Filtern
Volltext vorhanden
- ja (11) (entfernen)
Gehört zur Bibliographie
- ja (11)
Dokumenttyp
Schlagworte
- Atherosclerosis (11) (entfernen)
Institut
- Graduate School of Life Sciences (6)
- Institut für Experimentelle Biomedizin (3)
- Medizinische Klinik und Poliklinik I (2)
- Physikalisches Institut (2)
- Abteilung für Funktionswerkstoffe der Medizin und der Zahnheilkunde (1)
- Deutsches Zentrum für Herzinsuffizienz (DZHI) (1)
- Institut für Pharmakologie und Toxikologie (1)
- Medizinische Klinik (bis 2004) (1)
- Rudolf-Virchow-Zentrum (1)
Sonstige beteiligte Institutionen
Bei der Atherosklerose handelt es sich um eine chronische inflammatorische Erkrankung, die sich an der arteriellen Gefäßinnenwand abspielt. Ihre Haupt-Manifestationsformen Schlaganfall und Herzinfarkt zählen zu den häufigsten Todesursachen weltweit. Eine chronische Endothelbelastung und -funktionsstörung, beeinflusst durch Risikofaktoren wie Diabetes, arterieller Bluthochdruck, Rauchen und Entzündungszustände, führen zur Permeabilitätserhöhung des Endothels, zur Zelleinwanderung, subendothelialen Lipidanreicherung, Migration glatter Muskelzellen und der Ausbildung atherosklerotischer Läsionen. Es kommt zu Aktivierung des Immunsystems und fortschreitender Entzündungsreaktion, schließlich zur Ausbildung eines nekrotischen Kerns und zunehmender Vulnerabilität des Plaques.
Epigenetische Veränderungen betreffen klassischerweise das Chromatingerüst. Durch DNA-Methylierung und -Demethylierung sowie verschiedene Modifikationen der Histon-Proteine kann die DNA in ihrer Zugänglichkeit verändert werden. So kann die Transkription eines bestimmten Genes direkt und potenziell längerfristig beeinflusst werden, ohne dass Alterationen der DNA-Basenfolge selbst stattfinden. Das Enzym SET7 nimmt hierbei eine Sonderrolle ein, da es neben einer Methylierung von Histon 3 auch verschiedene zelluläre Zielstrukturen posttranslational direkt methylieren kann.
Epigenetische Veränderungen im Kontext der Atherosklerose sind bereits vereinzelt beschrieben. Auch sind sie relevant in der Reaktion auf Umwelteinflüsse und bei inflammatorischen Vorgängen. Der Frage, ob epigenetische Mechanismen im atherosklerotischen Geschehen eine Rolle spielen, sollte in dieser Arbeit nachgegangen werden. Dazu wurde in Zellkulturversuchen für Makrophagen und glatte Muskelzellen geprüft, ob die einzelnen pro-atherosklerotischen Stimuli oxLDL, IL-1β, TNFα und LPS bereits zu relevanten Veränderungen epigenetischer Enzyme führen. Dies erfolgte über Vergleich der entsprechenden mRNA mittels qPCR. Zur Untersuchung der genaueren Dynamik wurde für die Enzyme SET7 und DNMT1 der zeitliche Ablauf dieser Reaktion auf TNFα-Stimulation in Makrophagen genauer betrachtet. Unter gleichen Versuchsbedingungen wurde außerdem die Änderung der mRNA-Expression einiger Matrixmetalloproteasen, TIMP-Enzyme, Zytokine und Transkriptionsfaktoren analysiert,um zukünftig kausale Zusammenhänge weiter aufdecken zu können. Auch die Frage nach Veränderungen epigenetischer Enzyme in der Ldlr-/--Maus nach fettreicher Diät im Vergleich zu Ldlr-/--Mäusen ohne Diät sollte hier beantwortet werden. Dazu wurde die mRNA der Zellsuspensionen aus Milz, Aortenwurzel und gesamter Aorta der Tiere mithilfe der qPCR verglichen. Schließlich sollte ein effizienter Weg für einen individuellen und flexiblen SET7 knock-out etabliert werden, um weitere Studien dieses Enzyms zu ermöglichen. Hierzu wurde die Methode des CRISPR/Cas9 Systems gewählt und abschließend die Funktionalität des Systems überprüft.
