(Circulation. 2001;103:3099.)
© 2001 American Heart Association, Inc.
Basic Science Reports |
From the Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital, and Harvard Medical School, Boston, Mass.
Correspondence to Paul L. Huang, MD, PhD, Cardiovascular Research Center, Massachusetts General Hospital East, 149 E 13th St, Charlestown, MA 02129. E-mail huangp{at}helix.mgh.harvard.edu
| Abstract |
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Methods and ResultsAfter 16 weeks of Western-type diet, the aortic lesion area in apoE/iNOS-dKO males and females was significantly reduced, by 22% and 21%, respectively, compared with apoE-KO males and females. This effect was more pronounced after 24 weeks of Western-type diet, after which lesion formation in male and female dKO mice was reduced by 38% and 40%, respectively. Plasma levels of lipoperoxides in apoE/iNOS-dKO mice (2.0±0.23 µmol/L) were significantly lower than in apoE-KO control animals (3.2±0.44 µmol/L; P=0.02). To test whether substrate deficiency plays a role in the proatherogenic actions of iNOS, we administered L-arginine to apoE-KO animals for 16 and 24 weeks. L-Arginine treatment did not affect lesion formation in apoE-KO animals fed a Western-type diet.
ConclusionsGenetic deficiency of iNOS decreases diet-induced atherosclerosis and lowers plasma levels of lipoperoxides, a marker for oxidative stress, in apoE-KO animals. Reduction in iNOS-mediated oxidative stress could partly explain protection from lesion formation in dKO animals. L-Arginine supplementation did not change lesion area in apoE-KO mice, indicating that substrate deficiency is not a likely cause for iNOS-mediated injury in this model of atherosclerosis.
Key Words: atherosclerosis nitric oxide nitric oxide synthase
| Introduction |
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NOSs use L-arginine as substrate, converting a terminal guanidino nitrogen to NO. The activities of eNOS and nNOS, the constitutive isoforms, are regulated by intracellular Ca2+ concentration. In contrast, iNOS expression is induced by microbial endotoxins or cytokine stimulation, and its activity does not vary with intracellular Ca2+ concentration. Although strong evidence suggests that eNOS plays an important role in protection of the vessel wall from atherosclerosis, the role of iNOS in modulating the development of atherosclerosis is unclear.
iNOS may contribute to lesion formation by increasing oxidative stress in the vessel wall.3 Reactive intermediates derived from NO accelerate LDL oxidation under acidic conditions.4 NO can react with superoxide to form peroxynitrite, a strong oxidant, with resultant generation of hydroxyl radicals.5 6 Peroxynitrite also promotes LDL lipid oxidation in vitro6 7 and nitrosylates protein tyrosine residues in atherosclerotic lesions.8 Because superoxide reacts with NO to form peroxynitrite faster than superoxide can be scavenged by superoxide dismutase,9 the rate of superoxide formation in the vessel wall can profoundly influence the fate of NO.
To study the contribution of iNOS to lesion formation, we combined a genetic model of iNOS deficiency with a mouse model of atherosclerosis, the hyperlipidemic apolipoprotein E (apoE)knockout (KO) mouse. ApoE-KO mice develop atherosclerotic lesions on a normal chow diet in a distribution closely resembling that in human disease.10 Disease progression can be substantially accelerated by feeding a "Western-type" atherogenic diet. We compared lesion formation in Western-type dietfed apoE/iNOSdouble knockout (dKO) mice and apoE-KO mice. This genetic approach overcomes problems with specificity and variability of NOS inhibitors. To avoid effects due to genetic background, we used highly inbred animals, all backcrossed 10 generations to the C57BL6 strain.
