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(Circulation. 2003;107:671.)
© 2003 American Heart Association, Inc.
Brief Rapid Communications |
From the Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
Correspondence to Noriyuki Ouchi, MD, PhD, Department of Internal Medicine and Molecular Science, Graduate School of Medicine, Osaka University, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan. E-mail ouchi{at}imed2.med.osaka-u.ac.jp
| Abstract |
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Methods and Results We studied a total of 101 male patients, 71 of whom had angiographically documented coronary atherosclerosis. As a control group, 30 patients with normal coronary angiogram were included. The plasma hs-CRP levels were negatively correlated with the plasma adiponectin levels (r=-0.29, P<0.01). The plasma adiponectin concentrations were significantly lower and the hs-CRP levels were significantly higher in the CAD patients compared with control subjects. The mRNA levels of CRP and adiponectin were analyzed by quantitative real-time polymerase chain reaction method. We found that the CRP mRNA was expressed in human adipose tissue. A significant inverse correlation was observed between the CRP and adiponectin mRNA levels in human adipose tissue (r=-0.89, P<0.01). In addition, the CRP mRNA level of white adipose tissue in adiponectin deficient mice was higher than that of wild-type mice.
Conclusions The reciprocal association of adiponectin and CRP levels in both human plasma and adipose tissue might participate in the development of atherosclerosis.
Key Words: coronary disease risk factors inflammation proteins
| Introduction |
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Adipose tissue secretes various bioactive substances, conceptualized as adipocytokines, including leptin, tumor necrosis factor-
(TNF-
), and adiponectin, that may directly contribute to obesity-liked metabolic and vascular diseases.7,8 Adiponectin is an adipocyte-specific plasma protein that we identified in a human adipose tissue cDNA library.8 We have reported that physiological concentrations of human recombinant adiponectin suppressed TNF-
induced endothelial adhesion molecule expression, macrophage-to-foam cell transformation, and TNF-
expression in macrophage and adipose tissue.912 Recently, we have reported that adiponectin-deficient mice exhibit severe diet-induced insulin resistance and enhanced neointimal thickening after vascular injury.12,13 Clinically, hypoadiponectinemia was observed in patients with obesity, type 2 diabetes, and CAD.9,14,15 These findings suggest that adiponectin has antiinflammatory properties and acts as an endogenous modulator of obesity-related diseases. Atherosclerosis can be considered a hyper-responsive healing process of the arterial wall.16 Fat tissue is an important secretory organ of the innate immune system.7 Therefore, we hypothesized that adiponectin and CRP might affect each other and contribute to the development of atherosclerosis. In the present study, we investigated the relation between adiponectin and CRP in both human plasma and adipose tissue.
| Methods |
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Quantitation of Adiponectin and CRP mRNA Levels
Human subcutaneous adipose tissue samples were obtained from 8 male Japanese subjects who suffered from gallbladder stones and underwent the elective surgical removal of gallbladder. These patients had no symptoms and no systemic signs of inflammation determined by the routine CRP assay before surgery. All subjects provided written informed consent. The Ethics Committee of Osaka University approved this study.
Adiponectin knockout (KO) male mice (12 weeks old) were generated as described previously.12 White adipose tissues were obtained from wild-type (WT) male or adiponectin KO male mice. The experimental protocol was approved by the Ethics Review Committee for Animal Experimentation of Osaka University School of Medicine.
Total RNA was prepared by RNA-TRIZOL extraction (Gibco) and treated with DNase I (Takara). cDNA was produced using Taqman reverse transcription (Perkin Elmer) kits. Real-time polymerase chain reaction was performed on ABI-Prism 7700 using SYBR Green I as a double stranded DNA specific dye according to manufacturers instruction (PE-Applied Biosystems).13 Primers were 5'-GTGTTTCCCAAAGAGTCGGATACT-3' and 5'-CCACGG-GTCGAGGACAGTT-3' for human CRP, 5'-AGGTTGG-ATGGCGGGC-3' and 5'-AAAGTGGCTACAGAGGGAATCC-3' for human adiponectin, 5'-CAATGACCCCTTCATTGACCTC-3' and 5'-AGCATCGCCCCACTTGATT-3' for human GAPDH, 5'-CCATTTCTACACTGCTCTGAGCAC-3' and 5'-CCAAAA-TATGAGAATGTCGTTAGAGTTC-3' for mouse CRP, and 5'-AGGTTGGATGGCAGGC-3' and 5'-CAGAGTGGGAATCC-TGGTTCTT-3' for mouse adiponectin. The primers for rodent GAPDH were obtained from Perkin Elmer.
