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Arteriosclerosis, Thrombosis, and Vascular Biology. 1997;17:680-687

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(Arteriosclerosis, Thrombosis, and Vascular Biology. 1997;17:680-687.)
© 1997 American Heart Association, Inc.


Articles

Lipid Oxidation Products Have Opposite Effects on Calcifying Vascular Cell and Bone Cell Differentiation

A Possible Explanation for the Paradox of Arterial Calcification in Osteoporotic Patients

Presented in part at the 68th Scientific Sessions of the American Heart Association, Anaheim, Calif, November 13-16, 1995.

Farhad Parhami; Andrew D. Morrow; Jennifer Balucan; Norbert Leitinger; Andrew D. Watson; Yin Tintut; Judith A. Berliner; ; Linda L. Demer

From the Division of Cardiology, Department of Medicine (F.P., A.D.M., J.B., Y.T., L.L.D.) and Department of Pathology (N.L., A.D.W., J.A.B.), University of California at Los Angeles School of Medicine.

Correspondence to F. Parhami, PhD, Division of Cardiology, UCLA School of Medicine, 47-123 Center for the Health Sciences, 10833 Le Conte Ave, Los Angeles, CA 90095. E-mail fparhami{at}medicine.medsch.ucla.edu


*    Abstract
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*Abstract
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Abstract Atherosclerotic calcification and osteoporosis often coexist in patients, yielding formation of bone mineral in vascular walls and its simultaneous loss from bone. To assess the potential role of lipoproteins in both processes, we examined the effects of minimally oxidized low-density lipoprotein (MM-LDL) and several other lipid oxidation products on calcifying vascular cells (CVCs) and bone-derived preosteoblasts MC3T3-E1. In CVCs, MM-LDL but not native LDL inhibited proliferation, caused a dose-dependent increase in alkaline phosphatase activity, which is a marker of osteoblastic differentiation, and induced the formation of extensive areas of calcification. Similar to MM-LDL, oxidized 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphorylcholine (ox-PAPC) and the isoprostane 8-iso prostaglandin E2 but not PAPC or isoprostane 8-iso prostaglandin F2{alpha} induced alkaline phosphatase activity and differentiation of CVCs. In contrast, MM-LDL and the above oxidized lipids inhibited differentiation of the MC3T3-E1 bone cells, as evidenced by their stimulatory effect on proliferation and their inhibitory effect on the induction of alkaline phosphatase and calcium uptake. These results suggest that specific oxidized lipids may be the common factors underlying the pathogenesis of both atherosclerotic calcification and osteoporosis.


Key Words: calcification • atherosclerosis • oxidized lipids • calcifying vascular cells • alkaline phosphatase


*    Introduction
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*Introduction
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Calcium deposits, consisting of the bone mineral apatite, are extremely common in atherosclerotic lesions and are associated with clinical complications such as myocardial infarction, impaired vascular tone, dissection in angioplasty, poor surgical outcome, and coronary insufficiency due to loss of aortic recoil.1 2 The mechanism of vascular calcification is not yet established; however, recent evidence implicates factors important in bone mineralization3 including matrix vesicles,4 bone morphogenetic protein-2,5 osteopontin,6 osteocalcin,7 and collagen I,8 all of which have been identified in atherosclerotic plaque.

We previously identified cloned subpopulations of aortic medial cells, termed CVCs, which spontaneously calcify in vitro and express osteoblast markers such as alkaline phosphatase, osteopontin, osteocalcin, osteonectin, and collagen I.9 This in vitro model was confirmed and enhanced by Shioi et al.10 CVC calcified nodules express the bone/liver/kidney isoform of alkaline phosphatase, which is widely used as an early marker of osteoblastic differentiation.11

The role of the ectoenzyme alkaline phosphatase associated with matrix vesicles in osteoblast differentiation and mineralization is most likely the hydrolysis of ester phosphates at sites of mineralization, providing ionic phosphate for incorporation into calcium-phosphate mineral.12 Previous studies, using the alkaline phosphatase inhibitor levamisole, have shown its importance in the commitment of bone preosteoblasts to mineralization.13 Alkaline phosphatase may also inactivate pyrophosphate, an inhibitor of hydroxyapatite formation,12 and it may have an intracellular function14 important in regulating cellular differentiation.

