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Circulation. 2000;102:1308-1314

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(Circulation. 2000;102:1308.)
© 2000 American Heart Association, Inc.


Basic Science Reports

Ribozyme Oligonucleotides Against Transforming Growth Factor-ß Inhibited Neointimal Formation After Vascular Injury in Rat Model

Potential Application of Ribozyme Strategy to Treat Cardiovascular Disease

Kei Yamamoto, MD; Ryuichi Morishita, MD, PhD; Naruya Tomita, MD, PhD; Takashi Shimozato, BS; Hironori Nakagami, MD; Akira Kikuchi, PhD; Motokuni Aoki, MD, PhD; Jitsuo Higaki, MD, PhD; Yasufumi Kaneda, MD, PhD; Toshio Ogihara, MD, PhD

From the Department of Geriatric Medicine (K.Y., R.M., N.T., H.N., M.A., J.H., T.O.) and the Division of Gene Therapy Science (R.M., Y.K.), Osaka University Medical School, Suita; BILIS (T.S.), Shiga; and Toyohashi Technology University (A.K.), Toyohashi, Japan.

Correspondence to Ryuichi Morishita, MD, PhD, Associate Professor, Division of Gene Therapy Science, Osaka University Medical School, Suita 565, Japan. E-mail morishit{at}geriat.med.osaka-u.ac.jp


*    Abstract
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*Abstract
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Background—Because the mechanisms of atherosclerosis or restenosis after angioplasty have been postulated to involve an increase in transforming growth factor (TGF)-ß, a selective decrease in TGF-ß may have therapeutic value. Thus, we used the ribozyme strategy to actively cleave the targeted gene to selectively inhibit TGF-ß expression.

Methods and Results—We constructed ribozyme oligonucleotides (ONs) targeted to the sequence of the TGF-ß gene that shows 100% homology among the human, rat, and mouse species. The specificity of ribozyme against TGF-ß gene was confirmed by selective inhibition of TGF-ß mRNA in cultured vascular smooth muscle cells as well as balloon-injured blood vessels in vivo. Importantly, the marked decrease in TGF-ß resulted in significant inhibition of neointimal formation after vascular injury in a rat carotid artery model (P<0.01), whereas DNA-based control ONs and mismatched ribozyme ONs did not have any inhibitory effect on neointimal formation. Inhibition of neointimal formation was accompanied by (1) a reduction in collagen synthesis and mRNA expression of collagen I and III and (2) a significant decrease in DNA synthesis as assessed by proliferating cell nuclear antigen staining. Moreover, we modified ribozyme ONs containing phosphorothioate DNA and RNA targeted to the TGF-ß gene. Of importance, modified ribozyme ONs showed a further reduction in TGF-ß expression.

Conclusions—Overall, this study provides the first evidence that selective blockade of TGF-ß resulted in inhibition of neointimal formation, accompanied by a reduction in collagen synthesis and DNA synthesis in a rat model. We anticipate that modification of ribozyme ON pharmacokinetics will facilitate the potential clinical utility of the ribozyme strategy.


Key Words: atherosclerosis • growth substances • gene therapy • enzymes


*    Introduction
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*Introduction
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As a consequence of the revolutionary developments in the field of molecular biology and their impact on our understanding of the mechanisms of disease processes, treatment strategies that exploit our expanding knowledge of the structures and functions of molecules are being pursued. One strategy for combating disease processes has been to target the transcriptional process. Two approaches have been used to accomplish this. One is the use of antisense oligonucleotides (ONs) complementary to the mRNA of interest.1 The second approach is the use of ribozyme, a unique class of RNA molecules that not only store information but also process catalytic activity.2 Ribozyme is known to catalytically cleave specific target RNA, leading to degradation, whereas antisense ONs inhibit translation by binding to mRNA sequences on a stoichiometric basis. Theoretically, ribozyme is more effective in inhibiting target gene expression. Therefore, we used a novel therapeutic strategy, ribozyme technology, to selectively inhibit target gene expression. Using ribozyme technology, we identified transforming growth factor-ß (TGF-ß) as a target, because TGF-ß plays a pivotal role in the pathogenesis of cardiovascular disease, eg, restenosis after angioplasty.3 4 5 Moreover, TGF-ß increases synthesis of extracellular matrix proteins, including collagen, laminin, and fibronectin, by a variety of cells.6 7 8 From this viewpoint, TGF-ß has been thought to be an ideal target molecule to prevent the progression of cardiovascular disease. Here, using ribozyme TGF-ß ONs, we demonstrated that the selective inhibition of TGF-ß resulted in a significant decrease in neointimal formation after vascular injury in a rat balloon-injury model. This is the first report of successful in vivo gene therapy using ribozyme technology to treat cardiovascular disease. Further innovation of ribozyme technology may open a new era in the treatment of cardiovascular disease.


