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![Morphologic characteristics of carotid artery atherosclerosis using MRI. 3-T magnetic resonance imaging (MRI) of a plaque in the right common carotid artery demonstrates fibrous cap rupture with ulcer formation (yellow arrows). The crescent-shaped high-signal region in the proton density-weighted (PDW), T2-weighted (T2W), and contrast enhanced T1-weighted (CE-T1W) images corresponds to a region of thrombus formation, shown on the matched histology section (hematoxylin and eosin stain). Reprinted with permission from Chu et al. [23].](publication/288890460/figure/fig2/AS:1086797979357235@1636124238536/Morphologic-characteristics-of-carotid-artery-atherosclerosis-using-MRI-3-T-magnetic.jpg)
Morphologic characteristics of carotid artery atherosclerosis using MRI. 3-T magnetic resonance imaging (MRI) of a plaque in the right common carotid artery demonstrates fibrous cap rupture with ulcer formation (yellow arrows). The crescent-shaped high-signal region in the proton density-weighted (PDW), T2-weighted (T2W), and contrast enhanced T1-weighted (CE-T1W) images corresponds to a region of thrombus formation, shown on the matched histology section (hematoxylin and eosin stain). Reprinted with permission from Chu et al. [23].
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Atherosclerosis is a chronic, progressive, multifocal arterial wall disease caused by local and systemic inflammation responsible for major cardiovascular complications such as myocardial infarction and stroke. With the recent understanding that vulnerable plaque erosion and rupture, with subsequent thrombosis, rather than luminal stenosis, is the...
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Atherosclerosis, which is a primary cause of cardiovascular disease (CVD) deaths around the world, is a chronic inflammatory disease that is characterised by the accumulation of lipid plaques in the arterial wall, triggering inflammation that is regulated by cytokines/chemokines that mediate innate and adaptive immunity. This review focuses on IL-3...
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Over the past several decades, significant progress has been made in the pathohistological assessment of vulnerable plaques and in invasive intravascular imaging techniques. However, the assessment of plaque morphology by invasive modalities is of limited value for the detection of subclinical coronary atherosclerosis and the subsequent prediction...
Background
Cardiovascular diseases are the leading cause of death worldwide. A prominent cause of cardiovascular events is atherosclerosis, a chronic inflammation of the arterial wall that leads to the formation of so called atherosclerotic plaques. There is a strong clinical need to develop new, non-invasive vascular imaging techniques in order to...
Citations
... ICAM-1 and VCAM-1 overexpression promotes ED, which is an early stage of atherosclerosis. Additionally, the upregulation of these molecules is one of the hallmark characteristics of ED [159,160]. Furthermore, previous studies also demonstrated that atherosclerosis was associated with intercellular monocyte adherence upregulation to the endothelium. Although ICAM-1, VCAM-1, and E-selectin play a significant role in the migration of lymphocytes, their prevalence in the case of atherosclerotic plaques is far from equal. ...
Endothelial dysfunction (ED) is characterized by imbalanced vasodilation and vasoconstriction, elevated reactive oxygen species (ROS), and inflammatory factors, as well as deficiency of nitric oxide (NO) bioavailability. It has been reported that the maintenance of endothelial cell integrity serves a significant role in human health and disease due to the involvement of the endothelium in several processes, such as regulation of vascular tone, regulation of hemostasis and thrombosis, cell adhesion, smooth muscle cell proliferation, and vascular inflammation. Inflammatory modulators/biomarkers, such as IL-1α, IL-1β, IL-6, IL-12, IL-15, IL-18, and tumor necrosis factor α, or alternative anti-inflammatory cytokine IL-10, and adhesion molecules (ICAM-1, VCAM-1), involved in atherosclerosis progression have been shown to predict cardiovascular diseases. Furthermore, several signaling pathways, such as NLRP3 inflammasome, that are associated with the inflammatory response and the disrupted H2S bioavailability are postulated to be new indicators for endothelial cell inflammation and its associated endothelial dysfunction. In this review, we summarize the knowledge of a plethora of reviews, research articles, and clinical trials concerning the key inflammatory modulators and signaling pathways in atherosclerosis due to endothelial dysfunction.
... In addition to the B-mode ultrasound used in the detection of the vulnerable plaques carotid MRI, and nuclear imaging techniques all promising accurate diagnostic quality. Charcot neuroarthropathy (CN) is also another epidemic impediment of DM in which imaging plays a vital role in the early and accurate diagnosis of CN, and in distinction of CN from osteomyelitis [10]. Conventional radiography, computed tomography, nuclear medicine scintigraphy, magnetic resonance imaging, and positron emission tomography are the imaging modalities currently in use for the detection of CN but modalities other than magnetic resonance imaging appeared to be as corresponding well in the early diagnosis of the CN [11]. ...