The role of LDL oxidation products and their accumulation in the vessel wall during atherosclerotic lesion formation is well established.15 16 Since calcium deposits are found as early as the fatty streak stage,17 often in close association with lipids,18 19 we hypothesized that oxidized lipids have a functional role in osteoblastic differentiation of vascular cells. Further evidence for the possible role of lipids in calcification is the inhibition of calcification in delipidated heart valves.20 21 MM-LDL is a potent atherogenic molecule with biologic activity in vitro and in vivo.22 23 Watson et al24 reported that ox-PAPC has biologic activity similar to MM-LDL. In 1996, Morrow and Roberts25 reported that prostaglandin-like isoprostanes, formed by the free radical–catalyzed peroxidation of arachidonic acid, are produced in vivo in humans and may contribute to oxidative injury. Isoprostanes have also been found in cell- and metal-oxidized LDL26 and may at least partially account for its biologic activity.

Osteoporotic loss of bone is attributed to abnormalities in the balance of bone remodeling, both increased bone resorption by osteoclasts and decreased bone formation by osteoblasts.27 Since osteoporosis commonly coexists with atherosclerotic calcification,28 29 30 31 32 common factors may be responsible in the pathogenesis of both diseases.

In the present study, we used alkaline phosphatase as a marker for osteoblastic differentiation of CVCs to examine the role of the above oxidized lipids and lipoprotein in in vitro vascular calcification. For comparison, the same treatments were applied to MC3T3-E1, a preosteoblast calvarial cell line that has been used extensively for bone cell physiological studies.33 MC3T3-E1 cells follow the same process of osteoblastic differentiation as osteoblasts in vivo, including inhibition of proliferation and upregulation of alkaline phosphatase at the onset of differentiation.33 34 Results showed a strong, dose-dependent positive effect of MM-LDL, ox-PAPC, and the isoprostane iso-PGE2 on osteoblastic differentiation of vascular cells but reciprocal effects on MC3T3-E1. These results led us to speculate that lipid accumulation and oxidation in the subendothelial space of the extensive vasculature in bone may inhibit differentiation of adjacent preosteoblasts, thus contributing to osteoporosis and accounting at least in part for the paradox of atherosclerotic calcification and osteoporosis occurring together in many patients.


*    Methods
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Cell Cultures
CVC clones were isolated from cultures of BASMCs in which multicellular nodules spontaneously appeared as previously described.9 CVCs were grown in DMEM (Irvine Scientific) containing 15% fetal bovine serum (Hyclone Labs) supplemented with sodium pyruvate (1 mmol/L), penicillin (100 U/mL), and streptomycin (100 U/mL), all from Irvine Scientific. MC3T3-E1 mouse preosteoblast cell line (from Riken Cell Bank) was grown in {alpha}MEM (Irvine Scientific) containing 10% FCS, 3 mmol/L ß-glycerophosphate (Sigma), and 25 µg/mL ascorbic acid and supplemented as indicated for DMEM above. The presence of ß-glycerophosphate and ascorbic acid significantly enhances calcification in MC3T3-E1 cultures. Isoprostanes were purchased from Cayman Chemical.

Alkaline Phosphatase Assay
A cell-associated alkaline phosphatase activity assay was performed with a modification of the alkaline phosphatase assay kit from Sigma. Cells were cultured in 24-well tissue-culture plates. After treatments with test agents, cells were rinsed twice with PBS and scraped into 200 µL of lysis buffer (0.2% NP-40 in 1 mmol/L MgCl2) with a rubber policeman and sonicated for 10 seconds. Next, 1 mL of reaction mixture was added to each well. Reaction mixture was 221 alkaline buffer (Sigma): stock substrate solution 1:1. Stock substrate solution was prepared by dissolving the contents of a 100-mg capsule of Sigma 104 phosphatase substrate in 25 mL of ddH2O. This mixture was then incubated for 30 minutes at 37°C. The yellow color was indicative of alkaline phosphatase activity. The reaction was stopped by the addition of 12 µL of 1N NaOH to each well, and absorbance was determined at 405 nm. Alkaline phosphatase activity was calculated using p-nitrophenol as a standard, according to the kit's instructions (Sigma). Results were normalized to total protein determined using the Bio-Rad protein assay solution (Bio-Rad Laboratories).

