Abstract
Systemic inflammation associated with major surgery rapidly accelerates atherosclerotic plaque progression in mice. Regulatory T cells (Tregs) have emerged as important modulators of atherogenesis. In coronary artery disease patients, low frequency of Tregs constitutes an independent risk factor for cardiovascular complications after non-cardiac surgery. In this exploratory analysis, we investigate whether preoperative Treg levels affect surgery-induced atherosclerotic lesion destabilization in a murine model of perioperative stress. After 9 weeks of high-cholesterol diet, atherosclerotic apolipoprotein E-deficient mice with modulated Treg levels were subjected to a 30-minute surgical procedure consisting of general isoflurane anesthesia, laparotomy and moderate blood loss. Controls underwent general anesthesia only. Brachiocephalic arteries were harvested 3 days after the intervention for histomorphological analyses of atherosclerotic plaques. Tregs were depleted by a single dose of anti-CD25 monoclonal antibody (mAb) administered 6 days prior to the intervention. Expansion of Tregs was induced by daily injections of IL-2/anti-IL-2 complex (IL-2C) on three consecutive days starting 3 days before surgery. Isotype-matched antibodies and PBS served as controls. Antibody-mediated modulation was Treg-specific. IL-2C treatment resulted in an eight-fold elevation of peripheral CD4+CD25+Foxp3+ Tregs compared to mice administered with anti-CD25 mAb. In mice treated with PBS and anti-CD25 mAb, surgical stress response caused a significant increase of atherosclerotic plaque necrosis (PBS: p < 0.001; anti-CD25 mAb: p = 0.037). Preoperative Treg expansion abrogated perioperative necrotic core formation (p = 0.556) and significantly enhanced postoperative atherosclerotic plaque stability compared to PBS-treated mice (p = 0.036). Postoperative plaque volume (p = 0.960), stenosis (p = 0.693), lesional collagen (p = 0.258), as well as the relative macrophage (p = 0.625) and smooth muscle cell content (p = 0.178) remained largely unaffected by preoperative Treg levels. In atherosclerotic mice, therapeutic expansion of Tregs prior to major surgery mitigates rapid effects on perioperative stress-driven atherosclerotic plaque destabilization. Future studies will show, whether short-term interventions modulating perioperative inflammation qualify for prevention of cardiovascular events associated with major non-cardiac surgery.
Highlights
Clinical manifestations of atherosclerosis, such as ischemic heart disease and stroke, account for 15 million deaths, globally [1]
In an atherosclerotic mouse model of surgical stress, we show that preoperative expansion of CD4+CD25+Foxp3+ Tregs by IL-2C treatment prevents from perioperative necrotic core (NC) formation and enhances postoperative atherosclerotic plaque stability
Impaired generation and immunosuppressive dysfunction of Tregs leads to dysregulated immune homeostasis and loss of tolerance [18], which critically drives atherosclerotic lesion initiation and progression [16]
Summary
Clinical manifestations of atherosclerosis, such as ischemic heart disease and stroke, account for 15 million deaths, globally [1]. Atherogenesis is generally regarded insidious in nature, numerous studies describe more rapid, accelerated lesion progression triggered by physical and inflammatory stressors [2,3,4,5]. In line with these findings, we and others have demonstrated that systemic inflammation associated with major surgical interventions rapidly accelerates atherosclerotic plaque progression in a murine model of perioperative stress [6, 7]. Factors triggering perioperative plaque rupture include endocrinological dysregulation, inflammation, hypercoagulability, and increased hemodynamic strain in response to surgical trauma and concomitant medication [14, 15]. Elucidating the pathophysiological mechanisms underlying perioperative MI will aid to develop effective preventive measures and treatment options
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