*    Methods
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*Methods
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Synthesis of Ribozyme ONs and Selection of Target Sequences
We constructed hammerhead ribozyme ONs targeted against TGF-ß mRNA, as shown in Figure 1Down. The target sequence of TGF-ß was identical among the human, rat, and mouse species.9 10 11 In this study, we used DNA-based control ONs as the negative control, because DNA ribozyme has no catalytic activity. Moreover, mismatched ribozyme ONs that had lost their catalytic activity were also used as an additional negative control.



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Figure 1. Scheme of ribozyme strategy. GUU is cleavage site for ribozyme ONs against TGF-ß.

In Vivo Gene Transfer
A 2F Fogarty catheter was used to induce vascular injury in male Sprague-Dawley rats (400 to 500 g; Charles River Breeding Laboratories, Shizuoka, Japan).12 13 In vivo gene transfer was performed under the following conditions: vascular injury of the common carotid artery was induced by the passage and inflation of a balloon catheter through an arteriotomy in the external carotid artery 3 times. The injured segment was transiently isolated with temporary ligatures. Then, 200 µL hemagglutinating virus of Japan (HVJ)–liposome complex containing either ribozyme ONs, DNA-control ONs, or mismatched ONs (each at 1 µmol/L contained in liposome) was incubated within the lumen for 10 minutes at room temperature. At 2 weeks after transfection, each carotid artery was processed for morphological study.12 13 For histological analyses, a segment of each artery was perfusion-fixed with 4% paraformaldehyde at physiological pressure (110 mm Hg) and subsequently processed. Areas of media and lumen were measured on a digitizing tablet (Power Laboratory) after staining with hematoxylin. At least 3 individual sections from the middle of the transfected arterial segments were analyzed. Animals were coded so that in the analysis, the researcher did not know which treatment each individual animal had received.

Preparation of HVJ-Liposome
We used HVJ-coated liposome, which is reported to provide highly efficient transfection of cells in culture.12 13 14 15 16 Briefly, phosphatidylserine, phosphatidylcholine, and cholesterol were mixed in a weight ratio of 1:4.8:2 to create a lipid mixture. Purified HVJ (Z strain) was inactivated by UV irradiation before use. The liposome suspension was mixed with HVJ, and then free HVJ was removed by sucrose density gradient centrifugation. This preparation method has been optimized to achieve maximal transfection efficiency as reported previously.15

In Vivo Transfection of FITC-Labeled Ribozyme ONs
FITC-labeled ribozyme ONs on the 3' and 5' ends were provided by Nihon Seifun Inc. Transfer of FITC-labeled ribozyme ONs was performed according to the following protocol; HVJ complex with FITC-labeled ribozyme ONs (1 µmol/L) was incubated for 10 minutes. The vessels were harvested 2 weeks after transfection and perfusion-fixed with 4% paraformaldehyde. Sections were examined by fluorescence microscopy after staining in Erichrome black T solution. Elastic fibers stained dark red and were readily distinguishable from the specific FITC-labeled ribozyme ONs by treatment with Erichrome black T solution.17

Northern Blot Analysis
RNA was extracted from injured vessels transfected with ribozyme ONs (1 µmol/L wrapped in liposome) treated with RNAzol (Tel-Test Inc) at 1 and 7 days after transfection. Contralateral arteries in ribozyme ON–transfected animals were also used as intact arteries. Levels of TGF-ß (1 day after transfection) and collagen I and III (7 days after transfection) mRNA were measured by Northern blot analysis. The filter was baked, prehybridized, and hybridized with mouse TGF-ß probe (pMTGFbeta, American Type Culture Collection), collagen I and III probes (donated by Dr S. Kim, Osaka City University), and G3PDH probe (Clontech Laboratories, Inc).