... Ultrasound imaging or US is an imaging technique that uses high frequency of sound waves (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) and their echoes to produce comparatively precise images of structures within the body [37]. US is currently use to detect lipohypertropy due to glycemic fluctuations associate with DM, since diabetic peripheral neuropathy (DPN) is a common complication with DM which can be diagnosed using US [38,39]. ...
Diabetes has become a health care problem of increasing concern in the world as number of individuals with disease are on the rise over the past
2 decades. Imaging technologies are noninvasive tools which are currently receiving an increase significance to guiding physician in finding and
therapeutic treatment of patients. Advanced imaging has upgraded our ability to assess the prospect of diabetics in patients. However, the capacity
of imaging to detect the existence of osteomyelitis and myotitis does not automatically mean that it should be employ on a regular basis for tentative
diagnosis of the diabetics. Diabetes is a multisystemic disease that exerts its effects through decrease insulin sensitivity causing various stages of
metablilic conditions. The Pathogenesis of the complication related to diabetes is solely depended to duration of the disease with other health
challenges which are refer to co-existing factors. The effects of long-standing effect of diabetes are usually associated with microvascular disease
resulting to diabetic retinopathy nephropathy and cardiomyopathy. However, imaging performs an important part in diagnosis and follow-up of
associated complications. This paper reviews the pathophysiology of diabetics, discuss the imaging appearance and provide detail review of the
diagnostic image profile of patient with diabetics
... Increased inflammatory mediators and matrix metalloproteinases are secreted by migratory cells during this process, which causes plaque rupture and thrombus development [4]. Various studies have shown that measuring levels of ICAM-1, VCAM-1, and E-selectin can provide a good reflection of inflammatory processes occurring in the endothelium [5,6]. Although there are several ways to diagnose atherosclerosis, VCAM-1 represents a favorable target for molecular imaging-based non-invasive detection of atherosclerosis [7,8]. ...
Cell adhesion molecules (CAM) including the intracellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) are from the immunoglobulin family which regulates leukocyte adherence to endothelial muscles in acute or chronic inflammatory states. TNF-α, a proinflammatory cytokine, triggers cell adhesion molecules, inflammatory molecules, and other cytokines. The
appearance level of these CAMs on the membrane of endothelial cells is a key factor in determining the comparable impact of VCAM-1 and ICAM-1 on the attraction of leukocytes in a particular disease state. Leukocytes and endothelial cells are two cell types that express ICAM 1 an Ig-like cell adhesion molecule. Transcriptional regulation is primarily responsible for regulating ICAM-1 expression. The ICAM-1 is critically important in inflammation and the T-cell-mediated immune response. Antigen-presenting cells use it to stimulate T cells that recognize only MHC class II antigens, whereas other cells use it to stimulate cytotoxic T cells by associating with MHC class I. Leukocyte migration to the inflammatory site is done by ICAM-1.
... Необходимо отметить тот факт, что острый коронарный синдром часто является результатом повреждения или разрыва гемодинамически незначимых атеросклеротических бляшек (АСБ) [5]. При этом риск развития сердечно-сосудистых осложнений, в большей мере, определяется степенью "нестабильности" АCБ, нежели выраженностью коронарного поражения [6,7]. ...
Subclinical coronary arteriosclerosis is a common cause of adverse cardiovascular events: myocardial infarction, stroke, sudden cardiac death. Currently, there is a large arsenal of methods for diagnosing coronary atherosclerosis. The article presents its main characteristics, advantages and disadvantages, the possibility of use in routine clinical practice.
... MRI also allows the generation of anatomical images and enables the native characterization of atherosclerotic plaque components with a high soft tissue contrast based on local tissue properties [84]. In addition, MRI offers to detect and visualize molecular probes with higher spatial and temporal resolution than modalities such as positron emission tomography (PET) and single photon emission computed tomography (SPECT). ...
... Additionally, MRI is a radiation-free technique, such that imaging can be repeated multiple times without radiation-associated risks. However, MRI is a relatively time-consuming technique, compared to, e.g., CT [84], and the sensitivity for the detection of molecular probes is lower compared to nuclear techniques like PET and SPECT. ...
