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(Circulation. 2003;107:1017.)
© 2003 American Heart Association, Inc.

Basic Science Reports

High Glucose Causes Upregulation of Cyclooxygenase-2 and Alters Prostanoid Profile in Human Endothelial Cells

Role of Protein Kinase C and Reactive Oxygen Species

Francesco Cosentino, MD, PhD; Masato Eto, MD, PhD; Paola De Paolis, PhD; Bernd van der Loo, MD; Markus Bachschmid, PhD; Volker Ullrich, MD; Alexei Kouroedov, MD; Chiara Delli Gatti, MD; Hana Joch; Massimo Volpe, MD; Thomas F. Lüscher, MD

From the Department of Cardiovascular Research, Institute of Physiology (F.C., M.E., B.v.d.L., A.K., C.D.G., H.J., T.F.L.), University of Zurich and Cardiovascular Center, University Hospital, Zurich, Switzerland; Department of Experimental Medicine and Pathology (F.C., P.D.P., M.V.), University "La Sapienza," Rome and IRCCS Neuromed, Pozzilli, Italy; and Faculty of Biology (M.B., V.U.), University of Konstanz, Germany.

Correspondence to Francesco Cosentino, MD, PhD, Cardiovascular Research, Institute of Physiology, University of Zurich-Irchel, CH-8057 Zürich, Switzerland. E-mail f_cosentino{at}hotmail.com

	Abstract

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Background— Prostaglandins generated by cyclooxygenase (COX) have been implicated in hyperglycemia-induced endothelial dysfunction. However, the role of individual COX isoenzymes as well as the molecular mechanisms linking oxidative stress and endothelial dysfunction in diabetes remains to be clarified.

Methods and Results— Human aortic endothelial cells were exposed to normal (5.5 mmol/L) and high (22.2 mmol/L) glucose. Glucose selectively increased mRNA and protein expression of COX-2. Its upregulation was associated with an increase of thromboxane A₂ and a reduction of prostacyclin (PGI₂) release. Glucose-induced activation of PKC resulted in the formation of peroxynitrite and tyrosine nitration of PGI₂ synthase. NO release was reduced despite 2-fold increase of endothelial NO synthase expression. Phorbol ester caused an increase of COX-2 and endothelial NO synthase expression similar to that elicited by glucose. These effects were prevented by the PKC inhibitor calphostin C. N-acetylcysteine, vitamin C, and calphostin C prevented ROS formation, restored NO release, and reduced colocalization of nitrotyrosine and PGI₂ synthase. Expression of p22^phox, a subunit of NAD(P)H oxidase, was increased, and diphenyleneiodonium inhibited ROS formation. By contrast, indomethacin did not affect glucose-induced ROS generation.

Conclusions— Thus, high glucose, via PKC signaling, induces oxidative stress and upregulation of COX-2, resulting in reduced NO availability and altered prostanoid profile.

Key Words: diabetes mellitus • nitric oxide • stress

	Introduction

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Loss of the modulatory role of the endothelium may be a critical and initiating factor in the development of diabetic vascular disease.¹ The endothelial activity extends far beyond the control of vascular tone. Indeed, it interferes, mainly via NO release, with key events in the development of atherosclerosis, such as monocyte and leukocyte adhesion, platelet-vessel wall interaction, and smooth muscle proliferation. Hyperglycemia, which is recognized as the culprit in the pathogenesis of diabetic complications, may cause a reduced bioavailability of NO.

Paradoxically, we demonstrated that in human aortic endothelial cells, high glucose increases endothelial NO synthase (eNOS) gene and protein expression.² However, upregulation of eNOS is associated with increased superoxide anion (O₂^-) production,² suggesting that NO is inactivated by O₂^-. The reaction of NO with O₂^- produces a potent oxidant peroxynitrite (ONOO^-), which has an array of biological actions contributing to impair endothelial function. In diabetic arteries, O₂^- may also favor contractions via formation of hydrogen peroxide and hydroxyl radical, which stimulate the production of contractile prostanoids.³

