1
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Warminski M, Trepkowska E, Smietanski M, Sikorski PJ, Baranowski MR, Bednarczyk M, Kedzierska H, Majewski B, Mamot A, Papiernik D, Popielec A, Serwa RA, Shimanski BA, Sklepkiewicz P, Sklucka M, Sokolowska O, Spiewla T, Toczydlowska-Socha D, Warminska Z, Wolosewicz K, Zuberek J, Mugridge JS, Nowis D, Golab J, Jemielity J, Kowalska J. Trinucleotide mRNA Cap Analogue N6-Benzylated at the Site of Posttranscriptional m6A m Mark Facilitates mRNA Purification and Confers Superior Translational Properties In Vitro and In Vivo. J Am Chem Soc 2024; 146:8149-8163. [PMID: 38442005 PMCID: PMC10979456 DOI: 10.1021/jacs.3c12629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 03/07/2024]
Abstract
Eukaryotic mRNAs undergo cotranscriptional 5'-end modification with a 7-methylguanosine cap. In higher eukaryotes, the cap carries additional methylations, such as m6Am─a common epitranscriptomic mark unique to the mRNA 5'-end. This modification is regulated by the Pcif1 methyltransferase and the FTO demethylase, but its biological function is still unknown. Here, we designed and synthesized a trinucleotide FTO-resistant N6-benzyl analogue of the m6Am-cap-m7GpppBn6AmpG (termed AvantCap) and incorporated it into mRNA using T7 polymerase. mRNAs carrying Bn6Am showed several advantages over typical capped transcripts. The Bn6Am moiety was shown to act as a reversed-phase high-performance liquid chromatography (RP-HPLC) purification handle, allowing the separation of capped and uncapped RNA species, and to produce transcripts with lower dsRNA content than reference caps. In some cultured cells, Bn6Am mRNAs provided higher protein yields than mRNAs carrying Am or m6Am, although the effect was cell-line-dependent. m7GpppBn6AmpG-capped mRNAs encoding reporter proteins administered intravenously to mice provided up to 6-fold higher protein outputs than reference mRNAs, while mRNAs encoding tumor antigens showed superior activity in therapeutic settings as anticancer vaccines. The biochemical characterization suggests several phenomena potentially underlying the biological properties of AvantCap: (i) reduced propensity for unspecific interactions, (ii) involvement in alternative translation initiation, and (iii) subtle differences in mRNA impurity profiles or a combination of these effects. AvantCapped-mRNAs bearing the Bn6Am may pave the way for more potent mRNA-based vaccines and therapeutics and serve as molecular tools to unravel the role of m6Am in mRNA.
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Affiliation(s)
- Marcin Warminski
- Division
of Biophysics, Institute of Experimental Physics, Faculty of Physics, University of Warsaw, 02-089 Warsaw, Poland
| | - Edyta Trepkowska
- Explorna
Therapeutics sp. z o.o. Zwirki i Wigury 93, 02-089 Warsaw, Poland
| | | | - Pawel J. Sikorski
- Centre
of New Technologies, University of Warsaw, 02-089 Warsaw, Poland
- Laboratory
of Epitranscriptomics, Department of Environmental Microbiology and
Biotechnology, Institute of Microbiology, Faculty of Biology, Biological
and Chemical Research Centre, University
of Warsaw, 02-089 Warsaw, Poland
| | | | - Marcelina Bednarczyk
- Centre
of New Technologies, University of Warsaw, 02-089 Warsaw, Poland
- Explorna
Therapeutics sp. z o.o. Zwirki i Wigury 93, 02-089 Warsaw, Poland
| | - Hanna Kedzierska
- Explorna
Therapeutics sp. z o.o. Zwirki i Wigury 93, 02-089 Warsaw, Poland
| | - Bartosz Majewski
- Explorna
Therapeutics sp. z o.o. Zwirki i Wigury 93, 02-089 Warsaw, Poland
| | - Adam Mamot
- Centre
of New Technologies, University of Warsaw, 02-089 Warsaw, Poland
| | - Diana Papiernik
- Explorna
Therapeutics sp. z o.o. Zwirki i Wigury 93, 02-089 Warsaw, Poland
| | - Agnieszka Popielec
- Explorna
Therapeutics sp. z o.o. Zwirki i Wigury 93, 02-089 Warsaw, Poland
| | - Remigiusz A. Serwa
- Proteomics
