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,1
* Departments of Pathology,
Ophthalmology, and
Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada NCA 5C1;
Department of Medicine, London Health Sciences Center, London, Ontario, Canada N6A 5W9; and || Vascular Biology Program and Department of Surgery, Childrens Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115
1To whom requests for reprints should be addressed at Department of Pathology, 4011 Dental Sciences Building, University of Western Ontario, London, Ontario, Canada NCA 5C1. E-mail: subrata.chakrabarti{at}schulich.uwo.ca
Abstract
Fibronectin (FN), a key extracellular matrix protein, is upregulated in target organs of diabetic angiopathy and in cultured cells exposed to high levels of glucose. FN has also been reported to undergo alternative splicing to produce the extra domain-B (ED-B) containing isoform, which is exclusively expressed during embryogenesis, tissue repair, and tumoral angiogenesis. The present study was aimed at elucidating the role and mechanism of endothelins (ETs) in FN and ED-B FN expression in diabetes. We investigated vitreous samples for ED-B FN expression from patients undergoing vitrectomy for proliferative diabetic retinopathy. Our results show increased FN and ED-B FN expression in the vitreous of diabetic patients in association with augmented ET-1. Using an antibody specific to the ED-B segment of FN, we show an increase in serum ED-B FN levels in patients with diabetic retinopathy and nephropathy. We further examined retinal tissues, as well as renal and cardiac tissues, from streptozotocin-induced diabetic rats. Diabetes increased FN and ED-B FN in all three organs, which was prevented by ET antagonist bosentan. To provide insight into the mechanism of glucose-induced and ET-mediated ED-B FN upregulation, we assayed endothelial cells (ECs). Inhibition of mitogen-activated protein kinase with pharmacological inhibitors and protein kinase B with dominant negative transfections prevented glucose- and ET-1mediated FN and ED-B FN expression. Furthermore, treatment of cells exposed to high levels of glucose with ET antagonist prevented the activation of all signaling pathways studied and normalized glucose-induced ED-B FN expression. We then determined the functional significance of ED-B in ECs and show that ED-B FN is involved in vascular endothelial growth factor expression and cellular proliferation. These studies show that glucose-induced and ET-mediated FN and ED-B FN expressions involve complex interplays between signaling pathways and that ET may represent an ideal target for therapy in chronic diabetic complications.
Key Words: basement membrane diabetic complications endothelins extracellular matrix fibronectin
Introduction
Despite the fact that insulin was introduced nearly 70 years ago to sustain life for people with diabetes, little progress has been made in developing preventive therapies for the chronic diabetic complications. Long-standing diabetes leads to both structural and functional anomalies in the vasculature (13). These secondary complications include retinopathy, nephropathy, cardiomyopathy, peripheral vascular disease, cerebrovascular disorders, and atherosclerosis. The single most important instigator of these complications is hyperglycemia (4, 5). Various biochemical changes have been attributed to mediate the adverse effects of high levels of glucose. These molecular events include activation of protein kinase C (PKC), augmentation of oxidative stress, glycation and modification of proteins, and increased glucose flux through the polyol pathway (3, 6, 7). Among the vast array of molecular changes, the single most consistent theme in the development of chronic diabetic complications seems to be the involvement of endothelial cell (EC) dysfunction (3, 8, 9).
The earliest changes during the onset of chronic diabetic complications are hemodynamic and dictated by the EC state (3, 6, 8). Reduced blood flow and increased permeability have been described in various animal models of chronic diabetic complications (3). These changes are essentially brought on by an imbalance between the vasoconstrictors and the vasodilators. Elaboration of the vasoconstrictor, endothelins (ETs), has been well established in animal models of the disease and human diabetes (3, 10). Beneficial effects of ET antagonism have also been shown (3, 11). A recent report indicates a possible advantageous effect of ET receptor inhibition in reducing hyperglycemia and the onset of vascular injury in the diabetic NOD (non-obese diabetic) animals (12). The involvement of ETs in EC dysfunction spans various parameters including permeability, vasoconstriction, and extracellular matrix (ECM) expansion (3, 13, 14). Administration of ET antagonists has been shown to prevent all of these EC functional changes (3, 8).
