Background: Cardiac issues following radiotherapy are increasingly prevalent among patients with thoracic cancer and coronary disease. However, the mechanisms underlying radiotherapy-induced plaque instability and changes in plaque characteristics on imaging remain unclear. This study used single-cell RNA sequencing to identify key features of vulnerable plaques following radiotherapy.
Methods: We applied dual-mode synchronized optical coherence tomography-intravascular ultrasound imaging in a rabbit model to reveal the characteristics of vulnerable plaques at various time points postradiotherapy. We then conducted single-cell RNA sequencing on atherosclerotic lesions from ApoE-/- (apolipoprotein E-/-) mice across 3 stages: nonirradiated, early irradiation, and advanced irradiation. Bioinformatics was used to analyze cell populations, trajectories, and interaction differences among the groups. This was followed by pathological staining, flow cytometry, gene knockout, and antibody depletion.
Results: In vivo optical coherence tomography-intravascular ultrasound imaging at the initial stage accurately evaluated radiation exposure's effect on the stability of rabbit carotid plaques. High-throughput single-cell transcriptomics mapped the radiotherapy-induced immune system remodeling in atherosclerotic lesions, and identified a granzyme K+ CD8+ (cluster of differentiation 8+) T-cell subpopulation. The infiltrating cells highly expressed the cytotoxic molecule GZMB (granzyme B) in the plaques. The absence of CD8+ T cells or GZMB ameliorated radiotherapy-exacerbated atherosclerotic lesions. This demonstrates the pathogenic function of GZMK+ (granzyme K+) CD8+ cytotoxic T cells in promoting radiotherapy-induced atherosclerotic lesion progression.
Conclusions: We identified characteristic arterial imaging changes resulting from radiation injury, accurately and dynamically assessing the effects of radiation exposure on plaque stability. Radiation exposure affected plaque stability by modulating GZMK+ CD8+ T-cell activation and GZMB function, suggesting GZMB as a mediator of radio-cardiovascular injury and a potential therapeutic target.
Keywords: CD8 T cell; atherosclerosis; optical coherence tomography; radiotherapy; single‐cell RNA sequencing.