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Circulation. 2000;102:806-812

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(Circulation. 2000;102:806.)
© 2000 American Heart Association, Inc.


Basic Science Reports

Increased Activity of Nuclear Factor-{kappa}B Participates in Cardiovascular Remodeling Induced by Chronic Inhibition of Nitric Oxide Synthesis in Rats

Shiro Kitamoto, MD; Kensuke Egashira, MD; Chu Kataoka, MD; Masamichi Koyanagi, MD; Makoto Katoh, MD; Hiroaki Shimokawa, MD; Ryuichi Morishita, MD; Yasufumi Kaneda, MD; Katsuo Sueishi, MD; Akira Takeshita, MD

From the Departments of Cardiovascular Medicine (S.K., K.E., C.K., M. Koyanagi, H.S., A.T.) and Pathology (K.S.), Graduate School of Medical Science, Kyushu University, Fukuoka; Division of Gene Therapy Sciences, Osaka University Medical School, Osaka (R.M., Y.K.); and Discovery Research Laboratory, Tanabe Sei-Yaku Co Ltd, Saitama (M. Katoh), Japan.

Correspondence to Kensuke Egashira, MD, PhD, Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. E-mail egashira{at}cardiol.med.kyushu-u.ac.jp


*    Abstract
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Background—Chronic inhibition of endothelial nitric oxide (NO) synthesis by the administration of N{omega}-nitro-L-arginine methyl ester (L-NAME) to rats induces early vascular inflammatory changes [monocyte infiltration into coronary vessels, nuclear factor-{kappa}B (NF-{kappa}B) activation, and monocyte chemoattractant protein-1 expression] as well as subsequent arteriosclerosis (medial thickening and perivascular fibrosis) and cardiac fibrosis. However, no direct evidence for the importance of NF-{kappa}B in this process is known.

Methods and Results—We examined the effect of a cis element decoy strategy to address the functional importance of NF-{kappa}B in the pathogenesis of cardiovascular remodeling. We found here that in vivo transfection of cis element decoy oligodeoxynucleotides against NF-{kappa}B to hearts prevented the L-NAME–induced early inflammation and subsequent coronary vascular medial thickening. In contrast, NF-{kappa}B decoy oligodeoxynucleotide transfection did not decrease the development of fibrosis, the expression of transforming growth factor-ß1 mRNA, or systolic pressure overload induced by L-NAME administration.

Conclusions—The NF-{kappa}B system participates importantly in the development of early vascular inflammation and subsequent medial thickening but not in fibrogenesis in this model. The present study may provide a new aspect of how endothelium-derived NO contributes to anti-inflammatory and/or antiarteriosclerotic properties of the vascular endothelium in vivo.


Key Words: endothelium-derived factors • inflammation • proteins • cells • nitric oxide • nuclear factor-{kappa}B


*    Introduction
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The vascular endothelium becomes dysfunctional in the early stages of vascular diseases.1 2 3 Such endothelial abnormalities are associated with reduced activity of nitric oxide (NO) and increased expression of inflammation-promoting genes.4 5 6 7 8 Recently, endothelium-derived NO has been recognized to be an anti-inflammatory and antiarteriosclerotic molecule. Mice lacking endothelial-type NO synthase exhibit hypertension and an enhanced vascular remodeling in response to injury.9 10 We recently reported that chronic inhibition of NO synthesis by the administration of N{omega}-nitro-L-arginine methyl ester (L-NAME) induces early inflammation [monocyte infiltration, monocyte chemoattractant protein-1 (MCP-1) expression, and nuclear factor-{kappa}B (NF-{kappa}B) activation] and late cardiovascular remodeling in rats (Figure 1Down).11 12 13 14 15 We also demonstrated that normalization of arterial hypertension by hydralazine treatment did not attenuate such pathological changes,11 13 16 17 suggesting a minor role of systemic arterial hypertension in the development of such pathological changes in this model.



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Figure 1. Working hypothesis of molecular mechanisms by which chronic inhibition of NO synthesis induces early inflammatory and proliferative changes as well as late cardiovascular remodeling.

