Atherosclerosis

Atherosclerosis, a disease of the large arteries, is the primary cause of heart disease and stroke. In westernized societies, it is the underlying cause of about 50% of all deaths. Epidemiological studies have revealed several important environmental and genetic risk factors associated with atherosclerosis. Progress in defining the cellular and molecular interactions involved, however, has been hindered by the disease's aetiological complexity. Over the past decade, the availability of new investigative tools, including genetically modified mouse models of disease, has resulted in a clearer understanding of the molecular mechanisms that connect altered cholesterol metabolism and other risk factors to the development of atherosclerotic plaque. It is now clear that atherosclerosis is not simply an inevitable degenerative consequence of ageing, but rather a chronic inflammatory condition that can be converted into an acute clinical event by plaque rupture and thrombosis.     

Low dose oral cannabinoid therapy reduces progression of atherosclerosis in mice

Atherosclerosis is a chronic inflammatory disease, and is the primary cause of heart disease and stroke in Western countries. Derivatives of cannabinoids such as delta-9-tetrahydrocannabinol (THC) modulate immune functions and therefore have potential for the treatment of inflammatory diseases. We investigated the effects of THC in a murine model of established atherosclerosis. Oral administration of THC (1 mg kg(-1) per day) resulted in significant inhibition of disease progression. This effective dose is lower than the dose usually associated with psychotropic effects of THC. Furthermore, we detected the CB2 receptor (the main cannabinoid receptor expressed on immune cells) in both human and mouse atherosclerotic plaques. Lymphoid cells isolated from THC-treated mice showed diminished proliferation capacity and decreased interferon-gamma secretion. Macrophage chemotaxis, which is a crucial step for the development of atherosclerosis, was also inhibited in vitro by THC. All these effects were completely blocked by a specific CB2 receptor antagonist. Our data demonstrate that oral treatment with a low dose of THC inhibits atherosclerosis progression in the apolipoprotein E knockout mouse model, through pleiotropic immunomodulatory effects on lymphoid and myeloid cells. Thus, THC or cannabinoids with activity at the CB2 receptor may be valuable targets for treating atherosclerosis.     

Role of cholesterol and lipid organization in disease

Membrane lipids are essential for biological functions ranging from membrane trafficking to signal transduction. The composition of lipid membranes influences their organization and properties, so it is not surprising that disorders in lipid metabolism and transport have a role in human disease. Significant recent progress has enhanced our understanding of the molecular and cellular basis of lipid-associated disorders such as Tangier disease, Niemann-Pick disease type C and atherosclerosis. These insights have also led to improved understanding of normal physiology.     

球囊损伤加高脂喂养建立兔颈动脉粥样硬化模型

目的探索建立颈动脉粥样硬化动物模型的有效方法。方法将29只日本大耳白兔随机分为3组,分别给予高脂饲料喂养加球囊损伤术(球囊损伤组n=12)、单纯高脂饲料喂养(高脂组n=9)和正常饲料喂养(正常组n=8)。在实验第8周分别处死各组动物,观察颈动脉病变的形态特征,计量其内膜增厚程度。结果球囊损伤组11只出现典型的动脉粥样硬化病变,包括内膜增厚、平滑肌细胞移行增殖、脂质沉积、弹力纤维和胶原基质的生成、粥样斑块形成等,死亡1只,无1只出现颈动脉闭塞;而在高脂组的颈动脉仅发现轻度动脉粥样硬化病变。结论球囊损伤加高脂饲料可以成功建立家兔颈动脉粥样硬化模型。     

Vascular respiratory uncoupling increases blood pressure and atherosclerosis

The observations that atherosclerosis often occurs in non-smokers without elevated levels of low-density lipoprotein cholesterol, and that most atherosclerosis loci so far identified in mice do not affect systemic risk factors associated with atherosclerosis, suggest that as-yet-unidentified mechanisms must contribute to vascular disease. Arterial walls undergo regional disturbances of metabolism that include the uncoupling of respiration and oxidative phosphorylation, a process that occurs to some extent in all cells and may be characteristic of blood vessels being predisposed to the development of atherosclerosis. To test the hypothesis that inefficient metabolism in blood vessels promotes vascular disease, we generated mice with doxycycline-inducible expression of uncoupling protein-1 (UCP1) in the artery wall. Here we show that UCP1 expression in aortic smooth muscle cells causes hypertension and increases dietary atherosclerosis without affecting cholesterol levels. UCP1 expression also increases superoxide production and decreases the availability of nitric oxide, evidence of oxidative stress. These results provide proof of principle that inefficient metabolism in blood vessels can cause vascular disease.     

