental work is required.

Atherosclerotic Yucatan microswine: an animal model with high-grade, fibrocalcific, nonfatty lesions suitable for testing catheter-based interventions

A new breed of swine, the Yucatan microswine, that was derived from repetitive inbreeding of selected, small Yucatan swine, was investigated as an animal model of advanced vascular atherosclerosis. Nineteen animals were fed an atherogenic diet for 9.9 +/- 1.5 (mean +/- SEM) weeks before and 19.9 +/- 1.8 weeks after balloon endothelial denudation of all four iliac arteries. In 18 (94.7%) of the 19 microswine, angiography performed at 33 to 87 weeks of age disclosed some degree of luminal diameter narrowing: six animals (33.3%) had one-vessel, six (33.3%) had two-vessel, four (22.2%) had three-vessel, and two (11.1%) had four-vessel disease. In 38 (50%) of 76 denuded arteries, angiographically apparent luminal diameter narrowing was observed as follows: three arteries (7.9%) were narrowed less than 50%; 10 arteries (26.3%) were narrowed 50% to 75%; seven arteries (18.4%) were narrowed 76% to 99%; and 18 arteries (47.3%) were occluded. Sixty-four arteries were harvested from 16 of the 18 microswine with angiographically apparent luminal narrowing, which yielded 748 histologic sections. Maximum cross-sectional area narrowing from atherosclerotic plaque exceeded 90% in 135 (18%) of the sections examined, while 65 sections (9%) were narrowed 76% to 90%, and 127 sections (17%) were narrowed 51% to 75%. Atherosclerotic plaque in these animals appeared histologically similar to the so-called "complex" lesion that is typical of human atherosclerosis, which consists predominantly of collagen with focal calcific deposits and a minor lipid component. The smaller size and lower weight of these animals, in comparison with full-size farm pigs and "minipigs," facilitated transportation, handling, and instrumentation. These findings establish the Yucatan microswine as a useful, representative, and economical atherosclerotic animal model for the evaluation of novel interventional techniques.

Deep arterial injury during experimental angioplasty: relation to a positive indium-111-labeled platelet scintigram, quantitative platelet deposition and mural thrombosis

Although it is not clear why coronary occlusion and restenosis occur after successful coronary angioplasty, factors related to the procedure may influence early and late results. The possible adverse effects of a medial tear documented histologically and produced during balloon angioplasty of the common carotid arteries were studied in 30 fully heparinized (100 U/kg body weight) normal pigs. Scanning electron microscopy showed endothelial denudation and extensive platelet deposition in all dilated arterial segments. Visible macroscopic mural thrombus was present within an hour of the procedure in 29 (91%) of the 32 arteries that had a medial tear documented by histologic study; the tear produced an indium-111-labeled platelet deposition of 116.4 +/- 26.5 X 10(6)/cm2 (mean +/- SE) and total thrombotic occlusion in 2 arteries (4%). None of the 24 arteries without a medial tear had a thrombus, and the mean platelet deposition in that group was 7.0 +/- 0.5 X 10(6)/cm2 (p less than 0.0008). In 12 pigs scanned with a gamma camera, visible thrombus was associated with platelet deposition in excess of 20 X 10(6)/cm2 in 12 arteries, 9 of which had a positive indium-111-labeled platelet scintigram. Thus, arterial angioplasty causes deep arterial injury, which appears to be a major cause of mural thrombosis, heavy platelet deposition, a positive indium-111-labeled platelet scintigram and acute arterial occlusion. A positive indium-111-labeled platelet scintigram was always associated with macroscopic thrombus of at least 20 > 10(6) platelets/cm2 and underlying deep arterial injury.

Inhibition of atherosclerosis by cod-liver oil in a hyperlipidemic swine model

We studied the effect of cod-liver oil on the development and progression of coronary artery disease in swine subjected to coronary balloon abrasion and fed an atherogenic diet for eight months. Sections from serial 3-mm segments of the coronary arteries were analyzed morphometrically in 7 pigs given a cod-liver-oil supplement and 11 control animals not given the supplement. Significantly less disease was seen in the sections from the animals fed cod-liver oil. The mean lesion area per vessel, mean luminal encroachment per vessel, and mean maximal luminal encroachment per vessel were reduced in animals fed cod-liver oil, as compared with controls, (P = 0.05, P = 0.016, and P = 0.011, respectively). Both groups of animals had severe hyperlipidemia throughout the study. Differences in the extent of coronary atherosclerosis were not related to differences in plasma lipid levels. Platelet arachidonate was markedly reduced, platelet eicosapentaenoic acid was increased, and serum thromboxane was decreased in the oil-fed group as compared with the control group. We conclude that in our animal mode, dietary cod-liver oil retarded the development of coronary artery disease, possibly through changes in prostaglandin metabolism.

