Review Article, Int J Cardiovas Res Vol: 6 Issue: 3

Human Pericoronary Adipose Tissue as Storage and Possible Supply Site for Lipoproteins in Atherosclerotic Coronary Plaques

Yasumi Uchida^1,2*

¹Japanese Foundation for Cardiovascular Research, Funabashi, Japan

²Department of Cardiology, Tokyo Jikei University School of Medicine, Tokyo, Japan

*Corresponding Author : Yasumi Uchida
Japan Foundation for Cardiovascular Research, 2-30-17, Narashinodai, Funabashi, 274-0063, Japan
Tel: +81-47-462-2159
E-mail: uchida73@ta2.so-net.ne.jp

Received: May 22, 2017 Accepted: June 06, 2017 Published: June 12, 2017

Citation: Uchida Y (2017) Human Pericoronary Adipose Tissue as Storage and Possible Supply Site for Lipoproteins in Atherosclerotic Coronary Plaques. Int J Cardiovasc sRes 6:3. doi: 10.4172/2324-8602.1000313

Abstract

Keywords: Apolipoprotein A1; High-density lipoprotein; Human coronary

Introduction

It is generally believed that low-density lipoprotein (LDL) enters the vascular wall from the lumen and becomes oxidized low-density lipoprotein (oxLDL) by oxidation, after which it plays a key role in the initiation, progression and destabilization of atherosclerotic plaques. Monocytes also migrate into the vascular wall from the lumen, and become macrophages, which in turn accumulate oxLDL and become foam cells, while producing collagen-degrading enzymes such as metalloproteases and collagenases which destroy collagen fibers, and also hypochlorous acid which damages endothelial cells, resulting in vulnerable plaques [1-6]. It is also generally believed that anti-atherogenic substances such as high-density lipoprotein (HDL) [7,8] and its component apolipoprotein A1 (ApoA1) [9-12] enter the vascular intima from the lumen either directly or via vasa vasorum. Based on these generally believed mechanisms and using the plasma levels of lipoproteins and apolipoproteins as markers, lipid-lowering therapies are administered in the clinical setting, but with limited preventive effects on ischemic cardiovascular events.

Our hypothesis

We considered that there are other hitherto unrecognized storage site(s) and supply route(s) for the pro-atherogenic and anti-atherogenic lipoproteins and their components, which are not reflected in their plasma levels.

OxLDL, HDL and ApoA1 in human pericoronary adipose tissue (PCAT): Pericoronary adipose tissue (PCAT) is a part of epicardial adipose tissue and lies within 3 mm in distance from the adjacent coronary artery [13]. Using immunohistochemical techniques, we demonstrated that oxLDL, HDL and ApoA1 but not LDL are stored in adipocytes of PCAT, both cytoplasm and plasma membrane (Figure 1a, 1b) [13-15]. There are two possibilities for their storage in the adipocytes of PCAT:

(a) They are formed in the adipocytes or

(b) They are conveyed to the adipocytes from the systemic circulation via adventitial vasa vasorum or microvessels connecting the myocardium to PCAT.

Absence of LDL, the precursor of oxLDL, in PCAT supports the latter possibility for oxLDL.

HDL and ApoA1 co-deposit with oxLDL in PCAT: It is also generally believed that HDL and ApoA1 enter the vascular wall from the lumen. Based on this belief, therapies to elevate the plasma levels of HDL are attempted using fibrates or HDL- or ApoA1 -mimetic substances, but their preventive effects on ischemic coronary events are currently inconsistent in the clinical setting [16]. Using immunohistochemical techniques, we found that oxLDL co-deposits with HDL (Figure 2) or ApoA1 in human PCAT [14,15].

Deposition patterns: OxLDL deposited in either a dotted (Figure 1) or diffuse pattern (Figure 1- B-1) in the intima (plaque), but only in a dotted pattern in the adventitia, media and intima13. ApoA1 also showed either dotted or diffuse deposition pattern (Figure 1a – B-1, C-1), whereas HDL and LDL diffuse pattern in the intima (Figure 1a – C-1; 1b – A-1, C-1).

Supply routes of oxLDL and ApoA1 to adjacent coronary intima (plaque): Single immunohistochemical staining revealed that dotted oxLDL and CD68(+) -macrophages frequently showed amoebic configuration, and appeared to traverse the adventitia, and external and internal elastic laminae, suggesting migration from the PCAT to the intima (Figure 3) [13]. Double immunohistochemical staining revealed that dotted oxLDL or ApoA1 deposits were contained in CD68(+) -macrophages (Figure 4). The oxLDL-containing -CD68(+) -macrophages were not found within the adventitial vasa vasorum but were found in the interstitial spaces of PCAT, adventitia, media and intima)[13]. Because the adventitial vasa vasorum did not contain oxLDL-containing CD68(+) -macrophages, it is conceivable that the macrophages which did not contain oxLDL migrated to the PCAT through either the adventitial vasa vasorum or penetrating microvessels that connect the myocardium to the PCAT and thus obtained oxLDL in the PCAT and conveyed it to the intima. It is conceivable that oxLDL was supplied through coronary circulation or from the myocardium and was stored in the PCAT. It seems that ApoA1 is supplied to PCAT via the same routes.

