Donate Help Contact The AHA Sign In Home
American Heart Association
Circulation
Search: search_blue_button Advanced Search
Circulation. 2003;108:1119-1125
Published online before print August 25, 2003, doi: 10.1161/01.CIR.0000086464.04719.DD
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
108/9/1119    most recent
01.CIR.0000086464.04719.DDv1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Köhler, R.
Right arrow Articles by Hoyer, J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Köhler, R.
Right arrow Articles by Hoyer, J.
Related Collections
Right arrow Restenosis

(Circulation. 2003;108:1119.)
© 2003 American Heart Association, Inc.


Basic Science Reports

Blockade of the Intermediate-Conductance Calcium-Activated Potassium Channel as a New Therapeutic Strategy for Restenosis

Ralf Köhler, PhD; Heike Wulff, PhD; Ines Eichler, MD; Marlene Kneifel; Daniel Neumann; Andrea Knorr; Ivica Grgic; Doris Kämpfe; Han Si, MSc; Judith Wibawa; Robert Real, MD; Klaus Borner, MD; Susanne Brakemeier, MD; Hans-Dieter Orzechowski, MD; Hans-Peter Reusch, MD; Martin Paul, MD; K. George Chandy, MD; Joachim Hoyer, MD

From the Departments of Nephrology (R.K., I.E., M.K., D.N., A.K., I.G., D.K., H.S., J.W., S.B., J.H.), Clinical Pharmacology and Toxicology (R.R., H.D.-O., M.P.), and Clinical Chemistry (K.B.), Benjamin Franklin Medical Center, Berlin, Germany; the Department of Clinical Pharmacology, Ruhr-Universität Bochum, Germany (H.-P.R.); the Department of Physiology and Biophysics (K.G.C.), University of California, Irvine; and the Department of Pharmacology and Toxicology (H.W.), University of California, Davis.

Correspondence to Dr R. Köhler, UKBF, Hindenburgdamm 30, 12200 Berlin, Germany. E-mail koe{at}zedat.fu-berlin.de

Received January 17, 2003; de novo received February 6, 2003; revision received April 24, 2003; accepted April 25, 2003.


*    Abstract
up arrowTop
*Abstract
down arrowIntroduction
down arrowMethods
down arrowResults
down arrowDiscussion
down arrowReferences
 
Background— Angioplasty stimulates proliferation and migration of vascular smooth muscle cells (VSMC), leading to neointimal thickening and vascular restenosis. In a rat model of balloon catheter injury (BCI), we investigated whether alterations in expression of Ca2+-activated K+ channels (KCa) contribute to intimal hyperplasia and vascular restenosis.

Methods and Results— Function and expression of KCa in mature medial and neointimal VSMC were characterized in situ by combined single-cell RT-PCR and patch-clamp analysis. Mature medial VSMC exclusively expressed large-conductance KCa (BKCa) channels. Two weeks after BCI, expression of BKCa was significantly reduced in neointimal VSMC, whereas expression of intermediate-conductance KCa (IKCa1) channels was upregulated. In the aortic VSMC cell line, A7r5 epidermal growth factor (EGF) induced IKCa1 upregulation and EGF-stimulated proliferation was suppressed by the selective IKCa1 blocker TRAM-34. Daily in vivo administration of TRAM-34 to rats significantly reduced intimal hyperplasia by {approx}40% at 1, 2, and 6 weeks after BCI. Two weeks of treatment with the related compound clotrimazole was equally effective. Reduction of intimal hyperplasia was accompanied by decreased neointimal cell content, with no change in the rate of apoptosis or collagen content.

Conclusions— The switch toward IKCa1 expression may promote excessive neointimal VSMC proliferation. Blockade of IKCa1 could therefore represent a new therapeutic strategy to prevent restenosis after angioplasty.


Key Words: angioplasty • restenosis • ion channels


*    Introduction
up arrowTop
up arrowAbstract
*Introduction
down arrowMethods
down arrowResults
down arrowDiscussion
down arrowReferences
 
Percutaneous balloon angioplasty, an intervention to relieve arterial stenosis and improve blood flow, is complicated by vascular restenosis within weeks as the result of proliferation of vascular smooth muscle cells (VSMC) and consequent renarrowing of the vessel lumen.1 Complex interactions between numerous growth-stimulating molecules have been proposed to promote migration and proliferation of VSMC,2 leading to neointima formation. Proliferating VSMC are characterized by alterations in functional plasticity as they switch from a contractile phenotype to a dedifferentiated phenotype.

Ca2+-activated K+ channels (KCa) are important regulators of VSMC function.3,4 Mature VSMC predominantly express the calcium-activated large-conductance channel (BKCa or maxi K),4 a product of the Slo gene,5 which plays a pivotal role in VSMC relaxation by dampening depolarization-dependent activation of Ca2+ channels and Ca2+ influx through membrane hyperpolarization.3,4 In contrast to the vasodilatory function of BKCa, the role of other KCa channels in VSMC is incompletely understood. The intermediate-conductance KCa channel encoded by the IKCa1 gene (also known as IK1, hSK4, KCa4, and KCa3.1 as per the new IUPHAR nomenclature: http://www.iuphar.org/compendium2. htm) has been proposed to be an important regulator of cell proliferation. In lymphocytes and fibroblasts, upregulation of IKCa1 expression is an essential step in mitogenesis.6–8

In the present study, we tested the hypothesis that a reorganization of KCa channel expression pattern after angioplasty promotes neointimal cell proliferation. After balloon catheter injury (BCI) to rat carotid artery (CA), neointimal VSMC switched KCa gene expression from Slo to IKCa1, representing a change from a KCa subtype mediating vasodilation to a KCa subtype promoting cell proliferation. Blockade of IKCa1 by the antimycotic clotrimazole (CLT) and its selective derivative TRAM-346 resulted in inhibition of epidermal growth factor (EGF)-stimulated VSMC proliferation in vitro and in reduced neointima formation in vivo.