Hypercholesterinämie und andere Risikofaktoren tragen zur Entstehung von Atherosklerose bei. Ein entscheidendes Merkmal der Pathogenese ist eine gestörte Endothelfunktion. Hierbei kommt es zu einer reduzierten Bioverfügbarkeit von NO (Stickstoffmonoxid), welches vasodilatativ und atheroprotektiv wirkt. NO kann jedoch auch abhängig vom vaskulären Milieu proatherogen wirken. Es ist Produkt verschiedener NO-Synthasen (NOS). Die potenten Cholesterinsenker Simvastatin und Ezetimib haben vermutlich zusätzliche pleiotrope Effekte auf die Endothelfunktion, deren Untersuchung Gegenstand der vorliegenden Arbeit ist. Hierzu wurden an LDL-R-KO Mäusen - neben Bestimmung der Plasmacholesterinspiegel und atherosklerotischer Plaqueläsionen - Messungen von NO und eNOS, korrelativen Parametern der endothelialen Funktion, durchgeführt. Endovaskuläre Messungen von NO zeigten erhöhte NO-Werte in direkter Nähe atherosklerotischer Plaques. Diese sind am ehesten als Korrelat einer erhöhten iNOS-Aktivität in den Läsionen anzusehen. Im Sinne der mehrdimensionalen Funktion von NO ist hier von einer proatherogenen Wirkung des NO auszugehen. Messungen der ubiquitären, im Blut zirkulierenden NO-Mengen dagegen zeigten eine signifikant erhöhte NO-Bioverfügbarkeit in mit Simvastatin behandelten Tieren. Dies belegt die bereits in der Literatur beschriebene Pleiotropie von Statinen, NO kommt hier eine atheroprotektive Bedeutung zu. Die rein quantitative Bestimmung der eNOS-Expression zeigte zum Zeitpunkt der Untersuchung keine signifikanten Unterschiede in allen Versuchsgruppen. Hierbei sind jedoch keine Rückschlüsse auf die Enzymaktivität oder die Genexpression in anderen Zielgeweben möglich. Simvastatin und Ezetimib wirken sowohl in Mono- als auch in Kombinationstherapie über ihre cholesterinsenkende Wirkung hinaus atheroprotektiv. Die Untersuchungen zeigen, dass bei der Betrachtung der Endothelfunktion die verschiedenen NO-Produktionsquellen sowie der Funktionszustand des NO von entscheidender Bedeutung sind.
Einfluß der Atherosklerose auf den NO:cGMP Signalweg am Modell des cholesteringefütterten Kaninchen
(2002)
Atherosklerose ist Volkskrankheit und Todesursache Nummer Eins in den sogenannten entwickelten Ländern. Ursachen für die meisten Folgeerkrankungen sind Minderperfusion und Gefäßverschluß, verursacht durch Ablagerungen und Verdickung der Gefäßwand und durch einen pathologisch erhöhten Gefäßtonus. Mehrere zelluläre Signalwege, die im Gesunden eine Vasodilatation hervorrufen können, sind in atherosklerotischen Gefäßen gestört, so auch der NO:cGMP-Signalweg. Der Einfluß der Atherosklerose auf den NO-abhängigen Teil des Signalwegs, also NO-Produktion und -Abbau, sowie Diffusion von NO zu den glatten Muskelzellen, ist seit längerem bekannt. In dieser Studie zeigen wir, daß im fortgeschrittenen Stadium der Erkrankung auch der NO-unabhängige Teil des Signalwegs in erheblichen Maße gestört ist. Die Expression und Aktivität der Enzyme lösliche Guanylatzyklase (sGC) und cGMP-abhängige Proteinkinase-I ist vor allem in der neugebildeten Neointima reduziert. P-VASP, ein Indikator der Aktivität des gesamten NO:cGMP-Signalwegs, ist in eindrucksvoller Weise reduziert. Die Enzyme des NO-unabhängigen Teils des NO:cGMP-Signalwegs werden in zunehmenden Maße pharmakologisch beeinflußbar. Die Ergebnisse dieser Studie stellen somit eine wichtige Grundlage für neue Therapieansätze der Atherosklerose dar.