ECM alterations and basement membrane (BM) thickening are structural hallmarks of diabetic complications (1517). These connective tissues comprise an insoluble meshwork of proteins that assemble into a sheetlike structure by cell surface anchors and receptors (1820). The importance of these connective tissues was realized when several vascular diseases were found to be associated with defects in the components of these structures (21). Furthermore, the presence of organ-specific molecules in the BMs suggests a significant role in modulating cell behavior and maintaining the tissue microenvironment. Increased ECM deposition and BM thickening in diabetic patients was first documented in the landmark study by Siperstein and colleagues in 1968 (15). Since these studies, major interest has been placed in elucidating the mechanism of BM thickening. We and others have shown increased ECM protein expression and BM thickening in all target organs of diabetic complications in animal models (3, 2224). In the context of diabetic vasculopathy, the predominant proteins overexpressed are collagen and fibronectin (FN). Among the ECM proteins, FN displays a significant functional role in regulating cell behavior (25, 26).
Although FN molecules are products of a single gene, there is great heterogeneity in the population of FN molecules (26, 27). This diversity is the result of alternative pre-mRNA splicing. Three sites have been identified that undergo alternative splicing. These sites are termed extra domain-A, extra domain-B (ED-B), and type III connecting segment (26). Alternative splicing at the extra domain-A and ED-B regions is regulated in a tissue-specific and developmental manner. FN molecules containing the ED-B segment are highly restricted in terms of expression (26). It has been shown that ED-B FN is expressed only in proliferating tissues such as embryonic and tumor tissues (28, 29). Furthermore, it has been demonstrated that ED-B FN, which is virtually absent in normal adult tissues, is highly expressed in neoplastic blood vessels, suggesting a potential as an angiogenic marker (30, 31).
In the present study, we have determined whether diabetes causes upregulation of ED-B FN. We have also examined the role of ET-1 in ED-B FN expression. In addition, we have elucidated the signaling pathways that may cause ET-induced ED-B FN upregulation.
Materials and Methods
Human Vitreous and Serum Samples.
Human vitreous samples were obtained from diabetic (n = 18; 7 females, 11 males; mean age ± SD, 58.1 ± 13.3 years) and nondiabetic (n = 6; 5 females, 1 male; mean age ± SD, 69.6 ± 8.91 years) patients undergoing vitrectomy for proliferative diabetic retinopathy and nondiabetes-associated ocular condition such as macular hole, respectively. The samples were pelleted by centrifuge and used for RNA isolation and real-time reverse transcriptase polymerase chain reaction (RT-PCR) (32). The vitreous is usually acellular but may contain hyalocytes, fibrocytes, and glial cells. However, during the course of proliferative diabetic retinopathy, the vitreous predominantly contains endothelial cells from the abnormal new blood vessels which grow in the plane anterior to the normal retinal vessels and extend into the vitreous.
Blood samples were obtained with consent of healthy volunteers (n = 6; 4 females, 2 males; mean age ± SD, 30.1 ± 8.1) and diabetic patients (n = 20; 12 males, 8 females; mean age ± SD, 58.8 ± 11.4) with known retinopathy or nephropathy, but not in dialysis, in collaboration with the department of Medicine, London Health Sciences Center, London. Serum from the blood samples was used for enzyme-linked immunosorbent assay. The antibody against ED-B FN has been characterized and shown to be specific to the ED-B region of FN (32). All human samples were obtained by approval of the Ethical Committee at University of Western Ontario and London Health Sciences Center, London, in accordance with the guidelines of the Declaration of Helsinki for research involving human tissues.
Animal Model of Diabetic Complications.
