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Fukushima D, Kondo K, Harada N, Terazono S, Uchino K, Shibuya K, Sugo N. Quantitative comparison between carotid plaque hardness and histopathological findings: an observational study. Diagn Pathol 2022; 17:58. [PMID: 35818059 PMCID: PMC9275256 DOI: 10.1186/s13000-022-01239-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 06/12/2022] [Indexed: 12/02/2022] Open
Abstract
Background Plaque hardness in carotid artery stenosis correlates with cerebral infarction. This study aimed to quantitatively compare plaque hardness with histopathological findings and identify the pathological factors involved in plaque hardness. Methods This study included 84 patients (89 lesions) undergoing carotid endarterectomy (CEA) at our institution. Plaque hardness was quantitatively measured immediately after excision using a hardness meter. Collagen and calcification were evaluated as the pathological factors. Collagen was stained with Elastica van Gieson stain, converted to a gray-scale image, and displayed in a 256-step histogram. The median gray-scale median (GSM) was used as the collagen content. The degree of calcification was defined by the hematoxylin–eosin stain as follows: "0:" no calcification, "1:" scattered microcalcification, or "2:" calcification greater than 1 mm or more than 2% of the total calcification. Carotid echocardiographic findings, specifically echoluminance or the brightness of the narrowest lesion of the plaque, classified as hypo-, iso-, or hyper-echoic by comparison with the intima-media complex surrounding the plaque, and clinical data were reviewed. Results Plaque hardness was significantly negatively correlated with GSM [Spearman's correlation coefficient: -0.7137 (p < 0.0001)]: the harder the plaque, the higher the collagen content. There were significant differences between plaque hardness and degree of calcification between "0" and "2" (p = 0.0206). For plaque hardness and echoluminance (hypo-iso-hyper), significant differences were found between hypo-iso (p = 0.0220), hypo-hyper (p = 0.0006), and iso-hyper (p = 0.0015): the harder the plaque, the higher the luminance. In single regression analysis, GSM, sex, and diabetes mellitus were significant variables, and in multiple regression analysis, only GSM was extracted as a significant variable. Conclusions Plaque hardness was associated with a higher amount of collagen, which is the main component of the fibrous cap. Greater plaque hardness was associated with increased plaque stability. The degree of calcification may also be associated with plaque hardness.
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Affiliation(s)
- Daisuke Fukushima
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, 143-8541, Japan.
| | - Kosuke Kondo
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, 143-8541, Japan
| | - Naoyuki Harada
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, 143-8541, Japan
| | - Sayaka Terazono
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, 143-8541, Japan
| | - Kei Uchino
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, 143-8541, Japan
| | - Kazutoshi Shibuya
- Department of Pathology, Toho University Omori Medical Center, Tokyo, Japan
| | - Nobuo Sugo
- Department of Neurosurgery (Omori), School of Medicine, Faculty of Medicine, Toho University, Tokyo, 143-8541, Japan
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Leyssens L, Pestiaux C, Kerckhofs G. A Review of Ex Vivo X-ray Microfocus Computed Tomography-Based Characterization of the Cardiovascular System. Int J Mol Sci 2021; 22:3263. [PMID: 33806852 PMCID: PMC8004599 DOI: 10.3390/ijms22063263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/27/2022] Open
Abstract
Cardiovascular malformations and diseases are common but complex and often not yet fully understood. To better understand the effects of structural and microstructural changes of the heart and the vasculature on their proper functioning, a detailed characterization of the microstructure is crucial. In vivo imaging approaches are noninvasive and allow visualizing the heart and the vasculature in 3D. However, their spatial image resolution is often too limited for microstructural analyses, and hence, ex vivo imaging is preferred for this purpose. Ex vivo X-ray microfocus computed tomography (microCT) is a rapidly emerging high-resolution 3D structural imaging technique often used for the assessment of calcified tissues. Contrast-enhanced microCT (CE-CT) or phase-contrast microCT (PC-CT) improve this technique by additionally allowing the distinction of different low X-ray-absorbing soft tissues. In this review, we present the strengths of ex vivo microCT, CE-CT and PC-CT for quantitative 3D imaging of the structure and/or microstructure of the heart, the vasculature and their substructures in healthy and diseased state. We also discuss their current limitations, mainly with regard to the contrasting methods and the tissue preparation.
