title: Metallothionein expression in the high-risk carotid atherosclerotic plaque.
abstract: OBJECTIVE
  Metallothioneins (MTs) are antioxidant proteins expressed in response to injury. We evaluated MT immunoreactivity in carotid plaques obtained from asymptomatic and symptomatic patients. We also assessed the relationship between ultrasonic plaque echodensity, histological grading, computed tomography findings and MT expression.
  
  
  RESULTS
  In this ongoing prospective study, patients (n = 123, mean age (+/-SD) 68.4 +/- 7.7 years, 97 men) with high-grade carotid stenosis underwent carotid endarterectomy. Specimens were assessed histologically and immunohistochemically. Echolucent plaques (types 1+2) were more common in symptomatic patients (p < 0.0001) and had more advanced histological lesions (p < 0.0001). Echolucent plaques expressed MTs (in macrophages, fibroblasts and T-lymphocytes) significantly more than echogenic plaques (types 3+4) (all p < 0.0001). MT expression was mainly related to carotid plaque echolucency rather than the presence of symptoms. MT expression was significantly more common in advanced histological lesions. Plaques from asymptomatic or symptomatic patients with abnormal computed tomography findings also showed increased MT expression. There was a time-dependent fall in MT expression after cerebrovascular events (p < or = 0.011).
  
  
  CONCLUSIONS
  MT overexpression may be triggered in unstable plaques as a local protective factor. There is a need to identify both causative and protective predictors of the 'vulnerable plaque' in the 'vulnerable patient'. Further studies are needed to resolve these issues.
authors.affiliation: Department of Vascular Surgery, Faculty of Medicine, Imperial College London, UK.
authors.forename: Stella S
authors.initials: SS
authors.lastname: Daskalopoulou
authors.forename: Marios E
authors.initials: ME
authors.lastname: Daskalopoulos
authors.forename: Stamatios
authors.initials: S
authors.lastname: Theocharis
authors.forename: Nicolaos
authors.initials: N
authors.lastname: Kavantzas
authors.forename: Despina
authors.initials: D
authors.lastname: Perrea
authors.forename: Despoina
authors.initials: D
authors.lastname: Karandrea
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Constantinides
authors.forename: Dimitri P
authors.initials: DP
authors.lastname: Mikhailidis
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Nicolaides
authors.forename: Christos D
authors.initials: CD
authors.lastname: Liapis
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D016022:Case-Control Studies; D016894:Endarterectomy, Carotid / Q000379:methods; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008668:Metallothionein / Q000032:analysis / Q000378:metabolism*; D008875:Middle Aged; D015588:Observer Variation; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
chemical_list: D015415:Biomarkers; D008668:Metallothionein