*    Methods
up arrowTop
up arrowAbstract
up arrowIntroduction
*Methods
down arrowResults
down arrowDiscussion
down arrowReferences
 
Balloon Catheter Injury and Treatment Protocols
Under the aegis of a protocol approved by the local Animal Care and Use Committee, Sprague-Dawley rats (weight, 350 to 450 g) were subjected to BCI of the left CA by use of a 2F Fogarty embolectomy catheter (Baxter Scientific).9 Rats were killed 2 weeks (n=5) after BCI, and left and right CA were excised. Separate groups (each n=4 to 11) were treated with daily subcutaneous injections of TRAM-34 (1-[(2-chlorophenyl)diphenylmethyl]-1H-pyrazole; 120 mg/kg per day) or the vehicle (peanut oil) for 1, 2, and 6 weeks after BCI. Another group (n=7) was treated with CLT (120 mg/kg per day) for 2 weeks. TRAM-34 and CLT serum levels and TRAM-34 concentrations in liver and subcutaneous fat were quantitatively determined by bioassay.10

Neointimal thickening was determined in paraffin-embedded and differential nonserial cross sections stained with hematoxylin and eosin to visualize nuclei and cytoplasm, or with Sirius red to detect collagen. Histomorphological analysis was done with the use of a computerized analysis system (Scion Image) in a blinded manner.

Mature and Neointimal VSMC and Patch-Clamp Experiments
Isolation of mature and neointimal VSMC, whole-cell patch-clamp experiments in situ, and data analysis were performed as described previously.11–13

Reverse Transcription and Single-Cell RT-PCR
Reverse transcription of mRNA from single-cell samples and "multiplex" single-cell RT-PCR were performed as described previously.11,12 Primer pairs for small KCa (rSK1–3), rIKCa1, and endothelial nitric oxide synthase (reNOS) as endothelial cell markers are stated elsewhere.12 First and "nested" primer pairs for rSlo and myosin heavy chain (rMyHC) as VSMC markers spanned intronic sequences, and identity of PCR products was verified by sequencing: Primer, rSlo: F5'-GGACTTAGGGGATGGTGGTT-3'; R5'-GGGATGGAGTGGACAGAGGA-3'; nested:F5'-TTTACCGGCTG AGAGATGCC-3'; R5'-TGTGAGGAGTGGGAGGAATGA-3'; (GenBankaccession:-AF135265) rMyHC: F5'-CATCAATGCCAACCGCAG-3'; R5'-TCCCGAGCATCCATTTCTTC-3'; nested: F5'-AGGCCACTGAGAGCAATGAG-3'; R5'-TCAATAACTCTACGGCCTCCA-3'. (GenBankaccession:-X16262).

Detection of Apoptosis
Apoptotic nuclei in the neointima were detected by TUNEL method (Apoptaq-Plus; Qbiogene). Slices were counterstained with methyl green.

In Vitro Proliferation Studies
To induce growth arrest, rat aortic VSMC (cell line: -A7r5) were kept in serum-free medium for 48 hours before stimulation with EGF (20 ng/mL) in the presence or absence of TRAM-34, CLT, TRAM-7 (1-tritylpyrrolidine), or IbTX. At 5% to 10% confluence, photomicrographs of cells were taken in fixed fields before and 48 hours after stimulation, and the percent increase in cell count was calculated.

RNA Isolation and Quantitative Real-Time RT-PCR
Cells were harvested at 2 hours or 48 hours after stimulation by scraping. RNA was isolated with TRIZOL and was reverse-transcribed with M-MLV reverse transcriptase (both Life Technologies). Expression was quantified with an ABI-Prism-7700 Sequence Detection System (Perkin-Elmer ABI), using intron-spanning primers and internal oligonucleotides labeled with 6-carboxy-fluorescein on the 5'end and 6-carboxytetramethylrhodamine on the 3'end. Identity of PCR products was verified by sequencing. Linearity of each PCR assay was confirmed by serial dilutions of cDNA; primer and internal oligonucleotides: rIKCa1: F5'-CTGAGAGGCAGGCTGTCAATG-3'; R5'-ACGTGTTTCTCCGCCTTGTT-3'; P5'-AAGATTGTCTGCTTGTGCACCGGAGTC-3'; rMyHC: F5'-CATCAATGCCAACCGCAG-3'; R5'-TCCCGAGCATCCATTTCTTC-3'; P5'-TGAGGCCATGGGCCGTGAGG -3'; rat glyceraldehyde-3-phosphate dehydrogenase (rGAPDH): F5'-CGGCACAGTCAAGGCTGAG-3'; R5'-CAGCATCACCCCATTTGATGT-3'; P5'-CCCATCACCATCTTCCAGGAGCGA-3' (GenBank accession: -AB017801).

Each 25-µL PCR reaction consisted of 500 nmol forward and reverse primer, 150 nmol probe, 3 µL cDNA, and 1xTaqMan Universal Master Mix (Perkin-Elmer ABI). PCR parameters were 50°Cx2 minutes, 95°Cx10 minutes, and 50 cycles at 95°Cx15 seconds, 60°Cx1 minute.

Threshold cycles (Ct) were calculated by means of TaqMan software (ABI, User Bulletin No. 2). Real-time RT-PCR signals for rIKCa1 and rMyHC were standardized to rGAPDH by use of the equation CtX-CtrGAPDH={Delta}Ct. The equation, {Delta}Ctw/o-{Delta}CtX={Delta}{Delta}Ct, was used to determine changes in expression, where the {Delta}CtX-value (EGF-stimulated) was subtracted from the control {Delta}Ctw/o-value (w/o=without stimulus) of the same experiment. Fold increases in expression were calculated by the equation 2 {Delta}{Delta}Ct=fold change.

Statistical Analysis
Data are given as mean±SEM. If appropriate, the Wilcoxon rank sum test or {chi}2 analyses were used to assess differences between groups. Values of P<0.05 were considered significant.