Motivation and Aim:
Cardiovascular disease has been the leading cause of mortality and morbidity throughout the world. In developed countries, cardiovascular diseases are already responsible for a majority of deaths and will become the pre-eminent health problem worldwide (1,2). Rupture of atherosclerotic plaque accounts for approximately 70% of fatal acute myocardial infarction and sudden heart deaths. Conventional criterias for the diagnosis of “vulnerable plaques” are calcified nodules, yellow appearance of plaque, a thin cap, a large lipid core, severe luminal stenosis, intraplaque hemorrhage, inflammation, thrombogenicity, and plaque injury (3-5).
Noninvasive diagnosis of vulnerable plaque still remains a great challenge and a huge research prospect, which triggered us to investigate the feasibility of PET imaging on the evaluation of atherosclerosis. Nuclear imaging of atherosclerosis, especially co-registered imaging modalities, could provide a promising diagnostic tool including both anatomy and activities to identify vulnerable atherosclerotic plaque or early detection of inflammatory endothelium at risk. Furthermore, the development of specific imaging tracers for clinical applications is also a challenging task. The aim of this work was to assess the potential of novel PET imaging probes associated with intra-plaque inflammation on animal models and in human respectively.
Methods
In this work, several molecular imaging modalities were employed for evaluation of atherosclerosis. They included Positron emission tomography / Computed tomography (PET/CT) for human studies, and micro-PET, autoradiography and high-resolution magnetic resonance imaging (MRI) for animal studies. Radiotracers for PET imaging included the glucose analogue 18F-Fluorodeoxyglucose (18F-FDG), the somatostatin receptor avide tracer 68Ga-DOTATATE, and the Gallium-68 labeled fucoidan (68Ga-Fucoidan), which was developed as a PET tracer to detect endothelial P-selectin, which overexpressed at early stage of atherosclerosis and endothelial overlying activated plaque. Tracer’s capabilities were firstly assessed on cellular level in vitro. Subsequently, Animal studies were conducted in two animal models: 1, Apolipoprotein E (ApoE-/-) mice having severe atherosclerotic plaque; 2, Lipopolysaccharide (LPS) -induced mice for receiving acute vascular inflammation. Corresponding analyses on protein and histological level were conducted as well to confirm our results.
In human study, 16 patients with neuroendocrine tumors (NETs) were investigated on imaging vascular inflammation. These patients had undergone both 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT for staging or restaging within 6 weeks. 16 patients were randomized into two groups: high-risk group and low-risk group. Uptake ratio of both tracers from two groups were compared and correlated with common cardiovascular risk factors.
Results and Conclusion
In murine study, the expression of somatostatin receptor 2, which is the main bio-target of 68Ga-DOTATATE on macrophage/monocyte was confirmed by flow cytometry and immunohistochemistry. Prospectively, high specific accumulation of 68Ga-DOTATATE to the macrophage within the plaques was observed in aorta lesions by autoradiography and by micro-PET. In study with 68Ga-fucoidan, a strong expression of P-selectin on active endothelium overlying on inflamed plaque but weaker on inactive plaques was confirmed. Specific focal uptake of 68Ga-fucoidan were detected at aorta segments by micro-PET, and correlated with high-resolution magnetic resonance imaging (MRI), which was used to characterize the morphology of plaques. 68Ga-fucoidan also showed a greater affinity to active inflamed plaque in comparison of inactive fibrous plaque, which was assessed by autoradiography. Specificity of 68Ga-DOTATATE and 68Ga-fucoidan were confirmed by ex-vivo blocking autoradiography and in vivo blocking PET imaging respectively.
In human study, focal uptake of both 18F-FDG and 68Ga-DOTATATE was detected. Analyzing concordance of two tracers’ uptake ratio, Out of the 37 sites with highest focal 68Ga-DOTATATE uptake, 16 (43.2%) also had focal 18F-FDG uptake. Of 39 sites with highest 18F-FDG uptake, only 11 (28.2%) had a colocalized 68Ga-DOTATATE accumulation. Correlated tracers’ uptake and calcium burden and risk factors, Mean target-to-background ratio (TBR) of 68Ga-DOTATATE correlated significantly with the presence of calcified plaques (r=0.52), hypertension (r=0.60), age (r=0.56) and uptake of 18F-FDG (r=0.64). TBRmean of 18F-FDG correlated significantly only with hypertension (r=0.58; p<0.05). Additionally, TBRmean of 68Ga-DOTATATE is significant higher in the high risk group while TBRmean of 18F-FDG is not.
