PDF herunterladen
CC BY-NC-ND 4.0 · Thromb Haemost 2021; 121(02): 234-241
DOI: 10.1055/s-0040-1716539
Atherosclerosis and Ischaemic Disease

Pathological Features of Ruptured Coronary Plaque and Thrombus Interfaces: Fibrin and von Willebrand Factor as Platelet Scaffolds on Rupture Sites

Atsushi Yamashita
1   Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
,
Kensaku Nishihira
1   Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
2   Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
,
Toshihiro Gi
1   Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
,
Kazunari Maekawa
1   Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
,
Kinta Hatakeyama
3   Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
4   Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan
,
Saki Horiuchi
1   Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
,
Kei Wada
5   Department of Medical Sciences, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
,
Yoshisato Shibata
2   Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
,
Yujiro Asada
1   Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
› Institutsangaben Funding This study was supported in part by Grants-in-Aid for Scientific Research in Japan (Numbers 19H03445, 16H05163, 16K08670, 19K07437, and 18K08123) from the Japan Society for the Promotion of Science, and the Cooperative Research Project Program of the Joint Usage/Research Center at the Institute of Development, Aging and Cancer, Tohoku University.
› Weitere Informationen
   Lizenzen und Reprints

Abstract

Arterial thrombus formation is thought to be initiated by platelet adhesion to the subendothelial matrix, but ruptured atherosclerotic plaques are characterized by substantial reduction of matrix proteins compared with stable plaques. Intraplaque erythrocytes and/or fibrin have been reported in high-risk coronary plaques. The aims of the current study were to identify factors that provide scaffolds for platelets at the sites of ruptured coronary plaques and investigate depositions of iron and bilirubin as hemoglobin catabolites in the ruptured plaques. Histological characteristics of plaque components and the thrombus interface were examined in 73 acute coronary aspirated thrombi. Necrotic debris (95%), macrophages (95%), and cholesterin clefts (81%) were observed frequently at the ruptured plaque and thrombus interface. A fibrous matrix (47%), calcification (32%), and extracellular deoxyribonucleic acid (15%) were identified as small foci. Tissue factor was localized in the necrotic core and macrophages. Fibrin and von Willebrand factor were consistently deposited within the plaques and beneath platelet aggregations. The citrullinated histone H3-immunopositive area accounted for only 0.5% of the plaque area. Bilirubin and iron depositions were detected in approximately 20% of the plaques in addition to biliverdin reductase and ferritin expression in macrophages. Fibrin and von Willebrand factor rather than matrix proteins and neutrophil extracellular traps may be major adhesive molecules at the sites of ruptured plaques. Iron and bilirubin deposits may be markers for rupture-prone plaques.

