(Circulation. 1999;99:1477-1484.)
© 1999 American Heart Association, Inc.
Basic Science Reports |
From the Laboratory of Molecular Cardiology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
Correspondence to Guy Leclerc, MD, Laboratory of Molecular Cardiology, CHUM, 1560, Sherbrooke East, Montreal, Quebec, Canada, H2L4 M1.
| Abstract |
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Methods and ResultsWe investigated in vitro the ability of
32P-labeled oligonucleotides to alter (1)
proliferation of human and porcine vascular smooth muscle cells (VSMCs)
and human coronary artery endothelial cells
(ECs), (2) cell cycle progression, (3) cell viability and
apoptosis, (4) cell migration, and (5) cell phenotype
and morphological features. ß radiation significantly reduced
proliferation of VSMCs (ED50 1.10 Gy) and ECs
(ED50 2.15 Gy) in a dose-dependent manner. Exposure to ß
emission interfered with cell cycle progression, with induction of
G0/G1 arrest in VSMCs, without evidence of cell
viability alteration, apoptosis, or ultrastructural changes.
This strategy also proved to efficiently inhibit VSMC migration by 80%
and induce contractile phenotype appearance, as shown by the
predominance of
-actin immunostaining in
ß-irradiated cells compared with control cells.
Conclusions32P-labeled oligonucleotide was highly effective in inhibiting proliferation of both VSMCs and ECs in a dose-dependent fashion, with ECs showing a higher resistance to these effects. ß irradiationinduced G1 arrest was not associated with cytotoxicity and apoptosis, thus demonstrating a potent cytostatic effect of ß-based therapy. This effect, coupled to that on VSMC migration inhibition and the appearance of a contractile phenotype, reinforced the potential of ionizing radiation to prevent neointima formation after angioplasty.
Key Words: restenosis radiation angioplasty cells endothelium apoptosis
| Introduction |
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-emitting sources).4 5 Several animal studies with
either ß particleemitting stents6 7 8 or wire-mediated
endovascular ß9 10 and
emissions10 11 12 13
have shown great promise in the field of restenosis prevention.
ß-Radioactive stents allow a long-term delivery of ß particles
within the arterial wall with a low dose rate, whereas
endovascular brachytherapy is characterized by high dose rates over a
short-term period.4 5 Although there is a great interest
in developing an effective clinical endovascular radiation strategy to
prevent restenosis,14 15 16 several questions
pertinent to the use of such strategies remain unanswered. Indeed, the
cellular consequences of ionizing radiation leading to the prevention
of neointima formation after balloon angioplasty remain to
be elucidated. Accordingly, we developed a strategy combining radiotherapy and gene transfer approaches to effect an in situ delivery of pure ß particles in vascular cells in a homogeneous manner. We propose in the present study to investigate in vitro the effect of ß emission on (1) proliferation of vascular smooth muscle cells (VSMCs) and endothelial cells (ECs), (2) cell cycle progression, (3) cytotoxicity and apoptosis induction, (4) cell migration, (5) vascular cell phenotype, and morphology features. We demonstrate in vitro the impact of local ß irradiation on both proliferation and migration of vascular cells in a dose-dependent manner and describe for the first time the interference of ß radiation with VSMC cell cycle progression, phenotype modulation, and absence of cytotoxic effects.
| Methods |
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-actin
immunostaining (Sigma). Human coronary artery
ECs (Clonetics Corp, San Diego, Calif) were grown in MCDB 131 medium
(Sigma) and U937 human cells (monocyte-like leukemic tumor, ATCC,
Rockville, Md) in RPMI medium.
Dosimetry for 32P-Labeled Oligonucleotides
In vitropredicted dose was calculated considering both the
specific activity of 32P-labeled
oligonucleotides and the exposure time according to the
dose-point-kernel (DPK) prediction. The DPK estimation, derived from
the Monte Carlo method, was based on the homogeneous
distribution of radioactive particles in the medium.18 On
the basis of autoradiograms, ß-particle delivery was
shown to be uniform in the 2-cm2 well, and no
radiation was detected in adjacent wells (data not shown).