Lipoprotein and Lipids
Human LDL was isolated by density-gradient centrifugation of serum and stored in phosphate-buffered 0.15 mol/L NaCl containing 0.01% EDTA. MM-LDL was prepared by iron oxidation of human LDL as previously described.35 Minimal oxidation of LDL resulted in a twofold to threefold increase in conjugated dienes and 2 to 3 nmol of thiobarbituric acid–reactive substances per milligram of cholesterol after dialysis. The concentrations of lipoprotein used in this study are reported in micrograms of protein. PAPC (Sigma) was oxidized as described previously.24 Briefly, PAPC was first dried under argon and exposed to air for 48 hours at room temperature under sterile conditions. The ox-PAPC was resuspended in chloroform and stored at -80°C covered with argon.

Von Kossa Staining for Calcification
Cell monolayers were fixed in 0.1% glutaraldehyde in PBS for 15 minutes at room temperature. Cells were then washed twice with ddH2O and incubated with 5% silver nitrate for 30 minutes at room temperature in the dark. Silver nitrate was removed and cells were rinsed twice with ddH2O. Next, cultures were air dried and exposed to sunlight until color development was complete. Cells were rinsed with ddH2O and prepared for phase microscopy.

[3H]Thymidine Incorporation
Cells were cultured in 24-well plates and treated with or without agonists. During the last 24 hours of treatments, cells were pulsed with 1 µCi/mL [3H]thymidine (Amersham). The incorporated label was extracted and quantitated as previously described.36

45Ca Accumulation
45Ca accumulation assay was performed as described previously.37 Briefly, cells were cultured in 24-well plates, in the presence or absence of oxidized lipids for 2 weeks. 45CaCl2 (Amersham) was then added at 0.5 µCi/mL. After 48 hours of incubation with the 45CaCl2, the medium was removed and the cells were rinsed twice with PBS and scraped in 0.3 mL of PBS, into vials containing 0.2 mL of perchloric acid. After vortexing, 0.4 mL of 3% hydrogen peroxide was added to each sample and incubated at 80°C for 1 hour. Samples were then dissolved in 0.6 mL of ethylene glycol monoethyl ether (Sigma) and vortexed, and the radioactivity accumulated was quantitated by scintillation counting. 45Ca accumulation measured by this technique is mainly matrix bound, since similar findings are obtained with Tx-100–permeabilized cells in which ionic calcium is removed.

Quantitation of Areas of Nodules
The area of nodules in control or MM-LDL–treated CVC cultures was quantitated by computer-assisted analysis of phase-contrast photographs of representative visual fields (x40). Photomicrographs were then scanned and the areas of nodules per field measured using the NIH image program. The areas (pixels) are reported as the mean±SD of at least five fields.

Statistical Analysis
Computer-assisted statistical analyses were performed using the ANOVA program.


*    Results
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*Results
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Effect of MM-LDL on CVC Morphology and Nodules
After 3 days of treatment with MM-LDL, CVC morphology changed distinctly from a thin fibroblastic to a cuboidal form (Fig 1ADown and 1BDown). A similar morphological change occurs in differentiation of preosteoblasts into mature osteoblasts.38 39 After 10 days of treatment, large areas of cellular condensations appeared in the MM-LDL–treated cultures as opposed to the typical small, round focal condensations seen in the control cultures (Fig 1CDown and 1DDown). This finding is also similar to the process of cell aggregation/condensation reported previously during bone and cartilage cell differentiation and mineralization in vitro and in vivo.40 Quantitation of the areas of condensation in control versus MM-LDL–treated cultures showed a 145% increase with MM-LDL treatment (control, 14 140±4378 pixels; MM-LDL, 34 591±7625 pixels; P<.001; n=5). After 3 weeks, von Kossa staining, though not quantitative, showed a less dense but substantially larger area of positively stained calcifying condensations in the MM-LDL–treated versus control cultures (Fig 1EDown and 1FDown). In addition, condensations in treated cultures were broader and more irregularly shaped than the condensations in control cultures, which were small, focal nodules as previously reported (Fig 1CDown and 1DDown).9 Native LDL did not have effects similar to MM-LDL on CVC morphology or von Kossa staining (data not shown). MM-LDL had no effect on BASMC morphology, in contrast to its effects on CVCs derived from BASMC cultures (data not shown).



