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Mangold A, Alias S, Scherz T, Hofbauer T, Jakowitsch J, Panzenböck A, Simon D, Laimer D, Bangert C, Kammerlander A, Mascherbauer J, Winter MP, Distelmaier K, Adlbrecht C, Preissner KT, Lang IM. Coronary neutrophil extracellular trap burden and deoxyribonuclease activity in ST-elevation acute coronary syndrome are predictors of ST-segment resolution and infarct size. Circ Res 2014; 116:1182-92. [PMID: 25547404 DOI: 10.1161/circresaha.116.304944] [Citation(s) in RCA: 310] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE Mechanisms of coronary occlusion in ST-elevation acute coronary syndrome are poorly understood. We have previously reported that neutrophil (polymorphonuclear cells [PMNs]) accumulation in culprit lesion site (CLS) thrombus is a predictor of cardiovascular outcomes. OBJECTIVE The goal of this study was to characterize PMN activation at the CLS. We examined the relationships between CLS neutrophil extracellular traps (NETs), bacterial components as triggers of NETosis, activity of endogenous deoxyribonuclease, ST-segment resolution, and infarct size. METHODS AND RESULTS We analyzed coronary thrombectomies from 111 patients with ST-elevation acute coronary syndrome undergoing primary percutaneous coronary intervention. Thrombi were characterized by immunostaining, flow cytometry, bacterial profiling, and immunometric and enzymatic assays. Compared with femoral PMNs, CLS PMNs were highly activated and formed aggregates with platelets. Nucleosomes, double-stranded DNA, neutrophil elastase, myeloperoxidase, and myeloid-related protein 8/14 were increased in CLS plasma, and NETs contributed to the scaffolds of particulate coronary thrombi. Copy numbers of Streptococcus species correlated positively with dsDNA. Thrombus NET burden correlated positively with infarct size and negatively with ST-segment resolution, whereas CLS deoxyribonuclease activity correlated negatively with infarct size and positively with ST-segment resolution. Recombinant deoxyribonuclease accelerated the lysis of coronary thrombi ex vivo. CONCLUSIONS PMNs are highly activated in ST-elevation acute coronary syndrome and undergo NETosis at the CLS. Coronary NET burden and deoxyribonuclease activity are predictors of ST-segment resolution and myocardial infarct size.
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Affiliation(s)
- Andreas Mangold
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Sherin Alias
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Thomas Scherz
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Thomas Hofbauer
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Johannes Jakowitsch
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Adelheid Panzenböck
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Daniel Simon
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Daniela Laimer
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Christine Bangert
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Andreas Kammerlander
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Julia Mascherbauer
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Max-Paul Winter
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Klaus Distelmaier
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Christopher Adlbrecht
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Klaus T Preissner
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Irene M Lang
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.).
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Alias S, Redwan B, Panzenboeck A, Winter MP, Schubert U, Voswinckel R, Frey MK, Jakowitsch J, Alimohammadi A, Hobohm L, Mangold A, Bergmeister H, Sibilia M, Wagner EF, Mayer E, Klepetko W, Hoelzenbein TJ, Preissner KT, Lang IM. Defective angiogenesis delays thrombus resolution: a potential pathogenetic mechanism underlying chronic thromboembolic pulmonary hypertension. Arterioscler Thromb Vasc Biol 2014; 34:810-819. [PMID: 24526692 DOI: 10.1161/atvbaha.113.302991] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Restoration of patency is a natural target of vascular remodeling after venous thrombosis that involves vascular endothelial cells and smooth muscle cells, as well as leukocytes. Acute pulmonary emboli usually resolve <6 months. However, in some instances, thrombi transform into fibrous vascular obstructions, resulting in occlusion of the deep veins, or in chronic thromboembolic pulmonary hypertension (CTEPH). We proposed that dysregulated thrombus angiogenesis may contribute to thrombus persistence. APPROACH AND RESULTS Mice with an endothelial cell-specific conditional deletion of vascular endothelial growth factor receptor 2/kinase insert domain protein receptor were used in a model of stagnant flow venous thrombosis closely resembling human deep vein thrombosis. Biochemical and functional analyses were performed on pulmonary endarterectomy specimens from patients with CTEPH, a human model of nonresolving venous thromboembolism. Endothelial cell-specific deletion of kinase insert domain protein receptor and subsequent ablation of thrombus vascularization delayed thrombus resolution. In accordance with these findings, organized human CTEPH thrombi were largely devoid of vascular structures. Several vessel-specific genes, such as kinase insert domain protein receptor, vascular endothelial cadherin, and podoplanin, were expressed at lower levels in white CTEPH thrombi than in organizing deep vein thrombi and organizing thrombi from aortic aneurysms. In addition, red CTEPH thrombi attenuated the angiogenic response induced by vascular endothelial growth factor. CONCLUSIONS In the present work, we propose a mechanism of thrombus nonresolution demonstrating that endothelial cell-specific deletion of kinase insert domain protein receptor abates thrombus vessel formation, misguiding thrombus resolution. Medical conditions associated with the development of CTEPH may be compromising early thrombus angiogenesis.
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Affiliation(s)
- Sherin Alias
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Bassam Redwan
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | | | - Max P Winter
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Uwe Schubert
- Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany
| | - Robert Voswinckel
- Department of Lung Development and Remodeling, Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Maria K Frey
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | | | - Lukas Hobohm
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Andreas Mangold
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Helga Bergmeister
- Department of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Maria Sibilia
- Institute for Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Erwin F Wagner
- Centro Nacional de Investigaciones Oncológicas, Madrid, Spain
| | - Eckhard Mayer
- Department of Thoracic Surgery, Kerckhoff Clinic Heart and Lung Centre, Bad Nauheim, Germany
| | - Walter Klepetko
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas J Hoelzenbein
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Klaus T Preissner
- Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany
| | - Irene M Lang
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
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