Adventitial Vasa Vasorum Neovascularization in Femoral Artery of Type 2 Diabetic Patients with Macroangiopathy Is Associated with Macrophages and Lymphocytes as well as the Occurrence of Cardiovascular Events

Abstract

Objectives This study was conducted to assess the relationship between adventitial vasa vasorum neovascularization (VVn) in femoral artery of type 2 diabetic patients with macroangiopathy and the recruitment of macrophages and lymphocytes, and to relate the density of VVn to the occurrence of cardiovascular events. Materials Femoral artery samples were obtained from amputation cases. A total of 55 type 2 diabetic patients with macroangiopathy, 15 autopsy cases with type 2 diabetes without atherosclerosis. Methods Hematoxylin and eosin (H&E) staining to observe the histopathological features; Victoria blue staining to analyze the histological features; immunohistochemistry (CD34, CD68, CD20, and CD3) to determine the VVn density and the expression of macrophages, B lymphocytes, and T lymphocytes. Results Type 2 diabetic patients with macroangiopathy showed a higher mean adventitial VVn density in femoral artery (48.40 ± 9.39 no./mm2) than patients with type 2 diabetes without atherosclerosis (19.75 ± 6.28 no./mm2) (p < 0.01). In addition, the VVn density was positively associated with the expression of CD68 macrophages (r = 0.62, p < 0.01) and CD20 B lymphocytes (r = 0.59, p < 0.01). Type 2 diabetic patients with high VVn density showed more adverse cardiovascular events (27/35 vs. 8/20 events, p = 0.006). In multivariable analysis adjusted for main risk factors for cardiovascular disease, VVn was still independently associated with adverse cardiovascular events (p = 0.01). Conclusion VVn density in type 2 diabetic patients with macroangiopathy is positively correlated with the adventitial immune-inflammatory cell numbers and the development of atherosclerotic lesions. Furthermore, VVn density is associated with adverse cardiovascular events.

Thrombosis and Haemostasis 2023 Editors' Choice Papers

“…This study offers insights for future lipid studies, hinting at novel approaches to target lipids beyond simplistic increase or decrease strategies. 73 Chen et al 74 underscored the formation of neo-vessels within vasa vasorum in large arteries of type 2 diabetes patients, potentially contributing to atherosclerosis within the host vessel. Insights into neo-vessel formation in vasa vasorum could aid in identifying early vascular wall changes and determining suitable interventions to counter the development of atherosclerotic lesions.…”

Atherosclerotic Plaque VASA Vasorum in Diabetic Macroangiopathy: WHEN IS Important, but also HOW IS Needed

“…How and what regulates neo-vessel formation on VV in the described conditions by Chen et al 40 remains to be investigated. However, because TF is expressed in ECs of newly formed vessels in atherosclerotic plaques, it might be interesting to investigate TF expression and function on type 2 diabetic patients with macroangiopathy (►Fig.…”

“…In this issue of the journal, Chen et al 40 (see article in this issue) report a study on neo-vessels on VV in in type 2 diabetic patients with macroangiopathy or without atherosclerosis in femoral artery samples from amputation cases. The study shows that in type 2 diabetic patients with macroangiopathy the density of neovascularization in VV is positively correlated with the number of immune-inflammatory cells in the adventitia and with atherosclerotic lesion development.…”