Leptin locally synthesized in carotid atherosclerotic plaques could be associated with lesion instability and cerebral emboli
Jacob Schneiderman, Katrin Schaefer, Frank D Kolodgie, Naphtali Savion, Shlomo Kotev-Emeth, Rima Dardik, Amos J Simon, Moshe Halak, Clara Pariente, Isaac Engelberg, Stavros Konstantinides, Renu Virmani, Jacob Schneiderman, Katrin Schaefer, Frank D Kolodgie, Naphtali Savion, Shlomo Kotev-Emeth, Rima Dardik, Amos J Simon, Moshe Halak, Clara Pariente, Isaac Engelberg, Stavros Konstantinides, Renu Virmani
Abstract
Background: Unstable carotid plaques cause cerebral emboli. Leptin promotes atherosclerosis and vessel wall remodeling. We hypothesized that carotid atherosclerotic lesion instability is associated with local leptin synthesis.
Methods and results: Carotid endarterectomy plaques from symptomatic (n=40) and asymptomatic patients with progressive stenosis (n=38) were analyzed for local expression of leptin, tumor necrosis factor (TNF)-α, and plasminogen activator inhibitor type 1. All lesions exhibited advanced atherosclerosis inclusive of thick- and thin-cap fibroatheromas or lesion rupture. Symptomatic lesions exhibited more plaque ruptures and macrophage infiltration (P=0.001 and P=0.05, respectively). Symptomatic plaques showed preferential leptin, TNF-α, and plasminogen activator inhibitor type 1 transcript (P=0.03, P=0.04, and P=0.05, respectively). Leptin mRNA and antigen in macrophages and smooth muscle cells were confirmed by in situ hybridization and immunohistochemistry. Plasma leptin levels were not significantly different between groups (P=1.0), whereas TNF-α was significantly increased in symptomatic patients (P=0.006). Human aortic smooth muscle cell culture stimulated by TNF-α, lipopolysaccharide, or lipoteichoic acid revealed 6-, 6.7-, and 6-fold increased secreted leptin antigen, respectively, at 72 hours (P<0.05).
Conclusions: Neurologically symptomatic patients overexpress leptin mRNA and synthesize leptin protein in carotid plaque macrophages and smooth muscle cells. Local leptin induction, presumably by TNF-α, could exert paracrine or autocrine effects, thereby contributing to the pathogenesis of lesion instability.
Clinical trial registration: URL: www.Clinicaltrials.gov. Unique identifier: NCT00449306.
Keywords: atherosclerosis; leptin; macrophages; smooth muscle cells; tumor necrosis factor-α.
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