Statistic Analysis
Data are presented as mean±SEM. Differences were analyzed by Students unpaired t test. The association between CRP and adiponectin was analyzed by linear regression analysis. P<0.05 was accepted as statistically significant. All calculations were performed by using a standard statistical package (JMP for Macintosh, version 4.0).
| Results |
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Inverse Correlation Between CRP and Adiponectin mRNA Levels in Adipose Tissue
We next examined whether CRP mRNA was expressed in human adipose tissue. The quantitative real-time polymerase chain reaction revealed that the human fat tissue expressed CRP mRNA. Interestingly, an inverse correlation was found between CRP and adiponectin mRNA levels in human adipose tissue (r=-0.89, P<0.01; Figure 2A).
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Finally, we examined CRP mRNA expression in white adipose tissue in adiponectin KO mice. The adiponectin mRNA in adipose tissue was not expressed in KO mice (Figure 2B), thereby confirming our hypothesis. The CRP mRNA levels of adipose tissue in adiponectin KO mice were higher than those in wild-type (WT) mice (Figure 2B). No significant differences were observed in body weight and various metabolic profiles between WT and KO mice, as previously described.14
| Discussion |
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Adipose tissue expresses a variety of adipocytokines, which participate in the immune and inflammation system. In the current study, human adipose tissue expressed CRP mRNA, which was negatively correlated with adiponectin expression in adipose tissue. The CRP mRNA level in adipose tissue was increased in adiponectin KO mice. These data suggested that the expression of CRP was negatively regulated by adiponectin in adipose tissue, although further mRNA study in a larger number might be needed to elucidate the precise link between CRP and adiponectin. Recent reports indicated that interleukin-6 (IL-6) was one of important adipocytokines linking obesity and CAD and was a main regulator of hepatic CRP production.2,17 Another adipocytokine, TNF-
, was reported to regulate the hepatic CRP synthesis and induce IL-6 expression.17 Because adiponectin could counteract the proinflammatory effects of TNF-
in vascular cellular components and adipose tissue,9,1113 adiponectin might influence IL-6 and CRP production through modulating the TNF-
action. Therefore, adiponectin may directly or indirectly affect the CRP levels in plasma and adipose tissue through modulating the inflammatory cascades. Further study will be needed to clarify the mechanism of the regulation of the CRP expression.
The principal source of CRP production has been assumed to be the liver.2 Recent data indicated that CRP was detected in arterial walls and that its expression was upregulated in atherosclerotic lesions, suggesting that vascular walls are one of the main CRP producers.2 In addition, plasma hs-CRP levels were positively associated with total body fat mass6 and decreased during weight reduction.15 These results proposed that adipose tissue acts as an important factor in modulating circulating hs-CRP levels. Taken together, the increased CRP expression in adipose tissue may partially account for the elevation of plasma hs-CRP.
Among adipocytokines, CRP and adiponectin have opposite properties against insulin resistance and atherosclerosis. Our observations suggest that the dysregulated elevation of CRP and reduction of adiponectin in adipose tissue and plasma may participate in the development of atherosclerosis.
| Acknowledgments |
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Received October 22, 2002; revision received December 17, 2002; accepted December 17, 2002.