*    Results
up arrowTop
up arrowAbstract
up arrowIntroduction
up arrowMethods
*Results
down arrowDiscussion
down arrowReferences
 
Alterations in KCa Functional Expression in Neointimal VSMC After BCI
To measure functional KCa channel expression, we performed whole-cell patch-clamp experiments on freshly isolated mature VSMC and neointimal VSMC in situ after BCI.12,13 Mature VSMC (n=14) from normal CA exhibited an outward Ca2+ activated and voltage-dependent K+ current with characteristics of the cloned BKCa channel.4,5,13 The outward K+ current was small at negative membrane potentials, increased steeply at positive membrane potentials, and was blocked by the selective BKCa inhibitor iberiotoxin (IbTX) (Figure 1A, left panel), with a potency (KD 11±3 nmol/L, Figure 1A, left inset) similar to the cloned BKCa channel. The selective SKCa blocker apamin (APA, 1 µmol/L), and the IKCa blockers TRAM-34 (1 µmol/L) and CLT (1 µmol/L)6,7,14 had no effect on this current (data not shown). A small residual voltage-gated Ca2+-independent (KV) K+ current (1.1±0.2 pA/pF at 0 mV) was sensitive to 2 mmol/L 4-aminopyridine (Figure 1A, right panel). The voltage dependence of the composite BKCa plus Kv current in mature VSMC, normalized for cell capacitance (IK [pA/pF]), is shown in Figure 1D.



View larger version (31K):
[in this window]
[in a new window]
 
Figure 1. Mature VSMC express BKCa currents; neointimal VSMC express IKCa currents at week 2 after BCI. A, Left panel, BKCa currents in mature VSMC and channel blockade by 100 nmol/L IbTX. Inset, Concentration-dependent blockade of BKCa currents by IbTX (n=4 to 5). Right panel, Voltage-gated K+ currents in mature VSMC recorded with a Ca2+-free pipette solution and blockade by 4-AP. B, Left panel, Mixed BKCa and IKCa currents in neointimal VSMC at week 2 after BCI and blockade of IKCa currents by TRAM-34 and BKCa currents by IbTX. Right panel, Concentration-dependent blockade of IKCa currents by TRAM-34 in a cell expression pure IKCa1 current. C, Pharmacology of IKCa currents; TRAM-34 (n=6 to 7, {bullet}), CLT (n=3 to 5; {circ}, and ChTX (n=3 to 4; {square}). D, Quantitative analysis of IKCa and BKCa currents in mature VSMC ({blacksquare}) and neointimal VSMC ({circ}. *P<0.05,**P<0.01, Wilcoxon rank sum test.

Two weeks after BCI, neointimal VSMC (n=30) had a substantially altered K+ current pattern. The majority of neointimal VSMC (19/30) expressed two KCa currents (Figure 1B, left panel) with properties resembling BKCa and IKCa channels. The IKCa component seen at negative potentials was eliminated by the selective IKCa inhibitor TRAM-34, leaving a residual BKCa current that could be suppressed by IbTX (Figure 1B, left panel). BKCa currents were absent in 11 of 30 neointimal VSMC that contained only IKCa currents (Figure 1B, right panel, and Figure 1C) with properties similar to the cloned and native IKCa channels.6–8,11,12,14–16,18 These IKCa currents were blocked by TRAM-34 in a dose-dependent fashion, 500 nmol/L TRAM-34 completely abolishing the current (Figure 1B, right panel). The dose-response curves in Figure 1C demonstrate that charybdotoxin (ChTX; KD 5±1 nmol/L), TRAM-34 (KD 10±2 nmol/L), and CLT (KD 31±4 nmol/L) blocked these currents with potencies similar to the cloned IKCa1 channel.6,14,18 The currents were not affected by TRAM-7 (1 µmol/L), an inactive analog of TRAM-34, or by the SK blocker APA (1 µmol/L) or the Kv blocker 4-aminopyridine (2 mmol/L) (not shown). When normalized for membrane capacitance (Figure 1D), the mean K+ current in neointimal VSMC was significantly increased at -40 and 0 mV and reduced at +100 mV, compared with mature VSMC, reflecting the shift from BKCa expression in mature VSMC to a mixture of IKCa and BKCa in neointimal cells.

Alterations in BKCa and IKCa1 mRNA Expression in Neointimal VSMC After BCI Correlate With Changes in Functional Expression
We used "multiplex" single-cell RT-PCR to determine whether the changes in functional BKCa and IKCa expression after BCI correlated with alterations in mRNA levels for the Slo and IKCa1 genes, respectively. The VSMC marker MyHC was detected in all mature VSMC (34/34) and in all neointimal VSMC (18/18) 2 weeks after BCI. Endothelial cell-specific eNOS expression was not detected in any of the cell samples, demonstrating that our VSMC samples are not contaminated with endothelial cells. None of the negative controls (n=24) yielded any PCR products.

Mature VSMC that functionally express BKCa and not IKCa channels (Figure 1A) contained substantial quantities of Slo mRNA (87%; 54/62) and no IKCa1 mRNA (0/27; Figure 2). Two weeks after BCI, the KCa gene expression pattern in neointimal VSMC was altered (Figure 2), in keeping with the changes observed in the amplitude of BKCa and IKCa currents in these cells (Figure 1B and 1D). Slo transcripts were detected less frequently (24/67; -36%) and IKCa1 transcripts more frequently (42/67; -63%) than in mature VSMC ({chi}2 analysis; P<0.01 and P<0.001, respectively). Transcripts of SK1-SK3 genes were not detected in mature or neointimal VSMC (data not shown). These results indicate that changes in Slo and IKCa1 mRNA levels after BCI contribute to the changes in BKCa and IKCa functional expression in VSMC.



