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Hou P, Fang J, Liu Z, Shi Y, Agostini M, Bernassola F, Bove P, Candi E, Rovella V, Sica G, Sun Q, Wang Y, Scimeca M, Federici M, Mauriello A, Melino G. Macrophage polarization and metabolism in atherosclerosis. Cell Death Dis 2023; 14:691. [PMID: 37863894 PMCID: PMC10589261 DOI: 10.1038/s41419-023-06206-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/22/2023]
Abstract
Atherosclerosis is a chronic inflammatory disease characterized by the accumulation of fatty deposits in the inner walls of vessels. These plaques restrict blood flow and lead to complications such as heart attack or stroke. The development of atherosclerosis is influenced by a variety of factors, including age, genetics, lifestyle, and underlying health conditions such as high blood pressure or diabetes. Atherosclerotic plaques in stable form are characterized by slow growth, which leads to luminal stenosis, with low embolic potential or in unstable form, which contributes to high risk for thrombotic and embolic complications with rapid clinical onset. In this complex scenario of atherosclerosis, macrophages participate in the whole process, including the initiation, growth and eventually rupture and wound healing stages of artery plaque formation. Macrophages in plaques exhibit high heterogeneity and plasticity, which affect the evolving plaque microenvironment, e.g., leading to excessive lipid accumulation, cytokine hyperactivation, hypoxia, apoptosis and necroptosis. The metabolic and functional transitions of plaque macrophages in response to plaque microenvironmental factors not only influence ongoing and imminent inflammatory responses within the lesions but also directly dictate atherosclerotic progression or regression. In this review, we discuss the origin of macrophages within plaques, their phenotypic diversity, metabolic shifts, and fate and the roles they play in the dynamic progression of atherosclerosis. It also describes how macrophages interact with other plaque cells, particularly T cells. Ultimately, targeting pathways involved in macrophage polarization may lead to innovative and promising approaches for precision medicine. Further insights into the landscape and biological features of macrophages within atherosclerotic plaques may offer valuable information for optimizing future clinical treatment for atherosclerosis by targeting macrophages.
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Affiliation(s)
- Pengbo Hou
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, Rome, Italy
- The First Affiliated Hospital of Soochow University, Institutes for Translational Medicine, State Key Laboratory of Radiation Medicine and Protection, Suzhou Medical College of Soochow University, Suzhou, China
| | - Jiankai Fang
- The First Affiliated Hospital of Soochow University, Institutes for Translational Medicine, State Key Laboratory of Radiation Medicine and Protection, Suzhou Medical College of Soochow University, Suzhou, China
| | - Zhanhong Liu
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, Rome, Italy
- The First Affiliated Hospital of Soochow University, Institutes for Translational Medicine, State Key Laboratory of Radiation Medicine and Protection, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yufang Shi
- The First Affiliated Hospital of Soochow University, Institutes for Translational Medicine, State Key Laboratory of Radiation Medicine and Protection, Suzhou Medical College of Soochow University, Suzhou, China
| | - Massimiliano Agostini
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Bernassola
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, Rome, Italy
| | - Pierluigi Bove
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, Rome, Italy
| | - Eleonora Candi
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Rovella
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Sica
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, Rome, Italy
| | - Qiang Sun
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, Rome, Italy
- The First Affiliated Hospital of Soochow University, Institutes for Translational Medicine, State Key Laboratory of Radiation Medicine and Protection, Suzhou Medical College of Soochow University, Suzhou, China
| | - Ying Wang
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, Rome, Italy
- The First Affiliated Hospital of Soochow University, Institutes for Translational Medicine, State Key Laboratory of Radiation Medicine and Protection, Suzhou Medical College of Soochow University, Suzhou, China
| | - Manuel Scimeca
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Federici
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy.
| | - Alessandro Mauriello
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, Rome, Italy.
| | - Gerry Melino
- Department of Experimental Medicine, TOR, University of Rome Tor Vergata, Rome, Italy.
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Analysis of Risk Factors for Vulnerable Plaque Formation and Pathogenic in Carotid Artery. J Craniofac Surg 2023; 34:e182-e186. [PMID: 36036515 DOI: 10.1097/scs.0000000000008953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/10/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The formation of vulnerable carotid artery plaque may be closely related to a single factor or caused by multiple factors. This paper discusses the pathogenic risk factors for vulnerable plaque in patients with severe internal carotid artery (ICA) stenosis who received endarterectomy through regression analysis. MATERIALS AND METHODS A total of 98 patients with a complete clinical and laboratory assessment underwent carotid endarterectomy. Metabolic syndrome (MetS) and MetS components, ICA plaque thickness and ICA peak systolic velocity, previous ischemic stroke or transient ischemic attack (TIA), and other risk factors were included in the pathogenic risk factor for vulnerable plaque. Univariate logistic regression analysis was used to determine vulnerable carotid plaque risk factors. If P <0.2, it was considered potential confounders. Binary logistic regression model was controlled for potential confounders. RESULTS Among the 98 patients, stable carotid plaques 38 (39%) and unstable carotid plaques 60 (61%), male 76 (77.6%) and female 22 (22.4%), and Han Chinese 68 (68.4%) and Mongols 30 (30.6%). Univariate logistic regression to P <0.2 has 6 risk factors, which are previous ischemic stroke or TIA, ICA peak systolic velocity, ICA plaque thickness, body mass index, total cholesterol, and alcohol consumption. The significant result of the binary logistic regression analysis was the previous ischemic stroke or TIA (OR=4.52; 95% CI, 1.67-12.09), P =0.003 and ICA peak systolic velocity (OR=1.01; 95% CI, 1.00-1.02), P =0.014. CONCLUSIONS The patients with previous ischemic stroke or TIA and higher ICA peak systolic velocity are associated with vulnerable plaque pathogenic features. There is no obligatory association between MetS and formation of carotid plaque vulnerability.
