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Skenteris NT, Hemme E, Delfos L, Karadimou G, Karlöf E, Lengquist M, Kronqvist M, Zhang X, Maegdefessel L, Schurgers LJ, Arnardottir H, Biessen EAL, Bot I, Matic L. Mast cells participate in smooth muscle cell reprogramming and atherosclerotic plaque calcification. Vascul Pharmacol 2023; 150:107167. [PMID: 36958707 DOI: 10.1016/j.vph.2023.107167] [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: 01/31/2023] [Revised: 03/14/2023] [Accepted: 03/19/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Calcification, a key feature of advanced human atherosclerosis, is positively associated with vascular disease burden and adverse events. We showed that macrocalcification can be a stabilizing factor for carotid plaque molecular biology, due to inverse association with immune processes. Mast cells (MCs) are important contributors to plaque instability, but their relationship with macrocalcification is unexplored. With a hypothesis that MC activation negatively associates with carotid plaque macrocalcification, we aimed to investigate the link between MCs and carotid plaque vulnerability, and study MC role in plaque calcification via smooth muscle cells (SMCs). METHODS Pre-operative computed tomography angiographies of patients (n = 40) undergoing surgery for carotid stenosis were used to characterize plaque morphology. Plaque microarrays (n = 40 and n = 126) were used for bioinformatic deconvolution of immune cell populations. Tissue microarrays (n = 103) were used to histologically validate the contribution of activated and resting MCs in plaques. RESULTS Activated MCs and their typical markers were negatively correlated with macrocalcification. The ratio of activated vs. resting MCs was increased in low-calcified plaques from symptomatic patients. There was no modulating effect of medication on MC ratios. In vitro experiments showed that SMC calcification attenuated MC activation, while both active and resting MCs stimulated SMC calcification and induced dedifferentiation towards a pro-inflammatory-, osteochondrocyte-like phenotype, without modulating their migro-proliferative function. CONCLUSIONS Integrative analyses from human plaques showed that MC activation is inversely associated with macrocalcification and positively with parameters of plaque vulnerability. Mechanistically, MCs induce SMC osteogenic reprograming, while matrix calcification in turn attenuates MC activation, offering new therapeutic avenues for exploration.
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Affiliation(s)
- Nikolaos T Skenteris
- Cardiovascular Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden; Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, the Netherlands
| | - Esmeralda Hemme
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, the Netherlands
| | - Lucie Delfos
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, the Netherlands
| | - Glykeria Karadimou
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Eva Karlöf
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Mariette Lengquist
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Malin Kronqvist
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Xiang Zhang
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Lars Maegdefessel
- Cardiovascular Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Technical University Munich, Klinikum rechts der Isar, Department for Vascular and Endovascular Surgery, Germany
| | - Leon J Schurgers
- Department of Biochemistry and CARIM, School for Cardiovascular Diseases, Maastricht University, Netherlands; Institute of Experimental Medicine and Systems Biology, RWTH Aachen University, Aachen, Germany
| | - Hildur Arnardottir
- Cardiovascular Medicine, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Erik A L Biessen
- Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, the Netherlands
| | - Ilze Bot
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Leiden University, the Netherlands
| | - Ljubica Matic
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
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Xiong X, Duan Z, Zhou H, Huang G, Niu L, Luo Z, Li W. Correlation of apolipoprotein A‐I with T cell subsets and interferon‐ү in coronary artery disease. Immun Inflamm Dis 2023; 11:e797. [PMID: 36988256 PMCID: PMC10013138 DOI: 10.1002/iid3.797] [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: 10/23/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/15/2023] Open
Abstract
Background The association of Apolipoprotein A‐I (APOAI) with T cell subsets and interferon‐ү (IFN‐γ) in patients with coronary artery disease (CAD) has been not reported. Thus, this study aimed to investigate the association of APOAI with T cell subsets and IFN‐γ in CAD. Methods This study included a total of 107 patients with CAD including acute coronary syndrome and chronic coronary syndrome. T cell subsets, and CD3‐CD56+ natural killer cells were quantified by flow cytometric analysis. The serum concentrations of IFN‐ү were measured by enzyme‐linked immunosorbent assay. Lipid profiles, C‐reactive protein (CRP), and fibrinogen were measured in the clinical laboratory. Clinical data was obtained duration hospitalization. Results The CD4+ T cells were higher in patients of the low‐APOAI group (<median: 1.2 mmol/L) than in patients of the high‐APOAI group(≥median: 1.2 mmol/L) (p < .05). The CD8+ T cells were lower in patients of the low APOAI group than in patients of the high‐APOAI group (p < .05). APOAI was inversely associated with CD4+ T cells, IFN‐γ, and was positively associated with CD8+ T cells (p < .05). No correlation was observed between CD3 + CD56+ cells, regulatory T cells (Tregs), and CD3‐CD56+ natural killer cells and APOAI (p > .05). The high‐density lipoprotein cholesterol (HDL‐C) was also inversely associated with CD4+ T cells (p < .05), and positively associated with CD8+ T cells (p < .05). Lastly, APOA1 and HDL‐C did not correlated with fibrinogen and CRP (p > .05). Conclusion The present study demonstrated the correlation of APOAI with T cell subsets and IFN‐γ in CAD. These results provided novel information for the regulatory action between APOAI and T cell subsets and inflammatory immunity in CAD.
