Endothelial vascular cell adhesion molecule 1 is a marker for high-risk carotid plaques and target for ultrasound molecular imaging

Craig C. Weinkauf, Kirsten Concha-Moore, Jonathan Lindner, Edmund R. Marinelli, Kyle P. Hadinger, Sandipan Bhattacharjee, Scott S. Berman, Kay Goshima, Luis R. Leon, Terry O. Matsunaga, Evan Unger

    Research output: Contribution to journalArticle

    4 Citations (Scopus)

    Abstract

    Background: Molecular imaging of carotid plaque vulnerability to atheroembolic events is likely to lead to improvements in selection of patients for carotid endarterectomy (CEA). The aims of this study were to assess the relative value of endothelial inflammatory markers for this application and to develop molecular ultrasound contrast agents for their imaging. Methods: Human CEA specimens were obtained prospectively from asymptomatic (30) and symptomatic (30) patients. Plaques were assessed by semiquantitative immunohistochemistry for vascular cell adhesion molecule 1 (VCAM-1), lectin-like oxidized low-density lipoprotein receptor 1, P-selectin, and von Willebrand factor. Established small peptide ligands to each of these targets were then synthesized and covalently conjugated to the surface of lipid-shelled microbubble ultrasound contrast agents, which were then evaluated in a flow chamber for binding kinetics to activated human aortic endothelial cells under variable shear conditions. Results: Expression of VCAM-1 on the endothelium of CEA specimens from symptomatic patients was 2.4-fold greater than that from asymptomatic patients (P < .01). Expression was not significantly different between groups for P-selectin (P = .43), von Willebrand factor (P = .59), or lectin-like oxidized low-density lipoprotein receptor 1 (P = .99). Although most plaques from asymptomatic patients displayed low VCAM-1 expression, approximately one in five expressed high VCAM-1 similar to plaques from symptomatic patients. In vitro flow chamber experiments demonstrated that VCAM-1-targeted microbubbles bind cells that express VCAM-1, even under high-shear conditions that approximate those found in human carotid arteries, whereas binding efficiency was lower for the other agents. Conclusions: VCAM-1 displays significantly higher expression on high-risk (symptomatic) vs low-risk (asymptomatic) carotid plaques. Ultrasound contrast agents bearing ligands for VCAM-1 can sustain high-shear attachment and may be useful for identifying patients in whom more aggressive treatment is warranted.

    Original languageEnglish (US)
    JournalJournal of Vascular Surgery
    DOIs
    StateAccepted/In press - Jan 1 2018

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    Molecular Imaging
    Vascular Cell Adhesion Molecule-1
    Ultrasonography
    Carotid Endarterectomy
    Class E Scavenger Receptors
    Contrast Media
    Microbubbles
    P-Selectin
    von Willebrand Factor
    Ligands
    Carotid Arteries
    Patient Selection
    Endothelium
    Endothelial Cells
    Immunohistochemistry
    Lipids
    Peptides

    ASJC Scopus subject areas

    • Surgery
    • Cardiology and Cardiovascular Medicine

    Cite this

    Endothelial vascular cell adhesion molecule 1 is a marker for high-risk carotid plaques and target for ultrasound molecular imaging. / Weinkauf, Craig C.; Concha-Moore, Kirsten; Lindner, Jonathan; Marinelli, Edmund R.; Hadinger, Kyle P.; Bhattacharjee, Sandipan; Berman, Scott S.; Goshima, Kay; Leon, Luis R.; Matsunaga, Terry O.; Unger, Evan.

    In: Journal of Vascular Surgery, 01.01.2018.