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Figure 1. Morphological change in CVCs treated with MM-LDL. CVCs at 80% confluence were incubated for 3 days (A and B) or 10 days (C and D) at 37°C with control buffer (A and C) or 250 µg/mL MM-LDL (B and D) in DMEM containing 5% FCS. Phase contrast reveals a change from spindle-shaped to cuboidal at the early stage and a change from round, focal (arrows) to large (arrowheads) condensations at the later stage (A and B, magnification x100; C and D, magnification x40). Von Kossa staining shows calcification in 3-week-old cultures treated with control buffer (E) or 250 µg/mL MM-LDL (F). Phase-contrast magnification x40.

Relationship of Alkaline Phosphatase Activity and CVC Nodule Formation
Induction of alkaline phosphatase is important in the differentiation of osteoblasts.11 Similar induction of alkaline phosphatase activity occurs during CVC differentiation, at the onset of the cellular condensation (Fig 2Down).



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Figure 2. Time course of alkaline phosphatase activity during CVC differentiation. CVCs were plated at 80% confluence and incubated for a total of 26 days, with medium changed every 4 days. At the indicated days postseeding, alkaline phosphatase activity was measured in total cell homogenates, and the results from a representative of four experiments are shown as the mean±SD of quadruplicate determinations. Corresponding morphological changes are indicated: proliferation indicates subconfluence; the condensation and nodule formation stage is characterized by cellular aggregation and formation of refringent matrix in nodules; and the mineralization stage is identified by positive staining for calcium mineral in most nodules.

Effect of MM-LDL on Alkaline Phosphatase Activity in CVCs and MC3T3-E1
To determine whether MM-LDL modulates CVC differentiation, we treated CVCs for 6 days with MM-LDL and found a significant dose-dependent induction of alkaline phosphatase activity (Fig 3Down). This effect persisted for at least 26 days of treatment, whereas even prolonged incubation with native LDL did not induce alkaline phosphatase activity in CVCs (Fig 4ADown). Alkaline phosphatase activity in BASMCs was not affected by MM-LDL (data not shown). We also examined the effect of MM-LDL on alkaline phosphatase activity of MC3T3-E1 bone preosteoblasts. Unexpectedly, in contrast to the response of CVCs, the expression of alkaline phosphatase activity was inhibited by MM-LDL treatment (Fig 4BDown), suggesting that the normal differentiation of these cells is inhibited by MM-LDL.



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Figure 3. Induction of alkaline phosphatase activity by MM-LDL. CVCs were incubated for 6 days at 37°C with control buffer or the indicated concentrations of MM-LDL in DMEM containing 5% FCS. Alkaline phosphatase activity was measured in total cell homogenates, and the results from a representative of three experiments are shown as the mean±SD of quadruplicate determinations. P<.005 for 62.5 µg/mL MM-LDL vs control.



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Figure 4. Time course of MM-LDL and native LDL effects on alkaline phosphatase activity in CVCs and MC3T3-E1. CVCs (A) or MC3T3-E1 (B) at 80% confluence were incubated for the entire experimental period with control buffer, 125 µg/mL MM-LDL, or 125 µg/mL native LDL (N-LDL) in medium containing 5% FCS. Treatments were replaced with feeding the cells every 4 days. Alkaline phosphatase activity was measured at indicated time points in total cell homogenates, and the results from a representative of five experiments are shown as the mean±SD of quadruplicate determinations.