View larger version (51K):
[in this window]
[in a new window]
 
Figure 2. Multiplex single-cell RT-PCR analysis of single mature and VSMC. Ethidium bromide-stained gels of RT-PCR products from representative mature VSMC and neointimal VSMC at week 2 after BCI. rSlo and rIKCa1 (upper panel) and myosin heavy chain rMyHC (lower panel). Columns show quantitative analysis of rSlo and rIKCa1 expression in mature VSMC (rats, n=9) and neointimal VSMC (rats, n=5). **P<0.01, Wilcoxon rank sum test.

EGF-Induced Upregulation of IKCa1 Expression and Proliferation of VSMC
The switch from BKCa expression in mature VSMC to a mixture of IKCa and BKCa in neointimal cells after BCI may reflect a change from a contractile to a proliferating phenotype. To test this hypothesis, we examined IKCa function and IKCa1 mRNA expression in the aortic VSMC cell line A7r5 after mitogenic stimulation with EGF. Forty-eight hours after stimulation, the amplitude of the K+ current increased 3-fold compared with untreated cells (Figure 3A and Table 1, P<0.01). Parallel RT-PCR studies revealed a 6-fold increase in IKCa1 mRNA levels as early as 2 hours after EGF stimulation and a 3-fold increase after 48 hours (Table 1). Pharmacological studies confirmed that the K+ currents in EGF-treated cells were indeed IKCa1 (Figure 3B). The currents were not affected by the BKCa inhibitor IbTX (100 nmol/L) but were blocked by TRAM-34 (KD 8±1 nmol/L), ChTX (KD 6±1 nmol/L), and CLT (KD 30±1 nmol/L) with potencies similar to IKCa1. Thus, the channel expression pattern in EGF-stimulated A7r5 cells resembles that seen in proliferating neointima in vivo.



View larger version (17K):
[in this window]
[in a new window]
 
Figure 3. EGF upregulates IKCa1 expression and induces proliferation of the VSMC line, A7r5. A, Representative Ca2+-activated K+ currents in unstimulated (w/o) and EGF-stimulated cells (48 hours). B, Blockade of IKCa currents in A7r5 cells by 100 nmol/L TRAM-34 but not by 100 nmol/L IbTX. C, Dose-dependent inhibition of EGF-induced proliferation (percent cell proliferation after 48 hours) by TRAM-34 (n=4 to 10, ) and CLT (n=6 to 8, {circ} but not by inactive TRAM-7 (1 µmol/L; n=3, {blacktriangleup}) or by IbTX (100 nmol/L; n=7; {Delta}). Dashed line indicates baseline proliferation in A7r5 cells in the absence of EGF.


View this table:
[in this window]
[in a new window]
 
TABLE 1. Mitogenic Regulation of rIKCa1 Expression and Function in A7r5 Cells

To test whether the enhanced IKCa expression in VSMC might have functional consequences, we examined whether the IKCa1 inhibitors TRAM-34 and CLT could suppress EGF-stimulated mitogenesis of A7r5 cells. The cell count increased 145±8% 48 hours after EGF stimulation but only 109±3% in unstimulated A7r5 cells (P<0.001). TRAM-34 (IC50 8±4 nmol/L) and CLT (IC50 14±5 nmol/L) suppressed EGF-stimulated proliferation in a dose-dependent fashion, reducing mitogenesis to baseline levels at 100 nmol/L (Figure 3C). The inactive triarylmethane TRAM-7 (1 µmol/L) did not suppress proliferation, indicating that the suppressive effect of TRAM-34 and CLT are not the result of nonspecific toxicity. The BKCa blocker IbTX (100 nmol/L) also had not effect on proliferation (Figure 3C). These results suggest that upregulation of IKCa channel expression is required for EGF-induced VSMC proliferation, as has been reported in lymphocyte activation and fibroblast mitogenesis.6–8,18

TRAM-34 and CLT Suppress BCI-Induced Intimal Hyperplasia In Vivo
IKCa upregulation in proliferating neointimal VSMC and the effectiveness of IKCa blockers in suppressing EGF-induced proliferation of A7r5 VSMC suggest that in vivo IKCa blockade might reduce intimal hyperplasia in CA of rats after BCI. We tested this idea by administration of CLT and TRAM-34 after BCI. Data from these experiments are summarized in Table 2, and representative cross sections of CA are shown in Figure 4.


View this table:
[in this window]
[in a new window]
 
TABLE 2. Effect of TRAM-34 and CLT on Intimal Hyperplasia After BCI



View larger version (71K):
[in this window]
[in a new window]
 
Figure 4. TRAM-34 and CLT reduce neointima formation after BCI. Upper panel, Representative cross sections of carotid arteries stained with hematoxylin and eosin after treatment with TRAM-34 or vehicle (Ve) at week 1 after BCI; original magnification x200; arrows indicate neointima/media borders. Middle panel, Representative cross sections after treatment with TRAM-34, CLT, or Ve at week 2 after BCI; original magnification x50. Lower panel, Representative cross sections after treatment with TRAM-34, CLT, or Ve at week 6 after BCI.

An initial 2-week trial with CLT (120 mg/kg per day) yielded encouraging results, but the CLT-treated rats gained less weight than the vehicle-treated group, and hepatomegaly developed as the result of reported CLT liver toxicity mediated by inhibition of P450-dependent enzymes. We therefore switched to the selective IKCa inhibitor TRAM-34 (120 mg/kg per day), which has no effect on P450-dependent enzymes and does not cause overt acute toxicity after intravenous administration.6 Although neointima formation progressively increased from week 1 to week 6 after BCI in the vehicle-treated group, the area of the neointimal cell layer in the TRAM-34-treated group was significantly smaller at week 1 (-64%; P<0.01), week 2 (-35%; P<0.01), and week 6 (-43%; P<0.01) after BCI (Figure 4 and Table 2). Two weeks’ treatment with CLT also resulted in a pronounced reduction of neointimal formation (-50%; P<0.001, Figure 4 and Table 2). The area of the medial smooth muscle cell layer was not different between rats treated with TRAM-34, CLT, or vehicle. The ratio of neointimal/medial areas (N/M) and the wall area bounded by the external elastic lamina (EEL) in TRAM-34-treated and CLT-treated rats were therefore significantly smaller than that of the respective vehicle-treated groups at all times measured after BCI. Reduced neointima formation in TRAM-34-treated animals resulted in larger residual lumina at week 2 (+34%; P<0.05) and at week 6 (+44%; P<0.01) after BCI compared with vehicle-treated rats. CLT-treated animals also displayed larger residual lumina at 2 weeks (+49%; P<0.001) after BCI. When the lumen area of the injured CA (rL) was normalized to that of the uninjured contralateral CA (rL/cL), TRAM-34-treated rats displayed reduced lumen narrowing (higher rL/CL values) at week 2 (-9%; P<0.01) and week 6 (-19%; P<0.01) than vehicle-treated control animals (-36% at week 2 and -50% week 6). Less lumen narrowing was also observed in CLT-treated animals 2 weeks after BCI (-18%; P<0.05).

