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(Circulation. 2007;116:II_33.)
© 2007 American Heart Association, Inc.

Novel Approaches to Plaque Rupture and Regression

Abstract 267: A Single Dose of Reconstituted High Density Lipoprotein Reduces Expression of Tissue-Factor In Human Carotid Atherosclerotic Plaques

Hosaam H Nasr; Ian M Loftus; Saiqa Sayed; Alun Jones; Evelyn Torsney; Matthew M Thompson; Gillian W Cockerill

St. George’s Hosp, London, United Kingdom

Background: Multiple infusions of HDLs have been shown to mediate approximately 4% reduction in plaque volume. This may relate to removal of intra-plaque lipid, but the precise mechanism is unknown. To test the hypothesis that HDLs may influence plaque stabilisation through modulating transcription, we examined the effects of a single dose of rHDL on expression of thrombomodulatory genes in carotid plaques.

Materials and Methods: Forty patients undergoing carotid endarterectomy (CEA) were stratified to three groups: early symptomatics (n=12, stroke/transient ischemic attack (TIA) 1month before CEA)late symptomatics (n=14, stroke/TIA > 1month before CEA); and asymptomatics (n=12). RNA was isolated from plaques following CEA, and expression of the thrombomodulatory genes, tissue factor (TF); tissue factor pathway inhibitor (TFPI); thrombomodulin (TM); tissue type plasminogen activator (tPA); urokinase plasminogen activator (uPA); plasminogen activator inhibitor-1 (PAI-1), measured using QRT-RT-PCR. Nine patients with early symptomatic carotid disease, undergoing CEA, were then randomised to infusion of reconstituted HDL (rHDL) 80mg/kg Apo A-I (n=4) or a similar volume of phosphate buffered saline (n=5). Plaque specimens were collected 24 hrs later and RNA isolated for QRT-RT- PCR measurement of thrombomodulatory gene expression.

Results: A significant difference in TF, TM, tPA and PAI-1 genes were observed in the 3 patient groups (see Table 1). In the rHDL group, a single dose of rHDL reduced the expression of TF (0.71 (0.65–0.75) vs 0.98 (0.81–1.14), P=0.05). No significant difference was observed in other thrombomodulatory factors between the 2 groups.

Conclusions: Plaque stabilisation, which occurs within one month of a clinical event may be facilitated, at the transcriptional level, following rHDL infusion. We hope to report a larger double blind placebo controlled trial which will determine the full effects of rHDLs on plaque stability.

Table 1

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