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Montone RA, Ford TJ, Galli M, Rinaldi R, Bland A, Morrow A, Angiolillo DJ, Berry C, Kaski JC, Crea F. Stratified medicine for acute and chronic coronary syndromes: A patient-tailored approach. Prog Cardiovasc Dis 2024:S0033-0620(24)00091-4. [PMID: 38936756 DOI: 10.1016/j.pcad.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 06/23/2024] [Indexed: 06/29/2024]
Abstract
The traditional approach to management of cardiovascular disease relies on grouping clinical presentations with common signs and symptoms into pre-specified disease pathways, all uniformly treated according to evidence-based guidelines ("one-size-fits-all"). The goal of precision medicine is to provide the right treatment to the right patients at the right time, combining data from time honoured sources (e.g., history, physical examination, imaging, laboratory) and those provided by multi-omics technologies. In patients with ischemic heart disease, biomarkers and intravascular assessment can be used to identify endotypes with different pathophysiology who may benefit from distinct treatments. This review discusses strategies for the application of stratified management to patients with acute and chronic coronary syndromes.
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Affiliation(s)
- Rocco A Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Thomas J Ford
- Faculty of Medicine - The University of Newcastle, Australia; Gosford Hospital Central Coast Local Health District, NSW Health, Australia; School Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; NHS Golden Jubilee Hospital, Clydebank, United Kingdom
| | - Mattia Galli
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Riccardo Rinaldi
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart Rome, Italy
| | - Adam Bland
- Faculty of Medicine - The University of Newcastle, Australia; Gosford Hospital Central Coast Local Health District, NSW Health, Australia
| | - Andrew Morrow
- School Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; NHS Golden Jubilee Hospital, Clydebank, United Kingdom
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Colin Berry
- School Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; NHS Golden Jubilee Hospital, Clydebank, United Kingdom
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
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Abela GS, Katkoori VR, Pathak DR, Bumpers HL, Leja M, Abideen ZU, Boumegouas M, Perry D, Al-Janadi A, Richard JE, Barnaba C, Meza IGM. Cholesterol crystals induce mechanical trauma, inflammation, and neo-vascularization in solid cancers as in atherosclerosis. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 35:100317. [PMID: 37981958 PMCID: PMC10655498 DOI: 10.1016/j.ahjo.2023.100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Background and aims Cancer and atherosclerosis share common risk factors and inflammatory pathways that promote their proliferation via vascular endothelial growth factor (VEGF). Because CCs cause mechanical injury and inflammation in atherosclerosis, we investigated their presence in solid cancers and their activation of IL-1β, VEGF, CD44, and Ubiquityl-Histone H2B (Ub-H2B), that promote cancer growth. Methods Tumor specimens from eleven different types of human cancers and atherosclerotic plaques were assessed for CCs, free cholesterol content and IL1-β by microscopy, immunohistochemistry, and biochemical analysis. Breast and colon cancer cell lines were cultured with and without CCs to select for expression of VEGF, CD44, and Ub-H2B. Western blot and immunofluorescence were performed on cells to assess the effect of CCs on signaling pathways. Results Cancers displayed higher CC content (+2.29 ± 0.74 vs +1.46 ± 0.84, p < 0.0001), distribution (5.06 ± 3.13 vs 2.86 ± 2.18, p < 0.001) and free cholesterol (3.63 ± 4.02 vs 1.52 ± 0.56 μg/mg, p < 0.01) than cancer free marginal tissues and similarly for atherosclerotic plaques and margins (+2.31 ± 0.51 vs +1.44 ± 0.79, p < 0.02; 14.0 ± 5.74 vs 8.14 ± 5.52, p < 0.03; 0.19 ± 0.14 vs 0.09 ± 0.04 μg/mg, p < 0.02) respectively. Cancers displayed significantly increased expression of IL1-β compared to marginal tissues. CCs treated cancer cells had increased expression of VEGF, CD44, and Ub-H2B compared to control. By microscopy, CCs were found perforating cancer tumors similar to plaque rupture. Conclusions These findings suggest that CCs can induce trauma and activate cytokines that enhance cancer growth as in atherosclerosis.
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Affiliation(s)
- George S. Abela
- Department of Medicine, Division of Cardiology, Michigan State University, East Lansing, MI, USA
- Department of Physiology, Division of Pathology, Michigan State University, East Lansing, MI, USA
| | - Venkat R. Katkoori
- Department of Physiology, Division of Pathology, Michigan State University, East Lansing, MI, USA
| | - Dorothy R. Pathak
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Harvey L. Bumpers
- Department of Surgery, Michigan State University, East Lansing, MI, USA
| | - Monika Leja
- Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Zain ul Abideen
- Department of Medicine, Division of Cardiology, Michigan State University, East Lansing, MI, USA
| | - Manel Boumegouas
- Department of Medicine, Division of Cardiology, Michigan State University, East Lansing, MI, USA
| | - Daniel Perry
- Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Anas Al-Janadi
- Department of Cancer Care Services, Corewell Health, Grand Rapids, MI, USA
| | | | - Carlo Barnaba
- Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - Ilce G. Medina Meza
- Biosystems and Agricultural Engineering, Michigan State University, East Lansing, MI, USA
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Luo Y, Guo Y, Wang H, Yu M, Hong K, Li D, Li R, Wen B, Hu D, Chang L, Zhang J, Yang B, Sun D, Schwendeman AS, Eugene Chen Y. Phospholipid nanoparticles: Therapeutic potentials against atherosclerosis via reducing cholesterol crystals and inhibiting inflammation. EBioMedicine 2021; 74:103725. [PMID: 34879325 PMCID: PMC8654800 DOI: 10.1016/j.ebiom.2021.103725] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 01/11/2023] Open
Abstract
Background Atherosclerosis-related cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. Cholesterol crystals (CCs) induce inflammation in atherosclerosis and are associated with unstable plaques and poor prognosis, but no drug can remove CCs in the clinic currently. Methods We generated a phospholipid-based and high-density lipoprotein (HDL)-like nanoparticle, miNano, and determined CC-dissolving capacity, cholesterol efflux property, and anti-inflammation effects of miNano in vitro. Both normal C57BL/6J and Apoe-deficient mice were used to explore the accumulation of miNano in atherosclerotic plaques. The efficacy and safety of miNano administration to treat atherosclerosis were evaluated in the Ldlr-deficient atherosclerosis model. The CC-dissolving capacity of miNano was also detected using human atherosclerotic plaques ex vivo. Findings We found that miNano bound to and dissolved CCs efficiently in vitro, and miNano accumulated in atherosclerotic plaques, co-localized with CCs and macrophages in vivo. Administration of miNano inhibited atherosclerosis and improved plaque stability by reducing CCs and macrophages in Ldlr-deficient mice with favorable safety profiles. In macrophages, miNano prevented foam cell formation by enhancing cholesterol efflux and suppressed inflammatory responses via inhibiting TLR4-NF-κB pathway. Finally, in an ex vivo experiment, miNano effectively dissolved CCs in human aortic atherosclerotic plaques. Interpretation Together, our work finds that phospholipid-based and HDL-like nanoparticle, miNano, has the potential to treat atherosclerosis by targeting CCs and stabilizing plaques. Funding This work was supported by the National Institutes of Health HL134569, HL109916, HL136231, and HL137214 to Y.E.C, HL138139 to J.Z., R21NS111191 to A.S., by the American Heart Association 15SDG24470155, Grant Awards (U068144 from Bio-interfaces and G024404 from M-BRISC) at the University of Michigan to Y.G., by the American Heart Association 19PRE34400017 and Rackham Helen Wu award to M.Y., NIH T32 GM07767 to K. H., Barbour Fellowship to D.L.