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Affiliation(s)
- Xinlin Xiong
- Department of cardiologyThe Affiliated Hospital of Guizhou Medical UniversityGuiyang cityGuizhou ProvincePeople's Republic of China,Department of cardiologyClinical Medical College& Affiliated Hospital of Chengdu UniversityChengdu citySichuan ProvincePeople's Republic of China
| | - Zonggang Duan
- Department of cardiologyThe Affiliated Hospital of Guizhou Medical UniversityGuiyang cityGuizhou ProvincePeople's Republic of China
| | - Haiyan Zhou
- Department of cardiologyThe Affiliated Hospital of Guizhou Medical UniversityGuiyang cityGuizhou ProvincePeople's Republic of China
| | - Guangwei Huang
- Department of cardiologyThe Affiliated Hospital of Guizhou Medical UniversityGuiyang cityGuizhou ProvincePeople's Republic of China
| | - Li Niu
- Department of cardiologyThe Affiliated Hospital of Guizhou Medical UniversityGuiyang cityGuizhou ProvincePeople's Republic of China
| | - Zhenhua Luo
- Department of Central Lab, Department of Respiratory and Critical Care Medicine, Guizhou Provincial People's HospitalThe Affiliated People's Hospital of Guizhou Medical UniversityGuiyang cityGuizhou ProvincePeople's Republic of China,Guizhou University School of MedicineGuiyang cityGuizhou ProvincePeople's Republic of China
| | - Wei Li
- Department of cardiologyThe Affiliated Hospital of Guizhou Medical UniversityGuiyang cityGuizhou ProvincePeople's Republic of China
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Mast Cells as Potential Accelerators of Human Atherosclerosis-From Early to Late Lesions. Int J Mol Sci 2019; 20:ijms20184479. [PMID: 31514285 PMCID: PMC6770933 DOI: 10.3390/ijms20184479] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/21/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023] Open
Abstract
Mast cells are present in atherosclerotic lesions throughout their development. The process of atherogenesis itself is characterized by infiltration and retention of cholesterol-containing blood-derived low-density lipoprotein (LDL) particles in the intimal layer of the arterial wall, where the particles become modified and ingested by macrophages, resulting in the formation of cholesterol-filled foam cells. Provided the blood-derived high-density lipoproteins (HDL) particles are able to efficiently carry cholesterol from the foam cells back to the circulation, the early lesions may stay stable or even disappear. However, the modified LDL particles also trigger a permanent local inflammatory reaction characterized by the presence of activated macrophages, T cells, and mast cells, which drive lesion progression. Then, the HDL particles become modified and unable to remove cholesterol from the foam cells. Ultimately, the aging foam cells die and form a necrotic lipid core. In such advanced lesions, the lipid core is separated from the circulating blood by a collagenous cap, which may become thin and fragile and susceptible to rupture, so causing an acute atherothrombotic event. Regarding the potential contribution of mast cells in the initiation and progression of atherosclerotic lesions, immunohistochemical studies in autopsied human subjects and studies in cell culture systems and in atherosclerotic mouse models have collectively provided evidence that the compounds released by activated mast cells may promote atherogenesis at various steps along the path of lesion development. This review focuses on the presence of activated mast cells in human atherosclerotic lesions. Moreover, some of the molecular mechanisms potentially governing activation and effector functions of mast cells in such lesions are presented and discussed.
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Mohajeri M, Kovanen PT, Bianconi V, Pirro M, Cicero AFG, Sahebkar A. Mast cell tryptase - Marker and maker of cardiovascular diseases. Pharmacol Ther 2019; 199:91-110. [PMID: 30877022 DOI: 10.1016/j.pharmthera.2019.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/01/2019] [Indexed: 12/14/2022]
Abstract
Mast cells are tissue-resident cells, which have been proposed to participate in various inflammatory diseases, among them the cardiovascular diseases (CVDs). For mast cells to be able to contribute to an inflammatory process, they need to be activated to exocytose their cytoplasmic secretory granules. The granules contain a vast array of highly bioactive effector molecules, the neutral protease tryptase being the most abundant protein among them. The released tryptase may act locally in the inflamed cardiac or vascular tissue, so contributing directly to the pathogenesis of CVDs. Moreover, a fraction of the released tryptase reaches the systemic circulation, thereby serving as a biomarker of mast cell activation. Actually, increased levels of circulating tryptase have been found to associate with CVDs. Here we review the biological relevance of the circulating tryptase as a biomarker of mast cell activity in CVDs, with special emphasis on the relationship between activation of mast cells in their tissue microenvironments and the pathophysiological pathways of CVDs. Based on the available in vitro and in vivo studies, we highlight the potential molecular mechanisms by which tryptase may contribute to the pathogenesis of CVDs. Finally, the synthetic and natural inhibitors of tryptase are reviewed for their potential utility as therapeutic agents in CVDs.
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Affiliation(s)
- Mohammad Mohajeri
- Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Vanessa Bianconi
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Matteo Pirro
- Unit of Internal Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Arrigo F G Cicero
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Nuotio K, Ijäs P, Heikkilä HM, Koskinen SM, Saksi J, Vikatmaa P, Sorto P, Mäkitie L, Eriksson H, Kasari S, Silvennoinen H, Valanne L, Mäyränpää MI, Kovanen PT, Soinne L, Lindsberg PJ. Morphology and histology of silent and symptom-causing atherosclerotic carotid plaques - Rationale and design of the Helsinki Carotid Endarterectomy Study 2 (the HeCES2). Ann Med 2018; 50:501-510. [PMID: 30010425 DOI: 10.1080/07853890.2018.1494851] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Every fifth ischemic stroke is caused by thromboembolism originating from an atherosclerotic carotid artery plaque. While prevention is the most cost-effective stroke therapy, antiplatelet and cholesterol-lowering drugs have a ceiling effect in their efficacy. Therefore, discovery of novel pathophysiologic targets are needed to improve the primary and secondary prevention of stroke. This article provides a detailed study design and protocol of HeCES2, an observational prospective cohort study with the objective to investigate the pathophysiology of carotid atherosclerosis. MATERIALS AND METHODS Recruitment and carotid endarterectomies of the study patients with carotid atherosclerosis were performed from October 2012 to September 2015. After brain and carotid artery imaging, endarterectomised carotid plaques (CPs) and blood samples were collected from 500 patients for detailed biochemical and molecular analyses. Findings to date: We developed a morphological grading for macroscopic characteristics within CPs. The dominant macroscopic CP characteristics were: smoothness 62%, ulceration 61%, intraplaque hemorrhage 60%, atheromatous gruel 59%, luminal coral-type calcification 34%, abundant (44%) and moderate (39%) intramural calcification, and symptom-causing "hot spot" area 53%. Future plans: By combining clinically oriented and basic biomedical research, this large-scale study attempts to untangle the pathophysiological perplexities of human carotid atherosclerosis. Key Messages This article is a rationale and design of the HeCES2 study that is an observational prospective cohort study with the objective to investigate the pathophysiology of carotid atherosclerosis. The HeCES2 study strives to develop diagnostic algorithms including radiologic imaging to identify carotid atherosclerosis patients who warrant surgical treatment. In addition, the study aims at finding out new tools for clinical risk stratification as well as novel molecular targets for drug development.