NF-{kappa}B is presumed to be an important redox-sensitive transcriptional factor that regulates transcription of genes encoding inflammatory cytokines, adhesion molecules, and chemokines.18 NF-{kappa}B is activated by a battery of stimuli leading to atherogenic events, including oxidative stress, tumor necrosis factor, and angiotensin II.19 20 21 MCP-1 is a member of the C-C chemokines and a potent chemotactic factor for monocytes.22 Increased activity of NF-{kappa}B23 or MCP-124 has been observed in arteriosclerotic and/or atherosclerotic lesions. We recently demonstrated that increased superoxide anion production contributes to the pathogenesis of ACE activation and that ACE inhibition, angiotensin II type 1 receptor blockade, or antioxidant therapy with N-acetylcysteine prevents vascular inflammation, MCP-1 expression, NF-{kappa}B activation, and subsequent remodeling in the rat model (Figure 1Up).25 These observations suggest that the increase in local angiotensin II activity plays a primary role in the development of such early and late cardiovascular pathological changes (Figure 1Up). It is also suggested that increased activity of NF-{kappa}B would participate in the inflammatory changes through transcription of MCP-1 in the rat model of chronic inhibition of NO synthesis (Figure 1Up). However, no direct evidence for the functional importance of NF-{kappa}B in the formation of such cardiovascular inflammation and remodeling has been addressed.

To achieve effective blockade of NF-{kappa}B activity in vivo, transfection of a cis element decoy against the NF-{kappa}B binding site seems to be a useful strategy.26 Recently, Morishita et al27 elegantly innovated the cis element decoy strategy as an effective and feasible in vivo gene therapy. They reported that transfection of NF-{kappa}B decoy oligodeoxynucleotides (ODNs) to rat hearts by injection of hemagglutinating virus of Japan (HVJ)–liposome complex in the ascending aorta markedly reduced myocardial injury due to myocardial infarction. Thus, we used this novel strategy and investigated the role of NF-{kappa}B in the development of early inflammatory changes and late cardiovascular remodeling in a rat model of chronic inhibition of NO synthesis.


*    Methods
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Decoy ODN Sequences and Preparation of HVJ-Liposome Complexes
The sequences of NF-{kappa}B decoy ODNs and scramble decoy ODNs used in this study were as follows (consensus sequences of binding site for NF-{kappa}B are italicized): NF-{kappa}B decoy ODN: 5'-CCTTGAAGGGATTTCCCTCC-3'; 3'-GGAACTTCCCTAAAGG-GAGG-5'. Scramble decoy ODN: 5'-TTGCCGTACCTGACT-TAGCC-3'; 3'-AACGGCATGGACTGAATCGG-5'.

The NF-{kappa}B decoy ODNs, but not scramble decoy ODNs, have been shown to bind the NF-{kappa}B transcriptional factor.27 HVJ-liposome complexes were prepared as described.27 The final concentration of decoy ODNs was 15 µmol/L.

In Vivo Transfection of ODNs Into Hearts
After a rat was anesthetized with intraperitoneal pentobarbital, the right common carotid artery was surgically exposed. A balloon catheter 1.5 mm in diameter was introduced into the common carotid artery and advanced to the ascending aorta. After the catheter tip was positioned at the aortic sinus of Valsalva, the balloon was inflated, and HVJ-liposome complex containing FITC-labeled or unlabeled ODNs (1 mL at 4°C) was infused selectively into the coronary arteries. Then the catheter was removed, the wound was closed, and the animals were allowed to recover from the surgery.

Animal Model of Chronic Inhibition of NO Synthesis
The present study protocol was reviewed and approved by the Committee on Ethics on Animal Experiments, Kyushu University Faculty of Medicine, and the experiments were conducted according to the Guidelines for Animal Experiments of Kyushu University Faculty of Medicine.

Four groups of male Wistar-Kyoto rats were studied. The control group received normal water and chow. The L-NAME group received L-NAME in drinking water (1 mg/mL). The L+NF group received L-NAME 2 days after NF-{kappa}B decoy transfection. The L+SD group received L-NAME 2 days after scramble decoy transfection.

On day 3 after L-NAME administration was begun, systolic blood pressures (by the tail-cuff method) were measured. Then the rats were euthanized for morphometric, immunohistochemical, and biochemical analyses. Furthermore, some rats in each group received L-NAME for 7 days and untreated water during the following 21 days. On day 28, they were euthanized for morphometric analysis.