| References |
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M. R. Manigrasso, P. Ferroni, F. Santilli, T. Taraborelli, M. T. Guagnano, N. Michetti, and G. Davi Association between Circulating Adiponectin and Interleukin-10 Levels in Android Obesity: Effects of Weight Loss J. Clin. Endocrinol. Metab., October 1, 2005; 90(10): 5876 - 5879. [Abstract] [Full Text] [PDF] |
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P. Calabro, D. W. Chang, J. T. Willerson, and E. T.H. Yeh Release of C-Reactive Protein in Response to Inflammatory Cytokines by Human Adipocytes: Linking Obesity to Vascular Inflammation J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1112 - 1113. [Full Text] [PDF] |
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S. B. Schwedler, K. Amann, K. Wernicke, A. Krebs, M. Nauck, C. Wanner, L. A. Potempa, and J. Galle Native C-Reactive Protein Increases Whereas Modified C-Reactive Protein Reduces Atherosclerosis in Apolipoprotein E-Knockout Mice Circulation, August 16, 2005; 112(7): 1016 - 1023. [Abstract] [Full Text] [PDF] |
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D. Rothenbacher, H. Brenner, W. Marz, and W. Koenig Adiponectin, risk of coronary heart disease and correlations with cardiovascular risk markers Eur. Heart J., August 2, 2005; 26(16): 1640 - 1646. [Abstract] [Full Text] [PDF] |
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C. S. Mantzoros, T. Li, J. E. Manson, J. B. Meigs, and F. B. Hu Circulating Adiponectin Levels Are Associated with Better Glycemic Control, More Favorable Lipid Profile, and Reduced Inflammation in Women with Type 2 Diabetes J. Clin. Endocrinol. Metab., August 1, 2005; 90(8): 4542 - 4548. [Abstract] [Full Text] [PDF] |
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K Yamamoto, T Kiyohara, Y Murayama, S Kihara, Y Okamoto, T Funahashi, T Ito, R Nezu, S Tsutsui, J-I Miyagawa, et al. Production of adiponectin, an anti-inflammatory protein, in mesenteric adipose tissue in Crohn's disease Gut, June 1, 2005; 54(6): 789 - 796. [Abstract] [Full Text] [PDF] |
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M. Saraheimo, C. Forsblom, J. Fagerudd, A.-M. Teppo, K. Pettersson-Fernholm, J. Frystyk, A. Flyvbjerg, P.-H. Groop, and on behalf of the FinnDiane Study Group Serum Adiponectin Is Increased in Type 1 Diabetic Patients With Nephropathy Diabetes Care, June 1, 2005; 28(6): 1410 - 1414. [Abstract] [Full Text] [PDF] |
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K. K. Koh, S. H. Han, M. J. Quon, J. Yeal Ahn, and E. K. Shin Beneficial Effects of Fenofibrate to Improve Endothelial Dysfunction and Raise Adiponectin Levels in Patients With Primary Hypertriglyceridemia Diabetes Care, June 1, 2005; 28(6): 1419 - 1424. [Abstract] [Full Text] [PDF] |
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Y. Iwashima, T. Katsuya, K. Ishikawa, I. Kida, M. Ohishi, T. Horio, N. Ouchi, K. Ohashi, S. Kihara, T. Funahashi, et al. Association of Hypoadiponectinemia With Smoking Habit in Men Hypertension, June 1, 2005; 45(6): 1094 - 1100. [Abstract] [Full Text] [PDF] |
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S. Otake, H. Takeda, Y. Suzuki, T. Fukui, S. Watanabe, K. Ishihama, T. Saito, H. Togashi, T. Nakamura, Y. Matsuzawa, et al. Association of Visceral Fat Accumulation and Plasma Adiponectin with Colorectal Adenoma: Evidence for Participation of Insulin Resistance Clin. Cancer Res., May 15, 2005; 11(10): 3642 - 3646. [Abstract] [Full Text] [PDF] |
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A. H. Berg and P. E. Scherer Adipose Tissue, Inflammation, and Cardiovascular Disease Circ. Res., May 13, 2005; 96(9): 939 - 949. [Abstract] [Full Text] [PDF] |
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D. C. W. Lau, B. Dhillon, H. Yan, P. E. Szmitko, and S. Verma Adipokines: molecular links between obesity and atheroslcerosis Am J Physiol Heart Circ Physiol, May 1, 2005; 288(5): H2031 - H2041. [Abstract] [Full Text] [PDF] |
