不稳定动脉粥样硬化斑块的研究进展

不稳定斑块破裂及继发血栓形成是导致急性心血管事件发生的主要病理基础。不稳定斑块的形成与炎症反应、细胞凋亡等有密切联系,新近研究表明,组织蛋白酶-S、生长相关基因蛋白-α和内质网应激在动脉粥样硬化斑块趋向不稳定的过程中发挥至关重要的作用。本文就相关研究进展进行综述,为深入了解不稳定斑块的形成机制提供依据。     

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。     

Relationship between Watershed Infarcts and Recent Intra Plaque Haemorrhage in Carotid Atherosclerotic Plaque

Objective

Watershed infarcts (WSI) are thought to result from hemodynamic mechanism, but studies have suggested that microemboli from unstable carotid plaques may distribute preferentially in watershed areas, i.e., between two cerebral arterial territories. Intraplaque haemorrhage (IPH) is an emerging marker of plaque instability and microembolic activity. We assessed the association between WSI and IPH in patients with recently symptomatic moderate carotid stenosis.

Methods and Results

We selected 65 patients with symptomatic moderate (median NASCET degree of stenosis = 31%) carotid stenosis and brain infarct on Diffusion-Weighted Imaging (DWI) on Magnetic Resonance Imaging (MRI) from a multicentre prospective study. Fourteen (22%) had WSI (cortical, n = 8; internal, n = 4; cortical and internal, n = 2). Patients with WSI were more likely to have IPH than those without WSI although the difference was not significant (50% vs. 31%, OR = 2.19; 95% CI, 0.66–7.29; P = 0.20). After adjustment for degree of stenosis, age and gender, the results remained unchanged.

Conclusion

About one in fifth of brain infarcts occurring in patients with moderate carotid stenosis were distributed in watershed areas. Albeit not significant, an association between IPH - more generally plaque component - and WSI, still remains possible.     

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.     

Atherosclerotic Plaque Destabilization in Mice: A Comparative Study

Atherosclerosis-associated diseases are the main cause of mortality and morbidity in western societies. The progression of atherosclerosis is a dynamic process evolving from early to advanced lesions that may become rupture-prone vulnerable plaques. Acute coronary syndromes are the clinical manifestation of life-threatening thrombotic events associated with high-risk vulnerable plaques. Hyperlipidemic mouse models have been extensively used in studying the mechanisms controlling initiation and progression of atherosclerosis. However, the understanding of mechanisms leading to atherosclerotic plaque destabilization has been hampered by the lack of proper animal models mimicking this process. Although various mouse models generate atherosclerotic plaques with histological features of human advanced lesions, a consensus model to study atherosclerotic plaque destabilization is still lacking. Hence, we studied the degree and features of plaque vulnerability in different mouse models of atherosclerotic plaque destabilization and find that the model based on the placement of a shear stress modifier in combination with hypercholesterolemia represent with high incidence the most human like lesions compared to the other models.     

Continuous Microevolution Accelerates Disease Progression during Sequential Episodes of Infection

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Mesenchymal Stem Cells Stabilize Atherosclerotic Vulnerable Plaque by Anti-Inflammatory Properties

Background and objectives

Formation and progression of atherosclerotic vulnerable plaque (VP) is the primary cause of many cardio-cerebrovascular diseases such as acute coronary syndrome and stroke. It has been reported that bone marrow mesenchymal stem cells (MSC) exhibit protective effects against many kinds of diseases including myocardial infarction. Here, we examined the effects of intravenous MSC infusion on a VP model and provide novel evidence of its influence as a therapy in this animal disease model.

Subjects and methods

Thirty healthy male New Zealand white rabbits were randomly divided into a MSC, VP or stable plaque (SP) group (n = 10/group) and received high fat diet and cold-induced common carotid artery intimal injury with liquid nitrogen to form atherosclerotic plaques. Serum hs-CRP, TNF-α, IL-6 and IL-10 levels were measured by ELISA at 1, 2, 3, 7, 14, 21 and 28 days after MSC transplantation. The animals were sacrificed at 4 weeks after MSC transplantation. Lesions in the right common carotid were observed using H&E and Masson staining, and the fibrous cap/lipid core ratio of atherosclerotic plaques were calculated. The expression of nuclear factor κB (NF-κB) and matrix metalloproteinase 1, 2, 9 (MMP-1,2,9) in the plaque were detected using immunohistochemistry, and apoptotic cells in the plaques were detected by TUNEL. In addition, the level of TNF-α stimulated gene/protein 6 (TSG-6) mRNA and protein were measured by quantitative Real-Time PCR and Western blotting, respectively.