Electrophoretic Mobility Shift Assays
To determine the increase in NF-{kappa}B binding to the nucleus, electrophoretic mobility shift assays were performed. Five rats in each group were used. Nuclear extracts were prepared from the whole-heart homogenates as described.15 The NF-{kappa}B oligonucleotides corresponding to putative consensus sequences (NF-{kappa}B: 5'-AGTTGAGGGGACTTTCCCAGGC-3') (Promega Biotechnology Inc) were labeled with [{gamma}-32P]ATP and T4 polynucleotide kinase and purified by Sephadex G-50 column (Pharmacia Biotechnology Inc). Nuclear extract (10 µg) was incubated with 1x105 cpm of labeled probe and 2 µg of poly(dI-dC) in a buffer containing 10 mmol/L Tris-HCl (pH 7.5), 1 mmol/L EDTA, 4% glycerol, 100 mmol/L NaCl, 5 mmol/L DTT, and 100 g/L BSA for 30 minutes at room temperature (25°C). Then the samples were electrophoresed on 5% acrylamide/0.5xTBE gel (1xTBE: 90 mmol/L Tris borate, 2 mmol/L EDTA). After electrophoresis, gels were dried and subjected to autoradiography. Autoradiographs were later subjected to laser densitometry. Specificity was determined by the addition of excess cold oligonucleotide to the nuclear extracts 10 minutes before addition of radiolabeled probe.

Northern Blot Analysis
Total RNA was extracted from each sample, poly(A)+RNA was purified, and then Northern blot hybridization was performed as we described.15 The cDNA probes used were as follows: a rat MCP-1,28 a rat transforming growth factor (TGF)-ß1 cDNA (a gift from Dr T. Nakamura, Department of Biochemistry, Kyushu University), and a mouse GAPDH (American Type Culture Collection). Relative amounts of MCP-1 and TGF-ß1 mRNA were normalized against the amounts of GAPDH mRNA.

Histopathology and Immunohistochemistry
Tissue sections were prepared as described.14 15 After fixation with methacarn solution, the left ventricle was separated from the atria, right ventricle, and great vessels. The left ventricle was cut into 5 pieces perpendicular to the long axis. All tissues were dehydrated, embedded in paraffin, cut into slices 5 µm thick, and mounted on slides. The sections were stained with either hematoxylin-eosin, Masson’s trichrome, or immunostaining with antibodies against macrophage/monocyte (ED1, Serotec), proliferating cell nuclear antigen (PCNA) (Dako), nonimmune mouse IgG (Zymed), or p50/NF-{kappa}B (Santa Cruz). The slides were washed and incubated with biotinylated, affinity-purified goat anti-mouse IgG. After avidin-biotin amplification, the slides were incubated with 3',3'-diaminobenzidine and counterstained with hematoxylin.

Morphometry and cell counting were performed by a single observer who was blind to the treatment protocols as described.15 On day 3, to quantify the number of immunopositive cells in hearts, each section (5 per heart) immunohistochemically stained by an antibody against ED1 or PCNA was scanned at x100 magnification. The number of positive cells in each section was counted, and the average number of positive cells per section was reported in each heart.

On day 28, to evaluate the thickening of the coronary arterial wall and the extent of perivascular fibrosis, short-axis images of the coronary artery were analyzed. The inner border of the lumen and the outer border of the tunica media were traced from Masson’s trichrome–stained sections at x100 to x200 magnification. The wall-to-lumen ratio (the ratio of medial thickness to the internal diameter) and the area of fibrosis (area of collagen deposition stained with aniline blue) immediately surrounding the blood vessel were then calculated. Perivascular fibrosis was estimated as the ratio of the area of fibrosis surrounding the vessel wall to the total vessel area. Myocardial reparative fibrosis after myocyte necrosis was also determined. Areas of myocardial necrosis replaced by fibrosis were calculated as the total area of fibrosis in the entire visual field divided by the total area of connective tissue and myocardium in the visual field.

Analysis of Fluorescence Isothiocyanate ODNs
The efficacy of FITC-labeled ODNs delivered by the HVJ-liposome method was assessed with a fluorescence microscope. Serial tissue sections of hearts injected with HVJ-liposome complex with FITC-labeled or unlabeled ODNs were prepared. One section was stained with propidium iodide to identify the nuclei. We used a 2-color fluorescence approach, which allows the identification of cells with nuclear incorporation of transfected ODNs. In addition, another section was stained with hematoxylin-eosin to differentiate cell types stained with FITC and/or propidium iodide.

Measurements of ACE Activity
Cardiac tissues were isolated, and the ACE activity was measured by fluorometric assay as described.11 12 Tissue ACE activity was calculated as nanomoles His-Leu generated per milligram tissue weight per hour.

