Characterization of macrophages in the decidual atherotic spiral artery with special reference to the cytology of foam cells.

"Acute atherosis" is characteristic in the spiral arteries of the placental bed of preeclampsia and a wide range of pregnancy disorders. The arterial lesion is histologically characterized by fibrinoid necrosis of the vessel walls with infiltration of foam cells, which under a light microscope appears similar to that seen in atherosclerosis. Although acute atherosis is currently considered as atheromatous-like lesions, the precise cellular mechanisms inducing these changes remain unelucidated. By histochemistry, immunohistochemistry, and electron microscopy, we investigated the decidual spiral arteries obtained by placental bed biopsy from 11 preeclamptic and 15 nonpreeclamptic women. In the decidual spiral arteries of preeclamptic patients, acute atherosis was observed in 23.5% (20/85 arteries). Fibrin deposition and accumulation of foam cells were observed more frequently in preeclamptic patients than in nonpreeclamptic patients. Endothelial cells remained in the atheromatous lesion, while the smooth muscle layer surrounding fibrin and foam cells became thin and was finally destroyed. The foam cells were immunohistochemically shown to be macrophages and neutral fat and phospholipids were histochemically demonstrated in them. Ultrastructurally, their cytoplasm was occupied by variously sized lipid droplets and membrane-bound myelin-like granules (myelinosomes). Plasma concentration of monocyte chemoattractant protein 1 (MCP-1), a potent monocyte chemoattractant factor, was significantly elevated in preeclamptic patients compared with normal healthy controls (P < 0.01). In conclusion, injuries to the smooth muscle layer and intramural fibrinoid necrosis may result in infiltration of monocytes into the arterial walls, their maturation into macrophages, and the transformation into foam cells. Considering that atherosclerosis is developed by accumulation of lipid-laden macrophages and migration and proliferation of smooth muscle cells, the roles of macrophages in acute atherosis differ from those in atherosclerosis.