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Prevalence and Predictors of Renal Disease in a National Representative Sample of the Romanian Adult Population: Data from the SEPHAR IV Survey. Diagnostics (Basel) 2022; 12:diagnostics12123199. [PMID: 36553206 PMCID: PMC9777169 DOI: 10.3390/diagnostics12123199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Background: The prevalence of chronic kidney disease (CKD) correlates with the prevalence of hypertension (HT). We studied the prevalence and predictors of CKD in a representative sample of the Romanian adult population. Methods: A sample of 1470 subjects were enrolled in the SEPHAR IV (Study for the Evaluation of Prevalence of Hypertension and Cardiovascular Risk) survey. All subjects were evaluated for blood pressure (BP) and extensive evaluations of target organ damage, blood, and urine samples were undertaken. Results: A total of 883 subjects were included in the statistical analysis. Those experiencing CKD with an eGFR < 60 mL/min/1.73 m2 were older at 71.94 ± 7.4 years (n = 19, 2.15%) compared with those without renal impairment at 50.3 ± 16.21 years (n = 864, 97.85%), p < 0.0001. The prevalence of CKD among hypertensives (379 from 883) was 4.49% (17/379), while 17 out of 19 subjects with CKD had HT (89.47%). After adjusting for age, sex, and diabetic status, only serum uric acid (SUR) > 6.9 mg/dL (OR: 6.61; 95% CI: 2.063, 10.83; p = 0.004) was an independent risk factor and a predictor of CKD. Conclusions: The prevalence of CKD in hypertensive Romanian adults was more than ten times higher than in the normotensive population. Levels of SUR > 6.9 mg/dL were predictors of CKD.
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Phyo WSY, Shirakawa M, Yamada K, Kuwahara S, Yoshimura S. Characteristics of Calcification and Their Association with Carotid Plaque Vulnerability. World Neurosurg 2022; 167:e1017-e1024. [PMID: 36058484 DOI: 10.1016/j.wneu.2022.08.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/28/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Carotid plaque vulnerability is one of the important features for evaluating the risk of subsequent ischemic stroke. Although magnetic resonance imaging (MRI) is the gold standard modality for evaluating plaque vulnerability, some patients cannot undergo MRI because of physical or economic issues. Computed tomography (CT) is more readily available. The purpose of this study was to establish a new category of calcification on CT and to assess its usefulness for detecting vulnerable plaque. MATERIALS AND METHODS We retrospectively evaluated consecutive patients who underwent plaque imaging using CT and MRI before carotid revascularization at our institute. Calcifications were classified into 4 types according to the new calcium classification. The patients were divided into 2 groups, the double layer sign (DLS)-positive group and the DLS-negative group. Signal intensity ratio (SIR) of carotid plaque was measured on MRI for evaluating plaque vulnerability and compared between type of calcification and SIR. RESULTS Among the 132 patients evaluated, 50 patients (62.5%) in DLS positive group and 16 patients (30.8%) in DLS negative group had calcification with vulnerable plaque (SIR > 1.47) (P < 0.01). Substantial interobserver agreement of type of calcification was observed (kappa, 0.79; P < 0.01). Multivariate analysis showed that DLS (odds ratio 3.03; 95% confidence interval 1.35-6.8; P < 0.01) and male sex (odds ratio 3.15; 95% confidence interval 1.02-9.68; P = 0.04) were independent predictors of vulnerable plaque. CONCLUSIONS DLS in our new classification of calcification on CT reliably detects vulnerable plaque and could thus be used in patients who cannot undergo MRI.