Statistical Analysis
Data are expressed as mean±SEM. Statistical analysis of differences was compared by ANOVA and Bonferroni’s multiple comparison test. A level of P<0.05 was considered statistically significant.


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Systolic Arterial Pressure
Compared with the control group, the L-NAME groups showed a rise in systolic arterial pressure on days 3 and 28 of treatment. This increase in systolic blood pressure was not influenced by NF-{kappa}B decoy transfection or scramble decoy transfection (TableDown).


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Table 1. Systolic Blood Pressure and Cardiac Tissue ACE Activity

In Vivo Transfection of Decoy ODNs Into Heart
Electrophoretic mobility shift assay showed that the NF-{kappa}B binding affinity was markedly increased in the hearts from the L-NAME group on day 3 of treatment (Figure 2ADown). The increased NF-{kappa}B activity was suppressed by NF-{kappa}B decoy ODN transfection but not by scramble decoy ODN transfection in vivo (FigureUp 2A). One day after intracoronary infusion of FITC-labeled ODNs, we examined the location of delivered decoy ODNs with the fluorescence microscope. The fluorescence was localized intensely in the nuclei (yellow) as well as cytoplasm (green) of vascular endothelial cells. Weak to moderate fluorescence (orange) was noted in the nuclei in vascular smooth muscle cells, cardiomyocytes, and some interstitial cells (Figure 2BDown).



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Figure 2. A, Electrophoretic mobility shift assays. Representative autoradiogram of NF-{kappa}B binding activity in heart from control, L-NAME, L+NF, and L+SD groups. Shifted bands were specific for NF-{kappa}B, because addition of 100-fold excess cold corresponding oligonucleotide to nuclear extract abolished band. B, Representative fluorescence photomicrographs of left coronary artery after transfection of FITC-labeled or unlabeled ODNs by HVJ-liposome methods (Fluorescence) and their serial sections stained with hematoxylin-eosin (HE). Top left, Section from rat transfected with unlabeled ODNs; top right, section from rat transfected with FITC-labeled ODNs. Nuclei stained red with propidium iodide. FITC stained green. Intense FITC was observed in nuclei (yellow) and cytoplasmic areas (green) of endothelial cells (intima). Weak to moderate (orange) fluorescence was localized in nuclei of vascular smooth muscle cells, cardiomyocytes, and interstitial cells. Serial section approach allow us to differentiate cell types with fluorescence-labeling cells.

Effects of the Transfection of NF-{kappa}B Decoy ODNs on the Inflammatory and Proliferative Changes and the mRNA Levels of MCP-1 and TGF-ß1 on Day 3
We observed no evidence of inflammation in the control group (Figure 3ADown). Attachment of mononuclear leukocytes to the endothelium of coronary vessels was seen in the L-NAME (data not shown) and L+SD groups (Figure 3ADown). A marked infiltration of mononuclear leukocytes in the perivascular areas immediately surrounding the coronary arteries and veins and the myocardial interstitial spaces was observed in those 2 groups (Figure 3ADown). The majority of leukocytes that had infiltrated into the lesions were found to be ED1-positive monocytes (Figure 3ADown). Nuclear staining for PCNA antibody was observed in some endothelial cells, vascular smooth muscle cells in the media, monocytes, or myofibroblast-like cells (Figure 3ADown). We also examined localization of NF-{kappa}B activation by immunohistochemistry (Figure 3BDown). Compared with the control group, the translocation of p50/NF-{kappa}B immunoreactivity to the nucleus, from faint cytoplasmic staining to a prominent nuclear pattern, was observed in the endothelial cells, some smooth muscle cells in the media, and infiltrated inflammatory cells (monocytes and myofibroblasts) in the L-NAME group. This change suggests that redistribution of p50/NF-{kappa}B from the cytoplasm to the nucleus has occurred. Such translocation of NF-{kappa}B immunoreactivity was observed in some areas in the myocardial myocyte to a similar extent in the control and L-NAME groups. These results suggest that NF-{kappa}B activation may occur predominantly in coronary vessels.



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Figure 3. A, Histopathological and immunohistochemical pictures of coronary arteries. Coronary artery sections stained with hematoxylin-eosin (HE) and those immunohistochemically stained for monocyte/macrophage (ED1), proliferating cells (PCNA), and nonimmune IgG (negative control) on day 3 after L-NAME administration was begun. B, Coronary artery sections immunohistochemically stained for p50/NF-{kappa}B from control rat and rat that received L-NAME for 3 days. Right, Expanded view of area outlined with black lines in middle panel. Arrowheads denote endothelial cells with nuclear staining with an anti–p50/NF-{kappa}B antibody. Bar=50 µm.

