1
|
Holm Nielsen S, Edsfeldt A, Tengryd C, Gustafsson H, Shore AC, Natali A, Khan F, Genovese F, Bengtsson E, Karsdal M, Leeming DJ, Nilsson J, Goncalves I. The novel collagen matrikine, endotrophin, is associated with mortality and cardiovascular events in patients with atherosclerosis. J Intern Med 2021; 290:179-189. [PMID: 33951242 PMCID: PMC8359970 DOI: 10.1111/joim.13253] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/27/2020] [Accepted: 12/08/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Rupture of atherosclerotic plaques is the major cause of acute cardiovascular events. The biomarker PRO-C6 measuring Endotrophin, a matrikine of collagen type VI, may provide valuable information detecting subjects in need of intensified strategies for secondary prevention. OBJECTIVE In this study, we evaluate endotrophin in human atherosclerotic plaques and circulating levels of PRO-C6 in patients with atherosclerosis, to determine the predictive potential of the biomarker. METHODS Sections from the stenotic human carotid plaques were stained with the PRO-C6 antibody. PRO-C6 was measured in serum of patients enrolled in the Carotid Plaque Imagining Project (CPIP) (discovery cohort, n = 577) and the innovative medicines initiative surrogate markers for micro- and macrovascular hard end-points for innovative diabetes tools (IMI-SUMMIT, validation cohort, n = 1,378). Median follow-up was 43 months. Kaplan-Meier curves and log-rank tests were performed in the discovery cohort. Cox proportional hazard regression analysis (HR with 95% CI) was used in the discovery cohort and binary logistic regression (OR with 95% CI) in the validation cohort. RESULTS PRO-C6 was localized in the core and shoulder of the atherosclerotic plaque. In the discovery cohort, PRO-C6 independently predicted future cardiovascular events (HR 1.089 [95% CI 1.019 -1.164], p = 0.01), cardiovascular death (HR 1.118 [95% CI 1.008 -1.241], p = 0.04) and all-cause death (HR 1.087 [95% CI 1.008 -1.172], p = 0.03). In the validation cohort, PRO-C6 predicted future cardiovascular events (OR 1.063 [95% CI 1.011 -1.117], p = 0.017). CONCLUSION PRO-C6 is present in the atherosclerotic plaque and associated with future cardiovascular events, cardiovascular death and all-cause mortality in two large prospective cohorts.
Collapse
Affiliation(s)
- S Holm Nielsen
- Nordic Bioscience, Herlev, Denmark.,Department of Biomedicine and Biotechnology, Technical University of Denmark, Lyngby, Denmark
| | - A Edsfeldt
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Malmö, Sweden
| | - C Tengryd
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - H Gustafsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - A C Shore
- Diabetes and Vascular Medicine, University of Exeter, Medical School, National Institute for Health Research Exeter Clinical Research Facility, Exeter, UK
| | - A Natali
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F Khan
- Division of Molecular and Clinical medicine, University of Dundee, Dundee, UK
| | | | - E Bengtsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | | | | | - J Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - I Goncalves
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| |
Collapse
|
2
|
Goncalves I, Tengryd C, Nielsen SH, Genovese F, Bengtsson E, Karsdal M, Leeming DJ, Nilsson J, Edsfeldt A. 3046High levels of MMP-cleaved mimecan is associated to carotid plaque stability and less future cardiovascular events. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The clinical consequences of atherosclerosis, myocardial infarction and stroke are the most common causes of death globally. Mimecan, a small leucine rich-repeat proteoglycan (SLRP), is cleaved by matrix metalloproteinases (MMPs) and known to be involved in collagen fibrillogenesis and angiogenesis. Circulating levels of MMP-cleaved mimecan (cMIM) has previously been identified as a marker of extracellular matrix remodelling in ApoE−/− knockout mice. The role of mimecan and its degradation in human atherosclerotic plaques has not been explored.
Purpose
We explored whether full-length mimecan and cleaved mimecan (cMIM) are associated to plaque composition and evaluated if they can predict future cardiovascular events.
