Human Aortic Vascular Smooth Muscle Cells Digest Extracellular Matrix by Elaboration of Plasminogen Activators: Implications for Atherogenesis

Monoclonal Antibody chP3R99 Reduces Subendothelial Retention of Atherogenic Lipoproteins in Insulin-Resistant Rats: Acute Treatment Versus Long-Term Protection as an Idiotypic Vaccine for Atherosclerosis

BACKGROUND

Atherosclerosis is triggered by the retention of apolipoprotein B-containing lipoproteins by proteoglycans. In addition to low-density lipoprotein, remnant lipoproteins have emerged as pivotal contributors to this pathology, particularly in the context of insulin resistance and diabetes. We have previously reported antiatherogenic properties of a monoclonal antibody (chP3R99) that recognizes sulfated glycosaminoglycans on arterial proteoglycans.

METHODS AND RESULTS

Solid-phase assays demonstrated that chP3R99 effectively blocked >50% lipoprotein binding to chondroitin sulfate and vascular extracellular matrix in vitro. The preperfusion of chP3R99 (competitive effect) resulted in specific antibody-arterial accumulation and reduced fluorescent lipoprotein retention by ~60% in insulin resistant JCR:LA-cp rats. This competitive reduction was dose dependent (25-250 μg/mL), effectively decreasing deposition of cholesterol associated with lipoproteins. In a 5-week vaccination study in insulin resistant rats with (200 μg subcutaneously, once a week), chP3R99 reduced arterial lipoprotein retention, and was associated with the production of antichondroitin sulfate antibodies (Ab3) able to accumulate in the arteries (dot-blot). Neither the intravenous inoculation of chP3R99 (4.5 mg/kg), nor the immunization with this antibody displayed adverse effects on lipid or glucose metabolism, insulin resistance, liver function, blood cell indices, or inflammation pathways in JCR:LA-cp rats.

CONCLUSIONS

Both acute (passive) and long-term administration (idiotypic cascade) of chP3R99 antibody reduced low-density lipoprotein and remnant lipoprotein interaction with proteoglycans in an insulin-resistant setting. These findings support the innovative approach of targeting proatherogenic lipoprotein retention by chP3R99 as a passive therapy or as an idiotypic vaccine for atherosclerosis.

Loss of insulin receptor substrate-1 signaling induces the cardiovascular and proteo(fibrino)lytic system derangements typical of insulin resistance

BACKGROUND

Type 2 diabetes and insulin resistance have been associated with several cardiac features including diastolic heart failure, impaired ventricular function, perimicrovascular fibrosis and increased expression of plasminogen activator inhibitor type-1 (PAI-1) in coronary arterial walls. Insulin receptor substrate-1 (IRS-1) is one mediator of insulin signaling. This study was performed to determine whether induction of cardiac manifestations typical of insulin resistance and increased PAI-1 expression occur developmentally or post-developmentally as a result of loss of IRS-1-mediated signaling.

METHODS

IRS-1 knockout mice were studied at 20 weeks of age.

RESULTS

Compared with control mice, the left ventricular (LV) and cardiac mass to body weight ratios were increased. Diastolic and systolic LV diameters and decreased fractional shortening were indicative of LV dilatation and dysfunction. Coronary perimicrovascular fibrosis, an increased coronary arterial wall to lumen ratio, increased immunoreactivity of PAI-1 in the tunica media and increased PAI-1 mRNA expression were present consistent with constrained mural proteo(fibrino)lysis. These cardiac manifestations were similar to those we and others have observed previously in insulin-resistant mice without impaired IRS-1-mediated signaling.

CONCLUSIONS

Loss of IRS-1 signaling is sufficient to induce cardiac manifestations typical of insulin resistance including increased coronary arterial mural PAI-1 expression. Furthermore, increased PAI-1 expression is not dependent on IRS-1 signaling.

Dissecting hematoma of intracranial internal carotid artery in an 8-year-old girl

BACKGROUND

An 8-year-old girl had a minor fall without head trauma and she collapsed the following day while playing. She was awake but mute with focal neurologic signs when admitted to hospital. Radiologic imaging studies showed a progressive left cerebral infarct with left hemisphere vascular narrowing and beading. She died on the third hospital day.

METHODS

Autopsy including exploration of neck vessels and neuropathological examination was performed. Postmortem studies included immunostaining for immunoglobulins and fixed complement.

RESULTS

Subtotal subintimal dissections of both proximal supraclinoid internal carotid arteries were found microscopically. On the left, the subintimal dissection extended into the major branches of the left internal carotid artery as dissecting hematomas with a major compromise of the arterial lumina. Specific IgM deposition at the dissection sites was found. A literature review shows that subintimal dissection of the intracranial internal carotid artery or its branches occurs rarely, it is often fatal, and it is present in patients with a mean age of 17.5 years in cases studied pathologically. Trauma and physical exertion are the most common associated factors.

