IJAR.2024.136
Type of Article: Original Research
Volume 12; Issue 3 (September 2024)
Page No.: 8981-8990
DOI: https://dx.doi.org/10.16965/ijar.2024.136
Effect of Type 2 Diabetes Mellitus on Expression of Vascular Endothelial Growth Factor-A (VEGF-A) in various grades of Stenosis of Coronary Artery Segments: An Autopsy-based Study
Sheeja Balakrishnan 1, Senthil Kumar B 2. P B Gujral 3. Jerry Joseph K 4.
*1 Department of Anatomy, Government Medical College (Institute of Integrated Medical Sciences), Palakkad-678013, Kerala, India. ORCiD: 0000-0001-8921-7297
2 Department of Anatomy Vinayaka Mission’s Kirupananda Variyar Medical College and Hospitals, Vinayaka Missions Research Foundation (DU)Salem-636308, Tamil Nādu, India. ORCiD: 0000-0001-6162-6312
3 Chief Consultant Forensic Medicine and Police Surgeon, Health Service, Kerala State. Kerala, India.
4 Department of Forensic Medicine, District Hospital Palakkad, Kerala, India.
Corresponding Author: Dr. Sheeja Balakrishnan, Department of Anatomy, Government Medical College Palakkad (Institute of Integrated Medical Sciences), Palakkad-678013, Kerala, India. E-Mail: sheejabkrishna@gmail.com
ABSTRACT
Background: VEGF has been reported as an important factor promoting collateral formation in Ischemic Cardiac diseases. However, the complete mechanism and factors affecting VEGF expression during Acute myocardial infarction are not fully understood. The present study aims to correlate the effect of Diabetes Mellitus on VEGF expression in endothelial cells in various grades of Coronary artery stenosis.
Materials and Methods: Selective coronary angiography of both right and left coronary arteries was done to know the grade of occlusion in autopsy samples with a history of sudden cardiac death.5cm slice, of coronary artery segments were taken at the level of the highest grade of stenosis. Decedents hearts were selected as the control and cases based on patients history and 3D image build after selective coronary Angiography (without any coronary occlusion). In control group segments were taken from the proximal part of both the Right and left coronary arteries for Analysis. A routine histo-technique was done to grade the stenosis in case study group on sections taken at the level of maximum occlusion. Immunohistochemical staining was done in all sections to know the VEGF expression of endothelial cells and infiltrated Monocyte. VEGF expression was then correlated based on the grades of stenosis, presence of cardiovascular risk factors like diabetes mellites and hypertension.
Results: The Coronary artery with less than 90% stenosis showed no substantial VEGF expression. A statistical significance was found when the VEGF expression was correlated with the various grade of stenosis and the presence of cardiovascular risk factors like diabetes Mellitus.
Conclusion: Considerable variation was shown in the Monocyte migration and expression of the VEGF in the endothelial cells of the coronary artery in Diabetic patients in higher grade of stenosis. Impaired monocyte migration might explain the reduced arteriogenic potential in diabetic patients when corelated with the control group.
Keywords: Coronary artery disease, Selective Coronary Angiography, VEGF (Vascular endothelial growth factor), Arteriogenesis, Angiogenesis, Diabetes mellitus.
REFERENCES
[1]. John A, Ambrose, Manmeet sigh. Pathophysiology of coronary artery disease leading to acute coronary syndrome. Prime report.2015;7(08):07-08.
https://doi.org/10.12703/P7-08
PMid:25705391 PMCid:PMC4311268
[2]. Garg M, Aggrawal A,Kataria S. Coronary atherosclerosis and Myocardial infarction. An autopsy study. J Indian Acad Forensic Med.2011; 33:971-973.
[3]. A sreeniwas Kumar, Nakul Sinha. Cardiovascular disease in India A 360 degree over view. Med J Armed forces India .2020;76(01):1-3.
https://doi.org/10.1016/j.mjafi.2019.12.005
PMid:32020960 PMCid:PMC6994761
[4]. Sian-Tsung Tan, William Scott, Vasileios Panoulas, Joban Sehmi, Weihua Zhang, James Scott , Paul Elliott, John Chambers, Jaspal S Kooner. Coronary heart disease in Indian Asians. Glob Cardiol Sci Pract. 2014; 2014(1): 13-23.
https://doi.org/10.5339/gcsp.2014.4
PMid:25054115 PMCid:PMC4104373
[5]. J Waltenberger. Impaired collateral vessel development in diabetes: potential cellular mechanism and therapeutic implications.2001; 4:554-560.
https://doi.org/10.1016/S0008-6363(00)00228-5
PMid:11166268
[6]. Ryo Naito and Takatoshi Kasai. Coronary artery disease in type 2 diabetes mellitus: Recent treatment strategies and future perspectives. World J Cardiol. 2015;7(3):119-124.
https://doi.org/10.4330/wjc.v7.i3.119
PMid:25810811 PMCid:PMC4365308
[7]. Doron Aronson and Elazer R. Edelman. Revascularization for coronary artery disease in diabetes mellitus: Angioplasty, stents and coronary artery bypass grafting. Rev EndocrMetabDisord.2010;11(1):75-86.
https://doi.org/10.1007/s11154-010-9135-3
PMid:20221852 PMCid:PMC3076727
[8]. J Koerselman 1, P P Th de Jaegere, M C Verhaar, Y van der Graaf, D E Grobbee, J Hum Hypertens. High blood pressure is inversely related with the presence and extent of coronary collaterals. 2005;19(10):809-1.
