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Circulation. 1996;94:3090-3097

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(Circulation. 1996;94:3090-3097.)
© 1996 American Heart Association, Inc.


Articles

Macrophages, Smooth Muscle Cells, and Tissue Factor in Unstable Angina

Implications for Cell-Mediated Thrombogenicity in Acute Coronary Syndromes

Pedro R. Moreno, MD; Victor H. Bernardi, MD; Julio Lopez-Cuellar, MD; Alvaro M. Murcia, MD; Igor F. Palacios, MD; Herman K. Gold, MD; Roxana Mehran, MD; Samin K. Sharma, MD; Yale Nemerson, MD; Valentin Fuster, MD, PhD; John T. Fallon, MD, PhD

the Cardiac Unit, Massachusetts General Hospital, Harvard Medical School, Boston, and the Cardiovascular Institute (R.M., S.K.S., Y.N., V.F., J.T.F.), Mount Sinai School of Medicine, New York, NY.

Correspondence to Pedro R. Moreno, MD, Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. E-mail prmoreno@bics.bwh.harvard.edu.

Background Macrophage expression of tissue factor may be responsible for coronary thrombogenicity in patients with plaque rupture. In patients without plaque rupture, smooth muscle cells may be the thrombogenic substrate. This study was designed to identify the cellular correlations of tissue factor in patients with unstable angina.

Methods and Results Tissue from 50 coronary specimens (1560 pieces) from patients with unstable angina and 15 specimens from patients with stable angina were analyzed. Total and segmental areas (in square millimeters) were identified with trichrome staining. Macrophages, smooth muscle cells, and tissue factor were identified by immunostaining. Tissue factor content was larger in unstable angina (42±3%) than in stable angina (18±4%) (P=.0001). Macrophage content was also larger in unstable angina (16±2%) than in stable angina (5±2%) (P=.002). The percentage of tissue factor located in cellular areas was larger in coronary samples from patients with unstable angina (67±8%) than in samples from patients with stable angina (40±5%) (P=.00007). Multiple linear stepwise regression analysis showed that coronary tissue factor content correlated significantly (r=.83, P<.0001) with macrophage and smooth muscle cell areas only in tissue from patients with unstable angina, with a strong relationship between tissue factor content and macrophages in the atheromatous gruel (r=.98, P<.0001).

Conclusions Tissue factor content is increased in unstable angina and correlates with areas of macrophages and smooth muscle cells, suggesting a cell-mediated thrombogenicity in patients with acute coronary syndromes.


Key Words: atherosclerosis • coronary disease • thrombosis • leukocytes




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Eur. Heart J., April 2, 1999; 20(8): 567 - 574.
[Abstract] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
M. M. E. D. van den Eijnden, J. T. van Noort, L. Hollaar, A. van der Laarse, and R. M. Bertina
Cholesterol or Triglyceride Loading of Human Monocyte-Derived Macrophages by Incubation With Modified Lipoproteins Does Not Induce Tissue Factor Expression
Arterioscler Thromb Vasc Biol, February 1, 1999; 19(2): 384 - 392.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
D. E. Gutstein and V. Fuster
Pathophysiology and clinical significance of atherosclerotic plaque rupture
Cardiovasc Res, February 1, 1999; 41(2): 323 - 333.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
A. C. van der Wal and A. E. Becker
Atherosclerotic plaque rupture - pathologic basis of plaque stability and instability
Cardiovasc Res, February 1, 1999; 41(2): 334 - 344.
[Full Text] [PDF]


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Cardiovasc ResHome page
C. Depre, X. Havaux, J. Renkin, J. L. J. Vanoverschelde, and W. Wijns
Expression of inducible nitric oxide synthase in human coronary atherosclerotic plaque
Cardiovasc Res, February 1, 1999; 41(2): 465 - 472.
[Abstract] [Full Text] [PDF]


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CirculationHome page
Z. Mallat, B. Hugel, J. Ohan, G. Leseche, J.-M. Freyssinet, and A. Tedgui
Shed Membrane Microparticles With Procoagulant Potential in Human Atherosclerotic Plaques : A Role for Apoptosis in Plaque Thrombogenicity
Circulation, January 26, 1999; 99(3): 348 - 353.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
B. Engelmann, S. Zieseniss, K. Brand, S. Page, A. Lentschat, A. J. Ulmer, and E. Gerlach
Tissue Factor Expression of Human Monocytes Is Suppressed by Lysophosphatidylcholine
Arterioscler Thromb Vasc Biol, January 1, 1999; 19(1): 47 - 53.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
G. Dangas, R. Mehran, P. C. Harpel, S. K. Sharma, S. M. Marcovina, G. Dube, J. A. Ambrose, and J. T. Fallon
Lipoprotein(a) and inflammation in human coronary atheroma: association with the severity of clinical presentation
J. Am. Coll. Cardiol., December 1, 1998; 32(7): 2035 - 2042.
[Abstract] [Full Text] [PDF]


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CirculationHome page
N. Marx, F.-J. Neumann, D. Zohlnhofer, T. Dickfeld, A. Fischer, S. Heimerl, and A. Schomig
Enhancement of Monocyte Procoagulant Activity by Adhesion on Vascular Smooth Muscle Cells and Intercellular Adhesion Molecule-1–Transfected Chinese Hamster Ovary Cells
Circulation, September 1, 1998; 98(9): 906 - 911.
[Abstract] [Full Text] [PDF]


