Osteoprotegerin Disruption Attenuates HySu-Induced Pulmonary Hypertension Through Integrin αvβ3/FAK/AKT Pathway SuppressionCLINICAL PERSPECTIVE by Daile.

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Osteoprotegerin Disruption Attenuates HySu-Induced Pulmonary Hypertension Through Integrin αvβ3/FAK/AKT Pathway SuppressionCLINICAL PERSPECTIVE by Daile Jia, Qian Zhu, Huan Liu, Caojian Zuo, Yuhu He, Guilin Chen, and Ankang Lu Circ Genom Precis Med Volume 10(1):e001591 January 11, 2017 Copyright © American Heart Association, Inc. All rights reserved.

Osteoprotegerin (OPG) serum levels in patients with pulmonary arterial hypertension (PAH). Osteoprotegerin (OPG) serum levels in patients with pulmonary arterial hypertension (PAH). A, Polymerse chain reaction products were verified by electrophoresis. B, OPG expression was increased in patients with PAH (n=31) compared with control patients (n=45). C, Positive correlation between serum OPG and mean pulmonary arterial pressure (mPAP) in patients with PAH (n=31). D, OPG levels in patients with World Health Organization (WHO) functional classification III and IV (n=18) are higher than those with I and II (n=13). E, OPG levels in patients with 6-minute walking test (6MWT) ≤440 m (n=22) are higher than those with 6MWT >440 m (n=9). F, 6MWT in patients with PAH pre- and post-treatment (n=14). G, Serum OPG levels in patients with PAH pre- and post-treatment (n=14). Data are presented as the means±SEM. *P<0.05, **P<0.01, ***P<0.001 vs controls. Daile Jia et al. Circ Cardiovasc Genet. 2017;10:e001591 Copyright © American Heart Association, Inc. All rights reserved.

Osteoprotegerin (OPG) is upregulated in vivo and in vitro. Osteoprotegerin (OPG) is upregulated in vivo and in vitro. A, Relative OPG mRNA expression in lung tissues and pulmonary arteries exposed to normoxia or HySu (hypoxia+SU5416; n=6). B, Relative OPG mRNA expression in murine and human pulmonary arterial smooth muscle cells exposed to normoxia or hypoxia (1% O2) for 24 hours (n=6). C and D, Immunofluorescence staining of α-smooth muscle actin (α-SMA; green), OPG (red), and nuclei (4′,6-diamidino-2-phenylindole, blue). Scale bars, 20 μm. E, Serum OPG levels were measured in control and HySu mice (n=8). F–G, Correlation between OPG and right ventricular systolic pressure (RVSP) and ratio of the right ventricular wall to the left ventricular wall plus the septum (RV/LV+S) in HySu-induced pulmonary arterial hypertension mice(n=8). Data are presented as the means±SEM. *P<0.05 vs normoxia. MCT indicates monocrotaline. Daile Jia et al. Circ Cardiovasc Genet. 2017;10:e001591 Copyright © American Heart Association, Inc. All rights reserved.

Osteoprotegerin (OPG) disruption attenuates hypoxia plus SU5416 (HySu)–induced pulmonary arterial hypertension development in model mice. Osteoprotegerin (OPG) disruption attenuates hypoxia plus SU5416 (HySu)–induced pulmonary arterial hypertension development in model mice. A, RVSP and (B) right ventricular wall to the left ventricular wall plus the septum in wild-type (WT) and OPG−/− mice after HySu treatment. C, The degree of muscularization (nonmuscularized, partially muscularized, and fully muscularized vessels, 20–70 μm in diameter) of small pulmonary vessels from HySu-induced mice. D, Representative hematoxylin and eosin staining and α-smooth muscle actin (α-SMA; green) immunostaining of lung sections from HySu-induced WT and OPG−/− mice. Scale bar, 20 μm. E, Quantification of the ratio of medial area to cross-sectional area (ie, Medial/cross-sectional area) in HySu-induced model mice. Data are presented as the means±SEM (n=8).*P<0.05 vs WT and #P<0.05 vs control. Daile Jia et al. Circ Cardiovasc Genet. 2017;10:e001591 Copyright © American Heart Association, Inc. All rights reserved.

