Biomechanical Forces and Atherosclerosis: From Mechanism to Diagnosis and Treatment

To patch or not to patch: is that the real question? The role of hemodynamics in carotid endarterectomy. Illustrative cases

BACKGROUND

The utilizationof patches in carotid endarterectomy (CEA) for carotid artery stenosis remains controversial, with conflicting evidence regarding postoperative outcomes. This report accentuates this discourse with two selected representative cases with divergent outcomes.

OBSERVATIONS

Computational fluid dynamics analyses of pre- and post-CEA hemodynamics revealed distinct hemodynamic profiles between the two patients. In the nonpatched internal carotid artery (ICA), the vessel retained a cylindrical shape, exhibiting swirling blood flow and higher wall shear stress (WSS)-patterns typical of healthy vasculature. The patched ICA adopted a bulbous shape, akin to the anatomical carotid bulb, and displayed lower WSS and noncoherent disturbed blood flow, which are features associated with atherosclerosis, endothelial dysfunction, and cellular damage.

LESSONS

This study suggests that the question may not be "To patch or not to patch?" but rather "Is the restoration of the anatomical bulb shape beneficial or deleterious?" It sheds light on the hemodynamic implications of this procedure and provides insight into the ongoing debate surrounding CEA. Using a patch might not necessarily result in improved flow or more favorable outcomes; thus, restoration of the carotid bulb configuration postendarterectomy might not optimize the hemodynamic profile for patients, but rather, a simple tubular shape, without a patch, might offer the best solution. https://thejns.org/doi/10.3171/CASE24840.

Pueraria Radix and Its Major Constituents Against Metabolic Diseases: Pharmacological Mechanisms and Potential Applications

Metabolic diseases (MD), a series of chronic disorders, severely decrease the quality of life for patients but also cause a heavy economic burden. The ancient Chinese herb Pueraria Radix (PR) plays an important role in curing MD. Up to now, the bioactive compounds found in PR demonstrate effective actions in treating various metabolic disorders. This paper systematically summarizes the recent research advances on the pharmacological activities of PR and its constituents, explains the underlying mechanisms of preventing and treating MD. Besides, phytochemicals, drug delivery systems, clinical application, and safety of PR have been researched, hoping to provide valuable information for the future application, development, and improvement of PR as well as MD treatment. The information about PR was collected from various sources including classic books about Chinese herbal medicine and scientific databases including Web of Science, PubMed, ScienceDirect, Springer, ACS, SCOPUS, CNKI, Google Scholar, X-MOL, and WANFANG using keywords given and terms like pharmacological and phytochemical details of this plant. The chemical constituents isolated and identified from PR, such as isoflavones including puerarin, formononetin, daidzin, daidzein, genistein, and so forth, polysaccharides, alkaloids, starch, and other components have been proved to have the effect of anti-diabetic, anti-obesity, anti-atherosclerotic, anti-osteoporotic, anti-hypertensive, anti-hyperlipidemia, and anti-nonalcoholic fatty liver disease (NAFLD) through PI3K/Akt, Nrf2/HO-1, LOX-1/ROS/Akt/eNOS, ERK1/2-Nrf2, GLP-1R, Caspase, MAPK, NF-κB, and other anti-inflammatory and anti-oxidant signaling pathways. Also, the active contents of PR have been designed as drug delivery systems to improve the therapeutic effects of MD. It provides a preclinical basis for the efficacy of PR as an effective therapeutic agent for the prevention and treatment of MD. Even so, further studies are still needed to enhance bioavailability and expand clinical application.

The effective constituent puerarin, from Pueraria lobata, inhibits the proliferation and inflammation of vascular smooth muscle in atherosclerosis through the miR-29b-3p/IGF1 pathway

CONTEXT

Atherosclerosis (AS) is the main cause of cardiovascular and cerebrovascular diseases. Pueraria lobata (Willd.) Ohwi (Fabaceae) has a positive effect on improving these diseases.

OBJECTIVE

The P. lobata effect on the proliferation and inflammation of vascular smooth muscle in AS and the potential mechanism were investigated.

MATERIALS AND METHODS

By feeding a high-fat diet to 8-week-old apolipoprotein E knockout mice, an atherosclerosis model was created. H&E and IHC staining were used to analyse the histopathology of mice. CCK-8, TUNEL, and scratch tests were used to detect cell proliferation, apoptosis, and migration after 24 h treatment, respectively. ELISA was performed to evaluate the level of IL-6 and IL-8. The target miRNA and its downstream target gene were screened by the bioinformatics method; RT-qPCR has conducted to analyse the expression of these genes.

RESULTS

In the aortic tissue and serum of AS mice, puerarin can lower the expression of α-SMA and the inflammatory proteins IL-6 and IL-8. Puerarin (200 M) decreased hVSMC proliferation, migration, and IL-6 and IL-8 secretion by more than half. The inhibitory impact of puerarin on hVSMC was decreased by overexpression of miR-29b-3p. IGF1 was miR-29b-3p's downstream target gene. IGF1 expression increased almost 3-fold in AS mice and hVSMC, but miR-29b-3p mimic inhibited it. The effect of miR-29b-3p on hVSMC was reversed when IGF1 was overexpressed.

DISCUSSION AND CONCLUSIONS

Puerarin inhibits the proliferation and inflammation of vascular smooth muscle in AS through the miR-29b-3p/IGF1 pathway. Puerarin may have a beneficial effect in the treatment of atherosclerosis and offer a novel therapy option.