Local ß-Particle Delivery
We used 32P-labeled DNA
oligonucleotides as a molecular delivery mode of ß
particles to vascular cells. In the present in vitro report, the
sense sequence of c-myc was used to ensure that the observed
effects were not sequence specific but mainly the result of
ß-particle emission. Previous studies conducted to compare sense and
antisense sequences reported that the efficacy of both
32P-labeled sequences was statistically similar
in inhibiting VSMC proliferation (unpublished data, 1996). Sense
c-myc phosphorothioate oligonucleotides
(5'-ATGCCCCTCAACGTG-3') were synthesized on a DNA/RNA automated
synthesizer (Applied Biosystems) and purified according to the
supplier's protocol (Glen Research). Oligonucleotides
were internally labeled with [32
ATP] (3000
Ci/mmol, Du Pont Canada Inc) by T4 polynucleotide kinase
(Gibco-BRL). The stability of the labeled oligomer was assessed by
incubating VSMCs with the probe (0.4 nmol/L) for 1 to 7 days. Extracts
were loaded on 20% urea-polyacrylamide gel and revealed by
autoradiography. To determine the cellular localization
of the radioactive source, VSMCs were transfected with oligomer
5'-labeled with fluorescein-isothiocyanate molecule (FITC,
2 µmol/L).
External
- and Electron-Particle Deliveries
To compare the low dose-rate strategy obtained with the use of
labeled oligonucleotides to a high dose-rate approach,
we exposed VSMCs, ECs, and U937 cells to either
60Co (Cobalt-60) or electron beam sources,
leading to
- (1.6 Gy/min) or electron-particle (4 Gy/min)
deliveries, respectively (3, 10, 20, and 30 Gy).
VSMC Viability
Cell integrity was evaluated by the trypan blue exclusion test
(Gibco-BRL).19 Increasing ß doses were tested (1, 3, 5,
10, 20, and 30 Gy) by incubating VSMCs with
labeled-oligonucleotides for 72 hours. Cell viability
assay was performed in triplicate on 4 cell preparations and expressed
as a percentage of total cell counts.
Cell Proliferation Assay
VSMCs and ECs were synchronized with serum-deprived medium for
48 hours and then stimulated with FBS in the presence of increasing
levels of 32P-labeled
oligonucleotides (0.4 to 10 Gy). Nonirradiated cells
received equal concentrations of unlabeled
oligonucleotides (<20 nmol/L). After
[methyl-3H]-thymidine incorporation (6.7
Ci/mmol, NEN Life Science Products), cells were treated as
previously described.20 To evaluate the cell regrowth
after removal of the ß source from the medium, VSMCs were first
incubated with labeled oligonucleotides (5.5 Gy),
leading to severe inhibition of proliferation (80%), then the ß
source was removed from the cell layer for 3 and 5 days. The effects of
local irradiation on proliferation was calculated as a percentage of
that obtained with nonirradiated cells, on the basis of quadruplicates
with 5 to 7 cell preparations. Because similar effects of labeled
oligonucleotides on porcine and human VSMCs were seen
(Figure 3
), we then decided to perform all the following
experiments on porcine VSMCs because porcine explants are more readily
available.
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Cell Cycle Progression
VSMCs were synchronized in serum-deprived medium for 48 hours.
Labeled oligonucleotides were
simultaneously added with 10% FBS. Cells were incubated
with ß sources (2, 10, and 30 Gy) and harvested 6, 10, 16, 20, 24,
48, 72, 96, and 120 hours after serum activation. Cells were fixed in
70% ethanol and treated with 0.1% sodium citrate, 0.3% NP-40, 0.02
mg/mL RNAse, and 0.05 mg/mL propidium iodide. Stained cells were
analyzed by flow cytometry with a FACScan model (Becton
Dickinson Immunocytometry Systems).