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Affiliation(s)
- Yonghong Luo
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Second Xiangya Hospital, Central South University, Hunan Province, China
| | - Yanhong Guo
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
| | - Huilun Wang
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Minzhi Yu
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kristen Hong
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI 48109, USA
| | - Dan Li
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ruiting Li
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI 48109, USA
| | - Bo Wen
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI 48109, USA
| | - Die Hu
- Second Xiangya Hospital, Central South University, Hunan Province, China
| | - Lin Chang
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Jifeng Zhang
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Bo Yang
- Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Duxin Sun
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI 48109, USA
| | - Anna S Schwendeman
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, Ann Arbor, MI 48109, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA.
| | - Y Eugene Chen
- Department of Internal Medicine, Cardiovascular Center, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
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Nidorf SM, Fiolet A, Abela GS. Viewing atherosclerosis through a crystal lens: How the evolving structure of cholesterol crystals in atherosclerotic plaque alters its stability. J Clin Lipidol 2020; 14:619-630. [DOI: 10.1016/j.jacl.2020.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 01/08/2023]
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El-Khatib LA, De Feijter-Rupp H, Janoudi A, Fry L, Kehdi M, Abela GS. Cholesterol induced heart valve inflammation and injury: efficacy of cholesterol lowering treatment. Open Heart 2020; 7:e001274. [PMID: 32747455 PMCID: PMC7402193 DOI: 10.1136/openhrt-2020-001274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/11/2020] [Accepted: 06/09/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Heart valves often undergo a degenerative process leading to mechanical dysfunction that requires valve replacement. This process has been compared with atherosclerosis because of shared pathology and risk factors. In this study, we aimed to elucidate the role of inflammation triggered by cholesterol infiltration and cholesterol crystals formation causing mechanical and biochemical injury in heart valves. METHODS Human and atherosclerotic rabbit heart valves were evaluated. New Zealand White male rabbits were fed an enriched cholesterol diet alone or with simvastatin and ezetimibe simultaneous or after 6 months of initiating cholesterol diet. Inflammation was measured using C-reactive protein (CRP) and RAM 11 of tissue macrophage content. Cholesterol crystal presence and content in valves was evaluated using scanning electron microscopy. RESULTS Cholesterol diet alone induced cholesterol infiltration of valves with associated increased inflammation. Tissue cholesterol, CRP levels and RAM 11 were significantly lower in simvastatin and ezetimibe rabbit groups compared with cholesterol diet alone. However, the treatment was effective only when initiated with a cholesterol diet but not after lipid infiltration in valves. Aortic valve cholesterol content was significantly greater than all other cardiac valves. Extensive amounts of cholesterol crystals were noted in rabbit valves on cholesterol diet and in diseased human valves. CONCLUSIONS Prevention of valve infiltration with cholesterol and reduced inflammation by simvastatin and ezetimibe was effective only when given during the initiation of high cholesterol diet but was not effective when given following infiltration of cholesterol into the valve matrix.
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Affiliation(s)
| | - Heather De Feijter-Rupp
- Department of Medicine, Division of Cardiovascular Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Abed Janoudi
- Department of Medicine, Division of Cardiovascular Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Levi Fry
- Department of Medicine, Division of Cardiovascular Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Michael Kehdi
- Department of Medicine, Division of Cardiovascular Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - George S Abela
- Department of Medicine, Division of Cardiovascular Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
- Department of Physiology, Division of Pathology, Michigan State University, East Lansing, Michigan, USA
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Otsuka K, Shimada K, Ishikawa H, Nakamura H, Katayama H, Takeda H, Fujimoto K, Kasayuki N, Yoshiyama M. Usefulness of pre- and post-stent optical frequency domain imaging findings in the prediction of periprocedural cardiac troponin elevation in patients with coronary artery disease. Heart Vessels 2019; 35:451-462. [DOI: 10.1007/s00380-019-01512-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/20/2019] [Indexed: 01/25/2023]
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Ruscica M, Ferri N, Macchi C, Corsini A, Sirtori CR. Lipid lowering drugs and inflammatory changes: an impact on cardiovascular outcomes? Ann Med 2018; 50:461-484. [PMID: 29976096 DOI: 10.1080/07853890.2018.1498118] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Inflammatory changes are responsible for maintenance of the atherosclerotic process and may underlie some of the most feared vascular complications. Among the multiple mechanisms of inflammation, the arterial deposition of lipids and particularly of cholesterol crystals is the one responsible for the activation of inflammasome NLRP3, followed by the rise of circulating markers, mainly C-reactive protein (CRP). Elevation of lipoproteins, LDL but also VLDL and remnants, associates with increased inflammatory changes and coronary risk. Lipid lowering medications can reduce cholesterolemia and CRP: patients with elevations of both are at greatest cardiovascular (CV) risk and receive maximum benefit from therapy. Evaluation of the major drug series indicates that statins exert the largest LDL and CRP reduction, accompanied by reduced CV events. Other drugs, mainly active on the triglyceride/HDL axis, for example, PPAR agonists, may improve CRP and the lipid pattern, especially in patients with metabolic syndrome. PCSK9 antagonists, the newest most potent medications, do not induce significant changes in inflammatory markers, but patients with the highest baseline CRP levels show the best CV risk reduction. Parallel evaluation of lipids and inflammatory changes clearly indicates a significant link, both guiding to patients at highest risk, and to the best pharmacological approach. Key messages Lipid lowering agents with "pleiotropic" effects provide a more effective approach to CV prevention In CANTOS study, patients achieving on-treatment hsCRP concentrations ≤2 mg/L had a higher benefit in terms of reduction in major CV events The anti-inflammatory activity of PCSK9 antagonists appears to be of a minimal extent.