Core Facility, IMol Polish Academy of Sciences, 02-247 Warsaw, Poland
| | - Brittany A. Shimanski
- Department
of Chemistry & Biochemistry, University
of Delaware, Newark, Delaware 19716, United States
| | - Piotr Sklepkiewicz
- Explorna
Therapeutics sp. z o.o. Zwirki i Wigury 93, 02-089 Warsaw, Poland
| | - Marta Sklucka
- Explorna
Therapeutics sp. z o.o. Zwirki i Wigury 93, 02-089 Warsaw, Poland
| | - Olga Sokolowska
- Explorna
Therapeutics sp. z o.o. Zwirki i Wigury 93, 02-089 Warsaw, Poland
| | - Tomasz Spiewla
- Division
of Biophysics, Institute of Experimental Physics, Faculty of Physics, University of Warsaw, 02-089 Warsaw, Poland
- Explorna
Therapeutics sp. z o.o. Zwirki i Wigury 93, 02-089 Warsaw, Poland
| | | | - Zofia Warminska
- Centre
of New Technologies, University of Warsaw, 02-089 Warsaw, Poland
| | - Karol Wolosewicz
- Explorna
Therapeutics sp. z o.o. Zwirki i Wigury 93, 02-089 Warsaw, Poland
| | - Joanna Zuberek
- Division
of Biophysics, Institute of Experimental Physics, Faculty of Physics, University of Warsaw, 02-089 Warsaw, Poland
| | - Jeffrey S. Mugridge
- Department
of Chemistry & Biochemistry, University
of Delaware, Newark, Delaware 19716, United States
| | - Dominika Nowis
- Explorna
Therapeutics sp. z o.o. Zwirki i Wigury 93, 02-089 Warsaw, Poland
- Laboratory
of Experimental Medicine, Faculty of Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Jakub Golab
- Explorna
Therapeutics sp. z o.o. Zwirki i Wigury 93, 02-089 Warsaw, Poland
- Laboratory
of Experimental Medicine, Faculty of Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Jacek Jemielity
- Centre
of New Technologies, University of Warsaw, 02-089 Warsaw, Poland
- Explorna
Therapeutics sp. z o.o. Zwirki i Wigury 93, 02-089 Warsaw, Poland
| | - Joanna Kowalska
- Division
of Biophysics, Institute of Experimental Physics, Faculty of Physics, University of Warsaw, 02-089 Warsaw, Poland
- Explorna
Therapeutics sp. z o.o. Zwirki i Wigury 93, 02-089 Warsaw, Poland
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2
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Sklepkiewicz P, Dymek B, Mlacki M, Zagozdzon A, Salamon M, Siwińska AM, Mazurkiewicz MP, de Souza Xavier Costa N, Mazur M, Mauad T, Gołębiowski A, Dzwonek K, Gołąb J, Zasłona Z. Inhibition of Macrophage-Specific CHIT1 as an Approach to Treat Airway Remodeling in Severe Asthma. Int J Mol Sci 2023; 24:ijms24054719. [PMID: 36902148 PMCID: PMC10003607 DOI: 10.3390/ijms24054719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023] Open
Abstract
Chitotriosidase (CHIT1) is an enzyme produced by macrophages that regulates their differentiation and polarization. Lung macrophages have been implicated in asthma development; therefore, we asked whether pharmacological inhibition of macrophage-specific CHIT1 would have beneficial effects in asthma, as it has been shown previously in other lung disorders. CHIT1 expression was evaluated in the lung tissues of deceased individuals with severe, uncontrolled, steroid-naïve asthma. OATD-01, a chitinase inhibitor, was tested in a 7-week-long house dust mite (HDM) murine model of chronic asthma characterized by accumulation of CHIT1-expressing macrophages. CHIT1 is a dominant chitinase activated in fibrotic areas of the lungs of individuals with fatal asthma. OATD-01 given in a therapeutic treatment regimen inhibited both inflammatory and airway remodeling features of asthma in the HDM model. These changes were accompanied by a significant and dose-dependent decrease in chitinolytic activity in BAL fluid and plasma, confirming in vivo target engagement. Both IL-13 expression and TGFβ1 levels in BAL fluid were decreased and a significant reduction in subepithelial airway fibrosis and airway wall thickness was observed. These results suggest that pharmacological chitinase inhibition offers protection against the development of fibrotic airway remodeling in severe asthma.
