Annexin A5 prevents post-interventional accelerated atherosclerosis development in a dose-dependent fashion in mice

BackgroundActivated cells in atherosclerotic lesions expose phosphatidylserine (PS) on their surface. Annexin A5 (AnxA5) binds to PS and is used for imaging atherosclerotic lesions. Recently, AnxA5 was shown to inhibit vascular inflammatory processes after vein grafting. Here, we report a therapeutic role for AnxA5 in post-interventional vascular remodeling in a mouse model mimicking percutaneous coronary intervention (PCI).Methods and resultsAssociations between the rs4833229 (OR = 1.29 (CI 95%), pallelic = 0.011) and rs6830321 (OR = 1.35 (CI 95%), pallelic = 0.003) SNPs in the AnxA5 gene and increased restenosis-risk in patients undergoing PCI were found in the GENDER study. To evaluate AnxA5 effects on post-interventional vascular remodeling and accelerated atherosclerosis development in vivo, hypercholesterolemic ApoE−/− mice underwent femoral arterial cuff placement to induce intimal thickening. Dose-dependent effects were investigated after 3 days (effects on inflammation and leukocyte recruitment) or 14 days (effects on remodeling) after cuff placement. Systemically administered AnxA5 in doses of 0.1, 0.3 and 1.0 mg/kg compared to vehicle reduced early leukocyte and macrophage adherence up to 48.3% (p = 0.001) and diminished atherosclerosis development by 71.2% (p = 0.012) with a reduction in macrophage/foam cell presence. Moreover, it reduced the expression of the endoplasmic reticulum stress marker GRP78/BiP, indicating lower inflammatory activity of the cells present.ConclusionsAnxA5 SNPs could serve as markers for restenosis after PCI and AnxA5 therapeutically prevents vascular remodeling in a dose-dependent fashion, together indicating clinical potential for AnxA5 against post-interventional remodeling.

► SNPs in the AnxA5 gene are associated with increased restenosis-risk in PCI patients. ► AnxA5 dose-dependently prevents vascular leukocyte infiltration following injury. ► Vascular inflammation and remodeling are reduced by AnxA5-treatment in mice. ► The arterial wall inflammatory phenotype is improved by AnxA5-treatment.