TRAM-34 treatment caused no visible side effects or macroscopic organ damage during the course of the study. After transient weight loss in the first week as the result of surgery, TRAM-34-treated rats gained weight (30±5 g at week 2; 99±6 g at week 6), similar to the vehicle-treated group (25±4 g at week 2, 90±15 g at week 6). In contrast, the CLT-treated group gained significantly less weight (7±6 g; P<0.05) within 2 weeks after BCI.

We used a functional bioassay10 to determine the levels of TRAM-34 and CLT in serum samples obtained at varying times (1, -2, -4, -6, -8, -12, -24 hours) after injection. CLT plasma levels peaked 4 hours after administration (2 µmol/L) and then progressively decreased over the next 24 hours (6 hours: 1.2 µmol/L; 12 hours: 600 nmol/L; 24 hours: 350 nmol/L). TRAM-34 levels in plasma peaked 1 hour after administration (1 µmol/L) and then dropped more rapidly than CLT (2 hours: 500 nmol/L; 4 and 6 hours: 200 nmol/L; 8 hours: 150 nmol/L; 24 hours: 120 nmol/L, 48 hours: 100 nmol/L). The continued presence of low levels (70 nmol/L) of TRAM-34 in the plasma 48 hours after injection suggested that the compound was partitioning into a "deep compartment" from which it was slowly being released back into the blood. The presence of 5 µmol/L TRAM-34 in the liver and 200 nmol/L in the subcutaneous fat at the 48-hour time point indicates that the highly lipophilic TRAM-34 (logP=4.0 versus 3.5 for CLT) accumulates in these tissues. Thus, after subcutaneous administration in peanut oil, TRAM-34 was slowly released into the blood stream, resulting in serum levels sufficient to suppress proliferation (in vitro: IC50 8 nmol/L) over a 24- to 48-hour period.

To understand the mechanism by which TRAM-34 and CLT reduced neointima formation, we investigated cell proliferation, apoptosis, and extracellular matrix (collagen) content. The neointimal nuclei count, a measure of cell proliferation, was reduced by -70% (P<0.05) after 1 week, by -39% (P<0.01) after 2 weeks, and by -61% (P<0.001) after 6 weeks of TRAM-34 treatment.

A similar reduction (-59%, P<0.001) in the neointimal nuclei count was observed in the CLT-treated group at 2 weeks after BCI. However, the collagen content and the rate of apoptosis (percentage of apoptotic nuclei) in the neointima was not different in TRAM-34-treated and CLT-treated rats compared with vehicle-treated control animals (Table 2 and Figure 5A and 5B). Taken together, our results demonstrate that in vivo IKCa blockade reduces neointima formation and vessel narrowing through inhibition of VSMC proliferation.



View larger version (51K):
[in this window]
[in a new window]
 
Figure 5. TRAM-34 and clotrimazole had no effect on collagen content or rate of apoptosis in the neointima after BCI. A, Representative cross sections stained with Sirius red (collagen stain) after treatment with TRAM-34, CLT, or vehicle (Ve) at week 2 after BCI; original magnification x100. B, Representative cross sections stained by use of the TUNEL method for detection of apoptotic nuclei in the neointima after treatment with TRAM-34, CLT, or Ve at week 2 after BCI; sections were counterstained with methyl green to visualize all nuclei; original magnification x400; arrows indicate apoptotic nuclei.


*    Discussion
up arrowTop
up arrowAbstract
up arrowIntroduction
up arrowMethods
up arrowResults
*Discussion
down arrowReferences
 
Using the rat balloon catheter injury model, we demonstrate that neointimal formation after angioplasty is associated with a switch in KCa channel expression from exclusive BKCa expression in mature contractile VSMC to downregulated BKCa and upregulated IKCa expression in proliferating neointimal VSMC. A similar upregulated IKCa channel expression pattern was observed in proliferating aortic VSMC A7r5 cells after stimulation with EGF, and selective IKCa blockade suppressed A7r5 mitogenesis in vitro, suggesting that IKCa channels play an important role in VSMC proliferation. Consistent with this idea, in vivo blockade of IKCa channels reduced BCI-triggered neointimal formation and vessel renarrowing, which suggests a novel therapeutic strategy for the prevention of restenosis after angioplasty.

Neointimal proliferation and IKCa upregulation after BCI is mediated by numerous mitogenic factors. Using the aortic VSMC line A7r5 as a model system, we demonstrated that mitogenic doses of EGF augment IKCa1 RNA and IKCa current amplitude. Upregulated IKCa expression has been similarly reported to contribute to the proliferation of mitogen-stimulated fibroblasts8 and human T lymphocytes.6,7,14,18 Enhanced IKCa1 expression might therefore be a functional characteristic of proliferating and dedifferentiated cells.8,15

IKCa channels may promote VSMC mitogenesis by enhancing the electrochemical driving force for Ca2+ influx through membrane hyperpolarization and thus sustain a high intracellular Ca2+ concentration required for gene transcription, as has been reported in lymphocytes and fibroblasts.6,7,18 IKCa1 may play a more important role than BKCa in shaping Ca2+ signals of proliferating VSMC because its higher Ca2+ affinity3,4,6,7,11,13–16 would result in channel opening and membrane hyperpolarization in response to subtle increases in the intracellular Ca2+ concentration. Induction of IKCa1 expression might thus be a required step for neointimal VSMC proliferation after BCI. Consistent with such a role, IKCa1 blockade by CLT and the specific inhibitor TRAM-34 suppressed the proliferation of cultured VSMC. IKCa1 blockers may therefore have therapeutic value for preventing neointimal proliferation and restenosis after BCI.

