(Circulation. 1999;99:2571-2576.)
© 1999 American Heart Association, Inc.
Basic Science Reports |
From the Departments of Pathology (A.H.H., S.F.), Medicine (M.F.L., S.J.B., V.R.B., L.A.G., S.F.), Pharmacology (M.F.L), Cell Biology (S.J.B), and Veterans Affairs (S.J.B), Vanderbilt University Medical Center, Nashville, Tenn.
Correspondence to Dr Sergio Fazio or Dr MacRae Linton, Division of Endocrinology, Vanderbilt University School of Medicine, 715 Medical Research Building II, Nashville, TN 37232-6303. E-mail sergio.fazio@mcmail.vanderbilt.edu or macrae.linton{at}mcmail.vanderbilt.edu
| Abstract |
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Methods and ResultsTo evaluate the role of macrophage apoE in different stages of atherogenesis, as well as to establish a novel gene therapy approach to atherosclerotic vascular disease, we used an apoE-expressing retrovirus to transduce apoE-deficient (-/-) bone marrow for transplantation into apoE(-/-) recipient mice. Three weeks after bone marrow transplantation, apoE was expressed from arterial macrophages and was detectable in plasma associated with lipoproteins at 0.5% to 1% of normal levels but did not affect plasma cholesterol levels. We used 2 groups of recipient mice: younger mice with lesions consisting primarily of foam cells and older mice with more advanced lesions. When either the mouse or human apoE transgenes were expressed in mice from 5 to 13 weeks of age, there was a significant reduction in lesion area, whereas no effects were detected in mice that expressed apoE from 10 to 26 weeks of age.
ConclusionsWe demonstrate that arterial macrophage apoE secretion can delay atherogenesis if expressed during foam cell formation but is not beneficial during the later stages of atherogenesis. These data also provide evidence that apoE transgene expression from arterial macrophages may have therapeutic applications.
Key Words: apolipoproteins atherosclerosis genes cholesterol
| Introduction |
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| Methods |
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cells. Plasmid DNA from colonies was
prepared and analyzed for the presence of the 1-kb apoE cDNA
inserts. Plasmid DNA was prepared with the Plasmid Maxi kit obtained
from Qiagen according to kit protocol. The sequence of the apoE cDNA
inserts was confirmed by use of the ThermoSequenase kit (Amersham).
Preparation of Producer Cell Lines
The retroviral constructs were used to transfect the ecotropic
packaging cell line Bosc-23, which has been shown to result in
transient high-titer production of infectious
virus.9 The infectious supernatant from these cells was
used to infect the amphotropic packaging cell line
PA317.10 The infectious medium from this cell line was
then used to infect the ecotropic packaging cell line
2 in a
transinfection or "ping-pong-ping" method for creating high-titer
producer cell lines.11 The infected
2 cells were
selected for the integration of the provirus with the neomycin analogue
G418 (Sigma) at 500 µg/mL. Individual clones were isolated and
analyzed for apoE expression and infectious titer. Individual
producer cell clones were analyzed for viral titer as well as
apoE secretion. Mouse apoEexpressing (pLMESN/
2), human
apoEexpressing (pLHESN/
2), and parental (pLXSN/
2) producer
cells were selected for use in bone marrow transplant experiments. The
producer cell lines used for bone marrow transplantation (BMT) studies
were assayed for the presence of recombinant wild-type virus by the
S+ L-
assay12 13 and were found to be helper virusfree.
Bone Marrow Collection, Transduction, and Transplantation
Bone marrow was collected from apoE(-/-) donor mice by
flushing femurs and tibias with RPMI 1640 with 2% FBS and 10 U/mL
heparin (Sigma) added. Cells were washed, counted, and plated in
suspension dishes, where proliferation was stimulated by preculturing
with interleukin 3 (IL-3) and interleukin 6 (IL-6). IL-3 and IL-6 were
produced by transfection of COS-7 cells (ATCC) with
pCD-mIL314 and pCD-mIL6.14 15 Bone
marrow cells were precultured by plating 5x106
cells in 10 mL of DMEM, 10% FBS, 3% IL-3, 3% IL-6 COS-7 medium for
48 hours. After preculture, bone marrow cells were collected and
replated at the same density in the above medium with 6 µg/mL
hexadimethrine bromide (Sigma) onto dishes of 80% confluent producer
cells for 48 hours. The suspended bone marrow cells were then collected
and used to transplant lethally irradiated apoE(-/-) mice as
previously described.16
Animal Procedures and Lipid Analyses
All mice used for these experiments were apoE(-/-) at the
sixth backcross or higher into the C57BL/6 background and were
originally purchased from Jackson Laboratories, Bar Harbor, Me.