However, the precise molecular mechanisms by which high glucose increases eNOS expression, O₂^- production, and vasoconstrictor prostanoids are not known. One possibility may involve activation of protein kinase C (PKC), because hyperglycemia increases diacylglycerol, a strong activator of PKC.^4,5 Interestingly, the promoter region of the human eNOS gene contains a phorbol ester responsive element.⁶ Furthermore, phorbol-12-myristate-13-acetate (PMA) increases expression of the inducible isoform of cyclooxygenase (COX) in many cell types.^7–9 In normal blood vessels, activation of PKC by phorbol ester impairs endothelium-dependent relaxation via release of O₂^- and vasoconstrictor prostanoids.¹⁰

Prostanoids are generated by COX from arachidonic acid. Two isoforms of the enzyme, encoded by distinct genes, have been isolated in mammalian cells.¹¹ COX-1 is constitutively expressed in most tissues and is involved in maintenance of cellular homeostasis, including regulation of vascular tone.¹¹ In contrast, under normal conditions, COX-2 is expressed at low or undetectable levels but is readily upregulated by inflammatory, mitogenic, and physical stimuli.¹¹ However, the mechanisms regulating COX expression in endothelial cells exposed to high glucose are unknown. It remains unclear which of the 2 COX isoforms plays a prominent role in the stimulated synthesis of vasoconstrictor prostanoids under this condition. This prompted us to investigate whether cumulative effects of oxidative stress along with hyperglycemia may interact with COX expression or activity and, hence, alter endothelial function.

	Methods

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Cell Culture
Human aortic endothelial cells (HAECs) were obtained from Clonetics (San Diego, Calif) and grown in gelatin-coated flasks in optimized endothelial growth medium (Clonetics) supplemented with 10% FCS. The cells were detached by exposure to trypsin/EDTA for 120 seconds in HEPES buffered saline and reseeded in collagen-coated 6-cm cell-culture dishes or 24-multiwell plates. Cells were first grown to confluency in humidified air, 5% CO₂ at 37°C. Confluent cells were maintained in endothelial growth medium containing 2% FCS. They were incubated with control (5.5 mmol/L) and elevated glucose concentration (22.2 mmol/L). Cells between the third and sixth subpassages were used.

Amplification of COX-1 and COX-2 mRNA
Semiquantitative RT-PCR
Total RNA was isolated by the acid guanidinium thiocyanate procedure¹² and reverse-transcribed with the use of the SuperScript preamplification system (GIBCO BRL). cDNA was used as a template in PCR. cDNA aliquots were amplified with primers specific for human COX-1 and COX-2 (5'-TGC CCA GCT CCT GGC CCG CCG CTT-3' and 5'-GTG CAT CAA CAC AGG CGC CTC TTC-3'; 5'-TTC AAA TGA GAT TGT GGG AAA ATT GCT-3' and 5'-GTG CAT CAA CAC AGG CGC CTC TTC, respectively). PCR products (303, 305, and 593 bp for COX-1, COX-2, and housekeeping gene GAPDH, respectively) were separated by electrophoresis on 1.5% agarose gels and transferred to Hybond-N filter (Amersham).

Southern Blotting
COX-1, COX-2, and GAPDH probes were obtained by using genomic DNA from blood cells as a template. Complementary DNA probes were [a-32P]-dCTP labeled with a random primer DNA labeling system (Life Technology). Results from autoradiograms were quantified by scanning densitometry and expressed as fold induction after normalization to GAPDH gene expression.

Western Blot
COX-1, COX-2, prostacyclin (PGI₂) synthase (PGIS), eNOS, and p22^phox proteins were analyzed by Western blot with anti-human COX-1 and COX-2 (Santa Cruz Biotechnology Inc), PGIS (Cayman Chemicals), eNOS (Transduction Laboratories), and p22^phox (kindly provided by Dr Imajoh-Ohmi, Department of Bacterial Infection, University of Tokyo, Japan) antibodies as described.² The membranes were visualized by the ECL kit (Amersham Life Sciences). Densitometric measurements were performed by Fotodyne visionary documentation system (Fotodyne, Bio Cell Consulting Research).

NO Measurements
Direct in situ measurements of NO were carried out as described.¹³ Immediately before NO measurements, the active tip of the L-shaped porphyrinic NO microsensor was placed directly on the surface of the endothelial cell monolayer. For maximal stimulation of eNOS, calcium ionophore A23187 was injected into the cell culture dish to yield a final concentration of 1 µmol/L.

