The role of magnetic resonance imaging and the expression of MMP-9 protein in the analysis of carotid atherosclerotic plaques in patients undergoing carotid endarterectomy: a prospective pilot study

Abstract

Components of carotid atherosclerotic plaque can be analysed preoperatively by non-invasive advanced imaging modalities such as magnetic resonance imaging (MRI). The expression of matrix metalloproteinase-9 protein (MMP-9), which has a potential role in remodelling of atherosclerotic plaques, can be analysed immunohistochemically. The aim of the present prospective pilot study is to analyse histological characteristics and expression of MMP-9 in carotid plaques of patients undergoing carotid endarterectomy (CEA) and to investigate the correlation with preoperative clinical symptoms and MRI features. Preoperative clinical assessment, MRI imaging, postoperative histological and immunohistochemical analyses were performed. Fifteen patients with symptomatic (7/15; 47%) and asymptomatic carotid artery stenosis undergoing CEA were included. Among symptomatic patients, 5 (71%) had recent stroke and 2 (29%) had recent transient ischaemic attack with a median timing of 6 weeks (IQR: 1, 18) before the surgery. Both groups did not significantly differ in respect to preoperative characteristics. Prevalence of unstable plaque was higher in symptomatic than asymptomatic patients, although it was not significant (63% vs. 37%, p = 0.077). The expression of MMP-9 in CD68 cells within the plaque by semiquantitative analysis was found to be significantly higher in symptomatic as compared to asymptomatic patients (86% vs. 25% with the highest expression, p = 0.014). The average microvascular density was found to be higher and lipid core area larger among both symptomatic patients and unstable carotid plaque specimens, although this did not reach statistical significance (p = 0.064 and p = 0.132, p = 0.360 and p = 0.569, respectively). Our results demonstrate that MRI is reliable in classifying carotid lesions and differentiating unstable from stable plaques. We have also shown that the expression of MMP-9 is significantly higher among symptomatic patients undergoing CEA. Trial Registration: This study has been registered at the ISRCTN registry (ID ISRCTN46536832), isrctn.org Identifier: https://www.isrctn.com/ISRCTN46536832.

Role and Mechanism of cGAS-STING Pathway in Cardiovascular System

“…The cGAS-STING pathway has emerged as a significant player in the development and progression of atherosclerosis, a chronic inflammatory disease characterized by the accumulation of plaque in the arterial wall [ 20 ]. The cGAS-STING pathway is activated in various cell types within the atherosclerotic plaque, including endothelial cells, vascular smooth muscle cells, and immune cells [ 21 , 22 ]. It detects the presence of cytosolic DNA derived from damaged cells, oxidized low-density lipoprotein (LDL), or microbial pathogens in the vessel wall.…”

cGAS-STING Pathway Performance in the Vulnerable Atherosclerotic Plaque

“…Matrix metalloproteinase-9 (MMP-9), an enzyme produced by infiltrating macrophages and VSMC, has been shown to play an important character in plaque development and pathogenesis of atherosclerosis [ 42 , 43 ]. During the progression of AS, PLT can be activated by thrombin and release mediators such as platelet-derived growth factor (PDGF)-BB.…”