on January 23, 2003
Arteriosclerosis, Thrombosis, and Vascular Biology. 2003
Published online before print January 23, 2003, doi: 10.1161/01.ATV.0000057807.28754.7F
Published online before print January 23, 2003, doi: 10.1161/01.ATV.0000057807.28754.7F
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Submitted on August 20, 2002
Accepted on December 17, 2002
Phagocytosis and Macrophage Activation Associated With Hemorrhagic Microvessels in Human Atherosclerosis
Mark M. Kockx ;
From the Divisions of Cardiology (K.M.C., J.M.B.) and Pharmacology (M.M.K., G.R.Y.D.M., A.G.H., H.B.), University of Antwerp, and the Divisions of Pathology (M.M.K.) and HistoGeneX (M.W.M.K.), AZ Middelheim, Antwerp, Belgium.
* To whom correspondence should be addressed. E-mail: Hidde.Bult{at}ua.ac.be.
Objective--Previously, we demonstrated that activated inducible NO synthase (iNOS)-expressing foam cells in human carotid plaques often produce autofluorescent (per)oxidized lipids (ceroid). Here, we investigate whether intraplaque microvessels can provide foam cells with lipids and trigger macrophage activation.
Methods and Results--Microvessels (von Willebrand factor [vWf] immunoreactivity), activated macrophages (iNOS immunoreactivity), and ceroid were systematically mapped in longitudinal sections of 15 human carotid endarterectomy specimens. An unbiased hierarchical cluster analysis classified vascular regions into 2 categories. One type with normal vWf expression and without inflammatory cells was seen, and another type with cuboidal endothelial cells, perivascular vWf deposits, and iNOS and ceroid-containing foam cells was seen in 4 (27%) of 15 plaques. The perivascular foam cells frequently contained platelets (glycoprotein Ib
) and erythrocytes (hemoglobin, iron), pointing to microhemorrhage/thrombosis and subsequent phagocytosis. Similar lipid-containing cells, expressing both ceroid and iNOS, were generated in atherosclerosis-free settings by incubating murine J774 macrophages with platelets or oxidized erythrocytes and also in vivo in organizing thrombi in normocholesterolemic rabbits.
Conclusions--Focal intraplaque microhemorrhages initiate platelet and erythrocyte phagocytosis, leading to iron deposition, macrophage activation, ceroid production, and foam cell formation. Neovascularization, besides supplying plaques with leukocytes and lipoproteins, can thus promote focal plaque expansion when microvessels become thrombotic or rupture prone.
Key words: atherosclerosis • microvessels • inducible NO synthase • hemorrhage • erythrocytes
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