In a rat model of BCI, in vivo administration of CLT significantly reduced neointimal thickening, but the trial was discontinued after 2 weeks because of reduced weight gain and the development of severe hepatomegaly, presumably because of liver toxicity17 caused by blockade of cytochrome P450-dependent enzymes.6 A subsequent trial with TRAM-34, an IKCa1 selective inhibitor that does not block cytochrome-P450 enzymes or exhibit acute toxicity,6 significantly reduced neointimal hyperplasia and vessel narrowing without causing visible signs of organ damage. The therapeutic effect of TRAM-34 was due to inhibition of neointimal cell proliferation and not due to increased apoptosis or decreased matrix formation. In conclusion, targeting IKCa1 channels in proliferating VSMC with TRAM-34 might have therapeutic utility in the prevention of restenosis after angioplasty and for the treatment of other cardiovascular disorders characterized by abnormal VSMC proliferation.


*    Acknowledgments
 
This work was supported by the Deutsche Forschungsgemeinschaft (FOR-341/5, FOR-341/7, FOR-341/10, Ho-1103/2-4, and GRK-276/2), NIH (MH59222), and the Rockefeller Brothers Fund (01-271).


*    References
up arrowTop
up arrowAbstract
up arrowIntroduction
up arrowMethods
up arrowResults
up arrowDiscussion
*References
 
1. McBride W, Lange R, Hillis L. Restenosis after successful coronary angioplasty: pathology and prevention. N Engl J Med. 1988; 318: 1734–1737.[Medline] [Order article via Infotrieve]

2. Newby AC, Zaltsman AB. Molecular mechanisms in intimal hyperplasia. J Pathol. 2000; 190: 300–309.[CrossRef][Medline] [Order article via Infotrieve]

3. Waldron GJ, Cole WC. Activation of vascular smooth muscle K+ channels by endothelium-derived relaxing factors. Clin Exp Pharmacol Physiol. 1999; 26: 180–184.[CrossRef][Medline] [Order article via Infotrieve]

4. Brenner R, Perez GJ, Bonev AD, et al. Vasoregulation by the beta1 subunit of the calcium-activated potassium channel. Nature. 2000; 407: 870–876.[CrossRef][Medline] [Order article via Infotrieve]

5. Atkinson NS, Robertson GA, Ganetzky B. A component of calcium-activated potassium channels encoded by the Drosophila slo locus. Science. 1991; 253: 551–555.[Abstract/Free Full Text]

6. Wulff H, Miller MJ, Hansel W, et al. Design of a potent and selective inhibitor of the intermediate-conductance Ca2+-activated K+ channel, IKCa1: a potential immunosuppressant. Proc Natl Acad Sci U S A. 2000; 97: 8151–8156.[Abstract/Free Full Text]

7. Khanna R, Chang MC, Joiner WJ, et al. hSK4/hIK1, a calmodulin-binding KCa channel in human T-lymphocytes. Roles in proliferation and volume-regulation. J Biol Chem. 1999; 274: 14838–14849.[Abstract/Free Full Text]

8. Pena TL, Chen SH, Konieczny SF, et al. Ras/MEK/ERK up-regulation of the fibroblast KCa channel FIK is a common mechanism for basic fibroblast growth factor and transforming growth factor-b suppression of myogenesis. J Biol Chem. 2000; 275: 13677–13682.[Abstract/Free Full Text]

9. Clowes AW, Reidy MA, Clowes MM. Mechanisms of stenosis after arterial injury. Lab Invest. 1983; 49: 208–215.[Medline] [Order article via Infotrieve]

10. Beeton C, Wulff H, Barbaria J, et al. Selective blockade of T lymphocyte K(+) channels ameliorates experimental autoimmune encephalomyelitis, a model for multiple sclerosis. Proc Natl Acad Sci U S A. 2001; 98: 13942–13947.[Abstract/Free Full Text]

11. Köhler R, Degenhardt C, Kühn M, et al. Expression and function of endothelial Ca2+-activated K+ channels in human mesenteric artery: a single-cell reverse transcriptase-polymerase chain reaction in situ. Circ Res. 2000; 87: 496–503.[Abstract/Free Full Text]

12. Köhler R, Brakemeier S, Kühn M, et al. Impaired hyperpolarization in regenerated endothelium after balloon catheter injury. Circ Res. 2001; 89: 174–179.[Abstract/Free Full Text]

13. Papassotiriou J, Köhler R, Prenen J, et al. Endothelial K+-channel lacks the Ca2+-sensitivity regulating ß-subunit. FASEB J. 2000; 14: 885–894.[Abstract/Free Full Text]

14. Logsdon NJ, Kang J, Togo JA, et al. A novel gene hKCa4, encodes the calcium-activated potassium channel in human T lymphocytes. J Biol Chem. 1997; 272: 32723–32726.[Abstract/Free Full Text]

15. Neylon CB, Lang RJ, Fu Y, et al. Molecular cloning and characterization of the intermediate-conductance Ca2+-activated K+ channel in vascular smooth muscle. Circ Res. 1999; 85: e33-e43.[Abstract/Free Full Text]

16. Ishii TM, Silva C, Hirschberg B, et al. A human intermediate conductance calcium-activated potassium channel. Proc Natl Acad Sci U S A. 1997; 94: 11651–11656.[Abstract/Free Full Text]