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Affiliation(s)
- Lisa Leyssens
- Institute of Mechanics, Materials, and Civil Engineering, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium; (L.L.); (C.P.)
- Institute of Experimental and Clinical Research, Université Catholique de Louvain, 1200 Woluwe-Saint-Lambert, Belgium
| | - Camille Pestiaux
- Institute of Mechanics, Materials, and Civil Engineering, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium; (L.L.); (C.P.)
- Institute of Experimental and Clinical Research, Université Catholique de Louvain, 1200 Woluwe-Saint-Lambert, Belgium
| | - Greet Kerckhofs
- Institute of Mechanics, Materials, and Civil Engineering, Université Catholique de Louvain, 1348 Louvain-la-Neuve, Belgium; (L.L.); (C.P.)
- Institute of Experimental and Clinical Research, Université Catholique de Louvain, 1200 Woluwe-Saint-Lambert, Belgium
- Department of Materials Engineering, Katholieke Universiteit Leuven, 3001 Leuven, Belgium
- Prometheus, Division of Skeletal Tissue Engineering, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
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O'Reilly BL, Hynes N, Sultan S, McHugh PE, McGarry JP. An experimental and computational investigation of the material behaviour of discrete homogenous iliofemoral and carotid atherosclerotic plaque constituents. J Biomech 2020; 106:109801. [DOI: 10.1016/j.jbiomech.2020.109801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/28/2020] [Accepted: 04/14/2020] [Indexed: 12/23/2022]
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Schimmel L, van der Stoel M, Rianna C, van Stalborch AM, de Ligt A, Hoogenboezem M, Tol S, van Rijssel J, Szulcek R, Bogaard HJ, Hofmann P, Boon R, Radmacher M, de Waard V, Huveneers S, van Buul JD. Stiffness-Induced Endothelial DLC-1 Expression Forces Leukocyte Spreading through Stabilization of the ICAM-1 Adhesome. Cell Rep 2019; 24:3115-3124. [PMID: 30231995 DOI: 10.1016/j.celrep.2018.08.045] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/11/2018] [Accepted: 08/16/2018] [Indexed: 12/29/2022] Open
Abstract
Leukocytes follow the well-defined steps of rolling, spreading, and crawling prior to diapedesis through endothelial cells (ECs). We found increased expression of DLC-1 in stiffness-associated diseases like atherosclerosis and pulmonary arterial hypertension. Depletion of DLC-1 in ECs cultured on stiff substrates drastically reduced cell stiffness and mimicked leukocyte transmigration kinetics observed for ECs cultured on soft substrates. Mechanistic studies revealed that DLC-1-depleted ECs or ECs cultured on soft substrates failed to recruit the actin-adaptor proteins filamin B, α-actinin-4, and cortactin to clustered ICAM-1, thereby preventing the ICAM-1 adhesome formation and impairing leukocyte spreading. This was rescued by overexpressing DLC-1, resulting in ICAM-1 adhesome stabilization and leukocyte spreading. Our results reveal an essential role for substrate stiffness-regulated endothelial DLC-1, independent of its GAP domain, in locally stabilizing the ICAM-1 adhesome to promote leukocyte spreading, essential for efficient leukocyte transendothelial migration.
