Age-dependent diseases are exponentially increasing due to the improvement of socio-economical perspective and the rapid increase of life expectancy in Western countries. Cardiovascular diseases (CVDs) represent the biggest cause of deaths worldwide. Among them, atherosclerosis is the most important representative leading to the known severe sequelae, i.e., myocardial infarction, stroke, and peripheral arterial occlusion. Evidence for an (auto)antigen-driven process at these sites of inflammation became available only recently. During the last decades, efforts have been done to identify exogenous and/or autologous antigens that may induce local cardiovascular immune reactions. Among them, the main candidates for such antigens are oxidized low-density lipoprotein (ox-LDL) and heat shock proteins (HSPs). Risk factors for CVDs (i.e., cigarette smoking, hypertension, diabetes, elevated lipid levels, and chronic infections) induce HSP60 and adhesion molecule expression in vascular endothelial cells (ECs), initiating the first inflammatory events. This chapter summarizes the involvment of innate and adpative immunity in atherosclerosis focusing on HSP60. Moreover, a scenario on the potential development of HSP60-based vaccines against atherosclerosis is also shown.

Heat shock protein 60 (HSP60), expressed on the surface of endothelial cells (ECs) stressed by e.g. oxidized LDL or mechanical shear, was shown to function as an auto-antigen and thus as a pro-atherosclerotic molecule. The aim of this study was to determine whether cigarette smoke chemicals can lead to the activation of the "HSP60 pathway." It was also our aim to elucidate the dynamics of HSP60 from gene expression to endothelial surface expression and secretion. Here we show for the first time that the exposure of human umbilical vein endothelial cells (HUVECs) to cigarette smoke extract (CSE) results in an up-regulation of HSP60 mRNA. Live cell imaging analysis of a HSP60-EYFP fusion protein construct transfected into ECs revealed that mitochondrial structures collapse in response to CSE exposure. As a result, HSP60 is released from the mitochondria, transported to the cell surface, and released into the cell culture supernatant. Analysis of HSP60 in the sera of healthy young individuals exposed to secondhand smoke revealed significantly elevated levels of HSP60. Cigarette smoking is one of the most relevant risk factors for atherosclerosis. Herein, we provide evidence that cigarette smoke may initiate atherosclerosis in the sense of the "auto-immune hypothesis of atherosclerosis."

Objectives—Although cadmium (Cd) is an important and common environmental pollutant and has been linked to cardiovascular diseases, little is known about its effects in initial stages of atherosclerosis. Methods and Results—In the 195 young healthy women of the Atherosclerosis Risk Factors in Female Youngsters (ARFY) study, cadmium (Cd) level was independently associated with early atherosclerotic vessel wall thickening (intima-media thickness exceeding the 90th percentile of the distribution; multivariable OR 1.6[1.1.–2.3], P=0.016). In line, Cd-fed ApoE knockout mice yielded a significantly increased aortic plaque surface compared to controls (9.5 versus 26.0 mm2, P<0.004). In vitro results indicate that physiological doses of Cd increase vascular endothelial permeability up to 6-fold by (1) inhibition of endothelial cell proliferation, and (2) induction of a caspase-independent but Bcl-xL-inhibitable form of cell death more than 72 hours after Cd addition. Both phenomena are preceded by Cd-induced DNA strand breaks and a cellular DNA damage response. Zinc showed a potent protective effect against deleterious effects of Cd both in the in vitro and human studies. Conclusion—Our research suggests Cd has promoting effects on early human and murine atherosclerosis, which were partly offset by high Zn concentrations.

The molecular mechanisms underlying the atherogenic activity of cigarette smoke have yet to be fully elucidated. In the present study, genome-wide microarray analysis was performed on endothelial cells exposed to an aqueous cigarette smoke extract (CSE) for 3, 7, and 24h, to obtain a better insight into how smoking may lead to endothelial damage. Microarray analysis showed the transcriptional response to CSE was dominated by heat shock, stress responsive, and inflammatory genes, along with genes encoding for anti-oxidant and metal detoxification proteins. The heat shock response was shown to be a result of short lived reactive species of CSE, with the abrogation of the effect by the addition of old CSE, the anti-oxidant N-acetyl cysteine, or the removal of metals from CSE implying that reactive oxygen species are the main culprit. This was further supported by a strong decline in the level of intracellular protein oxidation levels seen under these conditions compared to freshly prepared CSE. Mitochondrial integrity was also found to be significantly compromised after CSE treatment, resulting in a threefold increase in depolarised mitochondria after 6h. Finally, cell cycle analysis showed the induction of G1 cell cycle arrest. An increased stress and inflammation response indicates that endothelial damage from smoking could contribute to immune cell infiltration, while decreased growth rates reduce endothelial layer repair, promoting atherogenesis.

Atherosclerosis is a multifactorial, chronic-inflammatory disease for which the underlying cause remains unknown. It is also well documented that T-cells are among the first cells to migrate into the arterial intimal vessel layer, but their function there is still unexplained. Clinical and experimental data have provided evidence that atherosclerosis starts as an autoimmune reaction based on humoral and cellular immunity against a phylogenetically highly conserved stress protein, heat shock protein 60 (HSP60). In the present study, we phenotypically characterized T-cells from endarterectomized specimens of the carotid artery, and tested their reactivity to human HSP60. In addition, the T-cell receptor repertoire of the T-cell lines was defined by immunoscope analysis. We found a mixed population of CD4+ and CD8+ intralesional T-cells, with a slight predominance of CD8+ cells. IFN-γ production prevailed over IL-4 production. The T-cell reaction against human HSP60 was significantly increased in intralesional cells compared to peripheral T-cells. The lesion-derived T-cells showed an oligoclonally-restricted repertoire, in contrast to the polyclonal pattern of PBMC. These results clearly show that HSP60 is a major antigenic candidate, and that an oligoclonal T-cell expansion takes place in advanced human atherosclerotic lesions.