17. Tettenborn D. Toxicity of clotrimazole. Postgrad Med J. 1974; 50: 17–20.

18. Ghanshani S, Wulff H, Miller MJ, et al. Up-regulation of the IKCa1 potassium channel during T-cell activation: molecular mechanism and functional consequences. J Biol Chem. 2000; 275: 37137–37149.[Abstract/Free Full Text]




This article has been cited by other articles:


Home page
Proc. Natl. Acad. Sci. USAHome page
I. Grgic, E. Kiss, B. P. Kaistha, C. Busch, M. Kloss, J. Sautter, A. Muller, A. Kaistha, C. Schmidt, G. Raman, et al.
Renal fibrosis is attenuated by targeted disruption of KCa3.1 potassium channels
PNAS, August 25, 2009; 106(34): 14518 - 14523.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Cell Physiol.Home page
V. G. Romanenko, K. S. Roser, J. E. Melvin, and T. Begenisich
The role of cell cholesterol and the cytoskeleton in the interaction between IK1 and maxi-K channels
Am J Physiol Cell Physiol, April 1, 2009; 296(4): C878 - C888.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Lung Cell. Mol. Physiol.Home page
O. Bardou, N. T. N. Trinh, and E. Brochiero
Molecular diversity and function of K+ channels in airway and alveolar epithelial cells
Am J Physiol Lung Cell Mol Physiol, February 1, 2009; 296(2): L145 - L155.
[Abstract] [Full Text] [PDF]


Home page
J. Physiol.Home page
A. Moreno-Dominguez, P. Cidad, E. Miguel-Velado, J. R. Lopez-Lopez, and M. T. Perez-Garcia
De novo expression of Kv6.3 contributes to changes in vascular smooth muscle cell excitability in a hypertensive mice strain
J. Physiol., February 1, 2009; 587(3): 625 - 640.
[Abstract] [Full Text] [PDF]


Home page
J. Biol. Chem.Home page
L. Garneau, H. Klein, U. Banderali, A. Longpre-Lauzon, L. Parent, and R. Sauve
Hydrophobic Interactions as Key Determinants to the KCa3.1 Channel Closed Configuration: AN ANALYSIS OF KCa3.1 MUTANTS CONSTITUTIVELY ACTIVE IN ZERO Ca2+
J. Biol. Chem., January 2, 2009; 284(1): 389 - 403.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Lung Cell. Mol. Physiol.Home page
N. T. N. Trinh, A. Prive, E. Maille, J. Noel, and E. Brochiero
EGF and K+ channel activity control normal and cystic fibrosis bronchial epithelia repair
Am J Physiol Lung Cell Mol Physiol, November 1, 2008; 295(5): L866 - L880.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Cell Physiol.Home page
R. Tao, C.-P. Lau, H.-F. Tse, and G.-R. Li
Regulation of cell proliferation by intermediate-conductance Ca2+-activated potassium and volume-sensitive chloride channels in mouse mesenchymal stem cells
Am J Physiol Cell Physiol, November 1, 2008; 295(5): C1409 - C1416.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
K. M. Lounsbury
Preventing Stenosis by Local Inhibition of KCa3.1: A Finger on the Phenotypic Switch
Arterioscler Thromb Vasc Biol, June 1, 2008; 28(6): 1036 - 1038.
[Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
D.L. Tharp, B.R. Wamhoff, H. Wulff, G. Raman, A. Cheong, and D.K. Bowles
Local Delivery of the KCa3.1 Blocker, TRAM-34, Prevents Acute Angioplasty-Induced Coronary Smooth Muscle Phenotypic Modulation and Limits Stenosis
Arterioscler Thromb Vasc Biol, June 1, 2008; 28(6): 1084 - 1089.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
K. A. Dora, N. T. Gallagher, A. McNeish, and C. J. Garland
Modulation of Endothelial Cell KCa3.1 Channels During Endothelium-Derived Hyperpolarizing Factor Signaling in Mesenteric Resistance Arteries
Circ. Res., May 23, 2008; 102(10): 1247 - 1255.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Respir. Cell Mol. Bio.Home page
M. C. Shepherd, S. M. Duffy, T. Harris, G. Cruse, M. Schuliga, C. E. Brightling, C. B. Neylon, P. Bradding, and A. G. Stewart
KCa3.1 Ca2+Activated K+ Channels Regulate Human Airway Smooth Muscle Proliferation
Am. J. Respir. Cell Mol. Biol., November 1, 2007; 37(5): 525 - 531.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Lung Cell. Mol. Physiol.Home page
N. T. N. Trinh, A. Prive, L. Kheir, J.-C. Bourret, T. Hijazi, M. G. Amraei, J. Noel, and E. Brochiero
Involvement of KATP and KvLQT1 K+ channels in EGF-stimulated alveolar epithelial cell repair processes
Am J Physiol Lung Cell Mol Physiol, October 1, 2007; 293(4): L870 - L882.
[Abstract] [Full Text] [PDF]


Home page
J. Neurophysiol.Home page
T. V. Nguyen, H. Matsuyama, J. Baell, B. Hunne, C. J. Fowler, J. E. Smith, K. Nurgali, and J. B. Furness
Effects of Compounds That Influence IK (KCNN4) Channels on Afterhyperpolarizing Potentials, and Determination of IK Channel Sequence, in Guinea Pig Enteric Neurons
J Neurophysiol, March 1, 2007; 97(3): 2024 - 2031.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
D. L. Tharp, B. R. Wamhoff, J. R. Turk, and D. K. Bowles
Upregulation of intermediate-conductance Ca2+-activated K+ channel (IKCa1) mediates phenotypic modulation of coronary smooth muscle
Am J Physiol Heart Circ Physiol, November 1, 2006; 291(5): H2493 - H2503.
[Abstract] [Full Text] [PDF]