Results

Two rabbits in the VP group died of lung infection and cerebral infarction respectively at 1 week after plaque injury by liquid nitrogen. Both H&E and Masson staining revealed that the plaques from the SP and MSC groups had more stable morphological structure and a larger fibrous cap/lipid core ratio than the VP group. Serum hs-CRP, TNF-α and IL-6 were significantly down-regulated, whereas IL-10 was significantly up-regulated in the MSC group compared with the VP group. .Immunohistochemistry analysis revealed that NF-κB and MMP expression was reduced in the MSC and SP groups compared to the VP group. Cell apoptosis decreased significantly in both the MSC and SP groups in comparison to the VP group. TSG-6 mRNA and protein expression were higher in the plaques of the MSC group compared to the VP and SP groups.

Conclusions

Our study results suggest that MSC transplantation can effectively stabilize vulnerable plaques in atherosclerotic rabbits. This may potentially offer a new clinical application of MSC in atherosclerosis.     

Tryptase Promotes Atherosclerotic Plaque Haemorrhage in ApoE-/- Mice

Tryptase, the most abundant mast cell (MC) granule protein, plays an important role in atherosclerosis plaque development. To test the hypothesis that tryptase participates directly in atherosclerosis plaque haemorrhage, the gene sequence and siRNA for tryptase were cloned into a lentivirus carrier and atherosclerosis plaque haemorrhage models in ApoE-/- mice were constructed. After a cuffing-cervical artery operation, the mice were randomly divided into 6 groups. Hematoxylin and eosin(HE) staining showed that the cervical artery plaque area was much larger in the tryptase overexpression group compared to the other groups, and there was greater artery stenosis. The artery stenosis from the cuff-side in all groups was more than 90%, except the siRNA group. Tryptase promotes plaque haemorrhage distinctively because 50% of the mice in the tryptase overexpression group had plaque haemorrhage, while only 10% in the siRNA group did. The immunohistochemistry of the cervical artery plaque showed that plasminogen activator inhibitor-1 (PAI-1) expression was the lowest while tissue plasminogen activator (tPA), CD31, CD34 and VEGF was the highest in the tryptase overexpression groups. This observation was completely contrary to what was observed in the siRNA group. Tryptase promoted bEnd.3 cell growth, migration and capillary-like tube formation, which suggests that tryptase can promote microvessel angiogenesis. PAI-1 expression was inhibited, while tPA expression was increased by tryptase in bEnd.3 cells. Our in vivo and in vitro studies suggest that trypase can promote atherosclerotic plaque haemorrhage by promoting angiogenesis and regulating the balance of PAI-1 and tPA. Thus, regulating tryptase expression in MCs may provide a potential target for atherosclerosis treatment.     

Inactivation of the Transcription Factor GLI1 Accelerates Pancreatic Cancer Progression

The role of GLI1 in pancreatic tumor initiation promoting the progression of preneoplastic lesions into tumors is well established. However, its function at later stages of pancreatic carcinogenesis remains poorly understood. To address this issue, we crossed the gli1 knock-out (GKO) animal with cre-dependent pancreatic activation of oncogenic kras concomitant with loss of the tumor suppressor tp53 (KPC). Interestingly, in this model, GLI1 played a tumor-protective function, where survival of GKO/KPC mice was reduced compared with KPC littermates. Both cohorts developed pancreatic cancer without significant histopathological differences in survival studies. However, analysis of mice using ultrasound-based imaging at earlier time points showed increased tumor burden in GKO/KPC mice. These animals have larger tumors, decreased body weight, increased lactate dehydrogenase production, and severe leukopenia. In vivo and in vitro expression studies identified FAS and FAS ligand (FASL) as potential mediators of this phenomenon. The FAS/FASL axis, an apoptotic inducer, plays a role in the progression of pancreatic cancer, where its expression is usually lost or significantly reduced in advanced stages of the disease. Chromatin immunoprecipitation and reporter assays identified FAS and FASL as direct targets of GLI1, whereas GKO/KPC mice showed lower levels of this ligand compared with KPC animals. Finally, decreased levels of apoptosis were detected in tumor tissue in the absence of GLI1 by TUNEL staining. Together, these findings define a novel pathway regulated by GLI1 controlling pancreatic tumor progression and provide a new theoretical framework to help with the design and analysis of trials targeting GLI1-related pathways.     