Immunohistochemistry
Sections were dewaxed, rehydrated, and incubated with PBS containing 0.3% hydrogen peroxide to reduce endogenous peroxidase activity. The sections were then incubated with primary antibodies or lectin diluted in PBS with 10% horse serum at room temperature for 60 minutes. After 3 washings in Tris-buffered saline containing 2% horse serum, species-appropriate biotinylated secondary antibodies were applied, followed by avidin-biotin peroxidase complex (Vectastain ABC kit, PK 6100, Vector Laboratories). Omission of primary antibodies and staining with type- and class-matched irrelevant immunoglobulin served as a negative control for each antibody. A monoclonal antibody for collagen I and III (mouse IgG, Chemicon) recognizes collagen I and III.

Sirius Red Method for Collagen Staining
Sirius red microscopy detects interstitial collagen, including types I and III.18 19 The stained sections were observed under polarized light and photographed with the same exposure time for each section. Analysis of Sirius red staining was performed with a computer-based quantitative color image analysis system. Photographs were scanned into a 1000x1000 image buffer of the Optimas 5.2 image analysis system (Optimas Co). A color threshold mask for immunostaining was defined to detect the red color by sampling, and the same threshold was applied to all specimens. The percentage of the total area with positive color was recorded for each section.

Quantification of Cell Proliferation in Medial Lesions
Paraffin-embedded sections of carotid artery harvested 4 days after transfection were used for quantification of cell proliferation.7 8 Four sections of each vessel spaced at 0.4-mm intervals were measured by a computerized image analyzer system (Image Command 5098, Olympus). Monoclonal antibody against proliferating cell nuclear antigen (PCNA; PC-10; 1:500; DAKO) was used as a specific marker for proliferating cells. The number of PCNA-positive nuclei was counted in the medium by the image analysis system at x400 magnification. Frequency of cell proliferation was expressed as PCNA index, defined as the ratio of the number of PCNA-positive nuclei to the total number of nuclei in the media. Samples were coded so that the analysis was performed without knowledge of which treatment each individual vessel had received.

Statistical Analysis
All values are expressed as mean±SEM. ANOVA with subsequent Bonferroni’s test was used to determine the significance of differences in multiple comparisons. A value of P<0.05 was considered statistically significant.


*    Results
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In Vivo Experiments
To inhibit TGF-ß expression, we constructed "hammerhead" ribozyme ONs targeted to the common sequence of TGF-ß among human, rat, and mouse species (Figure 1Up; References 9 through 119 10 11 ). Hammerhead ribozyme is known to cleave the specific sequences GUH (H=C, U, or A), but not other sequences.2 Therefore, we transfected ribozyme ONs against TGF-ß into a rat balloon-injury carotid artery model. To enhance the efficiency and stability, we used the HVJ-liposome delivery system, which is reported to bypass endocytosis, thereby avoiding degradation in lysosomes.16 23 Successful transfection of ribozyme ONs is shown in Figure 2Down, top right. Transfection of FITC-labeled ribozyme ONs resulted in fluorescence in the balloon-injured vessels at 1 day after transfection. The fluorescence was localized primarily in cell nuclei (Figure 2Down) and persisted for up to 2 weeks after transfection (data not shown). Untreated or HVJ complex without ON–treated vessels revealed no specific fluorescence (except autofluorescence) in the elastic lamina, demonstrating that this fluorescence was specific for FITC-labeled ribozyme ONs.



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Figure 2. Representative in vivo findings of fluorescence microscopy of FITC-labeled ribozyme ONs using HVJ-liposome method 1 day after transfection. BSS HVJ control (left) indicates blood vessels transfected with HVJ-liposome complex without ONs; FITC-labeled ribozyme (right), blood vessels transfected with HVJ-liposome complex containing FITC-labeled ribozyme ONs. This experiment was performed 5 times.