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Affiliation(s)
- Wint Shwe Yee Phyo
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Manabu Shirakawa
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kiyofumi Yamada
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Shuntaro Kuwahara
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
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Stonko DP, Goldsborough E, Kibrik P, Zhang G, Holscher CM, Hicks CW. Use of Transcarotid Artery Revascularization, Transfemoral Carotid Artery Stenting, and Carotid Endarterectomy in the US From 2015 to 2019. JAMA Netw Open 2022; 5:e2231944. [PMID: 36112371 PMCID: PMC9482062 DOI: 10.1001/jamanetworkopen.2022.31944] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE A transcarotid artery revascularization (TCAR) device was approved by the US Food and Drug Administration in 2015 for carotid revascularization in patients at high risk for stroke, cranial nerve injury, or major cardiac event. It is unclear how the introduction of TCAR has changed the use of carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TFCAS). OBJECTIVE To quantify the temporal changes in the operative approach to carotid revascularization (CEA vs TFCAS vs TCAR), and to identify patient and disease characteristics commonly associated with each approach. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study obtained data from the Vascular Quality Initiative database from January 1, 2015, to December 31, 2019. Patients with carotid artery stenosis who underwent CEA, TFCAS, or TCAR were included. Data were analyzed from January to April 2022. EXPOSURES Month and year of surgery as well as patient risk status. MAIN OUTCOMES AND MEASURES Number and proportion of carotid revascularization procedures by operative approach. RESULTS A total of 108 676 patients (mean [SD] age 56.6 [12.5] years; 66 684 men [61.4%]) were included in the analysis. The most common operative approach overall was CEA (n = 81 508 [75.0%]), followed by TFCAS (n = 15 578 [14.3%]) and TCAR (n = 11 590 [10.7%]). The number of procedures increased over the study period (16 754 in 2015 vs 27 269 in 2019; P < .001). In 2015, CEA was used in 84.9% of all cases, followed by TFCAS (14.4%) and TCAR (0.8%). In 2019, CEA was used in 64.8% of cases, followed by TCAR (21.9%) and TFCAS (13.3%). The proportional use of CEA decreased by 5.0% (95% CI, -7.4% to -2.6%) per year, and TCAR use increased by 5.3% (95% CI, 2.3%-8.3%) per year. Among patients at high risk, the change was greater: CEA use decreased by 7.8% (95% CI, -11.9% to -3.8%) per year, TFCAS decreased by 4.8% (95% CI, -9.5% to -0.14%) per year, and TCAR increased by 12.6% (95% CI, 7.1%-18.1%) per year. Multinomial logistic regression showed that patient risk status was the most important characteristic associated with TCAR compared with CEA (relative risk ratio, 36.10; 95% CI, 29.24-44.66; P < .001) and TFCAS (relative risk ratio, 14.10; 95% CI, 11.86-16.66; P < .001). Linear regression revealed no association between year of surgery and in-hospital myocardial infarction, stroke, or mortality. CONCLUSIONS AND RELEVANCE Results of this study indicate that TCAR has become the dominant carotid revascularization approach, surpassing TFCAS and CEA in patients at high risk for stroke, cranial nerve injury, or cardiovascular events. Patient high-risk status was the main characteristic associated with a stenting approach, highlighting the perceived importance of carotid stenting therapies in this patient population.
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Affiliation(s)
- David P. Stonko
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
- R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore
| | - Earl Goldsborough
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Pavel Kibrik
- Vascular Institute of New York, Brooklyn, New York
| | - George Zhang
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Courtenay M. Holscher
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Caitlin W. Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
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Peix A. Choosing between anatomy and function is not always evident for the heart of end-stage renal disease patients. How low can we go? J Nucl Cardiol 2021; 28:2671-2675. [PMID: 32342299 DOI: 10.1007/s12350-020-02118-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
Patients with chronic kidney disease (CKD) are at a very high risk of adverse cardiovascular events. In CKD patients, vascular calcification is more prevalent, appears at an earlier age, and is more severe than in the general population. CKD physiology rather than the effects of dialysis is the primary driver of microvascular disease in these patients. Considering the significant morbidity and mortality attributable to cardiovascular disease in the CKD population, risk stratification remains an important challenge. Topics such as function vs anatomy to properly risk stratify these patients, as well as future perspectives on non-invasive techniques, will be addressed.
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Affiliation(s)
- Amalia Peix
- Nuclear Medicine Department, Institute of Cardiology, 17 No. 702, Vedado, CP 10 400, La Habana, Cuba.
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Scimeca M, Montanaro M, Cardellini M, Bonfiglio R, Anemona L, Urbano N, Bonanno E, Menghini R, Casagrande V, Martelli E, Servadei F, Giacobbi E, Ippoliti A, Bei R, Manzari V, Federici M, Schillaci O, Mauriello A. High Sensitivity C-Reactive Protein Increases the Risk of Carotid Plaque Instability in Male Dyslipidemic Patients. Diagnostics (Basel) 2021; 11:diagnostics11112117. [PMID: 34829465 PMCID: PMC8624324 DOI: 10.3390/diagnostics11112117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 12/15/2022] Open
Abstract
Background: The aim of this study was to evaluate how the high sensitivity C-reactive protein (hs-CRP) values influence the risk of carotid plaque instability in association with other cardiovascular risk factors. Methods: One hundred and fifty-six carotid plaques from both symptomatic and asymptomatic patients requiring surgical carotid endarterectomy were retrospectively collected. According to the modified American Heart Association, atherosclerosis plaques have been histologically distinguished into unstable and stable. The following anamnestic and hematochemical data were also considered: age, gender, hypertension, diabetes mellitus, smoking habit, therapy, low-density lipoprotein (LDL)-C, kidney failure and hs-CRP. Results: The results of our study clearly show that high levels of hs-CRP significantly increase the carotid plaque instability in dyslipidemic patients. Specifically, a 67% increase of the risk of carotid plaque instability was observed in patients with high LDL-C. Therefore, the highest risk was observed in male dyslipidemic patients 2333 (95% CI 0.73–7.48) and in aged female patients 2713 (95% CI 0.14–53.27). Discussion: These data strongly suggest a biological relationship between the hs-CRP values and the alteration of lipidic metabolism mostly in male patients affected by carotid atherosclerosis. The measurement of hs-CRP might be useful as a potential screening tool in the prevention of atheroscletotic disease.