When ED1-positive monocytes or PCNA-positive cells were counted by use of immunohistochemistry, the number of immunopositive cells per section was significantly greater in the L-NAME group than in the control group (Figure 4ADown and 4BDown). These inflammatory and proliferative changes were markedly reduced by NF-{kappa}B decoy ODN transfection but not by scramble decoy ODN transfection (Figure 4ADown and 4BDown).



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Figure 4. Effect of in vivo transfection of NF-{kappa}B decoy ODNs on inflammatory and proliferative changes and on mRNA levels of MCP-1 and TGF-ß1 on day 3. A, Number of ED1-positive monocytes infiltrated into coronary vessels and myocardium (n=6). B, Number of PCNA-positive cells appearing in coronary vessels and myocardium (n=6). *P<0.01 vs control group, {dagger}P<0.01 vs L-NAME group, #P<0.01 vs L+SD group. C, Northern blot analysis, representative autoradiogram of expression of cardiac MCP-1, TGF-ß1, and GAPDH mRNA in rats from control group, L-NAME group, L+NF group, and L+SD group. D, Densitometric analysis of data in C (n=6). Expression of MCP-1 and TGF-ß1 mRNA in each sample is normalized relative to GAPDH mRNA expression in that sample. *P<0.01 vs control group, {dagger}P<0.05 vs L-NAME group, #P<0.01 vs L+SD group.

We examined the expression of MCP-1 and TGF-ß1 mRNA in the heart (Figure 4CUp and 4DUp). The cardiac MCP-1 and TGF-ß1 mRNA levels were significantly increased in the L-NAME group. The increased expression of MCP-1 mRNA was significantly reduced in the L+NF group but not in the L+SD group. In contrast, the increased expression of TGF-ß1 mRNA was not reduced by NF-{kappa}B decoy or scramble decoy ODN transfection (Figure 4CUp and 4DUp).

Effects of the Transfection of NF-{kappa}B Decoy on Cardiovascular Remodeling on Day 28
The increase in the medial thickening (the wall-to-lumen ratio) of coronary arteries seen in the L-NAME group was prevented in the L+NF group but not in the L+SD group (Figure 5Down). In contrast, the increases in perivascular and cardiac fibrosis were not affected by NF-{kappa}B decoy or scramble decoy transfection (Figure 5Down). We did not examine left ventricular hypertrophy or function, because no such changes are evident within 28 days of treatment.11



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Figure 5. Effect of NF-{kappa}B decoy transfection on medial thickening (wall-to-lumen ratio), perivascular fibrosis, and cardiac fibrosis on day 28. A, Wall-to-lumen ratio of coronary arteries (n=6). B, Perivascular fibrosis of coronary arteries (n=6). C, Cardiac fibrosis (n=6). *P<0.01 vs control group, {dagger}P<0.01 vs L-NAME group, #P<0.05 vs L+SD group.

Tissue ACE Activity
Cardiac tissue ACE activity was increased in the L-NAME group (TableUp). This increased ACE activity was not influenced by NF-{kappa}B decoy ODN transfection or scramble decoy ODN transfection (TableUp).


*    Discussion
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up arrowResults
*Discussion
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The novel findings that have emerged from the present study are that in vivo transfection of cis element decoy against NF-{kappa}B binding site to the heart markedly suppressed NF-{kappa}B activity and prevented early inflammatory changes. Furthermore, transfection of NF-{kappa}B decoy ODNs inhibited the late development of coronary vascular medial thickening after inhibition of NO synthesis. The observed effect of NF-{kappa}B decoy transfection was independent of arterial hypertension induced by L-NAME administration. Our present findings suggest that the NF-{kappa}B system may be essential in the development of early inflammation and subsequent coronary vascular medial thickening in our model.

In the present study, we could transfect the decoy ODNs superselectively into coronary arteries and demonstrate that the strategy achieved NF-{kappa}B blockade in rat hearts (Figure 2Up). Thus, our present observations suggest that increased activity of NF-{kappa}B participates essentially in the L-NAME–induced increases in MCP-1 expression and subsequent monocyte recruitment. This claim is supported by in vitro evidence that cis-acting elements for the NF-{kappa}B binding site in the MCP-1 gene promoter region are responsible for increased transcription of the MCP-1 gene29 and that inhibition of NO synthesis increases the activity of NF-{kappa}B in vitro.5 6 7 8 We previously demonstrated the increased production of MCP-1 protein in endothelial cells, medial smooth muscle cells, and infiltrating inflammatory cells.14 15 Because the NF-{kappa}B activation in immunohistochemistry was also observed in these cells (Figure 3BUp), it is likely that increased NF-{kappa}B–mediated transcription and protein production of MCP-1 participate essentially in the development of inflammatory changes in our model.