CD68(+) -macrophages contain both oxLDL and ApoA1: Unexpectedly, a certain group of CD68(+) -macrophages in PCAT and intima contained both oxLDL and ApoA1, or oxLDL or ApoA1 only (Figure 5), but to what group of macrophage phenotype this group belongs remains to be elucidated.

OxLDL, LDL, HDL and ApoA1 in plaques: The incidence of oxLDL was compared between normal coronary segments, white plaques (growth stage of plaque), yellow plaque without a necrotic core (NC) (mature stage) and yellow plaques with a NC (end stage of maturation) that were classified by conventional angioscopy and histology [17]. The incidence was low in normal segments, increased in the growth and mature stages and decreased in the end stage of plaques [13].

Different to oxLDL, the incidence of HDL in the coronary intima increased with plaque growth and increased further with plaque maturation [14]. Especially in plaques with NC, the core was filled with HDL.

The incidence of ApoA1 was low in normal coronary segments, increased with plaque growth and increased further with plaque maturation as with HDL. This finding indicated that, although an anti-atherogenic substance as with HDL, ApoA1 resembled oxLDL in its supply routes to the intima but differed from oxLDL and resembled HDL in its relation to plaque morphology [15].

The incidence of LDL in intima was low and had no obvious relation to plaque morphology [14].

Co-localization of oxLDL, HDL and ApoA1 with intimal vasa vasorum: Co-localization of diffuse oxLDL, HDL or ApoA1 deposits and vasa vasorum was more frequently observed in the outer half (medial side) of the intima in segments with white plaques than in normal segments and those with yellow plaques, and in both the inner (luminal side) and outer halves of the intima more frequently in segments with yellow plaques, indicating that oxLDL spread with the development of vasa vasorum (Figure 6) [13-15]. Deposition of oxLDL in the superficial layer of intima alone was rarely observed. These findings suggested that these proteins were mostly conveyed to the intima by either macrophages or neovascularized vasa vasorum. LDL did not necessarily colocalize with vasa vasorum and therefore its supply route(s) to intima remains to be elucidated.

Based on the aforementioned findings, I propose a hypothesis on the storage and supply routes of oxLDL, HDL and ApoA1 (Figure 7). Imbalanced deposition in the PCAT and their supply to the intima may determine the fate of plaques. It remained obscure whether the CD68(+) -macrophages that contain both oxLDL and ApoA1 accelerate or suppress atherosclerosis.

Other reports

Perivascular adipocytes (PVA) produce large numbers of metabolically active substances with both endocrine and paracrine actions [18]; PVA of human internal thoracic artery release NO [19]; PVA releases nicotinamide adenine dinucleotide phosphateoxidase in mice [20]; rat PVA release compliment 23 [21] rat PVA release metylpalmitate ester [22], interleukin-6, plasminogen activator inhibitor-1, monocyte chemoattractant protein-1 genes are overexpressed in epicardial adipose tissue in patients with acute coronary syndrome [23] cultured human epicardial adipose tissues release ApoA1 and glutation S-transferase P [24] But, reports describing storage and release of lipoproteins from human PVA, including PCAT, to the adjacent vessel wall were not found.

Increased volume of epicardial adipose tissue is a risk factor for coronary heart disease [25,26]. Increased supply of pro-atherogenic lipoproteins such as oxLDL from thick PCAT to coronary intima may accelerate coronary atherosclerosis.

Clinical implications

Our findings suggested that molecular therapy targeting lipoproteins in the PCAT could be effective in preventing coronary atherosclerosis, by inhibiting storage of oxLDL or by enhancing storage of HDL and/or ApoA1.

Study limitations

a. Definite evidence of the supply routes of oxLDL, HDL and ApoA1 from the PCAT to the coronary intima (plaque) is lacking because demonstration of real-time movement of these proteins in the clinical setting is beyond the scope of current immunohistochemical techniques. Tracing these native proteins using biomarkers may be one possible method of observing real-time movements of these substances in vivo.

b. It remains to be clarified whether the CD68(+) -macrophages that contain both oxLDL and ApoA1 accelerate or inhibit coronary atherosclerosis [27,28].

Conclusions

Using immunohistochemical techniques as summarized in Table 1, we clarified that an important pro-atherogenic lipoprotein, oxLDL, and anti-atherogenic substances, HDL and ApoA1, are stored in human PCAT. Also, a supply route from the PCAT to coronary plaques, hitherto unrecognized, was strongly suggested by our findings. Imbalance in storage and supply between these proteins may determine the fate of atherosclerotic coronary plaques in patients.

Table 1: Deposition Sites and Patterns and Possible Supply Routes of Oxidized low-density lipoprotein (OxLDL), Low-density lipoprotein (LDL), High-density lipoprotein (HDL) and Apolipoprotein A1(ApoA1) to Coronary Intima.

Disclosure

The authors have no conflicts of interest to declare.

Relationships with Industry

The authors have no relationships with industry.

Funding

No external funding was received for this study.

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