难治性溃疡性结肠炎证治

目的：根据难治的溃疡性结肠炎辩证治疗，探索中西医药合治的新途径。方法：内外合治、中西医结合。结果：较单纯传统中药治疗效果为优。结论：辨清病因、标本兼治，则疗效显。     

Myocardial infarction accelerates atherosclerosis

During progression of atherosclerosis, myeloid cells destabilize lipid-rich plaques in the arterial wall and cause their rupture, thus triggering myocardial infarction and stroke. Survivors of acute coronary syndromes have a high risk of recurrent events for unknown reasons. Here we show that the systemic response to ischaemic injury aggravates chronic atherosclerosis. After myocardial infarction or stroke, Apoe-/- mice developed larger atherosclerotic lesions with a more advanced morphology. This disease acceleration persisted over many weeks and was associated with markedly increased monocyte recruitment. Seeking the source of surplus monocytes in plaques, we found that myocardial infarction liberated haematopoietic stem and progenitor cells from bone marrow niches via sympathetic nervous system signalling. The progenitors then seeded the spleen, yielding a sustained boost in monocyte production. These observations provide new mechanistic insight into atherogenesis and provide a novel therapeutic opportunity to mitigate disease progression.     

Insulin signalling and the regulation of glucose and lipid metabolism.

The epidemic of type 2 diabetes and impaired glucose tolerance is one of the main causes of morbidity and mortality worldwide. In both disorders, tissues such as muscle, fat and liver become less responsive or resistant to insulin. This state is also linked to other common health problems, such as obesity, polycystic ovarian disease, hyperlipidaemia, hypertension and atherosclerosis. The pathophysiology of insulin resistance involves a complex network of signalling pathways, activated by the insulin receptor, which regulates intermediary metabolism and its organization in cells. But recent studies have shown that numerous other hormones and signalling events attenuate insulin action, and are important in type 2 diabetes.     

多基因突变小鼠模型与动脉粥样硬化研究

目前己知人类有近 2 0 0 0 0种疾病 ,其发生与发展都与基因受损有着直接或间接的关系 ,其中相当一部分疾病的发病涉及到两个以上的基因功能异常。动脉粥样硬化 (AS)、肥胖、糖尿病、高血压等多基因疑难疾病是目前严重影响人类健康的重大疾病。在AS的发病过程中 ,血脂代谢异常是其重要原因之一。在载脂蛋白E(apoE)通过与低密度脂蛋白受体 (LDLR)和乳糜微粒受体的特异性结合 ,介导血浆脂蛋白的转运与清除 ,在脂质的代谢中起着非常重要的作用。瘦素受体 (OB R)在体内介导瘦素的信号传导 ,调节能量代谢与平衡与肥胖以及血脂代谢有关。通过…     

Induction of endothelial cell expression of granulocyte and macrophage colony-stimulating factors by modified low-density lipoproteins.

Oxidized lipoproteins have been identified in atherosclerotic plaques and in early lesions in humans as well as in animals. There is accumulating evidence that such oxidized lipoproteins have an important role in atherosclerosis. Treatment of endothelial cells with altered lipoproteins stimulates monocyte binding as well as the production of chemotactic factors for monocytes. Both these findings could be relevant to the accumulation of monocytes-macrophages in the arterial wall during the early stages of lesion development. We now report that treatment of endothelial cells (EC) with modified low-density lipoproteins obtained by mild iron oxidation or by prolonged storage, results in a rapid and large induction of the expression of granulocyte-macrophage colony-stimulating factor (GM-CSF), macrophage CSF (M-CSF) and granulocyte CSF (G-CSF). These growth factors affect the differentiation, survival, proliferation, migration and metabolism of macrophages/granulocytes, and G-CSF and GM-CSF also affect the migration and proliferation of EC. Because EC and macrophages are important in the development of atherosclerosis, the expression of the CSFs by these cells could contribute to the disease.     