To assess the importance of the duration of MM-LDL exposure, CVCs were incubated for different times with MM-LDL, rinsed, and fed with fresh medium for the 6-day total culture period. Treatment for 24 hours or less had no effect on alkaline phosphatase, whereas a 6-day treatment induced its activity (Fig 5Down), suggesting that further modification, internalization, or processing of MM-LDL may be necessary for this effect. In addition, similar experiments showed that a minimum of 3 days of incubation with MM-LDL is required for the induction of alkaline phosphatase activity (data not shown).



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Figure 5. Kinetics of induction of alkaline phosphatase activity by MM-LDL. CVCs at 80% confluence were treated with control buffer (C) or 125 µg/mL MM-LDL for 6 days or for 2, 6, or 24 hours, followed by rinsing and addition of fresh medium containing the control buffer. After 6 days from the start of the experiment, alkaline phosphatase activity was measured in quadruplicate wells, and the results from a representative of three experiments are shown as the mean±SD of quadruplicate determinations.

Effect of Ox-PAPC and Iso-PGE2 on Alkaline Phosphatase Activity
Since ox-PAPC has biologic activity similar to MM-LDL,24 we tested the effect of ox-PAPC on CVCs. The results showed that similar to MM-LDL, ox-PAPC caused a dose-dependent activation of alkaline phosphatase activity in these cells, with greater potency than MM-LDL (Fig 6Down); PAPC itself did not have similar effects. Kinetic studies of the effect of ox-PAPC showed that continuous incubation of CVCs for at least 2 days was necessary for induction of alkaline phosphatase activity to the level induced after 6 days of treatment with MM-LDL (data not shown). Ox-PAPC also had an inhibitory effect on the induction of alkaline phosphatase activity in MC3T3-E1 (data not shown).



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Figure 6. Effect of PAPC and ox-PAPC on alkaline phosphatase activity in CVCs. CVCs at 80% confluence were treated with PAPC (PA) or ox-PAPC (OX) at the indicated concentrations, in DMEM containing 5% FCS. For comparison, additional cells were treated with 250 µg/mL MM-LDL. After 6 days, alkaline phosphatase activity was measured in total cell homogenates. Results from a representative of two experiments are shown as the mean±SD of quadruplicate determinations. P<.005 for 2 µg/mL ox-PAPC vs control.

Since isoprostanes are present in oxidized LDL26 as well as in oxidatively damaged tissues,25 we tested the effect of purified iso-PGE2 on CVCs. Similar to the other oxidized lipids tested, iso-PGE2 at 1 to 50 µmol/L caused a significant dose-dependent induction of alkaline phosphatase activity and morphological changes in CVCs (Fig 7ADown). Isoprostane iso-PGF2{alpha}, a stereoisomer of PGF2, did not induce alkaline phosphatase activity in CVCs (Fig 7ADown), suggesting that the effect is specific to iso-PGE2. Iso-PGE2 did not have similar effects on BASMCs (data not shown). Similar to MM-LDL and ox-PAPC, iso-PGE2 but not iso-PGF2{alpha} had an inhibitory effect on the induction of alkaline phosphatase activity in MC3T3-E1 preosteoblasts (Fig 7BDown), suggesting the inhibition of normal differentiation in these cells.



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Figure 7. Effect of isoprostanes on CVCs and MC3T3-E1 alkaline phosphatase activity. CVCs (A) or MC3T3-E1 cells (B) at 80% confluence were treated with control buffer (0) or 1 to 50 µmol/L iso-PGE2 or iso-PGF2{alpha} for 6 days. Alkaline phosphatase activity was measured in total cell homogenates, and results from a representative of three experiments are shown as the mean±SD of quadruplicate determinations.

Effect of MM-LDL on DNA Synthesis
Differentiation of osteoblastic cells is associated with the inhibition of proliferative activity.11 As a measure of proliferation, we examined the effect of MM-LDL on DNA synthesis in CVCs and MC3T3-E1 by the method of [3H]thymidine incorporation. Treatment of CVCs at 80% confluence with 250 µg/mL MM-LDL or native LDL for 24 hours in the presence of [3H]thymidine showed no significant change in the incorporation of the label with either agent (data not shown). However, after 6 days of treatment with MM-LDL, there was a 40% inhibition in DNA synthesis; treatment with native LDL had no effect (Fig 8ADown). In further contrast to the response of CVCs, MM-LDL stimulated DNA synthesis in MC3T3-E1 cells (Fig 8BDown).



