Abstract 3134: Integrated Multi-Omics Profiling Reveals Neutrophil Extracellular Traps Promote Aortic Dissection

Background: Negative aortic remodeling increases the risk of aorta-related adverse events (AAEs) after thoracic endovascular aortic repair (TEVAR) for patients with aortic dissection (AD). Research Questions and Aims: It is worth investigating prognostic indicators to streamline the identification of individuals at elevated risk for postoperative AAEs, and therapeutic targets to optimize the efficacy of TEVAR. Methods: We performed single-cell transcriptomic and proteomic profiling of aortic lesions and peripheral blood samples, respectively. We then integrated single-cell with publicly accessible bulk data to identify phenotype-relevant subpopulations. We further confirmed the results in human plasma samples and in mouse models. The Cox regression analysis were used to identify independent risk factors. Results: Integrated multi-omics analysis identified a highly phenotype-associated and disease-relevant macrophage subset, which closely interacted with neutrophil via CXCL3/CXCR2 axis, and promoted neutrophil extracellular traps (NETs) within aortic lesion. Likewise, increased NETs formation is a defining feature of systemic immunity of AD, with an expansion of inflammatory cytokines in the peripheral blood. Furthermore, we demonstrated that in a prospective cohort of 115 patients with a median follow-up of 13 months, the level of citrullinated histone H3 (CitH3), a NETs marker, could serve as a risk factor for the occurrence of AAEs following TEVAR (HR 8.78, p < .001). The CitH3 level, determined at a cut-off value of 6.9 ng/ml, predicted the postoperative AAEs with a sensitivity and specificity of 0.6 and 0.9, respectively, and an area under the curve of 0.75. In addition, inhibiting NETs formation through the blockade of CitH3 alleviated the progression and rupture of AD in mice. Conclusions: The multi-omics profiling reveals highly disease-relevant macrophage subpopulation, which promotes NETs formation and inflammation infiltration in the development of AD. Increased NETs formation is a defining feature of both aortic lesion and peripheral blood of patients with AD. CitH3 could facilitate the risk stratification and prognostic evaluation, and might serve as potential therapeutic targets of patients with AD.