Calcification in atherosclerosis. I. Human studies

Early atherosclerotic lesions in human aortas less than five hours postmortem were studied by light microscopy (20 cases) and electron microscopy (10 cases), to determine the morphological and cytochemical character of calcium deposition in the lesions. Routine and multiple special stains by light microscopy demonstrated atherosclerotic (intimal) calcium to be deposited as fine grains, ring-shaped droplets or small needle-shaped crystals, and medial calcium as fine grains or ring-shaped droplets. The calcium deposits were frequently associated with the PAS-positive basal lamina surrounding smooth muscle cells. In the intimal lesions the calcium deposits were often associated with fine granular lipid, while this association was much less frequent in the media. Calcium in atherosclerotic intima was generally not closely associated with elastic fibers but in the media was often deposited along or near elastic fibers. By electron microscopy the atherosclerotic lesions were composed of many smooth muscle cells (with or without lipid droplets), newly formed elastic fibers, amorphous ground substance, a few collagen fibrils and many membrane-limited matrix vesicle-like structures, 100-700 nm diameter. Many similar vesicles were present between the elastic laminae of the media. With the potassium pyroantimonate technique for demonstrating calcium, reaction products were most concentrated within these matrix vesicles but were also present in mitochondria of smooth muscle cells, within extracellular mitochondria-like structures, in pericellular basal lamina-like material and loosely dispersed in the interstitial ground substance. All elastic fibers were negative for calcium by this technique. The membrane of the matrix vesicle-like structures were cytochemically positive for alkaline phosphatase and adenosine triphosphatase. These studies suggest that calcification in human atherosclerosis and media is related to smooth muscle cell degeneration and that the major initial loci for calcium deposition are matrix vesicles from degraded cells, comparable to osteogenic calcification of cartilage.