In conclusion, we evaluated vascular inflammation of atherosclerosis non-invasively using the two PET tracers: 68Ga-DOTATATE and 68Ga-Fucoidan. 68Ga-DOTATATE show specific affinity to infiltrated macrophage within the plaques. 68Ga-Fucoidan may hold the potential to discriminate between active and inactive atherosclerotic plaques in terms of variant accumulation on different-types of plaques. PET as leading molecular imaging technique provides superiority in assessing cellular activity, which is pivotal for understanding internal activity of atherosclerotic plaques. Since diagnosis of atherosclerosis is a complex and multi-dimensional task. More integrated imaging technology such as PET/MRI, faster imaging algorithm, more efficient radiotracer are required for further development of atherosclerosis imaging,
Die Atherosklerose ist als Ursache kardiovaskulärer Erkrankungen, welche die häufigste Todesursache weltweit darstellen, von großer klinischer und wissenschaftlicher Relevanz. Atherosklerose ist charakterisiert durch Einlagerungen von Lipiden in die Gefäßwand, welche zur Ausbildung von Plaques führen. Als Folge wird eine chronische Entzündungsreaktion eingeleitet, die durch spezifische Immunzellen, unter anderem T-Lymphozyten, und komplexe molekulare Prozesse aufrechterhalten wird. Durch eine verminderte Sauerstoffdiffusionskapazität und eine hohe Zelldichte ist das Milieu in den Plaques hypoxisch. Zur zellulären Anpassung an ein solches hypoxisches Milieu werden Hypoxie-induzierbare Faktoren (HIF) in den Immunzellen stabilisiert. Der Transkriptionsfaktor HIF-1 ist ein heterodimeres Protein, welches die Transkription bestimmter Zielgene initiiert, die den Zellen notwendige Adaptationen des Zellstoffwechsels an ein vermindertes Sauerstoffangebot ermöglichen.
Das Ziel der vorliegenden Arbeit bestand darin zu untersuchen, inwiefern sich ein Ausschalten des Transkriptionsfaktor HIF-1α selektiv in T-Lymphozyten auf Atherosklerose und Myokardinfarkt auswirkt. Die funktionelle Bedeutung von HIF-1α in T-Zellen in der Pathogenese dieser Erkrankungen wurde an zwei Mausmodellen untersucht.
Im Atherosklerose Modell wurde Biomaterial von LDLR-/- Mäusen mit T-Zell spezifischem Knockout von HIF-1α nach achtwöchiger fettreicher Western-Typ Diät untersucht. Histologisch zeigte sich eine vermehrte Plaqueausprägung und ein verminderter Makrophagenanteil in den Plaques. Durchflusszytometrisch und mittels qPCR konnten keine Unterschiede in der Lymphozytendifferenzierung in Milz und Lymphknoten dieser Mäuse nachgewiesen werden.
Im Myokardinfarkt-Modell mit T-Zell spezifischem HIF-1α Knockout konnte in früheren Untersuchungen der Arbeitsgruppe eine vergrößerte Infarktzone mit eingeschränkter kardialer Funktion nachgewiesen werden. Histologisch konnte im Rahmen dieser Arbeit hierfür kein zellmorphologisches Korrelat in Kardiomyozytengröße oder der Vaskularisation des Myokards gefunden werden.
In Zukunft könnte HIF-1α in T-Lymphozyten ein möglicher Angriffspunkt zur medikamentösen Prävention oder Therapie kardiovaskulärer Erkrankungen sein.