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Affiliation(s)
- Manuel Scimeca
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.M.); (R.B.); (L.A.); (E.B.); (F.S.); (E.G.); (A.M.)
- San Raffaele University, Via di Val Cannuta 247, 00166 Rome, Italy
- Faculty of Medicine, Saint Camillus International University of Health Sciences, Via di Sant’Alessandro 8, 00131 Rome, Italy
- Correspondence: ; Tel.: +39-0620-903-934
| | - Manuela Montanaro
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.M.); (R.B.); (L.A.); (E.B.); (F.S.); (E.G.); (A.M.)
| | - Marina Cardellini
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (M.C.); (R.M.); (V.C.); (M.F.)
- Center for Atherosclerosis, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Rita Bonfiglio
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.M.); (R.B.); (L.A.); (E.B.); (F.S.); (E.G.); (A.M.)
| | - Lucia Anemona
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.M.); (R.B.); (L.A.); (E.B.); (F.S.); (E.G.); (A.M.)
| | - Nicoletta Urbano
- Nuclear Medicine Unit, Department of Oncohaematology, Policlinico “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy;
| | - Elena Bonanno
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.M.); (R.B.); (L.A.); (E.B.); (F.S.); (E.G.); (A.M.)
| | - Rossella Menghini
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (M.C.); (R.M.); (V.C.); (M.F.)
| | - Viviana Casagrande
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (M.C.); (R.M.); (V.C.); (M.F.)
| | - Eugenio Martelli
- Department of General and Specialist Surgery “P. Stefanini”, Sapienza University of Rome, 00185 Rome, Italy;
- Division of Vascular Surgery, S. Anna and S. Sebastiano Hospital, 81100 Caserta, Italy
| | - Francesca Servadei
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.M.); (R.B.); (L.A.); (E.B.); (F.S.); (E.G.); (A.M.)
| | - Erica Giacobbi
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.M.); (R.B.); (L.A.); (E.B.); (F.S.); (E.G.); (A.M.)
| | - Arnaldo Ippoliti
- Vascular Surgery Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Roberto Bei
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.B.); (V.M.)
| | - Vittorio Manzari
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (R.B.); (V.M.)
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (M.C.); (R.M.); (V.C.); (M.F.)
- Center for Atherosclerosis, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy;
- IRCCS Neuromed, Via Atinense, 18, 8607 Pozzilli, Italy
| | - Alessandro Mauriello
- Department of Experimental Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.M.); (R.B.); (L.A.); (E.B.); (F.S.); (E.G.); (A.M.)
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Montanaro M, Scimeca M, Toschi N, Bonanno E, Giacobbi E, Servadei F, Ippoliti A, Santeusanio G, Mauriello A, Anemona L. Effects of Risk Factors on In Situ Expression of Proinflammatory Markers Correlated to Carotid Plaque Instability. Appl Immunohistochem Mol Morphol 2021; 29:741-749. [PMID: 34039839 DOI: 10.1097/pai.0000000000000947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Several studies demonstrated a role of active chronic inflammatory infiltrate in carotid plaques progression suggesting a possible link between cardiovascular risk factors and inflammation-related plaque instability. The aim of this study is therefore to evaluate the possible effects of cardiovascular risk factors on in situ expression of proinflammatory markers associated with carotid plaque instability. METHODS AND RESULTS A tissue microarray containing carotid plaques from 36 symptomatic (major stroke or transient ischemic attack) and 37 asymptomatic patients was built. Serial sections were employed to evaluate the expression of some inflammatory markers by immunohistochemistry [CD3, CD4a, CD8, CD20, CD86, CD163, interleukin (IL)-2, IL-6, IL-17]. Immunohistochemical data were analyzed to study the possible associations between in situ expression of inflammatory biomarker and the main cardiovascular risk factors. Our data demonstrated that plaque instability is associated with the high in situ expression of some cytokines, such as IL-2, IL-6, IL-17. Besides the female sex, none of the risk factors analyzed showed a significant association between the in situ expression of these markers and unstable plaques. A significant increase of IL-6-positive and IL-17-positive cells was observed in unstable atheromatous plaques of female patients, as compared with unstable plaques of male patients. CONCLUSIONS Plaque destabilization is certainly correlated with the presence of the major cardiovascular risk factors, however, our results showed that, with the exception of sex, their action in the evolutive process of plaque instability seems rather nonspecific, favoring a general release of proinflammatory cytokines.