Transfection of NF-{kappa}B decoy ODNs also inhibited the increase in PCNA (a marker of cell proliferation)-positive cells. Nuclear staining for PCNA antibody was observed in endothelial cells, vascular smooth muscle cells in the media, infiltrating monocytes, and myofibroblasts.14 15 These results suggest that increased NF-{kappa}B–mediated transcription of inflammation-promoting genes, including MCP-1, activated those cells and thus induced the vascular proliferative changes. These proliferating cells can secrete growth-promoting factors such as platelet-derived growth factor, fibroblast growth factor, and reactive oxygen species.1 3 Therefore, we hypothesize that NF-{kappa}B–mediated transcription of MCP-1 induced the recruitment of monocytes and activated vascular smooth muscle cells and monocytes during the early phase, which in turn caused proliferation of vascular smooth muscles by producing those growth-promoting factors. Transfection of NF-{kappa}B decoy ODNs thereby inhibited the development of vascular medial thickening during the late phase in the present study. A recent study demonstrated that MCP-1 may directly stimulate proliferation and migration of cultured vascular smooth muscle cells.30 Hence, it is reasonable to assume that the NF-{kappa}B system plays a key role in early vascular inflammation and subsequent vascular medial thickening after blockade of NO synthesis in vivo.

Despite a marked inhibition of monocyte infiltration, transfection of NF-{kappa}B decoy ODNs could not reduce gene expression of TGF-ß1 as well as perivascular and cardiac fibrosis. TGF-ß1 may induce transformation of fibroblasts to myofibroblasts, stimulate production of extracellular matrix proteins, and thus play an central role in tissue fibrosis.31 There are no NF-{kappa}B binding sites in the promoter region of the TGF-ß1 gene. Thus, the NF-{kappa}B system may not be involved in cardiac fibrogenesis in our model.

We previously demonstrated that local activity of ACE plays an important role in early cardiovascular inflammation and late remodeling in our model.9 13 In this study, there was no significant difference in the enzyme activity between hearts from the L-NAME, L+NF, and L+SD group. Thus, it is likely that the observed effects of NF-{kappa}B transfection were independent of local ACE activity.

We previously demonstrated that pharmacological inhibition of endothelial NO synthesis by L-NAME administration caused early cardiovascular inflammation and subsequent remodeling in rats. This conclusion is supported by our previous reports demonstrating that (1) endothelial NO production was blunted in the aorta from rats that received L-NAME but not from those that received D-NAME,14 (2) treatment with L-arginine prevented the L-NAME–induced inflammation and remodeling,13 14 17 and (3) administration of D-NAME did not induce such cardiovascular pathological changes.17 However, such pathological changes as seen in the rat model have not been described in genetically mutant mice lacking the endothelial NO synthase gene.9 10 These mice exhibit greater inflammatory and proliferative vascular responses to injury. The mechanisms of the difference between the rat and mouse models is probably multifactorial. One plausible explanation is that a defective endothelial NO synthase gene since birth might be compensated by other genes, so that no inflammatory or proliferative vascular changes have been observed at rest in mice lacking the endothelial NO synthase gene. In contrast, postnatal blockade of NO synthesis by administration of L-NAME to adult rats caused early inflammatory vascular responses and subsequent remodeling, as seen in the present study. Thus, these observations in the L-NAME–treated rats as well as in the mice lacking endothelial NO synthase may have clinically relevant implications, in that endothelium-derived NO is recognized to be an endogenous anti-inflammatory and/or antiarteriosclerotic factor.