Allogeneic hematopoietic cell transplantation (Allo-HCT) is the main and only treatment for many malignant and non-malignant haematological disorders. Even though the treatment has improved through the years and patient life expectancy has increased, graft versus host disease (GvHD) is still considered the main obstacle and one of the main reasons for increased mortality. Furthermore, improved patient’s survival and life expectancy brought into question the late post-HCT complications. The leading cause of late death after allo-HCT is the relapse of primary disease as well as chronic GvHD (cGvHD). However, a clear relationship was also described with pulmonary complications, endocrine dysfunction and infertility, and cataracts in post-HCT patients. In the last years big concern regarding a cumulative cardiovascular incidence in long-term survivors has been raised. Severe cardiovascular disease (CVD) is caused by atherosclerosis which is considered a chronic inflammatory disease of blood vessels. As such, it takes a long time from endothelial damage, as the onset event, and followed plaque formation to a manifestation of severe consequences, such as stroke, coronary heart disease, or peripheral arterial disease. Endothelial damage is well documented in patients post-HCT. In the context of allo-HCT, the endothelial damage is induced by the conditioning regimen with or without total body irradiation (TBI). Furthermore, endothelial cells (ECs) have been documented as a target of GvHD and increased concentration of circulating endothelial cells (CEC) coinciding with an increase in the number of circulating alloreactive T cells. According to 2021 ESC Guidelines on CVD prevention, the main atherosclerotic CVD (ASCVD) risk factors are blood apolipoprotein B (ApoB)-containing lipoproteins (of which low-density lipoprotein (LDL) is the most abundant), high blood pressure, cigarette smoking and diabetes mellitus (DM). GvHD is considered a high-risk factor for the onset of dyslipidaemia, hypertension, and DM. Overall, the risk of premature cardiovascular death is 2.7 fold increased in comparison to the general population, while the cumulative incidence of cardiovascular complications was shown to be up to 47% at ten years after reduced intensity conditioning (RIC), post-HCT. However, up to date, there are no available studies elucidating the interconnection between GvHD and atherosclerosis. The goal of this study was, therefore, to investigate the involvement of GvHD in the progression of atherosclerosis as well as to elucidate whether cytotoxic, CD8+ T cells that were shown to play a significant role in endothelial damage during the course of skin GvHD on one hand, and inducers of formation of unstable plaque on the other, are involved in this interconnection. For that purpose we established a novel minor histocompatibility anti gens (miHAg) allo-HCT Western diet (WD)-induced atherosclerosis mouse model. We were able to show that GvHD has a significant impact on atherosclerosis development in B6.Ldlr−/− recipient mice even in the absence of overt clinical disease activity. It seems that the impact is at least partly induced by CD8+ T cells, that showed significantly increased infiltration of aortic lesions in mice facing subclinical GvHD. As studies have shown in regular atherosclerotic mouse models as well as in humans, these CD8+ T cells exhibited not only increased expression of genes involved in activation, survival and differentiation to cytotoxic phenotype, but also some genes pointing out their exhaustion, that were absent in CD4+ T cell cluster. When anti-CD8β antibody was applied once per week along with WD feeding for eight weeks, the plaque formation was significantly reduced in aorta and aortic root pointing out the importance of these cells in an alloreactivity induced lesion formation. Furthermore, anti-CD8β treatment led to significantly decreased necrotic core formation followed by overall increase in plaque stability. Strikingly, bone marrow plus T cells (BMT) recipients fed WD showed significantly increased serum cholesterol levels in comparison to bone marrow (BM) (a group lacking alloreactive T cells that induce GvHD). This effect was reversed when anti-CD8β treatment was applied, suggesting, at least partly, an impact of alloreactive CD8+ T cells on cholesterol levels. Expression of genes responsible for lipid metabolism pointed out the tendency of the liver to regulate the increased cholesterol levels, however, the mechanism behind this phenotype still remains to be revealed. On the other hand, the impact of obesity, induced by chronic high-fat diet (HFD) feeding, has been shown to be an independent risk factor for gastrointestinal GvHD. Similarly, in major histocompatibility complex (MHC) disparate allo-HCT mouse model, we have noticed that even short-term WD intake leads to a significant decrease in survival of mice post-HCT. When the concentration of transplanted alloreactive T cells was reduced, the survival was improved, pointing out the involvement of these cells in the pathogenesis. Additionally, bioluminescence imaging (BLI) during initiation and effector phase of acute GvHD (aGvHD) revealed increased infiltration of alloreactive T cells in mice fed WD. Studies in an obesity model, we could confirm the involvement of specifically CD4+ T cells in WD induced impact, as the relative number of these cells was significantly increased in small intestine on day six post-HCT in mice fed WD. This increased intestinal infiltration was preceded by increase in the number of alloreactive T cells expressing intestine homing receptor (α4β7 integrin) in peripheral lymph nodes (LNs). Even though the number of T cells was not changed in the spleen of WD fed mice, the subset of CD4+ and CD8+ T cells that were highly secreting TNFα was increased as well as the expression of genes regulating pro-inflammatory cytokines such as IL-6 and interferon (IFN)γ pointing out significant WD-induced inflammation. Moreover, slight tendency towards increased intestinal permeability and load of translocated luminal bacteria, that we observed, could induce severe endotoxemia and dysregulated systemic immune response that could lead to detrimental induction of cell death. Justifying our speculations, we noted increased levels of transaminases and an increase in lactate dehydrogenase (LDH) levels (pointing out significant tissue damages). However, the exact mechanism behind this detrimental WD impact still remains to be elucidated.
