动脉粥样硬化斑块钙化机制的研究进展

心血管疾病中动脉粥样硬化斑块的钙化是动脉粥样硬化的临床标志之一,主要发生在动脉血管的内膜.动脉粥样硬化斑块核心的钙化不会增加斑块的易损性,而粥样斑块纤维帽上的微钙化会加强纤维帽的周向应力,致使斑块的易损性增加.动脉粥样硬化斑块的钙化机制包括被动钙化和主动钙化,被动钙化受激素和局部信号的调节,主动钙化机制涉及复杂的细胞生命过程,基质囊泡、细胞凋亡、外泌体、氧化应激反应和细胞自噬等均参与了钙化过程.本文对动脉粥样硬化斑块的钙化机制的进展进行综述.     

载脂蛋白E基因敲除小鼠用于动脉粥样硬化研究的进展

载脂蛋白（apolipoprotein,ApoE）基因敲除小鼠是目前研究动脉粥样硬化发生发展机制的最为理想的动物模型之一,尤其是近年来,又成为易损斑块动物模型研究的热点。有关apoE^-I-小鼠动脉粥样硬化斑块病理特点、炎症在斑块破裂中的作用及对其干预治疗等研究,近来又有了许多新的发现。     

小型猪动脉粥样硬化模型

动脉硬化（arteriosclerosis）泛指动脉变硬,由于形态特征不同分为三种疾病,动脉粥样硬化是最主要的一种动脉硬化疾病,其病灶累及弹性动脉和较多弹性纤维的肌性动脉,典型的动脉粥样硬化病灶内含有大量的脂质和坏死细胞构成的“粥样”成分。另两种动脉硬化疾病分别为门克伯格氏中膜钙化性硬化（Mfinckeberg medial calcific sclerosis）和微（小）动脉硬化（arteriolosclerosis）     

动脉粥样硬化斑块的微区拉曼光谱检测

为探讨动脉粥样硬化斑块的微区拉曼光谱特征,以球囊损伤日本长耳白兔右侧颈总动脉后予以高脂饮食喂养,在实验过程中监测体重和血脂变化情况。3个月后,以中国斑点蝰蛇毒和组胺加以触发使斑块破裂,将动物处死并查找动脉硬化斑块,动脉组织经大体病理分类后,进行微区拉曼光谱及病理检测。结果显示:动脉粥样硬化斑块的拉曼光谱图在1450及1660cm-1处均有明显的胆固醇等脂质特征峰。特征峰曲线下相对面积统计结果表明:明显动脉粥样硬化斑块的谱峰下相对面积(5.80×10-3±3.51×10-3)显著高于轻度动脉粥样硬化组织(2.01×10-3±1.49×10-3)及正常动脉组织(1.01×10-3±0.94×10-3),P<0.05。正常动脉组织拉曼光谱曲线较光滑,无明显特征峰。血栓形成处拉曼光谱图荧光背底较强,未见特征谱峰。该研究结果证明微区拉曼光谱可以对动脉粥样硬化斑块的胆固醇等脂质含量进行特异性定量检测,表明微区拉曼光谱是评估动脉粥样硬化程度及斑块稳定性的可行方法。     

