Female Gene Networks Are Expressed in Myofibroblast-Like Smooth Muscle Cells in Vulnerable Atherosclerotic Plaques

Ernest Diez Benavente, Santosh Karnewar, Michele Buono, Eloi Mili, Robin J G Hartman, Daniek Kapteijn, Lotte Slenders, Mark Daniels, Redouane Aherrahrou, Tobias Reinberger, Barend M Mol, Gert J de Borst, Dominique P V de Kleijn, Koen H M Prange, Marie A C Depuydt, Menno P J de Winther, Johan Kuiper, Johan L M Björkegren, Jeanette Erdmann, Mete CivelekMichal Mokry, Gary K Owens, Gerard Pasterkamp, Hester M den Ruijter


BACKGROUND: Women presenting with coronary artery disease more often present with fibrous atherosclerotic plaques, which are currently understudied. Phenotypically modulated smooth muscle cells (SMCs) contribute to atherosclerosis in women. How these phenotypically modulated SMCs shape female versus male plaques is unknown.

METHODS: Gene regulatory networks were created using RNAseq gene expression data from human carotid atherosclerotic plaques. The networks were prioritized based on sex bias, relevance for smooth muscle biology, and coronary artery disease genetic enrichment. Network expression was linked to histologically determined plaque phenotypes. In addition, their expression in plaque cell types was studied at single-cell resolution using single-cell RNAseq. Finally, their relevance for disease progression was studied in female and male Apoe-/- mice fed a Western diet for 18 and 30 weeks.

RESULTS: Here, we identify multiple sex-stratified gene regulatory networks from human carotid atherosclerotic plaques. Prioritization of the female networks identified 2 main SMC gene regulatory networks in late-stage atherosclerosis. Single-cell RNA sequencing mapped these female networks to 2 SMC phenotypes: a phenotypically modulated myofibroblast-like SMC network and a contractile SMC network. The myofibroblast-like network was mostly expressed in plaques that were vulnerable in females. Finally, the mice ortholog of key driver gene MFGE8 showed retained expression in advanced plaques from female mice but were downregulated in male mice during atherosclerosis progression.

CONCLUSIONS: Female atherosclerosis is characterized by gene regulatory networks that are active in fibrous vulnerable plaques rich in myofibroblast-like SMCs.

Original languageEnglish
JournalArteriosclerosis, Thrombosis, and Vascular Biology
Issue number10
Pages (from-to)1836-1850
Number of pages15
Publication statusPublished - 10.2023

Research Areas and Centers

  • Research Area: Medical Genetics
  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 201-05 General Genetics and Functional Genomics

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