Assessing carotid plaque structure

Research output: ThesisDoctoral Thesis (compilation)


Atherosclerosis is the leading cause of death and disability in the western world. Its clinical complications include acute myocardial infarction, sudden death and stroke. Thirty to 40 % of all ischemic strokes are caused by a carotid stenosis. The acute clinical event is triggered by an occluding thrombosis and even more frequently by embolization. Besides the degree of stenosis, the structure of the carotid plaque can be relevant for the appearance of symptoms. This thesis is focused on different aspects of the human carotid plaque. We compared the biochemical components of plaques from symptomatic and and asymptomatic patients. Plaques from symptomatic patients were less calcified and had more elastin, cholesteryl esters and cells. No differences were found for collagen and sulphated glycosaminoglycans. We also compared the composition of the plaque according to their different characteristics when assessed with standardized high-definition ultrasonography. Echolucent plaques have previously been associated with increased risk for neurological events. We observed that echolucent plaques had less calcium, more elastin and more cells. Surprisingly, in contrast to previous histological reports, our biochemical analysis did not show significant differences in the amounts of lipids or collagen. We also separated different types of elastin present in the plaques and found that intermediate-sized forms were increased both in echolucent and in plaques associated with symptoms. We demonstrated the presence of the transcription factor activator protein-1 (AP-1) and its subunits in human carotid plaques and showed that its activity is increased in symptomatic plaques. AP-1 activity correlated with cholesteryl esters and with elastin. This transcription factor may be involved in lipid accumulation, inflammation and/or tissue remodelling. Finally, we showed that antibodies against specific antigens present in oxidized LDL reflect plaque structure as assessed by histology and immunohistochemistry. IgG against an aldehyde modified apoB-100 fragment (amino acids 3136-3155) was associated with small, lipid-rich and fibrous-poor plaques, whereas IgM against that peptide sequence and against a fragment containing amino acids 3661-3680 were associated with fibrous-rich, lipid-poor plaques with few macrophages. This suggests that monitoring humoral immune response against oxidized-LDL epitopes may be used to identify patients with vulnerable plaques. These studies contribute to a better characterization of the vulnerable carotid plaque, revealing possible new paths for diagnostic and therapeutic strategies.
Original languageEnglish
Awarding Institution
  • Department of Clinical Sciences, Malmö
  • [unknown], [unknown], Supervisor, External person
Award date2004 Nov 27
ISBN (Print)91-89625-39-0
Publication statusPublished - 2004

Bibliographical note

Defence details

Date: 2004-11-27
Time: 10:15
Place: Medicinska Klinikens aula, Malmö University Hospital, Malmö

External reviewer(s)

Name: Falk, Erling
Title: Prof.
Affiliation: Department of Cardiology, Cardiovascular Research Unit, Århus University Hospital (Skejby), Århus. Denmark


Article: I. Changes related to age and cerebrovascular symptoms in the extracellular matrix of human carotid plaques.Isabel Gonçalves, Jonatan Moses, Nuno Dias, Luís Pedro, José Fernandes e Fernandes, Jan Nilsson, Mikko P. S. Ares. Stroke. 2003;34:616-622.

Article: II. Echolucency of carotid plaques correlates with plaque cellularity.Isabel Gonçalves, Jonatan Moses, Luís Pedro, Nuno Dias, José Fernandes e Fernandes, Jan Nilsson, Mikko P. S. Ares. Eur J Vasc Endovasc Surg. 2003;26:32-38.

Article: III. Elastin and calcium rather than collagen or lipid content are associated with the echogenicity of human carotid plaques.Isabel Gonçalves, Marie W. Lindholm, Luís Pedro, Nuno Dias, José Fernandes e Fernandes, Gunilla Nordin Fredrikson, Jan Nilsson, Jonatan Moses, Mikko P. S. Ares. Stroke, December 2004. In press.

Article: IV. Increased levels of Activator Protein-1 (AP-1) in carotid plaques associated with cerebrovascular symptoms.Isabel Gonçalves, Maria M. Stollenwerk, Marie W. Lindholm, Nuno Dias, Luís Pedro, José Fernandes e Fernandes, Jonatan Moses, Gunilla Nordin Fredrikson, Jan Nilsson, Mikko P. S. Ares. Submitted for publication.

Article: V. Humoral immune response against defined oxidized LDL antigens reflects structure and disease activity of carotid plaques.Isabel Gonçalves, Marie-Louise Gronholdt, Ingrid Söderberg, Mikko P. S. Ares, Borge Nordestgaard, Jacob F. Bentzon, Gunilla Nordin Fredrikson, Jan Nilsson. Submitted for publication.

The information about affiliations in this record was updated in December 2015.
The record was previously connected to the following departments: Internal Medicine (013242500), Emergency medicine/Medicine/Surgery (013240200)

Subject classification (UKÄ)

  • Clinical Medicine


  • Cardiovascular system
  • Kardiovaskulära systemet
  • Modified LDL
  • Antibodies
  • Lipids
  • AP-1
  • Cellularity
  • Extracellular Matrix
  • Calcification
  • Elastin
  • Stroke
  • Gray-Scale Median
  • Echogenicity
  • Ultrasound
  • Atherosclerosis
  • Carotid Plaque


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