巨噬细胞源性破骨细胞在血管钙化中的作用

血管钙化是一种细胞介导的主动生物学过程，类似于骨重塑，在急慢性心脑血管事件的发生与演进过程中发挥了重要的推动作用。近年来有关血管钙化的机制与防治研究逐渐受到广大学者的关注，但遗憾的是，精准的分子与细胞靶向治疗尤其是能在临床推广应用的成果却罕有出现。新近的研究显示，糖尿病动脉粥样硬化斑块中存在成骨细胞表型和功能失调的破骨细胞表型，成骨细胞与破骨细胞调控的失衡可能是动脉粥样硬化斑块内钙化形成的关键环节。已知由巨噬细胞分化而来的破骨细胞是机体内唯一有骨吸收特性的细胞，具备促钙化消退的潜能。因此，探索促斑块内巨噬细胞源性破骨细胞骨吸收活性的研究是一个有望为钙化防治带来新突破的方向。然而，目前关于破骨细胞在血管钙化中的作用和相关调控机制仍存在争议。基于该领域的研究进展和本课题组的实验结果，本文凝练出了羧甲基赖氨酸（CML）通过STAT3调控NFATc1-GNPTAB信号介导斑块内巨噬细胞破骨化吸收障碍的假说，并从血管钙化的概念与机制、破骨细胞与血管钙化间的关系、血管钙化中破骨细胞的调控机制以及破骨细胞作为血管钙化治疗靶点4个方面进行简要阐述，希望为后续血管钙化的精准防治提供新的切入点。     

胆固醇结晶激活动脉粥样硬化斑块巨噬细胞NLRP3炎症体的途径

动脉粥样硬化既是胆固醇在血管壁聚集的疾病,也是发生在动脉壁的一种低强度慢性炎症形式。近年来有研究证实胆固醇结晶在动脉粥样硬化发生发展中具有重要作用。新的显微技术证实,胆固醇结晶在动脉粥样硬化斑块形成的早期即已出现,并与早期炎症有关。胆固醇结晶通过诱发局部炎症,促进大的脂质核心形成;刺破纤维帽,导致斑块破裂进而促进动脉粥样硬化斑块的进展。在影响斑块进程中,NLRP3炎症体的激活对此发挥了重要的作用。NLRP3炎症体是研究最多最明确的炎症体,其与非炎症性疾病的发生发展密切相关。以胆固醇结晶激活NLRP3炎症体的途径作为研究靶点,为动脉粥样硬化的诊断和治疗提供了新的思路和方法。该文就胆固醇结晶在动脉粥样硬化斑块中激活巨噬细胞NLRP3炎症体的两种途径做一综述。     

一个日益重要的冠心病标志物———新蝶呤

动脉粥样硬化是一种慢性炎症过程,炎症反应在动脉粥样斑块的形成、发展、稳定性丧失和斑块破裂过程中都起着非常重要的作用,贯穿于动脉粥样硬化的各个环节。从早期的脂质条纹到进一步的动脉粥样病变及血栓性并发症都能见到炎症细胞的浸润,其中又以激活的巨噬细胞尤为重要。新蝶呤是巨噬细胞激活后的代谢产物,它不仅是巨噬细胞激活的炎症标志物,还参与多种调节氧化平衡的生化途径,增加氧化应激水平,促进动脉粥样硬化的进展,是斑块不稳定性及不良性心血管事件的独立预测因子。在临床上,降低血清新蝶呤水平可以降低冠心病患者发生危险事件的风险。因此,新蝶呤对冠心病的诊断和治疗都有重要意义。本文将对新蝶呤在冠心病中的角色做一综述。     

脂联素抗冠状动脉粥样硬化机制的研究进展

脂联素是近年来发现的具有抗冠状动脉粥样硬化作用的脂肪因子,它是脂肪细胞分泌的一种蛋白质,分别在粥样斑块形成早期、粥样斑块形成过程中和粥样斑块的稳定性等多个方面发挥抗粥样硬化的作用.脂联素的抗粥样硬化机制是一个复杂的病理生理机制,包括维护动脉内皮细胞的正常功能、抑制巨噬细胞和平滑肌细胞的迁移和增生、稳定粥样斑块等.脂联素的抗动脉粥样硬化作用显示了巨大的临床应用潜力.     

