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Original Article Protein Z-deficiency is associated with enhanced neointima formation and inflammatory response after vascular injury in mice


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Background: Protein Z (PZ) is a vitamin K-dependent coagulation factor without catalytic activity. Evidence points towards PZ as an independent risk factor for the occurrence of human atherosclerotic vascular diseases. The aim of this study was to investigate the role of PZ in vascular arterial disease. Material and methods: PZ-deficient (PZ(-/-)) mice and their wild-type littermates (PZ(+/+)) were subjected to unilateral carotid artery injury by using ferric chloride and dissected 21 days thereafter for histological analysis. Human aortic smooth muscle cells (SMC) were used for in vitro wound healing assay to assess the influence of PZ on SMC migration and for cell proliferation studies. Results: Morphometric analysis of neointima formation revealed a significantly increased area and thickness of the neointima and subsequently increased luminal stenosis in carotid arteries of PZ(-/-) mice compared to PZ(+/+) mice (p < 0.05, n = 9). Immunohistochemical analysis of neointima lesion composition revealed significantly higher numbers of PCNA-positive and α-SMA-positive cells in the neointima of PZ(-/-) mice. Furthermore, PZ showed an anti-migratory potency in in vitro wound healing assay with SMCs, while no effect of PZ on SMC proliferation was detectable. Conclusion: PZ contributes to a reduced neointima formation after vascular injury, underlining the modulatory role of the coagulation cascade in vascular homeostasis.
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Int J Clin Exp Pathol 2014;7(9):6064-6071 /ISSN:1936-2625/IJCEP0001572
Original Article
Protein Z-deciency is associated with enhanced
neointima formation and inammatory
response after vascular
injury in mice
Antje Butschkau1, Nana-Maria Wagner2, Laura Bierhansl2, Berit Genz1, Brigitte Vollmar1
1Institute for Experimental Surgery, Rostock University Medical Center, Rostock, Germany; 2Clinic for Anesthesiology
and Critical Care Medicine, Rostock University Medical Center, Rostock, Germany
Rceived July 28, 2014; Acepted August 23, 2014; Epub August 15, 2014; Published September 1, 2014
Abstract: Background: Protein Z (PZ) is a vitamin K-dependent coagulation factor without catalytic activity. Evidence
points towards PZ as an independent risk factor for the occurrence of human atherosclerotic vascular diseases. The
aim of this study was to investigate the role of PZ in vascular arterial disease. Material and methods: PZ-decient
(PZ-/-) mice and their wild-type littermates (PZ+/+) were subjected to unilateral carotid artery injury by using ferric chlo-
ride and dissected 21 days thereafter for histological analysis. Human aortic smooth muscle cells (SMC) were used
for in vitro wound healing assay to assess the inuence of PZ on SMC migration and for cell proliferation studies.
Results: Morphometric analysis of neointima formation revealed a signicantly increased area and thickness of the
neointima and subsequently increased luminal stenosis in carotid arteries of PZ-/- mice compared to PZ+/+ mice (p <
0.05, n = 9). Immunohistochemical analysis of neointima lesion composition revealed signicantly higher numbers
of PCNA-positive and α-SMA-positive cells in the neointima of PZ-/- mice. Furthermore, PZ showed an anti-migratory
potency in in vitro wound healing assay with SMCs, while no effect of PZ on SMC proliferation was detectable.
Conlusion: PZ contributes to a reduced neointima formation after vascular injury, underlining the modulatory role of
the coagulation cascade in vascular homeostasis.
Keywords: Atherosclerosis, critical leg ischemia, thrombosis, coagulation, smooth muscle cells
Despite major advances in vascular medicine
over the past decades, cardiovascular diseas-
es remain the main cause of morbidity and
mortality in the Western world [1, 2].
Atherosclerosis constitutes the underlying
pathology of coronary artery disease and poses
the main contributor to death caused by cardi-
ac diseases [3]. The important role of platelets
in atherotrombotic disease has become evi-
dent from many studies investigating platelet
inhibition. However, the impact of coagulation
components and the crosstalk of coagulation
and inammation in atherosclerotic vascular
disease are less well established [4]. Data from
animal models investigating the effects of
hypercoagulability on atherosclerotic disease
revealed aggravated atherogenesis in different
hypercoagulable genotypes such as factor V
Leiden mutation and protein C (PC) deciency
Human Protein Z (PZ) is a 62 kDa vitamin
K-dependent coagulation glycoprotein identi-
ed in human plasma in 1984 [6]. PZ is charac-
terized by a structural homology with the other
vitamin K-dependent proteins, factors VII, IX, X
and PC [7], but in contrast to these zymogens,
PZ has no catalytic activity [8]. PZ serves as a
cofactor for the protein Z-dependent protease
inhibitor (ZPI), a serpin of 72 kDa which inhibits
factor Xa [9, 10].
In 2007, So et al. observed an association
between low PZ-levels and both the occurrence
and the severity of peripheral arterial disease
(PAD) in a case-control study, hypothesizing
that PZ is linked to the atherosclerotic process
apart from the acute thrombotic event with a
PZ deciency in vascular injury
6065 Int J Clin Exp Pathol 2014;7(9):6064-6071
strict relationship to arterial risk factors [11]. In
2009 they could conrm these results by
another case-control study, demonstrating
again a signicant association of low PZ-levels
with the occurrence and severity of PAD [12].
