CD163+macrophages restrain vascular calcification, promoting the development of high-risk plaque

Vascular calcification (VC) is concomitant with atherosclerosis, yet it remains uncertain why rupture-prone high-risk plaques do not typically show extensive calcification. Intraplaque hemorrhage (IPH) deposits erythrocyte-derived cholesterol, enlarging the necrotic core and promoting high-risk plaque development. Pro-atherogenic CD163+ alternative macrophages engulf hemoglobin:haptoglobin (HH) complexes at IPH sites. However, their role in VC has never been examined to our knowledge. Here we show, in human arteries, the distribution of CD163+ macrophages correlated inversely with VC. In vitro experiments using vascular smooth muscle cells (VSMCs) cultured with HH-exposed human macrophage - M(Hb) - supernatant reduced calcification, while arteries from ApoE-/- CD163-/- mice showed greater VC. M(Hb) supernatant- exposed VSMCs showed activated NF-KB, while blocking NF-KB attenuated the anticalcific effect of M(Hb) on VSMCs. CD163+ macrophages altered VC through NF-KB-induced transcription of hyaluronan synthase (HAS), an enzyme that catalyzes the formation of the extracellular matrix glycosaminoglycan, hyaluronan, within VSMCs. M(Hb) supernatants enhanced HAS production in VSMCs, while knocking down HAS attenuated its anticalcific effect. NF-KB blockade in ApoE-/- mice reduced hyaluronan and increased VC. In human arteries, hyaluronan and HAS were increased in areas of CD163+ macrophage presence. Our findings highlight an important mechanism by which CD163+ macrophages inhibit VC through NF-KB-induced HAS augmentation and thus promote the high-risk plaque development.

Automated summary

Vascular calcification (VC) and atherosclerosis coexist, but it is unclear why rupture-prone high-risk plaques do not typically calcify extensively. In this study, the researchers found that CD163+ macrophages, which are involved in atherosclerosis, have an inverse correlation with VC in human arteries. They also discovered that these macrophages inhibit VC through NF-KB-induced hyaluronan synthase (HAS), an enzyme that plays a role in the formation of the extracellular matrix. These findings provide insights into the mechanism by which CD163+ macrophages promote high-risk plaque development by inhibiting VC.