Home page
ThoraxHome page
G Cruse, S M Duffy, C E Brightling, and P Bradding
Functional KCa3.1 K+ channels are required for human lung mast cell migration
Thorax, October 1, 2006; 61(10): 880 - 885.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
H. Si, W.-T. Heyken, S. E. Wolfle, M. Tysiac, R. Schubert, I. Grgic, L. Vilianovich, G. Giebing, T. Maier, V. Gross, et al.
Impaired Endothelium-Derived Hyperpolarizing Factor-Mediated Dilations and Increased Blood Pressure in Mice Deficient of the Intermediate-Conductance Ca2+-Activated K+ Channel
Circ. Res., September 1, 2006; 99(5): 537 - 544.
[Abstract] [Full Text] [PDF]


Home page
Mol. Cell. Biol.Home page
S. Srivastava, K. Ko, P. Choudhury, Z. Li, A. K. Johnson, V. Nadkarni, D. Unutmaz, W. A. Coetzee, and E. Y. Skolnik
Phosphatidylinositol-3 Phosphatase Myotubularin-Related Protein 6 Negatively Regulates CD4 T Cells
Mol. Cell. Biol., August 1, 2006; 26(15): 5595 - 5602.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
B. R. Wamhoff, D. K. Bowles, and G. K. Owens
Excitation-Transcription Coupling in Arterial Smooth Muscle
Circ. Res., April 14, 2006; 98(7): 868 - 878.
[Abstract] [Full Text] [PDF]


Home page
PhysiologyHome page
J. Ledoux, M. E. Werner, J. E. Brayden, and M. T. Nelson
Calcium-Activated Potassium Channels and the Regulation of Vascular Tone
Physiology, February 1, 2006; 21(1): 69 - 78.
[Abstract] [Full Text] [PDF]


Home page
J. Physiol.Home page
A. Ivanov, V. Gerzanich, S. Ivanova, R. DenHaese, O. Tsymbalyuk, and J. M. Simard
Adenylate cyclase 5 and KCa1.1 channel are required for EGFR up-regulation of PCNA in native contractile rat basilar artery smooth muscle
J. Physiol., January 1, 2006; 570(1): 73 - 84.
[Abstract] [Full Text] [PDF]


Home page
Mol. Biol. CellHome page
S. Srivastava, P. Choudhury, Z. Li, G. Liu, V. Nadkarni, K. Ko, W. A. Coetzee, and E. Y. Skolnik
Phosphatidylinositol 3-Phosphate Indirectly Activates KCa3.1 via 14 Amino Acids in the Carboxy Terminus of KCa3.1
Mol. Biol. Cell, January 1, 2006; 17(1): 146 - 154.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
W. F. Jackson
Potassium Channels and Proliferation of Vascular Smooth Muscle Cells
Circ. Res., December 9, 2005; 97(12): 1211 - 1212.
[Full Text] [PDF]


Home page
Circ. Res.Home page
E. Miguel-Velado, A. Moreno-Dominguez, O. Colinas, P. Cidad, M. Heras, M. T. Perez-Garcia, and J. R. Lopez-Lopez
Contribution of Kv Channels to Phenotypic Remodeling of Human Uterine Artery Smooth Muscle Cells
Circ. Res., December 9, 2005; 97(12): 1280 - 1287.
[Abstract] [Full Text] [PDF]


Home page
J. Biol. Chem.Home page
H. M. Jones, K. L. Hamilton, and D. C. Devor
Role of an S4-S5 Linker Lysine in the Trafficking of the Ca2+-activated K+ Channels IK1 and SK3
J. Biol. Chem., November 4, 2005; 280(44): 37257 - 37265.
[Abstract] [Full Text] [PDF]


Home page
J. Physiol.Home page
M. D Ganfornina, M. T Perez-Garcia, G Gutierrez, E Miguel-Velado, J. R Lopez-Lopez, A Marin, D Sanchez, and C Gonzalez
Comparative gene expression profile of mouse carotid body and adrenal medulla under physiological hypoxia
J. Physiol., July 15, 2005; 566(2): 491 - 503.
[Abstract] [Full Text] [PDF]


Home page
Mol. Cell. Biol.Home page
S. Srivastava, Z. Li, L. Lin, G. Liu, K. Ko, W. A. Coetzee, and E. Y. Skolnik
The Phosphatidylinositol 3-Phosphate Phosphatase Myotubularin- Related Protein 6 (MTMR6) Is a Negative Regulator of the Ca2+-Activated K+ Channel KCa3.1
Mol. Cell. Biol., May 1, 2005; 25(9): 3630 - 3638.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
I. Grgic, I. Eichler, P. Heinau, H. Si, S. Brakemeier, J. Hoyer, and R. Kohler
Selective Blockade of the Intermediate-Conductance Ca2+-Activated K+ Channel Suppresses Proliferation of Microvascular and Macrovascular Endothelial Cells and Angiogenesis In Vivo
Arterioscler Thromb Vasc Biol, April 1, 2005; 25(4): 704 - 709.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
A. Sato, K. Terata, H. Miura, K. Toyama, F. R. Loberiza Jr., O. A. Hatoum, T. Saito, I. Sakuma, and D. D. Gutterman
Mechanism of vasodilation to adenosine in coronary arterioles from patients with heart disease
Am J Physiol Heart Circ Physiol, April 1, 2005; 288(4): H1633 - H1640.
[Abstract] [Full Text] [PDF]


Home page
J. Immunol.Home page
H. Wulff, H.-G. Knaus, M. Pennington, and K. G. Chandy
K+ Channel Expression during B Cell Differentiation: Implications for Immunomodulation and Autoimmunity
J. Immunol., July 15, 2004; 173(2): 776 - 786.
[Abstract] [Full Text] [PDF]


This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
108/9/1119    most recent
01.CIR.0000086464.04719.DDv1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Köhler, R.
Right arrow Articles by Hoyer, J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Köhler, R.
Right arrow Articles by Hoyer, J.
Related Collections
Right arrow Restenosis