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Affiliation(s)
- M Ruscica
- a Dipartimento di Scienze Farmacologiche e Biomolecolari , Università degli Studi di Milano , Milan , Italy
| | - N Ferri
- b Dipartimento di Scienze del Farmaco , Università degli Studi di Padova , Padova , Italy
| | - C Macchi
- a Dipartimento di Scienze Farmacologiche e Biomolecolari , Università degli Studi di Milano , Milan , Italy
| | - A Corsini
- a Dipartimento di Scienze Farmacologiche e Biomolecolari , Università degli Studi di Milano , Milan , Italy
| | - C R Sirtori
- c Centro Dislipidemie , A.S.S.T. Grande Ospedale Metropolitano Niguarda , Milan , Italy
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8
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Pervaiz MH, Durga S, Janoudi A, Berger K, Abela GS. PET/CTA detection of muscle inflammation related to cholesterol crystal emboli without arterial obstruction. J Nucl Cardiol 2018; 25:433-440. [PMID: 28224451 DOI: 10.1007/s12350-017-0826-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/06/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND PET/CTA was used to evaluate the effect of cholesterol crystal emboli (CCE) on muscle injury. Cholesterol crystals (CCs) released during plaque rupture travel downstream and lodge in muscle triggering inflammation and tissue injury. METHODS Thigh muscles in three groups of rabbits (n = 22) were studied after intra-arterial injection of CCs, Group I (n = 10); polystyrene microspheres, Group II (n = 5); or normal saline, Group III (n = 7). After 48 hours, muscle inflammation and injury were measured by fluorodeoxy-glucose uptake using PET/CTA, serum tissue factor (TF), and creatinine phosphokinase (CPK). Macrophages were stained with RAM11 and CCs with Bodipy. RESULTS SUVmax of thigh muscles was greater for Group I vs Group II and III (0.40 ± 0.16 vs 0.21 ± 0.11, P = .038 and 0.23 ± 0.06, P = .036). CPK levels rose significantly in Group I vs Group II and III (6.7 ± 6.0 vs 0.6 ± 0.4, P = .007 and 0.9 ± 0.4 mg·dL-1, P = .023). No arterial thrombosis was detected by CTA or histology of embolized arteries and TF did not rise significantly. There were extensive macrophage infiltrates surrounding muscle necrosis in Group I only. CONCLUSIONS Cholesterol crystal emboli triggered muscle inflammation and necrosis with an intact circulation. PET/CTA may help in the early detection of inflammation caused by CCs.
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Affiliation(s)
- M Hassan Pervaiz
- Division of Cardiology, Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Sridevi Durga
- Division of Cardiology, Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Abed Janoudi
- Division of Cardiology, Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Kevin Berger
- Department of Radiology, Michigan State University, East Lansing, MI, USA
| | - George S Abela
- Division of Cardiology, Department of Medicine, Michigan State University, East Lansing, MI, USA.
- Division of Pathology, Department of Physiology, Michigan State University, East Lansing, MI, USA.
- Michigan State University, B208 Clinical Center, East Lansing, MI, 48824, USA.
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9
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Bryniarski KL, Yamamoto E, Takumi H, Xing L, Zanchin T, Sugiyama T, Lee H, Jang IK. Differences in coronary plaque characteristics between patients with and those without peripheral arterial disease. Coron Artery Dis 2017; 28:658-663. [DOI: 10.1097/mca.0000000000000531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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10
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Abela GS, Kalavakunta JK, Janoudi A, Leffler D, Dhar G, Salehi N, Cohn J, Shah I, Karve M, Kotaru VPK, Gupta V, David S, Narisetty KK, Rich M, Vanderberg A, Pathak DR, Shamoun FE. Frequency of Cholesterol Crystals in Culprit Coronary Artery Aspirate During Acute Myocardial Infarction and Their Relation to Inflammation and Myocardial Injury. Am J Cardiol 2017; 120:1699-1707. [PMID: 28867129 DOI: 10.1016/j.amjcard.2017.07.075] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 12/13/2022]
Abstract
Cholesterol crystals (CCs) have been associated with plaque rupture through mechanical injury and inflammation. This study evaluated the presence of CCs during acute myocardial infarction (AMI) and associated myocardial injury, inflammation, and arterial blood flow before and after percutaneous coronary intervention. Patients presenting with AMI (n = 286) had aspiration of culprit coronary artery obstruction. Aspirates were evaluated for crystal content, size, composition, and morphology by scanning electron microscopy, crystallography, and infrared spectroscopy. These were correlated with inflammatory biomarkers, cardiac enzymes, % coronary stenosis, and Thrombolysis in Myocardial Infarction (TIMI) blush and flow grades. Crystals were detected in 254 patients (89%) and confirmed to be cholesterol by spectroscopy. Of 286 patients 240 (84%) had CCs compacted into clusters that were large enough to be measured and analyzed. Moderate to extensive CC content was present in 172 cases (60%). Totally occluded arteries had significantly larger CC clusters than partially occluded arteries (p <0.05). Patients with CC cluster area >12,000 µm2 had significantly elevated interleukin-1 beta (IL-1β) levels (p <0.01), were less likely to have TIMI blush grade of 3 (p <0.01), and more likely to have TIMI flow grade of 1 (p <0.01). Patients with recurrent AMI had smaller CC cluster area (p <0.04), lower troponin (p <0.02), and IL-1β levels (p <0.04). Women had smaller CC clusters (p <0.04). Macrophages in the aspirates were found to be attached to CCs. Coronary artery aspirates had extensive deposits of CCs during AMI. In conclusion, presence of large CC clusters was associated with increased inflammation (IL-1β), increased arterial narrowing, and diminished reflow following percutaneous coronary intervention.