Therefore, the aim of this study was to assess
the role for PZ in arterial vascular diseases, by
using an in vivo model of vascular injury in mice
decient for PZ and their wild-type littermates
as well as established in vitro assays.
Material and methods
The experiments were conducted in accord-
ance with the guidelines for the Care and Use of
Laboratory Animals and the Institutional Animal
Care and Use Committee (Rostock University
Medical Center, Rostock, Germany; reference
number: 7221.3-1-055/13). PZ-decient mice
(PZ-/-) in a C57Bl/6x129 genetic background, as
described by Yin et al. [13], were compared to
their respective wild-type littermates (PZ+/+).
Male mice were used at an age of 3-6 months
and a body weight of 25-30 g.
Genotyping of PZ mice
All animals were genotyped for presence or
absence of PZ by PCR, as described by Yin et al.
[13] using genomic DNA isolated from the tail
Vascular injury protocol
Mice were anaesthetized by intraperitoneal
injection of ketamine (75 mg/kg bw) and xyla-
zine (5 mg/kg bw) and subjected to carotid
artery injury using 10% ferric chloride as previ-
ously described [14, 15]. Briey, the left carotid
artery was carefully separated from the accom-
panying nerve and vein and any adventitial tis-
sue, which might prevent diffusion of the ferric
chloride solution, was removed by forceps. The
carotid was injured by placing a 0.5-1.0 mm
strip of lter paper soaked in 10% ferric chlo-
ride solution onto the adventitia for 3 min. The
wound was carefully sutured with prolene 6-0
(Ethicon Johnson & Johnson Medical GmbH,
Norderstedt, Germany) and the mice returned
to their cages.
Three weeks after injury, mice were anesthe-
tized as described above and carefully per-
fused with physiological saline and xed with
phosphate buffered formalin (4%) through the
left ventricle. Several 5 µm thick cross sections
of the carotid artery were done in 200 µm
Morphometric analysis of neointima formation
Neointima formation was quantied per speci-
men in hematoxylin-eosin (HE) stained sec-
tions, in particular by assessing neointima
area, thickness and luminal stenosis using
computerized image analysis software (Image-
Pro Plus; Media Cybernetics, Silver Spring, Md.,
USA), as previously described [15]. Thickness
of neointima was measured from the highest
point of the area to the internal elastic lamina.
Luminal stenosis was calculated by substrac-
tion of the neointima area from the area of the
original lumen and is given in %. The results
were averaged for each animal (n = 9 per
Immunhistochemical analysis of neointima
lesion composition
Parafn sections of carotid arteries at 3 weeks
after arterial injury were analyzed for the pres-
ence of α-actin-positive smooth muscle cells
(α-SMA; abcam ab5694) by analysis of the
α-SMA-positive area in the neointima lesion.
Proliferating cells were detected using anti-pro-
liferating cell nuclear antigen (PCNA; abcam
ab29 [PC10]) antibody. PCNA-positive cells
were manually counted and expressed as the
percentage of total cell nuclei within neointima
Cell culture
Human aortic smooth muscle cells (SMC) were
purchased from Lonza (Basel, Switzerland).
After thawing, the cells were seeded into 10 cm
cell culture dishes and cultured according to
the supplier’s recommendations in SmGMTM-
2BulletKitTM (Lonza, Basel, Switzerland) supple-
mented with 10% fetal calf serum (FCS), 0.1%
hEGF, 0.1% insulin, 0.2% hFGF-B and 1% peni-
cillin/streptomycin. The cells were placed in a
humidied incubator at 37°C and 5% CO2 and
used from passage 5 to 10.
In vitro wound healing assay
SMC migration was analyzed employing the in
vitro wound scratch assay [16]. The cells were
PZ deciency in vascular injury
6066 Int J Clin Exp Pathol 2014;7(9):6064-6071
cultured in 12-well plates and a cross scratch
wound was created in the center of the cellular
monolayer by gentle removal of the attached
cells with a sterile plastic pipette tip. The cells
were then gently washed with PBS to remove
single not-adherent cells and incubated with PZ
(3 µg/ml; South Bend, IN, USA) or TNF-α (10 ng/
ml; R&D Systems, Minneapolis, MN, USA) in
serum- and growth-factor reduced medium
(containing 1% FCS) in duplicate. Non-
stimulated cells served as control (ctrl). Images
of the cells were taken at 12 h after wound
scratching. The images were captured using a
uorescence microscope (Leica, Germany) and
wound closure was quantied employing imag-
ing software (ImageProPlus Software, CA, USA)
Figure 1. Morphometric analysis of neointima formation in PZ mice. (A) Representative images of HE-stained cross
sections from carotids of PZ+/+ and PZ-/- mice. (B) Quantication of neointima area, (C) neointima thickness and (D)
luminal stenosis in PZ+/+ mice and PZ-/- mice after carotid artery injury using 10% ferric chloride. Data are given as
box plots indicating the median with the 25th and 75th percentiles. Mann-Whitney rank-sum test, *P value of less
than 0.05 versus PZ+/+ mice; n = 9.
