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(Circulation. 2008;118:S226-S233.)
© 2008 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Short Hairpin RNA Interference Therapy for Ischemic Heart Disease

Mei Huang, PhD; Denise A. Chan, PhD; Fangjun Jia, PhD; Xiaoyan Xie, PhD; Zongjin Li, MD, PhD; Grant Hoyt, BS; Robert C. Robbins, MD; Xiaoyuan Chen, PhD; Amato J. Giaccia, PhD; Joseph C. Wu, MD, PhD

From the Departments of Radiology (M.H., F.J., X.X., Z.L., X.C., J.C.W.), Radiation Oncology (D.C., A.G.), Surgery (G.H., R.C.R.), and Medicine (J.C.W.), Division of Cardiology, Stanford, Calif.

Correspondence to Joseph C. Wu, MD, PhD, Stanford University School of Medicine, Edwards Building R354, Stanford, CA 94305-5344. E-mail joewu{at}stanford.edu

Background— During hypoxia, upregulation of hypoxia inducible factor-1 alpha transcriptional factor can activate several downstream angiogenic genes. However, hypoxia inducible factor-1 alpha is naturally degraded by prolyl hydroxylase-2 (PHD2) protein. Here we hypothesize that short hairpin RNA (shRNA) interference therapy targeting PHD2 can be used for treatment of myocardial ischemia and this process can be followed noninvasively by molecular imaging.

Methods and Results— PHD2 was cloned from mouse embryonic stem cells by comparing the homolog gene in human and rat. The best candidate shRNA sequence for inhibiting PHD2 was inserted into the pSuper vector driven by the H1 promoter followed by a separate hypoxia response element-incorporated promoter driving a firefly luciferase reporter gene. This construct was used to transfect mouse C2C12 myoblast cell line for in vitro confirmation. Compared with the control short hairpin scramble (shScramble) as control, inhibition of PHD2 increased levels of hypoxia inducible factor-1 alpha protein and several downstream angiogenic genes by >30% (P<0.01). Afterward, shRNA targeting PHD2 (shPHD2) plasmid was injected intramyocardially following ligation of left anterior descending artery in mice. Animals were randomized into shPHD2 experimental group (n=25) versus shScramble control group (n=20). Bioluminescence imaging detected plasmid-mediated transgene expression for 4 to 5 weeks. Echocardiography showed the shPHD2 group had improved fractional shortening compared with the shScramble group at Week 4 (33.7%±1.9% versus 28.4%±2.8%; P<0.05). Postmortem analysis showed increased presence of small capillaries and venules in the infarcted zones by CD31 staining. Finally, Western blot analysis of explanted hearts also confirmed that animals treated with shPHD2 had significantly higher levels of hypoxia inducible factor-1 alpha protein.

Conclusions— This is the first study to image the biological role of shRNA therapy for improving cardiac function. Inhibition of PHD2 by shRNA led to significant improvement in angiogenesis and contractility by in vitro and in vivo experiments. With further validation, the combination of shRNA therapy and molecular imaging can be used to track novel cardiovascular gene therapy applications in the future.

Key Words: hypoxia inducible factor • ischemic heart disease • molecular imaging • prolyl hydroxylases • RNA interference

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