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Affiliation(s)
- Krista Nuotio
- a Molecular Neurology, Research Programs Unit, Biomedicum Helsinki , University of Helsinki , Helsinki , Finland.,b Department of Neurology , Helsinki University Hospital and Clinical Neurosciences, University of Helsinki , Helsinki , Finland
| | - Petra Ijäs
- a Molecular Neurology, Research Programs Unit, Biomedicum Helsinki , University of Helsinki , Helsinki , Finland.,b Department of Neurology , Helsinki University Hospital and Clinical Neurosciences, University of Helsinki , Helsinki , Finland
| | - Hanna M Heikkilä
- a Molecular Neurology, Research Programs Unit, Biomedicum Helsinki , University of Helsinki , Helsinki , Finland
| | - Suvi M Koskinen
- c Clinicum, Department of Neurosciences , University of Helsinki , Helsinki , Finland.,d Department of Radiology, Hospital District of Helsinki and Uusimaa Medical Imaging Center , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Jani Saksi
- a Molecular Neurology, Research Programs Unit, Biomedicum Helsinki , University of Helsinki , Helsinki , Finland
| | - Pirkka Vikatmaa
- e Abdominal Center, Vascular Surgery, Helsinki University Hospital , Helsinki , Finland
| | - Pia Sorto
- a Molecular Neurology, Research Programs Unit, Biomedicum Helsinki , University of Helsinki , Helsinki , Finland
| | - Laura Mäkitie
- a Molecular Neurology, Research Programs Unit, Biomedicum Helsinki , University of Helsinki , Helsinki , Finland.,b Department of Neurology , Helsinki University Hospital and Clinical Neurosciences, University of Helsinki , Helsinki , Finland
| | - Henrietta Eriksson
- a Molecular Neurology, Research Programs Unit, Biomedicum Helsinki , University of Helsinki , Helsinki , Finland.,b Department of Neurology , Helsinki University Hospital and Clinical Neurosciences, University of Helsinki , Helsinki , Finland
| | - Sonja Kasari
- a Molecular Neurology, Research Programs Unit, Biomedicum Helsinki , University of Helsinki , Helsinki , Finland
| | - Heli Silvennoinen
- d Department of Radiology, Hospital District of Helsinki and Uusimaa Medical Imaging Center , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Leena Valanne
- d Department of Radiology, Hospital District of Helsinki and Uusimaa Medical Imaging Center , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Mikko I Mäyränpää
- f Department of Pathology , University of Helsinki and HUSLAB, Helsinki University Hospital , Helsinki , Finland
| | | | - Lauri Soinne
- a Molecular Neurology, Research Programs Unit, Biomedicum Helsinki , University of Helsinki , Helsinki , Finland.,b Department of Neurology , Helsinki University Hospital and Clinical Neurosciences, University of Helsinki , Helsinki , Finland
| | - Perttu J Lindsberg
- a Molecular Neurology, Research Programs Unit, Biomedicum Helsinki , University of Helsinki , Helsinki , Finland.,b Department of Neurology , Helsinki University Hospital and Clinical Neurosciences, University of Helsinki , Helsinki , Finland
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Kovanen PT, Bot I. Mast cells in atherosclerotic cardiovascular disease – Activators and actions. Eur J Pharmacol 2017; 816:37-46. [DOI: 10.1016/j.ejphar.2017.10.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 12/19/2022]
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Plotkin JD, Elias MG, Dellinger AL, Kepley CL. NF-κB inhibitors that prevent foam cell formation and atherosclerotic plaque accumulation. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2017; 13:2037-2048. [PMID: 28457935 DOI: 10.1016/j.nano.2017.04.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 03/30/2017] [Accepted: 04/16/2017] [Indexed: 11/30/2022]
Abstract
The transformation of monocyte-derived macrophages into lipid-laden foam cells is one inflammatory process underlying atherosclerotic disease. Previous studies have demonstrated that fullerene derivatives (FDs) have inflammation-blunting properties. Thus, it was hypothesized that FD could inhibit the transformation process underlying foam cell formation. Fullerene derivatives inhibited the phorbol myristic acid/oxidized low-density lipoprotein-induced differentiation of macrophages into foam cells as determined by lipid staining and morphology.Lipoprotein-induced generation of TNF-α, C5a-induced MC activation, ICAM-1 driven adhesion, and CD36 expression were significantly inhibited in FD treated cells compared to non-treated cells. Inhibition appeared to be mediated through the NF-κB pathway as FD reduced expression of NF-κB and atherosclerosis-associated genes. Compared to controls, FD dramatically inhibited plaque formation in arteries of apolipoprotein E null mice. Thus, FD may be an unrecognized therapy to prevent atherosclerotic lesions via inhibition of foam cell formation and MC stabilization.
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Affiliation(s)
- Jesse D Plotkin
- University of North Carolina Greensboro, Joint School of Nanoscience and Nanoengineering, Greensboro, NC, United States
| | - Michael G Elias
- University of North Carolina Greensboro, Joint School of Nanoscience and Nanoengineering, Greensboro, NC, United States
| | - Anthony L Dellinger
- University of North Carolina Greensboro, Joint School of Nanoscience and Nanoengineering, Greensboro, NC, United States
| | - Christopher L Kepley
- University of North Carolina Greensboro, Joint School of Nanoscience and Nanoengineering, Greensboro, NC, United States.