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Affiliation(s)
- George S Abela
- Department of Medicine, Michigan State University, East Lansing, Michigan; Division of Cardiology, Michigan State University, East Lansing, Michigan; Division of Pathology, Department of Physiology, Michigan State University, East Lansing, Michigan.
| | - Jagadeesh K Kalavakunta
- Division of Cardiology, Michigan State University, East Lansing, Michigan; Borgess Hospital, Kalamazoo, Michigan and Michigan State University, East Lansing, Michigan
| | - Abed Janoudi
- Department of Medicine, Michigan State University, East Lansing, Michigan; Division of Cardiology, Michigan State University, East Lansing, Michigan
| | - Dale Leffler
- Spectrum Health Medical Group Cardiovascular Medicine, Holland, Michigan
| | - Gaurav Dhar
- Department of Medicine, Michigan State University, East Lansing, Michigan; Division of Cardiology, Michigan State University, East Lansing, Michigan; Sparrow Hospital/Thoracic and Cardiovascular Institute, Lansing, Michigan
| | - Negar Salehi
- Department of Medicine, Michigan State University, East Lansing, Michigan
| | - Joel Cohn
- Department of Medicine, Michigan State University, East Lansing, Michigan; Division of Cardiology, Michigan State University, East Lansing, Michigan; Sparrow Hospital/Thoracic and Cardiovascular Institute, Lansing, Michigan
| | | | | | | | - Vishal Gupta
- Department of Medicine, Michigan State University, East Lansing, Michigan; Borgess Hospital, Kalamazoo, Michigan and Michigan State University, East Lansing, Michigan
| | - Shukri David
- St. John Providence Health System, Wayne State University, Detroit, Michigan
| | - Keerthy K Narisetty
- Department of Medicine, Michigan State University, East Lansing, Michigan; Division of Cardiology, Michigan State University, East Lansing, Michigan
| | - Michael Rich
- College of Engineering, Composite Materials and Structures Center, Michigan State University, East Lansing, Michigan
| | - Abigail Vanderberg
- Center for Advanced Microscopy, Michigan State University, East Lansing, Michigan
| | - Dorothy R Pathak
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - Fadi E Shamoun
- Division of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona
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Abstract
Well into the 21st century, we still triage acute myocardial infarction on the basis of the presence or absence of ST-segment elevation, a century-old technology. Meanwhile, we have learned a great deal about the pathophysiology and mechanisms of acute coronary syndromes (ACS) at the clinical, pathological, cellular, and molecular levels. Contemporary imaging studies have shed new light on the mechanisms of ACS. This review discusses these advances and their implications for clinical management of the ACS for the future. Plaque rupture has dominated our thinking about ACS pathophysiology for decades. However, current evidence suggests that a sole focus on plaque rupture vastly oversimplifies this complex collection of diseases and obscures other mechanisms that may mandate different management strategies. We propose segmenting coronary artery thrombosis caused by plaque rupture into cases with or without signs of concomitant inflammation. This distinction may have substantial therapeutic implications as direct anti-inflammatory interventions for atherosclerosis emerge. Coronary artery thrombosis caused by plaque erosion may be on the rise in an era of intense lipid lowering. Identification of patients with of ACS resulting from erosion may permit a less invasive approach to management than the current standard of care. We also now recognize ACS that occur without apparent epicardial coronary artery thrombus or stenosis. Such events may arise from spasm, microvascular disease, or other pathways. Emerging management strategies may likewise apply selectively to this category of ACS. We advocate this more mechanistic approach to the categorization of ACS to provide a framework for future tailoring, triage, and therapy for patients in a more personalized and precise manner.
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Affiliation(s)
- Filippo Crea
- From Department of Cardiovascular and Thoracic Sciences, Catholic University, Rome, Italy (F.C.); and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.L.)
| | - Peter Libby
- From Department of Cardiovascular and Thoracic Sciences, Catholic University, Rome, Italy (F.C.); and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.L.).
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12
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Kalavakunta JK, Mittal MK, Janoudi A, Abela OG, Alreefi F, Abela GS. Role of Cholesterol Crystals During Acute Myocardial Infarction and Cerebrovascular Accident. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2017. [DOI: 10.15212/cvia.2017.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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13
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Ghanem F, Vodnala D, K Kalavakunta J, Durga S, Thormeier N, Subramaniyam P, Abela S, S Abela G. Cholesterol crystal embolization following plaque rupture: a systemic disease with unusual features. J Biomed Res 2017; 31:82-94. [PMID: 28808190 PMCID: PMC5445211 DOI: 10.7555/jbr.31.20160100] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Cholesterol crystal embolic (CCE) syndrome is often a clinically challenging condition that has a poor prognostic implication. It is a result of plaque rupture with release of cholesterol crystals into the circulation that embolize into various tissue organs. Plaque rupture seems to be triggered by an expanding necrotic core during cholesterol crystallization forming sharp tipped crystals that perforate and tear the fibrous cap. Embolizing cholesterol crystals then initiate both local and systemic inflammation that eventually lead to vascular fibrosis and obstruction causing symptoms that can mimic other vasculitic conditions. In fact, animal studies have demonstrated that cholesterol crystals can trigger an inflammatory response via NLRP3 inflammasome similar to that seen with gout. The diagnosis of CCE syndrome often requires a high suspicion of the condition. Serum inflammation biomarkers including elevated sedimentation rate, abnormal renal function tests and eosinophilia are useful but non-specific. Common target organ involvement includes the skin, kidney, and brain. Various testing including fundoscopic eye examination and other non-invasive procedures such as trans-esophageal echocardiography and magnetic resonance imaging may be helpful in identifying the embolic source. Treatment includes aspirin and clopidogrel, high dose statin and possibly steroids. In rare cases, mechanical intervention using covered stents may help isolate the ruptured plaque. Anticoagulation with warfarin is not recommended and might even be harmful. Overall, CCE syndrome is usually a harbinger of extensive and unstable atherosclerotic disease that is often associated with acute cardiovascular events.
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Affiliation(s)
- Firas Ghanem
- Department of Medicine, Division of Cardiology, College of Human Medicine, Michigan State University, East Lansing, MI, USA; Wheaton Franciscan Health, Brookfield, WI, USA
| | - Deepthi Vodnala
- University of Missouri, St. Luke's Health System, Kansas City, MO 48824, USA
| | - Jagadeesh K Kalavakunta
- Department of Medicine, Division of Cardiology, College of Human Medicine, Michigan State University, East Lansing, MI, USA.,Borgess Hospital, Kalamazoo, MI, USA
| | - Sridevi Durga
- Department of Medicine, Division of Cardiology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Noah Thormeier
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Prem Subramaniyam
- Department of Medicine, Division of Cardiology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Scott Abela
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - George S Abela
- Department of Medicine, Division of Cardiology, College of Human Medicine, Michigan State University, East Lansing, MI, USA.,Department of Physiology, Division of Pathology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
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14
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Abela OG, Ahsan CH, Alreefi F, Salehi N, Baig I, Janoudi A, Abela GS. Plaque Rupture and Thrombosis: the Value of the Atherosclerotic Rabbit Model in Defining the Mechanism. Curr Atheroscler Rep 2016; 18:29. [PMID: 27091328 DOI: 10.1007/s11883-016-0587-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Persistent inflammation and mechanical injury associated with cholesterol crystal accretion within atherosclerotic plaques typically precedes plaque disruption (rupture and/or erosion) and thrombosis--often the terminal events of atherosclerotic cardiovascular disease. To elucidate the mechanisms of these events, the atherosclerotic rabbit model provides a unique and powerful tool that facilitates studies of atherogenesis starting with plaque buildup to eventual disruption. Examination of human coronary arteries obtained from patients who died with myocardial infarction demonstrates evidence of cholesterol crystals perforating the plaque cap and intimal surface of the arterial wall that can lead to rupture. These observations were made possible by omitting ethanol, an avid lipid solvent, from the tissue processing steps. Importantly, the atherosclerotic rabbit model exhibits a similar pathology of cholesterol crystals perforating the intimal surface as seen in ruptured human plaques. Local and systemic inflammatory responses in the model are also similar to those observed in humans. The strong parallel between the rabbit and human pathology validates the atherosclerotic rabbit model as a predictor of human pathophysiology of atherosclerosis. Thus, the atherosclerotic rabbit model can be used with confidence to evaluate diagnostic imaging and efficacy of novel anti-atherosclerotic therapy.