Atherosklerose und Hypercholesterinämie führen zu einer deutlichen Beeinträchtigung der vaskulären Funktion. Neben der bereits vielfältig beschriebenen Hemmung der endothelvermittelten Vasodilatation durch oxidierte Lipoproteine, fanden sich in den vergangenen Jahren auch zunehmend Hinweise für ein verändertes Kontraktionsverhalten von Arterien unter dem Einfluss von oxidiertem LDL. In der vorliegenden Arbeit wurde untersucht, ob oxidiertes Lipoprotein die Angiotensin II induzierte Vasokonstriktion verändert, durch welche Mechanismen dies geschieht und ob sich durch den Einsatz bereits bekannter und etablierter antihypertensiver Medikamente und neuerer Substanzen ein Einfluss hierauf nehmen lässt. Hierfür wurden Kontraktionsexperimente an isolierten Kaninchenaorten durchgeführt. Zu Beginn der Arbeit wurde zunächst die Angiotensin II induzierte Vasokonstriktion studiert, hierbei zeigte sich, dass Angiotensin II selbst bei repetitiver Stimulation zu einer Zunahme der Kontraktilität isolierter Kaninchenaorten führt. Wie weiterführende Untersuchungen zeigten, konnte dieser Effekt durch die Blockade von Calciumkanälen nur teilweise beeinflusst werden. Hiervon ausgehend kann festgestellt werden, dass Angiotensin II zu einer Zunahme der Kontraktilität durch eine Sensibilisierung des kontraktilen Apparates gegenüber Calcium führt. Der Mechanismus der Ca2+- Sensibilisierung ist noch nicht vollständig geklärt, in vorangehenden Studien unterschiedlicher Arbeitsgruppen fanden sich jedoch viele Hinweise auf eine Rho-Kinase vermittelte Aktivitätsmodulierung der Myosin-Leichtketten-Phosphastase. Die Beteiligung der Rho-Kinase an der Angiotensin II induzierten Vasokonstriktion konnte durch den Einsatz des Rho-Kinase Hemmers Y27632 gezeigt werde. Nach Inkubation kam es zu einer signifikant verringerten Ausprägung der Angiotensin II induzierten Vasokonstriktion. Auch durch die Blockade des AT1-Rezepors konnte die Angiotensin II induzierte Vasokonstriktion verhindert werden, während der Einsatz eines Angiotensin-Converting-Enzym-Inhibitors ohne Einfluss auf die Vasomotorik blieb. Im Anschluss wurde der Effekt des oxidierten Low Density Lipoproteins auf die Angiotensin II induzierte Vasokonstriktion untersucht. OxLDL steigerte die durch eine Schwellenkonzentration von Angiotensin II hervorgerufene Kontraktion isolierter Kaninchenaortenringe um das 2,9 fache, während es den Basaltonus unkontrahierter Gefäße nicht beeinflusste. Dabei war zunächst unklar, über welchen Mechanismus diese Potenzierung der Angiotensin II induzierten Vasokonstriktion vermittelt wird. Durch den Einsatz eines Calciumkanalantagonisten konnte gezeigt werden, dass die OxLDL induzierte Zunahme der Kontraktilität nicht einzig durch eine Steigerung der intrazellulären Calciumionenkonzentration vermittelt ist, da dieser nur eine partiellen Effekt von etwa 40% hatte. Der Rho-Kinase-Inhibitor Y27632 führte jedoch zu einem Ausbleiben bzw. Rückgang der Potenzierung. Daher bleibt festzustellen, dass sowohl bei Angiotensin II induzierten Vasokonstriktion als auch deren Potenzierung durch OxLDL die Rho-Kinase beteiligt ist. Auch eine Hemmung der Angiotensin II induzierten Vasokonstriktion durch einen AT1-Rezeptorblocker verhinderte den potenzierenden Einfluss von OxLDL. In der Hypertonus Therapie bei hypercholesterinämischen Patienten könnte der Einsatz von AT1-Rezeptorblockern und Rho-Kinase-Hemmern erfolgsversprechend sein.