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Moreno M, Puig J, Serrano M, Moreno-Navarrete JM, Ortega F, Ricart W, Fernandez-Real JM. Circulating tryptase as a marker for subclinical atherosclerosis in obese subjects. PLoS One 2014; 9:e97014. [PMID: 24830464 PMCID: PMC4022630 DOI: 10.1371/journal.pone.0097014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/14/2014] [Indexed: 01/04/2023] Open
Abstract
Introduction Mast cells participate in atherogenesis by releasing cytokines to induce vascular cell protease expression. Tryptase is expressed highly in human atherosclerotic lesions and the inhibition of tryptase activity hampers its capacity to maintain cholesterol inside macrophague foam cells. We aimed to investigate the association between circulating tryptase levels and subclinical atherosclerosis through estimation of carotid intima-media thickness (c-IMT) as surrogate marker for increased cardiovascular risk in obese and non-obese subjects. Methods Circulating tryptase levels (ELISA) and metabolic parameters were analyzed in 228 subjects. Atherosclerosis (c-IMT>0.9 mm) was evaluated ultrasonographically. Results Significant positive associations were evident between circulating tryptase levels and BMI, fat mass, glycated haemoglobin, fasting insulin, HOMAIR, fasting triglycerides and ultrasensitive PCR (p<0.05 from linear-trend ANOVA). The positive association between tryptase levels and insulin resistance parameters, suggested a glucose homeostasis impairment in individuals with higher tryptase levels. The negative asociation between tryptase levels and HDL-cholesterol supports the proatherogenic role of this protease (p<0.0001). Circulating tryptase levels were strongly associated with c-IMT measurements (p<0.0001 from linear-trend ANOVA), and were higher in subjects with presence of carotid plaque (p<0.0001). Tryptase levels (beta = 0.015, p = 0.001) contributed independently to subclinical atherosclerosis variance after controlling for cardiovascular risk factors (BMI, blood pressure, LDL-cholesterol). Conclusions Circulating tryptase level is associated to obesity related parameters and has a close relation with various metabolic risk factors. Moreover, serum tryptase level was independently associated with c-IMT, suggesting its potential use as a surrogate marker for subclinical atherosclerosis in obese subjects.
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Affiliation(s)
- María Moreno
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi), CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
| | - Josep Puig
- Department of Radiology, Institut d'Investigació Biomèdica de Girona (IdIBGi), CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
| | - Marta Serrano
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi), CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
| | - José María Moreno-Navarrete
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi), CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
| | - Francisco Ortega
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi), CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
| | - Wifredo Ricart
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi), CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
| | - Jose Manuel Fernandez-Real
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdIBGi), CIBEROBN (CB06/03/010) and Instituto de Salud Carlos III (ISCIII), Girona, Spain
- * E-mail:
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Salem SAM, Attia EAS, Osman WM, El Gendy MA. Skin tags: a link between lesional mast cell count/tryptase expression and obesity and dyslipidemia. Indian J Dermatol 2013; 58:240. [PMID: 23723485 PMCID: PMC3667297 DOI: 10.4103/0019-5154.110843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The etiology of skin tags (STs) is not fully understood. A relation to diabetes mellitus and obesity was suggested. Few studies of possible mast cells (MCs) involvement were reported. Tyrptase is a mast cell mediator and a potent fibroblast growth factor. It may provide a molecular link between mast cell activation and fibrosis. AIMS The aim was to assess clinical and laboratory findings in patients with STs, and the possible link between obesity, dyslipidemia, and lesional MC count/tryptase expression. MATERIALS AND METHODS A total of 20 patients with STs were subjected to clinical examination, estimation of body mass index (BMI), fasting blood glucose (FBG), postprandial blood glucose (PPBG), serum cholesterol and triglycerides, abdominal ultrasound for fatty liver assessment, in addition to study of MCs through staining for MC tryptase in two skin biopsies; lesional and nonlesional (control). RESULTS All patients showed abnormally high BMI and hypertriglyceridemia, with abnormal sonographic pattern in 15 patients (75%). STs number positively correlated with the age of patients. STs showed significantly higher MC counts and tryptase expression, compared with control skin (P < 0.001), with no correlation of the STs number or MC count with BMI, FBG, PPBG or serum cholesterol. Obese patients showed a significantly higher MC count than overweight and there was a positive correlation between MC count and serum triglycerides. Axilla and under breast STs showed a higher MC count compared with other sites. CONCLUSIONS STs seem to be related to obesity and hypertriglyceridemia. MCs with their tryptase are possibly involved in pathogenesis of STs. MC count is related to the associated factors; obesity and serum triglycerides. MC tryptase expression is a reliable method for accurate tissue MC counting.
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Affiliation(s)
| | - Enas AS Attia
- From the Department of Dermatology, Venereology and Andrology, Cairo, Egypt
| | - Wesam M Osman
- Department of Pathology, Faculty of Medicine Ain Shams University, Cairo, Egypt
| | - Marwa A El Gendy
- From the Department of Dermatology, Venereology and Andrology, Cairo, Egypt
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Saksi J, Ijäs P, Nuotio K, Sonninen R, Soinne L, Salonen O, Saimanen E, Tuimala J, Lehtonen-Smeds EM, Kaste M, Kovanen PT, Lindsberg PJ. Gene expression differences between stroke-associated and asymptomatic carotid plaques. J Mol Med (Berl) 2011; 89:1015-26. [PMID: 21607540 PMCID: PMC3170468 DOI: 10.1007/s00109-011-0773-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 05/06/2011] [Accepted: 05/11/2011] [Indexed: 02/02/2023]
Abstract
Atherosclerotic carotid stenosis is an important risk factor for stroke. Carotid plaques (CPs) causing stroke may present a distinct type of molecular pathology compared with transient ischemic attack (TIA)-associated or asymptomatic plaques. We compared the gene expression profiles of CPs from stroke patients (n = 12) and asymptomatic patients (n = 9), both with similar risk factors and severity of carotid stenosis (>70%). Sixty probes showed over 1.5-fold expression difference at 5% false discovery rate. Functional clustering showed enrichment of genes in 51 GO categories and seven pathways, the most significant of which relate to extracellular-matrix interaction, PPAR gamma signaling, scavanger receptor activity, and lysosomal activity. Differential expression of ten genes was confirmed in an extended replication group (n = 43), where the most significant expression differences were found in CD36 (2.1-fold change, p = 0.005), CD163 (1.7-fold change, p = 0.007) and FABP4 (2.2-fold change, p = 0.015). These include four genes not previously linked to plaque destabilization: GLUL (2.2-fold change, p = 0.016), FUCA1 (2.2-fold change, p = 0.025), IL1RN (1.6-fold change, p = 0.034), and S100A8 (2.5-fold change, p = 0.047). Strong correlations were found to plaque ulceration, plaque hemorrhage, and markers of apoptosis and proliferation (activated caspase 3, TUNEL, and Ki67). Protein expression of these genes was confirmed by immunohistochemistry and was found in the atheromatous areas of CPs critical for plaque destabilization. This study presents a comprehensive transcriptional analysis of stroke-associated CPs and demonstrates a significant transcriptome difference between stroke-associated and asymptomatic CPs. Follow-up studies on the identified genes are needed to define whether they could be used as biomarkers of symptomatic CPs or have a role in plaque destabilization.