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Affiliation(s)
| | - Manuel Scimeca
- Departments of Experimental Medicine
- University of San Raffaele
- Saint Camillus International University of Health Sciences, Rome, Italy
| | - Nicola Toschi
- Biomedicine and Prevention, University of Rome "Tor Vergata"
- Imaging Martinos Center for Biomedical Imaging
- Harvard Medical School, Massachusetts General Hospital, Boston, MA
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Scarale MG, Antonucci A, Cardellini M, Copetti M, Salvemini L, Menghini R, Mazza T, Casagrande V, Ferrazza G, Lamacchia O, De Cosmo S, Di Paola R, Federici M, Trischitta V, Menzaghi C. A Serum Resistin and Multicytokine Inflammatory Pathway Is Linked With and Helps Predict All-cause Death in Diabetes. J Clin Endocrinol Metab 2021; 106:e4350-e4359. [PMID: 34192323 DOI: 10.1210/clinem/dgab472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Type 2 diabetes (T2D) shows a high mortality rate, partly mediated by atherosclerotic plaque instability. Discovering novel biomarkers may help identify high-risk patients who would benefit from more aggressive and specific managements. We recently described a serum resistin and multicytokine inflammatory pathway (REMAP), including resistin, interleukin (IL)-1β, IL-6, IL-8, and TNF-α, that is associated with cardiovascular disease. OBJECTIVE We investigated whether REMAP is associated with and improves the prediction of mortality in T2D. METHODS A REMAP score was investigated in 3 cohorts comprising 1528 patients with T2D (409 incident deaths) and in 59 patients who underwent carotid endarterectomy (CEA; 24 deaths). Plaques were classified as unstable/stable according to the modified American Heart Association atherosclerosis classification. RESULTS REMAP was associated with all-cause mortality in each cohort and in all 1528 individuals (fully adjusted hazard ratio [HR] for 1 SD increase = 1.34, P < .001). In CEA patients, REMAP was associated with mortality (HR = 1.64, P = .04) and a modest change was observed when plaque stability was taken into account (HR = 1.58; P = .07). REMAP improved discrimination and reclassification measures of both Estimation of Mortality Risk in Type 2 Diabetic Patients and Risk Equations for Complications of Type 2 Diabetes, well-established prediction models of mortality in T2D (P < .05-< .001). CONCLUSION REMAP is independently associated with and improves predict all-cause mortality in T2D; it can therefore be used to identify high-risk individuals to be targeted with more aggressive management. Whether REMAP can also identify patients who are more responsive to IL-6 and IL-1β monoclonal antibodies that reduce cardiovascular burden and total mortality is an intriguing possibility to be tested.
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Affiliation(s)
- Maria Giovanna Scarale
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, Italy
| | - Alessandra Antonucci
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, Italy
| | - Marina Cardellini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome 00133, Italy
- Center for Atherosclerosis, Department of Medical Sciences, Policlinico Tor Vergata University, Rome 00133, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo 71013, Italy
| | - Lucia Salvemini
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, Italy
| | - Rossella Menghini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| | - Tommaso Mazza
- Bioinformatics Unit, IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo 71013, Italy
| | - Viviana Casagrande
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| | - Gianluigi Ferrazza
- Center for Atherosclerosis, Department of Medical Sciences, Policlinico Tor Vergata University, Rome 00133, Italy
| | - Olga Lamacchia
- Unit of Endocrinology and Diabetology, Department of Medical and Surgical Sciences, University of Foggia, Foggia 71100, Italy
| | - Salvatore De Cosmo
- Department of Clinical Sciences, Fondazione IRCCS "Casa Sollievo Della Sofferenza," San Giovanni Rotondo 71013, Italy
| | - Rosa Di Paola
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, Italy
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, Rome 00133, Italy
- Center for Atherosclerosis, Department of Medical Sciences, Policlinico Tor Vergata University, Rome 00133, Italy
| | - Vincenzo Trischitta
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, Italy
- Department of Experimental Medicine, "Sapienza" University, Rome 00185, Italy
| | - Claudia Menzaghi
- Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCCS "Casa Sollievo della Sofferenza," 71013 San Giovanni Rotondo, Italy
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10
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Servadei F, Anemona L, Cardellini M, Scimeca M, Montanaro M, Rovella V, Di Daniele F, Giacobbi E, Legramante IM, Noce A, Bonfiglio R, Borboni P, Di Daniele N, Ippoliti A, Federici M, Mauriello A. The risk of carotid plaque instability in patients with metabolic syndrome is higher in women with hypertriglyceridemia. Cardiovasc Diabetol 2021; 20:98. [PMID: 33957931 PMCID: PMC8103747 DOI: 10.1186/s12933-021-01277-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/15/2021] [Indexed: 12/24/2022] Open
Abstract
Background Metabolic syndrome certainly favors growth of carotid plaque; however, it is uncertain if it determines plaque destabilization. Furthermore, it is likely that only some components of metabolic syndrome are associated with increased risk of plaque destabilization. Therefore, we evaluated the effect of different elements of metabolic syndrome, individually and in association, on carotid plaques destabilization. Methods A total of 186 carotid endarterectomies from symptomatic and asymptomatic patients were histologically analysed and correlated with major cardiovascular risk factors. Results Metabolic syndrome, regardless of the cluster of its components, is not associated with a significant increase in risk of plaque destabilization, rather with the presence of stable plaques. The incidence of unstable plaques in patients with metabolic syndrome is quite low (43.9 %), when compared with that seen in the presence of some risk factors, but significantly increases in the subgroup of female patients with hypertriglyceridemia, showing an odds ratio of 3.01 (95% CI, 0.25–36.30). Conclusions Our data may help to identify patients with real increased risk of acute cerebrovascular diseases thus supporting the hypothesis that the control of hypertriglyceridemia should be a key point on prevention of carotid atherosclerotic plaque destabilization, especially in post-menopausal female patients.