Increased aortic stiffness is known to be associated with atherosclerosis and has a predictive value for cardiovascular events. This study aims to investigate the local distribution of early arterial stiffening due to initial atherosclerotic lesions. Therefore, global and local pulse wave velocity (PWV) were measured in ApoE\(^{-/-}\) and wild type (WT) mice using ultrahigh field MRI. For quantification of global aortic stiffness, a new multi-point transit-time (TT) method was implemented and validated to determine the global PWV in the murine aorta. Local aortic stiffness was measured by assessing the local PWV in the upper abdominal aorta, using the flow/area (QA) method. Significant differences between age matched ApoE\(^{-/-}\) and WT mice were determined for global and local PWV measurements (global PWV: ApoE\(^{-/-}\): 2.7 ±0.2m/s vs WT: 2.1±0.2m/s, P<0.03; local PWV: ApoE\(^{-/-}\): 2.9±0.2m/s vs WT: 2.2±0.2m/s, P<0.03). Within the WT mouse group, the global PWV correlated well with the local PWV in the upper abdominal aorta (R\(^2\) = 0.75, P<0.01), implying a widely uniform arterial elasticity.
In ApoE\(^{-/-}\) animals, however, no significant correlation between individual local and global PWV was present (R\(^2\) = 0.07, P = 0.53), implying a heterogeneous distribution of vascular stiffening in early atherosclerosis. The assessment of global PWV using the new multi-point TT measurement technique was validated against a pressure wire measurement in a vessel
phantom and showed excellent agreement. The experimental results demonstrate that vascular stiffening caused by early atherosclerosis is unequally distributed over the length of large vessels. This finding implies that assessing heterogeneity of arterial stiffness by multiple local measurements of PWV might be more sensitive than global PWV to identify early atherosclerotic lesions.
Cardiovascular diseases represent the leading cause of death worldwide, with myocardial infarction and strokes being the most common complications. In both cases, the appearance of an enlarged artery wall as a consequence of a growing plaque is responsible for the disturbance of the blood flow. The formation of plaques is driven by a chronic inflammatory condition known as atherosclerosis, characterized by an initial step of endothelial cell (EC) dysfunction followed by the recruitment of circulating immune cells into the tunica intima of the vessel. Accumulation of lipids and cells lead to the formation of atheromatous plaques that will define the cardiovascular outcome of an individual.
The role of the immune system in the progression of atherosclerosis has been widely recognized. By far, macrophages constitute the most abundant cell type in lesions and are known to be the major source of the lipid-laden foam cell pool during the course of the disease. However, other immune cells types, including T cells, dendritic cells (DCs) or mast cells, among others, have been described to be present in human and mouse plaques. How these populations can modulate the atherogenic process is dependent on their specialized function.
DCs constitute a unique population with the ability to bridge innate and adaptive immune responses, mainly by their strong capacity to present antigens bound to a major histocompatibility complex (MHC) molecule. Given their ability to polarize T cells and secrete cytokines, their role in atherosclerosis has gained attention for the development of new therapeutic approaches that could impact lesion growth. Hence, knowing the effect of a specific subset is an initial key step to evaluate its potential for clinical purposes. For example, the basic leucine zipper ATF-like 3 transcription factor (Batf3) controls the development of conventional dendritic cells type 1 (cDCs1), characterized by the expression of the surface markers CD8 and CD103. Initially, they were described to promote both T-helper 1 (Th1) and regulatory T cell (Treg) responses, known to accelerate and to protect against atherosclerosis, respectively. The first part of this thesis aimed to elucidate the potential role of Batf3-dependent DCs in atherosclerosis and concluded that even though systemic immune responses were mildly altered they do not modify the course of the disease and may not represent an attractive candidate for clinical studies.
DCs also have the ability to impact lesion growth through the release of a broad range of cytokines, which can either directly impact atherosclerotic plaques by modulating resident cells, or by further polarizing T cell responses. Among others, interleukin (IL) 23, a member of the IL-12 family of cytokines, has received much attention during the past year due to its connection to autoimmunity.