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Affiliation(s)
- Jani Saksi
- Research Programs Unit, Molecular Neurology, Biomedicum Helsinki, University of Helsinki, P.O. Box700, Haartmaninkatu 8, FI-00290, Helsinki, Finland.
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Cheuk B, Cheng S. Annexin A1 Expression in Atherosclerotic Carotid Plaques and its Relationship with Plaque Characteristics. Eur J Vasc Endovasc Surg 2011; 41:364-71. [DOI: 10.1016/j.ejvs.2010.11.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 11/20/2010] [Indexed: 11/28/2022]
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12
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Isoviita PM, Nuotio K, Saksi J, Turunen R, Ijäs P, Pitkäniemi J, Soinne L, Kaste M, Kovanen PT, Lindsberg PJ. An Imbalance Between CD36 and ABCA1 Protein Expression Favors Lipid Accumulation in Stroke-Prone Ulcerated Carotid Plaques. Stroke 2010; 41:389-93. [DOI: 10.1161/strokeaha.109.567636] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pia M. Isoviita
- From Research Program of Molecular Neurology (P.M.I., K.N., J.S., R.T., P.I., L.S., P.J.L.), Biomedicum Helsinki, Finland; Department of Neurology (K.N., P.I., L.S., M.K., P.J.L.), Helsinki University Central Hospital, Finland; Department of Public Health (J.P.), University of Helsinki, Finland; Wihuri Research Institute (P.T.K.), Helsinki, Finland
| | - Krista Nuotio
- From Research Program of Molecular Neurology (P.M.I., K.N., J.S., R.T., P.I., L.S., P.J.L.), Biomedicum Helsinki, Finland; Department of Neurology (K.N., P.I., L.S., M.K., P.J.L.), Helsinki University Central Hospital, Finland; Department of Public Health (J.P.), University of Helsinki, Finland; Wihuri Research Institute (P.T.K.), Helsinki, Finland
| | - Jani Saksi
- From Research Program of Molecular Neurology (P.M.I., K.N., J.S., R.T., P.I., L.S., P.J.L.), Biomedicum Helsinki, Finland; Department of Neurology (K.N., P.I., L.S., M.K., P.J.L.), Helsinki University Central Hospital, Finland; Department of Public Health (J.P.), University of Helsinki, Finland; Wihuri Research Institute (P.T.K.), Helsinki, Finland
| | - Riitta Turunen
- From Research Program of Molecular Neurology (P.M.I., K.N., J.S., R.T., P.I., L.S., P.J.L.), Biomedicum Helsinki, Finland; Department of Neurology (K.N., P.I., L.S., M.K., P.J.L.), Helsinki University Central Hospital, Finland; Department of Public Health (J.P.), University of Helsinki, Finland; Wihuri Research Institute (P.T.K.), Helsinki, Finland
| | - Petra Ijäs
- From Research Program of Molecular Neurology (P.M.I., K.N., J.S., R.T., P.I., L.S., P.J.L.), Biomedicum Helsinki, Finland; Department of Neurology (K.N., P.I., L.S., M.K., P.J.L.), Helsinki University Central Hospital, Finland; Department of Public Health (J.P.), University of Helsinki, Finland; Wihuri Research Institute (P.T.K.), Helsinki, Finland
| | - Janne Pitkäniemi
- From Research Program of Molecular Neurology (P.M.I., K.N., J.S., R.T., P.I., L.S., P.J.L.), Biomedicum Helsinki, Finland; Department of Neurology (K.N., P.I., L.S., M.K., P.J.L.), Helsinki University Central Hospital, Finland; Department of Public Health (J.P.), University of Helsinki, Finland; Wihuri Research Institute (P.T.K.), Helsinki, Finland
| | - Lauri Soinne
- From Research Program of Molecular Neurology (P.M.I., K.N., J.S., R.T., P.I., L.S., P.J.L.), Biomedicum Helsinki, Finland; Department of Neurology (K.N., P.I., L.S., M.K., P.J.L.), Helsinki University Central Hospital, Finland; Department of Public Health (J.P.), University of Helsinki, Finland; Wihuri Research Institute (P.T.K.), Helsinki, Finland
| | - Markku Kaste
- From Research Program of Molecular Neurology (P.M.I., K.N., J.S., R.T., P.I., L.S., P.J.L.), Biomedicum Helsinki, Finland; Department of Neurology (K.N., P.I., L.S., M.K., P.J.L.), Helsinki University Central Hospital, Finland; Department of Public Health (J.P.), University of Helsinki, Finland; Wihuri Research Institute (P.T.K.), Helsinki, Finland
| | - Petri T. Kovanen
- From Research Program of Molecular Neurology (P.M.I., K.N., J.S., R.T., P.I., L.S., P.J.L.), Biomedicum Helsinki, Finland; Department of Neurology (K.N., P.I., L.S., M.K., P.J.L.), Helsinki University Central Hospital, Finland; Department of Public Health (J.P.), University of Helsinki, Finland; Wihuri Research Institute (P.T.K.), Helsinki, Finland
| | - Perttu J. Lindsberg
- From Research Program of Molecular Neurology (P.M.I., K.N., J.S., R.T., P.I., L.S., P.J.L.), Biomedicum Helsinki, Finland; Department of Neurology (K.N., P.I., L.S., M.K., P.J.L.), Helsinki University Central Hospital, Finland; Department of Public Health (J.P.), University of Helsinki, Finland; Wihuri Research Institute (P.T.K.), Helsinki, Finland
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13
