Background: Pathological changes of the adrenal gland and the possible underlying molecular mechanisms are currently unclear in the case of atherosclerosis (AS) combined with chronic stress (CS). Methods and Findings: New Zealand white rabbits were used to construct a CS and AS animal model. Proteomics and bioinformatics were employed to identify hub proteins in the adrenal gland related to CS and AS. Hematoxylin–eosin staining was used to visualize pathological changes in adrenal gland. Hub proteins were detected using immunohistochemistry, immunofluorescence assays, and Western blotting. Real-time quantitative polymerase chain reaction (RT-qPCR) was used to analyze the expression of hub protein mRNAs. In addition, a neural network model was constructed. The quantitative relationships among the results of the three techniques were inferred by cubic spline interpolation. Two most significant hub proteins (citrate synthase and OGDH) that were related to CS and AS were identified in the adrenal gland using numerous bioinformatic methods. The hub proteins were mainly enriched in mitochondrial proton transport ATP synthase complex, ATPase activation, and the AMPK signaling pathway. Compared with the control group, the adrenal glands were larger and more disordered, irregular, and necrotic in the AS+CS group. The expression of citrate synthase and OGDH were higher in the AS+CS group than the control group, both at the protein and mRNA levels (P<0.05). There were strong correlations among the cross-sectional areas of adrenal glands, citrate synthase, and OGDH (P<0.05) via Spearman’s rho analysis, receiver operating characteristic curves, a neural network model, and cubic spline interpolation. Conclusions: AS combined with CS plays an important role in the hypothalamic–pituitary–adrenal (HPA) axis, promotes adrenomegaly, increases the release of GC, and may enhance ATP synthesis and energy metabolism in the body through citrate synthase and OGDH gene targets, providing a potential research direction for future, related explorations into this mechanism. Funding: The present study was funded by the National Key R&D Program of China (Grant no. 2020YFC2003000), Chinese Academy of Medical Sciences, CAMS Innovation Fund for Medical Sciences (Grant no. 2018-I2M-1-002.), National Natural Science Foundation of China (Grant no. 31271097, and 51672030). Declaration of Interest: The authors declare that they have no competing interests Ethical Approval: All experiments were approved by Animal Care and Use Committee of the Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College. All institutional and national guidelines for the care and use of laboratory animals were followed.
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