经皮冠状动脉介入治疗术后支架内再狭窄患者血浆Rap1A水平变化及其机制

Changes of plasma Rap1A levels in patients with in-stent restenosis after percutaneous coronary intervention and the underlying mechanisms

目的:经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)是冠状动脉疾病(coronary artery disease,CAD)的主要治疗方法之一,PCI术后支架内再狭窄(in-stent restenosis,ISR)是其一种严重的并发症,然而目前缺乏有效的防治手段。本研究拟检测Ras相关蛋白1A(Ras-related protein 1A,Rap1A)在ISR患者血浆中的表达水平及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)诱导人脐静脉内皮细胞(human umbilical vein endothelial cells,HUVECs)炎症损伤模型中的表达差异,并探讨Rap1A在调控TNF-α诱导的HUVECs炎症中的作用,为ISR的防治提供一个新的潜在靶点。方法:纳入2020年12月至2022年7月于中南大学湘雅医院心血管内科接受PCI支架植入术,且术后1年复查经皮冠状动脉造影(coronary arteriography,CAG)的冠心病住院患者共60例。患者入院后根据CAG诊断27例为PCI术后ISR,33例为无支架内再狭窄(non-in-stent restenosis,non-ISR)。收集2组患者的临床资料,并通过酶联免疫吸附法(enzyme linked immunosorbent assay,ELISA)测定患者血浆Rap1A水平,比较2组患者血浆Rap1A水平。在细胞实验中,通过TNF-α(10 ng/mL,24 h)构建HUVECs炎症损伤模型,采用实时反转录聚合酶链反应(realtime reverse transcription PCR,real-time RT-PCR)和蛋白质印迹法检测Rap1A、白细胞介素-6(interleukin-6,IL-6)和血管细胞黏附分子-1(vascular cell adhesion molecule-1,VCAM-1)的mRNA及蛋白质表达水平。以TNF-α处理HUVECs诱导内皮细胞炎症,并运用小干扰RNA(small interfering RNA,siRNA)敲减Rap1A,以探究Rap1A在调控TNF-α诱导的HUVECs炎症中的作用。结果:与non-ISR患者相比,ISR患者中有吸烟史(P=0.005)及合并糖尿病者比例更高(P=0.028),糖化血红蛋白(glycosylated hemoglobin,HbA1c)(P=0.012)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-c)(P=0.014)及高敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)(P=0.027)水平升高,余指标在2组间差异均无统计学意义(均P>0.05)。而ISR组的血浆Rap1A水平显著高于non-ISR组[942.14(873.28~1133.81)μg/mL vs 886.93(812.61~930.98)μg/mL;P=0.004]。单因素logistic回归分析结果显示糖尿病、LDL-c、Rap1A是ISR的危险因素(均P<0.05)。在细胞实验中,与对照组相比,以10 ng/mL TNF-α诱导24 h后,HUVECs中炎症因子IL-6、VCAM-1的mRNA及蛋白质表达水平均升高(均P<0.05),同时Rap1A的mRNA及蛋白质水平升高(均P<0.05)。进一步通过敲减HUVECs中Rap1A基因的表达,TNF-α诱导的IL-6、VCAM-1的mRNA及蛋白质表达水平均显著降低(均P<0.05)。结论:在冠心病PCI术后ISR患者血浆及TNF-α诱导的内皮细胞炎症损伤模型中,Rap1A蛋白质水平显著升高,提示Rap1A可能是预测ISR的潜在生物标志物。而在敲减Rap1A基因表达后,TNF-α诱导的内皮细胞炎症反应水平下降,提示Rap1A可能是治疗ISR内皮细胞炎症的潜在靶点。

Objective:Percutaneous coronary intervention(PCI)is one of the most important treatments for coronary artery disease(CAD).However,in-stent restenosis(ISR)after PCI is a serious complication without effective measures for prevention and treatment.This study aims to investigate the Ras-related protein 1A(Rap1A)level in ISR patients and in the tumor necrosis factor-α(TNF-α)-induced inflammatory injury model of human umbilical vein endothelial cells(HUVECs),to explore the role of Rap1A in regulating TNF-α-induced inflammation in HUVECs and to provide a new potential target for ISR prevention and treatment.Methods:A total of 60 CAD patients,who underwent PCI between December 2020 and July 2022 from the Department of Cardiovascular Medicine of Xiangya Hospital,Central South University,and re-examined coronary angiography(CAG)1 year after the operation,were included.After admission,27 patients were diagnosed with ISR and 33 patients were diagnosed with non-in-stent restenosis(non-ISR)according to the CAG.Clinical data were collected,and the plasma Rap1A level was determined by enzyme linked immunosorbent assay(ELISA).In cell experiments,an inflammatory injury model was established with TNF-αtreatment(10 ng/mL,24 h)in HUVECs.The mRNA and protein expression levels of Rap1A,interlukin-6(IL-6),and vascular cell adhesion molecule-1(VCAM-1)were measured by real-time reverse transcription PCR and Western blotting.Small interfering RNA(siRNA)was used to explore the role of Rap1A in regulating TNF-α-induced inflammation in HUVECs.Results:Compared with the non-ISR patients,a higher proportion of ISR patients had a history of smoking(P=0.005)and diabetes(P=0.028),and higher levels of glycosylated hemoglobin(HbA1c)(P=0.012),low-density lipoprotein cholesterol(LDL-c)(P=0.014),and hypersensitive C-reactive protein(hs-CRP)(P=0.027).The remaining projects did not show significant differences(all P>0.05).The plasma level of Rap1A in the ISR group was significantly higher than that in the non-ISR group[942.14(873.28 to 1133.81)μg/mL vs 886.93(812.61 to 930.98)μg/mL;P=0.004].Diabetes,LDL-c,and Rap1A were risk factors for ISR by univariate logistic regression analysis(all P<0.05).The mRNA and protein expression levels of inflammatory factors IL-6 and VCAM-1 were increased in HUVECs after 10 ng/mL TNF-αtreatment for 24 h compared with the control group(all P<0.05),while the mRNA and protein levels of Rap1A were increased(both P<0.05).After inhibition of Rap1A in HUVECs,the mRNA and protein expression levels of IL-6 and VCAM-1 were significantly decreased(all P<0.05).Conclusion:The plasma Rap1A level was significantly elevated in patients with ISR,suggesting that Rap1A may be a potential biomarker for predicting ISR.In the TNF-α-induced HUVECs inflammatory injury model,the expression level of Rap1A was increased.The level of TNF-α-induced endothelial cell inflammation was decreased after inhibition of Rap1A expression,suggesting that Rap1A may be a potential target for the treatment of endothelial cell inflammation in ISR.