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N. Ouchi, R. Shibata, and K. Walsh AMP-Activated Protein Kinase Signaling Stimulates VEGF Expression and Angiogenesis in Skeletal Muscle Circ. Res., April 29, 2005; 96(8): 838 - 846. [Abstract] [Full Text] [PDF] |
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B. J. Nicklas, T. You, and M. Pahor Behavioural treatments for chronic systemic inflammation: effects of dietary weight loss and exercise training Can. Med. Assoc. J., April 26, 2005; 172(9): 1199 - 1209. [Abstract] [Full Text] [PDF] |
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M.-P. Chen, J. C.-R. Tsai, F.-M. Chung, S.-S. Yang, L.-L. Hsing, S.-J. Shin, and Y.-J. Lee Hypoadiponectinemia Is Associated With Ischemic Cerebrovascular Disease Arterioscler Thromb Vasc Biol, April 1, 2005; 25(4): 821 - 826. [Abstract] [Full Text] [PDF] |
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D. M. Maahs, L. G. Ogden, G. L. Kinney, P. Wadwa, J. K. Snell-Bergeon, D. Dabelea, J. E. Hokanson, J. Ehrlich, R. H. Eckel, and M. Rewers Low Plasma Adiponectin Levels Predict Progression of Coronary Artery Calcification Circulation, February 15, 2005; 111(6): 747 - 753. [Abstract] [Full Text] [PDF] |
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J. R. Greenfield, K. Samaras, C. S. Hayward, D. J. Chisholm, and L. V. Campbell Beneficial Postprandial Effect of a Small Amount of Alcohol on Diabetes and Cardiovascular Risk Factors: Modification by Insulin Resistance J. Clin. Endocrinol. Metab., February 1, 2005; 90(2): 661 - 672. [Abstract] [Full Text] [PDF] |
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M. B. Schulze, I. Shai, E. B. Rimm, T. Li, N. Rifai, and F. B. Hu Adiponectin and Future Coronary Heart Disease Events Among Men With Type 2 Diabetes Diabetes, February 1, 2005; 54(2): 534 - 539. [Abstract] [Full Text] [PDF] |
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M. von Eynatten, J. G. Schneider, P. M. Humpert, G. Rudofsky, N. Schmidt, P. Barosch, A. Hamann, M. Morcos, J. Kreuzer, A. Bierhaus, et al. Decreased Plasma Lipoprotein Lipase in Hypoadiponectinemia: An association independent of systemic inflammation and insulin resistance Diabetes Care, December 1, 2004; 27(12): 2925 - 2929. [Abstract] [Full Text] [PDF] |
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G. K. Shetty, P. A. Economides, E. S. Horton, C. S. Mantzoros, and A. Veves Circulating Adiponectin and Resistin Levels in Relation to Metabolic Factors, Inflammatory Markers, and Vascular Reactivity in Diabetic Patients and Subjects at Risk for Diabetes Diabetes Care, October 1, 2004; 27(10): 2450 - 2457. [Abstract] [Full Text] [PDF] |
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A. Prasad and A. A. Quyyumi Renin-Angiotensin System and Angiotensin Receptor Blockers in the Metabolic Syndrome Circulation, September 14, 2004; 110(11): 1507 - 1512. [Full Text] [PDF] |
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B. B. Duncan, M. I. Schmidt, J. S. Pankow, H. Bang, D. Couper, C. M. Ballantyne, R. C. Hoogeveen, and G. Heiss Adiponectin and the Development of Type 2 Diabetes: The Atherosclerosis Risk in Communities Study Diabetes, September 1, 2004; 53(9): 2473 - 2478. [Abstract] [Full Text] [PDF] |
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A. D. Kriketos, J. R. Greenfield, P. W. Peake, S. M. Furler, G. S. Denyer, J. A. Charlesworth, and L. V. Campbell Inflammation, Insulin Resistance, and Adiposity: A study of first-degree relatives of type 2 diabetic subjects Diabetes Care, August 1, 2004; 27(8): 2033 - 2040. [Abstract] [Full Text] [PDF] |
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M. K. Rutter, J. B. Meigs, L. M. Sullivan, R. B. D'Agostino Sr, and P. W.F. Wilson C-Reactive Protein, the Metabolic Syndrome, and Prediction of Cardiovascular Events in the Framingham Offspring Study Circulation, July 27, 2004; 110(4): 380 - 385. [Abstract] [Full Text] [PDF] |