Mice were maintained in microisolator cages on a rodent chow diet (PMI
No. 5010) containing 4.5% fat. All mice were given autoclaved water
acidified to pH 2.6. One week before and 2 weeks after BMT, 100 mg/L
neomycin (Sigma) and 10 mg/L polymyxin B sulfate (Sigma) were added to
the acidified water. Blood samples were collected by retro-orbital
venous plexus puncture with heparinized tubes, and serum was separated
by centrifugation. Serum cholesterol and
triglyceride levels were determined with clinical
reagents on a microtiter plate assay, as previously
described.17 A 100-µL aliquot of serum from mice was
separated by Superose 6 chromatography on a Waters
high-performance liquid chromatography system
model 600 as described.18 Animal care and experimental
procedures were performed according to the regulations of Vanderbilt
University's Animal Care Committee.
Western Blotting and Immunohistochemical Analysis for
ApoE
Serum samples were tested for the presence of mouse or human
apoE by Western blot analysis as described.19 The
primary antibodies used were polyclonal rabbit anti-mouse apoE
(BioDesign International) and polyclonal goat anti-human apoE
(BioDesign). Similar Western blot analyses were performed on
fast protein liquid chromatography samples after
concentration of pooled fractions by centrifugation
with Microcon-10 columns (Amicon). Immunocytochemical analysis
of tissue samples for macrophages and mouse apoE was performed
essentially as described.7 Briefly, 5-µm sections were
fixed in acetone and incubated with either a rat monoclonal antibody to
macrophages, MOMA-2 (Accurate Chemicals), or a rabbit
polyclonal antibody to mouse apoE (BioDesign International). Signal was
detected with the ABC kit (Vector Laboratories) followed by incubation
with the fast red TR/naphthol As-NX substrate (Sigma). Photomicroscopy
was performed on a Zeiss Axiophot with Plan-FLUAR objectives.
Primary Macrophage Cultures
Peritoneal cells were collected 2 days after injection of
thioglycollate as described,20 counted, and plated into
12-well dishes at 1x106 cells/well in DMEM+10%
FBS. After 2 hours, nonadherent cells were removed. Wild-type, C57BL/6
mouse peritoneal leukocytes collected and plated in the same manner
served as a positive control. Medium was collected from
macrophages at 48-hour intervals and frozen in 1 mmol/L
PMSF for Western blot analysis.
Lesion Area Quantification
Experiments were designed in 2 parts: (1) male 5-week-old
apoE(-/-) mice killed at 13 weeks and (2) female 10-week-old
apoE(-/-) mice killed at 26 weeks. Atherosclerosis
studies in apoE(-/-) mice have not demonstrated any sex
differences in extent of lesion formation.21 Frozen
sections 10 µm thick were cut from the region of the proximal
aorta starting from the end of the aortic sinus and continuing
distally, according to the technique of Paigen et al.22
Sections were stained with oil red O and counterstained with
hematoxylin. Quantification of lesion area was performed on 15 sections
per animal by digitizing morphometry and was reported in mean
µm2/section. Computer morphometry was performed
with the KS300 software by Kontron Elektronik on a Compaq Presario
9240. Statistical analyses were performed with both Student's
t test and the Mann-Whitney rank sum test comparing control
and experimental lesion area in both experiments.
| Results |
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0.5% to 1% and 5% of normal, respectively (Figure 1
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The distribution of serum lipoproteins in experimental and control mice
was similar to that in nontransplant apoE(-/-) mice as determined by
gel filtration chromatography (data not shown). Both
mouse and human apoE were found to be associated with lipoproteins,
with most of the apoE on the large VLDL and on IDL/LDL (Figure 2
). ApoE was detected in HDL fractions on
longer exposures.