Keywords

acute myocardial infarction - bilirubin - fibrin - pathology - platelet

Supplementary Material



Publikationsverlauf

Eingereicht: 02. Juni 2020

Angenommen: 26. Juli 2020

Artikel online veröffentlicht:
13. September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Furie B, Furie BC. Mechanisms of thrombus formation. N Engl J Med 2008; 359 (09) 938-949
    CrossrefPubMedGoogle Scholar
  • 2 Otsuka F, Yasuda S, Noguchi T, Ishibashi-Ueda H. Pathology of coronary atherosclerosis and thrombosis. Cardiovasc Diagn Ther 2016; 6 (04) 396-408
    CrossrefPubMedGoogle Scholar
  • 3 Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 2000; 20 (05) 1262-1275
    CrossrefPubMedGoogle Scholar
  • 4 Stakos D, Skendros P, Konstantinides S, Ritis K. Traps N′ Clots: NET-mediated thrombosis and related diseases. Thromb Haemost 2020; 120 (03) 373-383
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 5 Fuchs TA, Brill A, Duerschmied D. et al. Extracellular DNA traps promote thrombosis. Proc Natl Acad Sci U S A 2010; 107 (36) 15880-15885
    CrossrefPubMedGoogle Scholar
  • 6 de Boer OJ, Li X, Teeling P. et al. Neutrophils, neutrophil extracellular traps and interleukin-17 associate with the organisation of thrombi in acute myocardial infarction. Thromb Haemost 2013; 109 (02) 290-297
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 7 Pertiwi KR, van der Wal AC, Pabittei DR. et al. Neutrophil extracellular traps participate in all different types of thrombotic and haemorrhagic complications of coronary atherosclerosis. Thromb Haemost 2018; 118 (06) 1078-1087
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 8 Sato Y, Hatakeyama K, Yamashita A, Marutsuka K, Sumiyoshi A, Asada Y. Proportion of fibrin and platelets differs in thrombi on ruptured and eroded coronary atherosclerotic plaques in humans. Heart 2005; 91 (04) 526-530
    CrossrefPubMedGoogle Scholar
  • 9 Tavora F, Cresswell N, Li L, Ripple M, Burke A. Immunolocalisation of fibrin in coronary atherosclerosis: implications for necrotic core development. Pathology 2010; 42 (01) 15-22
    CrossrefPubMedGoogle Scholar
  • 10 Kuroiwa Y, Uchida A, Yamashita A. et al. Coronary high-signal-intensity plaques on T1-weighted magnetic resonance imaging reflect intraplaque hemorrhage. Cardiovasc Pathol 2019; 40: 24-31
    CrossrefPubMedGoogle Scholar
  • 11 Yamashita A, Sumi T, Goto S. et al. Detection of von Willebrand factor and tissue factor in platelets-fibrin rich coronary thrombi in acute myocardial infarction. Am J Cardiol 2006; 97 (01) 26-28
    CrossrefPubMedGoogle Scholar
  • 12 Kolodgie FD, Gold HK, Burke AP. et al. Intraplaque hemorrhage and progression of coronary atheroma. N Engl J Med 2003; 349 (24) 2316-2325
    CrossrefPubMedGoogle Scholar
  • 13 Takaya N, Yuan C, Chu B. et al. Presence of intraplaque hemorrhage stimulates progression of carotid atherosclerotic plaques: a high-resolution magnetic resonance imaging study. Circulation 2005; 111 (21) 2768-2775
    CrossrefPubMedGoogle Scholar
  • 14 Pimstone NR, Tenhunen R, Seitz PT, Marver HS, Schmid R. The enzymatic degradation of hemoglobin to bile pigments by macrophages. J Exp Med 1971; 133 (06) 1264-1281
    CrossrefPubMedGoogle Scholar
  • 15 Orchard GE. Pigments and minerals. In: Suvarna SK, Layton C, Bancroft JD. eds. Theory and Practice of Histological Techniques. 7th ed.. Amsterdam: Elsevier; 2013: 239-270
    Google Scholar
  • 16 Dhall D, Kim SA, Mc Phaul C. et al. Heterogeneity of fibrosis in liver biopsies of patients with heart failure undergoing heart transplant evaluation. Am J Surg Pathol 2018; 42 (12) 1617-1624
    CrossrefPubMedGoogle Scholar
  • 17 Yamashita A, Nishihira K, Matsuura Y. et al. Paucity of CD34-positive cells and increased expression of high-mobility group box 1 in coronary thrombus with type 2 diabetes mellitus. Atherosclerosis 2012; 224 (02) 511-514
    CrossrefPubMedGoogle Scholar
  • 18 Katayama Y, Tanaka A, Taruya A. et al. Feasibility and clinical significance of in vivo cholesterol crystal detection using optical coherence tomography. Arterioscler Thromb Vasc Biol 2020; 40 (01) 220-229
    CrossrefPubMedGoogle Scholar
  • 19 Nishihira K, Yamashita A, Imamura T. et al. Thioredoxin in coronary culprit lesions: possible relationship to oxidative stress and intraplaque hemorrhage. Atherosclerosis 2008; 201 (02) 360-367
    CrossrefPubMedGoogle Scholar
  • 20 Sahebkar A, Serban C, Ursoniu S. et al; Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group. The impact of statin therapy on plasma levels of von Willebrand factor antigen. Systematic review and meta-analysis of randomised placebo-controlled trials. Thromb Haemost 2016; 115 (03) 520-532
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 21 Liakos CI, Vyssoulis GP, Michaelides AP. et al. The effects of angiotensin receptor blockers vs. calcium channel blockers on the acute exercise-induced inflammatory and thrombotic response. Hypertens Res 2012; 35 (12) 1193-1200
    CrossrefPubMedGoogle Scholar