动脉钙化发生机制研究进展

动脉钙化是指钙盐沉积在动脉壁组织的一种病理改变,会减少主动脉和支动脉的弹性,改变心血管系统的血液流动力学,导致高血压、主动脉瓣狭窄、心脏肥厚、心肌和下肢缺血、充血性心力衰竭等严重心脑血管疾病发生。动脉钙化在老年人群中是一种常见的疾病。早期研究发现尿毒症患者体内磷酸钙沉积的抑制剂——焦磷酸盐水平升高,故有学者认为钙磷被动地沉积于血管壁是引起血管钙化的主要原因。近年来的研究发现,血管钙化并非简单地由于磷酸钙晶体被动地沉积于血管壁,而是一个与骨发育相似的主动的、可预防和可逆转的高度可调控的生物学过程。动脉钙化的发生受多因素共同调控,但其确切机制尚不清楚,最近发现炎症小体也以某种未知的机制参与钙化调控过程。     

液氮冻伤术建立动脉粥样硬化破裂斑块及血栓模型

目的创建一种操作简单、经济实用的动脉粥样硬化（AS）破裂斑块及血栓动物模型。方法21只雄性纯种新西兰白兔随机分为两组：液氮冻伤＋高脂喂养组（A组=11只）和高脂喂养组（B组=10只）。A组实施右颈总动脉内膜液氮冻伤术结合高脂饲料喂养,B组单纯给予高脂饲料喂养。8周末以液氮激发斑块破裂,激发前后分别采血检测血脂、hsC-RP、MMP-9及PAI-1水平;激发48h后处死所有动物,取出右颈总动脉作HE染色及免疫组化染色等,光镜及电镜观察破裂斑块及血栓形成情况。结果8周后兔血脂水平明显升高;激发后血浆hsC-RP、MMP-9及PAI-1均明显升高;所有A组兔子的右颈总动脉均可见AS破裂斑块及血栓形成,而B组兔子未见斑块或血栓形成;所建立的破裂斑块在组织结构、细胞构成、生长特征和脂质沉积方面与人类斑块相似。结论液氮冻伤术能简便、快速、高效地建立AS破裂斑块及血栓模型,从而为研究人类AS破裂斑块及血栓形成的机理和药物干预治疗提供了一种新型动物模型。     

小型猪动脉粥样硬化斑块稳定性模型研究

目前已有的动物模型在研究动脉粥样硬化斑块破裂、破裂的可控性及量化研究方面均不能满足研究的需要.为了建立类似于人类动脉粥样硬化病变的斑块模型,体外研究斑块稳定性,应用传统的高脂高胆固醇膳食诱导建立了小型猪动脉粥样硬化模型,并从血脂水平和斑块病理形态学特征方面加以了证实.该模型中斑块与人类成熟斑块的高度相似性使其成为研究斑块稳定性和斑块破裂的较好模型.从量化比较这一出发点着手,建立了一个体外可控可量化诱导斑块破裂模型,方法简单易行,是一个较好的量化研究斑块破裂和破裂相关因素间关系的实验模型.     

Calcifications in atherosclerotic plaques and impact on plaque biomechanics

The catastrophic mechanical rupture of an atherosclerotic plaque is the underlying cause of the majority of cardiovascular events. The infestation of vascular calcification in the plaques creates a mechanically complex tissue composite. Local stress concentrations and plaque tissue strength properties are the governing parameters required to predict plaque ruptures. Advanced imaging techniques have permitted insight into fundamental mechanisms driving the initiating inflammatory-driven vascular calcification of the diseased intima at the (sub-) micron scale and up to the macroscale. Clinical studies have potentiated the biomechanical relevance of calcification through the derivation of links between local plaque rupture and specific macrocalcification geometrical features. The clinical implications of the data presented in this review indicate that the combination of imaging, experimental testing, and computational modelling efforts are crucial to predict the rupture risk for atherosclerotic plaques. Specialised experimental tests and modelling efforts have further enhanced the knowledge base for calcified plaque tissue mechanical properties. However, capturing the temporal instability and rupture causality in the plaque fibrous caps remains elusive. Is it necessary to move our experimental efforts down in scale towards the fundamental (sub-) micron scales in order to interpret the true mechanical behaviour of calcified plaque tissue interactions that is presented on a macroscale in the clinic and to further optimally assess calcified plaques in the context of biomechanical modelling.     

