Christos E. Chadjichristos

Connexin37 protects against atherosclerosis by regulating monocyte adhesion

A genetic polymorphism in the human gene encoding connexin37 (CX37, encoded by GJA4, also known as CX37) has been reported as a potential prognostic marker for atherosclerosis. The expression of this gap-junction protein is altered in mouse and human atherosclerotic lesions: it disappears from the endothelium of advanced plaques but is detected in macrophages recruited to the lesions. The role of CX37 in atherogenesis, however, remains unknown. Here we have investigated the effect of deleting the mouse connexin37 (Cx37) gene (Gja4, also known as Cx37) on atherosclerosis in apolipoprotein E–deficient (Apoe−/−) mice, an animal model of this disease. We find that Gja4−/−Apoe−/− mice develop more aortic lesions than Gja4+/+Apoe−/− mice that express Cx37. Using in vivo adoptive transfer, we show that monocyte and macrophage recruitment is enhanced by eliminating expression of Cx37 in these leukocytes but not by eliminating its expression in the endothelium. We further show that Cx37 hemichannel activity in primary monocytes, macrophages and a macrophage cell line (H36.12j) inhibits leukocyte adhesion. This antiadhesive effect is mediated by release of ATP into the extracellular space. Thus, Cx37 hemichannels may control initiation of the development of atherosclerotic plaques by regulating monocyte adhesion. H36.12j macrophages expressing either of the two CX37 proteins encoded by a polymorphism in the human GJA4 gene show differential ATP-dependent adhesion. These results provide a potential mechanism by which a polymorphism in CX37 protects against atherosclerosis.

Endothelial-Specific Deletion of Connexin40 Promotes Atherosclerosis by Increasing CD73-Dependent Leukocyte Adhesion

Background— Endothelial dysfunction is the initiating event of atherosclerosis. The expression of connexin40 (Cx40), an endothelial gap junction protein, is decreased during atherogenesis. In the present report, we sought to determine whether Cx40 contributes to the development of the disease. Methods and Results— Mice with ubiquitous deletion of Cx40 are hypertensive, a risk factor for atherosclerosis. Consequently, we generated atherosclerosis-susceptible mice with endothelial-specific deletion of Cx40 (Cx40del mice). Cx40del mice were indeed not hypertensive. The progression of atherosclerosis was increased in Cx40del mice after 5 and 10 weeks of a high-cholesterol diet, and spontaneous lesions were observed in the aortic sinuses of young mice without such a diet. These lesions showed monocyte infiltration into the intima, increased expression of vascular cell adhesion molecule-1, and decreased expression of the ecto-enzyme CD73 in the endothelium. The proinflammatory phenotype of Cx40del mice was confirmed in another model of induced leukocyte recruitment from the lung microcirculation. Endothelial CD73 is known to induce antiadhesion signaling via the production of adenosine. We found that reducing Cx40 expression in vitro with small interfering RNA or antisense decreased CD73 expression and activity and increased leukocyte adhesion to mouse endothelial cells. These effects were reversed by an adenosine receptor agonist. Conclusions— Cx40-mediated gap junctional communication contributes to a quiescent nonactivated endothelium by propagating adenosine-evoked antiinflammatory signals between endothelial cells. Alteration in this mechanism by targeting Cx40 promotes leukocyte adhesion to the endothelium, thus accelerating atherosclerosis.

Reduced Connexin43 Expression Limits Neointima Formation After Balloon Distension Injury in Hypercholesterolemic Mice

Background— Reducing the expression of the gap junction protein connexin43 (Cx43) inhibits the progression of atherosclerosis, a chronic inflammatory disease. Furthermore, acute vascular injury induced by percutaneous coronary interventions is associated with increased Cx43 expression in neointimal smooth muscle cells (SMCs). However, the relevance of Cx43 after acute vascular injury remains unclear. Methods and Results— To investigate whether reducing Cx43 expression would affect neointima formation in vivo, we subjected hypercholesterolemic Cx43+/− LDL receptor–deficient (LDLR−/−) mice and Cx43+/+LDLR−/− control littermates to carotid balloon distension injury, which induced marked endothelial denudation and activation of medial SMCs. We observed decreased macrophage infiltration in Cx43+/−LDLR−/− mice 7 days after injury. Similarly, peritoneal macrophages isolated from Cx43+/−LDLR−/− mice showed reduced migration in vitro compared with Cx43+/+LDLR−/− macrophages. Interestingly, Cx43+/−LDLR−/− macrophages also displayed decreased chemotactic activity for SMCs. In addition, we observed less SMC infiltration and proliferation in Cx43+/−LDLR−/− mice 7 and 14 days after balloon angioplasty. Likewise, Cx43+/−LDLR−/− SMCs showed decreased proliferation and migration in vitro compared with Cx43+/+LDLR−/− cells. All these events resulted in a reduction of neointimal thickening after vascular injury in Cx43+/−LDLR−/− mice. Conclusions— The present study shows for the first time that reducing Cx43 limits neointima formation after acute vascular injury by decreasing the inflammatory response and reducing SMC migration and proliferation. Thus, decreasing Cx43 expression may offer a novel therapeutic strategy for reducing restenosis after percutaneous coronary intervention.