Internucleosomal DNA Fragmentation
VSMCs, ECs, and U937 cells were incubated with labeled
oligonucleotides for 72 hours (1, 3, 5, 10, 20, and 30
Gy). The 3 cell types were also exposed to external
60Co and electron beam sources (3, 10, 20, and 30
Gy) and processed 24 and 72 hours after irradiation. As a positive
control of DNA fragmentation, we treated U937 cells with 1
µmol/L camptothecin, a DNA topoisomerase I inhibitor
(Sigma) for 6 hours. Genomic DNA was extracted from treated cells as
described.21
Transmission Electron Microscopy
VSMCs, ECs, and U937 cells were incubated with labeled
oligonucleotides for 72 hours (3 and 30 Gy). Cells were
fixed in Millonig's sodium phosphate solution containing 2.5%
glutaraldehyde and stored in 0.1 mol/L Millonig's
solution until processing (50 to 70 nm thick). Transmission electron
microscopy was performed with a Zeiss Em10 CA microscope (JFE
Enterprises).
Cell Migration and Immunofluorescence
VSMC and EC migration assays were performed with modified Boyden
chambers (Neuroprobe Inc) in which cells were allowed to migrate
through a polycarbonate membrane (8-µm pore size, Costar
Corp).22 Immunostaining was performed to
investigate effects of ß irradiation on cell phenotype by
incubating cells with either anti
-actin or antivon
Willebrand factor antibodies (Sigma) for VSMCs and ECs,
respectively.23 After nuclei staining with 0.01% Hoechst
solution (Sigma), slides were observed with an epifluorescence
microscope. Low ß-irradiation doses (0.4 and 1 Gy) were used to
evaluate the setting of migration and phenotype modulation.
Statistical Analysis
All values are expressed as mean±SEM. Differences between
control and irradiated cells were assessed by ANOVA, with subsequent
Student-Newman-Keuls test for multiple comparisons. Statistical
significance was established at a value of P<0.05.
| Results |
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Cell Viability
After ß irradiation, viable cell proportion was maintained to an
average of 95%±1% (1, 3, and 10 Gy), compared with 96%±0.6% in
control VSMCs. Interestingly, molecular ß irradiation, even at high
doses (20 and 30 Gy), did not alter significantly VSMC viability
(94%±0.9% for 30 Gy, P=NS, vs 1 to 10 Gy), suggesting
that 32P-labeled oligonucleotides
were not lethal for VSMCs.
Vascular Cell Proliferation
The effect of unlabeled oligonucleotides (<20
nmol/L) on cell proliferation was evaluated to be a reduction of
<10%, in accordance with previous studies.20 26 For the
first time, we report a significant inhibition of VSMC proliferation
with ß irradiation in a dose-dependent manner (0.4 to 10 Gy, Figure 3A
), with an ED50
at 1.10±0.07 Gy and 1.08±0.12 Gy for porcine and human, respectively,
an ED50 statistically similar in both species.
Increasing ß dose induced comparable patterns of growth inhibition in
ECs, with an ED50 at 2.15±0.10 Gy (Figure 3B
). However, ED50 comparison of VSMC and
EC demonstrated that the ability of ß irradiation to inhibit
proliferation was significantly higher in VSMCs compared with that with
ECs (P<0.01), except at the highest dose (10 Gy). Removal
of 32P-labeled oligonucleotides
did not completely abolish the potential inhibitory effect
of ß irradiation on VSMC proliferation over 3 to 5 days
(P<0.05 vs nonirradiated cells, Figure 4
).
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Cell Cycle Progression in VSMCs
As shown in Figure 5
, serum-deprived
cells were mainly distributed in the
G0/G1 phase of the cell
cycle (57%±2%, panel A) with reduced DNA synthesis activity
(32%±2%) and low level of cell division (8%±1% in the
G2/M phase). Between 3 to 20 hours after serum
activation, quiescent cells did not progress into the S phase (data not
shown). As previously described,27 24 hours after serum
addition, we observed that most of VSMCs progressed into the S phase
(85%±3%, Figure 5B
), and to a lesser extent, cells remained
in the G0/G1 state.
Interestingly, VSMCs remained in the
G0/G1 phase after ß
exposure (2, 10, and 30 Gy), with a concomitant reduction in cell cycle
progression into the S phase (Figures 5
and 6
). ß irradiation did not modify
significantly the G2/M phase of the cell cycle
(Figure 6
). As illustrated in Figure 5
, no
apoptotic peak corresponding to DNA degradation was noted at
low or high ß doses. Investigation of long-term effects of ß
exposure on cell cycle progression showed that cells remained mainly in
the G0/G1 state (57%±3%)
for up to 120 hours.
