Metallothionein expression in the high-risk carotid atherosclerotic plaque.
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.
Daskalopoulou
Stella S
SS
Department of Vascular Surgery, Faculty of Medicine, Imperial College London, UK.
Daskalopoulos
Marios E
ME
Theocharis
Stamatios
S
Kavantzas
Nicolaos
N
Perrea
Despina
D
Karandrea
Despoina
D
Constantinides
Anthony G
AG
Mikhailidis
Dimitri P
DP
Nicolaides
Andrew N
AN
Liapis
Christos D
CD
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
D015415:Biomarkers; D008668:Metallothionein