Osteoprotegerin (OPG)-related pulmonary arterial smooth muscle cell (PASMC) proliferation in vivo and in vitro. Osteoprotegerin (OPG)-related pulmonary arterial smooth muscle cell (PASMC) proliferation in vivo and in vitro. A, Representative confocal images of proliferating cell nuclear antigen (PCNA; red) and α-smooth muscle actin (α-SMA; green) in the lungs of hypoxia plus SU5416 (HySu)–induced pulmonary arterial hypertension (PAH) mice. Scale bars, 20 μm. B, PCNA-expressing cells in pulmonary arteries. Quantification of vascular PCNA+ cells in A. At least 10 fields/mouse were selected for calculation (n=8). Values are expressed as a percentage relative to wild-type (WT) pulmonary arteries (Pas). C, Quantification of α-SMA+ cells in PAs from HySu-induced PAH mice from at least 10 fields/mouse (n=6). Data are presented as the means±SEM. *P<0.05 vs WT and #P<0.05 vs normoxia. D, Effect of recombinant OPG (rOPG) on murine PASMC (mPASMC) proliferation (n=5). E, Effect of rOPG on human PASMC (hPASMC) proliferation (n=5). Data are presented as the means±SEM. *P<0.05 vs vehicle. F, Effect of OPG disruption on the proliferation of hypoxic (Hy) and normoxic (Nr) mPASMCs (n=6). Data are presented as the means±SEM.*P<0.05 vs normoxia and #P<0.05 vs WT. Daile Jia et al. Circ Cardiovasc Genet. 2017;10:e001591 Copyright © American Heart Association, Inc. All rights reserved.

Osteoprotegerin (OPG) reconstitution in lung tissues exacerbates hypoxia plus SU5416 (HySu)–induced pulmonary arterial hypertension (PAH) in OPG−/− mice. Osteoprotegerin (OPG) reconstitution in lung tissues exacerbates hypoxia plus SU5416 (HySu)–induced pulmonary arterial hypertension (PAH) in OPG−/− mice. A, OPG−/− mice were transduced with OPG-expressing lentivirus before HySu treatment. Transfection efficiency was assessed by immunostaining for α-smooth muscle actin (α-SMA; green) and OPG (red). Scale bars, 50 μm. B, OPG mRNA expression in lung tissues after lentivirus transfection (n=8). Data are presented as the means±SEM. **P<0.01 vs GFP control (lenti-GFP). C, Right ventricular systolic pressure (RVSP) and (D) right ventricular wall to the left ventricular wall plus the septum (RV/LV+S) in lenti-OPG and lenti-GFP–transfected mice after HySu treatment (n=8). E, Representative hematoxylin and eosin staining and α-SMA (green) immunostaining of lung sections from lenti-green fluorescent protein and lenti-OPG–transfected mice after HySu treatment. Scale bar, 20 μm. F, Quantification of the ratio of vascular medial thickness to total vessel size (ie, Medial/cross-sectional area) in HySu-induced model mice (n=8). G, The degree of muscularization (nonmuscularized, partially muscularized, and fully muscularized vessels, 20–70 μm in diameter) of small pulmonary vessels from HySu-induced mice (n=8). H, Representative confocal images of proliferating cell nuclear antigen (PCNA; red) and α-smooth muscle actin (α-SMA; green) staining in lungs from HySu-induced PAH mice. Scale bars, 20 μm. I, PCNA-expressing cells in pulmonary arteries. H, Quantification of vascular PCNA+ cells in I. At least 10 fields/mouse were selected for calculation (n=8). Values are expressed as a percentage relative to lenti-GFP pulmonary arteries (PAs). Data are presented as the means±SEM.*P<0.05 vs lenti-GFP. Daile Jia et al. Circ Cardiovasc Genet. 2017;10:e001591 Copyright © American Heart Association, Inc. All rights reserved.

