Shimonaga Koji, Matsushige Toshinori, Takahashi Hiroki, Hashimoto Yukishige, Yoshiyama Michitsura, Kaneko Mayumi, Sakamoto Shigeyuki
Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
Department of Neurosurgery and Interventional Neuroradiology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Ann Vasc Surg. 2022 Sep;85:284-291. doi: 10.1016/j.avsg.2022.02.023. Epub 2022 Mar 9.
Vulnerable carotid plaques are related to cerebral thromboembolic and ischemic events. Neutrophil extracellular traps (NETs) can induce endothelial dysfunction and induce inflammation and coagulation. The aim of the present study was to investigate NETs in patients with carotid artery plaques.
Carotid plaques were collected by carotid endarterectomy (CEA) from 26 symptomatic and 8 asymptomatic patients between August 2017 and January 2021. The specimens were stained with hematoxylin-eosin and Elastica-van Gieson. Immunohistochemistry was performed staining by CD31 for identifying endothelial cells. NETs were detected by digoxigenin-labeled antihistone H3 (HH3) (citrulline R2+R8+R17). The relationships between the presence of NETs and patient profile and histopathological findings were assessed.
HH3-positive cells were detected in 17 (asymptomatic = 2 symptomatic = 15) of 34 carotid plaques (median = 9.7/mm). The number of NETs was correlated with the number of diffusion-weighted imaging high-intensity lesions [P = 0.01], plaque rupture [P = 0.001], intraplaque hemorrhage [P = 0.02], intra luminal thrombus [P = 0.001], and thin fibrous cap [P = 0.001].
The presence of NETs was associated with the instability of carotid plaques, intraluminal thrombus, which may lead to subsequent cerebral infarction. Clarifying the roles of NETs in carotid plaques may improve the treatment of carotid artery disease.
易损性颈动脉斑块与脑栓塞和缺血性事件相关。中性粒细胞胞外陷阱（NETs）可诱导内皮功能障碍，并引发炎症和凝血。本研究旨在调查颈动脉斑块患者中的NETs情况。
2017年8月至2021年1月期间，通过颈动脉内膜切除术（CEA）从26例有症状患者和8例无症状患者中收集颈动脉斑块。标本用苏木精-伊红和弹性蛋白-van Gieson染色。通过免疫组织化学用CD31染色来识别内皮细胞。用洋地黄毒苷标记的抗组蛋白H3（HH3）（瓜氨酸R2+R8+R17）检测NETs。评估NETs的存在与患者资料及组织病理学结果之间的关系。
在34个颈动脉斑块中的17个（无症状=2，有症状=15）检测到HH3阳性细胞（中位数=9.7/mm）。NETs的数量与弥散加权成像高信号病变数量[P=0.01]、斑块破裂[P=0.001]、斑块内出血[P=0.02]、管腔内血栓[P=0.001]和薄纤维帽[P=0.001]相关。
NETs的存在与颈动脉斑块的不稳定性、管腔内血栓相关，这可能导致随后的脑梗死。阐明NETs在颈动脉斑块中的作用可能会改善颈动脉疾病的治疗。