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Strbian D, Kovanen PT, Karjalainen-Lindsberg ML, Tatlisumak T, Lindsberg PJ. An emerging role of mast cells in cerebral ischemia and hemorrhage. Ann Med 2009; 41:438-50. [PMID: 19412821 DOI: 10.1080/07853890902887303] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Mast cells (MCs) are perivascularly located resident cells of hematopoietic origin, recognized as effectors in inflammation and immunity. Their subendothelial location at the boundary between the intravascular and extravascular milieus, and their ability to rapidly respond to blood- and tissue-borne stimuli via release of potent vasodilatatory, proteolytic, fibrinolytic, and proinflammatory mediators, render MCs with a unique status to act in the first-line defense in various pathologies. We review experimental evidence suggesting a role for MCs in the pathophysiology of brain ischemia and hemorrhage. In new-born rats, MCs contributed to brain damage in hypoxic-ischemic insults. In experimental cerebral ischemia/reperfusion, MCs regulated permeability of the blood-brain barrier, brain edema formation, and the intensity of local neutrophil infiltration. MCs were reported to play a role in the tissue plasminogen activator-mediated cerebral hemorrhages after experimental ischemic stroke, and to be involved in the expansion of hematoma and edema following intracerebral hemorrhage. Importantly, the MC-stabilizing drug cromoglycate inhibited MC-mediated adverse effects on brain pathology and improved survival of experimental animals. This brings us to a position to consider MC stabilization as a novel initial adjuvant therapy in the prevention of brain injuries in hypoxia-ischemia in new-borns, as well as in ischemic stroke and intracerebral hemorrhage in adults.
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Affiliation(s)
- Daniel Strbian
- Department of Neurology, Helsinki University Central Hospital, Haartmaninkatu 4, Helsinki, Finland.
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14
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Aust G, Richter O, Rohm S, Kerner C, Hauss J, Klöting N, Ruschke K, Kovacs P, Youn BS, Blüher M. Vaspin serum concentrations in patients with carotid stenosis. Atherosclerosis 2008; 204:262-6. [PMID: 18848328 DOI: 10.1016/j.atherosclerosis.2008.08.028] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 08/20/2008] [Accepted: 08/26/2008] [Indexed: 11/16/2022]
Abstract
Obesity is associated with accelerated atherosclerosis. Adipokines may directly influence vessel wall homeostasis by influencing the function of endothelial cells, arterial smooth muscle cells, and modulating inflammation. Recently, visceral adipose tissue-derived serpin (vaspin) was identified as a novel adipokine related to obesity and its metabolic consequences. However, the regulation of vaspin serum concentrations in human atherosclerosis is unknown. We therefore assessed vaspin serum concentrations in 107 consecutive patients with carotid stenosis undergoing carotid endarterectomy (CEA) in relation to severity of atherosclerosis, measures of obesity and circulating markers of obesity and atherosclerosis. Vaspin serum concentrations were significantly lower in patients with carotid stenosis who experienced an ischemic event within 3 months before surgery compared to asymptomatic patients. However, circulating vaspin was not associated with measures of atherosclerosis severity as maximum percentage stenosis. Vaspin serum concentrations were indistinguishable before and after CEA. We found a significant correlation between vaspin and leptin serum concentrations supporting previous results that vaspin closely reflects body fat mass. In conclusion, our data show that low vaspin serum concentrations correlate with recently experienced ischemic events in patients with carotid stenosis despite the lack of an association between circulating vaspin and parameters of atherosclerosis severity.
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Affiliation(s)
- Gabriela Aust
- Center of Surgery, Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, Medical Faculty, University of Leipzig, Leipzig, Germany.
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15
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Markers of instability in high-risk carotid plaques are reduced by statins. J Vasc Surg 2008; 47:513-22. [DOI: 10.1016/j.jvs.2007.11.045] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Revised: 11/07/2007] [Accepted: 11/13/2007] [Indexed: 11/23/2022]
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16
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Chen XY, Wong KS, Lam WWM, Zhao HL, Ng HK. Middle Cerebral Artery Atherosclerosis: Histological Comparison between Plaques Associated with and Not Associated with Infarct in a Postmortem Study. Cerebrovasc Dis 2007; 25:74-80. [PMID: 18033961 DOI: 10.1159/000111525] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Accepted: 07/19/2007] [Indexed: 11/19/2022] Open
Affiliation(s)
- Xiang Yan Chen
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
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17
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Lindstedt KA, Mäyränpää MI, Kovanen PT. Mast cells in vulnerable atherosclerotic plaques--a view to a kill. J Cell Mol Med 2007; 11:739-58. [PMID: 17760836 PMCID: PMC3823253 DOI: 10.1111/j.1582-4934.2007.00052.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The aim of the present review is to discuss the participation of mast cells in the pathogenesis of erosion and rupture of atherosclerotic plaques, the major causes behind acute coronary syndromes and myocardial infarction. We present ex vivo observations describing mast cells and their activation in human atherosclerotic plaques and discuss in vitro and in vivo data showing that mast cells are potential regulators of inflammation, immunity and adverse remodeling, including matrix remodeling and cell death. Furthermore, we focus on studies that have been performed with human tissues and human mast cells, but when appropriate, we also discuss observations made in animal models. Finally, we present potential pharmacological means to modulate mast cell responses in the arterial vessel walls.
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Affiliation(s)
- Ken A Lindstedt
- Wihuri Research Institute, Kalliolinnantie 4, FI-00140 Helsinki, Finland.
