Authors: Daskalopoulou, Stella S.¹; Daskalopoulos, Marios E.²; Theocharis, Stamatios³; Kavantzas, Nicolaos⁴; Perrea, Despina⁵; Karandrea, Despoina⁶; Constantinides, Anthony G.⁷; Mikhailidis, Dimitri P.⁸; Nicolaides, Andrew N.⁹; Liapis, Christos D.²

Source: Current Medical Research and Opinion, Volume 23, Number 3, March 2007 , pp. 659-670(12)

Publisher: Informa Healthcare

Abstract:

Objective: Metallothioneins (MTs) are antioxidant proteins expressed in response to injury. We evaluated MT immunoreactivity in carotid plaques obtained from asymptomatic and symptomatic patients. We also assessed the relationship between ultrasonic plaque echodensity, histological grading, computed tomography findings and MT expression.

Methods and results: In this ongoing prospective study, patients (n = 123, mean age (±SD) 68.4 ± 7.7 years, 97 men) with high-grade carotid stenosis underwent carotid endarterectomy. Specimens were assessed histologically and immunohistochemically. Echolucent plaques (types 1+2) were more common in symptomatic patients (p < 0.0001) and had more advanced histological lesions (p < 0.0001). Echolucent plaques expressed MTs (in macrophages, fibroblasts and T-lymphocytes) significantly more than echogenic plaques (types 3+4) (all p < 0.0001). MT expression was mainly related to carotid plaque echolucency rather than the presence of symptoms. MT expression was significantly more common in advanced histological lesions. Plaques from asymptomatic or symptomatic patients with abnormal computed tomography findings also showed increased MT expression. There was a time-dependent fall in MT expression after cerebrovascular events (p ≤ 0.011).

Conclusions: MT overexpression may be triggered in unstable plaques as a local protective factor. There is a need to identify both causative and protective predictors of the 'vulnerable plaque' in the 'vulnerable patient'. Further studies are needed to resolve these issues.

Keywords: CAROTID PLAQUE; METALLOTHIONEIN; STENOSIS; STROKE; ULTRASOUND

Document Type: Research article

DOI: http://dx.doi.org/10.1185/030079907X178829

Affiliations: 1: Department of Vascular Surgery, Faculty of Medicine, Imperial College London, UK; Department of Vascular Surgery, Medical School, Athens University, Greece; Department of Clinical Biochemistry and Department of Surgery, Royal Free and University 2: Department of Vascular Surgery, Medical School, Athens University, Greece 3: Department of Forensic Medicine and Toxicology, Medical School, Athens University, Greece 4: Department of Pathology, Medical School, Athens University, Greece 5: Laboratory of Experimental Surgery and Surgical Research, Medical School, Athens University, Greece 6: Department of Histology and Embryology, Medical School, Athens University, Greece 7: Department of Electrical and Electronic Engineering, Imperial College London, UK 8: Department of Clinical Biochemistry and Department of Surgery, Royal Free and University College School of Medicine, University of London, UK 9: Department of Vascular Surgery, Faculty of Medicine, Imperial College London, UK; Department of Biological Sciences, University of Cyprus, Nicosia, Cyprus

Publication date: 2007-03-01

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