    Research output: Contribution to journalArticle

    Weinkauf, CC, Concha-Moore, K, Lindner, J, Marinelli, ER, Hadinger, KP, Bhattacharjee, S, Berman, SS, Goshima, K, Leon, LR, Matsunaga, TO & Unger, E 2018, 'Endothelial vascular cell adhesion molecule 1 is a marker for high-risk carotid plaques and target for ultrasound molecular imaging', Journal of Vascular Surgery. https://doi.org/10.1016/j.jvs.2017.10.088
    Weinkauf, Craig C. ; Concha-Moore, Kirsten ; Lindner, Jonathan ; Marinelli, Edmund R. ; Hadinger, Kyle P. ; Bhattacharjee, Sandipan ; Berman, Scott S. ; Goshima, Kay ; Leon, Luis R. ; Matsunaga, Terry O. ; Unger, Evan. / Endothelial vascular cell adhesion molecule 1 is a marker for high-risk carotid plaques and target for ultrasound molecular imaging. In: Journal of Vascular Surgery. 2018.
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    abstract = "Background: Molecular imaging of carotid plaque vulnerability to atheroembolic events is likely to lead to improvements in selection of patients for carotid endarterectomy (CEA). The aims of this study were to assess the relative value of endothelial inflammatory markers for this application and to develop molecular ultrasound contrast agents for their imaging. Methods: Human CEA specimens were obtained prospectively from asymptomatic (30) and symptomatic (30) patients. Plaques were assessed by semiquantitative immunohistochemistry for vascular cell adhesion molecule 1 (VCAM-1), lectin-like oxidized low-density lipoprotein receptor 1, P-selectin, and von Willebrand factor. Established small peptide ligands to each of these targets were then synthesized and covalently conjugated to the surface of lipid-shelled microbubble ultrasound contrast agents, which were then evaluated in a flow chamber for binding kinetics to activated human aortic endothelial cells under variable shear conditions. Results: Expression of VCAM-1 on the endothelium of CEA specimens from symptomatic patients was 2.4-fold greater than that from asymptomatic patients (P < .01). Expression was not significantly different between groups for P-selectin (P = .43), von Willebrand factor (P = .59), or lectin-like oxidized low-density lipoprotein receptor 1 (P = .99). Although most plaques from asymptomatic patients displayed low VCAM-1 expression, approximately one in five expressed high VCAM-1 similar to plaques from symptomatic patients. In vitro flow chamber experiments demonstrated that VCAM-1-targeted microbubbles bind cells that express VCAM-1, even under high-shear conditions that approximate those found in human carotid arteries, whereas binding efficiency was lower for the other agents. Conclusions: VCAM-1 displays significantly higher expression on high-risk (symptomatic) vs low-risk (asymptomatic) carotid plaques. Ultrasound contrast agents bearing ligands for VCAM-1 can sustain high-shear attachment and may be useful for identifying patients in whom more aggressive treatment is warranted.",
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    AU - Weinkauf, Craig C.

    AU - Concha-Moore, Kirsten

    AU - Lindner, Jonathan

    AU - Marinelli, Edmund R.

    AU - Hadinger, Kyle P.

    AU - Bhattacharjee, Sandipan

    AU - Berman, Scott S.

    AU - Goshima, Kay

    AU - Leon, Luis R.

    AU - Matsunaga, Terry O.

    AU - Unger, Evan

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    N2 - Background: Molecular imaging of carotid plaque vulnerability to atheroembolic events is likely to lead to improvements in selection of patients for carotid endarterectomy (CEA). The aims of this study were to assess the relative value of endothelial inflammatory markers for this application and to develop molecular ultrasound contrast agents for their imaging. Methods: Human CEA specimens were obtained prospectively from asymptomatic (30) and symptomatic (30) patients. Plaques were assessed by semiquantitative immunohistochemistry for vascular cell adhesion molecule 1 (VCAM-1), lectin-like oxidized low-density lipoprotein receptor 1, P-selectin, and von Willebrand factor. Established small peptide ligands to each of these targets were then synthesized and covalently conjugated to the surface of lipid-shelled microbubble ultrasound contrast agents, which were then evaluated in a flow chamber for binding kinetics to activated human aortic endothelial cells under variable shear conditions. Results: Expression of VCAM-1 on the endothelium of CEA specimens from symptomatic patients was 2.4-fold greater than that from asymptomatic patients (P < .01). Expression was not significantly different between groups for P-selectin (P = .43), von Willebrand factor (P = .59), or lectin-like oxidized low-density lipoprotein receptor 1 (P = .99). Although most plaques from asymptomatic patients displayed low VCAM-1 expression, approximately one in five expressed high VCAM-1 similar to plaques from symptomatic patients. In vitro flow chamber experiments demonstrated that VCAM-1-targeted microbubbles bind cells that express VCAM-1, even under high-shear conditions that approximate those found in human carotid arteries, whereas binding efficiency was lower for the other agents. Conclusions: VCAM-1 displays significantly higher expression on high-risk (symptomatic) vs low-risk (asymptomatic) carotid plaques. Ultrasound contrast agents bearing ligands for VCAM-1 can sustain high-shear attachment and may be useful for identifying patients in whom more aggressive treatment is warranted.

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