Figure 2. Cellular composition of neointima formation in PZ mice. A. Representative images of immunohistochemi-
cal detection of PCNA within vascular lesions of PZ+/+ and PZ-/- mice (brown signal). B. Quantication of PCNA-
positive cells in percent of all cells in the neointimal lesion. PCNA, proliferating cell nuclear antigen; Data are given
as box plots indicating the median with the 25th and 75th percentiles. Mann-Whitney rank-sum test, *P value of less
than 0.05 versus PZ+/+ mice; n = 9. C. Representative images of immunohistochemical detection of α-SMA positive
SMCs within the neointimal lesion (pink signal). D. Quantication of α-SMA positive SMCs within the neointima.
α-SMA, α-smooth muscle actin; Data are given as box plots indicating the median with the 25th and 75th percentiles.
Mann-Whitney rank-sum test, *P value of less than 0.05 versus PZ+/+ mice; n = 9.
PZ deciency in vascular injury
6067 Int J Clin Exp Pathol 2014;7(9):6064-6071
by counting migrated cells into the wound in 8
high power elds per wound.
Cell proliferation studies
Cell proliferation was analyzed by measuring
DNA synthesis with a colorimetric bromodeoxy-
uridine (BrdU) enzyme-linked immunosorbent
assay kit (Roche Diagnostics, Basel, Swi-
tzerland), according to the manufacturer’s
instructions. Briey, 1 × 104 cells were seeded
into a 96-well microplate and starved 5 hours
before stimulation with PZ (3 µg/ml; South
Bend, IN, USA) or TNF-α (50 ng/ml; R&D
Systems, Minneapolis, MN, USA) in serum- and
growth-factor reduced medium (containing 1%
FCS). After 24 hours of stimulation the cells
were then labelled with BrdU labeling reagent
for 10 hours. After xation, the cells were incu-
bated with anti-BrdU antibody for 90 min. After
washing, 100 µl of substrate (tetramethylbenzi-
dine) was added to each well and the plates
were incubated at room temperature for 30
min. The absorbance was measured at 450 nm
Figure 3. Inuence of PZ on migration of SMCs
in wound healing assay in vitro. A. Representa-
tive images of scratch wound closures after 12
hours of incubation with PZ (ctrl corresponds
to untreated cells). 50-fold magnication. B.
Quantication of migration of PZ stimulated
SMCs after 12 hours of stimulation; Data
are given as box plots indicating the median
with the 25th and 75th percentiles. ANOVA on
Ranks, #P value of less than 0.05 versus ctrl,
§p value of less than 0.05 versus TNF-α; n = 6
independent experiments.
PZ deciency in vascular injury
6068 Int J Clin Exp Pathol 2014;7(9):6064-6071
with a multilabel plate reader (VICTOR X, Perkin
Elmer, Waltham, MA, USA).
Statistical analysis
All data are given as median and interquartile
range (IQR; the 25% and 75% percentiles).
Differences between groups were calculated
using Mann-Whitney rank-sum test, followed by
Bonferroni correction. Overall statistical signi-
cance was dended as a P-value of < 0.05. The
statistical power was calculated for each sig-
nicance at α = 0.05 with a level of 80%.
Statistics, power calculation and graphics were
performed using the software packages
SigmaStat software version 3.5 and SigmaPlot
software version 12.5 (Jandel Corporation, San
Rafael, CA, USA).
Murine PZ-deciency is accompanied by in-
creased neointima formation
Focal arterial inammation that results in
remodeling of the vascular wall is an initial step
leading to arterial disease. Using the neointima
lesion model in PZ+/+ and PZ-/- mice we morpho-
metrically analyzed the developed lesions. Area
of the neointima induced by ferric chloride was
signicantl y increased in PZ-/- mice compared to
their wild-type littermates (Figure 1A, 1B), with
the vascular lumen found almost occluded in
PZ-/- mice. Also neointima thickness was signi-
cantly higher in PZ-/- mice with a median of 145
µm compared to 93 µm in PZ+/+ mice (Figure
1A, 1C). As a consequence of increased neo-
intima area and thickness, PZ-/- mice showed a
signicantly higher degree of luminal stenosis
(57% in PZ-/- mice vs. 38% in PZ+/+ mice; P <
0.05; Figure 1A, 1D). Five mice out of 14 PZ-/-
mice died within a few days after induction of
the neointima lesion, while no loss could be
registered in the PZ+/+ mice group, which con-
ceivably underlines the increased susceptibility
proliferation. Within the neointimal lesion PZ-/-
mice exhibited signicantly more PCNA-positive
cells compared to their wild-type littermates
PZ+/+ (21% PZ-/- mice vs. 9% in PZ+/+ mice; P <
0.05; Figure 2A, 2B), indicating an accelerated
proliferative phenotype of PZ-/- mice. Migration
and proliferation of SMCs in response to endo-
thelial activation are thought to be major
pathomechanisms underlying intimal hyperpla-
sia [17]. Immunohistochemical analysis reve-
aled an increased area of α-actin-positive
SMCs in neointimal lesions of PZ-/- mice (medi-
an 37%) vs. PZ+/+ mice (median 21%; Figure 2C,
2D), indicating an increased proliferation of
SMC in PZ-/- mice.