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18
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Nuotio K, Isoviita PM, Saksi J, Ijäs P, Pitkäniemi J, Sonninen R, Soinne L, Saimanen E, Salonen O, Kovanen PT, Kaste M, Lindsberg PJ. Adipophilin expression is increased in symptomatic carotid atherosclerosis: correlation with red blood cells and cholesterol crystals. Stroke 2007; 38:1791-8. [PMID: 17446422 DOI: 10.1161/strokeaha.106.478867] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Adipophilin is an adipose differentiation-related protein expressed in lipid-containing cells. Using DNA microarray analysis, we previously found the adipophilin gene (ADFP) to be overexpressed in symptomatic carotid plaques (CP). This led us to further examine the role of adipophilin in carotid atherosclerosis relative to symptom status. METHODS Ninety-eight high-grade (>70%) CPs were obtained in carotid endarterectomy. The relative expression of ADFP mRNA was measured by quantitative real-time RT-PCR, and the relative amount of adipophilin protein was quantified with Western blotting. Detailed topographical correlations with extravasated red blood cells and extracellular cholesterol crystals were obtained by means of immunohistochemistry. RESULTS The relative expression of ADFP mRNA was increased in symptomatic compared with asymptomatic CPs at both the mRNA level (1.82+/-0.19[SE] versus 1.25+/-0.15, P=0.012) and the protein level (1.04+/-0.23 versus 0.46+/-0.14, P=0.043). Adipophilin colocalized with macrophage foam cells, extravasated red blood cells (P<0.0001), and cholesterol crystals (P<0.0001), and its expression associated with macroscopic ulceration of CP (P<0.0001). CONCLUSIONS Intraplaque hemorrhages may contribute to intracellular lipid accumulation and consequent adipophilin expression. Because adipophilin blocks cholesterol efflux from lipid-laden cells, they may die and develop a necrotic lipid core, thereby destabilizing the plaque.
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Affiliation(s)
- Krista Nuotio
- Neuroscience Program, Biomedicum Helsinki, Haartmaninkatu, Helsinki, Finland.
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19
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Ijäs P, Nuotio K, Saksi J, Soinne L, Saimanen E, Karjalainen-Lindsberg ML, Salonen O, Sarna S, Tuimala J, Kovanen PT, Kaste M, Lindsberg PJ. Microarray analysis reveals overexpression of CD163 and HO-1 in symptomatic carotid plaques. Arterioscler Thromb Vasc Biol 2006; 27:154-60. [PMID: 17095719 DOI: 10.1161/01.atv.0000251991.64617.e7] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We studied by microarray analysis whether symptomatic and asymptomatic carotid plaques from the same patient differ in gene expression and whether the same changes are present in an independent sample set. METHODS AND RESULTS Carotid plaques from four patients with bilateral high-grade stenosis, one being symptomatic and the other asymptomatic, were analyzed on Affymetrix U95Av2 arrays. 33 genes showed >1.5-fold change between symptomatic and asymptomatic plaques in an intraindividual comparison with FDR ranging from 0.28 to 0.40. Three genes involved in iron-heme homeostasis, CD163, HO-1, and transferrin receptor, were further analyzed in 40 independent plaques. HO-1 (fold-change 1.93, 95%CI 1.04 to 3.94, P=0.040) and CD163 (1.58, 1.11 to 2.40, P=0.013) mRNAs were again induced, and also HO-1 protein was overexpressed in symptomatic plaques (4.38, 1.54 to 12.20, P=0.024). The expression of HO-1 and CD163 correlated with tissue iron content but iron itself was not associated with the symptom status. CONCLUSIONS Symptomatic plaques show overexpression of CD163 and HO-1 both in intraindividual and interindividual comparison. Their expression correlates with iron deposits but asymptomatic and symptomatic plaques from isolated patients do not differ in macroscopic hemorrhages or iron deposits. We suggest that symptomatic plaques show a more pronounced induction of CD163 and HO-1 in response to plaque hemorrhages.
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MESH Headings
- Aged
- Antigens, CD/genetics
- Antigens, CD/metabolism
- Antigens, Differentiation, Myelomonocytic/genetics
- Antigens, Differentiation, Myelomonocytic/metabolism
- Carotid Stenosis/genetics
- Carotid Stenosis/metabolism
- Carotid Stenosis/physiopathology
- DNA/genetics
- Female
- Gene Expression Regulation
- Heme/metabolism
- Heme Oxygenase-1/genetics
- Heme Oxygenase-1/metabolism
- Hemorrhage
- Humans
- Iron/metabolism
- Male
- Middle Aged
- Oligonucleotide Array Sequence Analysis/methods
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Receptors, Cell Surface/genetics
- Receptors, Cell Surface/metabolism
- Receptors, Transferrin/genetics
- Receptors, Transferrin/metabolism
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Affiliation(s)
- Petra Ijäs
- Department of Neurology, Helsinki University Central Hospital, Finland.
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20
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Nuotio K, Mäyränpää MI, Saksi J, Ijas P, Sairanen T, Carpén O, Soinne L, Saimanen E, Salonen O, Lepäntalo M, Kovanen PT, Kaste M, Lindsberg PJ. Endothelial Apoptosis Does Not Determine Symptom Status in Carotid Artery Disease. Cerebrovasc Dis 2006; 23:27-34. [PMID: 16968983 DOI: 10.1159/000095755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Accepted: 05/22/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We examined the hypothesis that endothelial denudation in advanced carotid plaques (CPs) occurs by increased apoptosis of endothelial cells (ECs) using scanning electron microscopy (SEM) as well as markers of cellular proliferation and apoptosis in advanced symptomatic CPs (SCPs) and asymptomatic CPs (ACPs). METHODS 93 consecutive patients underwent carotid endarterectomy. Five additional specimens were studied by SEM. We performed TUNEL assays, and immunostaining against Fas receptor (FasR), Fas ligand (FasL), activated caspase 3 (ACA3) and Ki-67. RESULTS SEM revealed morphological changes consistent with EC detachment. Surprisingly, ACA3 positivity was more pronounced on the endothelium of ACPs (4.6 +/- 0.7% of total EC count) than on SCPs (3.3 +/- 0.7%, p = 0.049), and was found to correlate positively with nuclear Ki-67 expression (r(s) = 0.275, p = 0.040). FasL expression was significantly increased on the endothelium of SCPs compared with ACPs (66.4 +/- 4.4 vs. 53.9 +/- 4.5%, p = 0.047). CONCLUSIONS Absence of increased positivity of apoptotic markers dismisses apoptosis as a dominant mechanism underlying endothelial detachment of SCPs. Rather, increased ACA3 with co-expression of Ki-67 in ACPs might suggest that renewal of endothelium by active cell turnover may contribute to clinically silent evolution of plaques with preserved EC integrity. These observations may assist in designing novel therapies to prevent endothelial decay and symptom generation in advanced carotid artery disease.
