Summary
Atherosclerosis is the major etiological process responsible for 25% of global deaths. Numerous reports
indicate both the adaptive and innate immune systems are involved in atherogenesis. In addition to well-
established risk factors such as age, hypertension, high circulating levels of low-density lipoprotein cholesterol,
and type 2 diabetes, the quality and quantity of sleep are now recognized as important factors for
atherogenesis. Sleep is vital for life. In the USA, ~70 million people report insufficient sleep and/or fragmented
sleep due to work responsibilities, sleep apnea, caregiving, and lifestyle choices. Changes in sleep are a part
of the normal aging process, leading to increased sleep fragmentation (SF), nighttime awakenings, and a
greater tendency for daytime sleep. Dysregulation of normal sleep negatively affects homeostatic functions and
is associated with an increased risk of chronic diseases, including atherosclerosis. Long-term SF may lead to
endothelial dysfunction, oxidative stress, and altered vessel wall structure. SF has a negative impact on
atherogenesis through the regulation of myelopoiesis, highlighting the complex relationship between sleep, the
vascular system, and the immune system. One of the remaining outstanding questions in the field is the extent
to which SF affects the vulnerability of plaques. Another important question that remains to be investigated is
whether the restoration of sleep quality might reduce atherosclerosis development and improve the phenotype
of the plaques.
Our results indicate that SF supports neutrophil functions such as ROS and NET production. We detect
increased circulating levels of LPS that might serve as a neutrophil activator during SF. Competitive homing
experiments clearly demonstrated that SF directs neutrophil recruitment into the aorta. Importantly, neutrophil
depletion improves plaque phenotype of SF mice. One of the strongest phenotypes observed in the circulation
and the gut was a significant degree of oxidative stress, cell death, and neutrophil activation. Gut inflammation
was also supported by alterations in the intestinal immune composition. In this application, we propose the
hypothesis that disturbed sleep negatively influences gut-associated inflammation, triggering LPS-induced
oxidative stress, and activating neutrophils, which, in turn, plays a key role in the formation of accelerated
vulnerable plaques. Here, we propose to investigate the role of NADPH-dependent oxidative stress in
vulnerable atherosclerotic plaque formation in response to SF in HFD-fed via neutrophil or intestinal epithelial
cell-specific NADPH-deficient Apoe-/- mice (Aim 1). In Aim 2, we will test to what extent restoring sleep quality
would improve the phenotype of atherosclerotic plaques and reduce atherogenesis. The findings from this
proposal could lead to the development of new treatments aimed at preventing gut-associated and neutrophil-
induced oxidative stress and suppressing accelerated atherogenesis induced by SF.