Atherosclerotic plaques can remain quiescent for years, but become life threatening upon rupture or disruption, initiating clot formation in the vessel lumen and causing acute myocardial infarction and ischemic stroke. Whether and how a plaque ruptures is determined by its macroscopic structure and microscopic composition. Rupture-prone plaques usually consist of a thin fibrous cap with few smooth muscle cells, a large lipid core, a dense infiltrate of inflammatory cells, and neovessels. Such lesions, termed high-risk plaques, can remain asymptomatic until the thrombotic event. Various imaging technologies currently allow visualization of morphological and biological characteristics of high-risk atherosclerotic plaques. Conventional protocols are often complex and lack specificity for high-risk plaque. Conversely, new imaging approaches are emerging which may overcome these limitations. Validation of these novel imaging techniques in preclinical models of atherosclerosis is essential for effective translational to clinical practice. Imaging the vessel wall, as well as its biological milieu in small animal models, is challenging because the vessel wall is a small structure that undergoes continuous movements imposed by the cardiac cycle as it is adjacent to circulating blood. The focus of this paper is to provide a state-of-the-art review on techniques currently available for preclinical imaging of atherosclerosis in small animal models and to discuss the advantages and limitations of each approach.
... During this process, migrating cells secrete more inflammatory cytokines and matrix metalloproteinases, leading to plaque rupture (5) and thrombus formation (4). The detection of atherosclerotic plaques at this inflammatory stage could allow the prevention of future acute cardiovascular events (6). ...
OBJECTIVES
Inflammatory molecules play a role in the development of atherosclerosis, which is the primary origin of cardiovascular disorders. However, to the best of our knowledge, no study has attempted to investigate the relationship between these circulating molecules and the prediction of cardiovascular risk. The present study aimed to investigate the relationships of vascular cell adhesion molecule-1, intercellular adhesion molecule-1, E-selectin and matrix metalloproteinase 9 serum concentrations with the extent of coronary lesions.
METHODS
Seventy-four individuals who were undergoing coronary angiography for the first time for diagnostic purposes were enrolled in this study. The extent of the coronary lesion was assessed using the Friesinger Index, and subjects were classified into four groups: no lesions, minor lesions, intermediate lesions and major lesions. Serum biochemical parameters and serum concentrations of vascular cell adhesion molecule-1, intercellular adhesion molecule-1, E-selectin and matrix metalloproteinase 9 were analyzed.
RESULTS
The vascular cell adhesion molecule-1 concentration was higher than 876 ng/mL in individuals with intermediate and major lesions (p<0.001 and p=0.020, respectively). Moreover, logistic regression analysis showed that these patients had an increased risk of having an intermediate lesion (p=0.007). Interestingly, all individuals with major lesions had vascular cell adhesion molecule-1 concentrations higher than 876 ng/mL. No association was found between the concentrations of the other proteins and the Friesinger Index.
CONCLUSIONS
Serum vascular cell adhesion molecule-1 may be associated with the extent of coronary lesions. Moreover, it may represent an alternative to improve the cardiovascular risk classification in patients without acute coronary syndrome.
... Figure 10) : plaque non calcifiée, calcifiée ou mixte [37]. La méthode TDRX permet de quantifier le degré de calcification de la plaque mais ne permet pas d'estimer sa vulnérabilité à la rupture [34]. ...
... L'IRM est une méthode non-invasive, dotée d'une excellente résolution spatiale en comparaison avec la tomodensitométrie ou avec l'échographie, ce qui permet d'obtenir un meilleur contraste tissulaire. La limite de cette technique est la différenciation entre les plaques inflammées ou non-inflammées [34]. ...
... (B) Image TDRX/TEP montrant l'absorption du 18 F-FDG au niveau de la bifurcation de l'artère coronaire principale gauche (flèche pleine) chez un patient atteint d'un syndrome coronarien aigu. L'absorption du 18 F-FDG aortique est indiquée par la flèche en pointillée[34]. ...
Les maladies cardiovasculaires représentent la première cause de mortalité et de morbidité dans le monde. L’athérosclérose est à l’origine de 50 % des décès dans les pays industrialisés. Cette pathologie multifactorielle est caractérisée par l’accumulation de lipides dans la paroi des artères formant une plaque d’athérome. Les manifestations cliniques dues à la rupture de cette plaque dépendent du territoire vasculaire touché, allant de l’accident vasculaire cérébral ischémique à l’infarctus du myocarde. Pour pallier ce problème majeur de santé publique dont la prévalence est deux fois supérieure à l’Île de La Réunion par rapport à la Métropole, nous proposons de développer de nouveaux outils de diagnostic par l’imagerie utilisant la tomographie par émission de positon (TEP). À ce jour, aucun outil ne permet la détection précoce de ces plaques d’athérome. Nous avons choisi de marquer deux types de lipoprotéines (HDL et LDL) pour imager ces plaques. Elles possèdent toutes les deux des rôles opposés mais ont en commun un tropisme avéré pour la plaque d’athérome. Nos travaux ont permis la synthèse puis le radiomarquage d’un nouvel agent chélatant PCTA du Gallium 68 couplé à un biovecteur phospholipidique, la 1,2-distéaroyl-sn-glycéro-3-phosphoéthanolamine (DSPE), qui a ensuite été insérée au niveau de la couche lipidique des lipoprotéines afin d’étudier sa biodistribution dans des modèles in vivo murin et ex vivo humain d’athérosclérose.