Given the successful transfection of ribozyme ONs into balloon-injured vessels, we next examined the in vivo inhibitory effect of ribozyme TGF-ß ONs on TGF-ß expression induced by vascular injury. As shown in Figure 1Up, ribozyme ONs can cleave the mRNA of TGF-ß at +817, based on the reported sequence,9 10 11 whereas other genes theoretically cannot be cleaved by ribozyme ONs. In the present study, we used DNA-based control ONs and mismatched ribozyme ONs as negative controls, because both control ONs have no catalytic activity. Neither DNA-ribozyme nor mismatched ribozyme ONs inhibited TGF-ß expression induced by vascular injury (Figure 3Down). No change in TGF-ß expression was observed in untransfected blood vessels. In contrast, transfection of ribozyme TGF-ß ONs significantly decreased TGF-ß expression (P<0.01, Figure 3Down). Thus, we examined the effect of ribozyme TGF-ß ONs on neointimal formation after vascular injury in the rat carotid artery. As shown in Figure 4Down, untreated, DNA-based control ON–transfected, and mismatched ribozyme ON–transfected (1 µmol/L) vessels exhibited neointimal formation at 2 weeks after transfection. In contrast, a single administration of ribozyme TGF-ß ONs (1 µmol/L) resulted in a significant reduction in neointimal formation (P<0.01; FigureUp 4B). Ribozyme ON treatment did not alter the medial area (TableDown). The reduction in neointimal formation was limited to transfected regions (data not shown). In addition, treatment with antisense thrombomodulin oligodeoxynucleotide had no effect on the ratio of neointimal to medial area as an additional negative control (data not shown).



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Figure 3. Effect of ribozyme ONs on TGF-ß mRNA in balloon-injured carotid artery 1 day after transfection as assessed by Northern blotting. Control indicates uninjured untransfected vessels; balloon injury, injured untransfected vessels; ribozyme, vessels transfected with ribozyme TGF-ß ONs; RNA control, vessels transfected with mismatched ribozyme TGF-ß ONs; DNA control, vessels transfected with DNA control ONs; and BSS HVJ control, vessels transfected with HVJ-liposome complex without ribozyme TGF-ß ONs. #P<0.01, n=3 per group; each sample contains 3 to 5 vessels.



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Figure 4. A, Typical example of intact carotid artery transfected with ribozyme TGF-ß ONs 2 weeks after transfection. B, Effect of ribozyme TGF-ß ONs on ratio of neointimal to medial area 2 weeks after transfection. Groups as in Figure 3Up. Each group contains 6 to 21 samples. #P<0.01.


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Table 1. Effect of TGF-ß Ribozyme ON on Neointimal and Medial Areas at 2 Weeks After Transfection

It is noteworthy how inhibition of TGF-ß resulted in the blockade of neointimal formation. Given the previous reports that TGF-ß stimulated extracellular matrix through the induction of collagen expression,6 7 8 we postulated that inhibition of TGF-ß would interfere with the matrix structure. Indeed, we have observed that mRNAs of collagen I and III were also reduced by ribozyme TGF-ß ONs, whereas they were induced after vascular injury (Figures 5Down and 6Down). In contrast, treatment with DNA-based control ONs or mismatched ribozyme ONs had no effect on collagen mRNA expression (Figures 5 and 6). The reduction of collagen I and III in blood vessels transfected with ribozyme TGF-ß ONs was also confirmed by the observation that positive immunohistochemical staining of collagen I and III was markedly decreased by ribozyme TGF-ß ONs but not mismatched ribozyme ONs (Figure 7ADown and 7BDown). In addition, we performed Sirius red staining for collagen, because Sirius red staining under polarized light visualizes collagen, including types I and III.19 Further evidence for the inhibition of extracellular matrix deposition was provided by the observation that treatment with ribozyme TGF-ß ONs decreased collagen content, as assessed by quantitative color image analysis using Sirius red staining (P<0.01, Figure 8Down). Blood vessels transfected with ribozyme TGF-ß ONs showed less positive Sirius red staining, indicating a low content of interstitial collagen (FigureUp 8). In contrast, blood vessels transfected with mismatched ribozyme ONs exhibited substantial accumulation of interstitial collagen within the neointima (Figure 8Down). In addition, as shown in Figure 9ADown, PCNA-stained nuclei were observed in the neointimal and medial layers of blood vessels at 4 days after vascular injury. Transfection of ribozyme ONs resulted in a significant decrease in the ratio of PCNA-positive nuclei to total cells at 4 days after transfection compared with blood vessels transfected with mismatched ribozyme ONs (P<0.01, FigureUp 9B). In contrast, untransfected intact carotid arteries exhibited few PCNA-stained nuclei.



