Treatment with a GnRH receptor agonist, but not the GnRH receptor antagonist degarelix, induces atherosclerotic plaque instability in ApoE(-/-) mice.

Androgen-deprivation therapy (ADT) for prostate cancer has been associated with increased risk for development of cardiovascular events and recent pooled analyses of randomized intervention trials suggest that this primarily is the case for patients with pre-existing cardiovascular disease treated with gonadotropin-releasing hormone receptor (GnRH-R) agonists. In the present study we investigated the effects of the GnRH-R agonist leuprolide and the GnRH-R antagonist degarelix on established atherosclerotic plaques in ApoE(-/-) mice. A shear stress modifier was used to produce both advanced and more stable plaques in the carotid artery. After 4 weeks of ADT, increased areas of necrosis was observed in stable plaques from leuprolide-treated mice (median and IQR plaque necrotic area in control, degarelix and leuprolide-treated mice were 0.6% (IQR 0-3.1), 0.2% (IQR 0-4.4) and 11.0% (IQR 1.0-19.8), respectively). There was also evidence of increased inflammation as assessed by macrophage immunohistochemistry in the plaques from leuprolide-treated mice, but we found no evidence of such changes in plaques from control mice or mice treated with degarelix. Necrosis destabilizes plaques and increases the risk for rupture and development of acute cardiovascular events. Destabilization of pre-existing atherosclerotic plaques could explain the increased cardiovascular risk in prostate cancer patients treated with GnRH-R agonists.

Scientific reports. 2016 May 18*** epublish ***

Anki Knutsson, Sabrina Hsiung, Selvi Celik, Sara Rattik, Ingrid Yao Mattisson, Maria Wigren, Howard I Scher, Jan Nilsson, Anna Hultgårdh-Nilsson

Department of Experimental Medical Science, Lund University, Lund, Sweden., Department of Experimental Medical Science, Lund University, Lund, Sweden., Department of Experimental Medical Science, Lund University, Lund, Sweden., Department of Clinical Sciences Malmoe, Lund University, Malmoe, Sweden., Department of Clinical Sciences Malmoe, Lund University, Malmoe, Sweden., Department of Clinical Sciences Malmoe, Lund University, Malmoe, Sweden., Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY., Department of Clinical Sciences Malmoe, Lund University, Malmoe, Sweden., Department of Experimental Medical Science, Lund University, Lund, Sweden.