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Affiliation(s)
- Oliver G Abela
- Department of Medicine, Division of Cardiovascular Medicine, University of Nevada, Las Vegas, NV, USA
| | - Chowdhury H Ahsan
- Department of Medicine, Division of Cardiovascular Medicine, University of Nevada, Las Vegas, NV, USA
| | - Fadi Alreefi
- Division of Cardiovascular Medicine, Michigan State University, East Lansing, MI, USA
| | - Negar Salehi
- Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Imran Baig
- Division of Cardiovascular Medicine, Michigan State University, East Lansing, MI, USA
| | - Abed Janoudi
- Division of Cardiovascular Medicine, Michigan State University, East Lansing, MI, USA
| | - George S Abela
- Division of Cardiovascular Medicine, Michigan State University, East Lansing, MI, USA.
- Department of Physiology, Division of Pathology, Michigan State University, East Lansing, MI, USA.
- Michigan State University, B208 Clinical Center, East Lansing, MI, 48824, USA.
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15
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Evans NR, Tarkin JM, Chowdhury MM, Warburton EA, Rudd JHF. PET Imaging of Atherosclerotic Disease: Advancing Plaque Assessment from Anatomy to Pathophysiology. Curr Atheroscler Rep 2016; 18:30. [PMID: 27108163 PMCID: PMC4842219 DOI: 10.1007/s11883-016-0584-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Atherosclerosis is a leading cause of morbidity and mortality. It is now widely recognized that the disease is more than simply a flow-limiting process and that the atheromatous plaque represents a nidus for inflammation with a consequent risk of plaque rupture and atherothrombosis, leading to myocardial infarction or stroke. However, widely used conventional clinical imaging techniques remain anatomically focused, assessing only the degree of arterial stenosis caused by plaques. Positron emission tomography (PET) has allowed the metabolic processes within the plaque to be detected and quantified directly. The increasing armory of radiotracers has facilitated the imaging of distinct metabolic aspects of atherogenesis and plaque destabilization, including macrophage-mediated inflammatory change, hypoxia, and microcalcification. This imaging modality has not only furthered our understanding of the disease process in vivo with new insights into mechanisms but has also been utilized as a non-invasive endpoint measure in the development of novel treatments for atherosclerotic disease. This review provides grounding in the principles of PET imaging of atherosclerosis, the radioligands in use and in development, its research and clinical applications, and future developments for the field.
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Affiliation(s)
- Nicholas R Evans
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Jason M Tarkin
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Mohammed M Chowdhury
- Division of Vascular and Endovascular Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Elizabeth A Warburton
- Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
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16
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Kim J, Park JE, Nahrendorf M, Kim DE. Direct Thrombus Imaging in Stroke. J Stroke 2016; 18:286-296. [PMID: 27733029 PMCID: PMC5066439 DOI: 10.5853/jos.2016.00906] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/01/2016] [Accepted: 09/17/2016] [Indexed: 01/02/2023] Open
Abstract
There is an emergent need for imaging methods to better triage patients with acute stroke for tissue-plasminogen activator (tPA)-mediated thrombolysis or endovascular clot retrieval by directly visualizing the size and distribution of cerebral thromboemboli. Currently, magnetic resonance (MR) or computed tomography (CT) angiography visualizes the obstruction of blood flow within the vessel lumen rather than the thrombus itself. The present visualization method, which relies on observation of the dense artery sign (the appearance of cerebral thrombi on a non-enhanced CT), suffers from low sensitivity. When translated into the clinical setting, direct thrombus imaging is likely to enable individualized acute stroke therapy by allowing clinicians to detect the thrombus with high sensitivity, assess the size and nature of the thrombus more precisely, serially monitor the therapeutic effects of thrombolysis, and detect post-treatment recurrence. This review is intended to provide recent updates on stroke-related direct thrombus imaging using MR imaging, positron emission tomography, or CT.