Mechanosensing and Mechanosignal Transduction in Atherosclerosis

PURPOSE OF REVIEW

This review aims to summarize the latest findings on mechanosensing in atherosclerosis, elucidating the molecular mechanisms, cellular players, and potential therapeutic targets.

RECENT FINDINGS

Atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaque within arterial walls, is a major contributor to cardiovascular disease-related mortality and morbidity. Interestingly, atherosclerosis predominantly occurs in arterial areas with curves and branches. In these regions, endothelial cells encounter irregular blood flow with distinctive low-intensity fluctuating shear stress. On the other hand, straight sections of arteries, subjected to a consistent flow and related high-intensity, one-way shear stress, are relatively safeguarded against atherosclerosis due to shear-dependent, disease-preventing endothelial cell reactions. In recent years, researchers have been investigating the role of mechanosensing in the development and progression of atherosclerosis. At the core of mechanosensing is the ability of various cells to sense and respond to biomechanical forces in their environment. In the context of atherosclerosis, endothelial cells, smooth muscle cells, and immune cells are subjected to various mechanical or physical stimuli, including shear stress, cyclic strain, and matrix stiffness. These mechanical cues play a crucial role in regulating cellular behavior and contribute to the pathophysiology of atherosclerosis. Accumulating evidence suggests that various mechanical or physical cues play a critical role in the development and promotion of atherosclerosis.

Non-Invasive Pulsatile Shear Stress Modifies Endothelial Activation; A Narrative Review

The monolayer of cells that line both the heart and the entire vasculature is the endothelial cell (EC). These cells respond to external and internal signals, producing a wide array of primary or secondary messengers involved in coagulation, vascular tone, inflammation, and cell-to-cell signaling. Endothelial cell activation is the process by which EC changes from a quiescent cell phenotype, which maintains cellular integrity, antithrombotic, and anti-inflammatory properties, to a phenotype that is prothrombotic, pro-inflammatory, and permeable, in addition to repair and leukocyte trafficking at the site of injury or infection. Pathological activation of EC leads to increased vascular permeability, thrombosis, and an uncontrolled inflammatory response that leads to endothelial dysfunction. This pathological activation can be observed during ischemia reperfusion injury (IRI) and sepsis. Shear stress (SS) and pulsatile shear stress (PSS) are produced by mechanical frictional forces of blood flow and contraction of the heart, respectively, and are well-known mechanical signals that affect EC function, morphology, and gene expression. PSS promotes EC homeostasis and cardiovascular health. The archetype of inducing PSS is exercise (i.e., jogging, which introduces pulsations to the body as a function of the foot striking the pavement), or mechanical devices which induce external pulsations to the body (Enhanced External Pulsation (EECP), Whole-body vibration (WBV), and Whole-body periodic acceleration (WBPA aka pGz)). The purpose of this narrative review is to focus on the aforementioned noninvasive methods to increase PSS, review how each of these modify specific diseases that have been shown to induce endothelial activation and microcirculatory dysfunction (Ischemia reperfusion injury-myocardial infarction and cardiac arrest and resuscitation), sepsis, and lipopolysaccharide-induced sepsis syndrome (LPS)), and review current evidence and insight into how each may modify endothelial activation and how these may be beneficial in the acute and chronic setting of endothelial activation and microvascular dysfunction.

Ginsenoside Rc ameliorated atherosclerosis via regulating gut microbiota and fecal metabolites

Atherosclerosis (AS) and the accompanied cardiovascular diseases (CVDs) were the leading cause of death worldwide. Recently, the association between CVDs, gut microbiota, and metabolites had aroused increasing attention. In the study, we headed our investigation into the underlying mechanism of ginsenoside Rc (GRc), an active ingredient of ginsenosides used for the treatment of CVDs, in apolipoprotein E-deficient (ApoE^−/−) mice with high-fat diet (HFD). Seven-week-old male ApoE^−/− mice were randomly divided into four groups: the normal control (NC) group, the HFD group, the GRc group (40 mg/kg/d), and the atorvastatin (Ato) group (10 mg/kg/d). Atherosclerotic injury was evaluated by aortic lesions, serum lipid levels, and inflammatory factors. The composition of gut microbiota and fecal metabolite profile were analyzed using 16S rRNA sequence and untargeted metabolomics, respectively. The results showed that GRc significantly alleviated HFD-induced aortic lesions, reduced serum levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), tumor necrosis factor-α (TNF-α), and interleukin (IL)-6 and IL-1β, and increased high-density lipoprotein cholesterol (HFD-C) level, as well as the alteration of gut microbiota composition, function, and metabolite profile. GRc also reversed HFD change of Bacteroidetes and Firmicutes at the phylum level, Muribaculaceae, Lactobacillus, Ileibacterium, Bifidobacterium, Faecalibaculum, Oscillibacter, Blautia, and Eubacterium_coprostanoligenes_group at the genus level, and 23 key metabolites involved in taurine and hypotaurine metabolism, arginine biosynthesis, ATP-binding cassette (ABC) transporters, primary bile acid biosynthesis, purine metabolism, tricarboxylic acid (TCA) cycle, and glucagon signaling pathways. Additionally, eight differential intestinal floras at the genus level were associated with 23 key differential metabolites involving atherosclerotic injury. In conclusion, our results demonstrated that GRc ameliorated atherosclerotic injury, regulated microbial and metabolomic changes in HFD-induced ApoE^−/− mice, and suggested a potential correlation among gut microbiota, metabolites, and atherosclerotic injury regarding the mechanisms of GRc against AS.