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Affiliation(s)
- Lilian Schimmel
- Molecular Cell Biology Laboratory, Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, 1066 CX Amsterdam, the Netherlands
| | - Miesje van der Stoel
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands
| | - Carmela Rianna
- Biophysics Institute, University of Bremen, D-28334 Bremen, Germany
| | - Anne-Marieke van Stalborch
- Molecular Cell Biology Laboratory, Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, 1066 CX Amsterdam, the Netherlands
| | - Aafke de Ligt
- Molecular Cell Biology Laboratory, Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, 1066 CX Amsterdam, the Netherlands
| | - Mark Hoogenboezem
- Departmental Central Facility, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, 1066 CX Amsterdam, the Netherlands
| | - Simon Tol
- Departmental Central Facility, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, 1066 CX Amsterdam, the Netherlands
| | - Jos van Rijssel
- Molecular Cell Biology Laboratory, Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, 1066 CX Amsterdam, the Netherlands
| | - Robert Szulcek
- Department of Pulmonary Diseases, VU Medical Center, 1081 HV Amsterdam, the Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Diseases, VU Medical Center, 1081 HV Amsterdam, the Netherlands
| | - Patrick Hofmann
- Department of Physiology, VU Medical Center, Amsterdam, the Netherlands
| | - Reinier Boon
- Department of Physiology, VU Medical Center, Amsterdam, the Netherlands
| | | | - Vivian de Waard
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands
| | - Stephan Huveneers
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences, Academic Medical Center, 1105 AZ Amsterdam, the Netherlands
| | - Jaap D van Buul
- Molecular Cell Biology Laboratory, Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, 1066 CX Amsterdam, the Netherlands.
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Pathological Mineralization: The Potential of Mineralomics. MATERIALS 2019; 12:ma12193126. [PMID: 31557841 PMCID: PMC6804219 DOI: 10.3390/ma12193126] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/11/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022]
Abstract
Pathological mineralization has been reported countless times in the literature and is a well-known phenomenon in the medical field for its connections to a wide range of diseases, including cancer, cardiovascular, and neurodegenerative diseases. The minerals involved in calcification, however, have not been directly studied as extensively as the organic components of each of the pathologies. These have been studied in isolation and, for most of them, physicochemical properties are hitherto not fully known. In a parallel development, materials science methods such as electron microscopy, spectroscopy, thermal analysis, and others have been used in biology mainly for the study of hard tissues and biomaterials and have only recently been incorporated in the study of other biological systems. This review connects a range of soft tissue diseases, including breast cancer, age-related macular degeneration, aortic valve stenosis, kidney stone diseases, and Fahr’s syndrome, all of which have been associated with mineralization processes. Furthermore, it describes how physicochemical material characterization methods have been used to provide new information on such pathologies. Here, we focus on diseases that are associated with calcium-composed minerals to discuss how understanding the properties of these minerals can provide new insights on their origins, considering that different conditions and biological features are required for each type of mineral to be formed. We show that mineralomics, or the study of the properties and roles of minerals, can provide information which will help to improve prevention methods against pathological mineral build-up, which in the cases of most of the diseases mentioned in this review, will ultimately lead to new prevention or treatment methods for the diseases. Importantly, this review aims to highlight that chemical composition alone cannot fully support conclusions drawn on the nature of these minerals.
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Cahalane RM, Barrett HE, O'Brien JM, Kavanagh EG, Moloney MA, Walsh MT. Relating the mechanical properties of atherosclerotic calcification to radiographic density: A nanoindentation approach. Acta Biomater 2018; 80:228-236. [PMID: 30218776 DOI: 10.1016/j.actbio.2018.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/04/2018] [Accepted: 09/11/2018] [Indexed: 12/20/2022]
Abstract
