Phagocytosis and macrophage activation associated with hemorrhagic microvessels in human atherosclerosis.
OBJECTIVE
Previously, we demonstrated that activated inducible NO synthase (iNOS)-expressing foam cells in human carotid plaques often produce autofluorescent (per)oxidized lipids (ceroid). Here, we investigate whether intraplaque microvessels can provide foam cells with lipids and trigger macrophage activation.


RESULTS
Microvessels (von Willebrand factor [vWf] immunoreactivity), activated macrophages (iNOS immunoreactivity), and ceroid were systematically mapped in longitudinal sections of 15 human carotid endarterectomy specimens. An unbiased hierarchical cluster analysis classified vascular regions into 2 categories. One type with normal vWf expression and without inflammatory cells was seen, and another type with cuboidal endothelial cells, perivascular vWf deposits, and iNOS and ceroid-containing foam cells was seen in 4 (27%) of 15 plaques. The perivascular foam cells frequently contained platelets (glycoprotein Ibalpha) and erythrocytes (hemoglobin, iron), pointing to microhemorrhage/thrombosis and subsequent phagocytosis. Similar lipid-containing cells, expressing both ceroid and iNOS, were generated in atherosclerosis-free settings by incubating murine J774 macrophages with platelets or oxidized erythrocytes and also in vivo in organizing thrombi in normocholesterolemic rabbits.


CONCLUSIONS
Focal intraplaque microhemorrhages initiate platelet and erythrocyte phagocytosis, leading to iron deposition, macrophage activation, ceroid production, and foam cell formation. Neovascularization, besides supplying plaques with leukocytes and lipoproteins, can thus promote focal plaque expansion when microvessels become thrombotic or rupture prone.
Kockx
Mark M
MM
Division of Pharmacology, University of Antwerp, Belgium.
Cromheeke
Kristel M
KM
Knaapen
Michiel W M
MW
Bosmans
Johan M
JM
De Meyer
Guido R Y
GR
Herman
Arnold G
AG
Bult
Hidde
H
D000368:Aged; D000818:Animals; D001161:Arteriosclerosis / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D002478:Cells, Cultured; D002566:Ceroid / Q000032:analysis; D004730:Endothelium, Vascular / Q000378:metabolism; D005487:Foam Cells / Q000201:enzymology; D006801:Humans; D007150:Immunohistochemistry; D008262:Macrophage Activation; D008297:Male; D051379:Mice; D009389:Neovascularization, Pathologic; D019001:Nitric Oxide Synthase / Q000378:metabolism; D052247:Nitric Oxide Synthase Type II; D010587:Phagocytosis; D011817:Rabbits; D013927:Thrombosis / Q000209:etiology / Q000378:metabolism*; D014841:von Willebrand Factor / Q000378:metabolism
D002566:Ceroid; D014841:von Willebrand Factor; C496319:NOS2 protein, human; D019001:Nitric Oxide Synthase; D052247:Nitric Oxide Synthase Type II; C496317:Nos2 protein, mouse