In conclusion, the present study has provided direct in vivo evidence of the role of the NF-{kappa}B system in the development of vascular medial thickening at least by inducing MCP-1 in the rat model of chronic inhibition of NO synthesis. Although we did not examine whether other cis elements of the promoter region, such as AP-1 and SP-1, are involved in the regulation of MCP-1 expression in our model, the present study may provide a new aspect of how endothelium-derived NO contributes to anti-inflammatory and/or antiarteriosclerotic properties of the vascular endothelium in vivo. It appears that NO decreases monocyte recruitment to the arterial wall at least by suppressing NF-{kappa}B–mediated transcription of MCP-1 in vivo. Thus, preservation of normal endothelial NO activity may be an effective therapeutic strategy to reduce cardiovascular ischemic events in patients with vascular diseases. It might be of clinical interest to know whether an NF-{kappa}B decoy strategy can reduce restenosis after coronary angioplasty or the vulnerability of an atherosclerotic plaque prone to rupture.


*    Acknowledgments
 
This study was supported by Grants-in-Aid for Scientific Research (11470164, 11158216, 11557056, 10307019, 10177226) from the Ministry of Education, Science, and Culture, Tokyo; by the Ryouichi Naito Foundation for Medical Research, Osaka; and by a Research Grant from the Kanae Foundation of Research for New Medicine, Osaka, Japan.

Received February 9, 2000; revision received March 15, 2000; accepted March 16, 2000.


*    References
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up arrowAbstract
up arrowIntroduction
up arrowMethods
up arrowResults
up arrowDiscussion
*References
 
1. Ross R. Atherosclerosis: an inflammatory disease. N Engl J Med. 1999;340:115–126.[Free Full Text]

2. Harrison DG. Cellular and molecular mechanisms of endothelial cell dysfunction. J Clin Invest. 1997;100:2153–2157.[Medline] [Order article via Infotrieve]

3. Griendling KK, Alexander RW. Endothelial control of the cardiovascular system: recent advances. FASEB J. 1996;10:283–292.[Abstract]

4. von der Leyen HE, Gibbons GH, Morishita R, et al. Gene therapy inhibiting neointimal vascular lesion: in vivo transfer of endothelial cell nitric oxide synthase gene. Proc Natl Acad Sci U S A. 1995;92:1137–1141.[Abstract/Free Full Text]

5. Tsao PS, Wang B, Buitrago R, et al. Nitric oxide regulates monocyte chemotactic protein-1. Circulation. 1997;96:934–940.[Abstract/Free Full Text]

6. Zeiher AM, Fisslthaler B, Schray-Utz B, et al. Nitric oxide modulates the expression of monocyte chemoattractant protein 1 in cultural human endothelial cells. Circ Res. 1995;76:980–986.[Abstract/Free Full Text]

7. Peng HB, Libby P, Liao JK. Induction and stabilization of I kappa B alpha by nitric oxide mediates inhibition of NF-kappa B. J Biol Chem. 1995;270:14214–14219.[Abstract/Free Full Text]

8. De Caterina R, Libby P, Peng HB, et al. Nitric oxide decreases cytokine-induced endothelial activation: nitric oxide selectively reduces endothelial expression of adhesion molecules and proinflammatory cytokines. J Clin Invest. 1995;96:60–68.

9. Moroi M, Zhang L, Yasuda T, et al. Interaction of genetic deficiency of endothelial nitric oxide, gender, and pregnancy in vascular response to injury in mice. J Clin Invest. 1998;101:1225–1232.[Medline] [Order article via Infotrieve]

10. Rudic RD, Shesely EG, Maeda N, et al. Direct evidence for the importance of endothelium-derived nitric oxide in vascular remodeling. J Clin Invest. 1998;101:731–736.[Medline] [Order article via Infotrieve]

11. Takemoto M, Egashira K, Usui M, et al. Important role of tissue angiotensin-converting enzyme activity in the pathogenesis of coronary vascular and myocardial structural changes induced by long-term blockade of nitric oxide synthesis in rats. J Clin Invest. 1997;99:278–287.[Medline] [Order article via Infotrieve]

12. Takemoto M, Egashira K, Tomita H, et al. Chronic angiotensin-converting enzyme inhibition and angiotensin II type 1 receptor blockade. Hypertension. 1997;30:1621–1627.[Abstract/Free Full Text]

13. Katoh M, Egashira K, Usui M, et al. Cardiac angiotensin II receptor is upregulated by long-term inhibition of nitric oxide synthesis in rats. Circ Res. 1998;83:743–751.[Abstract/Free Full Text]

14. Tomita H, Egashira K, Kubo-Inoue M, et al. Inhibition of nitric oxide synthesis induces inflammatory changes and monocyte chemoattractant protein-1 expression in rat hearts and vessels. Arterioscler Thromb Vasc Biol. 1998;18:1456–1464.[Abstract/Free Full Text]

15. Usui M, Egashira K, Tomita H, et al. Important role of local angiotensin II activity mediated via type 1 receptor in the pathogenesis of cardiovascular inflammatory changes induced by chronic blockade of nitric oxide synthesis in rats. Circulation. 2000;101:305–310.[Abstract/Free Full Text]

16. Numaguchi K, Egashira K, Takemoto M, et al. Chronic inhibition of nitric oxide synthesis causes pathologic coronary microvascular remodeling and myocardial fibrosis. Hypertension. 1995;26(pt 1):957–962.