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CirculationHome page
S. D. Gertz, J. T. Fallon, R. Gallo, M. B. Taubman, S. Banai, W. L. Barry, L. W. Gimple, Y. Nemerson, S. Thiruvikraman, S. S. Naidu, et al.
Hirudin Reduces Tissue Factor Expression in Neointima After Balloon Injury in Rabbit Femoral and Porcine Coronary Arteries
Circulation, August 11, 1998; 98(6): 580 - 587.
[Abstract] [Full Text] [PDF]


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Vasc MedHome page
P. V Tisi and C. P Shearman
Biochemical and inflammatory changes in the exercising claudicant
Vascular Medicine, August 1, 1998; 3(3): 189 - 198.
[Abstract] [PDF]


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Vasc MedHome page
P. K Shah
Role of inflammation and metalloproteinases in plaque disruption and thrombosis
Vascular Medicine, August 1, 1998; 3(3): 199 - 206.
[Abstract] [PDF]


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Vasc MedHome page
P. Libby
The interface of atherosclerosis and thrombosis: basic mechanisms
Vascular Medicine, August 1, 1998; 3(3): 225 - 229.
[Abstract] [PDF]


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Vasc MedHome page
V. Fuster, J. J. Badimon, and J. H Chesebro
Atherothrombosis: mechanisms and clinical therapeutic approaches
Vascular Medicine, August 1, 1998; 3(3): 231 - 239.
[Abstract] [PDF]


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StrokeHome page
S. Jander, M. Sitzer, R. Schumann, M. Schroeter, M. Siebler, H. Steinmetz, and G. Stoll
Inflammation in High-Grade Carotid Stenosis : A Possible Role for Macrophages and T Cells in Plaque Destabilization
Stroke, August 1, 1998; 29(8): 1625 - 1630.
[Abstract] [Full Text] [PDF]


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CirculationHome page
P. Theroux and V. Fuster
Acute Coronary Syndromes : Unstable Angina and Non–Q-Wave Myocardial Infarction
Circulation, March 31, 1998; 97(12): 1195 - 1206.
[Full Text] [PDF]


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CirculationHome page
S. S. Patel, R. Thiagarajan, J. T. Willerson, and E. T. H. Yeh
Inhibition of {alpha}4 Integrin and ICAM-1 Markedly Attenuate Macrophage Homing to Atherosclerotic Plaques in ApoE-Deficient Mice
Circulation, January 13, 1998; 97(1): 75 - 81.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
A. D. Schecter, B. J. Rollins, Y. J. Zhang, I. F. Charo, J. T. Fallon, M. Rossikhina, P. L. A. Giesen, Y. Nemerson, and M. B. Taubman
Tissue Factor Is Induced by Monocyte Chemoattractant Protein-1 in Human Aortic Smooth Muscle and THP-1 Cells
J. Biol. Chem., November 7, 1997; 272(45): 28568 - 28573.
[Abstract] [Full Text] [PDF]


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CirculationHome page
F. Mach, U. Schonbeck, J.-Y. Bonnefoy, J. S. Pober, and P. Libby
Activation of Monocyte/Macrophage Functions Related to Acute Atheroma Complication by Ligation of CD40 : Induction of Collagenase, Stromelysin, and Tissue Factor
Circulation, July 15, 1997; 96(2): 396 - 399.
[Abstract] [Full Text]


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CirculationHome page
P. R. Moreno, V. H. Bernardi, J. Lopez-Cuellar, J. B. Newell, C. McMellon, H. K. Gold, I. F. Palacios, V. Fuster, and J. T. Fallon
Macrophage Infiltration Predicts Restenosis After Coronary Intervention in Patients With Unstable Angina
Circulation, December 15, 1996; 94(12): 3098 - 3102.
[Abstract] [Full Text]


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J. Biol. Chem.Home page
A. a. Belaaouaj, A. Li, T.-C. Wun, H. G. Welgus, and S. D. Shapiro
Matrix Metalloproteinases Cleave Tissue Factor Pathway Inhibitor. EFFECTS ON COAGULATION
J. Biol. Chem., August 25, 2000; 275(35): 27123 - 27128.
[Abstract] [Full Text] [PDF]


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CirculationHome page
P. R. Moreno, R. A. Lodder, K. R. Purushothaman, W. E. Charash, W. N. O'Connor, and J. E. Muller
Detection of Lipid Pool, Thin Fibrous Cap, and Inflammatory Cells in Human Aortic Atherosclerotic Plaques by Near-Infrared Spectroscopy
Circulation, February 26, 2002; 105(8): 923 - 927.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
R. Baetta, M. Camera, C. Comparato, C. Altana, M. D. Ezekowitz, and E. Tremoli
Fluvastatin Reduces Tissue Factor Expression and Macrophage Accumulation in Carotid Lesions of Cholesterol-Fed Rabbits in the Absence of Lipid Lowering
Arterioscler Thromb Vasc Biol, April 1, 2002; 22(4): 692 - 698.
[Abstract] [Full Text] [PDF]