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Kimura N, Futamura K, Arakawa M, Okada N, Emrich F, Okamura H, Sato T, Shudo Y, Koyano TK, Yamaguchi A, Adachi H, Matsuda A, Kawahito K, Matsumoto K, Fischbein MP. Gene expression profiling of acute type A aortic dissection combined with in vitro assessment. Eur J Cardiothorac Surg 2018; 52:810-817. [PMID: 28402522 DOI: 10.1093/ejcts/ezx095] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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] [Received: 09/05/2016] [Accepted: 02/26/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The mechanisms underlying aortic dissection remain to be fully elucidated. We aimed to identify key molecules driving dissection through gene expression profiling achieved by microarray analysis and subsequent in vitro experiments using human aortic endothelial cells (HAECs) and aortic vascular smooth muscle cells (AoSMCs). METHODS Total RNA, including microRNA (miRNA), was isolated from the intima-media layer of dissected ascending aorta obtained intraoperatively from acute type A aortic dissection (ATAAD) patients without familial thoracic aortic disease (n = 8) and that of non-dissected ascending aorta obtained from transplant donors (n = 9). Gene expression profiling was performed with mRNA and miRNA microarrays, and results were confirmed by quantitative polymerase chain reaction (qPCR). Target genes and miRNA were identified by gene ontology analysis and a literature search. To reproduce the in silico results, HAECs and AoSMCs were stimulated in vitro by upstream cytokines, and expression of target genes was assessed by qPCR. RESULTS Microarray analysis revealed 1536 genes (3.6%, 1536/42 545 probes) and 41 miRNAs (3.0%, 41/1368 probes) that were differentially expressed in the ATAAD group (versus donor group). The top 15 related pathways included regulation of inflammatory response, growth factor activity and extracellular matrix. Gene ontology analysis identified JAK2 (regulation of inflammatory response), PDGFA, TGFB1, VEGFA (growth factor activity) and TIMP3, TIMP4, SERPINE1 (extracellular matrix) as the target genes and miR-21-5p, a TIMP3 repressor, as target miRNA that interacts with the target genes. Validation qPCR confirmed the altered expression of all 7 target genes and miR-21-5p in dissected aorta specimens (all genes, P < 0.05). Ingenuity pathway analysis showed TNF-α and TGF-β to be upstream cytokines for the target genes. In vitro experiments showed these cytokines inhibit TIMP3 expression (P < 0.05) and enhance VEGFA expression (P < 0.01) in AoSMCs but not HAECs. miR-21-5p expression increases in AoSMCs under TNF-α and TGF-β stimulation (fold change: 1.36; P = 0.011). CONCLUSIONS Results of our novel approach, integrating in vitro assessment into gene expression profiling, implicated chronic inflammation characterized by MMP-TIMP dysregulation, increased VEGFA expression, and TGF-β signalling in the development of dissection. Further investigation may reveal novel diagnostic biomarkers and uncover the mechanism(s) underlying ATAAD.
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Affiliation(s)
- Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kyoko Futamura
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Mamoru Arakawa
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, CA, USA
| | - Naoko Okada
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Fabian Emrich
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, CA, USA
| | - Homare Okamura
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, CA, USA
| | - Tetsuya Sato
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, CA, USA
| | - Yasuhiro Shudo
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, CA, USA
| | - Tiffany K Koyano
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, CA, USA
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Adachi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Akio Matsuda
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Koji Kawahito
- Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Kenji Matsumoto
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, CA, USA
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Emrich FC, Okamura H, Dalal AR, Penov K, Merk DR, Raaz U, Hennigs JK, Chin JT, Miller MO, Pedroza AJ, Craig JK, Koyano TK, Blankenberg FG, Connolly AJ, Mohr FW, Alvira CM, Rabinovitch M, Fischbein MP. Enhanced Caspase Activity Contributes to Aortic Wall Remodeling and Early Aneurysm Development in a Murine Model of Marfan Syndrome. Arterioscler Thromb Vasc Biol 2015; 35:146-54. [DOI: 10.1161/atvbaha.114.304364] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective—
Rupture and dissection of aortic root aneurysms remain the leading causes of death in patients with the Marfan syndrome, a hereditary connective tissue disorder that affects 1 in 5000 individuals worldwide. In the present study, we use a Marfan mouse model (
Fbn1
C1039G/+
) to investigate the biological importance of apoptosis during aneurysm development in Marfan syndrome.
Approach and Results—
Using in vivo single-photon emission computed tomographic-imaging and ex vivo autoradiography for Tc99m-annexin, we discovered increased apoptosis in the
Fbn1
C1039G/+
ascending aorta during early aneurysm development peaking at 4 weeks. Immunofluorescence colocalization studies identified smooth muscle cells (SMCs) as the apoptotic cell population. As biological proof of concept that early aortic wall apoptosis plays a role in aneurysm development in Marfan syndrome,
Fbn1
C1039G/+
mice were treated daily from 2 to 6 weeks with either (1) a pan-caspase inhibitor, Q-V
D
-OPh (20 mg/kg), or (2) vehicle control intraperitoneally. Q-V
D
-OPh treatment led to a significant reduction in aneurysm size and decreased extracellular matrix degradation in the aortic wall compared with control mice. In vitro studies using
Fbn1
C1039G/+
ascending SMCs showed that apoptotic SMCs have increased elastolytic potential compared with viable cells, mostly because of caspase activity. Moreover, in vitro (1) cell membrane isolation, (2) immunofluorescence staining, and (3) scanning electron microscopy studies illustrate that caspases are expressed on the exterior cell surface of apoptotic SMCs.
Conclusions—
Caspase inhibition attenuates aneurysm development in an
Fbn1
C1039G/+
Marfan mouse model. Mechanistically, during apoptosis, caspases are expressed on the cell surface of SMCs and likely contribute to elastin degradation and aneurysm development in Marfan syndrome.
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Affiliation(s)
- Fabian C. Emrich
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Homare Okamura
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Alex R. Dalal
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Kiril Penov
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Denis R. Merk
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Uwe Raaz
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Jan K. Hennigs
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Jocelyn T. Chin
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Miquell O. Miller
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Albert J. Pedroza
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Juliana K. Craig
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Tiffany K. Koyano
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Francis G. Blankenberg
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Andrew J. Connolly
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Friedrich W. Mohr
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Cristina M. Alvira
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Marlene Rabinovitch
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Michael P. Fischbein
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
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