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Circulation. 2003;107:398-404
Published online before print January 6, 2003, doi: 10.1161/01.CIR.0000052617.91920.FD
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(Circulation. 2003;107:398.)
© 2003 American Heart Association, Inc.


Clinical Investigation and Reports

C-Reactive Protein Increases Plasminogen Activator Inhibitor-1 Expression and Activity in Human Aortic Endothelial Cells

Implications for the Metabolic Syndrome and Atherothrombosis

Sridevi Devaraj, PhD; Dan Yan Xu, MD, PhD; Ishwarlal Jialal, MD, PhD

From the Laboratory for Atherosclerosis and Metabolic Research, University of California, Davis Medical Center, Sacramento, Calif.

Correspondence to I. Jialal, MD, PhD, Laboratory for Atherosclerosis and Metabolic Research, Department of Pathology, 4635 Second Ave, Research 1 Building, Room 3000, UC Davis Medical Center, Sacramento, CA 95817. E-mail ishwarlal.jialal{at}ucdmc.ucdavis.edu

Background— Inflammation plays a pivotal role in atherosclerosis. In addition to being a risk marker for cardiovascular disease, much recent data suggest that C-reactive protein (CRP) promotes atherogenesis via effects on monocytes and endothelial cells. The metabolic syndrome is associated with significantly elevated levels of CRP. Plasminogen activator inhibitor-1 (PAI-1), a marker of atherothrombosis, is also elevated in the metabolic syndrome and in diabetes, and endothelial cells are the major source of PAI-1. However, there are no studies examining the effect of CRP on PAI-1 in human aortic endothelial cells (HAECs).

Methods and Results— Incubation of HAECs with CRP results in a time- and dose-dependent increase in secreted PAI-1 antigen, PAI-1 activity, intracellular PAI-1 protein, and PAI-1 mRNA. CRP stabilizes PAI-1 mRNA. Inhibitors of endothelial NO synthase, blocking antibodies to interleukin-6 and an endothelin-1 receptor blocker, fail to attenuate the effect of CRP on PAI-1. CRP additionally increased PAI-1 under hyperglycemic conditions.

Conclusions— This study makes the novel observation that CRP induces PAI-1 expression and activity in HAECs and thus has implications for both the metabolic syndrome and atherothrombosis. (Circulation. 2003;107:398-404.)


Key Words: inflammation • endothelium • thrombosis




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J. T. Willerson and P. M. Ridker
Inflammation as a Cardiovascular Risk Factor
Circulation, June 1, 2004; 109(21_suppl_1): II-2 - II-10.
[Abstract] [Full Text] [PDF]


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CirculationHome page
A. S.M. Shamsuzzaman, M. Winnicki, R. Wolk, A. Svatikova, B. G. Phillips, D. E. Davison, P. B. Berger, and V. K. Somers
Independent Association Between Plasma Leptin and C-Reactive Protein in Healthy Humans
Circulation, May 11, 2004; 109(18): 2181 - 2185.
[Abstract] [Full Text] [PDF]


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CirculationHome page
S. Verma, M. A. Kuliszewski, S.-H. Li, P. E. Szmitko, L. Zucco, C.-H. Wang, M. V. Badiwala, D. A.G. Mickle, R. D. Weisel, P. W.M. Fedak, et al.
C-Reactive Protein Attenuates Endothelial Progenitor Cell Survival, Differentiation, and Function: Further Evidence of a Mechanistic Link Between C-Reactive Protein and Cardiovascular Disease
Circulation, May 4, 2004; 109(17): 2058 - 2067.
[Abstract] [Full Text] [PDF]


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ChestHome page
D. Monakier, M. Mates, M. W. Klutstein, J. A. Balkin, B. Rudensky, D. Meerkin, and D. Tzivoni
Rofecoxib, a COX-2 Inhibitor, Lowers C-Reactive Protein and Interleukin-6 Levels in Patients With Acute Coronary Syndromes
Chest, May 1, 2004; 125(5): 1610 - 1615.
[Abstract] [Full Text] [PDF]


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CirculationHome page
T. Khreiss, L. Jozsef, L. A. Potempa, and J. G. Filep
Conformational Rearrangement in C-Reactive Protein Is Required for Proinflammatory Actions on Human Endothelial Cells
Circulation, April 27, 2004; 109(16): 2016 - 2022.
[Abstract] [Full Text] [PDF]


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Diabetes CareHome page
M. B. Schulze, E. B. Rimm, T. Li, N. Rifai, M. J. Stampfer, and F. B. Hu
C-Reactive Protein and Incident Cardiovascular Events Among Men With Diabetes
Diabetes Care, April 1, 2004; 27(4): 889 - 894.
[Abstract] [Full Text] [PDF]


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J. Am. Coll. Nutr.Home page
G. Block, C. Jensen, M. Dietrich, E. P. Norkus, M. Hudes, and L. Packer
Plasma C-Reactive Protein Concentrations in Active and Passive Smokers: Influence of Antioxidant Supplementation
J. Am. Coll. Nutr., April 1, 2004; 23(2): 141 - 147.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Renal Physiol.Home page
J. T. Lane
Microalbuminuria as a marker of cardiovascular and renal risk in type 2 diabetes mellitus: a temporal perspective
Am J Physiol Renal Physiol, March 1, 2004; 286(3): F442 - F450.
[Abstract] [Full Text] [PDF]