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Affiliation(s)
- Jongseong Kim
- Molecular Imaging and Neurovascular Research (MINER) Laboratory, Dongguk University Ilsan Hospital, Goyang, Korea.,Global Research Laboratory for Thrombus-targeted Theranostics at Dongguk University Ilsan Hospital (Korea) and Massachusetts General Hospital ( USA )
| | - Jung E Park
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Matthias Nahrendorf
- Global Research Laboratory for Thrombus-targeted Theranostics at Dongguk University Ilsan Hospital (Korea) and Massachusetts General Hospital ( USA ).,Center for Systems Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Dong-Eog Kim
- Molecular Imaging and Neurovascular Research (MINER) Laboratory, Dongguk University Ilsan Hospital, Goyang, Korea.,Global Research Laboratory for Thrombus-targeted Theranostics at Dongguk University Ilsan Hospital (Korea) and Massachusetts General Hospital ( USA ).,Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
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17
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Zhang MD, Zhao XC, Zhang YH, Yan YF, Wang ZM, Lv SZ, Zhao QM. Plaque Thrombosis is Reduced by Attenuating Plaque Inflammation with Pioglitazone and is Evaluated by Fluorodeoxyglucose Positron Emission Tomography. Cardiovasc Ther 2016; 33:118-26. [PMID: 25825053 DOI: 10.1111/1755-5922.12119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The relationship between the beneficial effects of pioglitazone in reducing clinical events and plaque inflammatory burden remains unknown. This study aimed to determine whether pioglitazone can reduce the number of plaque thrombosis incidences and whether decreasing plaque inflammation is the mechanism by which pioglitazone reduces plaque thromboses. METHODS AND RESULTS therosclerotic rabbits were divided into two groups: the atherosclerosis group (n = 13) and pioglitazone group (n = 10). The rabbits underwent pharmacological triggering to induce thrombosis. Serum inflammatory markers, FDG uptake, macrophage, and neovessel staining detected arterial inflammation. PET/CT scans were performed twice (baseline and posttreatment scans). Plaque area, macrophages, and neovessels were measured and the histologic sections were matched with the PET/CT scans. Serum MMP-9 and hsCRP were lower in the pioglitazone group compared to the atherosclerosis group. The SUVmean significantly decreased in the pioglitazone group (0.62 ± 0.21 vs. 0.55 ± 0.19, P = 0.008), but increased in the atherosclerosis group (0.61 ± 0.15 vs. 0.91 ± 0.20, P < 0.000). The incidence rate of plaque rupture, plaque area, macrophage density, and neovessel density was significantly lower in rabbits with pioglitazone than without (15% vs. 38%, P < 0.001; 18.00 ± 2.30 vs. 27.00 ± 1.60; P < 0.001; 8.80 ± 3.94 vs. 28.26 ± 2.49; P < 0.001; 16.50 ± 3.09 vs. 29.00 ± 2.11; P < 0.001, respectively). Moreover, plaque area and macrophage density were positively correlated with SUV values. CONCLUSIONS Our study suggests that pioglitazone can reduce the number of plaque thrombosis incidences by decreasing plaque inflammation. (18)F-FDG-PET/CT can detect plaque inflammation and assess the effects of antiatherosclerotic drugs.
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Affiliation(s)
- Ming-Duo Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xue-Cheng Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yu-Hui Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yun-Feng Yan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Zheng-Ming Wang
- Center for PET/CT, General Hospital of Second Artillery of PLA, Beijing, China
| | - Shu-Zheng Lv
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Quan-Ming Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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18
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Janoudi A, Shamoun FE, Kalavakunta JK, Abela GS. Cholesterol crystal induced arterial inflammation and destabilization of atherosclerotic plaque. Eur Heart J 2015; 37:1959-67. [PMID: 26705388 DOI: 10.1093/eurheartj/ehv653] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/16/2015] [Indexed: 01/14/2023] Open
Abstract
Evolution of plaque that is prone to rupture is characterized by inflammation and physical changes. Accumulation of low-density lipoprotein in the sub-intima provides esterified cholesterol (ESC) to macrophages and smooth muscle cells that convert it into free cholesterol (FRC) by cholesteryl ester hydrolases (CEHs). Membrane-bound cholesterol carriers transport FRC to high-density lipoprotein (HDL). Impaired HDL transport function and altered composition can lead to extracellular accumulation of FRC, whereas impaired membrane carrier activity can lead to intracellular FRC accumulation. Saturation of FRC can result in cholesterol crystallization with cell death and intimal injury. Disequilibrium between ESC and FRC can impact foam cell and cholesterol crystal (CC) formation. Cholesterol crystals initiate inflammation via NLRP3 inflammasome leading to interleukin-1β (IL-1β) production inducing C-reactive protein. Eventually, crystals growing from within the plaque and associated inflammation destabilize the plaque. Thus, inhibition of inflammation by antagonists to IL-1β or agents that dissolve or prevent CC formation may stabilize vulnerable plaques.
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Affiliation(s)
- Abed Janoudi
- Department of Medicine, Division of Cardiology, Michigan State University, East Lansing, MI, USA
| | - Fadi E Shamoun
- Division of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
| | - Jagadeesh K Kalavakunta
- Department of Medicine, Division of Cardiology, Michigan State University, East Lansing, MI, USA Borgess Hospital, Kalamazoo, MI, USA
| | - George S Abela
- Department of Medicine, Division of Cardiology, Michigan State University, East Lansing, MI, USA Department of Physiology, Division of Pathology, Michigan State University, East Lansing, MI, USA
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19
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Nasiri M, Janoudi A, Vanderberg A, Frame M, Flegler C, Flegler S, Abela GS. Role of cholesterol crystals in atherosclerosis is unmasked by altering tissue preparation methods. Microsc Res Tech 2015; 78:969-74. [DOI: 10.1002/jemt.22560] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/23/2015] [Accepted: 07/25/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Mojdeh Nasiri
- Department of Medicine; Division of Cardiology; Michigan State University; East Lansing Michigan
| | - Abed Janoudi
- Department of Medicine; Division of Cardiology; Michigan State University; East Lansing Michigan
| | - Abigail Vanderberg
- Center for Advanced Microscopy, Michigan State University; East Lansing Michigan
| | - Melinda Frame
- Center for Advanced Microscopy, Michigan State University; East Lansing Michigan
| | | | - Stanley Flegler
- Center for Advanced Microscopy, Michigan State University; East Lansing Michigan
| | - George S. Abela
- Department of Medicine; Division of Cardiology; Michigan State University; East Lansing Michigan
- Department of Physiology; Division of Pathology; Michigan State University; East Lansing Michigan
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20
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Increased 18F-FDG uptake is predictive of rupture in a novel rat abdominal aortic aneurysm rupture model. Ann Surg 2015; 261:395-404. [PMID: 24651130 DOI: 10.1097/sla.0000000000000602] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine whether F-fluorodeoxyglucose (F-FDG) micro-positron emission tomography (micro-PET) can predict abdominal aortic aneurysm (AAA) rupture. BACKGROUND An infrarenal AAA model is needed to study inflammatory mechanisms that drive rupture. F-FDG PET can detect vascular inflammation in animal models and patients. METHODS After exposing Sprague-Dawley rats to intra-aortic porcine pancreatic elastase (PPE) (12 U/mL), AAA rupture was induced by daily, subcutaneous, β-aminopropionitrile (BAPN, 300 mg/kg, N = 24) administration. Negative control AAA animals (N = 15) underwent daily saline subcutaneous injection after PPE exposure. BAPN-exposed animals that did not rupture served as positive controls [nonruptured AAA (NRAAA) 14d, N = 9]. Rupture was witnessed using radiotelemetry. Maximum standard uptakes for F-FDG micro-PET studies were determined. Aortic wall PAI-1, uPA, and tPA concentrations were determined by western blot analyses. Interleukin (IL)-1β, IL-6, IL-10, and MIP-2 were determined by Bio-Plex bead array. Neutrophil and macrophage populations per high-power field were quantified. Matrix metalloproteinase (MMP) activities were determined by zymography. RESULTS When comparing ruptured AAA (RAAA) to NRAAA 14d animals, increased focal F-FDG uptakes were detected at subsequent sites of rupture (P = 0.03). PAI-1 expression was significantly less in RAAA tissue (P = 0.01), with comparable uPA and decreased tPA levels (P = 0.02). IL-1β (P = 0.04), IL-6 (P = 0.001), IL-10 (P = 0.04), and MIP-2 (P = 0.02) expression, neutrophil (P = 0.02) and macrophage presence (P = 0.002), and MMP9 (P < 0.0001) activity were increased in RAAA tissue. CONCLUSIONS With this AAA rupture model, increased prerupture F-FDG uptake on micro-PET imaging was associated with increased inflammation in the ruptured AAA wall. F-FDG PET imaging may be used to monitor inflammatory changes before AAA rupture.