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Affiliation(s)
| | | | | | | | | | | | | | - Natalia de Souza Xavier Costa
- Department of Pathology, Faculty of Medicine, University of São Paulo, Avenida Dr. Arnaldo, 455, Room 1150, Cerqueira Cesar, São Paulo 01246-903, Brazil
| | | | - Thais Mauad
- Department of Pathology, Faculty of Medicine, University of São Paulo, Avenida Dr. Arnaldo, 455, Room 1150, Cerqueira Cesar, São Paulo 01246-903, Brazil
| | | | | | - Jakub Gołąb
- Department of Immunology, Medical University of Warsaw, 02-097 Warsaw, Poland
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3
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Dymek B, Sklepkiewicz P, Mlacki M, Güner NC, Nejman-Gryz P, Drzewicka K, Przysucha N, Rymaszewska A, Paplinska-Goryca M, Zagozdzon A, Proboszcz M, Krzemiński Ł, von der Thüsen JH, Górska K, Dzwonek K, Zasłona Z, Dobrzanski P, Krenke R. Pharmacological Inhibition of Chitotriosidase (CHIT1) as a Novel Therapeutic Approach for Sarcoidosis. J Inflamm Res 2022; 15:5621-5634. [PMID: 36199746 PMCID: PMC9529231 DOI: 10.2147/jir.s378357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/17/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Methods Results Conclusion
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Affiliation(s)
- Barbara Dymek
- Molecure SA, Warsaw, 02-089, Poland
- Postgraduate School of Molecular Medicine, Medical University of Warsaw, Warsaw, 02-097, Poland
- Correspondence: Barbara Dymek, Żwirki i Wigury 101, Warsaw, 02-089, Poland, Tel +48 22 552 67 24, Email
| | | | | | | | - Patrycja Nejman-Gryz
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, 02-097, Poland
| | | | - Natalia Przysucha
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, 02-097, Poland
| | | | - Magdalena Paplinska-Goryca
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, 02-097, Poland
| | | | - Małgorzata Proboszcz
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, 02-097, Poland
| | | | - Jan H von der Thüsen
- Department of Pathology, Erasmus Medical Center, Rotterdam, 3015 GD, the Netherlands
| | - Katarzyna Górska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, 02-097, Poland
| | | | | | | | - Rafał Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, 02-097, Poland
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4
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Sklepkiewicz P, Dymek BA, Mlacki M, Koralewski R, Mazur M, Nejman-Gryz P, Korur S, Zagozdzon A, Rymaszewska A, von der Thüsen JH, Siwińska AM, Güner NC, Cheda Ł, Paplinska-Goryca M, Proboszcz M, van den Bosch TPP, Górska K, Golab J, Kamiński RM, Krenke R, Golebiowski A, Dzwonek K, Dobrzanski P. Inhibition of CHIT1 as a novel therapeutic approach in idiopathic pulmonary fibrosis. Eur J Pharmacol 2022; 919:174792. [PMID: 35122869 DOI: 10.1016/j.ejphar.2022.174792] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 12/13/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive and eventually fatal lung disease with a complex etiology. Approved drugs, nintedanib and pirfenidone, modify disease progression, but IPF remains incurable and there is an urgent need for new therapies. We identified chitotriosidase (CHIT1) as new driver of fibrosis in IPF and a novel therapeutic target. We demonstrate that CHIT1 activity and expression are significantly increased in serum (3-fold) and induced sputum (4-fold) from IPF patients. In the lungs CHIT1 is expressed in a distinct subpopulation of profibrotic, disease-specific macrophages, which are only present in patients with ILDs and CHIT1 is one of the defining markers of this fibrosis-associated gene cluster. To define CHIT1 role in fibrosis, we used the therapeutic protocol of the bleomycin-induced pulmonary fibrosis mouse model. We demonstrate that in the context of chitinase induction and the macrophage-specific expression of CHIT1, this model recapitulates lung fibrosis in ILDs. Genetic inactivation of Chit1 attenuated bleomycin-induced fibrosis (decreasing the Ashcroft scoring by 28%) and decreased expression of profibrotic factors in lung tissues. Pharmacological inhibition of chitinases by OATD-01 reduced fibrosis and soluble collagen concentration. OATD-01 exhibited anti-fibrotic activity comparable to pirfenidone resulting in the reduction of the Ashcroft score by 32% and 31%, respectively. These studies provide a preclinical proof-of-concept for the antifibrotic effects of OATD-01 and establish CHIT1 as a potential new therapeutic target for IPF.
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Affiliation(s)
| | - Barbara A Dymek
- OncoArendi Therapeutics SA, 02-089, Warsaw, Poland; Postgraduate School of Molecular Medicine, Medical University of Warsaw, 02-097, Warsaw, Poland.