Targeting Connexin 43 Prevents Platelet-Derived Growth Factor-BB–Induced Phenotypic Change in Porcine Coronary Artery Smooth Muscle Cells

We previously reported that reducing the expression of the gap junction protein connexin (Cx)43 in mice restricts intimal thickening formation after acute vascular injury by limiting the inflammatory response and the proliferation and migration of smooth muscle cells (SMCs) toward the damaged site. SMC populations isolated from porcine coronary artery exhibit distinct phenotypes: spindle-shaped (S) and rhomboid (R). S-SMCs are predominant in the normal media, whereas R-SMCs are recovered in higher proportion from stent-induced intimal thickening, suggesting that they participate in the restenotic process. Here, we further investigate the relationship between connexin expression and SMC phenotypes using porcine coronary artery SMCs. Cx40 was highly expressed in normal media of porcine coronary artery in vivo, whereas Cx43 was barely detectable. In contrast, Cx40 was downregulated and Cx43 was markedly upregulated in stent-induced intimal thickening. In vitro, S-SMCs expressed Cx40 and Cx43. In R-SMCs, Cx43 expression was increased and Cx40 was absent. We confirmed that S-SMCs treated with platelet-derived growth factor-BB acquire an R phenotype. This was accompanied by an upregulation of Cx43 and a loss of Cx40. Importantly, platelet-derived growth factor-BB–induced S-to-R phenotypic change was prevented by a reduction of Cx43 expression with antisense, ie, S-SMCs retained their typical elongated appearance and the expression of &agr;-smooth muscle actin, a well-known SMC differentiation marker, whereas the expression of S100A4, a typical marker of R-SMCs, was prevented. In conclusion, limiting Cx43 expression in S-SMCs prevents platelet-derived growth factor-BB–induced S-to-R modulation. This suggests that Cx43 may be an additional target for local delivery strategies aimed at reducing restenosis.

Role of Endogenous Fas (CD95/Apo-1) Ligand in Balloon-Induced Apoptosis, Inflammation, and Neointima Formation

Background— Fas (CD95/Apo-1) ligand (FasL)–induced apoptosis in Fas-bearing cells is critically involved in modulating immune reactions and tissue repair. Apoptosis has also been described after mechanical vascular injury such as percutaneous coronary intervention. However, the relevance of cell death in this context of vascular repair remains unknown. Methods and Results— To determine whether FasL-induced apoptosis is causally related to neointimal lesion formation, we subjected FasL-deficient (generalized lymphoproliferative disorder [gld], C57BL/6J) and corresponding wild-type (WT) mice to carotid balloon distension injury, which induces marked endothelial denudation and medial cell death. FasL expression in WT mice was induced in injured vessels compared with untreated arteries (P<0.05; n=5). Conversely, absence of functional FasL in gld mice decreased medial and intimal apoptosis (terminal deoxynucleotidyltransferase–mediated dUTP nick end labeling [TUNEL] index) at 1 hour and 7 days after balloon injury (P<0.05; n=6). In addition, peritoneal macrophages isolated from gld mice showed no apoptosis and enhanced migration (P<0.05; n=4). In parallel, we observed increased balloon-induced macrophage infiltrations (anti-CD68) in injured arteries of FasL-deficient animals (P<0.05; n=6). Together with enhanced proliferation (bromodeoxyuridine index; P<0.05), these events resulted in a further increase in medial and neointimal cells (P<0.01; n=8) with thickened neointima in gld mice (intima/media ratio, ×3.8 of WT; P<0.01). Conclusions— Our data identify proapoptotic and antiinflammatory effects of endogenous FasL as important factors in the process of neointimal lesion formation after balloon injury. Moreover, they suggest that activation of FasL may decrease neointimal thickening after percutaneous coronary intervention.

Connexins: New genes in atherosclerosis

Atherosclerosis, the main cause of death and disability in adult populations of industrialized societies, is a multifactorial progressive process involving a variety of pathogenic mechanisms. Our current view on the pathogenesis of the disease implies complex patterns of interactions between a dysfunctional endothelium, leukocytes, and activated smooth muscle cells in which cytokines and growth factors are known to play a crucial role. Apart from paracrine cell‐to‐cell signalling, a role for gap junction‐mediated intercellular communication in the development of the disease has been recently suggested. Gap junction channels result from the docking of two hemichannels or connexons, formed by the hexameric assembly of connexins, and directly connect the cytoplasm of adjacent cells. In this review, we summarize existing evidence implicating connexins in atherosclerosis. Indeed, the expression pattern of vascular connexins is altered during atherosclerotic plaque formation. In addition, changes in connexin expression or gap junctional communication have been observed in vascular cells in vitro by disturbances in blood flow, cholesterol, inflammatory cytokines, and growth factors. Furthermore, genetically modifying connexin expression affects the course of the atherosclerotic process in mouse models of the disease. Finally, the involvement of connexins in treatment of atherosclerotic disease will be discussed.