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Figure 8. Effect of MM-LDL and native LDL on DNA synthesis. CVCs (A) or MC3T3-E1 (B) at 80% confluence were treated with control buffer, MM-LDL, or native LDL (N-LDL) for 6 days. The lipoproteins (250 µg/mL and 125 µg/mL) were used for CVCs and MC3T3-E1 cells, respectively. The cells were pulsed with 1 µCi/mL [3H]thymidine during the last 24 hours of incubation and its incorporation was quantitated by scintillation counting. Results from a representative of two experiments are shown as the mean±SD of quadruplicate determinations. P<.005 for MM-LDL vs control.

Effect of MM-LDL on MC3T3-E1 Calcification
The effect of MM-LDL on calcification in the MC3T3-E1 cultures was determined by von Kossa staining and 45Ca accumulation assay.37 After 2 weeks in culture, von Kossa staining showed extensive calcification, which was inhibited by MM-LDL incubation (Fig 9ADown). The inhibitory effect of MM-LDL on calcification of MC3T3-E1 was also shown by the inhibition of 45Ca accumulation (Fig 9BDown). This was further evidence that in the presence of MM-LDL, the differentiation and hence mineralization of MC3T3-E1 cells was inhibited.



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Figure 9. Effect of MM-LDL on MC3T3-E1 calcification. MC3T3-E1 cells at 80% confluence were treated with control buffer or MM-LDL at 250 µg/mL for 2 weeks, followed by Von Kossa staining of control (A, left panel) and MM-LDL–treated (A, right panel) cells. B, 45Ca accumulation assay, as described in "Methods," is shown.


*    Discussion
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*Discussion
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The paradox of osteoporosis in the face of atherosclerotic calcification,28 29 30 31 32 involving bone mineral loss in one location and its formation in another, suggests that neither process is attributable to simple systemic calcium excess or deficiency. The present study is the first to report on the possible role of oxidized lipids, which have an established role in atherogenesis,16 in both vascular calcification and osteoporosis.

On the basis of characteristic morphological changes, inhibition of proliferation, induction of alkaline phosphatase, and formation of extensive cellular condensations containing calcium mineral, we determined that treatment of cloned CVCs with MM-LDL but not native LDL induced osteoblastic differentiation. We have consistently observed that in long-term CVC cultures, calcification is limited to areas of abundant matrix within the condensation and eventually covers the entire condensation. We refer to these areas as being "competent for calcification." Although the total area competent for calcification was increased by MM-LDL, the calcification appeared less dense in treated versus control cultures. This observation suggests that MM-LDL treatment may prolong the stage of matrix maturation,11 when matrix competent for calcification is formed. Therefore, we anticipate that with longer time in culture, dense calcification would appear throughout the condensation network in MM-LDL–treated cultures. However, due to time limitations on cell survival in culture, such prolonged experiments are not possible. It is also possible that MM-LDL can induce osteoblastic differentiation of CVCs without an immediate effect on calcification. Unexpectedly, in contrast to CVCs, treatment of preosteoblastic MC3T3-E1 cells with MM-LDL inhibited their differentiation, as indicated by the stimulation of proliferation, inhibition of alkaline phosphatase activity, and inhibition of calcification. Similar to the effects of MM-LDL, ox-PAPC and iso-PGE2 also induced prodifferentiation and antidifferentiation effects on CVCs and MC3T3-E1 bone preosteoblasts, respectively. These observations suggest that isoprostanes may be important molecules in vascular disease and require further attention. In addition, the formation of oxidized phospholipids in the plasma membrane of intact or dying cells in response to oxidative stress41 may contribute to the earliest events in ectopic calcification under oxidative stress.