This chapter focuses on atherosclerosis and autoimmune hypothesis of atherogenesis. Heat shock proteins (HSPs) are expressed by prokaryotic and eukaryotic cells as a response to various stress factors. HSP60 is a special case since it is not only an important and highly antigenic component of bacteria and parasites, but also plays a major role in several autoimmune diseases. The autoimmune hypothesis of atherogenesis postulates that pre-existing adaptive and innate immunity to HSP60 exposed on the surface of arterial endothelial cells (ECs) leads to the development of an initial inflammatory stage of this disease. Immunity against HSP60 seems to be an important facet of the defense system, e.g., as reflected by the fact that a considerable proportion of lymphocytes within the vascular-associated lymphoid tissue (VALT) show reactivity against HSP60. Also, every healthy animal and human possesses humoral antibodies against HSP60. It is noted that cells of the innate immune system recognize HSP60 as a danger signal, be it of microbial or autologous origin. The development of atherosclerosis therefore depends on the expression and accessibility of atherogenic HSP60 epitopes on the surface of ECs.

OBJECTIVE:Metal constituents of tobacco have long been suspected to contribute to cardiovascular diseases. In this study, we determined the serum concentrations of aluminum, cadmium (Cd), cobalt, copper, iron, manganese, nickel, lead, strontium (Sr), and zinc of young nonsmokers, passive smokers, and smokers.METHODS AND RESULTS:Cd and Sr were found to be significantly increased in smokers compared with nonsmokers. The effects of these metals on primary arterial endothelial cells were then assessed using microarray technology and real-time polymerase chain reaction (RT-PCR). The data showed that Sr does not interfere with endothelial cell transcription. In contrast, the effects of Cd in amounts delivered to the human body by smoking were dramatic.CONCLUSIONS:Arterial endothelial cells responded to Cd exposure by massively upregulating metal and oxidant defense genes (metallothioneins) and by downregulating a number of transcription factors. In addition, the mRNA of the intermediate filament protein vimentin, crucial for the maintenance of cellular shape, was reduced. Surprisingly, a number of pro-inflammatory genes were downregulated in response to Cd. The present data suggest that by delivering Cd to the human body, smoking deregulates transcription, exerts stress, and damages the structure of the vascular endothelium; furthermore, in contrast to the effects of cigarette smoke as a whole, Cd seems to possess anti-inflammatory properties.

Smoking is a significant risk factor for development of atherosclerosis. However, the pathophysiology of smoking-mediated vessel wall damage is not understood. With tools ranging from analytical chemistry to cell biology, we show that cigarette smoke contains metals that catalyze the direct oxidation of cellular proteins by smoke oxidants. Oxidation of cellular proteins causes a loss of microtubule function, culminating in microtubule depolymerization and proteasome-dependent degradation of alpha-tubulin. As a consequence of the microtubule collapse, cytoskeletal structures as well as intermediate filaments break down, leading finally to a contraction of vascular endothelial cells. We observed a smoke extract-induced, calpain-dependent degradation of the intracellular form of platelet-endothelial cell adhesion molecule 1/CD31, as well as a release of P-selectin/CD62P, IL-6, and IL-8 from endothelial cells into the supernatant. Increased levels of soluble CD62P and IL-6 are well known to be associated with smoking in humans. Increased permeability of the vascular endothelium is a crucial event in atherogenesis. This work highlights the compounds and mechanisms by which cigarette smoke induces leakiness of the vascular endothelium.

Introduction: Smokers have an increased risk for a variety of diseases. Among the most prominent is atherosclerosis, the leading cause of death in the Western world. Although this conjunction is accepted knowledge, the basic biological mechanisms and the identities of the active tobacco smoke constituents surprisingly are still unknown. One reason for this is the lack of accurate in vitro models. Methods: Cell culture experiments, including cell morphology and cell death analyses, high-performance liquid chromatography, and liquid chromatography coupled to mass spectrometry via an electrospray ionization interface allowing collision-induced dissociation analyses, were applied. Results and discussion: In this study, we present and validate an in vitro model that has proven to be useful for standardized studies of cellular and histological effects of cigarette smoke. The system consists of a cigarette smoke sampling device in which water-soluble cigarette smoke constituents pass over from the gas phase into the aqueous phase resulting in nicotine concentrations identical to the in vivo concentrations, suggesting in vivo similar conditions for gas-to-liquid compound exchange.

Teaching files are common in radiology. Although there is an increasing role of digital technology in radiology departments, today's teaching files have not yet seen the application of this new technology. This may have been due in part to poor or incomplete implementation in many commercial software packages. We have demonstrated that by utilizing free software from the Internet, a web-based teaching file system, which is easy to use, low cost, and secure, can be created.

The controversy over whether magnetic fields (MF) produced by electrical wiring and appliances contribute to diseases such as cancer has been debated in the literature for more than 2 decades. These extremely low frequency fields at 50 or 60 Hz are omnipresent in the industrialized world and have been linked to various forms of cancer by epidemiological studies. Little has been published investigating any possible role of MF and cardiovascular disease, and this is the first study looking specifically at the effect of exposure to high-intensity MF on the development and progression of restenosis. A mouse arteriovenous bypass model was used, and mice were exposed to MF for periods of 1, 2, or 3 weeks. Neointima formation, infiltration of mononuclear cells, and heat shock protein 60 expression were all studied at the conclusion of the exposure regimen. Animals exposed to the MF for 1 week showed significantly smaller neointima formation compared with control mice exposed to a null field, although this difference was not observed in mice exposed for 2 or 3 weeks. No difference was found between mice exposed to MF and controls in any of the other parameters investigated.