Prostanoid Determination
Thromboxane B₂ and 6-Keto prostaglandin F₁ were measured in the culture medium after stimulation with calcium ionophore A23187 (300 nmol/L) by radioimmunoassay as described¹⁴ (Amersham Life Science).

Intracellular Reactive Oxygen Species
The intracellular formation of reactive oxygen species (ROS) was detected with the fluorescent probe CM-H₂DCFDA (Molecular Probes). Cells were loaded with 10 mmol CM-H₂DCFDA, incubated for 45 minutes at 37°C, and analyzed in an HTS 7000 Bio Assay Fluorescent Plate Reader (Perkin Elmer) using the HTSoft program. ROS production was determined from an H₂O₂ standard curve (10 to 200 nmol/mL^-1).

Immunocytochemistry of 3-Nitrotyrosine and PGIS
For examination of 3-nitrotyrosine formation and PGIS, endothelial cells were grown on culture slides (Becton & Dickinson). After incubation, cells were fixed. After blocking, cells were incubated with a 1:30 dilution of monoclonal antibody against nitrotyrosine (Upstate Biotechnology) and with a 1:300 dilution of polyclonal antibody against PGIS (kindly provided by Dr Tanabe, University Medical School, Osaka, Japan). Thereafter, fluorescence-labeled secondary antibodies (Molecular Probes) with the AlexaTM dye 568 and 488 for PGIS and 3-nitrotyrosine, respectively, were applied for 1 hour (1:200). Then the slides were rinsed with PBS and embedded in Immu-Mount for fluorescence microscopy with a Leica DMIRB equipped with a digital spot camera (Visitron System).

Nitration of PGIS
Nitration of PGIS in cell extracts was assessed by immunoprecipitation and Western blotting, as described.^15,16

Cell Fractionation and PKC Activity
PKC activity was measured by using the PKC enzyme assay system (Amersham) after cell fractionation into a cytosolic and a membrane fraction. Cells were harvested and sonicated, and samples were centrifuged at 100 000g for 1 hour at 4°C. The supernatant was used as the cytosolic fraction. The pellet was resuspended in 40 mL of buffer containing 1% Triton X-100 and 0.1% SDS. Cell debris were separated by centrifugation, and the supernatant was used as the membrane fraction.

Statistical Analysis
Results are expressed as mean±SEM, and n indicates number of experiments. Statistical evaluation of the data was performed with Student’s t test for simple comparison between 2 values when appropriate. For multiple comparisons, results were analyzed by ANOVA followed by Fisher’s test. P<0.05 was considered statistically significant.

	Results

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Effect of Glucose and Phorbol Ester on Cyclooxygenase Pathway
Exposure to high glucose (22.2 mmol/L) increased the expression of COX-2 mRNA (3-fold induction of COX-2/GAPDH relative ratio versus control; n=4; P<0.05; Figure 1A), whereas no changes were observed for COX-1 (n=4; P=NS; Figure 1A). Mannitol (22.2 mmol/L), used as an osmotic control, did not affect the expression of COX-1 or COX-2 mRNA (Figure 1A). Furthermore, glucose-induced selective upregulation of COX-2 expression was also observed by Western blotting (data not shown).

View larger version (25K): [in this window] [in a new window]   Figure 1. A, Expression of COX-1 and COX-2 mRNA in HAECs exposed to control (5.5 mmol/L) and high concentration of glucose or mannitol (22.2 mmol/L). Representative blots and densitometric quantification of mRNA expression normalized by GAPDH levels. B, Calphostin C (cal C) prevents glucose- and PMA-induced increase of COX-2 mRNA expression. HG indicates high glucose. Data are mean±SEM (n=4) and expressed as fold induction relative to control value. *P<0.05 vs control.

Treatment with PMA (1 µmol/L) caused a selective increase of COX-2 expression (Figure 1B). Interestingly, coincubation of endothelial cells with the PKC inhibitor calphostin C (300 nmol/L) reduced glucose and PMA-induced upregulation of COX-2 mRNA (Figure 1B). Glucose-induced increases of COX-2 mRNA and protein expression were associated with a higher release of thromboxane B₂ after stimulation of endothelial cells with calcium ionophore A23187 (300 nmol/L; Figure 2A). Although high glucose increased PGIS expression (Figure 2B), the levels of 6-keto-prostaglandin F₁, a stable metabolite of vasodilator PGI₂, were reduced (Figure 2A).

