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Apoptosis and histopathologic changes in diffuse coronary atherosclerosis
Marjeta Zorc1, Ruda Zorc-Pleskovic, Olga Vraspir-Porenta
1Institute of Histology and Embryology, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
Insights
Apoptosis plays a role in diffuse coronary atherosclerosis, though at low levels. Advanced atherosclerotic lesions, predominantly fibrous tissue, were observed in patients undergoing coronary artery bypass grafting.
Area of Science:
- Cardiovascular Pathology
- Cell Biology
Background:
- Diffuse coronary atherosclerosis is a complex disease.
- Understanding the cellular mechanisms, including programmed cell death (apoptosis), is crucial for characterizing lesion development.
Purpose of the Study:
- To investigate the histopathologic features of atherosclerotic lesions in diffuse coronary atherosclerosis.
- To evaluate the role of apoptosis in the development of this condition.
Main Methods:
- Histopathologic analysis of coronary endarterectomy specimens from 59 patients.
- TUNEL staining to detect apoptotic cells (TUNEL-positive cells).
- Immunohistochemical analysis for MIB-1-positive cells and characterization of mononuclear infiltrates (macrophages, T-lymphocytes, B-lymphocytes).
Main Results:
- Advanced atherosclerotic lesions (Type VII and VIII) predominated (62.7%).
- Apoptotic cells (TUNEL-positive) were found in 6.8% of specimens, primarily within mononuclear infiltrates (0.5% of cells in infiltrates).
- Intense mononuclear infiltrates, rich in macrophages and lymphocytes, were present in 50% of samples, with a higher proportion of MIB-1-positive cells in these areas.
Conclusions:
- Apoptosis, although present at low levels within mononuclear infiltrates, is likely involved in diffuse coronary atherosclerosis.
- The association between higher apoptotic and MIB-1-positive cell proportions in infiltrates suggests a dynamic cellular process.
- The observed advanced lesion types indicate significant disease progression in the studied patient cohort.
Abstract:
The aims of the study were to investigate the histopathologic characteristics of atherosclerotic lesions and to evaluate the role of apoptosis or programmed cell death in diffuse coronary atherosclerosis. The study included 59 patients who underwent coronary artery bypass grafting coupled with coronary endarterectomy because of diffuse coronary atherosclerosis. Histopathologic analysis of endarterectomy sequesters showed atheroma with confluent extracellular lipid core-type IV lesions in 13 cases (22%); atheroma with lipid core and a cap of fibromuscular layers-type V lesions in 9 cases (15.3%); predominantly calcified fibrous tissue-type VII lesions in 13 cases (22%); and predominantly fibrous tissue-type VIII lesions in 24 cases (40.7%). TUNEL-positive cells were observed in 4 endarterectomy sequesters (6.8%) of subjects with diffuse coronary atherosclerosis. TUNEL-positive cells were demonstrated in the area of mononuclear infiltrates as well as in the vessel wall. The percentage of TUNEL-positive cells in mononuclear infiltrates was 0.5%. Intense mononuclear infiltrates in tunica intima were found in 50% of sequesters, and they consisted of macrophages (40%), T-lymphocytes (17%), and B-lymphocytes (14%). In the area of infiltrates the proportion of MIB-1-positive cells was 2.7%, which was higher than in the intima outside the area of infiltrates (0.5%). In conclusion, apoptosis, which is confined to mononuclear infiltrates, is most likely involved in the development of diffuse coronary atherosclerosis; however, the percentage of apoptotic cells was low (0.5%). A higher proportion of apoptotic cells in the area of infiltrates compared to the rest of the intima was associated with a higher proportion of MIB-1-positive cells. Atherosclerotic lesions in diffuse coronary atherosclerosis were advanced, with a predominance of type VII to VIII lesions.