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Association between inflammation in perivascular epicardial adipose tissue and coronary artery disease: a clinical pathological study

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Daniela Souza Farias
Total Authors: 1
Document type: Master's Dissertation
Press: São Paulo.
Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
Defense date:
Examining board members:
Claudia Kimie Suemoto; Márcio Sommer Bittencourt
Advisor: Claudia Kimie Suemoto

Introduction: Among the cardiovascular diseases, ischaemic heart disease (IHD) is the main cause of mortality and morbidity worldwide. Atherosclerosis is the main cause of IHD, and inflammation in the epicardial adipose tissue (EAT) seems to be associated with coronary artery disease (CAD). Inflammation in the EAT proximal to the atherosclerotic plaque could have an active role in the inflammation that contributes to atherosclerosis pathophysiology. However, controversy remains whether this inflammation is only adjacent to the atherosclerotic plaque or whether it is present in the whole EAT. Moreover, the association between inflammation in EAT and unstable plaques, as well as the role of B-lymphocytes in the inflammatory process, have not been investigated yet. Aim: To investigate the association between inflammation in perivascular epicardial adipose tissue (PAT) and CAD in a clinicopathological study. Methods: This cross sectional study used autopsy material collected at the Sao Paulo Autopsy Service (SPAS) from University of Sao Paulo, after informed consent term sign by the next-of-kin (NOK). A semi-structured clinical interview was applied to the NOK. Coronary arteries were dissected with PAT and fixed in 4% buffered formalin. Coronary artery fragments (left trunk, anterior descending, circumflex, and right coronary) were sampled at the region with the greatest obstruction or unstable plaque, and also at a distal region without atherosclerosis. PAT adjacent to the atherosclerotic plaque (PATp), distal to the plaque (PATd), subcutaneous adipose tissue (SAT), and perirenal adipose tissue (PrAT) were sampled. Atherosclerotic plaque fragments were classified regarding plaque stability, and percentage of arterial obstruction measured by morphometric methods. The number of inflammatory cells in adipose tissues was counted in slides stained using immunohistochemistry: CD68 (macrophages), CD3 (T-lymphocytes), CD20 (B-lymphocytes). The number of inflammatory cells in all fragments was compared using generalized linear models adjusted for confounders. Results: 82 participants were included (162 fragments of coronary arteries with stable plaques and 84 fragments with unstable plaques). The number of macrophages (beta: 0.008; IC95% 0.002; 0,014; p=0.007) and B-lymphocytes (beta: 0.009; IC95% 0.002; 0.015; p=0.01) increased with the percentage of arterial obstruction. We observed a large number of B-lymphocytes in the presence of unstable plaques (beta: 0.554; IC95% 0.194; 0.914; p=0.002). These associations were restricted to PATp, when compared to PATd. The number of macrophages (beta: 5.717; IC95% 1.802; 9.632; p=0.004) and T-lymphocytes were greater in the PATp than in the SAT (beta: 0.991; IC95% 0.030; 1.951; p=0.04). The number of macrophages was also greater in the TAPp compared to PrAT with the increase of the percentage of arterial obstruction (beta: 5.523; IC95% 0.910; 10.136; p=0.01), and in presence of unstable plaques (beta: 12.781; IC95% 4.363; 21.200; p=0.002). Conclusion: Macrophages, and B-lymphocytes were associated with CAD, and this association was restricted to PATp when compared to all other adipose tissues. Therefore, inflammation in PATp seems to be associated with greater arterial obstruction and atherosclerotic plaque instability (AU)