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Brief Reviews |
From the Department of Cell Biology, Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence to Martha K. Cathcart, PhD, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail cathcam{at}ccf.org
Series Editor: Marschall S. Runge
ATVB In Focus
Extracellular Mediators in Atherosclerosis and Thombosis
Previous Brief Review in this Series:
Brasier AR, Recinos A III, Eledrisi MS. Vascular inflammation and the renin-angiotensin system. 2002;22:12571266.
Moser M. Patterson C. Thrombin and vascular development: a sticky subject. 2003;23:922930.
Major CD, Santulli RJ, Derian CK, Andrade-Gordon P. Extracellular mediators in atherosclerosis and thrombosis: lessons from thrombin receptor knockout mice. 2003;23:931939.
Yin Y-J, Salah Z, Grisaru-Granovsky S, Cohen I, Even-Ram SC, Maoz M, Uziely B, Peretz T, Bar-Shavit R. Human protese-activated receptor 1 expression in malignant epithelia: a role in invasiveness. 2003;23:940944.
Stouffer GA, Smyth SS. Effects of thrombin on interactions between ß3-integrins and extracellular matrix in platelets and vascular cells. 2003;23:19711978.
| Abstract |
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Key Words: monocyte macrophage superoxide anion NADPH oxidase atherosclerosis
| Introduction |
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When circulating in blood, monocytes are resting cells poised to respond to an activating stimulus. In response to such a stimulus, monocytes adhere to activated endothelial cells on the blood vessel wall and extravasate into the adjacent tissue. While residing in the tissue, they differentiate to monocyte-derived macrophages. One of the most immediate responses of monocytes to a variety of activating stimuli is the production of the potent oxygen free radical, superoxide anion. The enzyme complex primarily responsible for the production of this highly reactive oxygen species is the NADPH oxidase complex. Recent studies in mice rendered deficient in a central component of the oxidase have revealed that NADPH oxidasedeficient animals develop significantly less atherosclerosis, as assessed by measuring total atherosclerotic lesion area.4 Therefore, understanding the regulation of the activity of this important enzyme complex may lead to novel therapeutic interventions for preventing atherosclerosis.
Data clearly indicate that monocytes actively contribute to atherosclerotic lesion development.13,5 The production of superoxide anion, as outlined above, also significantly contributes to lesion development. Although many cells in the vascular wall have been shown to be able to produce superoxide anion, monocytes/macrophages are likely a significant source of NADPH oxidasederived superoxide anion in atherosclerotic lesions. It is therefore reasonable to suggest that monocyte/macrophage-derived superoxide anion participates in the pathogenesis of atherosclerosis.
The regulation of the activity of NADPH oxidase in primary human monocyte/macrophages, the predominant inflammatory cell in atherosclerotic vessels, has been the focus of several years of research in our laboratory. This review summarizes our present understanding of the regulation of NADPH oxidase activity in monocyte/macrophages and compares and contrasts the enzyme complex components and oxidase regulation to that in neutrophils and to the related enzyme oxidase complexes expressed in other arterial cells, such as vascular smooth muscle cells. For all of our research, we have activated the monocytic NADPH oxidase using opsonized zymosan, a mimic of a yeast pathogen and a potent NADPH oxidase activator. Clearly, other activators of this complex are present in inflammatory sites, including cytokines. We have identified numerous pathways that are important regulators of NADPH oxidase activation by opsonized zymosan. Although opsonized zymosan is not the likely activator of the oxidase complex in atherosclerosis, it is likely that some of these regulatory pathways are shared. Indeed, it has recently been shown that several regulatory pathways are similar between angiotensin II stimulation of NADPH oxidase and that observed in our model system.68 These regulatory pathways are potential therapeutic targets for regulating superoxide anion production and controlling chronic inflammation. Additional research is needed to identify the best pathways to target in order to intervene in the pathologic contributions of this enzyme complex.
| Monocyte NADPH Oxidase |
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Evidence indicates that the NADPH oxidase of monocytes resembles, but is regulated differently than, the well-studied NADPH oxidase enzyme complex of neutrophils.9 Some examples of these differences are that neutrophils, on stimulation, produce a more immediate respiratory burst (peaking at 2 to 10 minutes, depending on the stimulus), whereas monocytes gradually increase production of superoxide anion. They have peak production at
1 hour that wanes over time but is still detectable after several hours.10,11 Furthermore, after stimulation of monocytes to activate NADPH oxidase, the cells can mount an additional response after sufficient recovery and restimulation. This process is not observed in neutrophils. These differences may contribute to the distinct roles of monocytes/macrophages and neutrophils in chronic versus acute inflammation.11 Additionally, agents that activate NADPH oxidase in neutrophils do not necessarily trigger the NADPH oxidase in monocytes/macrophages, indicating differential regulation likely through alternative signal transduction pathways.12 Thus, it is important to understand the unique pathways regulating NADPH oxidase activity in monocytes.
