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Vitamin D attenuates HMGB1-mediated neointimal hyperplasia after percutaneous coronary intervention in swine

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Abstract

Intracoronary stenting is a common procedure in patients with coronary artery disease (CAD). Stent deployment stretches and denudes the endothelial layer, promoting a local inflammatory response, resulting in neointimal hyperplasia. Vitamin D deficiency associates with CAD. In this study, we examined the association of vitamin D status with high mobility group box 1 (HMGB1)-mediated pathways (HMGB1, receptor for advanced glycation end products [RAGE], and Toll-like receptor-2 and -4 [TLR2 and TLR4]) in neointimal hyperplasia in atherosclerotic swine following bare metal stenting. Yucatan microswine fed with a high-cholesterol diet were stratified to receive vitamin D-deficient (VD-DEF), vitamin D-sufficient (VD-SUF), and vitamin D-supplemented (VD-SUP) diet. After 6 months, PTCA (percutaneous transluminal balloon angioplasty) followed by bare metal stent implantation was performed in the left anterior descending (LAD) artery of each swine. Four months following coronary intervention, angiogram and optical coherence tomography (OCT) were performed and swine euthanized. Histology and immunohistochemistry were performed in excised LAD to evaluate the expression of HMGB1, RAGE, TLR2, and TLR4. OCT analysis revealed the greatest in-stent restenosis area in the LAD of VD-DEF compared to VD-SUF or VD-SUP swine. The protein expression of HMGB1, RAGE, TLR2, and TLR4 was significantly higher in the LAD of VD-DEF compared to VD-SUF or VD-SUP swine. Vitamin D deficiency was associated with both increased in-stent restenosis and increased HMGB1-mediated inflammation noted in coronary arteries following intravascular stenting. Inversely, vitamin D supplementation was associated with both a decrease in this inflammatory profile and in neointimal hyperplasia, warranting further investigation for vitamin D as a potential adjunct therapy following coronary intervention.

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Acknowledgements

This work was supported by research Grants R01HL144125, R01HL116042 and R01HL120659 to DK Agrawal from the National Heart, Lung and Blood Institute, National Institutes of Health, USA. The content of this original research article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Clinical & Translational Science, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68178, USA

    Mohan Satish, Palanikumar Gunasekar & Juan A. Asensio

  2. Department of Translational Research, Western University of Health Sciences, 309 E. Second Street, Pomona, CA, 91766, USA

    Devendra K. Agrawal

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  1. Mohan Satish
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Contributions

Conception and design: DKA, MS, and PG; Contributed reagents/materials/analysis tool: DKA; Conducting Experiments, analysis and interpretation of the data: MS and PG; Drafting of the article: MS and PG; Critical revision of the article for important intellectual content: MS, PG, JAA, and DKA; Final approval of the article: MS, PG, JAA, and DKA.

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Correspondence to Devendra K. Agrawal.

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The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

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Creighton University Institutional Animal Care and Use Committee approved the animal research protocol (#0831.2).

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Satish, M., Gunasekar, P., Asensio, J.A. et al. Vitamin D attenuates HMGB1-mediated neointimal hyperplasia after percutaneous coronary intervention in swine. Mol Cell Biochem 474, 219–228 (2020). https://doi.org/10.1007/s11010-020-03847-y

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