Osteoprotegerin (OPG) disruption suppresses integrin αvβ3/FAK/AKT signaling in hypoxia-treated pulmonary arterial smooth muscle cells (PASMCs).A, Relative integrin mRNA expression in primary murine PASMCs (mPASMCs) exposed to 1% O2 (n=6). Osteoprotegerin (OPG) disruption suppresses integrin αvβ3/FAK/AKT signaling in hypoxia-treated pulmonary arterial smooth muscle cells (PASMCs).A, Relative integrin mRNA expression in primary murine PASMCs (mPASMCs) exposed to 1% O2 (n=6). B, Relative integrin mRNA levels in pulmonary arteries from hypoxia plus SU5416–treated mice (n=6). Data are presented as the means±SEM.*P<0.05 vs normoxia and **P<0.01 vs normoxia. C, Lysates from mPASMCs under normoxia and hypoxia were immunoprecipitated with anti-OPG antibody. Immunoprecipitates were subjected to Western blot analysis for α1, α8, αv, and β3. D, Western blot analysis of phosphorylated (p-)FAK, AKT, and extracellular signal–regulated kinase (ERK) in normoxic and hypoxic OPG–/– and wild-type (WT) PASMCs. E, Quantification of p-FAK, p-AKT, and p-ERK bands in D was done by densitometry and controlled with focal adhesion kinase (FAK), AKT, and ERK, respectively. Protein levels are expressed as fold change over normoxic WT (n=4). Data are presented as the means±SEM.*P<0.05 vs WT and #P<0.05 vs normoxic controls. Daile Jia et al. Circ Cardiovasc Genet. 2017;10:e001591 Copyright © American Heart Association, Inc. All rights reserved.

Knockdown of αvβ3, focal adhesion kinase (FAK), or AKT attenuates osteoprotegerin (OPG)-induced pulmonary arterial smooth muscle cell (PASMC) proliferation. Knockdown of αvβ3, focal adhesion kinase (FAK), or AKT attenuates osteoprotegerin (OPG)-induced pulmonary arterial smooth muscle cell (PASMC) proliferation. A, Effect of αvβ3 knockdown on mRNA levels of αv and β3 in PASMCs (n=6). Data are presented as the means±SEM. *P<0.05 vs scramble. B, Effect of αvβ3 knockdown on FAK/AKT signaling in OPG-stimulated PASMCs. C, Quantification of p-FAK and p-AKT bands in B was done by densitometry and controlled with FAK and AKT, respectively. Data are presented as the means±SEM. Protein levels are expressed as fold change over control (n=4). *P<0.05 vs scramble and #P<0.05 vs control. D, Effect of αvβ3 knockdown on PASMC proliferation after OPG stimulation. PASMCs were transfected with αvβ3 siRNA or scramble and then incubated with OPG (50 ng/mL) for 48 hours, after which cell proliferation were determined (n=6). Data are presented as the means±SEM. *P<0.05 vs scramble and #P<0.05 vs control. E, Western blot analysis of OPG-induced FAK and AKT phosphorylation in OPG−/− PASMCs. F, Quantification of p-FAK and p-AKT bands in E was done by densitometry and controlled with FAK and AKT, respectively. Protein levels are expressed as fold change over control (n=4). #P<0.05 vs control. G, Effect of FAK knockdown on PASMC proliferation after OPG stimulation (n=6). PASMCs were transfected with FAK siRNA or scramble and then incubated with OPG (50 ng/mL) for 48 hours, after which cell proliferation were determined. H, Inhibition of AKT on the proliferation of PASMCs after OPG stimulation (n=6). PASMCs were incubated with OPG (50 ng/mL) in the absence and presence of triciribine (10 μmol/L). Data are presented as the means±SEM. *P<0.05 vs scramble and #P<0.05 vs control. Daile Jia et al. Circ Cardiovasc Genet. 2017;10:e001591 Copyright © American Heart Association, Inc. All rights reserved.