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Figure 5. Effect of ribozyme ONs on mRNA of collagen I in balloon-injured carotid artery 1 day after transfection as assessed by Northern blotting. Groups as in Figure 3Up. #P<0.01, n=3 per group; each sample contains 3 to 5 vessels.



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Figure 6. Effect of ribozyme ONs on mRNA of collagen III in balloon-injured carotid artery 1 day after transfection as assessed by Northern blotting. Groups as in Figure 3Up. #P<0.01, n=3 per group; each sample contains 3 to 5 vessels.



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Figure 7. Effects of ribozyme ONs on protein of collagen I and III in balloon-injured carotid artery 7 days after transfection as assessed by immunostaining. A and C, Examples of immunohistochemical analysis of collagen I (A) or III (C) in arteries 7 days after balloon injury (x200). B and D, Effect of ribozyme ONs on positive-stained area of collagen I (B) and III (D) in balloon-injured carotid artery at 7 days after transfection. (1) Control; (2) balloon injury; (3) RNA control; (4) ribozyme. Groups as in Figure 3Up. #P<0.01 vs 2 and 3.



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Figure 8. A, Typical example of Sirius red staining in balloon-injured carotid artery 7 days after transfection. B, Effect of transfection of ribozyme TGF-ß ONs on collagen synthesis as assessed by Sirius red staining 7 days after transfection. Groups as in Figure 3Up. Each group contains 7 samples. #P<0.01.



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Figure 9. A, Typical example of PCNA immunostaining in balloon-injured carotid artery transfected with ribozyme TGF-ß ONs 7 days after transfection. Cells stained brown were considered PCNA-positive cells. B, Ratio of PCNA-positive cells to total cells in intact carotid arteries transfected with ribozyme TGF-ß ONs 7 days after transfection. Groups as in Figure 3Up. Each group contains 7 samples. #P<0.01.


*    Discussion
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up arrowAbstract
up arrowIntroduction
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up arrowResults
*Discussion
down arrowReferences
 
TGF-ß has been of interest in vascular biology because numerous studies indicated it to be increased in cardiovascular disease, such as atherosclerosis and restenosis after angioplasty.3 4 5 Recent studies using gene transfer technology showing that blood vessels expressing the TGF-ß gene develop neointimal formation have focused on the mitogenic action of TGF-ß.24 25 More recently, the blockade of TGF-ß actions through the type II receptor with the dominant-negative construct led to the inhibition of neointimal formation in a rat balloon-injury model.26 However, there are numerous controversial reports that TGF-ß exhibited inhibitory effects on vascular smooth muscle cell (VSMC) proliferation in cultured VSMCs.27 28 29 Thus, it is still unclear whether TGF-ß contributes to the progression of restenotic lesion formation. Therefore, we examined the effects of inhibition of TGF-ß synthesis on neointimal formation after vascular injury. To discuss this issue, we used ribozyme technology rather than antisense, for the following reasons: (1) It is better to target the common sequence of target genes among humans, rats, pigs, etc, for applying results of preclinical animal studies to human trials using antisense or ribozyme technology. However, it is difficult to select antisense sequences around ATG sites that are most effective as antisense sequences, because the structure of the TGF-ß gene around ATG sites is not identified in the human, rat, and mouse species. (2) The inhibitory effect of ribozyme on target gene expression is theoretically greater than that of antisense (passive versus active).2 Fortunately, we detected a possible site as a target sequence for ribozyme catalysis in the TGF-ß gene. As shown in Figure 1Up, the target sequences are completely identical among the human, rat, and mouse species.