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R. Mills and D. L. Bhatt The yin and yang of arterial inflammation J. Am. Coll. Cardiol., July 7, 2004; 44(1): 50 - 52. [Full Text] [PDF] |
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M. B. Schulze, E. B. Rimm, I. Shai, N. Rifai, and F. B. Hu Relationship Between Adiponectin and Glycemic Control, Blood Lipids, and Inflammatory Markers in Men With Type 2 Diabetes Diabetes Care, July 1, 2004; 27(7): 1680 - 1687. [Abstract] [Full Text] [PDF] |
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J. R. Greenfield, K. Samaras, A. B. Jenkins, P. J. Kelly, T. D. Spector, J. R. Gallimore, M. B. Pepys, and L. V. Campbell Obesity Is an Important Determinant of Baseline Serum C-Reactive Protein Concentration in Monozygotic Twins, Independent of Genetic Influences Circulation, June 22, 2004; 109(24): 3022 - 3028. [Abstract] [Full Text] [PDF] |
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J. Sutinen, K. Kannisto, E. Korsheninnikova, R. M. Fisher, E. Ehrenborg, T. Nyman, A. Virkamaki, T. Funahashi, Y. Matsuzawa, H. Vidal, et al. Effects of rosiglitazone on gene expression in subcutaneous adipose tissue in highly active antiretroviral therapy-associated lipodystrophy Am J Physiol Endocrinol Metab, June 1, 2004; 286(6): E941 - E949. [Abstract] [Full Text] [PDF] |
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M. Kumada, S. Kihara, N. Ouchi, H. Kobayashi, Y. Okamoto, K. Ohashi, K. Maeda, H. Nagaretani, K. Kishida, N. Maeda, et al. Adiponectin Specifically Increased Tissue Inhibitor of Metalloproteinase-1 Through Interleukin-10 Expression in Human Macrophages Circulation, May 4, 2004; 109(17): 2046 - 2049. [Abstract] [Full Text] [PDF] |
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T. Pischon, C. J. Girman, G. S. Hotamisligil, N. Rifai, F. B. Hu, and E. B. Rimm Plasma Adiponectin Levels and Risk of Myocardial Infarction in Men JAMA, April 14, 2004; 291(14): 1730 - 1737. [Abstract] [Full Text] [PDF] |
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K. Shinohara, A. Wakatsuki, K. Watanabe, N. Ikenoue, T. Fukaya, N. Sattar, J. Ramsey, N. Jamieson, and I. A. Greer Plasma Adiponectin Concentrations in Women With Preeclampsia * Response: Adiponectin Concentrations in Preeclampsia Hypertension, April 1, 2004; 43(4): e17 - e17. [Full Text] [PDF] |
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K. C. B. Tan, A. Xu, W. S. Chow, M. C. W. Lam, V. H. G. Ai, S. C. F. Tam, and K. S. L. Lam Hypoadiponectinemia Is Associated with Impaired Endothelium-Dependent Vasodilation J. Clin. Endocrinol. Metab., February 1, 2004; 89(2): 765 - 769. [Abstract] [Full Text] [PDF] |
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T. Mazurek, L. Zhang, A. Zalewski, J. D. Mannion, J. T. Diehl, H. Arafat, L. Sarov-Blat, S. O'Brien, E. A. Keiper, A. G. Johnson, et al. Human Epicardial Adipose Tissue Is a Source of Inflammatory Mediators Circulation, November 18, 2003; 108(20): 2460 - 2466. [Abstract] [Full Text] [PDF] |
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J. R. Turk, J. A. Carroll, M. H. Laughlin, T. R. Thomas, J. Casati, D. K. Bowles, and M. Sturek C-reactive protein correlates with macrophage accumulation in coronary arteries of hypercholesterolemic pigs J Appl Physiol, September 1, 2003; 95(3): 1301 - 1304. [Abstract] [Full Text] [PDF] |
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M. Chandran, S. A. Phillips, T. Ciaraldi, and R. R. Henry Adiponectin: More Than Just Another Fat Cell Hormone? Diabetes Care, August 1, 2003; 26(8): 2442 - 2450. [Full Text] [PDF] |
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J. Krakoff, T. Funahashi, C. D.A. Stehouwer, C. G. Schalkwijk, S. Tanaka, Y. Matsuzawa, S. Kobes, P. A. Tataranni, R. L. Hanson, W. C. Knowler, et al. Inflammatory Markers, Adiponectin, and Risk of Type 2 Diabetes in the Pima Indian Diabetes Care, June 1, 2003; 26(6): 1745 - 1751. [Abstract] [Full Text] [PDF] |
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