https://doi.org/10.1038/sj.jhh.1001917
PMid:16107856
[9]. Mohamed Khalfallah, EnasDraz, Khaled Shalaby, Yasser Mostafa Hafez. Predictors of poorly developed coronary collateral circulation in patients with subclinical hypothyroidism suffered from chronic stable angina. Glob Cardiol Sci Pract. 2019; 10:1-10.
https://doi.org/10.21542/gcsp.2019.10
PMid:31799285 PMCid:PMC6865308
[10]. Z Sun, Shen Y, Lu et al. Clinical and angiographic features associated with coronary collateralization instable angina patients with chronic total occlusion. J Zhenjiang Univ Sci B.2013; 14(8):705-712.
https://doi.org/10.1631/jzus.BQICC704
PMid:23897789 PMCid:PMC3735970
[11]. Daniel Bexell, Randolph M Setser, Paul Schoenhagen, Michael L Lieber, Sorin J Brener, Thomas B Ivanc, Eva M Balazs, Thomas P O’Donnell, Arthur E Stillman,1 HåkanArheden, Galen S Wagner, and Richard D White. Influence of Coronary Artery Stenosis Severity and Coronary Collateralization on Extent of Chronic Myocardial Scar: Insights from Quantitative Coronary Angiography and Delayed-Enhancement MRI.Open Cardiovasc Med J. 2008; 2:9-86.
https://doi.org/10.2174/1874192400802010079
PMid:19337359 PMCid:PMC2627523
[12]. T Wang,J Tian, SHan,YJin,Correlation between circulating vascular endothelial growth factor level and coronary artery Disease and its influence on the establishment of coronary collateral circulation: a systemic review and meta-analysis. Journal of Xiangya Medicine.2002;6:6-19.
https://doi.org/10.21037/jxym-21-3
[13]. S Balakrishnan,S Kumar.Correlation of serum vascular endothelial growth factor and cardiovascular risk factors on collateral formation in patients with acute coronary arterysyndrome.Clinicalanatomy,35(5):673-678.
https://doi.org/10.1002/ca.23890
PMid:35451175
[14]. Go Inokuchi, Daisuke Yajima, Mutsumi Hayakawa, Ayumi Motomura, Fumiko Chiba, Suguru Torimitsu , Yohsuke Makino, Hirotaro Iwase. The utility of postmortem computed tomography selective coronary angiography in parallel with autopsy. ForensicSciMed Pathol.2013;9:506-514.
https://doi.org/10.1007/s12024-013-9473-z
PMid:23846906
[15]. Harrison T R and Kasper, D L. Harrison’s Principles of Internal Medicine. Mc Graw -Hill.2005;16:1425-1462.
https://doi.org/10.1016/S1097-8690(05)71780-7
[16]. Jang JS, Jin HY, Seo JS, Yang TH, Kim DK, Kim DS, Kim DK, Seol SH, Kim DI, Cho KI, Kim BH, Park YH, Je HG, Jeong YH, Kim WJ, Lee JY, Lee SW. A meta-analysis of randomized controlled trials. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] 2012. York (UK): Centre for Reviews and Dissemination (UK); 1995.
[17]. M Inoue, H Itoh, M Ueda, T Naruko, A Kojima, R Komatsu, K Doi, Y Ogawa, N Tamura, K Takaya, T Igaki, J Yamashita, T H Chun, K Masatsugu, A E Becker, K Nakao. Vascular endothelial growth factor (VEGF) expression in human coronary atherosclerotic lesions: possible pathophysiological significance of VEGF in progression of atherosclerosis. Circulation.1998;98(20):2108-16.
https://doi.org/10.1161/01.CIR.98.20.2108
PMid:9815864
[18]. M H Prabhu. Prabhu.M.H, Siraj Ahmed S, Aftab Begum. Atherosclerosis of Coronary Arteries-An autopsy study. Global journal of Medical Research. 2013;13(3):19-24.
[19]. Vandana Porwal, Shweta Khandelwal. Deepali Jain, Seema Gupta. Histological classification of atherosclerosis and correlation with ischemic heart disease: A autopsy based study. Annals of Pathology and Laboratory Medicine. 2016; 6(3):99-104.
[20]. Ylä-Herttuala S, Rissanen T. T, Vajanto I, Hartikainen J. Vascular Endothelial Growth. Factors.J.Am.Coll.Cardiol.2007;49:1015-1026.
https://doi.org/10.1016/j.jacc.2006.09.053
PMid:17349880
[21]. Ze-Mou Yu , Xiao-Tao Deng , Ruo-Mei Qi , Lu-Yan Xiao , Chong-Qing Yang , Tao Gong. Mechanism of Chronic Stress-induced Reduced Atherosclerotic Medial Area and Increased Plaque Instability in Rabbit Models of Chronic Stress. Chin Med J (E 2018; 20;131(2):161-170.
https://doi.org/10.4103/0366-6999.222322
PMid:29336364 PMCid:PMC5776846
[22]. M.S. Pepper, N. Ferrara, L. Orci, R. Montesano. Potent synergism between vascular endothelial growth factor and basic fibroblast growth factor in the induction of angiogenesis in vitro.Biochem Biophys Res Commun. 1992 Dec 15;189(2):824-31.
https://doi.org/10.1016/0006-291X(92)92277-5
PMid:1281999