Male Sprague-Dawley rats (Charles River Canada Ltd., St. Constant, Canada) weighing 200250 g were made diabetic by a single intravenous injection of streptozotocin (65 mg/kg). Hyperglycemia was confirmed by blood glucose measurement (SurestepTM/Lifescan, Burnaby, Canada). Age- and sex-matched controls were given citrate buffer. Diabetic rats were divided into two groups, diabetics (DM) and diabetics on dual ET-receptor antagonist, bosentan (DM-B; oral gavage 100 mg/kg/day) (Courtesy of Dr. M. Clozel/Acetelion Ltd., Allschwill, Switzerland). After 3 months of treatment, rats were euthanized and tissues were obtained. All animal care adhered to the ARVO Statement for the Use of Animals in Ophthalmic and Vision Research.
EC Cultures.
Human umbilical vein endothelial cells (HUVECs; American Type Culture Collection, Rockville, MD) were cultured as previously described (32). For dose-response experiments, subconfluent cells were incubated with 5 mM (control), 15 mM, 25 mM, or 35 mM D-glucose for 24 hrs. After incubation, total RNA was extracted and subjected to real-time RT-PCR. The role of ET-1 in mediating the effects of high glucose was elucidated by treating cells in 5 mM glucose (CO) with 5 nM ET-1 (Peninsula Laboratories, Belmont, CA). In addition, we incubated cells in high glucose (HG; 25 mM) with 10 µM dual ET receptor antagonist, bosentan. Other pharmacologic inhibitors were used at optimal doses (U0216, 10 µM; PD098059, 50 µM; ML-9, 100 µM; chelerythrine, 1 µM). After 24 hrs of treatment period, total RNA was extracted and subjected to real-time RT-PCR. Gene silencing experiments were carried out as described by us previously (32).
Statistical Analysis.
The data are expressed as mean ± SEM and were analyzed by ANOVA followed by Students t test. Differences were considered significant at values of P < 0.05.
Results
ETs, Regulation of ECM Composition, and Cellular Proliferation.
The emerging role of ETs in cellular proliferation is being realized (3336). A number of human cancers exhibit increased ET-1 levels (35). ET-1 has been shown to increase cell growth in human cancer and suppress apoptosis of the cancer cells (37, 38). Studies in cultured cells and animal models indicate a role of ET in EC proliferation, migration and invasion, and neovascularization in vivo (35). ETs also increase the expression of vascular endothelial growth factor (VEGF) (39).
We have assayed for increased ED-B FN expression in vitrectomy specimens and serum samples from patients with proliferative diabetic retinopathy or nephropathy. Our results indicate that ED-B FN is upregulated in the vitreous from the diabetic patients as compared to the controls (Fig. 1
). Interestingly, ET-1 and transforming growth factorß1 (TGF-ß1) levels were also elevated in the vitreous specimens suggesting an important association of these mitogens in ED-B FN expression. We next generated an antibody against the ED-B domain of human FN. The antibody was characterized and shown to be specific to ED-Bpositive FN (32). Using this antibody, we assayed for serum levels of ED-B FN in diabetic patients. Our results indicate a 3-fold higher ED-B FN levels in diabetic patients (Fig. 2
). Diabetic patients with established retinopathy or nephropathy showed a significantly higher serum ED-B level as compared with diabetics without documented microvascular complication (data not shown).
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The signaling pathways involved in ET-induced ECM protein synthesis are not fully understood. ETs activate a number of intracellular signaling molecules including PKC, protein kinase B (PKB), and mitogen activated protein kinase (MAPK) (44). In the present study, we have investigated the signaling proteins which arbitrate the high glucose-induced and ET-mediated ED-B FN upregulation in cultured ECs. HUVECs were cultured in the presence of 5, 15, 25, and 35 mM glucose and assayed for total and relative ED-B FN (ED-B FN:total FN) upregulation by real-time RT-PCR. Our results indicate that both total and relative ED-B FN mRNA levels were augmented in HUVECs exposed to 25 mM glucose for 24 hrs (Fig. 5A
). Such upregulation of FN was also observed in cells treated with 5 nM ET-1 peptide. In parallel to the increased ED-B FN expression, high glucose and ET-1 peptide caused activation of PKB and MAPK (Fig. 5B
). To determine the role of ET-1, we treated HUVECs exposed to high levels of glucose with the dual ET receptor antagonist, bosentan. ET receptor inhibition caused complete normalization of ED-B FN expression.