View larger version (19K): [in this window] [in a new window]   Figure 2. A, Bar graphs showing release of thromboxane B2 (left) and 6-keto-prostaglandin F1 (right) after stimulation with calcium ionophore A23187 (300 nmol/L) in HAECs exposed to control and high glucose. Data are mean±SEM (n=6). *P<0.05 vs control. B, Representative blot of PGIS in protein homogenates. Similar findings were observed in 4 independent experiments.

Effect of Glucose on PKC Activity
Glucose increased membrane-bound PKC activity at 1 hour (191% versus control; n=4; P<0.05; data not shown). Glucose-induced activation of PKC was not affected by N-acetylcysteine (NAC; 50 µmol/L) or vitamin C (100 µmol/L). Mannitol had no significant effect on PKC distribution.

Effect of Glucose on NO Pathway
We also determined the effects of glucose on eNOS protein expression and compared the results with the effect of PMA (Figure 3A). Densitometric analysis showed an almost 2-fold upregulation of eNOS protein in cells exposed to high glucose, whereas mannitol did not affect the expression of the enzyme (Figure 3A). PMA induced a similar upregulation of eNOS (Figure 3A). Incubation of endothelial cells with calphostin C reduced eNOS protein expression almost to control values. The inhibitor alone had no significant effect (data not shown).

View larger version (26K): [in this window] [in a new window]   Figure 3. A, eNOS protein expression in cells exposed to control (5.5 mmol/L), high levels of glucose or mannitol (22.2 mmol/L), and PMA (1 µmol/L). Calphostin C (cal C) prevents the effect of glucose and PMA. Representative Western blot and densitometric quantification of eNOS in protein homogenates. B, Bar graphs showing NO release after stimulation with calcium ionophore A23187 (1 µmol/L) in the absence and presence of vitamin C (vit C, 100 µmol/L), NAC (50 µmol/L), and calphostin C (300 nmol/L). HG indicates high glucose. Data are mean±SEM (n=4 to 6). *P<0.05 vs control.

Despite the glucose-induced 2-fold increase of eNOS expression, NO release after stimulation with calcium ionophore A23187 (10 µmol/L) was reduced in endothelial cells exposed to high glucose (n=6; P<0.05; Figure 3B). However, in the presence of vitamin C or NAC, peak NO concentrations could be restored to control values (Figure 3B). Calphostin C blunted the inhibitory effect of glucose on NO concentrations (Figure 3B). Furthermore, in the presence of direct O₂^- scavengers polyethylene glycol-superoxide dismutase (500 u/mL) or SOD mimetic, 4-hydroxy-tempo (10 µmol/L) NO production was greater than control values (n=4; P<0.05; data not shown).

Glucose-Induced ROS Generation and NAD(P)H Oxidase Expression
High glucose increased ROS intracellular formation, as assessed by the fluorescent probe CM-H₂DCFDA (Figure 4A). Incubation of the cells with NAC or vitamin C prevented this increase in fluorescence (Figure 4A). When we compared the effects of high glucose with those of PMA, we observed a similar increase of ROS generation (24893±3996 and 27450±4327 relative intensity for glucose and PMA, respectively). Thus, inhibition of PKC abolished glucose-induced generation of ROS (Figure 4A). Furthermore, diphenyleneiodonium (1 µmol/L) blunted the stimulatory effect of glucose on ROS generation (Figure 4A). By contrast, indomethacin (10 µmol/L) did not affect glucose-induced ROS generation (Figure 4A). High glucose significantly increased the expression of the NAD(P)H oxidase subunit p22^phox (Figure 4B).

View larger version (18K): [in this window] [in a new window]   Figure 4. A, Bar graphs showing ROS production in HAECs exposed to high glucose in the absence and presence of vitamin C (vit C, 100 mmol/L), NAC (50 mol/L), calphostin C (cal C, 300 nmol/L), diphenyleneiodonium (DPI, 1 µmol/L), and indomethacin (10 µmol/L). B, Representative blot and densitometric quantification of p22phox subunit expression in protein homogenates. Data are mean±SEM (n=6). *P<0.05 vs control, **P<0.05 vs high glucose alone.