他汀类药物在心血管疾病治疗中的新进展

他汀类药物已广泛应用于临床高脂血症的治疗，大量临床试验证明，他汀类药物不仅可降低血脂水平，而且还有抑制炎症反应、稳定动脉粥样硬化斑块、抑制血栓形成、调节血管内皮细胞舒张功能及血管平滑肌功能等非降脂作用。文章就他汀类药物对心血管疾病的非降脂作用进行综述。     

冠心病的相关危险因素分析与干预

冠状动脉粥样硬化性心脏病（简称冠心病）是一种最为常见的心脏病,它的病理基础是冠状动脉粥样硬化,国内外学者都对其危险因素进行了大量的研究。现概述其相关危险因素,同时探讨可变的危险因素的干预方法,预防冠心病的发生。     

Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease

Metabolomics studies hold promise for the discovery of pathways linked to disease processes. Cardiovascular disease (CVD) represents the leading cause of death and morbidity worldwide. Here we used a metabolomics approach to generate unbiased small-molecule metabolic profiles in plasma that predict risk for CVD. Three metabolites of the dietary lipid phosphatidylcholine--choline, trimethylamine N-oxide (TMAO) and betaine--were identified and then shown to predict risk for CVD in an independent large clinical cohort. Dietary supplementation of mice with choline, TMAO or betaine promoted upregulation of multiple macrophage scavenger receptors linked to atherosclerosis, and supplementation with choline or TMAO promoted atherosclerosis. Studies using germ-free mice confirmed a critical role for dietary choline and gut flora in TMAO production, augmented macrophage cholesterol accumulation and foam cell formation. Suppression of intestinal microflora in atherosclerosis-prone mice inhibited dietary-choline-enhanced atherosclerosis. Genetic variations controlling expression of flavin monooxygenases, an enzymatic source of TMAO, segregated with atherosclerosis in hyperlipidaemic mice. Discovery of a relationship between gut-flora-dependent metabolism of dietary phosphatidylcholine and CVD pathogenesis provides opportunities for the development of new diagnostic tests and therapeutic approaches for atherosclerotic heart disease.     

阿托伐他汀联合氯吡格雷对急性脑梗死患者颈动脉粥样硬化斑块及凝血功能的影响

目的探讨阿托伐他汀联合氯吡格雷治疗对急性脑梗死患者颈动脉粥样硬化斑块及凝血功能的影响.方法将80例急性脑梗死患者根据随机数字法分为对照组(阿司匹林及阿托伐他汀)和观察组(对照组基础上,加用氯吡格雷),比较两组治疗的临床疗效、治疗前后动脉粥样硬化斑块面积及颈动脉中层厚度,治疗前后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)水平变化情况.结果与对照组相比,观察组治疗的总有效率明显增高(P0.05);与对照组相比,观察组治疗后动脉粥样硬化斑块面积及颈动脉中层厚度均明显减少(P0.05);与对照组相比,观察组治疗后PT,APTT均明显增高,FIB水平显著降低(P0.05).结论阿托伐他汀联合氯吡格雷治疗能够明显减少急性脑梗死患者的斑块面积,改善凝血指标,提高疗效,值得临床推广使用.     

血清总胆红素与冠状动脉粥样硬化相关性的探讨

目的探讨血清总胆红素(TBIL)水平与冠状动脉粥样硬化的关系.方法根据178例冠状动脉造影的结果,将其分成正常组与疾病组,疾病组中依据冠状动脉狭窄程度和范围分成轻度狭窄组和重度狭窄组,根据临床、心肌酶学、心电图又将疾病组分为急性冠状动脉病变组和非急性冠状动脉病变组,将各组的血清TBIL进行比较分析.结果正常组血清总胆红素显著高于疾病组(P<0.01),血清TBIL水平与冠状动脉粥样硬化狭窄程度和范围呈负相关(P<0.01),急性冠状动脉病变患者血清总胆红素水平明显升高(P<0.01).结论血清总胆红素对冠状动脉可能有一定的保护作用.     