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Discussion
The present study demonstrates the upregulation of the ED-B FN in vitreous and serum samples from diabetic patients. Using a well-established model of chronic diabetic complications, we have shown that ED-B FN is upregulated in the retinal tissues of diabetic rats. This hyperglycemia-induced upregulation of ED-B FN was shown to be mediated via elaboration of mitogenic growth factor, ET-1, and its possible regulatory interaction with TGF-ß1. Treatment of diabetic rats with a dual ET receptor antagonist, bosentan, was able to normalize diabetes-induced changes in the retina. We have extrapolated the studies to further demonstrate that upregulation of ED-B FN is not restricted to the retinal tissue. Other target organs of chronic diabetic complications include the heart and the kidney. We have demonstrated that these tissues also exhibit diabetes-induced preferential expression of ED-B FN. These findings suggest that such preference toward a particular isoform may represent a general phenomenon in hyperglycemia-induced vascular damage.
Isoform switching of FN in the ECM may represent an important phenomenon in altering the behavior of vascular ECs. It is increasingly being realized that the ECM provides positional and environmental information (45). This information is important for proper tissue function; a phenomenon evident in studies which demonstrate heterogeneity in ECM composition and architecture in a tissue-specific manner (45). Signaling from the ECM would depend on the matrix composition (signal), the repertoire of receptors (transducers), and the types of cells (target). Connections from matrix through these receptors could determine the organization of cytoskeletal components and activation of signaling molecules (46, 47). The mosaic of FN species deposited may, therefore, be important in mediating signals to vascular cells and modulating their behavior. In support of such a notion are findings that indicate increased expression of an embryonic isoform of tenascin in promoting retinal endothelial migration and proliferation (48).
High levels of glucose have been shown to mediate proliferation of ECs (49). Our study suggests that ED-B domain, in part, mediates such proliferative effects. Targeted gene silencing of ED-B FN in ECs resulted in decreased proliferative capacity. We have also demonstrated that selective targeting and subsequent inhibition of ED-B FN production results in reduced VEGF expression.
The molecular mechanism by which high glucose-induced ET-1 expression leads to increased ED-B FN expression remains to be fully elucidated. PKC, phosphatidylinositol 3-kinase, and MAPKs may play a role in FN expression. Here, we provide evidence that ED-B FN expression in ECs is regulated by concurrent activation of various signaling pathways, including PKB, MAPK, and PKC.
In conclusion our results suggest that ETs may represent the determining factor in ECM expression (Fig. 7
). Our in vivo and in vitro findings suggest that inhibition of ETs is associated with almost complete attenuation of PKB, MAPK, PKC, transcription factor activity, and FN expression. These findings also suggest an important feedback mechanism for chronic activation of these signaling pathways in diabetic complications. ET expression has been reported to increase with augmented PKC activation. Interestingly, upregulated ETs appear to be necessary for continued activation of PKC and possibly other signaling proteins in the diabetic context. Therefore, ETs may provide an invaluable target for the development of therapeutic modalities for diabetic complications and other angiogenic and fibrotic diseases.
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Footnotes
The authors acknowledge grant supports from the Canadian Diabetes Association in honor of the late Glenn W Liebrock, the Canadian Institutes of Health Research (MOP 43841), and the Lawson Health Research Institute.
Received for publication September 29, 2005. Accepted for publication November 14, 2005.
References
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