Plasma Small Extracellular Vesicle-Carried miRNA-501-5p Promotes Vascular Smooth Muscle Cell Phenotypic Modulation-Mediated In-Stent Restenosis

Xiao-Fei Gao,Guan-Wen Ding,Shuai Luo,Xiao-Min Jiang,Jun-Jie Zhang,Guang-Feng Zuo,Ai-Qun Chen,Zhen Ge,Xiang-Quan Kong,Shao-Liang Chen,Zhi-Mei Wang,Feng Wang,Yan Chen,Yue Gu,Albino Carrizzo

doi:10.1155/2021/6644970

Abstract

Vascular smooth muscle cell (VSMC) phenotypic modulation plays an important role in the occurrence and development of in-stent restenosis (ISR), the underlying mechanism of which remains a key issue needing to be urgently addressed. This study is designed to investigate the role of plasma small extracellular vesicles (sEV) in VSMC phenotypic modulation. sEV were isolated from the plasma of patients with ISR (ISR-sEV) or not (Ctl-sEV) 1 year after coronary stent implantation using differential ultracentrifugation. Plasma sEV in ISR patients are elevated markedly and decrease the expression of VSMC contractile markers α-SMA and calponin and increase VSMC proliferation. miRNA sequencing and qRT-PCR validation identified that miRNA-501-5p was the highest expressed miRNA in the plasma ISR-sEV compared with Ctl-sEV. Then, we found that sEV-carried miRNA-501-5p level was significantly higher in ISR patients, and the level of plasma sEV-carried miRNA-501-5p linearly correlated with the degree of restenosis (R2 = 0.62). Moreover, miRNA-501-5p inhibition significantly increased the expression of VSMC contractile markers α-SMA and calponin and suppressed VSMC proliferation and migration; in vivo inhibition of miRNA-501-5p could also blunt carotid artery balloon injury induced VSMC phenotypic modulation in rats. Mechanically, miRNA-501-5p promoted plasma sEV-induced VSMC proliferation by targeting Smad3. Notably, endothelial cells might be the major origins of miRNA-501-5p. Collectively, these findings showed that plasma sEV-carried miRNA-501-5p promotes VSMC phenotypic modulation-mediated ISR through targeting Smad3.

Highlights

Percutaneous coronary intervention with stent implantation has been an extremely important treatment for patients with coronary artery disease, but it is blamed for 5%-10% risk of in-stent restenosis (ISR) [1,2,3], despite drug-eluting stents (DES) are widely used nowadays
Study flowchart was summarized in Supplemental Figure 1. small extracellular vesicles (sEV) were isolated from the plasma of patients with ISR (ISRsEV) or not (Ctl-sEV) 1 year after coronary stent implantation using differential ultracentrifugation
TEM images showed rounded particles of both ISR-sEV and CtlsEV (Figure 1(a)), and nanoparticle tracking analysis (NTA) revealed a similar size distribution (118:80 ± 1:96 vs. 113:20 ± 1:02 nm) but a higher plasma concentration (9:27 ± 0:15 vs. 5:40 ± 0:06, ×1011 particles/mL) of ISR-sEV compared with Ctl-sEV (Figure 1(b))

Summary

Introduction

Percutaneous coronary intervention with stent implantation has been an extremely important treatment for patients with coronary artery disease, but it is blamed for 5%-10% risk of in-stent restenosis (ISR) [1,2,3], despite drug-eluting stents (DES) are widely used nowadays. Responding to vessel injury and local environmental alternations after stent implantation, contractile ( called mature or differentiated) VSMC for hemodynamic regulation can be switched to a synthetic/dedifferentiated phenotype to increase proliferation, migration, and ECM synthesis for tissue reparation or abnormal vessel narrowing [4, 5]. This process of VSMC phenotypic modulation has been studied for decades, but we still do not fully understand the mechanisms well enough to be able to prevent or treat ISR successfully.

Methods

Results

Conclusion