Sukhavasi Katyayani, Mocci Giuseppe, Ma Lijiang, Hodonsky Chani J, Diez Benevante Ernest, Muhl Lars, Liu Jianping, Gustafsson Sonja, Buyandelger Byambajav, Koplev Simon, Lendahl Urban, Vanlandewijck Michael, Singha Prosanta, Örd Tiit, Beter Mustafa, Selvarajan Ilakya, Laakkonen Johanna P, Väli Marika, den Ruijter Hester M, Civelek Mete, Hao Ke, Ruusalepp Arno, Betsholtz Christer, Järve Heli, Kovacic Jason C, Miller Clint L, Romanoski Casey, Kaikkonen Minna U, Björkegren Johan L M
Department of Cardiac Surgery and The Heart Clinic, Tartu University Hospital and Department of Cardiology, Institute of Clinical Medicine, Tartu University, Tartu, Estonia.
Department of Medicine, Karolinska Institutet, Karolinska Universitetssjukhuset, Huddinge, Sweden.
Nat Cardiovasc Res. 2025 Apr;4(4):412-432. doi: 10.1038/s44161-025-00628-y. Epub 2025 Apr 10.
Carotid stenosis causes ischemic stroke in both sexes, but the clinical presentation and plaque characteristics differ. Here we run deep single-cell sequencing of 7,690 human carotid plaque cells from male and female patients. While we found no sex differences in major cell types, we identified a predominance of the osteogenic phenotype in smooth muscle cells, immunomodulating macrophages (MPs) and endothelial cells (ECs) undergoing endothelial-to-mesenchymal transition in females. In males, we found smooth muscle cells with the chondrocytic phenotype, MPs involved in tissue remodeling and ECs with angiogenic activity. Sex-biased subcellular clusters were integrated with tissue-specific gene-regulatory networks (GRNs) from the Stockholm-Tartu Atherosclerosis Reverse Network Engineering Task study. We identified GRN195 involved in angiogenesis and T cell-mediated cytotoxicity in male ECs, while in females, we found GRN33 and GRN122 related to TREM2/TREM1 MPs and endothelial-to-mesenchymal transition. The impact of GRN195 on EC proliferation in males was functionally validated, providing evidence for potential therapy targets for atherosclerosis that are sex specific.
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