Novel visualization techniques towards identification of atherosclerotic patients at risk

Atherosclerosis is an inflammatory disease of the artery wall. The genesis of atherosclerosis is associated with auto-immune diseases (the immune system turns against constituents of the own body) such as rheumatoid arthritis (RA). Atherosclerosis is a chronic process that leads to the formation of atherosclerotic plaques, making the blood vessels thinning. In the first part of this thesis, several markers for early atherosclerosis were examined by measurements in the blood, such as endothelial precursor cells (EPCs), vascular endothelial growth factors (VEGF), soluble vascular cell adhesion molecul-1 (sVCAM-1), trombomoduline (TM or CD141) and von Willebrand Factor (vWF). The vascular elasticity can also be measured (small arterial elasticity; SAE) and the advanced glycation end products (AGEs; measured in the skin with fluorescence). These are related to disease activity in patients with RA, and can therefore be used as risk estimation of cardiovascular disease.  Plaques are vulnerable to rupture, which is directly related to cardiovascular diseases, such as a heart attack or stroke. Vulnerable plaques are characterized by inflammation. Possibly macrophages (inflammatory cells) can be used to identify inflammatory responses in atherosclerosis, and therefore predict the risk of cardiovascular disease. In the second part of the thesis we identified inflammatory responses using folate receptor-beta, which is on the surface of activated macrophages, by means of an optical fluorescent contrast agent (FITC) and technetium. Also, matrix metalloproteinases (MMPs; proteins that break down the matrix) have been made visible.