... Plaques A number of imaging modalities have been developed to visualize the characteristics of atherosclerotic plaques within the blood vessel. A wide range of these modalities has been utilized in the investigation of the effects of EPA on atherosclerotic plaques (summarized inTable 1[20][21][22][23][24][25]). Results of imaging studies evaluating the effects of EPA on atherosclerotic plaques are summarized in ...
... Optical coherence tomography (OCT) is an optical method using emission and reflection of near-infrared light to produce cross-sectional images of coronary arteries[44]. OCT has approximately 10-fold greater resolution than ultrasound-based approaches with resolution of 4–20 µm, which makes it an ideal imaging modality to identify the thin fibrous cap (defined as <65 µm) in patients with thin-cap fibroatheroma (TCFA)[45,21]. TCFA is associated with major adverse cardiac events and is significantly more likely to be found in severe (>70%) coronary stenosis than in mild stenosis (30%–49%) (36% vs 18%, respectively; P=0.002)[46,47]. ...
Residual cardiovascular (CV) risk remains in some patients despite optimized statin therapy and may necessitate add-on therapy to reduce this risk. Eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid, lowers plasma triglyceride levels without raising low-density lipoprotein cholesterol levels and has potential beneficial effects on atherosclerotic plaques. Animal studies have shown that EPA reduces levels of pro-inflammatory cytokines and chemokines. In clinical trials utilizing a wide spectrum of plaque imaging modalities, EPA has shown beneficial effects on plaque characteristics. Studies of patients with coronary artery disease receiving statin therapy suggest that EPA may decrease plaque vulnerability and prevent plaque progression. EPA also decreased pentraxin-3 and macrophage accumulation. A large, randomized, Japanese study reported that EPA plus a statin resulted in a 19% relative reduction in major coronary events at 5years versus a statin alone in patients with hypercholesterolemia (P=0.011). Icosapent ethyl, a high-purity prescription form of EPA ethyl ester, has been shown to reduce triglyceride levels and markers of atherosclerotic inflammation. Results of an ongoing CV outcomes study will further define the potential clinical benefits of icosapent ethyl in reducing CV risk in high-risk patients receiving statin therapy.
The rupture of an atherosclerotic plaque cap overlying a lipid pool and/or necrotic core can lead to thrombotic cardiovascular events. In essence, the rupture of the plaque cap is a mechanical event, which occurs when the local stress exceeds the local tissue strength. However, due to inter- and intra-cap heterogeneity, the resulting ultimate cap strength varies, causing proper assessment of the plaque at risk of rupture to be lacking. Important players involved in tissue strength include the load-bearing collagenous matrix, macrophages, as major promoters of extracellular matrix degradation, and microcalcifications, deposits that can exacerbate local stress, increasing tissue propensity for rupture. This review summarizes the role of these components individually in tissue mechanics, along with the interplay between them. We argue that to be able to improve risk assessment, a better understanding of the effect of these individual components, as well as their reciprocal relationships on cap mechanics, is required. Finally, we discuss potential future steps, including a holistic multidisciplinary approach, multifactorial 3D in vitro model systems, and advancements in imaging techniques. The obtained knowledge will ultimately serve as input to help diagnose, prevent, and treat atherosclerotic cap rupture.
A significant amount of vascular thrombotic events are associated with rupture of the fibrous cap that overlie atherosclerotic plaques. Cap rupture is however difficult to predict due to the heterogenous composition of the plaque, unknown material properties, and the stochastic nature of the event. Here, we aim to create tissue engineered human fibrous cap models with a variable but controllable collagen composition, suitable for mechanical testing, to scrutinize the reciprocal relationships between composition and mechanical properties. Myofibroblasts were cultured in 1 × 1.5 cm-sized fibrin-based constrained gels for 21 days according to established (dynamic) culture protocols (i.e. static, intermittent or continuous loading) to vary collagen composition (e.g. amount, type and organization). At day 7, a soft 2 mm ∅ fibrin inclusion was introduced in the centre of each tissue to mimic the soft lipid core, simulating the heterogeneity of a plaque. Results demonstrate reproducible collagenous tissues, that mimic the bulk mechanical properties of human caps and vary in collagen composition due to the presence of a successfully integrated soft inclusion and the culture protocol applied. The models can be deployed to assess tissue mechanics, evolution and failure of fibrous caps or complex heterogeneous tissues in general.