Because most of what we know about NADPH oxidase regulation and activity has been derived from cell-free components of neutrophils or from intact neutrophils, our laboratory has focused on defining the regulation of NADPH oxidase assembly and activation in monocytes/macrophages. An additional key reason for focusing on understanding this process in monocytes derives from the fact that whereas NADPH oxidase has been shown to promote atherogenesis, neutrophils are not present in the vessel wall either early or late in lesion development. Although other vascular cells express similar oxidases, monocytes/macrophages are a plausible source of superoxide anion in this disease.13
Most of our studies have been conducted on peripheral blood monocytes, isolated by adherence to serum-coated plastic and studied within 24 hours. We therefore refer to the cells prepared in this fashion as monocytes/macrophages. We have confirmed most of our observations in elutriated monocytes and monocyte-derived macrophages (monocytes cultured for 7 to 10 days) and have as yet observed no differences in the regulation of NADPH oxidase activity between these related cells.
It should also be noted that we have focused our studies on the induction of NADPH oxidase activity during the first hour after exposure to the activator; thus, altered gene expression does not contribute to our observations. In contrast, expression of NADPH oxidase components can be induced by treatment with cytokines or growth factors in smooth muscle cells and monocytes/macrophages.1416 This likely contributes to the magnitude of superoxide production by these cells but is not a factor in our studies.
| Calcium Influx and Release Are Required |
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| cPLA2 Activity Regulates Monocyte/Macrophage NADPH Oxidase |
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When cPLA2 activity was inhibited with pharmacologic inhibitors or cPLA2 protein expression was inhibited by treatment with specific antisense oligodeoxyribonucleotides (ODN), NADPH oxidase activity was impaired. Importantly, the addition of one of the major products of cPLA2 activity, arachidonic acid (AA), restored NAPDH oxidase activity in the cPLA2-deficient monocytes.21 This result indicated that the production of AA by cPLA2 was an essential regulator of monocyte/macrophage NADPH oxidase activity (see the scheme in the Figure).
To additionally understand the role for cPLA2 and its product AA in regulating NADPH oxidase activity, we conducted a series of experiments exploring the effect of blocking cPLA2 expression on the phosphorylation and assembly of the central NADPH oxidase components p47phox and p67phox. These studies revealed that oxidase assembly was blocked when cPLA2 expression was inhibited by treatment with antisense ODN.23 Specifically, the cytosol to membrane translocation of p47phox and p67phox was prevented in cPLA2-deficient monocytes. The addition of AA to cPLA2-deficient monocytes restored translocation of both p47phox and p67phox, thus allowing the normal, activation-induced assembly of the oxidase and superoxide anion production.23 These results strongly support the conclusion that AA, derived from cPLA2 activity, contributes to the translocation of essential NADPH oxidase components, allowing for assembly of the active enzyme complex. Our laboratory is presently investigating the mechanisms whereby AA regulates the translocation of NADPH oxidase components (summarized in the Figure).