PZ diminishes SMC migration in vitro
To analyze the inuence of PZ on SMC migra-
tion in vitro, a conuent monolayer of cells was
scratched and incubated with PZ or TNF-α and
were compared to unstimulated cells serving
as control. Following 12 hours of incubation
quantication of migrated cells revealed a
trend towards increased migration of cells upon
TNF-α stimulation. SMCs stimulated with PZ
showed signicantly diminished migration com-
pared to TNF-α and ctrl (Figure 3A, 3B).
PZ has no inuence on SMC proliferation in
Analyzing the proliferation of SMC by measur-
ing BrdU incorporation, there was no signicant
inuence of PZ on SMC proliferation compared
to unstimulated control SMCs (Table 1). TNF-α
stimulated SMCs showed a slight increase of
In the present model, placement of FeCl3
soaked lter paper on a very small section of
the carotid artery induced vascular injury with
denudation of the inner vascular wall, resulting
in vascular healing processes with an inam-
Table 1. Inuence of PZ on SMC proliferation in vitro
ctrl PZ TNF-α
Median (IQR) Median (IQR) Median (IQR)
OD x-fold vs. ctrl 1.0 (1.0-1.0) 1.1 (1.1-1.2) 1.2 (1.2-1.3)
Data are given as median and IQR. ANOVA on Ranks; n = 3 independ-
ent experiments. Abbreviations: Ctrl, control; OD, optical density; PZ,
protein Z; TNF-α, tumor necrosis factor alpha; IQR, interquartile range.
of PZ-/- mice to arterial vascular disease-
related complications (data not shown).
Cellular composition of neointima for-
mation reects an increased inamma-
tory response in PZ-/- mice
In order to analyse arterial lesion com-
position carotids were stained for PCNA,
which is an established marker for cell
PZ deciency in vascular injury
6069 Int J Clin Exp Pathol 2014;7(9):6064-6071
matory component. Employing this model in
PZ-decient mice for the rst time, our results
contribute to the so far incompletely under-
stood function of PZ in vascular homeostasis
and disease.
The potential contribution of coagulation pro-
teins to the process of atherosclerosis and
thrombosis is so far incompletely understood
[5]. Regarding animal studies analyzing the
impact of mechanisms of the coagulation cas-
cade on atherosclerosis, Loeffen et al. conclud-
ed that although there were variations in ani-
mal age, diet and atherosclerosis model in
these studies, overall hypercoagulability on an
atherogenic background increased the devel-
opment and progression of atherosclerosis [5].
One of these studied coagulation factors is PC,
a functional homologue of PZ [7]. PC+/- mice
subjected to copper/silicona arterial cuff dis-
played enhanced focal arterial inammation
and thrombosis, leading to larger neointima for-
mation and subsequent localized occlusion, as
compared to their WT counterparts [18]. Zorio
et al. found a signicant association between
low circulating APC levels and the extent and
severity of coronary atherosclerosis, which
might be related to the anticoagulatory and
anti-inammatory properties of APC [19]. It has
also been reported that the presence of athero-
sclerotic plaques decreased the expression of
thrombomodulin and endothelial PC receptor
by endothelial cells [20]. Further, the activity of
the PC anticoagulant pathway may be impaired
in atherosclerotic arteries because of the com-
bination of decreased HDL-cholesterol and
increased LDL-cholesterol [21]. Thus, it is most
likely that the benecial effect of PC in vascular
disease is due to a combination of anti-coagu-
lant and anti-inammatory properties. The
strength of PC appears to be attributed to its
capacity to restore the regulation of coagula-
tion and inammation at the endothelial site
With respect to the structural homology of PZ
and PC, comparable mechanisms may underlie
the action prole of PZ, though not studied yet
in full detail. In the current study PZ-deciency
is accompanied by increased neointima forma-
tion and addition of PZ to wound scratched
SMCs limited cell migration. In an earlier study
of our group it was shown, that murine
PZ-deciency in endotoxin-induced generalized
Shwartzman reaction, displaying disseminated
intravascular coagulation, is accompanied by
an increased inammatory response as reect-
ed by excessive cy tokine release and inltra-
tion of inammatory cells into tissue [23].
Cesari et al. reported a strong positive correla-
tion between PZ and interleukin-6 at baseline
and three months after an acute coronary
artery event and concluded that PZ may be an
acute phase marker with a longer latency time
[24]. This strengthens a possible role of PZ in
inammation-related atherosclerotic diseases.
Further on, PZ was found histologically in
human macrovascular endothelial cells of
arteries from healthy and atherosclerotic
patients, where the proliferating subendothelial
space in atherosclerotic vascular lesions
showed signicant immunopositivity for PZ
[25]. It is not clear so far, whether PZ repre-
sents a causal role in these atherosclerotic
lesions or is rather a contributor to the local
wound healing response. As PZ was only immu-
nologically detected, the positivity of PZ could
be either due to PZ biosynthesis by endothelial
cells, or due to PZ antigen deposition. Due to
the fact that in the current study PZ revealed
anti-migratory potency on SMCs in vitro and
that PZ-/- mice showed increased neointima for-
mation, it can be hypothesized that PZ has
probably a compensatory function at the vascu-
lar wall in this model of vascular injury. Other
groups also found PZ immunolocalized in the
endothelium of arterial and venous vessel sec-
tions, which implies the binding of PZ to a pos-
tulated, but so far not identied endothelial
receptor [26] and points towards a paracrine
function of PZ independent of its function in the
coagulation cascade.