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Affiliation(s)
- Francesca Servadei
- Anatomic Pathology, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, RM, 00133, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, RM, 00133, Italy
| | - Marina Cardellini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Manuel Scimeca
- Anatomic Pathology, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, RM, 00133, Italy.,San Raffaele University, Via di Val Cannuta 247, 00166, Rome, Italy.,Saint Camillus International University of Health Sciences, Via di Sant'Alessandro, 8, 00131, Rome, Italy
| | - Manuela Montanaro
- Anatomic Pathology, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, RM, 00133, Italy
| | - Valentina Rovella
- UOC of Internal Medicine, Center of Hypertension, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Di Daniele
- PhD School of Applied Medical, Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Erica Giacobbi
- Anatomic Pathology, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, RM, 00133, Italy
| | | | - Annalisa Noce
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Rita Bonfiglio
- Anatomic Pathology, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, RM, 00133, Italy.,Fondazione Umberto Veronesi (FUV), Piazza Velasca 5, MI, 20122, Milano, Italy
| | - Patrizia Borboni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Di Daniele
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Arnaldo Ippoliti
- Vascular Surgery, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Mauriello
- Anatomic Pathology, Department of Experimental Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, RM, 00133, Italy. .,Tor Vergata Oncoscience Research (TOR), University of Rome "Tor Vergata", Rome, Italy.
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11
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Lin S, Wang M, Liu Y, Huang J, Wu Y, Zhu Y, Wang X. Concurrence of HBV infection and non-alcoholic fatty liver disease is associated with higher prevalence of chronic kidney disease. Clin Res Hepatol Gastroenterol 2021; 45:101483. [PMID: 32646847 DOI: 10.1016/j.clinre.2020.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/22/2020] [Accepted: 06/11/2020] [Indexed: 02/04/2023]
Abstract
AIMS Coexistence of non-alcoholic fatty liver disease (NAFLD) and hepatitis B virus (HBV) infection is common in clinical practice. This study was to explore the prevalence of chronic kidney disease (CKD) in patients with NAFLD and/or HBV. METHODS Participants who received health examination in a physical examination center were included in this cross-sectional study. Binary logistic regression was used to estimate the odds ratios (ORs) for CKD. RESULTS A total of 32,578 cases were included in the final analysis, with 52.3% males and an average age of 44.01±13.09 years old. The positive rate of HBV surface antigen was 14.5% and NAFLD was diagnosed in 30.2% cases. The coexistence of NAFLD and HBV-infection was found in 1,275 (3.9%) cases. In overall population, 713 (2.2%) cases were diagnosed with CKD. The CKD prevalence were 1.4%, 2.1%, 3.5% and 5.0% in those without NAFLD or HBV, HBV-infection alone, NAFLD alone and those with concomitant HBV-infection and NAFLD, respectively. After adjustment for age, sex, body mass index, diabetes and hypertension, the correlation between CKD and liver disease was still significant in HBV group (OR=1.388, 95%CI: 1.055-1.809), yet no longer existed in patients with NAFLD (OR=1.183, 95%CI: 0.986-1.420). The concomitant of NAFLD and HBV infection was associated with a higher odds ratio for CKD compared to any other group (OR=1.961, 95%CI=1.454-2.645). CONCLUSIONS The coexistence of NAFLD and HBV increases the risk of CKD by 2-fold. The control of multiple liver diseases will be beneficial not only to liver but also to kidney.
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Affiliation(s)
- Su Lin
- Department of Gastroenterology, Union Hospital of Fujian Medical University, Fuzhou, Fujian
| | - Mingfang Wang
- Liver Research Center of the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
| | - Yuxiu Liu
- Liver Research Center of the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
| | - Jiaofeng Huang
- Liver Research Center of the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
| | - Yinlian Wu
- Liver Research Center of the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
| | - Yueyong Zhu
- Liver Research Center of the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
| | - Xiaozhong Wang
- Department of Gastroenterology, Union Hospital of Fujian Medical University, Fuzhou, Fujian.