| Regulation of NADPH Oxidase by Component Phosphorylation: Protein Kinase C Is Essential |
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PKC comprises an enzyme family that mediates the phosphorylation of serine and threonine on proteins with particular amino acid motifs. The PKC family is comprised of several isoenzymes that can be distinguished from each other by amino acid sequence, calcium dependence, phospholipid regulation, substrate specificity, and intracellular localization. Members of this enzyme family serve as important mediators of signal transduction. The PKC family is comprised of several isoenzymes (presently 12 members). They can be divided into 3 subtypes: cPKC (classical PKC), nPKC (novel PKC), and aPKC (atypical PKC).2628
Our early studies indicated a requirement for PKC activity in the activation of the NADPH oxidase. We showed that monocytes express several PKC isoforms, including PKC
, PKCßI, PKCßII, PKC
, PKC
, and PKC
. The expression of each of these isoforms was induced upon monocyte activation.7 PKC activity also increased and translocated from the soluble to the particulate cell fraction. The activity of the cPKC group of PKC isoenzymes is regulated by calcium, and, based on our prior studies showing the critical role for calcium, this group was therefore singled out as a likely participant for regulating NADPH oxidase. The cPKC isoenzymes consist of PKC
, PKCßI, PKCßII, and PKC
. PKC inhibitors and antisense ODN specific for a conserved mRNA sequence shared among the cPKC family members blocked NADPH oxidase activity.29 The cPKC isoenzymes expressed in monocytes are PKC
, PKCßI, and PKCßII. Additional studies using isoenzyme-specific antisense ODN revealed that PKC
was required for superoxide anion production and the related oxidation of LDL, whereas PKCßI and PKCßII were not involved.7
Relationship Between PKC and cPLA2
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was shown to be required for mediating the phosphorylation and activation of cPLA2. When monocytes were rendered deficient in PKC
expression, also using specific antisense ODN, the activity of NADPH oxidase could be restored by AA.7 This finding reveals that PKC
is solely required for mediating the phosphorylation and activation of cPLA2 and thereby regulates the production of superoxide anion (Q. Li et al, unpublished data, 2003) (Figure).
Although the aforementioned studies demonstrate that PKC
is the cPKC enzyme that is required for NADPH oxidase activity, these studies do not rule out the involvement of other PKC isoenzymes in regulating superoxide anion production by NADPH oxidase, eg, members of the aPKC and nPKC groups. In addition to the dedicated role of PKC
in regulating NADPH oxidase activity via cPLA2, we have recently discovered that another PKC isoform regulates NADPH oxidase activity.
Using a pharmacologic inhibitor and specific antisense ODN, our recent studies indicate that PKC
expression and activity are also required for NADPH oxidase activity. Our results indicate that PKC
is required for the phosphorylation of both p47phox and p67phox (E.A. Bey and M.K. Cathcart, unpublished data, 2003; X. Zhao and M.K. Cathcart, unpublished data, 2003). Translocation of both of these NADPH oxidase components is also regulated by PKC
. It thus appears that PKC
controls the phosphorylation of both p47phox and p67phox and regulates their translocation to the membrane fraction and controls the assembly of the active NADPH oxidase complex.
We are careful to interpret these data at face value. Although it is tempting to speculate that PKC
directly phosphorylates p47phox and p67phox, our data do not prove that this is the case. Our studies indicate that PKC
regulates phosphorylation of these components, but direct phosphorylation in vivo remains to be determined. To begin to assess this, we examined whether recombinant PKC
could phosphorylate p47phox and p67phox in vitro and found that both NADPH oxidase components were directly phosphorylated (E.A. Bey and M.K. Cathcart, unpublished data, 2003; X. Zhao and M.K. Cathcart, unpublished data, 2003). We are now investigating the location of the phosphorylation sites on p47phox and p67phox obtained in vitro and are comparing them to those that are induced in intact cells on monocyte activation.
| Superoxide Anion, NADPH Oxidase, and Atherosclerosis |
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Among the proatherogenic properties of oxidized LDL is the characteristic unregulated uptake of this modified lipoprotein by macrophages that thereby contributes to the formation of foam cells. Numerous other proatherogenic biologic activities have been attributed to oxidized LDL.38
As mentioned, our laboratory was the first to demonstrate that activated monocytes could oxidize LDL.37,39 This was found to be a unique activity of leukocytes, because they are the only lesion cells that oxidize LDL in the absence of added free metal ions.40 Macrophage-mediated LDL oxidation was shown to be entirely dependent on the production of superoxide anion by the NADPH oxidase enzyme complex.10,41
In atherosclerotic lesions, oxidized lipids are believed to be formed not only by free radical oxidation but also by a variety of enzymatic pathways, including cyclooxygenases and lipoxygenases. We found that oxidized lipid products of 15-lipoxygenase are present in human atherosclerotic lesions, and others have documented that 15-lipoxygenase is expressed in lesion macrophages.42,43 Myeloperoxidase and ceruloplasmin have also been implicated in mediating lipid and LDL oxidation in atherosclerotic lesions.40 It is important to note that superoxide anion is an important mediator of LDL oxidation both as a reactive oxygen radical and as a required substrate or cofactor in the oxidation reactions catalyzed by these enzymes, particularly myeloperoxidase, ceruloplasmin, and lipoxygenases.