We show that genetic deficiency of the inducible NOS protects from atherosclerosis in apoE/iNOS-dKO mice. Furthermore, apoE/iNOS-dKO mice had significantly lower plasma levels of lipid peroxides, suggesting that the reduction in lesion formation may be due to a decrease in lipid peroxidation.
| Methods |
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Lesion Assessment
The aorta was dissected and analyzed as
previously described.15
Animals were euthanized with pentobarbital (80 µg/kg IP), and the
aorta was perfused with PBS (pH 7.4), dissected from the aortic valve
to the iliac bifurcation, and fixed in 4%
paraformaldehyde overnight. Adventitial tissue was
removed, and the aorta was opened longitudinally and pinned onto a
black wax surface with micro needles (Fine Science Tools). Serial
images of the submerged vessels were captured with a video camera and a
still 35-mm camera. Lipid-rich intraluminal lesions were stained with
Sudan IV.15 Image
analysis was performed with Image Pro Plus (version 3.0.1;
Media Cybernetics). The amount of aortic lesion formation in each
animal was measured as percent lesion area per total area of the
aorta.
Tissue Preparation and Histology
Animals were euthanized with pentobarbital (80
µg/kg IP) and perfused with 0.9% NaCl followed by 10%
phosphate-buffered formalin through a catheter placed in the left
ventricle. The heart was fixed in 10% phosphate-buffered formalin for
48 hours and embedded in paraffin. Serial 5-µm sections were taken
from the aortic valve area. Sections were stained with
hematoxylin-eosin, Massons trichrome, Weigerts method for elastic
fibers, and von Kossa stain for mineral salts.
Immunohistochemistry
Immunohistochemistry was carried out on
paraffin-embedded sections with a goat anti-mouse IgG1 antibody raised
against iNOS (clone 2, N52920, Transduction
Laboratories). A Vectastain ABC kit
with DAB as the substrate was used for
visualization.
Lipids and Lipoprotein Characterization
Animals were fasted for 4 hours, and blood was drawn
from the left ventricle of anesthetized animals. Plasma total
cholesterol was measured with Sigma
kit 352. Lipoprotein cholesterol distribution of plasma
samples was evaluated after fractionation by fast protein liquid
chromatography (FPLC) gel filtration. Plasma (200 µL)
was fractionated on a Superose 6 column with an ÄKTA-FPLC
(Amersham Pharmacia Biotech) system.
Cholesterol concentrations were measured with a microtiter
plate assay (Sigma kit 352; Spectra MAX 250; Molecular
Devices).
Plasma Lipoperoxide Measurement
Malondialdehydethiobarbituric acid (MDA-TBA) adduct
was measured by high-performance liquid
chromatography (HPLC) as
described.16 Blood was drawn
from the left ventricle of animals under pentobarbital
anesthesia (40 to 60 mg/kg IP) and collected in tubes
containing EDTA. Plasma was separated, and fractionation of the
protein-free extract was done with a C18 column (Micro Bondapak,
Waters) in an ÄKTApurifier HPLC system
(Amersham Pharmacia Biotech). A standard curve was constructed with
tetraethoxypropane standards.
Statistical Analysis
Statistical analysis was performed with
StatView 4.51 (Abacus Concepts, Inc). Two-way
ANOVA was used for repeated measures, followed by Scheffés F test.
A probability value of P<0.05
was considered significant.
| Results |
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The body weight, total area of the aorta, and total
cholesterol did not differ between apoE-KO mice and
apoE/iNOS-dKO mice within each sex
(Table
).
Female mice, however, were smaller than male mice of the same
genotype. The lipoprotein profile, as assessed by FPLC, also
did not differ between apoE-KO mice and apoE/iNOS-dKO mice (data not
shown).
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After 16 weeks of Western-type diet, the aortic lesion areas
in apoE/iNOS-dKO males and females were reduced by 22% and 21%,
respectively (males: mean area 11.4±0.7%, n=9; females: mean area
14.2±0.7%, n=7), compared with apoE-KO males and females (mean area
14.6±0.8%, n=7, P=0.035, and
18.0±0.6%, n=8, P=0.005)
(Figure 3
, left). After 24 weeks of Western-type diet, lesion
formation in male and female dKO mice was reduced by 38% and 40%,
respectively (males: mean area 19.5±1.5%, n=9; females: mean area
19.2±1.4%, n=8), compared with apoE-KO control animals (males: mean
area 31.3±1.6%, n=11,
P=0.0006; females: mean area
32.1±3.3%, n=6, P=0.0017)
(Figure 3
, right).