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21
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Chistiakov DA, Orekhov AN, Bobryshev YV. Contribution of neovascularization and intraplaque haemorrhage to atherosclerotic plaque progression and instability. Acta Physiol (Oxf) 2015; 213:539-53. [PMID: 25515699 DOI: 10.1111/apha.12438] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/13/2014] [Accepted: 12/10/2014] [Indexed: 12/14/2022]
Abstract
Atherosclerosis is a continuous pathological process that starts early in life and progresses frequently to unstable plaques. Plaque rupture leads to deleterious consequences such as acute coronary syndrome, stroke and atherothrombosis. The vulnerable lesion has several structural and functional hallmarks that distinguish it from the stable plaque. The unstable plaque has large necrotic core (over 40% plaque volume) composed of cholesterol crystals, cholesterol esters, oxidized lipids, fibrin, erythrocytes and their remnants (haeme, iron, haemoglobin), and dying macrophages. The fibrous cap is thin, depleted of smooth muscle cells and collagen, and is infiltrated with proinflammatory cells. In unstable lesion, formation of neomicrovessels is increased. These neovessels have weak integrity and leak thereby leading to recurrent haemorrhages. Haemorrhages deliver erythrocytes to the necrotic core where they degrade promoting inflammation and oxidative stress. Inflammatory cells mostly presented by monocytes/macrophages, neutrophils and mast cells extravagate from bleeding neovessels and infiltrate adventitia where they support chronic inflammation. Plaque destabilization is an evolutionary process that could start at early atherosclerotic stages and whose progression is influenced by many factors including neovascularization, intraplaque haemorrhages, formation of cholesterol crystals, inflammation, oxidative stress and intraplaque protease activity.
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Affiliation(s)
- D. A. Chistiakov
- Department of Medical Nanobiotechnology; Pirogov Russian State Medical University; Moscow Russia
- The Mount Sinai Community Clinical Oncology Program; Mount Sinai Comprehensive Cancer Center; Mount Sinai Medical Center; Miami Beach FL USA
- Research Center for Children's Health; Moscow Russia
| | - A. N. Orekhov
- Laboratory of Angiopathology; Institute of General Pathology and Pathophysiology; Russian Academy of Sciences; Moscow Russia
- Skolkovo Innovative Center; Institute for Atherosclerosis Research; Moscow Russia
| | - Y. V. Bobryshev
- Laboratory of Angiopathology; Institute of General Pathology and Pathophysiology; Russian Academy of Sciences; Moscow Russia
- Faculty of Medicine and St Vincent's Centre for Applied Medical Research; University of New South Wales; Sydney NSW Australia
- School of Medicine; University of Western Sydney; Campbelltown NSW Australia
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22
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Marzec KM, Wrobel TP, Rygula A, Maslak E, Jasztal A, Fedorowicz A, Chlopicki S, Baranska M. Visualization of the biochemical markers of atherosclerotic plaque with the use of Raman, IR and AFM. JOURNAL OF BIOPHOTONICS 2014; 7:744-756. [PMID: 24604883 DOI: 10.1002/jbio.201400014] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/06/2014] [Indexed: 06/03/2023]
Abstract
In this work, we describe a methodology to visualize the biochemical markers of atherosclerotic plaque in cross sections of brachiocephalic arteries (BCA) taken from ApoE/LDLR(-/-) mice. The approach of the visualization of the same area of atherosclerotic plaque with the use of Raman, IR and AFM imaging enables the parallel characterisation of various features of atherosclerotic plaques. This support to the histochemical staining is utilized mainly in studies on mice models of atherosclerotic plaques, where micro and sub-micro resolutions are required. This work presents the methodology of the measurement and visualization of plaque features important for atherosclerosis development and plaques vulnerability analysis. Label-free imaging of cholesterol, cholesteryl esters, remodeled media, heme, internal elastic lamina, fibrous cap and calcification provides additional knowledge to previously presented quantitative measurements of average plaque features. AFM imaging enhanced the results obtained with the use of vibrational microspectroscopies with additional topographical information of the sample. To the best of our knowledge, this is the first work which demonstrates that co-localized measurement of atherosclerotic plaque with Raman, IR and AFM imaging provides a comprehensive insight into the biochemical markers of atherosclerotic plaques, and can be used as an integrated approach to assess vulnerability of the plaque.
