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© American Heart Association, Inc.
Clinical Investigation and Reports |
From the Division of Cardiac Surgery (S.V., S.-H.L., P.E.S., C.-H.W., M.V.B., D.A.G.M., R.D.W., P.W.M.F.), Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada, and the Division of Cardiology (M.A.K., L.Z., D.J.S., M.J.B.K.), Terrence Donnelly Heart Centre, St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada.
Correspondence to Subodh Verma, MD, PhD, Division of Cardiac Surgery, Toronto General Hospital, 14EN-215, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4. E-mail subodh.verma{at}sympatico.ca
Received January 28, 2003; de novo received February 17, 2004; revision received March 16, 2004; accepted March 16, 2004.
Background Myocardial ischemia provides a potent stimulus to angiogenesis, and the mobilization and differentiation of endothelial progenitor cells (EPCs) has been shown to be important in this process. An elevated level of C-reactive protein (CRP) has emerged as one of the most powerful predictors of cardiovascular disease. However, the impact of CRP on EPC biology is unknown.
Methods and Results EPCs were isolated from the peripheral venous blood of healthy male volunteers. Cells were cultured in endothelial cell basal medium-2 in the absence and presence of CRP (5 to 20 µg/mL), rosiglitazone (1 µmol/L), and/or vascular endothelial growth factor. EPC differentiation, survival, and function were assayed. CRP at concentrations
15 µg/mL significantly reduced EPC cell number, inhibited the expression of the endothelial cellspecific markers Tie-2, EC-lectin, and VE-cadherin, significantly increased EPC apoptosis, and impaired EPC-induced angiogenesis. EPC-induced angiogenesis was dependent on the presence of nitric oxide, and CRP treatment caused a decrease in endothelial nitric oxide synthase mRNA expression by EPCs. However, all of these detrimental CRP-mediated effects on EPCs were attenuated by pretreatment with rosiglitazone, a peroxisome proliferatoractivated receptor-
(PPAR
) agonist.
Conclusions Human recombinant CRP, at concentrations known to predict adverse vascular outcomes, directly inhibits EPC differentiation, survival, and function, key components of angiogenesis and the response to chronic ischemia. This occurs in part via an effect of CRP to reduce EPC eNOS expression. The PPAR
agonist rosiglitazone inhibits the negative effects of CRP on EPC biology. The ability of CRP to inhibit EPC differentiation and survival may represent an important mechanism that further links inflammation to cardiovascular disease.
Key Words: C-reactive protein cells apoptosis nitric oxide synthase
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