Quantifying effects of plaque structure and material properties on stress distributions in human atherosclerotic plaques using 3D FSI models

BACKGROUND: Atherosclerotic plaques may rupture without warning and cause acute cardiovascular syndromes such as heart attack and stroke. Methods to assess plaque vulnerability noninvasively and predict possible plaque rupture are urgently needed. METHOD: MRI-based three-dimensional unsteady models for human atherosclerotic plaques with multi-component plaque structure and fluid-structure interactions are introduced to perform mechanical analysis for human atherosclerotic plaques. RESULTS: Stress variations on critical sites such as a thin cap in the plaque can be 300% higher than that at other normal sites. Large calcification block considerably changes stress/strain distributions. Stiffness variations of plaque components (50% reduction or 100% increase) may affect maximal stress values by 20-50%. Plaque cap erosion causes almost no change on maximal stress level at the cap, but leads to 50% increase in maximal strain value. CONCLUSIONS: Effects caused by atherosclerotic plaque structure, cap thickness and erosion, material properties, and pulsating pressure conditions on stress/strain distributions in the plaque are quantified by extensive computational case studies and parameter evaluations. Computational mechanical analysis has good potential to improve accuracy of plaque vulnerability assessment.     

Effect of calcification on the mechanical stability of plaque based on a three-dimensional carotid bifurcation model

Background

This study characterizes the distribution and components of plaque structure by presenting a three-dimensional blood-vessel modelling with the aim of determining mechanical properties due to the effect of lipid core and calcification within a plaque. Numerical simulation has been used to answer how cap thickness and calcium distribution in lipids influence the biomechanical stress on the plaque.

Method

Modelling atherosclerotic plaque based on structural analysis confirms the rationale for plaque mechanical examination and the feasibility of our simulation model. Meaningful validation of predictions from modelled atherosclerotic plaque model typically requires examination of bona fide atherosclerotic lesions. To analyze a more accurate plaque rupture, fluid-structure interaction is applied to three-dimensional blood-vessel carotid bifurcation modelling. A patient-specific pressure variation is applied onto the plaque to influence its vulnerability.

Results

Modelling of the human atherosclerotic artery with varying degrees of lipid core elasticity, fibrous cap thickness and calcification gap, which is defined as the distance between the fibrous cap and calcification agglomerate, form the basis of our rupture analysis. Finite element analysis shows that the calcification gap should be conservatively smaller than its threshold to maintain plaque stability. The results add new mechanistic insights and methodologically sound data to investigate plaque rupture mechanics.

Conclusion

Structural analysis using a three-dimensional calcified model represents a more realistic simulation of late-stage atherosclerotic plaque. We also demonstrate that increases of calcium content that is coupled with a decrease in lipid core volume can stabilize plaque structurally.     

A Pathophysiologic Primary Prevention Review of Aspirin Administration to Prevent Cardiovascular Thrombosis

Objective: Cardiovascular disease is the leading metabolic cause of mortality in the United States. Among current therapies, low-dose aspirin has been shown to reduce cardiovascular thrombosis. However, aspirin also causes major complications (hemorrhagic stroke and gastrointestinal bleeding). The American Heart Association recommends that aspirin only be prescribed for “high-risk” individuals. No guidelines are available as to the duration of aspirin therapy.Methods: A reasonable approach to aspirin administration is to determine the appropriateness of aspirin therapy based on the pathophysiology of coronary artery thrombosis. It suggests that the coronary artery calcium (CAC) score be used as the basis for determining “high risk.” This score was shown to accurately predict future cardiovascular events. The greater the CAC score, the greater the extent of coronary artery atherosclerotic plaque and future cardiovascular risk.Results: A CAC score >400 places an individual at very-high 10-year risk for an atherosclerotic event. Since aggressive medical therapy initiates stabilization of unstable atherosclerotic plaques within 1 month and reversal within 2 years, this treatment significantly reduces the risk of the individual for a cardiovascular event. Thus, most individuals aged <75 years with a CAC score of >400 should receive aspirin therapy for a maximum of 2 years.Conclusion: Utilization of a CAC score greatly simplifies the decision of whom to treat with aspirin and for what duration. Importantly, focusing on two factors (hemorrhage and plaque stabilization) is easily understood by both the physician and the patient.Abbreviations: CAC = coronary artery calcium; CVD = cardiovascular disease; LDL = low-density lipoprotein; OCT = optical coherence tomography     

Is Cadmium Exposure Associated with the Burden,Vulnerability and Rupture of Human Atherosclerotic Plaques?

