Erdem TEZCAN, Ayhan OLCAY, Onur YOLAY, Emir CANTÜRK, Barış AKDEMİR, Bekir İNAN

Cerrahi Endarterektomi Plaklarının Elemental Yapısı

GİRİŞ ve AMAÇ: Epidemiyolojik çalışmalar diyet, sigara ve çevresel faktörler ile alınan metallerin artmış kardiyovasküler risk oluşturduğunu göstermektedir. Aterosklerotik karotis plaklarının element yapısı ile ilgili sınırlı çalışma mevcuttur. YÖNTEM ve GEREÇLER: Çalışmada cerrahi karotis endarterektomi materyallerinin element yapısı ve hastaların klinik özellikleri incelendi. Karotis endarterektomi yapılan 19 hastadan alınan plaklarda indüktif-eşli plazma emisyon spektrometresi (ICP-OES) yöntemi ile element yapısı incelendi. BULGULAR: Hastalardan sadece iki tanesi kadındı. Ortalama yaş 71.9±7.2 yıl olarak bulundu. Hastaların %47.4'ünde diyabet ve %52.6'sında hipertansiyon saptandı. Sadece 1 hasta hiç sigara içmemişti. Plaklarda sodyum (Na), magnezyum (Mg), potasyum (K), kalsiyum (Ca), fosfor (P), demir (Fe), bakır (Cu), bor (B), manganez (Mn), çinko (Zn), alüminyum (Al), sülfür (S), krom (Cr), nikel (Ni), platin (Pt), antimon (Sb), selenyum (Se) elementleri farklı konsantrasyonda saptandı fakat arsenik (As), bizmut (Bi), kadmiyum (Cd), kobalt (Co), molibden (Mo), kurşun (Pb) seviyeleri ICP-OES sisteminin belirleme limitinin altında saptandı. Hastalarda varyasyon olmakla birlikte en yoğun olarak Ca ve P saptandı. TARTIŞMA ve SONUÇ: Saptanan elementlerin aterojenik sürece katkıları detaylı incelenmelidir. Ca ve P'nin sık bulunan Ca(NO3)2, CaCl2, Na2HPO4, (NH4)2HPO4 gibi tuzları kanda ve suda yüksek çözünürlüğe sahiptir fakat Ca10 (PO4)6(OH)2'nin (kemikteki hidroksi apatit) çözünürlüğü çok düşüktür. Kan akımı ile aterosklerotik plak arasında bir hücre tabakası olduğu için muhtemelen Ca ve P elementleri plak içine ayrı olarak gelip suda çözünmeyen kompleksler oluşturarak birikmektedir. Karotis plaklarında element birikmesi, bu elementleri kemik ve diyetten gelen kısımlarının detaylı araştırılması ile yeni önleyici ve tedavi edici yaklaşımlar geliştirilebilir.

Elemental Composition Of Surgically Removed Carotid Plaques

INTRODUCTION: Epidemiological studies indicate thatmetal exposure through diet, environment and smoking isassociated with increased risk of cardiovascular disease. Thereare few data on the elemental composition of atheroscleroticcarotid plaques.METHODS: We examined clinical characteristics andelemental composition of surgical carotid endarterectomyplaques. Carotid endarterectomy plaques from 19 patientswere collected and elemental compositions were determined byinductively coupled plasma optical emission spectrometry(ICP-OES) method.RESULTS: Two of the 19 patients were female. Average ageof the patients was 71.9±7.2 years. 47.4% of the patients werediabetic and 52.6% were hypertensive. Only one of the patientsnever smoked. Sodium (Na), magnesium (Mg), potassium (K),calcium (Ca), phosphorus (P), iron (Fe), copper (Cu), boron(B), manganese (Mn), zinc (Zn), aluminum (Al), sulphur (S),chromium (Cr), nickel (Ni), platinum (Pt), antimony (Sb),selenium (Se) were found in different concentrations butconcentrations of arsenic (As), bismuth (Bi), cadmium (Cd),cobalt (Co), molybdenum (Mo), lead (Pb) in the carotidendarterectomy samples were below the detection limit of ICPOES.Despite of fluctuations of metal concentrations amongthe patients, concentrations of Ca and P were significantlyhigh with averages of 68613 ppm and 36669 ppm respectively.DISCUSSION AND CONCLUSION: Results of those elementlevels should be carefully evaluated for their role inproatherogenic role. Common salts of Ca and P such asCa(NO3)2, CaCl2, Na2HPO4, (NH4)2HPO4 are highlysoluble in water and in blood but complexes of Ca with P suchas Ca10(PO4)6(OH)2 (hydroxyapatite in bones) has very lowsolubility. Since there is a cell layer between theatherosclerotic plaques and the blood flow, probably solublesalts of Ca and P ions come to the accumulation site separatelyand they form insoluble complexes, which cannot pass the celllayer and accumulate. Also, reasons of the elementalaccumulation and sources of the elements from bones, diet orother sources should be investigated in detail because theylead to development of new preventive and treatmentapproaches for carotid atherosclerotic plaques.

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