Comparison of pathologic and angiographic findings in a porcine preparation of coronary atherosclerosis

Coronary atherosclerosis was induced in Yorkshire swine by diet-induced hyperlipidemia and balloon intimal abrasion of a coronary artery. Severe stenoses pathologically similar to the lesions of human atherosclerosis were seen after 8 months of the atherogenic regimen. To examine the relationship between the angiogram and pathology in the assessment of the extent and location of coronary atherosclerosis, antemortem angiographic results were compared with results of pathologic examination. Vernier caliper measurements of the coronary angiogram were compared with results of morphometric evaluation of perfusion-fixed coronary arteries. Isolated focal stenoses were correctly localized and quantified, as were focal lesions within vessels diffusely diseased. Both overestimation and underestimation of lesions occurred at bifurcation sites. Diffuse disease without focal stenoses was not well demonstrated angiographically. Vessels that were angiographically thought to be normal or only minimally diseased demonstrated significantly larger lumens angiographically than pathologically. This is believed to be due to fixation and paraffin-processing artifact, even though fixation was performed by perfusion at physiologic pressure. The demonstration of an excellent correlation between the luminal size as determined angiographically and morphometrically at sites of focal obstruction confirms the value of quantitation of coronary angiograms in vivo as a diagnostic tool in coronary atherosclerosis.

Proteoglycan distribution in areas of differing permeability to Evans blue dye in the aortas of young pigs. An ultrastructural study

We studied proteoglycan distribution in areas of spontaneously occurring high and low permeability by TEM examination of ruthenium red-stained sections of the aortic arch of normolipemic and hyperlipemic pigs. We noted granules of two sizes: those smaller than 20 nm contained heparan sulphate, and those from 20 to 50 nm in size contained chondroitin or dermatan sulphate. In the aortas of pigs fed a normal diet, there were significantly more granules of both types in low permeability areas than in areas permeable to Evans blue dye. This is consistent with the theory that glycosaminoglycan provides a component for the control of aortic permeability. In the aortas of pigs fed cholesterol, there was an accumulation of lipid-filled monocytes in areas of high permeability and an increase in proteoglycan granule concentration, suggesting an increase in glycosaminoglycan concentration, which may be the precursor to extracellular lipid deposition.

Relations between spontaneous and induced arterial lesions in swine and arteriosclerosis in humans

The rabbit which for practical reasons is so frequently used for experimental arteriosclerosis considerably differs from humans in its metabolism, nourishment, and arterial wall responses to atherogenic noxae. In this respect, domestic pigs show more resemblance to the conditions in man, and they have recently been used for experimental research work in the field of atherosclerosis. Our own investigations performed with a view to constructing an antherosclerosis model being as far as possible resemblant to conditions prevailing in humans have shown that among various forms of diets only one combined form which is rich in cholesterol (1.5 percent) and lipids (15 percent) produces changes in the intima that in certain arterial regions correspond to lesions found in humans. These are lipofibrous beds up to complicated atheromas. The location of the spontaneous changes (without atherogenic diet) suggest that these may be considered as early stages. The various forms of development were studied light- and electron-microscopically; moreover the development of the blood lipids was determined biochemically during the experiment.

[Some mechanical properties of the pig aorta (author's transl)]

In a machine for tensile tests the ultimate strength, stress and strain of the aorta ascendens of 47 female pigs (German landrace) at three different regions of the vessel wall were determined. The animals were fattened under identical conditions in a progeny testing station and slaughtered at the same living weight (102 +/- 2 kg). Weak regressions of body weight and age on parameters measured were nevertheless accounted for. The average elastin content of the aorta ascendens diminished with advancing age but was not significantly correlated to biomechanical properties of the three single samples. Maximum load, stress and modulus of vessel wall segment I (stamped out nearer to the heart) was greater than in sample II. These circumferential segments however exhibited highly stronger biomechanical resistance than sample III, which was stamped longitudinally. In samples I and II there was a negative correlation between thickness of the wall and ultimate tensile stress (N/mm2). Freezing of the material prior to test at -18degrees C for one week resulted in a significant rise in ultimate tensile strength and stress. The meaning of these findings for comparative angiology is discussed.

The effect of renal hypertension on the regional deposition of cholesterol and phospholipid in the aorta of normally- and cholesterol-fed rabbits

The effect of renal hypertension on dry defatted tissue mass and lipid accumulation in different segments of the aortic intima was studied in both normally-fed and cholesterol-fed rabbits. In normally-fed rabbits hypertension caused an increase in intimal dry weight in the aorta. The increase was greatest in the lower thoracic intimal segment but was not significant in the aortic arch. The increase in tissue mass was not influenced by the addition of cholesterol to the diet and no regression of the increased tissue mass occurred when a 4-week period of hypertension was followed by a 4-week period of normotension. Hypertension did not increase the intimal cholesterol or phospholipid concentrations in normally-fed rabbits, suggesting that an observed increase in lipid content represented the cellular component of the intimal hypertrophy. Hypertension in cholesterol-fed animals caused preferential lipid accumulation in the lower thoracic segment, an effect that was independent of the total intimal cholesterol level. Intimal cholesterol, cholesterol ester and phospholipid were all increased. When a 4-week period of normotension and cholesterol feeding was preceded by a 4-week period of hypertension with normal feeding the amount of cholesterol deposited did not exceed that of the normotensive control, suggesting either that hypertension increased intimal permeability to lipid only in the presence of hypercholesterolaemia, or that healing of damaged intima had occurred before hypercholesterolaemia was fully established.