Methods
Two hundred and eighteen human atherosclerotic plaques were stained for mimecan using immunohistochemistry. cMIM was measured in 202 plaque tissue homogenates using a competitive ELISA assay. Histological components (α-actin, CD68 and glycophorin A) were assessed using immunohistochemistry, neutral lipids were measured using Oil Red O and visible areas of calcium deposits were quantified. Matrix metalloproteinases (MMP-1, -2, -3, -9, -10 and -12), tissue inhibitors of matrix metalloproteinases (TIMP-1 and -2) were analysed in plaque tissue homogenates using ELISA assays and a proximity extension assay. ECM components (glycosaminoglycans, collagen and elastin) were detected with colorimetric assays and the TGF-β1, β2 and β3 were measured by a multiplex assay. Cardiovascular events were registered using national registers, patient records and telephone calls during a follow-up period of 59 months IQR (34–73).
Results
Mimecan was expressed in human atherosclerotic plaques. The expression correlated positively with neutral lipids and intraplaque hemorrhage and inversely with α-actin. In contrast cMIM correlated with α-actin and inversely with neutral lipids. cMIM correlated also with stabilizing extracellular matrix proteins elastin, collagen as well as TGF-β1, β2 and β3. Mimecan correlated to MMP-9 and cMIM correlated to MMP-2 and TIMP-2. Patient with high levels of cMIM had a lower risk of future cardiovascular events which remained significant after adjusting for risk factors (age, gender, diabetes and symptoms) in a multivariate Cox regression
Conclusion(s)
Mimecan was associated with vulnerable plaque features, whereas cMIM was related to stable plaque features. Low levels of cMIM predicted future cardiovascular events, independently of known risk factors. Taken together this suggests a possible role for mimecan and its cleavage in atherosclerosis that needs to be further explored.
Acknowledgement/Funding
Danish Research Foundation, Swedish Research Council, Swedish Heart and Lung Foundation, Skåne University Hospital and more.
Collapse
Affiliation(s)
- I Goncalves
- Lund University, Clinical Sciences Malmö and Department of Cardiology, Malmö, Sweden
| | - C Tengryd
- Lund University, Clinical Sciences Malmö, Malmö, Sweden
| | - S H Nielsen
- Nordic Bioscience, Biomarkers & Research, Technical University Denmark, Biotechnology & Biomedicine, Herlev and Kgs. Lyngby, Denmark
| | - F Genovese
- Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
| | - E Bengtsson
- Lund University, Clinical Sciences Malmö, Malmö, Sweden
| | - M Karsdal
- Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
| | - D J Leeming
- Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
| | - J Nilsson
- Lund University, Clinical Sciences Malmö, Malmö, Sweden
| | - A Edsfeldt
- Lund University, Clinical Sciences Malmö and Department of Cardiology, Malmö, Sweden
| |
Collapse
|
3
|
Holm Nielsen S, Tengryd C, Edsfeldt A, Brix S, Genovese F, Bengtsson E, Karsdal M, Leeming DJ, Nilsson J, Goncalves I. A biomarker of collagen type I degradation is associated with cardiovascular events and mortality in patients with atherosclerosis. J Intern Med 2019; 285:118-123. [PMID: 30156050 DOI: 10.1111/joim.12819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Atherosclerosis is characterized by accumulation of lipids, cells and extracellular matrix (ECM) proteins in the arterial wall. Collagen type I (COL1), a component of the arterial ECM, is cleaved by matrix metalloproteinases (MMPs) and known to be remodelled in atherosclerosis. We explored whether the MMP-mediated COL1 biomarker, C1M, was associated with cardiovascular events, cardiovascular mortality and all-cause mortality in a large prospective cohort of patients with known atherosclerosis. METHODS Serum from 787 patients who underwent a carotid endarterectomy was included. Circulating levels of C1M were measured in serum. A total of 473 patients were followed for 6 years after surgery. Associations between C1M and incidence of cardiovascular events, cardiovascular mortality and all-cause mortality were assessed by Kaplan-Meier curves and Cox regression analysis. RESULTS A total of 101 (21.4%) patients suffered from nonfatal cardiovascular events during the follow-up period, and 64 (13.5%) patients died. Of these, 39 (60.9%) died from cardiovascular diseases. Patients with C1M levels above the median were significantly associated with cardiovascular events, cardiovascular mortality and all-cause mortality (P < 0.001, P = 0.004 and P < 0.001, respectively). C1M was included in the final model for prediction of cardiovascular events (HR 2.15, 95% CI 1.40-3.32, P = 0.001), cardiovascular mortality (HR 2.20, 95% CI 1.07-4.51, P = 0.031) and all-cause mortality (HR 2.98 95% CI 1.67-5.33, P = < 0.001). CONCLUSIONS In patients with atherosclerotic carotid lesions, high levels of C1M predicted cardiovascular events, cardiovascular mortality and all-cause mortality. These findings emphasize the importance of remodelling mechanisms in atherosclerosis that are now becoming more and more explored.