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Evidence of Stem Cell Transduction
The prolonged apoE expression in transplant mice suggests that
pluripotent stem cells or early progenitor cells were transduced,
because the progeny of late-stage progenitors probably persist in
circulation for no more than 3 to 4 months.23 To
investigate whether stem cells had been transduced, a secondary
transplantation was performed. Bone marrow was collected from 3 of the
murine apoEexpressing mice 16 weeks post-BMT and transplanted into 6
lethally irradiated apoE(-/-) recipient mice. ApoE was detected in
serum at 3 months post-BMT in these secondary transplant mice,
providing further evidence for stem cell transduction in the original
transplants (Figure 3
).
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Analysis of ApoE Expression by Peritoneal and Arterial
Macrophages
ApoE expression in the medium of BMT macrophages was 0.5%
that of C57BL/6 macrophages (Figure 4
). ApoE was also expressed from other
tissues, such as the spleen and the artery wall. Immunocytochemistry
analyses showed that apoE was secreted by arterial
macrophages of pLMESN/
2 mice from the 5- to 13-week group
(Figure 5
) as well as the 10- to 26-week
group (data not shown). These apoE-producing macrophages were
found throughout the plaques and at the valve cusps, but there was a
high degree of variability in apoE expression between individual
experimental mice. Of a total of 14 mice in the treated group of the
"late study," 2 showed apoE in 60% to 80% of the
arterial macrophages, 5 in 30% to 40%, and 6 in
10% to 20%, and 1 had undetectable apoE. This degree of variability
was similar to that observed in the mice of the "early" group, in
which significant effects on lesion growth were observed.
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Quantification of Atherosclerosis
In mice that received transplants at 10 weeks of age and
were killed at 26 weeks of age, there were no significant differences
in the extent or distribution of lesions detected between the
experimental (mouse apoE, n=23) and control groups (n=21)
(186 282±97 333 versus 183 168±88 771
µm2±SEM, respectively). In contrast,
experimental mice given transplants of either murine (n=11) or human
(n=15) apoE at 5 weeks of age and killed at 13 weeks of age had
significantly smaller lesions than control mice (n=9) (4847±2410,
5294±2868, and 12 837±7166 µm2±SEM,
respectively) (Figure 6
). The differences
between murine or human apoEexpressing mice and controls were
significant at the level of P<0.003 and
P<0.002, respectively (Student's t test and
Mann-Whitney rank sum test). There was no difference between mice that
expressed either murine or human apoE. By immunocytochemistry
analysis, no major differences in plaque composition were
detectable between treated and control groups in either study.
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| Discussion |
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0.5% to 1% of normal, and was
associated with lipoproteins. ApoE was expressed by both splenic and
peritoneal macrophages, as well as by macrophages
within the artery wall of transplant mice. Finally, both human and
mouse apoEs were effective in reducing foam cell formation when
expressed during early atherogenesis but had no effect during later
stages of atherogenesis.
In the first experiment, mice received transplants at 5 weeks of age
and were followed up until 13 weeks. When normal marrow is used to
reconstitute apoE(-/-) mice, apoE is not detected in serum until 3
weeks post-BMT.16 Therefore, mice in the present study
expressed apoE only from 8 to 13 weeks of age (monocyte adhesion and
foam cell formation stages of atherogenesis). Although plasma lipid
levels were not affected by the intervention, mice that expressed
either mouse or human apoE had significantly smaller lesion area (2- to
7-fold) than controls (P<0.003, mouse apoE versus controls,
and P<0.002, human apoE versus controls). These data
demonstrate that low-level apoE expression from arterial
macrophages is able to modulate early atherogenic events even
when expressed for only a few weeks. The second group received
transplants at 10 weeks and were allowed to progress until 26 weeks.