The in vivo relevance of the effects of oxidized lipids on osteoblastic cells may not be immediately apparent. However, given that bone is a highly vascular tissue and its building block, the osteon, closely resembles the artery wall (Fig 10Down), it is clear that lipoprotein accumulation in the subendothelial spaces of bone could affect osteoblasts. The osteon is centered on an endothelial cell–lined blood lumen surrounded by a subendothelial space containing matrix and fibroblast-like cells, which is in turn surrounded by preosteoblasts and osteoblasts occupying a position analogous to smooth muscle cells in the artery wall. Trabecular bone osteoblasts also interface with a vascular space, the bone marrow, and its subendothelial spaces. Since histological studies have shown that arteriosclerotic changes, including lipid de-position, occur in bone vasculature,42 we speculate that blood vessels in bone may also be susceptible to lipoprotein entry into the subendothelial space. In addition, similar to the correlation between LDL concentrations in the arterial intima and in plasma, equilibration of LDL concentrations in bone interstitial space with plasma levels might be anticipated. Products of lipoprotein oxidation may then inhibit the differentiation and activity of osteogenic cells, as well as possibly induce migration of monocytes, which in bone tissue differentiate into bone-resorbing osteoclasts. Recently, the stimulatory effect of the antioxidant vitamin E on bone formation in chicks fed a high-fat diet has been reported,43 suggesting a correlation between induction of normal bone growth and inhibition of lipid oxidation.



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Figure 10. Diagram illustrating the similarity of the unit element of bone architecture, the osteon with artery wall, and particularly the presence of a subendothelial space. If accumulation of oxidized lipids in the subendothelial space of bone occurs, it may inhibit mineralization.

Although atherosclerotic vascular calcification occurs earlier in men than in women and the opposite holds for osteoporosis, these differences may be due to the higher peak bone mass in men and the multiple modulating effects of gonadal and steroidal hormones. In addition, in the age range when osteoporosis afflicts women (after menopause), vascular calcification and atherosclerotic disease occur as often as in men.44

We conclude that specific oxidized lipids have reciprocal effects on CVCs and bone cells in vitro. Therefore, we suggest that oxidized lipid accumulation in the subendothelial space of arteries promotes arterial calcification and that its accumulation in the subendothelial space of skeletal bone arteries inhibits bone mineral formation. These events may account for the paradox of atherosclerotic calcification in the face of osteoporosis.


*    Selected Abbreviations and Acronyms
 
BASMC = bovine aortic smooth muscle cell
CVC = calcifying vascular cell
ddH2O = deuterium-depleted water
FCS = fetal calf serum
iso-PG = 8-iso prostaglandin
MM-LDL = minimally oxidized LDL
ox-PAPC = oxidized PAPC
PAPC = 1-palmitoyl-2-arachidonoyl-sn-glycero-3- phosphorylcholine


*    Acknowledgments
 
This work was supported in part by NIH grants HL30568 and HL43379, as well as by the Oberkotter Research Foundation, the Stein-Oppenheimer Research Foundation, and the Streisand Research Fund established by The Lincy Foundation.

Received September 25, 1996; accepted January 7, 1997.


*    References
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up arrowResults
up arrowDiscussion
*References
 
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2. Baron MG. Significance of coronary artery calcification. Radiology. 1994;192:613-614. [Free Full Text]

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16. Witztum JL, Steinberg D. Role of oxidized low density lipoprotein in atherogenesis. J Clin Invest. 1991;88:1785-1792.