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Comparative Effects of Local and External Irradiation on DNA
Fragmentation
Labeled oligonucleotides at low (3 Gy) and
elevated dose ranges (10, 20, and 30 Gy) did not induce DNA
fragmentation in VSMCs, ECs, and U937 cells (Figure 7A
). Exposure to
60Co or electron beam sources did not alter DNA
integrity in VSMCs and ECs, whereas this type of delivery induced DNA
laddering in U937 cells (Figures 7B
and 7C
). These data suggest
that U937 cells may be more sensible than vascular cells after high
dose-rate radiation. Camptothecin also led to severe DNA fragmentation
in leukemic cells after 6 hours (Figure 7A
, lane 4), as
previously reported.21
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Morphological Changes and Apoptosis
Electron micrographs showed that after
labeled-oligonucleotide irradiation (3 and 30 Gy),
VSMCs, ECs, and U937 cells conserved normal ultrastructural features
(Figure 8
). Presence of apoptotic
cells was identified by the following features: chromatin compaction,
cell surface blebbing, cytoplasmic shrinkage, and condensation.
Morphological studies reported that the frequency of apoptotic
cells in control and ß-irradiated VSMCs, ECs, and U937 cells
was<3%, whereas after camptothecin treatment, 50% to 60% of
leukemic cells met the apoptosis criteria.21
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Cell Migration and Phenotype
Our results reported similar inhibitory effect in
migration of VSMCs (43%±0.4% and 20%±3.5% of control cell level)
and ECs (47.3%±2.5% and 13%±2.3% of control cell level) for doses
of 0.4 and 1 Gy, respectively (P<0.001 vs control cells).
Proliferating VSMCs showed a weak immunostaining of
-actin proteins, corresponding to the synthetic phenotype
(Figure 9A
). Local ß irradiation
induced an increase in
-actin fibers that appeared to be dose
dependent (Figures 9B
and 9C
) and occurred in nearly all cells
(>95%, panel D), suggesting the appearance of a contractile
phenotype in irradiated VSMCs. With ECs, ß irradiation (0.4
and 1 Gy) did not modify von Willebrand factor
immunostaining (data not shown).
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| Discussion |
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source to prevent restenosis over
short-term9 10 12 and long-term observation
periods.9 11 28 Verin et al29 and Waksman
et al10 30 subsequently demonstrated the effectiveness of
a ß source in reducing intimal hyperplasia in rabbit and pig models,
respectively. Stent-based approaches were also proposed as platforms
from which ß emission could be delivered to the vessel
wall.6 7 8 In a landmark trial, Teirstein et
al14 reported the successful reduction of
restenosis rates in injured arteries with iridium-192. Although
the concept of radiotherapy to prevent restenosis recently
reached the clinical arena, several questions regarding its mechanism
of action on vascular cells remain unanswered. Therefore, we proposed
in this study to examine the consequences of ß emission radiation on
various fundamental functions of vascular cells such as cell viability,
proliferation, and migration. We also dissected the effects of ß
radiation on cell cycle progression, apoptosis induction,
phenotype modulation, and morphological features in VSMCs and
ECs. To deliver ß particles in a homogenous fashion, we developed a novel approach based on the local delivery of radiolabeled short DNA single strands. We demonstrate that oligomers internally labeled with phosphorus-32 (32P) provided a stable source of radiation and an uniform dose distribution to target cells. Comparison of the effects of sense and antisense sequences demonstrated that both labeled sequences had similar inhibitory effects, supporting the concept that the oligonucleotides only served as a molecular vector to locally deliver ß particles. The 32P-isotope (half-life 14.3 days) has already been adopted by 2 different platforms in coronary radiation clinical trials (wire based and stent based).