Collapse
Affiliation(s)
- S Holm Nielsen
- Nordic Bioscience, Herlev, Denmark.,Technical University of Denmark, Kgs. Lyngby, Denmark
| | - C Tengryd
- Experimental Cardiovascular Research Unit, Lund University, Malmö, Sweden
| | - A Edsfeldt
- Experimental Cardiovascular Research Unit, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - S Brix
- Technical University of Denmark, Kgs. Lyngby, Denmark
| | | | - E Bengtsson
- Experimental Cardiovascular Research Unit, Lund University, Malmö, Sweden
| | | | | | - J Nilsson
- Experimental Cardiovascular Research Unit, Lund University, Malmö, Sweden
| | - I Goncalves
- Experimental Cardiovascular Research Unit, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
4
|
Goncalves I, Holm Nielsen S, Tengryd C, Brix S, Edsfeldt A, Genovese F, Bengtsson E, Karsdal M, Julie Leeming D, Nilsson J. 4982Markers of basement membrane remodelling are associated with higher mortality in patients with advanced carotid atherosclerosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.4982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- I Goncalves
- Lund University, Clinical Sciences Malmö and Department of Cardiology, Malmö, Sweden
| | - S Holm Nielsen
- Technical University of Denmark / Nordic Bioscience, Disease Systems Immunology, Department of Biotechnology and Biomedicine / Biomarkers and Research, Kgs. Lyngby/Herlev, Denmark
| | - C Tengryd
- Lund University, Clinical Sciences Malmö, Malmö, Sweden
| | - S Brix
- Technical University of Denmark, Disease Systems Immunology, Department of Biotechnology and Biomedicine, Kgs. Lyngby, Denmark
| | - A Edsfeldt
- Lund University, Clinical Sciences Malmö and Department of Cardiology, Malmö, Sweden
| | - F Genovese
- Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
| | - E Bengtsson
- Lund University, Clinical Sciences Malmö, Malmö, Sweden
| | - M Karsdal
- Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
| | | | - J Nilsson
- Lund University, Clinical Sciences Malmö, Malmö, Sweden
| |
Collapse
|
5
|
Holm Nielsen S, Tengryd C, Brix S, Genovese F, Bengtsson E, Karsdal M, Lynge Reese-Pedersen A, Leeming DJ, Edsfeldt A, Nilsson J, Goncalves I. 4984A marker of collagen type I degradation is associated with cardiovascular events and mortality in patients with known atherosclerosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.4984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - C Tengryd
- Lund University, Department of clinical Sciences, Malmo, Sweden
| | - S Brix
- Technical University of Denmark, Department of Biotechnology and Biomedicine, Kgs. Lyngby, Denmark
| | | | - E Bengtsson
- Lund University, Department of clinical Sciences, Malmo, Sweden
| | | | | | | | - A Edsfeldt
- Lund University, Department of clinical Sciences, Malmo, Sweden
| | - J Nilsson
- Lund University, Department of clinical Sciences, Malmo, Sweden
| | - I Goncalves
- Skane University Hospital, Department of cardiology, Malmo, Sweden
| |
Collapse
|
6
|
Hultgårdh-Nilsson A, Tengryd C, Shami A, Gonsalves I, Nilsson J. The collagen binding protein fibromodulin contributes to atherosclerotic plaque inflammation and cerebrovascular events. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|