| | | | | | | | - Patrycja Nejman-Gryz
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-097, Warsaw, Poland
| | - Serdar Korur
- OncoArendi Therapeutics SA, 02-089, Warsaw, Poland
| | | | | | - Jan H von der Thüsen
- Department of Pathology, Erasmus Medical Center, 3015 GD, Rotterdam, the Netherlands
| | | | | | - Łukasz Cheda
- OncoArendi Therapeutics SA, 02-089, Warsaw, Poland
| | - Magdalena Paplinska-Goryca
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-097, Warsaw, Poland
| | - Małgorzata Proboszcz
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-097, Warsaw, Poland
| | | | - Katarzyna Górska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-097, Warsaw, Poland
| | - Jakub Golab
- Department of Immunology, Medical University of Warsaw, 02-097, Warsaw, Poland
| | | | - Rafał Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-097, Warsaw, Poland
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5
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Koralewski R, Dymek B, Mazur M, Sklepkiewicz P, Olejniczak S, Czestkowski W, Matyszewski K, Andryianau G, Niedziejko P, Kowalski M, Gruza M, Borek B, Jedrzejczak K, Bartoszewicz A, Pluta E, Rymaszewska A, Kania M, Rejczak T, Piasecka S, Mlacki M, Mazurkiewicz M, Piotrowicz M, Salamon M, Zagozdzon A, Napiorkowska-Gromadzka A, Bartlomiejczak A, Mozga W, Dobrzański P, Dzwonek K, Golab J, Nowotny M, Olczak J, Golebiowski A. Discovery of OATD-01, a First-in-Class Chitinase Inhibitor as Potential New Therapeutics for Idiopathic Pulmonary Fibrosis. J Med Chem 2020; 63:15527-15540. [PMID: 33078933 DOI: 10.1021/acs.jmedchem.0c01179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chitotriosidase (CHIT1) and acidic mammalian chitinase (AMCase) are the enzymatically active chitinases that have been implicated in the pathology of chronic lung diseases such as asthma and interstitial lung diseases (ILDs), including idiopathic pulmonary fibrosis (IPF) and sarcoidosis. The clinical and preclinical data suggest that pharmacological inhibition of CHIT1 might represent a novel therapeutic approach in IPF. Structural modification of an advanced lead molecule 3 led to the identification of compound 9 (OATD-01), a highly active CHIT1 inhibitor with both an excellent PK profile in multiple species and selectivity against a panel of other off-targets. OATD-01 given orally once daily in a range of doses between 30 and 100 mg/kg showed significant antifibrotic efficacy in an animal model of bleomycin-induced pulmonary fibrosis. OATD-01 is the first-in-class CHIT1 inhibitor, currently completed phase 1b of clinical trials, to be a potential treatment for IPF.
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Affiliation(s)
- Robert Koralewski
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Barbara Dymek
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Marzena Mazur
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | | | - Sylwia Olejniczak
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | | | | | - Gleb Andryianau
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Piotr Niedziejko
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Michal Kowalski
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Mariusz Gruza
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Bartłomiej Borek
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Karol Jedrzejczak
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | | | - Elżbieta Pluta
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | | | - Magdalena Kania
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Tomasz Rejczak
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Sylwia Piasecka
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Michal Mlacki
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | | | - Michał Piotrowicz
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Magdalena Salamon
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | | | | | - Aneta Bartlomiejczak
- Structural Biology Center, International Institute of Molecular and Cell Biology, Trojdena 4, 02-109 Warsaw, Poland
| | - Witold Mozga
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Paweł Dobrzański
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Karolina Dzwonek
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Jakub Golab
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland.,Department of Immunology, Medical University of Warsaw, Nielubowicza 5, 02-097 Warsaw, Poland
| | - Marcin Nowotny
- Structural Biology Center, International Institute of Molecular and Cell Biology, Trojdena 4, 02-109 Warsaw, Poland
| | - Jacek Olczak
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
| | - Adam Golebiowski
- OncoArendi Therapeutics SA, Żwirki i Wigury 101, 02-089 Warsaw, Poland
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6
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Mazur M, Dymek B, Koralewski R, Sklepkiewicz P, Olejniczak S, Mazurkiewicz M, Piotrowicz M, Salamon M, Jędrzejczak K, Zagozdzon A, Czestkowski W, Matyszewski K, Borek B, Bartoszewicz A, Pluta E, Rymaszewska A, Mozga W, Stefaniak F, Dobrzański P, Dzwonek K, Golab J, Golebiowski A, Olczak J. Development of Dual Chitinase Inhibitors as Potential New Treatment for Respiratory System Diseases. J Med Chem 2019; 62:7126-7145. [PMID: 31291098 DOI: 10.1021/acs.jmedchem.9b00681] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Acidic mammalian chitinase (AMCase) and chitotriosidase-1 (CHIT1) are two enzymatically active proteins produced by mammals capable of cleaving the glycosidic bond in chitin. Based on the clinical findings and animal model studies, involvement of chitinases has been suggested in several respiratory system diseases including asthma, COPD, and idiopathic pulmonary fibrosis. Exploration of structure-activity relationships within the series of 1-(3-amino-1H-1,2,4-triazol-5-yl)-piperidin-4-amines, which was earlier identified as a scaffold of potent AMCase inhibitors, led us to discover highly active dual (i.e., AMCase and CHIT1) inhibitors with very good pharmacokinetic properties. Among them, compound 30 was shown to reduce the total number of cells in bronchoalveolar lavage fluid of mice challenged with house dust mite extract after oral administration (50 mg/kg, qd). In addition, affinity toward the hERG potassium channel of compound 30 was significantly reduced when compared to the earlier reported chitinase inhibitors.