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12
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Montanaro M, Scimeca M, Anemona L, Servadei F, Giacobbi E, Bonfiglio R, Bonanno E, Urbano N, Ippoliti A, Santeusanio G, Schillaci O, Mauriello A. The Paradox Effect of Calcification in Carotid Atherosclerosis: Microcalcification is Correlated with Plaque Instability. Int J Mol Sci 2021; 22:ijms22010395. [PMID: 33401449 PMCID: PMC7796057 DOI: 10.3390/ijms22010395] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 12/14/2022] Open
Abstract
Background: this study aims to investigate the possible association among the histopathologic features of carotid plaque instability, the presence of micro- or macrocalcifications, the expression of in situ inflammatory biomarkers, and the occurrence of the major risk factors in this process in a large series of carotid plaques. Methods: a total of 687 carotid plaques from symptomatic and asymptomatic patients were collected. Histological evaluation was performed to classify the calcium deposits in micro or macrocalcifications according to their morphological features (location and size). Immunohistochemistry was performed to study the expression of the main inflammatory biomarkers. Results: results here reported demonstrated that calcifications are very frequent in carotid plaques, with a significant difference between the presence of micro- and macrocalcifications. Specifically, microcalcifications were significantly associated to high inflamed unstable plaques. Paradoxically, macrocalcifications seem to stabilize the plaque and are associated to a M2 macrophage polarization instead. Discussion: the characterization of mechanisms involved in the formation of carotid calcifications can lay the foundation for developing new strategies for the management of patients affected by carotid atherosclerosis. Data of this study could provide key elements for an exhaustive evaluation of carotid plaque calcifications allowing to establish the risk of associated clinical events.
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Affiliation(s)
- Manuela Montanaro
- Department of Experimental Medicine, University “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (M.M.); (M.S.); (L.A.); (F.S.); (E.G.); (R.B.); (E.B.); (G.S.)
| | - Manuel Scimeca
- Department of Experimental Medicine, University “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (M.M.); (M.S.); (L.A.); (F.S.); (E.G.); (R.B.); (E.B.); (G.S.)
- Saint Camillus International University of Health Sciences, Via di Sant’Alessandro 8, 00131 Rome, Italy
| | - Lucia Anemona
- Department of Experimental Medicine, University “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (M.M.); (M.S.); (L.A.); (F.S.); (E.G.); (R.B.); (E.B.); (G.S.)
| | - Francesca Servadei
- Department of Experimental Medicine, University “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (M.M.); (M.S.); (L.A.); (F.S.); (E.G.); (R.B.); (E.B.); (G.S.)
| | - Erica Giacobbi
- Department of Experimental Medicine, University “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (M.M.); (M.S.); (L.A.); (F.S.); (E.G.); (R.B.); (E.B.); (G.S.)
| | - Rita Bonfiglio
- Department of Experimental Medicine, University “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (M.M.); (M.S.); (L.A.); (F.S.); (E.G.); (R.B.); (E.B.); (G.S.)
- Fondazione Umberto Veronesi (FUV), Piazza Velasca 5, 20122 Milano, Italy
| | - Elena Bonanno
- Department of Experimental Medicine, University “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (M.M.); (M.S.); (L.A.); (F.S.); (E.G.); (R.B.); (E.B.); (G.S.)
| | - Nicoletta Urbano
- Nuclear Medicine Unit, Department of Oncohaematology, Policlinico “Tor Vergata”, viale oxford 81, 00133 Rome, Italy;
| | - Arnaldo Ippoliti
- Vascular Surgery, Department of Biomedicine and Prevention, Policlinico “Tor Vergata”, viale oxford 81, 00133 Rome, Italy;
| | - Giuseppe Santeusanio
- Department of Experimental Medicine, University “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (M.M.); (M.S.); (L.A.); (F.S.); (E.G.); (R.B.); (E.B.); (G.S.)
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy;
- IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Alessandro Mauriello
- Department of Experimental Medicine, University “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (M.M.); (M.S.); (L.A.); (F.S.); (E.G.); (R.B.); (E.B.); (G.S.)
- Saint Camillus International University of Health Sciences, Via di Sant’Alessandro 8, 00131 Rome, Italy
- Correspondence: ; Tel.: +39-0620903908
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13
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Nelson AJ, Raggi P, Wolf M, Gold AM, Chertow GM, Roe MT. Targeting Vascular Calcification in Chronic Kidney Disease. JACC Basic Transl Sci 2020; 5:398-412. [PMID: 32368697 PMCID: PMC7188874 DOI: 10.1016/j.jacbts.2020.02.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/24/2020] [Accepted: 02/03/2020] [Indexed: 12/22/2022]
Abstract
Cardiovascular (CV) disease remains an important cause of morbidity and mortality for patients with chronic kidney disease (CKD). Although clustering of traditional risk factors with CKD is well recognized, kidney-specific mechanisms are believed to drive the disproportionate burden of CV disease. One perturbation that is frequently observed at high rates in patients with CKD is vascular calcification, which may be a central mediator for an array of CV sequelae. This review summarizes the pathophysiological bases of intimal and medial vascular calcification in CKD, current strategies for diagnosis and management, and posits vascular calcification as a risk marker and therapeutic target.