Thus, based on the observations of this study,
it is obvious that PZ activity is of importance in
the development of neointimal lesions and con-
tributes to vascular healing by coagulation-
independent pathways. The further underlying
mechanisms of the contribution of PZ in arterial
vascular disease remain to be elucidated.
This work was supported by a grant of the
Deutsche Forschungsgemeinschaft (VO 450/
Disclosure of conict of interest
PZ deciency in vascular injury
6070 Int J Clin Exp Pathol 2014;7(9):6064-6071
Address correspondence to: Antje Butschkau,
Institute for Experimental Surgery, Rostock
University Medical Center, Schillingallee 69a,
Rostock D-18057, Germany. Tel: +49381-4942504;
Fax: +49381-4942502; E-mail: antje.butschkau@
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... Differential gene expression analysis revealed downregulated genes associated with tumor suppression (Endod1, S100a14, and Vsig1), interferon response (Irf7, Isg15, and Rsad2), apoptosis (Irf7), and oxidative stress (Gsta1) (Qiu et al., 2017, Bernal et al., 2020, Fan and Zhang, 2013, Honda et al., 2005 (Figures 6.10G). Differential gene expression analysis of upregulated genes highlighted genes involved in inflammatory response regulation (Rgs16, Kcnj15, Ntn1, Slc10a6, Proz, and Tnfsf9), coagulation (Proz), inhibition of apoptosis (Ntn1), and negative regulation of differentiation (Enc1) , Kosters et al., 2016, Pascual et al., 2005, Andrei et al., 2004, Patten et al., 2003, Mirakaj et al., 2010, Butschkau et al., 2014, Fong et al., 2000, Suurväli et al., 2015, Bethea et al., 1992 (Figure 6.10G). Further, Rgs16 has a putative role in maintenance of the undifferentiated state in pluripotent stem cells (Bourillot et al., 2009) ( Figure 6.10G). ...
The alveolus is the functional unit of gas exchange in the lung and home to two major epithelial cell lineages: alveolar epithelial type 1 (AT1) and type 2 (AT2) cells. Large, squamous AT1 cells cover the vast majority of the adult lung surface area, creating the gas diffusible interface between the external environment and the vasculature. Cuboidal AT2 cells secrete pulmonary surfactant to reduce surface tension at this air-liquid interface to prevent alveolar collapse. These cells are essential for lung function, and many are lost upon lung injury. Thus, understanding the signals required to generate and regenerate these cells is vital to develop interventions to support long term pulmonary health. In this dissertation, I use a combination of epigenetic and transcriptomic profiling, in vivo mouse genetic and injury models, ex vivo organoid assays, and human patient tissue to define essential mediators of the developmental emergence, lineage commitment, and plasticity of AT1 and AT2 cells. I demonstrate that Dnmt1 ensures the proper specification and compartmentalization of proximal and distal epithelial cell lineages during development. Developing a method to segment heterogeneously injured adult lung tissue into distinct zones by severity, I define specific injury niches and characterize the spatially restricted cellular responses to damage intensity in mice and humans. I determine that Fgfr2 maintains early AT2 cell identity and balances AT2 cell proliferation and differentiation during lung regeneration. Additionally, I demonstrate the extent of AT1 cell plasticity during neonatal and adult regeneration to generate AT2 cells. Finally, I show that Klf5 regulates AT1 cell lineage commitment during both lung development and regeneration. This work defines essential factors that determine alveolar epithelial cell fate and reveals how these choices impact both lung development and regeneration.
... In this regard, firstly, an increasing number of studies support the notion that reduced PZ levels may constitute an independent risk factor for the development of atherosclerosis. A recent animal study from Butschkau et al. [28] showed PZ contributes to a reduced neointima formation after vascular injury, and PZ knock-out mice showed a significantly increased Group A, AMI patients; Group B, CCAD patients without AMI history and free of major clinical events; Group C, health healthy control group. area and thickness of the neointima and subsequently increased luminal stenosis in carotid arteries after injury compared to wild type mice, suggesting PZ could mitigate the development of atherosclerosis. ...
Objectives: To examine plasma protein Z (PZ) levels in acute myocardial infarction (AMI) and chronic coronary atherosclerosis disease (CCAD) patients without history of AMI and explore its potential clinical significance. Methods: Plasma PZ concentrations were measured in 90 AMI patients (Group A), 87 CCAD patients without AMI history who remained free of major clinical events at least one year (Group B), and 88 clinically healthy controls (Group C). Results: PZ was found to be significantly lower (P<0.001) in Group A (1508.5±486.2ng/mL) compared with Group B (1823.0±607.8ng/mL) and C (2001.7±733.0ng/mL) and in Group A+B compared with Group C (Group A+B 1663.1±570.0 ng/mL, P<0.001). No statistically significant difference was reached between Group B and C (P=0.081). PZ level was significantly correlated with concentration of creatine kinase MB, high sensitive-cardiac troponin T, high sensitive C reactive protein, D-dimer and coagulation factor II and may be a useful predictor for AMI (OR: 1.38, 95% CI: 1.13-1.77, P=0.03). Subgroup analysis showed PZ concentration below the lowest tertile (<1398ng/mL) had a significantly increased risk for AMI and CCAD (OR: 3.39; 95% CI: 1.12-10.31; P=0.03 and OR: 7.39; 95% CI: 2.62-20.79; P<0.001 respectively). Conclusions: PZ deficiency is found in AMI patients and could potentially reflect the myocardium injury, local coagulation activation and inflammation response during the acute phase of coronary atherosclerosis disease.