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Affiliation(s)
- Marzena Mazur
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland
| | - Barbara Dymek
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland
| | - Robert Koralewski
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland
| | - Piotr Sklepkiewicz
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland
| | - Sylwia Olejniczak
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland
| | | | - Michał Piotrowicz
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland
| | - Magdalena Salamon
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland
| | - Karol Jędrzejczak
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland
| | | | | | | | - Bartłomiej Borek
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland
| | | | - Elżbieta Pluta
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland
| | | | - Witold Mozga
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland
| | - Filip Stefaniak
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland.,Laboratory of Bioinformatics and Protein Engineering , International Institute of Molecular and Cell Biology in Warsaw , Ks. Trojdena 4 , 02-109 Warsaw , Poland
| | - Paweł Dobrzański
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland
| | - Karolina Dzwonek
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland
| | - Jakub Golab
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland.,Department of Immunology , Medical University of Warsaw , Nielubowicza 5 , 02-097 Warsaw , Poland
| | - Adam Golebiowski
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland
| | - Jacek Olczak
- OncoArendi Therapeutics SA , Żwirki i Wigury 101 , 02-089 Warsaw , Poland
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7
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Sonett J, Goldklang M, Sklepkiewicz P, Gerber A, Trischler J, Zelonina T, Westerterp M, Lemaître V, Okada Y, D’Armiento J. A critical role for ABC transporters in persistent lung inflammation in the development of emphysema after smoke exposure. FASEB J 2018; 32:fj201701381. [PMID: 29906247 PMCID: PMC6219826 DOI: 10.1096/fj.201701381] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 06/04/2018] [Indexed: 01/13/2023]
Abstract
Macrophage infiltration is common to both emphysema and atherosclerosis, and cigarette smoke down-regulates the macrophage cholesterol efflux transporter ATP binding cassette (ABC)A1. This decreased cholesterol efflux results in lipid-laden macrophages. We hypothesize that cigarette smoke adversely affects cholesterol transport via an ABCA1-dependent mechanism in macrophages, enhancing TLR4/myeloid differentiation primary response gene 88 (Myd88) signaling and resulting in matrix metalloproteinase (MMP) up-regulation and exacerbation of pulmonary inflammation. ABCA1 is significantly down-regulated in the lung upon smoke exposure conditions. Macrophages exposed to cigarette smoke in vivo and in vitro exhibit impaired cholesterol efflux correlating with significantly decreased ABCA1 expression, up-regulation of the TLR4/Myd88 pathway, and downstream MMP-9 and MMP-13 expression. Treatment with liver X receptor (LXR) agonist restores ABCA1 expression after short-term smoke exposure and attenuates the inflammatory response; after long-term smoke exposure, there is also attenuated physiologic and morphologic changes of emphysema. In vitro, treatment with LXR agonist decreases macrophage inflammatory activation in wild-type but not ABCA1 knockout mice, suggesting an ABCA1-dependent mechanism of action. These studies demonstrate an important association between cigarette smoke exposure and cholesterol-mediated pathways in the macrophage inflammatory response. Modulation of these pathways through manipulation of ABCA1 activity effectively blocks cigarette smoke-induced inflammation and provides a potential novel therapeutic approach for the treatment of chronic obstructive pulmonary disease.-Sonett, J., Goldklang, M., Sklepkiewicz, P., Gerber, A., Trischler, J., Zelonina, T., Westerterp, M., Lemaître, V., Okada, V., D'Armiento, J. A critical role for ABC transporters in persistent lung inflammation in the development of emphysema after smoke exposure.