The apoE in these mice was therefore expressed at the beginning and
well into the intermediate lesion formation stage. In these mice, low
levels of mouse apoE were expressed for a longer time than in the
younger group but had no apparent effect on lesion formation. These
data support the concept that apoE expression from macrophages
in the artery wall is important in the early stages of atherogenesis
but is not beneficial when delivered to more advanced lesions. The
difference in atherosclerosis between studies cannot be
ascribed to variations in apoE expression level or duration in
transplant mice. Dot blot assays using all the samples of all time
points from all mouse groups confirmed that in every instance, plasma
apoE levels were
0.5% of normal (not shown). In addition, secondary
transplants using the marrow from retrovirus-infected mice from the
late experiment show that apoE was detectable in the plasma of apoE
null recipients of marrow from primary transplant mice, proving that
long-lived stem cells were transduced during the original procedure
(Figure 3
). Although we cannot exclude the possibility that the
lack of apoE effect on atherosclerosis in the mice of
the late experiment was specific for the female sex, previous work from
other investigators shows that progression and composition of
arterial plaques in apoE null mice is not significantly
different between sexes.21 24
Because no macrophage-specific promoter was used in
this study, it is possible that other bone marrowderived cell lines
may have contributed to plasma apoE levels in reconstituted mice. The
question of which cell type expressed apoE in the retrovirus-infected
mice was indirectly addressed in a series of experiments comparing apoE
levels in plasma and in macrophage-conditioned medium of either
the retrovirus-infected apoE null mice (pLMESN) or apoE null mice that
received 2 different dilutions (5% and 10%) of C57BL/6 marrow in apoE
null marrow. Because the macrophage is the only apoE-producing
cell line derived from normal unmanipulated bone marrow, we used the
ratio between the densitometric readings of plasma and
macrophage medium apoE in normal transplant mice as a
comparative marker of the contribution of macrophages to plasma
apoE in retrovirus-infected mice. The data (not shown) are compatible
with the notion that
70% of apoE in the plasma of these mice is
derived from macrophages, whereas only 30% derives from other
leukocytes.
The beneficial effect of apoE in the artery wall may be a result of one
of several mechanisms: (1) the promotion of cholesterol
efflux from the cholesterol-loaded
macrophage25 ; (2) the facilitation of reverse
cholesterol transport from the artery wall26 ;
(3) the induction of remnant uptake through apoE-dependent pathways (as
explained by the secretion-capture hypothesis)27 ; or (4)
its local effects on inflammatory processes such as platelet
aggregation,28 leukocyte activation,29 30 or
growth factor sequestration (see Reference 31 for review).
It is interesting to note that the level of human apoE in serum was
higher than that of mouse apoE (Figure 1
), but still no
reduction in serum cholesterol levels was observed.
Although human apoE3 binds to the murine LDL receptor with lower
affinity than mouse apoE, it was nonetheless as effective as mouse apoE
in reducing lesion area in transplant mice. These data suggest that the
mechanism of action of macrophage apoE in the artery wall is
not completely explained by its receptor-binding properties.
Gene therapy has been considered a promising alternative for treatment of cardiovascular diseases, such as restenosis and atherosclerosis.32 33 The majority of studies performed to date have focused on eliminating smooth muscle cell proliferation in vascular injury models of restenosis. Several different approaches have been taken using adenoviral vectors to deliver many different categories of genes, including oligonucleotides against proto-oncogenes,34 suicide genes,35 and genes affecting cellular proliferation.36 Although these studies have clearly demonstrated the potential for reducing smooth muscle cell proliferation after angioplasty procedures, they do not address the question of whether gene therapy for atherosclerosis might be possible. Endothelial cells, smooth muscle cells, and macrophages all contribute to atherogenesis and are potential target cells for gene therapy approaches. Because monocytes/macrophages are derived from bone marrow progenitors, can migrate into the vessel wall, and are involved in the very early events in atherogenesis, they are attractive targets for cell-mediated gene therapy of atherosclerosis.
This study clearly demonstrates that macrophage-derived apoE has a significant impact on foam cell formation but does not play a role in the later stages of atherogenesis, in which macrophages are no longer the principal cell type involved in the lesion formation. In addition, this study demonstrates the feasibility and efficacy of transduction of bone marrow followed by transplantation as a way to express transgenes from macrophages in the artery wall with potent effects on atherogenesis. ApoE represents only one of the many potential genes with therapeutic effects on atherosclerosis. Other genes related to lipoprotein metabolism, fibrinolysis, thrombosis, cell proliferation, and oxidation have a potential application for gene therapy of atherosclerosis if expressed from macrophages in the artery wall.
| Acknowledgments |
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Received September 1, 1998; revision received January 22, 1999; accepted February 4, 1999.
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