17. Guyton JR, Klemp KF. Transitional features in human atherosclerosis. Am J Pathol. 1993;143:1444-1457. [Abstract]

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Arterioscler. Thromb. Vasc. Bio.Home page
L. L. Demer
Boning Up (or Down) on Statins
Arterioscler Thromb Vasc Biol, October 1, 2001; 21(10): 1565 - 1566.
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Am. J. Physiol. Lung Cell. Mol. Physiol.Home page
L. J. Janssen
Isoprostanes: an overview and putative roles in pulmonary pathophysiology
Am J Physiol Lung Cell Mol Physiol, June 1, 2001; 280(6): L1067 - L1082.
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Physiol. GenomicsHome page
T. A. DRAKE, E. SCHADT, K. HANNANI, J. M. KABO, K. KRASS, V. COLINAYO, L. E. GREASER III, J. GOLDIN, and A. J. LUSIS
Genetic loci determining bone density in mice with diet-induced atherosclerosis
Physiol Genomics, April 27, 2001; 5(4): 205 - 215.
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J. Clin. Endocrinol. Metab.Home page
W. S. Browner, L.-Y. Lui, and S. R. Cummings
Associations of Serum Osteoprotegerin Levels with Diabetes, Stroke, Bone Density, Fractures, and Mortality in Elderly Women
J. Clin. Endocrinol. Metab., February 1, 2001; 86(2): 631 - 637.
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CirculationHome page
Y. Tintut, J. Patel, F. Parhami, and L. L. Demer
Tumor Necrosis Factor-{alpha} Promotes In Vitro Calcification of Vascular Cells via the cAMP Pathway
Circulation, November 21, 2000; 102(21): 2636 - 2642.
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Arterioscler. Thromb. Vasc. Bio.Home page
F. Parhami, A. Garfinkel, and L. L. Demer
Role of Lipids in Osteoporosis
Arterioscler Thromb Vasc Biol, November 1, 2000; 20(11): 2346 - 2348.
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Arterioscler. Thromb. Vasc. Bio.Home page
A. E. Hak, H. A. P. Pols, A. M. van Hemert, A. Hofman, and J. C. M. Witteman
Progression of Aortic Calcification Is Associated With Metacarpal Bone Loss During Menopause : A Population-Based Longitudinal Study
Arterioscler Thromb Vasc Biol, August 1, 2000; 20(8): 1926 - 1931.
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J Am Coll CardiolHome page
R. F. Redberg, N. Rifai, L. Gee, and P. M. Ridker
Lack of association of C-reactive protein and coronary calcium by electron beam computed tomography in postmenopausal women: implications for coronary artery disease screening
J. Am. Coll. Cardiol., July 1, 2000; 36(1): 39 - 43.
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J Am Coll CardiolHome page
M. Nishino, M. J. Malloy, J. Naya-Vigne, J. Russell, J. P. Kane, and R. F. Redberg
Lack of association of lipoprotein(a) levels with coronary calcium deposits in asymptomatic postmenopausal women
J. Am. Coll. Cardiol., February 1, 2000; 35(2): 314 - 320.
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J. Biol. Chem.Home page
Y. Tintut, F. Parhami, V. Le, G. Karsenty, and L. L. Demer
Inhibition of Osteoblast-specific Transcription Factor Cbfa1 by the cAMP Pathway in Osteoblastic Cells. UBIQUITIN/PROTEASOME-DEPENDENT REGULATION
J. Biol. Chem., October 8, 1999; 274(41): 28875 - 28879.
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Circ. Res.Home page
T. Wada, M. D. McKee, S. Steitz, and C. M. Giachelli
Calcification of Vascular Smooth Muscle Cell Cultures : Inhibition by Osteopontin
Circ. Res., February 5, 1999; 84(2): 166 - 178.
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Genes Dev.Home page
N. Bucay, I. Sarosi, C. R. Dunstan, S. Morony, J. Tarpley, C. Capparelli, S. Scully, H. L. Tan, W. Xu, D. L. Lacey, et al.
osteoprotegerin-deficient mice develop early onset osteoporosis and arterial calcification
Genes & Dev., May 1, 1998; 12(9): 1260 - 1268.
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J. Biol. Chem.Home page
Y. Tintut, F. Parhami, K. Bostrom, S. M. Jackson, and L. L. Demer
cAMP Stimulates Osteoblast-like Differentiation of Calcifying Vascular Cells. POTENTIAL SIGNALING PATHWAY FOR VASCULAR CALCIFICATION
J. Biol. Chem., March 27, 1998; 273(13): 7547 - 7553.
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J. Biol. Chem.Home page
S. Jono, C. Peinado, and C. M. Giachelli
Phosphorylation of Osteopontin Is Required for Inhibition of Vascular Smooth Muscle Cell Calcification
J. Biol. Chem., June 23, 2000; 275(26): 20197 - 20203.
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Circ. Res.Home page
F. Parhami, Y. Tintut, A. Ballard, A. M. Fogelman, and L. L. Demer
Leptin Enhances the Calcification of Vascular Cells : Artery Wall as a Target of Leptin
Circ. Res., May 11, 2001; 88(9): 954 - 960.
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