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L-Argininesupplemented
drinking water was given to male and female apoE-KO mice fed the
Western-type diet. After 16 weeks of Western-type diet and
L-arginine supplementation,
lesion formation in male and female apoE-KO mice (males: mean area
16.2±1.1%, n=5, P
0.6;
females: mean area 18.7±1.0%, n=5,
P
0.9) did not differ from
that in apoE-KO mice fed the Western-type diet alone
(Figure 4
, left). This result did not change when we examined
the 24-week time point (males: mean area 30.7±2.1%, n=8,
P
0.9; females: mean area
27.7±1.0%, n=8, P
0.5) with
apoE-KO animals fed the Western-type diet alone for the same amount of
time
(Figure 4
, right).
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Plasma levels of lipoperoxides, assayed as MDA-TBA adducts
by HPLC, were significantly reduced in apoE/iNOS-dKO mice (2.01±0.23
µmol/L, n=12) compared with apoE-KO control animals (3.20±0.44
µmol/L, n=7, P=0.018) at the
4-month time point, as seen in
Figure 5
. In good agreement with the basal lipoperoxide
levels measured in rats (1.4 µmol/L) by Wong et
al,16 the basal plasma
lipoperoxide level in wild-type C57BL6 mice on a normal chow diet
averaged 0.99±0.11 µmol/L (n=8), which was significantly lower than
the values measured in apoE/iNOS-dKO mice
(P=0.037) and apoE-KO animals
(P
0.0001).
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| Discussion |
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The role of iNOS in vascular pathology is variable and poorly defined in atherosclerosis. Transplant atherosclerosis is exacerbated in a model of chronic cardiac rejection in iNOS-KO mice, suggesting a protective role for iNOS.22 The same authors reported, however, that iNOS deficiency reduced inflammatory infiltrates and lowered rejection scores in a model of acute cardiac allograft rejection, suggesting a pathological role for iNOS.23 Recently, Knowles et al24 reported that absence of iNOS had no effect on atherosclerosis development in apoE/iNOS-dKO mice, but details were not provided. The potential effects of iNOS in atherosclerosis have clinical implications beyond a molecular mechanism of atherogenesis as well. Gene transfer of iNOS to injured vascular segments reduces neointima formation in normocholesterolemic animals,25 providing impetus for studies involving gene transfer of iNOS in patients. Thus, a possible involvement of iNOS in the development of atherosclerotic lesions has important clinical implications.
In the present study, we show that genetic deficiency of iNOS decreases atherosclerosis in apoE/iNOS-dKO mice. Male and female apoE/iNOS-dKO animals showed significant 22% and 21% reductions in aortic lesion area after 16 weeks and 38% and 40% reductions after 24 weeks of Western-type diet, respectively. Thus, protection from lesion formation in genetic iNOS deficiency increases over time, suggesting that iNOS accelerates lesion progression from an early time point and that the amount of iNOS-mediated injury increases over time.
Reduction in lesion formation was associated with a decrease in plasma lipoperoxide concentrations. Plasma levels of MDA, a highly reactive compound generated during lipid peroxidation by phagocytic cells, were significantly higher in apoE-KO animals than in apoE/iNOS-dKO animals and normocholesterolemic C57BL6 mice. In addition, MDA levels in apoE/iNOS-dKO animals were significantly higher than in C57BL6 animals. This demonstrates that iNOS is not the sole contributor to the elevated MDA levels seen in Western-type dietfed apoE-KO mice. The decrease in atherosclerotic lesion area and lowered plasma lipoperoxide levels are not due to secondary changes in plasma total cholesterol, lipoprotein distribution, or body weight, because none of these parameters differed between apoE-KO and apoE/iNOS-dKO animals.