Glucose and Nitration of PGIS
Endothelial cells exposed to high glucose exhibited a markedly enhanced specific immunostaining with a monoclonal antibody to 3-nitrotyrosine compared with control cells (Figures 5A and 5B), which was reduced by coincubation with NAC, vitamin C, or calphostin C (data not shown). By contrast, immunostaining with polyclonal anti-PGIS antibody remained unchanged in control and glucose-treated cells (Figures 5C and 5D). However, to determine whether 3-nitrotyrosine and PGIS colocalize in endothelial cells exposed to high glucose, a double-staining approach was adopted. The same cells show a good colocalization of green and red spots that is represented in yellow in the merged image (Figure 5F). Nitration of PGIS was also identified by immunoprecipitation and Western blotting (Figure 5G).

View larger version (56K): [in this window] [in a new window]   Figure 5. Colocalization of 3-nitrotyrosine and PGIS. Green signal (3-nitrotyrosine) and red signal (PGIS) localization in HAECs exposed to control (A and C) and high glucose (B and D). The merged image (yellow) of the 2 signals is shown in panel F for glucose-treated cells and in panel E for control cells. Nitration of PGIS was also identified by immunoprecipitation and Western blotting (G), representative blot, and densitometric quantification in protein homogenates. Data are mean±SEM (n=3). *P<0.05 vs control.

	Discussion

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In the present study, we demonstrate for the first time that high glucose causes PKC-dependent upregulation of inducible COX-2 and eNOS expression as well as selective increase of thromboxane production and reduced NO release. Hence, activation of the PKC pathway represents a proximal node in the intracellular signaling leading to hyperglycemia-induced oxidative stress and endothelial dysfunction. Several lines of evidence support this conclusion. Glucose augmented membrane-bound PKC activity. Furthermore, PMA increased COX-2 and eNOS expression to a similar extent as high glucose. The effects of glucose and PMA were totally reversed by the PKC inhibitor calphostin C. Despite glucose-induced PGIS upregulation, prostacyclin release was decreased. By contrast, thromboxane levels were enhanced. Indeed, glucose-induced increase of PKC activity resulted in the formation of the NO/O₂^- reaction product ONOO^- and tyrosine nitration of PGIS. NAC, vitamin C, and calphostin C restoring the balance between NO release and ROS formation reduced colocalization of 3-nitrotyrosine and PGIS.

The effects of high glucose on PKC activation are mediated via an intracellular increase of diacylglycerol levels.^5,17 Activation of PKC by phorbol esters leads to an impairment of endothelium-dependent relaxations in intact arteries similar to that observed in diabetes.¹⁰ In agreement with our results, the adverse effects of elevated glucose levels on acetylcholine-induced relaxations of rabbit aorta and rat pial arterioles can be restored by PKC inhibitors.^10,18 Moreover, in vivo treatment with PKC inhibitors ameliorates vascular complications in diabetic rats.¹⁹ PKC also plays a role in mediating increased O₂^- production in streptozotocin-induced diabetes²⁰ However, the precise molecular mechanisms underlying PKC-mediated endothelial dysfunction have been thoroughly addressed in this study.

We demonstrate that high glucose, via PKC, induces oxidative stress and upregulation of COX-2, resulting in reduced NO availability and altered prostanoid profile (Figure 6). Indeed, the present study provides first direct evidence for an involvement of PKC in the activation of cyclooxygenase (COX) pathway by glucose. The elevation of glucose significantly increased the expression of COX-2 mRNA and protein levels but did not affect COX-1. This effect was also elicited by PMA as well as abolished by calphostin C.^7,8 Most interestingly, glucose-induced COX-2 upregulation was associated with a shift in the balance of vasodilatory (6-keto-PGF₁) and vasoconstricting (TXB₂) eicosanoids produced by the endothelial cells in favor of the latter. Prostaglandin H₂ is the common precursor for prostaglandins, thromboxane, and PGI₂. PGI₂ is synthesized from prostaglandin H₂ by a specific enzyme, PGIS.²¹ Exposure to high glucose increased PGIS protein expression. However, increased formation of NO/O₂^- reaction product was associated with tyrosine nitration of PGIS. Tyrosine nitration is a mechanism of selective inactivation of PGIS by peroxynitrite.^15,16 Thus, the same molecular mechanism leading to inactivation of NO also caused inactivation of PGIS (Figure 6). Our data provide the molecular background to several observations that have implicated an overproduction of vasoconstrictor prostanoids in diabetes-induced endothelial dysfunction.²² In the rabbit aorta, the impaired relaxations are restored by nonselective COX blockade, prostanoid receptor antagonists, as well as SOD, suggesting that vasoconstrictor prostanoids and ROS are the underlying cause of endothelial dysfunction.^3,22 The glucose-induced release of vasoconstrictor prostanoids is also prevented by PKC inhibitors.¹⁰ A recent experimental study has shown an important role of COX-2-derived prostanoids in the pathogenesis of diabetic renal hemodynamic changes.²³