Superoxide anion, in addition to mediating LDL oxidation, may contribute to the pathogenesis of atherosclerosis in a variety of other ways. Among these, the production of reactive oxygen species induces stress responses that alter cell function, including adhesion, proliferation, and motility. Superoxide anion is also a very effective scavenger of nitric oxide and can thereby regulate endothelial relaxation and in the process also generate highly reactive peroxynitrite. Thus, superoxide anion has the potential to contribute to atherosclerosis in numerous ways.
NADPH oxidase has been assessed for its contributions to the development of atherosclerosis in mice. Three studies have been performed in animals with gene knockouts of either of 2 central components of this enzyme complex (p47phox or gp91phox).4,44,45 All 3 studies indicate that NADPH oxidase has little or no effect on the development of atherosclerosis in the aortic sinus. In contrast, however, 1 study evaluated total aortic lesions rather than those localized to the aortic sinus. In this study, lesions were dramatically decreased in the p47phox-null, NADPH oxidasedeficient animals.4 The interpretation of these observations was that aortic sinus lesions may be more advanced and differences between the NADPH oxidase-deficient and control animals might be difficult to detect at this stage of lesion development. This interpretation remains to be confirmed.
In addition to the NADPH oxidases of monocytes and neutrophils, several other cell types have been reported to have lower-activity NAD(P)H oxidases. It is believed that the lower production of superoxide anion may function as a second messenger, regulating basic cell functions such as cell growth. This is in striking contrast to the high-activity NADPH oxidase of phagocytes that, in addition to serving as intracellular signaling molecules, also is produced in sufficient quantities for killing microorganisms, mediating tissue injury, and oxidizing lipoproteins. This latter feature of monocyte-derived superoxide anion is believed to contribute to the pathogenesis of atherosclerosis as outlined above; however, the relative contributions of NADPH oxidases from different cell sources remains to be determined.
In the murine studies described above, none of the genetic knockouts were cell- or tissue-specific. It is therefore not possible to determine which cell type, among those with the capacity to produce superoxide anion by this or a similar enzyme complex, was responsible for the observed protection against atherosclerosis. It is important to pursue these studies to discriminate between monocyte/macrophage NADPH oxidase and that of smooth muscle cells or endothelial cells in this disease process. It is of utmost importance to evaluate total aortic lesions in the gp91phox-null animals, because gp91phox is important for phagocyte NADPH oxidase but not for the NAD(P)H oxidase complex of smooth muscle cells. Additional confirmation with bone marrow transplants from p47phox-null mice into atherosclerosis-prone animals would also clarify the source of the disease-promoting NADPH oxidase activity observed in the studies by Barry-Lane et al.4
In summary, it is likely that superoxide anion functions at several different levels in contributing to the pathologic processes in atherosclerotic lesions. Superoxide anion likely participates in direct lipid and lipoprotein oxidation reactions, leading to foam cell formation, and also serves as a precursor for mediating myeloperoxidase and ceruloplasmin oxidation of lipids. Superoxide anion, either directly or indirectly, may alter vascular cell behavior, gene expression, and injury. Each of these roles could significantly contribute to lesion development. Additional experiments are needed to determine the importance of monocyte/macrophage-derived superoxide anion in the pathogenesis of atherosclerosis and to identify the critical regulatory pathways that could serve as targets for therapeutic intervention.
The goal in designing therapeutic agents to regulate monocyte/macrophage NADPH oxidase is to preserve the function of the enzyme complex so that it can function properly in host defense while regulating excessive and chronic superoxide anion production that seems to contribute to inflammatory injury. Identification of the molecular pathways, such as those summarized in the Figure, that regulate NADPH oxidase assembly and activity will help to ascertain the optimal pathways for controlling oxidase activation.
| Acknowledgments |
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The major contributions of the following laboratory members to the work reviewed in this study are greatly appreciated: Venkita Subbulakshmi, Claudine Horton, and Drs Amy McNally, Qing Li, Virginia Folcik, Erik Bey, and Xiaoxian Zhao.
Received May 9, 2003; accepted September 16, 2003.
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