17. Tomita H, Egashira K, Ohara Y, et al. Early induction of transforming growth factor-ß via angiotensin II type 1 receptors contributes to cardiac fibrosis induced by long-term blockade of nitric oxide synthesis in rats. Hypertension. 1998;32:273–279.[Abstract/Free Full Text]

18. Collins T, Read MA, Neish AS, et al. Transcriptional regulation of endothelial cell adhesion molecules: NF-{kappa}B and cytokine-inducible enhancers. FASEB J. 1995;9:899–909.[Abstract]

19. Marui N, Offermann MK, Swerlick R, et al. Vascular cell adhesion molecule-1 (VCAM-1) gene transcription and expression are regulated through an antioxidant-sensitive mechanism in human vascular endothelial cells. J Clin Invest. 1993;92:1866–1874.

20. Satriano JA, Shuldiner M, Hora K, et al. Oxygen radical as second messenger for expression of the monocyte chemoattractant protein, JE/MCP-1, and the monocyte colony-stimulating factor, CSF-1, in response to tumor necrosis factor-alpha and immunoglobulin G. J Clin Invest. 1993;92:1564–1571.

21. Hernandez-Presa M, Bustos C, Ortego M, et al. Angiotensin-converting enzyme inhibition prevents arterial nuclear factor-kappa B activation, monocyte chemoattractant protein-1 expression, and macrophage infiltration in a rabbit model of early accelerated atherosclerosis. Circulation. 1997;95:1532–1541.[Abstract/Free Full Text]

22. Rollins BJ. Chemokines. Blood. 1997;90:909–928.[Free Full Text]

23. Collins T. Endothelial nuclear factor-kappa B and the initiation of the atherosclerotic lesion. Lab Invest. 1993;68:499–508.[Medline] [Order article via Infotrieve]

24. Yla-Herttuala S, Lipton BA, Rosenfeld ME, et al. Expression of monocyte chemoattractant protein 1 in macrophage-rich areas of human and rabbit atherosclerotic lesions. Proc Natl Acad Sci U S A. 1991;88:5252–5256.[Abstract/Free Full Text]

25. Usui M, Egashira K, Kitamoto S, et al. Pathogenic role of oxidative stress in vascular angiotensin-converting enzyme activation in long-term blockade of nitric oxide synthesis in rats. Hypertension. 1999;34:546–551.[Abstract/Free Full Text]

26. Morishita R, Higaki J, Tomita N, et al. Application of transcription factor "decoy" strategy as means of gene therapy and study of gene expression in cardiovascular disease. Circ Res. 1998;82:1023–1028.[Abstract/Free Full Text]

27. Morishita R, Sugimoto T, Aoki M, et al. In vivo transfection of cis element "decoy" against nuclear factor-kappaB binding site prevents myocardial infarction. Nat Med. 1997;3:894–899.[Medline] [Order article via Infotrieve]

28. Sakanashi Y, Takeya M, Yoshimura T, et al. Kinetics of macrophage subpopulations and expression of monocyte chemoattractant protein-1 (MCP-1) in bleomycin-induced lung injury of rats studied by a novel monoclonal antibody against rat MCP-1. J Leukoc Biol. 1994;56:741–750.[Abstract]

29. Ueda A, Okuda K, Ohno S, et al. NF-kappa B and Sp1 regulate transcription of the human monocyte chemoattractant protein-1 gene. J Immunol. 1994;153:2052–2063.[Abstract]

30. Porreca E, Di Febbo C, Reale M, et al. Monocyte chemotactic protein 1 (MCP-1) is a mitogen for cultured rat vascular smooth muscle cells. J Vasc Res. 1997;34:58–65.[Medline] [Order article via Infotrieve]

31. Weber KT. Extracellular matrix remodeling in heart failure: a role for de novo angiotensin II generation. Circulation. 1997;96:4065–4082.[Free Full Text]




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