Biomechanics and Inflammation in Atherosclerotic Plaque Erosion and Plaque Rupture: Implications for Cardiovascular Events in Women

Objective

Although plaque erosion causes approximately 40% of all coronary thrombi and disproportionally affects women more than men, its mechanism is not well understood. The role of tissue mechanics in plaque rupture and regulation of mechanosensitive inflammatory proteins is well established, but their role in plaque erosion is unknown. Given obvious differences in morphology between plaque erosion and rupture, we hypothesized that inflammation in general as well as the association between local mechanical strain and inflammation known to exist in plaque rupture may not occur in plaque erosion. Therefore, our objective was to determine if similar mechanisms underlie plaque rupture and plaque erosion.

Methods and Results

We studied a total of 74 human coronary plaque specimens obtained at autopsy. Using lesion-specific computer modeling of solid mechanics, we calculated the stress and strain distribution for each plaque and determined if there were any relationships with markers of inflammation. Consistent with previous studies, inflammatory markers were positively associated with increasing strain in specimens with rupture and thin-cap fibroatheromas. Conversely, overall staining for inflammatory markers and apoptosis were significantly lower in erosion, and there was no relationship with mechanical strain. Samples with plaque erosion most closely resembled those with the stable phenotype of thick-cap fibroatheromas.

Conclusions

In contrast to classic plaque rupture, plaque erosion was not associated with markers of inflammation and mechanical strain. These data suggest that plaque erosion is a distinct pathophysiological process with a different etiology and therefore raises the possibility that a different therapeutic approach may be required to prevent plaque erosion.     

A Human Ex Vivo Atherosclerotic Plaque Model to Study Lesion Biology

Atherosclerosis is a chronic inflammatory disease of the vasculature. There are various methods to study the inflammatory compound in atherosclerotic lesions. Mouse models are an important tool to investigate inflammatory processes in atherogenesis, but these models suffer from the phenotypic and functional differences between the murine and human immune system. In vitro cell experiments are used to specifically evaluate cell type-dependent changes caused by a substance of interest, but culture-dependent variations and the inability to analyze the influence of specific molecules in the context of the inflammatory compound in atherosclerotic lesions limit the impact of the results. In addition, measuring levels of a molecule of interest in human blood helps to further investigate its clinical relevance, but this represents systemic and not local inflammation. Therefore, we here describe a plaque culture model to study human atherosclerotic lesion biology ex vivo. In short, fresh plaques are obtained from patients undergoing endarterectomy or coronary artery bypass grafting and stored in RPMI medium on ice until usage. The specimens are cut into small pieces followed by random distribution into a 48-well plate, containing RPMI medium in addition to a substance of interest such as cytokines or chemokines alone or in combination for defined periods of time. After incubation, the plaque pieces can be shock frozen for mRNA isolation, embedded in Paraffin or OCT for immunohistochemistry staining or smashed and lysed for western blotting. Furthermore, cells may be isolated from the plaque for flow cytometry analysis. In addition, supernatants can be collected for protein measurement by ELISA. In conclusion, the presented ex vivo model opens the possibility to further study inflammatory lesional biology, which may result in identification of novel disease mechanisms and therapeutic targets.     

颅内动脉粥样硬化斑块形成与血管重构的关系

目的:研究颅内动脉粥样硬化斑块的形成与血管重构的关系。方法:选择2017年3月到2017年10月在上海市第一人民医院神经内科接受治疗的47例诊断为缺血性脑血管疾病的患者,所有患者发病7天内行头颅核磁共振以及高分辨率核磁共振检查。使用vesselmass软件测量斑块处血管及正常对照处的血管壁面积、流体面积,计算斑块负荷以及血管重构比(RR)。RR1.05为正向重构,0.95≤RR≤1.05为中间重构,RR0.95为负向重构。分析大脑中动脉与基底动脉内斑块形成处血管重构情况。根据临床症状以及影像学检查,将斑块分为责任斑块与非责任斑块,比较两组斑块的负荷大小。结果:47例患者中,共有72个斑块,其中责任斑块47个(占65.28%),非责任斑块25个(占34.72%)。位于大脑中动脉的斑块有51个(占70.83%),位于基底动脉的有21个(占29.17%)。大脑中动脉出现负向重构比例较基底动脉更高(47.06%vs. 19.05%,P=0.027),基底动脉出现正向重构比例较大脑中动脉更高(57.14%vs. 25.49%,P=0.010)。相比非责任斑块,责任斑块的斑块负荷更大(0.70±0.08 vs. 0.65±0.07,P=0.017)。结论:颅内动脉在应对斑块形成后出现不同的血管重构模式,负荷更大的斑块更不稳定。     