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Affiliation(s)
- Jarrod Sonett
- Department of Anesthesiology, Center for Molecular Pulmonary Disease, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Monica Goldklang
- Department of Anesthesiology, Center for Molecular Pulmonary Disease, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Piotr Sklepkiewicz
- Department of Anesthesiology, Center for Molecular Pulmonary Disease, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Adam Gerber
- Department of Anesthesiology, Center for Molecular Pulmonary Disease, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Jordis Trischler
- Department of Anesthesiology, Center for Molecular Pulmonary Disease, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Tina Zelonina
- Department of Anesthesiology, Center for Molecular Pulmonary Disease, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Marit Westerterp
- Division of Molecular Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Pediatrics, Section of Molecular Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vincent Lemaître
- Department of Anesthesiology, Center for Molecular Pulmonary Disease, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Yasunori Okada
- Department of Pathophysiology for Locomotive and Neoplastic Diseases, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jeanine D’Armiento
- Department of Anesthesiology, Center for Molecular Pulmonary Disease, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Sklepkiewicz P, Shiomi T, Kaur R, Sun J, Kwon S, Mercer B, Bodine P, Schermuly RT, George I, Schulze PC, D'Armiento JM. Loss of secreted frizzled-related protein-1 leads to deterioration of cardiac function in mice and plays a role in human cardiomyopathy. Circ Heart Fail 2015; 8:362-72. [PMID: 25669938 DOI: 10.1161/circheartfailure.114.001274] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The Wnt/β-catenin signaling pathway plays a central role during cardiac development and has been implicated in cardiac remodeling and aging. However, the role of Wnt modulators in this process is unknown. In this study, we examined the role of the Wnt signaling inhibitor secreted frizzled-related protein-1 (sFRP-1) in aged wild-type and sFRP-1-deficient mice. METHODS AND RESULTS sFRP-1 gene deletion mice were grossly normal with no difference in mortality but developed abnormal cardiac structure and dysfunction with progressive age. Ventricular dilation and hypertrophy in addition to deterioration of cardiac function and massive cardiac fibrosis, all features present in dilated cardiomyopathy, were observed in the aged sFRP-1 knockout mice. Loss of sFRP-1 led to increased expression of Wnt ligands (Wnt1, 3, 7b, and 16) and Wnt target genes (Wisp1 and Lef1) in aged hearts, which correlated with increased protein levels of β-catenin. Cardiac fibroblasts lacking endogenous sFRP-1 showed increased α-smooth muscle actin expression, higher cell proliferation rates, and increased collagen production consistent with the cardiac phenotype exhibited in aged sFRP-1 knockout mice. The clinical relevance of these findings was supported by the demonstration of decreased sFRP-1 gene expression and increased Wisp-1 levels in the left ventricles of patients with ischemic dilated cardiomyopathy and dilated cardiomyopathy. CONCLUSIONS This study identifies a novel role of sFRP-1 in age-related cardiac deterioration and fibrosis. Further exploration of this pathway will identify downstream molecules important in these processes and also suggest the potential use of Wnt signaling agents as therapeutic targets for age-related cardiovascular disorders in humans.
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Affiliation(s)
- Piotr Sklepkiewicz
- From the Center for Molecular Pulmonary Disease, Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY (P.S., T.S., R.K., J.S., S.K., B.M., J.M.D.); Women's Health Research Institute, Department of Osteoporosis, Wyeth Research, Collegeville, PA (P.B.); Max Planck Institute, Department of Pathophysiology and Pulmonary, Bad Nauheim, Germany (R.T.S.); Center for Advanced Cardiac Care, Columbia University Medical Center, New York, NY (C.S.); and Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY (I.G.)
| | - Takayuki Shiomi
- From the Center for Molecular Pulmonary Disease, Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY (P.S., T.S., R.K., J.S., S.K., B.M., J.M.D.); Women's Health Research Institute, Department of Osteoporosis, Wyeth Research, Collegeville, PA (P.B.); Max Planck Institute, Department of Pathophysiology and Pulmonary, Bad Nauheim, Germany (R.T.S.); Center for Advanced Cardiac Care, Columbia University Medical Center, New York, NY (C.S.); and Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY (I.G.)
| | - Rajbir Kaur
- From the Center for Molecular Pulmonary Disease, Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY (P.S., T.S., R.K., J.S., S.K., B.M., J.M.D.); Women's Health Research Institute, Department of Osteoporosis, Wyeth Research, Collegeville, PA (P.B.); Max Planck Institute, Department of Pathophysiology and Pulmonary, Bad Nauheim, Germany (R.T.S.); Center for Advanced Cardiac Care, Columbia University Medical Center, New York, NY (C.S.); and Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY (I.G.)
| | - Jie Sun
- From the Center for Molecular Pulmonary Disease, Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY (P.S., T.S., R.K., J.S., S.K., B.M., J.M.D.); Women's Health Research Institute, Department of Osteoporosis, Wyeth Research, Collegeville, PA (P.B.); Max Planck Institute, Department of Pathophysiology and Pulmonary, Bad Nauheim, Germany (R.T.S.); Center for Advanced Cardiac Care, Columbia University Medical Center, New York, NY (C.S.); and Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY (I.G.)
| | - Susan Kwon
- From the Center for Molecular Pulmonary Disease, Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY (P.S., T.S., R.K., J.S., S.K., B.M., J.M.D.); Women's Health Research Institute, Department of Osteoporosis, Wyeth Research, Collegeville, PA (P.B.); Max Planck Institute, Department of Pathophysiology and Pulmonary, Bad Nauheim, Germany (R.T.S.); Center for Advanced Cardiac Care, Columbia University Medical Center, New York, NY (C.S.); and Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY (I.G.)
| | - Becky Mercer
- From the Center for Molecular Pulmonary Disease, Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY (P.S., T.S., R.K., J.S., S.K., B.M., J.M.D.); Women's Health Research Institute, Department of Osteoporosis, Wyeth Research, Collegeville, PA (P.B.); Max Planck Institute, Department of Pathophysiology and Pulmonary, Bad Nauheim, Germany (R.T.S.); Center for Advanced Cardiac Care, Columbia University Medical Center, New York, NY (C.S.); and Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY (I.G.)