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MESH Headings
- Aged
- Apoptosis
- Carotid Artery, Internal/enzymology
- Carotid Artery, Internal/immunology
- Carotid Artery, Internal/pathology
- Carotid Artery, Internal/physiopathology
- Carotid Artery, Internal/surgery
- Carotid Stenosis/enzymology
- Carotid Stenosis/immunology
- Carotid Stenosis/pathology
- Carotid Stenosis/physiopathology
- Carotid Stenosis/surgery
- Caspase 3/analysis
- Cell Adhesion
- Endarterectomy, Carotid
- Endothelium, Vascular/enzymology
- Endothelium, Vascular/immunology
- Endothelium, Vascular/physiopathology
- Endothelium, Vascular/ultrastructure
- Fas Ligand Protein/analysis
- Female
- Humans
- Immunohistochemistry
- In Situ Nick-End Labeling
- Ki-67 Antigen/analysis
- Male
- Microscopy, Electron, Scanning
- Middle Aged
- Risk Factors
- Severity of Illness Index
- fas Receptor/analysis
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Affiliation(s)
- Krista Nuotio
- Neuroscience Program, Biomedicum Helsinki, Helsinki, Finland.
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21
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Helgason CM. Carotid endarterectomy for asymptomatic plaque. Neurol Clin 2006; 24:661-7. [PMID: 16935194 DOI: 10.1016/j.ncl.2006.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Statistical correlations are linear noninteractive relationships, but the dynamics of causation are nonlinear and involve complex interactions where variables change through their effect on one another and interact with the context of the patient over time. The discovery and interpretation of plaque vulnerable features in the individual patient are not determined for the asymptomatic patient being considered for carotid endarterectomy. New technologies for identification of plaque chemical and morphologic composition are on the horizon and may be applicable to certain patients but change in their usefulness as the plaque and patient change over time.
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Affiliation(s)
- Cathy M Helgason
- Department of Neurology, University of Illinois College of Medicine at Chicago, 912 South Wood Street, Room 855N, Chicago, IL 60612, USA.
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22
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Kaste M. Evidence, education and practice. Cerebrovasc Dis 2006; 22:342-9. [PMID: 16888373 DOI: 10.1159/000094849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Accepted: 06/07/2006] [Indexed: 11/19/2022] Open
Abstract
Stroke causes greater loss of quality-adjusted life years than any other disease and is also one of the most expensive disorders. The burden of stroke will increase in the future due to change in the age structure of populations. We have a vast body of evidence on how to prevent stroke and how to treat stroke patients. Good examples are treatment of hypertension, antithrombotic agents and carotid surgery in stroke prevention, thrombolysis in ischaemic stroke and stroke unit care for all stroke patients. We only have to translate scientific evidence into daily practice. If some pieces are missing, it is our duty to generate them through research. While taking part in randomized clinical trials (RCTs), the discipline, an essential part of RCTs, will improve the daily care of all stroke patients. Besides RCTs there are many other sources of scientific evidence for stroke management, one of which is the European Stroke Initiative (EUSI). The mission of the EUSI is to improve and optimize stroke management in Europe through education and by offering best practice guidelines. Also national and international societies and organizations play an important role in providing education. The human factor is one obstacle to more successful stroke management because to be more effective we must change our own clinical routine. We can make a difference by applying available evidence to our daily practice.
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Affiliation(s)
- Markku Kaste
- Department of Neurology, Helsinki University Central Hospital, University of Helsinki, Finland.
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23
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Soinne L, Saimanen E, Malmberg-Céder K, Kovanen P, Lindsberg PJ, Kaste M, Lassila R. Association of the fibrinolytic system and hemorheology with symptoms in patients with carotid occlusive disease. Cerebrovasc Dis 2005; 20:172-9. [PMID: 16088112 DOI: 10.1159/000087201] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Accepted: 04/19/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The risk of stroke caused by a symptomatic high-grade carotid stenosis (CS) is high. Disturbed balance between the procoagulant and fibrinolytic activity in blood associated with unfavorable hemorheology could render CS symptomatic. We wanted to assess whether hemostatic and fibrinolytic plasma markers as well as basic indicators of hemorheology differentiate asymptomatic and symptomatic patients with a high-grade CS and whether they are associated with the macroscopic appearance of the plaque and the rate of microembolization. METHODS We recruited 92 consecutive consenting patients referred to the neurological or the surgical department of our university teaching hospital for treatment of their high-grade CS. Blood samples were collected before surgery for determination of prothrombin fragments F1 and 2, thrombin-antithrombin complex, tissue-type plasminogen activator (tPA) activity and antigen, plasminogen activator inhibitor-1 (PAI-1) activity and antigen, D-dimer, homocysteine, fibrinogen, in plasma, and hematocrit in blood, and the patients underwent transcranial Doppler ultrasonology for evaluation of microembolic signals (MES). RESULTS Patients with symptomatic plaques had higher hematocrit levels (p = 0.04), as well as trends for higher tPA antigen and MES rate (p = 0.07). Hematocrit, tPA antigen, and PAI-1 antigen and activity were positively correlated with the degree of stenosis. Ulceration was more common in symptomatic plaques but did not reflect variables of hemostasis or fibrinolysis. In multivariate analysis, tPA antigen and hematocrit were risk factors for a symptomatic high-grade stenosis. CONCLUSION Mediators of fibrinolysis and unfavorable hemorheology may contribute to the development of a symptomatic disease in patients with a high-grade CS.
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Affiliation(s)
- Lauri Soinne
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
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