Calcification morphology can determine atherosclerotic plaque stability and is associated with increased failures rates for endovascular interventions. Computational efforts have sought to elucidate the relationship between calcification and plaque rupture in addition to predicting tissue response during aggressive revascularisation techniques. However, calcified material properties are currently estimated and may not reflect real tissue conditions. The objective of this study is to correlate calcification mechanical properties with three radiographic density groups obtained from corresponding Computed Tomography (CT) images. Seventeen human plaques extracted from carotid (n = 10) and peripheral lower limb (n = 7) arteries were examined using micro-computed tomography (µCT), simultaneously locating the calcified deposits within their internal structure and quantifying their densities. Three radiographic density groups were defined based on the sample density distribution: (A) 130-299.99 Hounsfield Units (HU), (B) 300-449.99 HU and (C) >450 HU. Nanoindentation was employed to determine the Elastic Modulus (E) and Hardness (H) values within the three density groups. Results reveal a clear distinction between mechanical properties with respect to radiographic density groups (p < 0.0005). No significant differences exist in the density-specific behaviours observed between carotid and peripheral samples. Previously defined calcification classifications indicate an association with specific radiographic density patterns. Scanning Electron Microscopy (SEM) examination revealed that density group A regions consist of both calcified and non-calcified tissues. Further research is required to define the radiographic thresholds which identify varying degrees of tissue calcification. This study demonstrates that the mechanical properties of fully mineralised atherosclerotic calcification emulate that of bone tissues (17-25 GPa), affording computational models with accurate material parameters. STATEMENT OF SIGNIFICANCE: Global mechanical characterisation techniques disregard the heterogeneous nature of atherosclerotic lesions. Previous nanoindentation results for carotid calcifications have displayed a wide range. This study evaluates calcification properties with respect to radiographic density obtained from Micro-CT images. This is the first work to characterise calcifications from peripheral lower limb arteries using nanoindentation. Results demonstrate a strong positive correlation between radiographic density and calcification mechanical properties. Characterising calcifications using their density values provides clarity on the variation in published properties for calcified tissues. Furthermore, this study confirms the hypothesis that fully calcified plaque tissue behaviour similar to that of bone. Appropriate material parameters for calcified tissues can now be employed in computational simulations.
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Cunnane EM, Mulvihill JJE, Barrett HE, Hennessy MM, Kavanagh EG, Walsh MT. Mechanical properties and composition of carotid and femoral atherosclerotic plaques: A comparative study. J Biomech 2016; 49:3697-3704. [PMID: 27776741 DOI: 10.1016/j.jbiomech.2016.09.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 09/27/2016] [Accepted: 09/30/2016] [Indexed: 01/25/2023]
Abstract
This study compares the mechanical properties of excised carotid and femoral human plaques and also develops a predictor of these properties based on plaque composition. Circumferential planar tension tests were performed on 24 carotid and 16 femoral plaque samples. Composition was characterised using Fourier Transform Infrared spectroscopy. Stretch at failure, strength, and stiffness are significantly higher in the carotid group (P=.012, P<.001 and P=.002, respectively). The ratio of calcified to lipid plaque content demonstrates the strongest correlation with the stretch at failure and strength (R2=.285, P<.001 and R2=.347, P<.001). No composition based parameter correlates significantly with stiffness. The significantly different mechanical properties of the two groups aids in explaining the varying endovascular treatment outcomes clinically observed in these vessels. Furthermore, determining the ratio of calcified to lipid plaque content may be useful in predicting individual plaque mechanical response to endovascular treatment.
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Affiliation(s)
- Eoghan M Cunnane
- School of Engineering, Bernal Institute, and the Health Research Institute, University of Limerick, Ireland
| | - John J E Mulvihill
- School of Engineering, Bernal Institute, and the Health Research Institute, University of Limerick, Ireland
| | - Hilary E Barrett
- School of Engineering, Bernal Institute, and the Health Research Institute, University of Limerick, Ireland
| | - Mairead M Hennessy
- Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - Eamon G Kavanagh
- Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland
| | - Michael T Walsh
- School of Engineering, Bernal Institute, and the Health Research Institute, University of Limerick, Ireland.
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Barrett H, Cunnane E, Kavanagh E, Walsh M. On the effect of calcification volume and configuration on the mechanical behaviour of carotid plaque tissue. J Mech Behav Biomed Mater 2016; 56:45-56. [DOI: 10.1016/j.jmbbm.2015.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/02/2015] [Accepted: 11/04/2015] [Indexed: 12/15/2022]
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Tang D, Li ZY, Gijsen F, Giddens DP. Cardiovascular diseases and vulnerable plaques: data, modeling, predictions and clinical applications. Biomed Eng Online 2015; 14 Suppl 1:S1. [PMID: 25602945 PMCID: PMC4306097 DOI: 10.1186/1475-925x-14-s1-s1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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