... There is growing awareness that there are sex-specific differences in response to specific interventions in animal models used for biomedical research (12). The majority of current preclinical studies in the vitamin K field rely on the use of a single-sex rodent model (13)(14)(15)(16)(17)(18); few studies, to our knowledge, have included both male and female rodents (19,20). However, in rats, females are reported to be more resistant to vitamin K deficiency than males (21,22), which has been hypothesized to be attributable to increased coprophagy in females (23), and increased vitamin K requirement in males (21,24), specific effects of sex hormones on vitamin K metabolism (25,26), and differences in the biosynthesis of MKs by gut bacteria and corresponding absorption (26). ...
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Background: There has been limited characterization of biological variables that impact vitamin K metabolism. This gap in knowledge can limit the translation of data obtained from preclinical animal studies to future human studies. Objective: The purpose of this study was to determine the effects of diet, sex, and housing on serum, tissue, and fecal vitamin K concentrations and gene expression in C57BL6 mice during dietary vitamin K manipulation. Methods: C57BL6 4-mo-old male and female mice were randomly assigned to conventional or suspended-wire cages and fed control [1400 ± 80 μg phylloquinone (PK)/kg] or deficient (31 ± 0.45 μg PK/kg) diets for 28 d in a factorial design. PK and menaquinone (MK) 4 plasma and tissue concentrations were measured by HPLC. Long-chain MKs were measured in all matrices by LC-atmospheric pressure chemical ionization-mass spectrometry. Gene expression was quantified by reverse transcriptase-polymerase chain reaction in the liver, brain, kidney, pancreas, and adipose tissue. Results: Male and female mice responded differently to dietary manipulation in a tissue-dependent manner. In mice fed the control diet, females had ∼3-fold more MK4 in the brain and mesenteric adipose tissue than did males and 100% greater PK concentrations in the liver, kidney, and mesenteric adipose tissue than did males. In mice fed the deficient diet, kidney MK4 concentrations were ∼4-fold greater in females than in males, and there were no differences in other tissues. Males and females differed in the expression of vitamin K expoxide reductase complex 1 (Vkorc1) in mesenteric adipose tissue and the pancreas and ubiA domain-containing protein 1 (Ubiad1) in the kidney and brain. There was no effect of housing on serum, tissue, or fecal concentrations of any vitamin K form. Conclusions: Vitamin K concentrations and expression of key metabolic enzymes differ between male and female mice and in response to the dietary PK concentration. Identifying factors that may impact study design and outcomes of interest is critical to optimize study parameters examining vitamin K metabolism in animal models.
Alveolar epithelial cell fate decisions drive lung development and regeneration. Using transcriptomic and epigenetic profiling coupled with genetic mouse and organoid models, we identified the transcription factor Klf5 as an essential determinant of alveolar epithelial cell fate across the lifespan. We show that although dispensable for both adult alveolar epithelial type 1 (AT1) and alveolar epithelial type 2 (AT2) cell homeostasis, Klf5 enforces AT1 cell lineage fidelity during development. Using infectious and non-infectious models of acute respiratory distress syndrome, we demonstrate that Klf5 represses AT2 cell proliferation and enhances AT2-AT1 cell differentiation in a spatially restricted manner during lung regeneration. Moreover, ex vivo organoid assays identify that Klf5 reduces AT2 cell sensitivity to inflammatory signaling to drive AT2-AT1 cell differentiation. These data define the roll of a major transcriptional regulator of AT1 cell lineage commitment and of the AT2 cell response to inflammatory crosstalk during lung regeneration.
Introduction: Neointima formation is closely linked to vascular stenosis and occurs after endothelial damage. Hydrogen sulphide is an endogenous pleiotropic mediator with numerous positive effects on the cardio vascular system. Objective: This study evaluates the effect of the slow releasing hydrogen sulfide donor GYY4137 (GYY) on neointimal formation in vivo. Methods: The effect of GYY on neointimal formation in the carotid artery was studied in the FeCl3 injury model in GYY- or vehicle-treated mice. The carotid arteries were studied at days 7 and 21 after treatment by means of histology and immunohistochemistry for proliferating cell nuclear antigen (PCNA) and alpha smooth muscle actin (α-SMA). Results: GYY treatment significantly reduced the maximal diameter and the area of the newly formed neointima on both days 7 and 21 when compared to vehicle treatment. GYY additionally reduced the number of PCNA- and α-SMA-positive cells within the neointima on day 21 after FeCl3 injury of the carotid artery. Conclusions: Summarizing, single treatment with the slow releasing hydrogen sulfide donor GYY reduced the extent of the newly formed neointima by affecting the cellular proliferation at the site of vascular injury.