CONCLUSIONS

Among the causes of ischemic stroke in young individuals, dissecting hematomas of the intracranial portions of the internal carotid artery system rank low. Few reported cases have identifiable pre-existing pathology. The pathogenesis of dissecting hematomas in this region is reviewed and expanded with speculation regarding relevant developmental, anatomical, flow stress and possibly humoral factors that are involved in the disruption of the arterial elastica and subsequent development and extension of a subintimal hematoma resulting in luminal closure and often death.

Interleukin-4 Modulation of Platelet-Derived Growth Factor-Induced Smooth Muscle Cell Urokinase Plasminogen Activator

Platelet-derived growth factor (PDGF) stimulates smooth muscle cell (SMC) migration owing to stimulation of SMC tissue plasminogen activator (t-PA) production. In this study we examined the effects of the T-cell lymphokine interleukin-4 (IL-4) on PDGF induction of human aortic SMC antigen levels of urokinase-type plasminogen activator (u-PA) and those of plasminogen activator inhibitor-1 (PAI-1), the endogenous inhibitor of t-PA and u-PA, measured by enzyme-linked immunosorbent assays (ELISAs). u-PA antigen levels from human aortic SMC incubated with PDGF 100 ng/mL and IL-4 500 U/mL were significantly greater than those incubated with PDGF 100 ng/mL alone. Coincubation of PDGF with IL-4 did not significantly increase SMC u-PA antigen levels in cellular lysates. Coincubation with PDGF 100 ng/mL and IL-4 500 U/mL did not significantly affect SMC PAI-1 antigen levels in conditioned media or cellular lysates. Therefore, interleukin-4 modulates vascular SMC u-PA production induced by PDGF.

Phosphorothioate Oligodeoxynucleotide Inhibition of Restenosis

Antisense therapy with phosphorothioate oligodeoxynucleotides (PS oligos) has emerged as a potentially useful strategy for inhibiting angioplasty restenosis. Several groups have reported that PS oligos inhibit in vitro vascular smooth muscle cell (SMC) proliferation as well as in vivo neointimal formation after rat carotid artery balloon injury. More recent studies have revealed the presence of a PS oligo G-quartet inhibitory effect, reflecting binding of oligonucleotides to cellular proteins, which is distinct from a hybridization-dependent antisense effect. Studies with the 28-mer phosphorothioate cytidine homopolymer S-dC28 have demonstrated the presence of a non-G-quartet, non-sequence-specific inhibitory effect on SMC proliferation and migration in vitro and neointimal hyperplasia after rat carotid balloon injury in vivo. These effects are the result, in part, of the avid binding of the polyanion PS oligos to heparin-binding growth factors, such as platelet-derived growth factor (PDGF) and basic fibroblast growth factor. Moreover, S-dC28 attenuates PDGF-induced SMC tissue plasminogen activator antigen levels without affecting SMC plasminogen activator inhibitor-1 levels, thereby suggesting a PS oligo net antifibrinolytic effect that would impede SMC migration. Therefore, the further development of these drugs to inhibit angioplasty restenosis must consider the hybridization-specific antisense effects, the non-G-quartet inhibitory effects, and the non-G-quartet, non-sequence-specific inhibitory effects of the pleiotropic PS oligos.

Effects of S-dC28 on vascular smooth muscle cell adhesion and plasminogen activator production

We sought to examine phosphorothioate oligodeoxynucleotide (PS oligo) non-G-quartet, nonsequence specific effects on smooth muscle cell (SMC) adhesion by using S-dC28, a 28-mer cytidine homopolymer that lacks contiguous guanosine residues. Human aortic SMC were incubated with vehicle or various doses of S-dC28, and the number of SMC adhered to noncoated plates was determined using a Coulter Counter. S-dC28 significantly inhibited SMC adhesion. SMC adhesion dramatically improved with S-dC28 in fibronectin-coated plates. When laminin-coated plates were used, the inhibition of SMC adhesion by S-dC28 was completely reversed. Replacement of serum-free medium with 5% fetal bovine serum medium for SMC cultured on non-coated plates also greatly attenuated inhibition of adhesion by S-dC28. Human SMC TPA, UPA, and PAI-1 antigen levels were determined by ELISAs. PDGF significantly induced SMC TPA antigen production measured by an ELISA. Coincubation of PDGF with S-dC28 significantly attenuated SMC TPA antigen levels. SMC UPA antigen levels after coincubation with PDGF and S-dC28 were significantly greater than the values observed in SMC incubated in medium containing PDGF alone. SMC PAI-1 antigen levels were not altered by the addition of S-dC28. We conclude that S-dC28 inhibits human SMC adhesion and that this inhibition can be diminished by fibronectin or laminin coating of culture plates or by the presence of serum in the culture medium. Furthermore, S-dC28 attenuates SMC TPA production, thereby inhibiting SMC migration, whereas S-dC28 augments SMC UPA production, thus diminishing SMC cellular adhesion.