NO has both oxidant and antioxidant effects. NO may inhibit lipid peroxidation by scavenging lipid radicals and terminating the peroxidative chain reaction.26 Conversely, NO reacts with superoxide to form peroxynitrite. Peroxynitrite can oxidize LDL, nitrosylate tyrosine residues within proteins, and generate hydroxyl radicals. Hydroxyl radicals, in turn, can attack unsaturated fatty acids to yield lipid hydroperoxides.6 MDA generated during lipid oxidation can itself modify LDL so that it is recognized by the macrophage scavenger receptor, an important step in foam cell formation.27 28
It has been suggested that the balance between local concentrations of NO and O2- may determine whether peroxynitrite forms and lipid peroxidation occurs.29 Conditions that favor peroxynitrite formation would favor lipid peroxidation, whereas excess NO without O2- may block lipid peroxidation by scavenging peroxyl radicals. The role of iNOS in this balance is complex, because iNOS can generate not only NO but also O2-, particularly under conditions of decreased L-arginine availability.30 31 L-Arginine supplementation reduces atherosclerosis development in hyperlipidemic rabbits and in LDL receptorknockout mice.13 14
To test whether L-arginine supplementation modulates atherosclerosis in apoE-KO animals, we supplemented the drinking water of Western-type dietfed animals with 2.5% L-arginine. After 16 and 24 weeks of L-arginine supplementation, the lesion area in apoE-KO mice did not differ from animals that were fed the Western-type diet alone. There are several potential explanations for this finding. First, in vitro studies show that O2- production by iNOS is inhibited only by high L-arginine concentrations. Whereas O2- production by nNOS is completely blocked by 100 µmol/L L-arginine, iNOS-mediated O2- formation was essentially unaltered. Even in the presence of 1 mmol/L L-arginine, O2- production was only partially blocked. Physiological cytosolic L-arginine concentrations (200 to 800 µmol/L) may thus not be able to block O2- generation from iNOS. Second, if there are additional sources of O2- that are independent of iNOS, reducing the contribution of iNOS to O2- formation may not affect the net amount of O2- present. In fact, by providing more NO, L-arginine supplementation may increase the amount of OONO- formed under these conditions. Third, the effects of L-arginine on atherosclerosis may depend on the relative amounts of the 3 NOS isoforms and their contribution to NO and O2- production in the various animal models of atherosclerosis. For example, L-arginine may result in increased eNOS production of NO, accounting for protection in some models independent of iNOS. Our results suggest that L-arginine may not be important in reducing iNOS-mediated atherogenesis in Western-type dietfed apoE-KO animals. Additional cofactor deficiency, low local L-arginine concentration despite supplementation, or the fact that iNOS is not substrate deficient in first place cannot be excluded, however. Our results differ from those in LDL receptorKO mice,14 in which L-arginine supplementation reduced atherosclerosis. In addition to the above-mentioned factors, the 2 animal models differ in several important ways. Our apoE-KO mice were fed a Western-type diet containing 0.15% cholesterol, whereas the LDL receptorKO mice were fed a high-cholesterol diet containing 1.25% cholesterol. Lesion areas are much greater in the apoE-KO model than the LDL receptorKO model.32
While our manuscript was in preparation, Knowles et al24 reported that iNOS deficiency has no effect on atherosclerosis development in apoE/iNOS-dKO mice. The difference in phenotype seen in the 2 studies may be due to the mixed genetic background of the animals, their use of normal chow diet rather than our use of a Western-type diet, or our study of later time points and the different assay for atherosclerosis development used. A more recent report confirms our results that iNOS deficiency reduces atherosclerosis in apoE-KO mice.33 Our study differs, however, because we assayed en face lesion area as opposed to aortic root lesions, we used animals that were all backcrossed to the C57BL6 strain, and we provide data about levels of plasma MDA-TBA adducts.
In summary, genetic deficiency of iNOS decreases atherosclerosis in Western-type dietfed apoE-KO animals. The reduction in atherosclerosis in dKO animals was associated with decreased plasma levels of lipoperoxides, suggesting that reduction in iNOS-mediated oxidative stress may explain the protection from lesion formation in dKO animals. L-Arginine supplementation did not change lesion area in apoE-KO mice after 16 and 24 weeks of Western-type diet.
| Acknowledgments |
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Received December 12, 2000; revision received February 14, 2001; accepted February 19, 2001.
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