To date, few data are available on the biological effects of radiation on vascular cells. Fischell et al31 observed that 32P-radioactive wires inhibited the growth and migratory functions of VSMCs by use of a nonuniform dose distribution. A dose-response effect of a cesium-137 source on VSMC proliferation was reported and showed "reproductive cell death" without, however, any sign of apoptosis.32 The current study reports for the first time that ß irradiation efficiently inhibits human and porcine VSMCs and human ECs in a dose-dependent manner. At a moderate range of ß-particle delivery (0.4 to 6 Gy), ECs appeared to be more radioresistant than VSMCs. No difference, however, could be seen at doses that induced optimal proliferation inhibition. Protocols used in current clinical trials of brachytherapy14 15 16 thus would not be expected to have a different effect on VSMCs and ECs. VSMC growth inhibition was maintained over at least 5 days after radioactive source removal, suggesting either that the effects of ß irradiation are sustained even after source removal or that remaining incorporated intracellular oligonucleotides continued to inhibit proliferation.24
To understand the mechanisms of the inhibitory effect of radiation, we investigated cell cycle progression in irradiated VSMCs. For the first time, we report that ß irradiation caused cells to remain in the G0/G1 phase and reduced cell numbers in the S phase, as leukemic cells after radiotherapy.33 Moreover, this growth arrest was maintained over 5 days. The mechanisms of ß irradiationinduced G1 arrest in VSMCs remain, however, to be defined. Recent recombinant adenoviral strategies reported that adenovirus containing p21,27 p53,34 or retinoblastoma35 efficiently blocked the cell cycle progression and successfully reduced intimal hyperplasia in animals. It may be hypothesized that p53-induced p21 inhibits the cyclin-dependent kinases,36 37 leading to the G1 arrest in irradiated VSMCs.
Previous studies on the effects of external radiation using high
dose-rates reported damage leading to "reproductive cell
kill"32 33 or apoptosis
induction.33 However, "reproductive cell kill" is
not synonymous to the loss of physical integrity. The current low
dose-rate ß-emission approach did not induce signs of loss of
organelle integrity or DNA fragmentation, as shown by ultrastructural
and FACS analyses. To compare this low dose-rate approach with
that used in brachytherapy, we exposed cells to external sources of
or electron particles. High dose-rate irradiation did not induce DNA
laddering in VSMCs and ECs, whereas leukemic cells appeared to die by
radiation-induced DNA fragmentation. This is in accordance with the low
level of apoptosis found in rabbit ß-irradiated
arteries29 and the absence of apoptosis reported
in porcine irradiated arteries.10 The low dose-rate
delivery effected by labeled oligonucleotides (2 to 10
cGy/h) is more closely related to that used with radioactive
stents6 7 8 than that used in brachytherapy (1 to 5
Gy/min).9 10 12 13 28 Consequently, such low dose-rate
strategies could be defined as cytostatic, preserving cell integrity
and viability and acting as a growth suppressor.37 Also,
no apoptosis could be seen in vascular cells in our high
dose-rate experiments. Whether "physical cell kill" is a desirable
end point in the objective of preventing clinical restenosis
remains unanswered.
In addition to inhibiting cell proliferation, ß irradiation
significantly reduced migration of VSMCs and ECs, at much lower ß
doses (1 Gy) than those affecting the proliferative properties,
suggesting that the migratory function may be more radiosensible than
cell growth. ß irradiation inhibited EC migration but failed to alter
von Willebrand factor immunostaining,
suggesting that reduced migratory function of irradiated ECs may be
responsible for potential endothelium-related
dysfunction by altering reendothelialization of injury
site after balloon angioplasty. VSMC functions are closely related to
their phenotype modulation,38 and in proliferative
disorders such as restenosis, contractile VSMCs become
dedifferentiated and develop the synthetic phenotype. This
immature stage, similar to the in vitro conditions, is correlated with
a high migratory capacity of VSMCs.38 We demonstrate that
low ß irradiation induced the transition from the synthetic to the
contractile phenotype as shown by the higher
-actin
immunostaining in ß-irradiated cells.
In conclusion, we report that labeled oligonucleotides inhibited proliferation of VSMCs and ECs in a cell-specific and dose-specific manner by acting as a growth suppressor, resulting in G1 arrest, with no morphological changes and apoptosis induction. ß radiation succeeded in inhibiting cell migration and enhanced the contractile phenotype of VSMCs. By acting on vascular cell function, the ß-radioactive strategy may contribute to prevent intimal hyperplasia after angioplasty.
| Acknowledgments |
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Received August 11, 1998; revision received November 2, 1998; accepted November 5, 1998.
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