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Key Words
- CAC, coronary artery calcification
- CI, confidence interval
- CKD, chronic kidney disease
- CT, computed tomography
- CV, cardiovascular
- CVD, cardiovascular disease
- ESKD, end-stage kidney disease
- FGF, fibroblast growth factor
- HR, hazard ratio
- LDL-C, low-density lipoprotein cholesterol
- MGP, matrix Gla protein
- PTH, parathyroid hormone
- VSMC, vascular smooth muscle cell
- chronic kidney disease
- dialysis
- eGFR, estimated glomerular filtration rate
- medial calcification
- vascular calcification
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Affiliation(s)
- Adam J. Nelson
- Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
| | - Paolo Raggi
- Division of Cardiology, Department of Medicine, University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Myles Wolf
- Division of Nephrology, Department of Medicine, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Alexander M. Gold
- Research and Development, Sanifit Therapeutics, San Diego, California
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Glenn M. Chertow
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Matthew T. Roe
- Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
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14
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Scimeca M, Anemona L, Granaglia A, Bonfiglio R, Urbano N, Toschi N, Santeusanio G, Schiaroli S, Mauriello S, Tancredi V, Schillaci O, Bonanno E, Mauriello A. Plaque calcification is driven by different mechanisms of mineralization associated with specific cardiovascular risk factors. Nutr Metab Cardiovasc Dis 2019; 29:1330-1336. [PMID: 31653516 DOI: 10.1016/j.numecd.2019.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 08/01/2019] [Accepted: 08/14/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to investigate possible associations among markers of mineralization, plaque instability and the main risk factors of atherosclerosis. METHODS AND RESULTS A Tissue MicroArray containing 52 samples of calcified carotid plaques from 52 symptomatic and asymptomatic patients were built. TMA serial sections were used to study the expression of inflammatory and mineralization markers (BMP-2, BMP-4, VDR, RANKL, Osteopontin, Sclerostin, β-catenin and calmodulin) by immunohistochemistry. Our data clearly demonstrated the expression of mineralization markers in atheromatic plaques. Indeed, with the exception of RANKL, all investigated markers were expressed in at least 60% of cases. Specifically, multivariate analysis displayed significant associations between both the expression of BMP-2 and the presence of unstable plaques as well as between the expression of β-catenin and the presence of stable plaques. We also found a significant inverse association between both a) the presence of hypertension and VDR and b) smoking habits and calmodulin expression. Finally, we noted a higher density of RANKL positive cells in plaques from diabetic patients as compared to non-diabetic ones and a significant positive association between hypertriglyceridemia and BMP-4 expression. CONCLUSION Our results support the hypothesis that the process of atherosclerotic plaque calcification presents a number of similarities with the physiological processes that occur in bone, involving both osteoblasts- and osteoclasts-like arterial cells. Finally, the present study suggests that risk factors, such as hypertension, cigarette smoke and diabetes, can cause the destabilization of the atheromatic plaque acting on calcification process as well as inflammation.
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Affiliation(s)
- Manuel Scimeca
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Rome, 00133, Italy; San Raffaele University, Via di Val Cannuta 247, 00166, Rome, Italy; Fondazione Umberto Veronesi (FUV), Piazza Velasca 5, 20122, Milano, Italy; Saint Camillus International University of Health Sciences, Via di Sant'Alessandro, 8, 00131 Rome, Italy.
| | - Lucia Anemona
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Annarita Granaglia
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Rita Bonfiglio
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | | | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Rome, 00133, Italy; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging and Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
| | - Giuseppe Santeusanio
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Stefania Schiaroli
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
| | - Silvestro Mauriello
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Rome, 00133, Italy.
| | - Virginia Tancredi
- San Raffaele University, Via di Val Cannuta 247, 00166, Rome, Italy; Department of Systems Medicine, School of Sport and Exercise Sciences, University of Rome Tor Vergata, Rome, Italy; Centre of Space Biomedicine, University of Rome Tor Vergata, Rome, Italy.
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Rome, 00133, Italy; IRCCS Neuromed, Pozzilli, Italy.
| | - Elena Bonanno
- Saint Camillus International University of Health Sciences, Via di Sant'Alessandro, 8, 00131 Rome, Italy; IRCCS Neuromed Lab. "Diagnostica Medica"; and "Villa dei Platani", Avellino, Italy.
| | - Alessandro Mauriello
- Saint Camillus International University of Health Sciences, Via di Sant'Alessandro, 8, 00131 Rome, Italy; TorVergata Oncoscience Research (TOR), University of Rome "Tor Vergata", Rome, Italy.
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