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J. Clin. Endocrinol. Metab.Home page
M. Y. Alenezi, M. Marcil, D. Blank, M. Sherman, and J. Genest Jr.
Is the Decreased High-Density Lipoprotein Cholesterol in the Metabolic Syndrome Due to Cellular Lipid Efflux Defect?
J. Clin. Endocrinol. Metab., February 1, 2004; 89(2): 761 - 764.
[Abstract] [Full Text] [PDF]


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JAMAHome page
H. D. Sesso, J. E. Buring, N. Rifai, G. J. Blake, J. M. Gaziano, and P. M. Ridker
C-Reactive Protein and the Risk of Developing Hypertension
JAMA, December 10, 2003; 290(22): 2945 - 2951.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
S. Verma and P. E. Szmitko
Coxibs and the endothelium
J. Am. Coll. Cardiol., November 19, 2003; 42(10): 1754 - 1756.
[Full Text] [PDF]


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CirculationHome page
P. M Ridker and on behalf of the JUPITER Study Group
Rosuvastatin in the Primary Prevention of Cardiovascular Disease Among Patients With Low Levels of Low-Density Lipoprotein Cholesterol and Elevated High-Sensitivity C-Reactive Protein: Rationale and Design of the JUPITER Trial*
Circulation, November 11, 2003; 108(19): 2292 - 2297.
[Full Text] [PDF]


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CirculationHome page
M. Schillinger, M. Exner, J. Amighi, W. Mlekusch, S. Sabeti, H. Rumpold, O. Wagner, and E. Minar
Joint Effects of C-Reactive Protein and Glycated Hemoglobin in Predicting Future Cardiovascular Events of Patients With Advanced Atherosclerosis
Circulation, November 11, 2003; 108(19): 2323 - 2328.
[Abstract] [Full Text] [PDF]


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QJMHome page
G.M. Hirschfield and M.B. Pepys
C-reactive protein and cardiovascular disease: new insights from an old molecule
QJM, November 1, 2003; 96(11): 793 - 807.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
G. J. Blake and P. M. Ridker
C-reactive protein: a surrogate risk marker or mediator of atherothrombosis?
Am J Physiol Regulatory Integrative Comp Physiol, November 1, 2003; 285(5): R1250 - R1252.
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Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
S. Verma and E. T. H. Yeh
C-reactive protein and atherothrombosis--Beyond a biomarker: an actual partaker of lesion formation
Am J Physiol Regulatory Integrative Comp Physiol, November 1, 2003; 285(5): R1253 - R1256.
[Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
B. E. Sobel, D. J. Taatjes, and D. J. Schneider
Intramural Plasminogen Activator Inhibitor Type-1 and Coronary Atherosclerosis
Arterioscler. Thromb. Vasc. Biol., November 1, 2003; 23(11): 1979 - 1989.
[Abstract] [Full Text] [PDF]


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CirculationHome page
S. Verma, M. R. Buchanan, and T. J. Anderson
Endothelial Function Testing as a Biomarker of Vascular Disease
Circulation, October 28, 2003; 108(17): 2054 - 2059.
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CirculationHome page
P. E. Szmitko, C.-H. Wang, R. D. Weisel, J. R. de Almeida, T. J. Anderson, and S. Verma
New Markers of Inflammation and Endothelial Cell Activation: Part I
Circulation, October 21, 2003; 108(16): 1917 - 1923.
[Full Text] [PDF]


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CirculationHome page
S. K. Venugopal, S. Devaraj, and I. Jialal
C-Reactive Protein Decreases Prostacyclin Release From Human Aortic Endothelial Cells
Circulation, October 7, 2003; 108(14): 1676 - 1678.
[Abstract] [Full Text] [PDF]


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Diabetes CareHome page
V. Palmieri, R. P. Tracy, M. J. Roman, J. E. Liu, L. G. Best, J. N. Bella, D. C. Robbins, B. V. Howard, and R. B. Devereux
Relation of Left Ventricular Hypertrophy to Inflammation and Albuminuria in Adults With Type 2 Diabetes: The Strong Heart Study
Diabetes Care, October 1, 2003; 26(10): 2764 - 2769.
[Abstract] [Full Text] [PDF]


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Clin. Chem.Home page
T. B. Ledue and N. Rifai
Preanalytic and Analytic Sources of Variations in C-reactive Protein Measurement: Implications for Cardiovascular Disease Risk Assessment
Clin. Chem., August 1, 2003; 49(8): 1258 - 1271.
[Abstract] [Full Text] [PDF]


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CirculationHome page
T. Huittinen, M. Leinonen, L. Tenkanen, H. Virkkunen, M. Manttari, T. Palosuo, V. Manninen, and P. Saikku
Synergistic Effect of Persistent Chlamydia pneumoniae Infection, Autoimmunity, and Inflammation on Coronary Risk
Circulation, May 27, 2003; 107(20): 2566 - 2570.
[Abstract] [Full Text] [PDF]