The general population is exposed to cadmium from food and smoking. Cadmium is a widely spread toxic pollutant that seems to be associated with cardiovascular diseases, although little is known if it contributes to the occurrence of atherosclerotic plaques and the process whereby plaques become vulnerable and are prone to rupture. We tested the hypotheses that cadmium exposure is associated not only with an increased subclinical burden of atherosclerotic plaques in different vascular territories and early signs of plaque vulnerability, but also with cadmium content and plaque-rupture in the clinical phase of the disease. Ultrasound technique was used to measure plaque prevalence and echogenicity in the carotid and femoral arteries in a population sample of women (n = 599) in whom blood cadmium was measured. In addition cadmium was measured in snap-frozen endarterectomies and whole blood obtained from patients who were referred to surgery because of symptomatic carotid plaques (n = 37). Sixteen endarterectomies were divided into three parts corresponding to different flow conditions and plaque vulnerability. In the population sample blood cadmium was associated with the number of vascular territories with plaques (p = 0.003 after adjustment for potential confounders). The cadmium concentrations in symptomatic plaques were 50-fold higher in plaque tissue than in blood. Cadmium levels in blood and plaque correlated, also after adjustment for smoking and other cardiovascular risk factors (p<0.001). Compared with the other parts of the plaque, the cadmium content was double as high in the part where plaque rupture usually occurs. In conclusion, the results show that cadmium exposure is associated with the burden of subclinical atherosclerosis in middle-aged women with different degrees of glucose tolerance, and that the content of cadmium in symptomatic plaques in patients is related to that in blood, but much higher, and preferentially located in the part of plaque where rupture often occurs.     

Thrombosis, physical activity, and acute coronary syndromes

Acute coronary syndromes (ACS) are common, life-threatening cardiac disorders that typically are triggered by rupture or erosion of an atherosclerotic plaque. Platelet deposition and activation of the blood coagulation cascade in response to plaque disruption lead to the formation of a platelet-fibrin thrombus, which can grow rapidly, obstruct coronary blood flow, and cause myocardial ischemia and/or infarction. Several clinical studies have examined the relationship between physical activity and ACS, and numerous preclinical and clinical studies have examined specific effects of sustained physical training and acute physical activity on atherosclerotic plaque rupture, platelet function, and formation and clearance of intravascular fibrin. This article reviews the available literature regarding the role of physical activity in determining the incidence of atherosclerotic plaque rupture and the pace and extent of thrombus formation after plaque rupture.     

DNA甲基化调控炎症反应干预As斑块稳定性的研究进展

动脉粥样硬化(As)斑块破裂是导致急性心脑血管事件发生的首要原因。既往对斑块破裂的基础研究多集中于细胞和分子水平,从表观遗传学角度阐述的研究较少。DNA甲基化作为表观遗传学修饰的主要方式之一,可在不改变基因核苷酸序列的情况下影响基因的表达。综合目前研究来看,炎症反应在斑块破裂过程中起关键性作用,而DNA甲基化对炎症反应又起重要的调控作用。因此,改变DNA甲基化状态来调控炎症反应干预As斑块稳定性,有望成为防治As等心脑血管疾病的有效途径之一。本文主要围绕与As炎症反应密切相关的几种炎症免疫细胞及炎症因子等方面,对近年来DNA甲基化调控炎症反应干预As斑块稳定性的研究进展作一综述。