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Sakamoto A, Kawakami R, Mori M, Guo L, Paek KH, Mosquera JV, Cornelissen A, Ghosh SKB, Kawai K, Konishi T, Fernandez R, Fuller DT, Xu W, Vozenilek AE, Sato Y, Jinnouchi H, Torii S, Turner AW, Akahori H, Kuntz S, Weinkauf CC, Lee PJ, Kutys R, Harris K, Killey AL, Mayhew CM, Ellis M, Weinstein LM, Gadhoke NV, Dhingra R, Ullman J, Dikongue A, Romero ME, Kolodgie FD, Miller CL, Virmani R, Finn AV. CD163+ macrophages restrain vascular calcification, promoting the development of high-risk plaque. JCI Insight 2023; 8:e154922. [PMID: 36719758 PMCID: PMC10077470 DOI: 10.1172/jci.insight.154922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/20/2023] [Indexed: 02/01/2023] Open
Abstract
Vascular calcification (VC) is concomitant with atherosclerosis, yet it remains uncertain why rupture-prone high-risk plaques do not typically show extensive calcification. Intraplaque hemorrhage (IPH) deposits erythrocyte-derived cholesterol, enlarging the necrotic core and promoting high-risk plaque development. Pro-atherogenic CD163+ alternative macrophages engulf hemoglobin:haptoglobin (HH) complexes at IPH sites. However, their role in VC has never been examined to our knowledge. Here we show, in human arteries, the distribution of CD163+ macrophages correlated inversely with VC. In vitro experiments using vascular smooth muscle cells (VSMCs) cultured with HH-exposed human macrophage - M(Hb) - supernatant reduced calcification, while arteries from ApoE-/- CD163-/- mice showed greater VC. M(Hb) supernatant-exposed VSMCs showed activated NF-κB, while blocking NF-κB attenuated the anticalcific effect of M(Hb) on VSMCs. CD163+ macrophages altered VC through NF-κB-induced transcription of hyaluronan synthase (HAS), an enzyme that catalyzes the formation of the extracellular matrix glycosaminoglycan, hyaluronan, within VSMCs. M(Hb) supernatants enhanced HAS production in VSMCs, while knocking down HAS attenuated its anticalcific effect. NF-κB blockade in ApoE-/- mice reduced hyaluronan and increased VC. In human arteries, hyaluronan and HAS were increased in areas of CD163+ macrophage presence. Our findings highlight an important mechanism by which CD163+ macrophages inhibit VC through NF-κB-induced HAS augmentation and thus promote the high-risk plaque development.
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Affiliation(s)
| | | | | | - Liang Guo
- CVPath Institute, Inc., Gaithersburg, Maryland, USA
| | - Ka Hyun Paek
- CVPath Institute, Inc., Gaithersburg, Maryland, USA
| | - Jose Verdezoto Mosquera
- Department of Public Health Sciences, Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Kenji Kawai
- CVPath Institute, Inc., Gaithersburg, Maryland, USA
| | | | | | | | - Weili Xu
- CVPath Institute, Inc., Gaithersburg, Maryland, USA
| | | | - Yu Sato
- CVPath Institute, Inc., Gaithersburg, Maryland, USA
| | | | - Sho Torii
- CVPath Institute, Inc., Gaithersburg, Maryland, USA
| | - Adam W. Turner
- Department of Public Health Sciences, Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Hirokuni Akahori
- Department of Cardiovascular and Renal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Salome Kuntz
- CVPath Institute, Inc., Gaithersburg, Maryland, USA
| | - Craig C. Weinkauf
- Division of Vascular and Endovascular Surgery, University of Arizona, Tucson, Arizona, USA
| | | | - Robert Kutys
- CVPath Institute, Inc., Gaithersburg, Maryland, USA
| | - Kathryn Harris
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | | | | - Roma Dhingra
- CVPath Institute, Inc., Gaithersburg, Maryland, USA
| | | | | | | | | | - Clint L. Miller
- Department of Public Health Sciences, Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Renu Virmani
- CVPath Institute, Inc., Gaithersburg, Maryland, USA
| | - Aloke V. Finn
- CVPath Institute, Inc., Gaithersburg, Maryland, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
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Guo L, Torii S, Fernandez R, Braumann RE, Fuller DT, Paek KH, Gadhoke NV, Maloney KA, Harris K, Mayhew CM, Zarpak R, Stevens LM, Gaynor BJ, Jinnouchi H, Sakamoto A, Sato Y, Mori H, Kutyna MD, Lee PJ, Weinstein LM, Collado-Rivera CJ, Ali BB, Atmakuri DR, Dhingra R, Finn ELB, Bell MW, Lynch M, Cornelissen A, Kuntz SH, Park JH, Kutys R, Park JE, Wang L, Hong SN, Gupta A, Hall JL, Kolodgie FD, Romero ME, Jeng LJB, Mitchell BD, Surve D, Fowler DR, Hong CC, Virmani R, Finn AV. Genetic Variants Associated With Unexplained Sudden Cardiac Death in Adult White and African American Individuals. JAMA Cardiol 2021; 6:1013-1022. [PMID: 34076677 DOI: 10.1001/jamacardio.2021.1573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Unexplained