| | - Peter Bodine
- From the Center for Molecular Pulmonary Disease, Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY (P.S., T.S., R.K., J.S., S.K., B.M., J.M.D.); Women's Health Research Institute, Department of Osteoporosis, Wyeth Research, Collegeville, PA (P.B.); Max Planck Institute, Department of Pathophysiology and Pulmonary, Bad Nauheim, Germany (R.T.S.); Center for Advanced Cardiac Care, Columbia University Medical Center, New York, NY (C.S.); and Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY (I.G.)
| | - Ralph Theo Schermuly
- From the Center for Molecular Pulmonary Disease, Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY (P.S., T.S., R.K., J.S., S.K., B.M., J.M.D.); Women's Health Research Institute, Department of Osteoporosis, Wyeth Research, Collegeville, PA (P.B.); Max Planck Institute, Department of Pathophysiology and Pulmonary, Bad Nauheim, Germany (R.T.S.); Center for Advanced Cardiac Care, Columbia University Medical Center, New York, NY (C.S.); and Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY (I.G.)
| | - Isaac George
- From the Center for Molecular Pulmonary Disease, Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY (P.S., T.S., R.K., J.S., S.K., B.M., J.M.D.); Women's Health Research Institute, Department of Osteoporosis, Wyeth Research, Collegeville, PA (P.B.); Max Planck Institute, Department of Pathophysiology and Pulmonary, Bad Nauheim, Germany (R.T.S.); Center for Advanced Cardiac Care, Columbia University Medical Center, New York, NY (C.S.); and Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY (I.G.)
| | - P Christian Schulze
- From the Center for Molecular Pulmonary Disease, Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY (P.S., T.S., R.K., J.S., S.K., B.M., J.M.D.); Women's Health Research Institute, Department of Osteoporosis, Wyeth Research, Collegeville, PA (P.B.); Max Planck Institute, Department of Pathophysiology and Pulmonary, Bad Nauheim, Germany (R.T.S.); Center for Advanced Cardiac Care, Columbia University Medical Center, New York, NY (C.S.); and Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY (I.G.)
| | - Jeanine M D'Armiento
- From the Center for Molecular Pulmonary Disease, Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY (P.S., T.S., R.K., J.S., S.K., B.M., J.M.D.); Women's Health Research Institute, Department of Osteoporosis, Wyeth Research, Collegeville, PA (P.B.); Max Planck Institute, Department of Pathophysiology and Pulmonary, Bad Nauheim, Germany (R.T.S.); Center for Advanced Cardiac Care, Columbia University Medical Center, New York, NY (C.S.); and Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY (I.G.).
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Shiomi T, Sklepkiewicz P, Bodine PVN, D'Armiento JM. Maintenance of the bronchial alveolar stem cells in an undifferentiated state by secreted frizzled-related protein 1. FASEB J 2014; 28:5242-9. [PMID: 25212222 DOI: 10.1096/fj.13-242735] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Bronchoalveolar stem cells (BASCs) are mobilized during injury and identified as lung progenitor cells, but the molecular regulation of this population of cells has not been elucidated. Secreted frizzled-related protein 1 (SFRP1) is a critical molecule involved in alveolar duct formation in the lung and here we demonstrate its importance in controlling cell differentiation during lung injury. Mice lacking SFRP1 exhibited a rapid repair response leading to aberrant proliferation of differentiated cells. Furthermore, SFRP1 treatment of BASCs maintained these cells in a quiescent state. In vivo overexpression of SFRP1 after injury suppressed differentiation and resulted in the accumulation of BASCs correlating with in vitro studies. These findings suggest that SFRP1 expression in the adult maintains progenitor cells within their undifferentiated state and suggests that manipulation of this pathway is a potential target to augment the lung repair process during disease.