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Cardiovascular diseases remain to be the leading cause of death in Western societies. Despite major findings in vascular biology that lead to a better understanding of the pathomechanisms involved in atherosclerosis, treatment of the disease has only changed slightly within the last years. A big body of evidence suggests that atherosclerosis is a chronic inflammatory disease of the vessel wall. Accumulation and peroxidation of LDL-particles within the vessel wall trigger a strong inflammatory response, causing macrophage and T-cell accumulation within the vessel wall. Additionally, B-cells and specific antibodies against LDL-particles, as well as the complement system are implicated in atherogenesis. Besides data from clinical trials and autopsy studies it was the implementation of mouse models of atherosclerosis and the emerging field of direct gen-modification that lead to a thorough description of the pathophysiological mechanisms involved in the disease and created overwhelming evidence for a participation of the immune system. Recently, the cross-talk between coagulation and inflammation in atherogenesis has gained attention. Serious limitations and disparities in the pathophysiology of atherosclerosis in mice and men complicated the translation of experimental data into clinical practice. Despite these limitations, new anti-inflammatory medical therapies in cardiovascular disease are currently being tested in clinical trials.
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This report presents final 2008 data on U.S. deaths, death rates, life expectancy, infant mortality, and trends by selected characteristics such as age, sex, Hispanic origin, race, state of residence, and cause of death. Information reported on death certificates, which is completed by funeral directors, attending physicians, medical examiners, and coroners, is presented in descriptive tabulations. The original records are filed in state registration offices. Statistical information is compiled in a national database through the Vital Statistics Cooperative Program of the Centers for Disease Control and Prevention's National Center for Health Statistics. Causes of death are processed in accordance with the International Classification of Diseases, Tenth Revision. In 2008, a total of 2,471,984 deaths were reported in the United States. The age-adjusted death rate was 758.3 deaths per 100,000 standard population, a decrease of 0.2 percent from the 2007 rate and a record low figure. Life expectancy at birth rose 0.2 years, from 77.9 years in 2007 to a record high 78.1 years in 2008. The age-specific death rate increased for age group 85 years and over. Age-specific death rates decreased for age groups: less than 1 year, 5-14, 15-24, 25-34, 35-44, and 65-74 years. The age-specific death rates remained unchanged for age groups: 1-4, 45-54, 55-64, and 75-84 years. The 15 leading causes of death in 2008 remained the same as in 2007, but Chronic lower respiratory diseases and suicide increased in the ranking while stroke and septicemia decreased in the ranking. Stroke is the fourth leading cause of death in 2008 after more than five decades at number three in the ranking. Chronic lower respiratory diseases is the third leading cause of death for 2008. The infant mortality rate decreased 2.1 percent to a historically low value of 6.61 deaths per 1000 live births in 2008. The decline of the age-adjusted death rate to a record low value for the United States and the increase in life expectancy to a record high value of 78.1 years are consistent with long-term trends in mortality.
Sepsis, a leading cause of mortality in critically ill patients, is closely linked to the excessive activation of coagulation and inflammation. Protein Z, a cofactor for the protein Z-dependent protease inhibitor, enhances the inhibition of coagulation factor Xa, and protein Z-dependent protease inhibitor inhibits factor XIa in a protein Z-independent fashion. The functions of protein Z and protein Z-dependent protease inhibitor in the inflammatory and coagulant responses to septic illness have not been evaluated. For induction of generalized Shwartzman reaction, dorsal skinfold chamber-equipped mice were challenged twice with lipopolysaccharide (0.05 mg/kg on day -1 and 5 mg/kg body weight 24 hr later). Time-matched control animals received equal volumes of saline. University research laboratory. Using intravital fluorescence microscopy in protein Z-dependent protease inhibitor deficient (ZPI) and protein Z deficient (PZ) mice, as well as their wild-type littermates (ZPI, PZ), kinetics of light/dye-induced thrombus formation and microhemodynamics were assessed in randomly chosen venules. Plasma concentrations of chemokine (C-X-C motif) ligand 1, interleukin-6, and interleukin-10 were measured. Liver and lung were harvested for quantitative analysis of leukocytic tissue infiltration and thrombus formation. After induction of generalized Shwartzman reaction, all mice showed significant impairment of microhemodynamics, including blood flow velocity, volumetric blood flow, and functional capillary density, as well as leukocytopenia and thrombocytopenia. Thrombus formation time was markedly prolonged after induction of generalized Shwartzman reaction in all mice, except of ZPI mice, which also had a significantly higher fraction of occluded vessels in liver sections. PZ mice developed the highest concentrations of interleukin-6 and interleukin-10 in response to generalized Shwartzman reaction and showed greater leukocytic tissue infiltration than their wild-type littermates. In this murine model of generalized Shwartzman reaction, protein Z-dependent protease inhibitor deficiency enhanced the thrombotic response to vascular injury, whereas protein Z deficiency increased inflammatory response.