动脉粥样硬化发病机制及其动物模型研究进展

摘要: 动脉粥样硬化( atherosclerosis,As) 是一类高发性常见性疾病,研究其发病原因,阐明其发病机制,建立一种能较好模拟人类病变过程的As 动物模型是目前国内外研究的重点和热点。本文就国内外报道的对动脉粥样硬化发生发展的病理机制,及其动物模型的选择,造模方法及模型的评价方面的研究进行综述分析,以期为今后动脉粥样硬化的研究提供参考思路与线索。     

Roles of PPARs in health and disease

In developed societies, chronic diseases such as diabetes, obesity, atherosclerosis and cancer are responsible for most deaths. These ailments have complex causes involving genetic, environmental and nutritional factors. There is evidence that a group of closely related nuclear receptors, called peroxisome proliferator-activated receptors (PPARs), may be involved in these diseases. This, together with the fact that PPAR activity can be modulated by drugs such as thiazolidinediones and fibrates, has instigated a huge research effort into PPARs. Here we present the latest developments in the PPAR field, with particular emphasis on the physiological function of PPARs during various nutritional states, and the possible role of PPARs in several chronic diseases.     

Imaging of atherosclerotic cardiovascular disease

Atherosclerosis is characterized by thickening of the walls of the arteries, a process that occurs slowly and 'silently' over decades. This prolonged course of disease provides a window of opportunity for diagnosis before symptoms occur. But, until recently, only advanced atherosclerotic disease could be observed. Now, developments in imaging technology offer many enticing prospects, including detecting atherosclerosis early, grouping individuals by the probability that they will develop symptoms of atherosclerosis, assessing the results of treatment and improving the current understanding of the biology of atherosclerosis.     

五指山小型猪动脉粥样硬化模型的病理学研究

目的观察小型猪动脉粥样硬化模型动脉病变的形态特点、分布规律和发展过程,为小型猪动脉粥样硬化模型的应用提供基础资料。方法3~4月龄五指山小型猪30头,随机分为3组,对照组6头,喂基础饲料,实验组分别饲喂含1.5%胆固醇的高脂饲料(T1组,12头)和含3.0%胆固醇的高脂饲料(T2组,12头),在实验后4、6、8和12个月,T1和T2组分别处死动物3头,对照组分别在实验后6个月和12个月各处死3头,对动物的心血管系统和主要脏器做病理学检查。结果实验后4个月,实验组动物均出现明显的早期动脉粥样硬化病变,至6个月和8个月,动脉病变逐渐加重,在实验后12个月,于动物的大、中血管观察到广泛的动脉病变。动脉病变易发且严重的部位为腹主动脉、髂动脉和冠状动脉,动脉病变少见且较轻的部位为颈总动脉、肠系膜总动脉和肾动脉。动脉病变大体分为3种类型,分别为以胸主动脉为代表的脂纹性病变,以腹主动脉为代表的纤维斑块病变和以冠状动脉为代表的中小动脉病变。动脉病变的发展过程在不同血管和不同部位也有差别,动脉病变的出现时间和严重程度动物个体之间差别较大,T1组和T2组差别不十分显著,以T2组略重。结论小型猪动脉粥样硬化病变与人类十分相似,但是不同部位的血管病变类型和发展过程有所不同,应根据实验需要选择观察血管和实验周期。     

湿热型痛风性关节炎的分期治疗

根据病患关节局部痛、热、痠、胀和全身症状等临床特点,将湿热型痛风性关节炎的发病过程分为急性发作期、间歇期、慢性期三个阶段,并根据不同病期的病机要点,予以中医药分期治疗,临床效果大多能取得良好疗效。