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Affiliation(s)
- Takayuki Shiomi
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York, USA; and
| | - Piotr Sklepkiewicz
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York, USA; and
| | | | - Jeanine M D'Armiento
- Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York, USA; and
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Sklepkiewicz P, Schermuly RT, Tian X, Ghofrani HA, Weissmann N, Sedding D, Kashour T, Seeger W, Grimminger F, Pullamsetti SS. Glycogen synthase kinase 3beta contributes to proliferation of arterial smooth muscle cells in pulmonary hypertension. PLoS One 2011; 6:e18883. [PMID: 21533110 PMCID: PMC3078925 DOI: 10.1371/journal.pone.0018883] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 03/24/2011] [Indexed: 01/17/2023] Open
Abstract
Rationale Pulmonary arterial hypertension (PAH) is a rare progressive pulmonary vascular disorder associated with vascular remodeling and right heart failure. Vascular remodeling involves numerous signaling cascades governing pulmonary arterial smooth muscle cell (PASMC) proliferation, migration and differentiation. Glycogen synthase kinase 3beta (GSK3ß) is a serine/threonine kinase and can act as a downstream regulatory switch for numerous signaling pathways. Hence, we hypothesized that GSK3ß plays a crucial role in pulmonary vascular remodeling. Methods All experiments were done with lung tissue or isolated PASMCs in a well-established monocrotaline (MCT)-induced PAH rat model. The mRNA expression of Wnt ligands (Wnt1, Wnt3a, Wnt5a), upstream Wnt signaling regulator genes (Frizzled Receptors 1, 2 and secreted Frizzled related protein sFRP-1) and canonical Wnt intracellular effectors (GSK3ß, Axin1) were assessed by real-time polymerase chain reaction and protein levels of GSK3ß, phospho-GSK3ß (ser 9) by western blotting and localization by immunohistochemistry. The role of GSK3ß in PASMCs proliferation was assessed by overexpression of wild-type GSK3ß (WT) and constitutively active GSK3ß S9A by [3H]-thymidine incorporation assay. Results Increased levels of total and phosphorylated GSK3ß (inhibitory phosphorylation) were observed in lungs and PASMCs isolated from MCT-induced PAH rats compared to controls. Further, stimulation of MCT-PASMCs with growth factors induced GSK3ß inactivation. Most importantly, treatment with the PDGFR inhibitor, Imatinib, attenuated PDGF-BB and FCS induced GSK3ß phosphorylation. Increased expression of GSK3ß observed in lungs and PASMC isolated from MCT-induced PAH rats was confirmed to be clinically relevant as the same observation was identified in human iPAH lung explants. Overexpression of GSK3ß significantly increased MCT-PASMCs proliferation by regulating ERK phosphorylation. Constitutive activation of GSK3ß (GSK3ß S9A, 9th serine replaced to alanine) inhibited MCT-PASMCs proliferation by decreasing ERK phosphorylation. Conclusion This study supports a central role for GSK3ß in vascular remodeling processes and suggests a novel therapeutic opportunity for the treatment of PAH.
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MESH Headings
- Animals
- Arteries/enzymology
- Arteries/pathology
- Base Sequence
- Blotting, Western
- Cell Proliferation
- Cells, Cultured
- Cloning, Molecular
- DNA Primers
- Disease Models, Animal
- Glycogen Synthase Kinase 3/genetics
- Glycogen Synthase Kinase 3/metabolism
- Glycogen Synthase Kinase 3 beta
- Humans
- Hypertension, Pulmonary/enzymology
- Hypertension, Pulmonary/pathology
- Immunohistochemistry
- Male
- Muscle, Smooth, Vascular/enzymology
- Muscle, Smooth, Vascular/pathology
- Mutagenesis
- Phosphorylation
- Polymerase Chain Reaction
- Rats
- Wnt Proteins/metabolism
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Affiliation(s)
| | - Ralph Theo Schermuly
- Medical Clinic II/V, University Hospital, Giessen, Germany
- Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Xia Tian
- Medical Clinic II/V, University Hospital, Giessen, Germany
| | | | | | | | | | - Werner Seeger
- Medical Clinic II/V, University Hospital, Giessen, Germany
- Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
| | | | - Soni Savai Pullamsetti
- Medical Clinic II/V, University Hospital, Giessen, Germany
- Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
- * E-mail:
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11
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Foronjy R, Imai K, Shiomi T, Mercer B, Sklepkiewicz P, Thankachen J, Bodine P, D'Armiento J. The divergent roles of secreted frizzled related protein-1 (SFRP1) in lung morphogenesis and emphysema. Am J Pathol 2010; 177:598-607. [PMID: 20595636 PMCID: PMC2913334 DOI: 10.2353/ajpath.2010.090803] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/13/2010] [Indexed: 11/20/2022]
Abstract
Developmentally expressed genes are believed to play a central role in tissue repair after injury; however, in lung disease their role has not been established. This study demonstrates that SFRP1, an inhibitor of Wnt signaling normally expressed during lung embryogenesis, is induced in the lungs of emphysema patients and in two murine models of the disease. SFRP1 was found to be essential for alveolar formation as Sfrp1(-/-) mice exhibited aberrant Wnt signaling, mesenchymal proliferation, and impaired alveoli formation. In contrast, SFRP1 activated ERK and up-regulated MMP1 and MMP9 without altering TIMP1 production when expressed in human lung epithelial cells. These findings demonstrate that SFRP1 promotes normal alveolar formation in lung development, although its expression in the adult up-regulates proteins that can cause tissue destruction. Thus, SFRP1 induction during tissue injury is unlikely to contribute to the repair response but rather is a participatory factor in the pathogenesis of emphysema and tissue destruction.
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Affiliation(s)
- Robert Foronjy
- Department of Medicine, Columbia University, New York, New York, USA
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