Connexins in atherosclerosis.

Remodeling of the vascular wall plays a central role in many physiological processes, but also in the pathogenesis of cardiovascular diseases such as atherosclerosis and restenosis. Atherosclerosis represents the major cause of death and disability in adult populations of Western societies. Angioplasty is a common and effective method of treatment for coronary atherosclerosis, but restenosis after the procedure continues to be a serious clinical complication. The development of atherosclerosis and restenosis involves complex patterns of interactions between the dysfunctional endothelium, inflammatory cells and smooth muscle cells in which cytokines and growth factors are known to play a critical role. Apart from paracrine cell-to-cell signaling, a role for gap-junction-mediated intercellular communication has recently been suggested. In this chapter, we summarize existing evidence supporting such a role. Thus, the pattern of vascular connexins is altered during atherosclerotic plaque formation and in restenosis. In addition, disturbances in flow, inflammation and smooth muscle cell activation and proliferation have been shown to affect connexin expression or gap junctional communication. Finally, genetically modified connexin expression alters the course of these diseases in mice. Further studies will tell us whether future treatment of atherosclerosis or restenosis may involve connexin-based strategies.

Molecular role of Cx37 in advanced atherosclerosis: A micro-array study

Recently, we showed that connexin37 (Cx37) protects against early atherosclerotic lesion development by regulating monocyte adhesion. The expression of this gap junction protein is altered in mouse and human atherosclerotic lesions; it is increased in macrophages newly recruited to the lesions and disappears from the endothelium of advanced plaques. To obtain more insight into the molecular role of Cx37 in advanced atherosclerosis, we used micro-array analysis for gene expression profiling in aortas of ApoE(-/-) and Cx37(-/-)ApoE(-/-) mice before and after 18 weeks of cholesterol-rich diet. Out of >15,000 genes, 106 genes were significantly differentially expressed in young mice before diet (P-value of <0.05, fold change of >0.7 or <-0.7, and intensity value >2.2 times background). Ingenuity pathway analysis (IPA) revealed differences in genes involved in cell-to-cell signaling and interaction, cellular compromise and nutritional disease. In addition, we identified 100 genes that were significantly perturbed after the cholesterol-rich diet. Similar to the analysis on 10-week-old mice, IPA revealed differences in genes involved in cell-to-cell signaling and interaction as well as to immuno-inflammatory disease. Furthermore, we found important changes in genes involved in vascular calcification and matrix degradation, some of which were confirmed at protein level by (immuno-)histochemistry. In conclusion, we suggest that Cx37 deficiency alters the global differential gene expression profiles in young mice towards a pro-inflammatory phenotype, which are then further influenced in advanced atherosclerosis. The results provide new insights into the significance of Cx37 in plaque calcification.

F001 Prominent role for the endothelial gap junction protein connexin40 in myocardial ischemia-reperfusion injury in mice

Intercellular channels formed by connexins (Cx) have been shown to play a critical role in cardiovascular disease. Indeed, connexin-deficient mice showed modifications in cell signalling, that appeared crucial in atherosclerosis and restenosis. In the heart, Cx40 is expressed in atrial myocytes, the conduction system and in endothelial cells. Here, we study the implication of endothelial Cx40 during ischemia and reperfusion in mice. For this purpose, we used the Cre-loxP system to create a mouse line in which Cx40 is deleted from the endothelium only. Immunostainings on TIE2- Cre+Cx40fl/flApoE-/- mice confirmed the absence of Cx40 in the endothelium, whereas the protein was normally expressed in the atria and cardiac conduction system. Moreover, mean arterial pressure and heart rates wehat appeared crucial in atheroscTIE2-Cre-Cx40fl/flApoE-/- and TIE2-Cre+Cx40 wt/wtApoE-/-) and TIE2-Cre+Cx40fl/flApoE-/- animals. Sixteen-week-old mice with or without endothelial-specific deletion of Cx40 were subjected to in vivo left coronary artery occlusion for 30 minutes and sacrificed 24-hours after reperfusion for analysis of infarct size. Myocardial surfaces areas at risk and infracted areas were measured from computed images using NIH Image software. Areas at risk, normalized to total left ventricle surfaces areas, were similar between the experimental groups, i.e controls 29.17±1.19 % (N=11) and TIE2- Cre-Cx40fl/flApoE-/- 29.29±2.37 % (N=7, n.s.). Interestingly, the infarct area, normalized to areas at risk, was significantly increased in TIE2-Cre+Cx40fl/flApoE-/- mice as compared to controls (20.67±4.74 % and 8.47±1.45 %, respectively, P