View larger version (16K): [in this window] [in a new window]   Figure 6. Schematic representation of intracellular signaling leading to hyperglycemia-induced oxidative stress, reduced NO availability, and altered prostanoid profile.

In patients with NIDDM and IDDM, vitamin C increases endothelium-dependent vasodilation in the forearm circulation.^24,25 In this study, we demonstrate that despite a paradoxical upregulation of eNOS, NO release was reduced, and coincubation with antioxidants restored the balance between NO and ROS formation. Accordingly, NO release was greater than control in the presence of polyethylene glycol-superoxide dismutase and 4-hydroxy-tempo, suggesting that the reduced availability is mainly attributable to scavenging of NO. However, other recent studies have also shown a reduction of eNOS activity under hyperglycemic conditions.^26,27 There are many potential sources of O₂^- in endothelial cells exposed to high glucose.^28,29 Diphenyleneiodonium, an inhibitor of flavin-containing enzymes including NAD(P)H oxidase, blunted the stimulatory effect of glucose on ROS generation, indicating that this enzyme may contribute to glucose-induced ROS generation. To additionally support this hypothesis, we found a marked increase in the NAD(P)H oxidase subunit p22^phox expression. Because calphostin C prevents glucose-induced ROS formation and PKC activates NAD(P)H oxidase in vascular tissue,³⁰ it is likely that the increased NAD(P)H oxidase-derived O₂^- production is at least in part mediated by PKC. However, the possibility that eNOS is also a source of O₂^- production cannot be excluded based on our present data.^20,29 By contrast, we ruled out that COX-2 is a source of ROS. Indeed, targeting COX-2 by indomethacin, a nonselective inhibitor, did not affect glucose-induced ROS generation.

In conclusion, our results show that a single unifying PKC-dependent mechanism is the triggering step by which hyperglycemia induces oxidative stress and in turn endothelial dysfunction. Indeed, high glucose via PKC signaling promotes oxidative stress as well as increased expression of COX-2, resulting in reduced NO availability and altered prostanoid profile. These findings may be relevant in understanding the intracellular signaling associated with vascular disease in diabetes mellitus and provide new pharmacological targets to prevent the development and progression of diabetic complications.

	Acknowledgments

 
This work was supported in part by the Swiss National Research Foundation (32-67202.01), Italian Ministry of Health (ICS 030.6/RF00-49), Swiss Heart Foundation, and Roche Research Foundation. We thank Alessia Lombardi for technical assistance.

Received September 26, 2002; revision received November 12, 2002; accepted November 15, 2002.

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				E. Osto, A. Kouroedov, P. Mocharla, A. Akhmedov, C. Besler, L. Rohrer, A. von Eckardstein, S. Iliceto, M. Volpe, T. F. Luscher, et al. Inhibition of Protein Kinase C{beta} Prevents Foam Cell Formation by Reducing Scavenger Receptor A Expression in Human Macrophages Circulation, November 18, 2008; 118(21): 2174 - 2182. [Abstract] [Full Text] [PDF]

				M. Li, L. Kuo, and J. N. Stallone Estrogen potentiates constrictor prostanoid function in female rat aorta by upregulation of cyclooxygenase-2 and thromboxane pathway expression Am J Physiol Heart Circ Physiol, June 1, 2008; 294(6): H2444 - H2455. [Abstract] [Full Text] [PDF]

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