Effect of circulating monocyte subsets and endothelial progenitor cells on coronary plaque rupture

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Monocytes represent a heterogenous circulating population of cells. We showed that dynamic changes occur in 2 distinct monocyte subset levels (CD14^+CD1^6-CCR2^+ and CD14^+CD16^+CX3CR1^+) in patients with acute myocardial infarction, and that stochastic profiling of this monocyte system may have hold clinical utility with respect to cardiovasculardiseases (J Am Coll Cardiol. 2009). Early diagnosis and risk stratification of patients with stable angina pectoris (SAP), or acute coronary syndrome is of utmost importance. We examined the impact of circulating monocyte subset levels on the burden of coronary vulnerable plaque. First, we investigated the relationship between monocyte subsets and coronary plaque vulnerability, such as positive remodeling (remodeling index >1.05) and/or low CT attenuation (<35 HU), assessed by multi-detector computed tomography (MDCT) in 80 patients with SAP. The distinct monocyte subsets were measured by flow cytometry. The relative proportions of CD14^+CD16^+CX3CR1^+ monocytes were significantly higher in patients with coronary vulnerable plaque than in patients without it. These monocyte subpopulations positively correlated with remodeling index, and negatively with CT attenuation value (Atherosclerosis. 2010). Next, we examined the association of monocyte subset counts with coronary fibrous cap thickness (FCT) in 40 patients with unstable angina pectoris. The changes in the non-culprit FCT were assessed by optical coherence tomography (OCT) at baseline and after 9 months. The percent changes in FCT showed significantly negative correlation with the percent changes in CD14^+CD16^+CX3CR1^+ monocytes, but not CD14^+CD16^-CCR2^+monocytes (Atherosclerosis. 2010). In conclusion, CD14+CD16^+CX3CR1^+ monocytes may serve as a novel biomarker for coronary plaque vulnerability.