The present study demonstrated that ribozyme ONs against TGF-ß selectively inhibited TGF-ß production without affecting other genes. The specificity of the inhibitory effect of ribozyme ONs on TGF-ß production presented in this study is supported by several lines of evidence: (1) Ribozyme ONs inhibited TGF-ß expression in vivo, whereas DNA-control ONs and mismatched ONs did not. (2) Ribozyme TGF-ß ONs inhibited TGF-ß but not G3PDH expression, as assessed by Northern blotting in human cultured VSMCs. High transfection efficiency of the HVJ-liposome method into blood vessels has been reported in balloon-injury and vein graft models.12 13 15 16 23 30 31 32 With nucleus-targeted LacZ, transfection of the LacZ gene exhibited diffuse and frequent X-Gal–positive signals in both medial and adventitial layers in vein grafts,30 consistent with a previous report.31 Similar results were also obtained with immunohistochemical staining against nitric oxide in vessels transfected with endothelial constitutive nitric oxide synthase.30 32 In addition, Yonemitsu et al15 documented that HVJ liposomes could achieve highly efficient gene transfection into the medial smooth muscle cells of intact arteries at 150 and 760 mm Hg of pressure (mean=85.3% and 93.5% of total smooth muscle cells, respectively). Moreover, the sufficient transfection efficiency of the HVJ-liposome method to inhibit neointimal formation was also supported by the previous publications.32 33 In contrast, the previous reports documented the expression of TGF-ß in balloon-injured arteries.26 34 35 By in situ hybridization, Smith et al26 reported that proliferating and quiescent smooth muscle cells in denuded vessels expressed high levels of mRNA for TGF-ß. A similar expression pattern of TGF-ß has also been reported.34 35 The localization of transfected cells seems to be identical to that of cells producing TGF-ß.

Using ribozyme ONs against TGF-ß, the present study demonstrated that inhibition of TGF-ß by ribozyme ONs resulted in a significant reduction in neointimal formation in a rat balloon-injury model. How do ribozyme TGF-ß ONs inhibit neointimal formation? As expected, the inhibition of neointimal formation was accompanied by a marked reduction in collagen synthesis and mRNA expression and protein content of collagen I and III, because TGF-ß stimulated extracellular matrix formation. Moreover, ribozyme TGF-ß ONs also significantly reduced DNA synthesis in VSMCs, as assessed by PCNA staining. Although previous reports documented an antiproliferative action of TGF-ß in cultured cells,27 28 29 the in vivo effects of TGF-ß might be mitogenic, consistent with previous reports.24 25 26 These results together suggest that TGF-ß contributes to the restenosis process through the accumulation of collagen synthesis and increase in DNA synthesis of VSMCs rather than antiproliferative actions in vivo. Moreover, this is the first report of successful in vivo application of ribozyme ON technology progressing toward human gene therapy in cardiovascular disease. The practical use of these ribozyme ONs as therapy for atherosclerosis induced by high TGF-ß is dependent on the development of a delivery system into blood vessels. Further studies are necessary to test the efficacy of ribozyme ONs in vivo to examine the therapeutic application. Here, we revealed the first evidence that TGF-ß expression can be selectively prevented by ribozyme ONs directed against the TGF-ß gene, suggesting a novel therapeutic strategy for the treatment of cardiovascular disease related to high TGF-ß. The selective blockade of TGF-ß is particularly attractive, because ribozyme TGF-ß ONs prevented neointimal formation, accompanied by a reduction in collagen synthesis and DNA synthesis in the rat model.


*    Acknowledgments
 
This work was supported in part by grants from the Hoan-sya Foundation and the Japan Cardiovascular Research Foundation, a Japan Heart Foundation Research Grant, a Grant-in-Aid from the Tokyo Biochemical Research Foundation, and a Grant-in-Aid from the Ministry of Education, Science, Sports, and Culture.

Received January 7, 2000; revision received April 7, 2000; accepted April 13, 2000.


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up arrowMethods
up arrowResults
up arrowDiscussion
*References
 
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