超声造影技术评价颈动脉粥样硬化斑块稳定性的临床研究

目的:探讨超声造影技术评价颈动脉粥样硬化斑块稳定性的临床价值,为动脉粥样硬化诊断准确性提供参考。方法:根据实时超声造影检查的回声图像特点将该院53例(59个斑块)颈动脉粥样硬化斑块患者分为软斑组(24个)、混合斑组(18个)、硬斑组(17个),比较3组的造影增强率、造影增强程度分级,并对各类型斑块的时间-强度进行定量分析。结果:59个斑块中有40个呈现不同程度的增强,增强率为67.80%,其中软斑组、混合斑组、硬斑组超声增强率分别为87.50%、72.22%、35.29%,差异具有统计学意义(P0.05);造影增强程度Ⅰ级和Ⅲ级在三组间差异具有统计学意义(P0.05),其中硬斑组造影增强程度Ⅰ级个数较软斑组和混合斑组多,软斑组造影增强程度Ⅲ级个数较混合斑组和硬斑组多,差异均有统计学意义(P0.05);软斑组达峰时间、平均渡越时间均低于混合斑组和硬斑组,斑块峰值强度高于混合斑组和硬斑组,混合斑组达峰时间、平均渡越时间均低于硬斑组,斑块峰值强度高于硬斑组,差异均具有统计学意义(P0.05)。结论:超声造影技术可无创性地通过造影增强实时反映出颈动脉粥样硬化斑块内的新生血管情况,提供参数成像与定量分析,正确评价斑块的稳定性。     

实验性兔主动脉粥样硬化易损斑块模型的建立与评价

目的探索建立实验性兔主动脉粥样硬化易损斑块模型的新方法。方法24只雄性日本大耳白家兔随机分为对照组8只,实验组16只,对照组给予普通饲料;实验组给予高胆固醇饲料、注射牛血清白蛋白及进行腹主动脉球囊拉伤术,分别于0周、3周、6周、10周检测血脂、ox-LDL、TNF-α、IL-1、IL-10,实验结束时取腹主动脉进行病理形态学分析及NF-κBp65亚基免疫组化染色分析。结果实验组斑块内膜面积比为53.6%,脂核面积与斑块面积比为54.9%,斑块纤维帽厚度与内膜中膜厚度（IMT）比约为8.5%;除甘油三酯变化不大外,实验组TC、LDL-C、HDL-C、LDL-C/HDL-C、TC/HDL-C、ox-LDL、TNF-α、IL-1、IL-10均有明显升高趋势,在3周、6周、10周时与对照组比较差异有统计学意义;且NF-κBp65亚基阳性染色面积较对照组高13.5倍。结论高脂喂养、免疫损伤加球囊拉伤可以成功建立家兔主动脉粥样硬化易损斑块模型。     

High Glucose Accelerates Tumor Progression by Regulating MEDAG-Mediated Autophagy Levels in Breast Cancer

Recent studies have shown that diabetes is a major risk factor for breast cancer (BC), but the mechanism is incompletely understood. Mesenteric estrogen-dependent adipogenesis (MEDAG) plays a significant role in both glucose uptake and BC development. However, the relationship between MEDAG and BC under high glucose (HG) conditions remains unclear. In our study, MEDAG expression was higher in BC tissue from diabetic patients than in BC tissue from nondiabetic patients. HG promoted BC progression in vitro and in vivo by upregulating MEDAG expression. Furthermore, MEDAG deficiency increased the autophagosome number and autophagic flux. Moreover, inhibition of autophagy partially reversed MEDAG knockdown (MEDAG^KD)-induced suppression of tumorigenic biological behaviors and epithelial-mesenchymal transition (EMT) progression. Finally, MEDAG significantly suppressed AMPK phosphorylation. Additionally, the AMPK inhibitor Compound C markedly reduced autophagosome accumulation and antitumor effects in MEDAG^KD cells. Treatment with the AMPK activator AICAR exhibited similar effects in MEDAG-overexpressing (MEDAG^OE) cells. In conclusion, the MEDAG-AMPK-autophagy axis is vital to BC progression in diabetic patients. Our findings provide a novel treatment target for BC in patients with diabetes.     

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。