IL-23 is known to induce pathogenicity of Th17 cells and is responsible for the development of several autoimmune diseases including multiple sclerosis, psoriasis or rheumatoid arthritis. Interestingly, these patients often present with an accelerated course of atherosclerosis and thus, are at higher risk of developing cardiovascular events. Several epidemiological studies have pointed toward a possible connection between IL-23 and its receptor IL-23R in atherosclerosis, although their exact contribution remains to be elucidated. The second part of this thesis showed that resident antigen-presenting cells (APCs) in the aorta produced IL-23 during the steady state but this secretion was greatly enhanced after incubation with oxidized low-density lipoprotein (oxLDL). Furthermore, disruption of the IL-23R signaling led to decreased relative necrotic plaque area in lesions of Ldlr-/-Il23r-/- mice fed a high-fat diet (HFD) for 6 and 12 weeks compared to Ldlr-/- controls. A proposed mechanism involves that increased IL-23 production in the context of atherosclerosis may promote the pathogenicity of IL-23-responding T cells, especially IL-23R+ γδ T cells in the aortic root. Response to IL-23 might increase the release of granulocyte-macrophage colony-stimulating factor (GM-CSF) and IL-17 and alter the pro- and anti-inflammatory balance of cytokines in the aortic root. Altogether, these data showed that the IL-23 / IL-23R axis play a role in plaque stability.
Role of Hypoxia-Inducible Factor (HIF) 1α in Dendritic Cells in Immune Regulation of Atherosclerosis
(2013)
Atherosclerosis is the underlying cause of cardiovascular diseases and a major threat to human health worldwide. It involves not only accumulation of lipids in the vessel wall but a chronic inflammatory response mediated by highly specific cellular and molecular responses. Macrophages and dendritic cells (DCs) play an essential role in taking up modified lipids and presenting them to T and B lymphocytes, which promote the immune response. Enhanced activation, migration and accumulation of inflammatory cells at the local site leads to formation of atherosclerotic plaques.
Atherosclerotic plaques become hypoxic due to reduced oxygen diffusion and high metabolic demand of accumulated cells. The various immune cells experience hypoxic conditions locally and inflammatory stimuli systemically, thus up-regulating Hypoxia-inducible factor 1α. Though the role of HIF1α in macrophages and lymphocytes has been elucidated, its role in DCs still remains controversial, especially with respect to atherosclerosis. In this project work, the role of HIF1α in DCs was investigated by using a cell specific knockout mouse model where HIF1α was deleted in CD11c+ cells.
Aortic root sections from atherosclerotic mice showed presence of hypoxia and up-regulation of HIF1α which co-localized with CD11c+ cells. Atherosclerotic splenic DCs also displayed enhanced expression of HIF1α, proving non-hypoxic stimulation of HIF1α due to systemic inflammation. Conditional knockout (CKO) mice lacking HIF1α in CD11c+ cells, under baseline conditions did not show changes in immune responses suggesting effects of HIF1α only under inflammatory conditions. When these mice were crossed to the Ldlr-/- line and placed on 8 weeks of high fat diet, they developed enhanced plaques with higher T-cell infiltration as compared to the wild-type (WT) controls. The plaques were of a complex phenotype, defined by increased percent of smooth muscle cells (SMCs) and necrotic core area and reduced percent of macrophages and DCs. The mice also displayed enhanced T-cell activation and a Th1 bias in the periphery.
The CKO DCs themselves exhibited increased expression of IL 12 and a higher capacity to proliferate and polarize naive T cells to the Th1 phenotype in vitro. The DCs also showed decreased expression of STAT3, in line with the inhibitory effects of STAT3 on DC activation seen in previous studies. When STAT3 was overexpressed in DCs in vitro, IL 12 was down-regulated, but its expression increased significantly on STAT3 inhibition using a mutant vector. In addition, when STAT3 was overexpressed in DCs in vivo using a Cre regulated lentiviral system, the mice showed decreased plaque formation compared to controls. Interestingly, the effects of STAT3 modulation were similar in WT and CKO mice, intending that STAT3 lies downstream of HIF1α. Finally, using a chromatin immunoprecipitation assay (ChIP), it was confirmed that HIF1α binds to hypoxia responsive elements (HREs) in the Stat3 gene promoter thus regulating its expression. When DCs lack HIF1α, STAT3 expression is not stimulated and hence IL 12 production by DCs is uninhibited. This excessive IL 12 can activate naive T cells and polarize them to the Th1 phenotype, thereby enhancing atherosclerotic plaque progression.
This project thus concludes that HIF1α restrains DC activation via STAT3 generation and prevents excessive production of IL 12 that helps to keep inflammation and atherosclerosis under check.