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Affiliation(s)
- Katarzyna M Marzec
- Jagiellonian Centre for Experimental Therapeutics JCET, Jagiellonian University, 30-348, Krakow, Poland
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23
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Yla-Herttuala S, Bentzon JF, Daemen M, Falk E, Garcia-Garcia HM, Herrmann J, Hoefer I, Jauhiainen S, Jukema JW, Krams R, Kwak BR, Marx N, Naruszewicz M, Newby A, Pasterkamp G, Serruys PWJC, Waltenberger J, Weber C, Tokgozoglu L. Stabilization of atherosclerotic plaques: an update. Eur Heart J 2013; 34:3251-8. [DOI: 10.1093/eurheartj/eht301] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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24
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Abdelbaky A, Corsini E, Figueroa AL, Fontanez S, Subramanian S, Ferencik M, Brady TJ, Hoffmann U, Tawakol A. Focal arterial inflammation precedes subsequent calcification in the same location: a longitudinal FDG-PET/CT study. Circ Cardiovasc Imaging 2013; 6:747-54. [PMID: 23833282 DOI: 10.1161/circimaging.113.000382] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Arterial calcium (Ca) deposition has been identified as an active inflammatory process. We sought to test the hypothesis that local vascular inflammation predisposes to subsequent arterial calcium deposition in humans. METHODS AND RESULTS From a hospital database, we identified 137 patients (age, 61 ± 13 years; 48.1% men) who underwent serial positron-emission tomography/computed tomography (1-5 years apart). Focal arterial inflammation was prospectively determined by measuring 18F-flourodeoxyglucose uptake (using baseline positron-emission tomography) within predetermined locations of the thoracic aortic wall and was reported as a standardized uptake value. A separate, blinded investigator evaluated calcium deposition (on the baseline and follow-up computed tomographic scans) along the same standardized sections of the aorta. New calcification was prospectively defined using square root-transformed difference of calcium volume score, with a cutoff value of 2.5. Accordingly, vascular segment was classified as either with or without subsequent calcification. Overall, 67 (9%) of aortic segments demonstrated subsequent calcification. Baseline median (interquartile range) standardized uptake value was higher in segments with versus without subsequent calcification (2.09 [1.84-2.44] versus 1.92 [1.72-2.20], P=0.002). This was also true in the subset of segments with Ca present at baseline (2.08 [1.81-2.40] versus 1.86 [1.66-2.09], P=0.02), as well as those without (2.17 [1.87-2.51] versus 1.93 [1.73-2.20], P=0.04). Furthermore, across all patients, subsequent Ca deposition was associated with the underlying 18F-flourodeoxyglucose uptake (inflammatory signal), measured as standardized uptake value (odds ratio [95% confidence interval]=2.94 [1.27-6.89], P=0.01) or target-to-background ratio (2.59 [1.18-5.70], =0.02), after adjusting for traditional cardiovascular risk factors. CONCLUSIONS Here, we provide first-in-man evidence that arterial inflammation precedes subsequent Ca deposition, a marker of plaque progression, within the underlying location in the artery wall.
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Affiliation(s)
- Amr Abdelbaky
- Cardiac MR PET CT Program, Division of Cardiology, and Department of Radiology, Massachusetts General Hospital, Boston, MA
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25
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Abstract
18F-FDG PET is a new noninvasive tool for inflammation functional imaging. Low spatial resolution is now compensated by coregistration with CT or MRI. New mechanistic insights have emerged from animal and histology to explain the obtained signals by hypoxia, macrophage infiltration, and differentiation. Mixed results have been found in biomarkers studies. Interesting data have come recently linking plaque anatomy and function in carotids and in aortic aneurysms as well as inflammation and events. In coronary arteries, plaque assessment is still hampered by myocardium uptake but developments are being made. 18-FDG PET has been able to monitor inflammation before and after several therapies in animals and humans but to date the lack of standardization and the absence of prospective event-driven studies prevent this promising technique to be used in clinical practice.
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Affiliation(s)
- David Rosenbaum
- Unité de Prévention Cardiovasculaire, Pole Cardiologie Métabolisme, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 83, Boulevard de l'Hôpital, 75651 Paris Cedex 13, France.
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26
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De Meyer I, Martinet W, De Meyer GRY. Therapeutic strategies to deplete macrophages in atherosclerotic plaques. Br J Clin Pharmacol 2012; 74:246-63. [PMID: 22309283 DOI: 10.1111/j.1365-2125.2012.04211.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Macrophages can be found in all stages of atherosclerosis and are major contributors of atherosclerotic plaque development, progression and destabilization. Continuous recruitment of monocytes drives this chronic inflammatory disease, which can be intervened by several strategies: reducing the inflammatory stimulus by lowering circulating lipids and promoting cholesterol efflux from plaque, direct and indirect targeting of adhesion molecules and chemokines involved in monocyte adhesion and transmigration and inducing macrophage death in atherosclerotic plaques in combination with anti-inflammatory drugs. This review discusses the outlined strategies to deplete macrophages from atherosclerotic plaques to promote plaque stabilization.
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Affiliation(s)
- Inge De Meyer
- Division of Physiopharmacology, University of Antwerp, Antwerp, Belgium.
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Michel JB, Delbosc S, Ho-Tin-Noé B, Leseche G, Nicoletti A, Meilhac O, Martin-Ventura JL. From intraplaque haemorrhages to plaque vulnerability. J Cardiovasc Med (Hagerstown) 2012; 13:628-34. [DOI: 10.2459/jcm.0b013e328357face] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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28
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Bibliography. Hyperlipidaemia and cardiovascular disease. Current world literature. Curr Opin Lipidol 2012; 23:386-91. [PMID: 22801387 DOI: 10.1097/mol.0b013e32835670af] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Suhalim J, Chung CY, Lilledahl M, Lim R, Levi M, Tromberg B, Potma E. Characterization of cholesterol crystals in atherosclerotic plaques using stimulated Raman scattering and second-harmonic generation microscopy. Biophys J 2012; 102:1988-95. [PMID: 22768956 PMCID: PMC3328706 DOI: 10.1016/j.bpj.2012.03.016] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 03/05/2012] [Accepted: 03/12/2012] [Indexed: 02/04/2023] Open
Abstract
Cholesterol crystals (ChCs) have been identified as a major factor of plaque vulnerability and as a potential biomarker for atherosclerosis. Yet, due to the technical challenge of selectively detecting cholesterol in its native tissue environment, the physiochemical role of ChCs in atherosclerotic progression remains largely unknown. In this work, we demonstrate the utility of hyperspectral stimulated Raman scattering (SRS) microscopy combined with second-harmonic generation (SHG) microscopy to selectively detect ChC. We show that despite the polarization sensitivity of the ChC Raman spectrum, cholesterol monohydrate crystals can be reliably discriminated from aliphatic lipids, from structural proteins of the tissue matrix and from other condensed structures, including cholesteryl esters. We also show that ChCs exhibit a nonvanishing SHG signal, corroborating the noncentrosymmetry of the crystal lattice composed of chiral cholesterol molecules. However, combined hyperspectral SRS and SHG imaging reveals that not all SHG-active structures with solidlike morphologies can be assigned to ChCs. This study exemplifies the merit of combining SRS and SHG microscopy for an enhanced label-free chemical analysis of crystallized structures in diseased tissue.
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Affiliation(s)
- Jeffrey L. Suhalim
- Beckman Laser Institute, University of California, Irvine, California
- Department of Biomedical Engineering, University of California, Irvine, California
| | - Chao-Yu Chung
- Department of Chemistry, University of California, Irvine, California
| | - Magnus B. Lilledahl
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ryan S. Lim
- Beckman Laser Institute, University of California, Irvine, California
| | - Moshe Levi
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Denver, Aurora, Colorado
| | - Bruce J. Tromberg
- Beckman Laser Institute, University of California, Irvine, California
- Department of Biomedical Engineering, University of California, Irvine, California
| | - Eric O. Potma
- Beckman Laser Institute, University of California, Irvine, California
- Department of Chemistry, University of California, Irvine, California
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