Abstract

BackgroundAtherosclerosis (AS) is a complex disease caused in part by dyslipidemia and chronic inflammation. AS is associated with serious cardiovascular disease and remains the leading cause of mortality worldwide. Mesenchymal stem cells (MSCs) have evolved as an attractive therapeutic agent in various diseases including AS. Human umbilical cord MSCs (UCSCs) have been used in cell therapy trials due to their ability to differentiate and proliferate. The present study aimed to investigate the effect of UCSCs treatment on atherosclerotic plaque formation and the progression of lesions in a high-fat diet rabbit model.MethodsRabbits were fed a high-fat diet and then randomly divided into three groups: control, model, and treatment groups. Rabbits in the treatment group were injected with UCSCs (6 × 106 in 500 μL phosphate buffered saline) after 1 month of high-fat diet, once every 2 weeks, for 3 months. The model group was given PBS only. We analyzed serum biomarkers, used ultrasound and histopathology to detect arterial plaques and laser Doppler imaging to measure peripheral blood vessel blood filling, and analyzed the intestinal flora and metabolism.ResultsHistological analysis showed that the aortic plaque area was significantly reduced in the treatment group. We also found a significant decrease in macrophage accumulation and apoptosis, an increase in expression of scavenger receptors CD36 and SRA1, a decrease in uptake of modified low–density protein (ox-LDL), and a decrease in levels of pro-inflammatory cytokines interleukin (IL)-6 and tumor necrosis factor (TNF)-α following UCSCs treatment. We also found that anti-inflammatory cytokines IL-10 and transforming growth factor (TGF)-β expression increased in the aorta atherosclerotic plaque of the treatment group. UCSCs treatment improved the early peripheral blood filling, reduced the serum lipid level, and inhibited inflammation progression by regulating the intestinal flora dysbiosis caused by the high-fat diet. More specifically, levels of the microbiota-dependent metabolite trimethylamine-N-oxide (TMAO) were down-regulated in the treatment group.ConclusionsUCSCs treatment alleviated atherosclerotic plaque burden by reducing inflammation, regulating the intestinal flora and TMAO levels, and repairing the damaged endothelium.

Highlights

  • Atherosclerosis (AS) is a complex disease caused in part by dyslipidemia and chronic inflammation

  • We found that umbilical cord MSCs (UCSCs) transplantation reduced inflammation in the aortic atherosclerotic plaques by regulating the production and polarization of macrophages, repairing damaged endothelial cells (EC), correcting the intestinal flora imbalance, and preventing harmful metabolite production caused by the high-fat diet

  • At 2 months after UCSCs treatment, serum alanine transaminase (ALT) (P < 0.01) and lowdensity lipoprotein cholesterol (LDL-C) (P < 0.05) levels declined in the treatment group compared to those in the model group

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Summary

Introduction

Atherosclerosis (AS) is a complex disease caused in part by dyslipidemia and chronic inflammation. Microbiota and AS are linked by the production of trimethylamine-N-oxide (TMAO), the oxidized form of trimethylamine (TMA) (a microbiota-dependent detrimental metabolite derived from diets). TMAO is synthesized in the liver, and it has been shown to enhance atherosclerotic lesions by increasing the expression of scavenger receptors, such as CD36 and SRA1, on macrophages [9]. These receptors have high sensitivity to modified lipoproteins and can induce the uptake of modified low–density lipoprotein (ox-LDL), reducing cholesterol efflux in macrophages resulting in foam cell formation [10, 11]

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