sudden cardiac death (SCD) describes SCD with no cause identified. Genetic testing helps to diagnose inherited cardiac diseases in unexplained SCD; however, the associations between pathogenic or likely pathogenic (P/LP) variants of inherited cardiomyopathies (CMs) and arrhythmia syndromes and the risk of unexplained SCD in both White and African American adults living the United States has never been systematically examined. Objective To investigate cases of unexplained SCD to determine the frequency of P/LP genetic variants of inherited CMs and arrhythmia syndromes. Design, Setting, and Participants This genetic association study included 683 African American and White adults who died of unexplained SCD and were included in an autopsy registry. Overall, 413 individuals had DNA of acceptable quality for genetic sequencing. Data were collected from January 1995 to December 2015. A total of 30 CM genes and 38 arrhythmia genes were sequenced, and variants in these genes, curated as P/LP, were examined to study their frequency. Data analysis was performed from June 2018 to March 2021. Main Outcomes and Measures The frequency of P/LP variants for CM or arrhythmia in individuals with unexplained SCD. Results The median (interquartile range) age at death of the 413 included individuals was 41 (29-48) years, 259 (62.7%) were men, and 208 (50.4%) were African American adults. A total of 76 patients (18.4%) with unexplained SCD carried variants considered P/LP for CM and arrhythmia genes. In total, 52 patients (12.6%) had 49 P/LP variants for CM, 22 (5.3%) carried 23 P/LP variants for arrhythmia, and 2 (0.5%) had P/LP variants for both CM and arrhythmia. Overall, 41 P/LP variants for hypertrophic CM were found in 45 patients (10.9%), 9 P/LP variants for dilated CM were found in 11 patients (2.7%), and 10 P/LP variants for long QT syndrome were found in 11 patients (2.7%). No significant difference was found in clinical and heart characteristics between individuals with or without P/LP variants. African American and White patients were equally likely to harbor P/LP variants. Conclusions and Relevance In this large genetic association study of community cases of unexplained SCD, nearly 20% of patients carried P/LP variants, suggesting that genetics may contribute to a significant number of cases of unexplained SCD. Our findings regarding both the association of unexplained SCD with CM genes and race-specific genetic variants suggest new avenues of study for this poorly understood entity.
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Affiliation(s)
- Liang Guo
- CVPath Institute, Gaithersburg, Maryland.,currently with Bioscience Cardiovascular Research and Early Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gaithersburg, Maryland
| | - Sho Torii
- CVPath Institute, Gaithersburg, Maryland.,currently with Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | | | | | | | | | | | - Kristin A Maloney
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kathryn Harris
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | - Laura M Stevens
- Institute for Precision Cardiovascular Medicine, American Heart Association, Dallas, Texas
| | - Brady J Gaynor
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | - Yu Sato
- CVPath Institute, Gaithersburg, Maryland
| | - Hiroyoshi Mori
- CVPath Institute, Gaithersburg, Maryland.,currently with Department of Internal Medicine, Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | | | - Parker J Lee
- CVPath Institute, Gaithersburg, Maryland.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | - Bakr B Ali
- CVPath Institute, Gaithersburg, Maryland
| | | | | | | | - Mack W Bell
- CVPath Institute, Gaithersburg, Maryland.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Megan Lynch
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Ji-Eun Park
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Libin Wang
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Susie N Hong
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Anuj Gupta
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jennifer L Hall
- Institute for Precision Cardiovascular Medicine, American Heart Association, Dallas, Texas
| | | | | | - Linda J B Jeng
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Braxton D Mitchell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - David R Fowler
- Office of the Chief Medical Examiner, Baltimore, Maryland
| | - Charles C Hong
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Aloke V Finn
- CVPath Institute, Gaithersburg, Maryland.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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