Objective: Clinical and experimental evidence suggests that periadventitial adipose tissue may modulate vascular lesion formation. The aim of this study was to determine the role of perivascular leptin expression on neointima formation and to differentiate it from local inflammation and systemically elevated leptin levels. Approach and results: Increased neointima formation after carotid artery injury was observed in hyperleptinemic, diet-induced obese wild-type mice, but not in leptin-deficient ob/ob mice. High-fat diet was associated with increased leptin expression in visceral adipose tissue (VAT) as well as in perivascular adipose tissue. Perivascular leptin overexpression achieved by adenoviral vectors enhanced intimal cell proliferation and neointima formation in wild-type mice, but not in leptin receptor-deficient mice. Perivascular transplantation of VAT from high-fat diet-induced obese wild-type mice around the carotid artery of immunodeficient mice also promoted neointima formation, without affecting body weight or systemic leptin levels, and this effect was absent, if VAT from ob/ob mice was used. On the contrary, perivascular transplantation of VAT from ob/ob mice fed high-fat diet, characterized by marked immune cell accumulation, promoted neointimal hyperplasia also in the absence of leptin. In vitro, recombinant leptin and VAT-conditioned medium increased human arterial smooth muscle cell proliferation in a (partly) leptin-dependent manner. Conclusions: Our findings suggest that locally elevated leptin levels may promote neointima formation, independent of obesity and systemic hyperleptinemia, but also underline the importance of perivascular inflammation in mediating the increased cardiovascular risk in obesity.
Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a critical resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best available national data on heart disease, stroke, and other cardiovascular disease-related morbidity and mortality and the risks, quality of care, use of medical procedures and operations, and costs associated with the management of these diseases in a single document. Indeed, since 1999, the Statistical Update has been cited >10 500 times in the literature, based on citations of all annual versions. In 2012 alone, the various Statistical Updates were cited ≈3500 times (data from Google Scholar). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas, as well as increasing the number of ways to access and use the information assembled. For this year's edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year. This year's edition includes a new chapter on peripheral artery disease, as well as new data on the monitoring and benefits of cardiovascular health in the population, with additional new focus on evidence-based approaches to changing behaviors, implementation strategies, and implications of the AHA's 2020 Impact Goals. Below are a few highlights from this year's Update.
Objectives-This report presents preliminary U.S. data on deaths, death rates, life expectancy, leading causes of death, and infant mortality for 2008 by selected characteristics such as age, sex, race, and Hispanic origin. Methods-Data in this report are based on death records comprising more than 99 percent of the demographic and medical files for all deaths in the United States in 2008. The records are weighted to independent control counts for 2008. For certain causes of death such as unintentional injuries, homicides, suicides, drug-induced deaths, and sudden infant death syndrome, preliminary and final data may differ because of the truncated nature of the preliminary file. Comparisons are made with 2007 final data. Results-The age-adjusted death rate decreased from 760.2 deaths per 100,000 population in 2007 to 758.7 deaths per 100,000 population in 2008. From 2007 to 2008, age-adjusted death rates decreased significantly for 6 of the 15 leading causes of death: Diseases of heart, Malignant neoplasms, Cerebrovascular diseases, Accidents (unintentional injuries), Diabetes mellitus, andAssault (homicide). From 2007 to 2008, age-adjusted death rates increased significantly for 6 of the 15 leading causes of death: Chronic lower respiratory diseases; Alzheimer's disease; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; Intentional self-harm (suicide); and Essential hypertension and hypertensive renal disease. Life expectancy decreased by 0.1 year from 77.9 years in 2007 to 77.8 in 2008.
Although the link between blood coagulation and atherogenesis has been long postulated, only recently, and through the extensive work on transgenic mice, crossbred on an atherogenic background, has the direction of this interaction become visible. In general, hypercoagulability in mice tends to increase atherosclerosis, whereas hypocoagulability reduces the atherosclerotic burden, depending on the mouse model used. The information on a direct relationship between coagulation and atherosclerosis in humans, however, is not that clear. Almost all coagulation proteins, including tissue factor, are found in atherosclerotic lesions in humans. In addition to producing local fibrin, a matrix for cell growth, serine proteases such as thrombin may be very important in cell signaling processes, acting through the activation of protease-activated receptors (PARs). Activation of PARs on vascular cells drives many complex processes involved in the development and progression of atherosclerosis, including inflammation, angiogenesis, and cell proliferation. Although current imaging techniques do not allow for a detailed analysis of atherosclerotic lesion phenotype, hypercoagulability, defined either by gene defects of coagulation proteins or elevated levels of circulating markers of activated coagulation, has been linked to atherosclerosis-related ischemic arterial disease. New, high-resolution imaging techniques and sensitive markers of activated coagulation are needed in order to study a causal contribution of hypercoagulability to the pathophysiology of atherosclerosis. Novel selective inhibitors of coagulation enzymes potentially have vascular effects, including inhibition of atherogenesis through attenuation of inflammatory pathways. Therefore, we propose that studying the long-term vascular side effects of this novel class of oral anticoagulants should become a clinical research priority.
Overwhelming evidence has linked inflammatory disorders to a hypercoagulable state. In fact, thromboembolic complications are among the leading causes of disability and death in many acute and chronic inflammatory diseases. Despite this clinical knowledge, coagulation and immunity were long regarded as separate entities. Recent studies have unveiled molecular underpinnings of the intimate interconnection between both systems. The studies have clearly shown that distinct pro-inflammatory stimuli also activate the clotting cascade and that coagulation in turn modulates inflammatory signaling pathways. In this review, we use evidence from sepsis and inflammatory bowel diseases as a paradigm for acute and chronic inflammatory states in general and rise hypotheses how a systematic molecular understanding of the “inflammation-coagulation” crosstalk may result in novel diagnostic and therapeutic strategies that target the inflammation-induced hypercoagulable state.