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Arteriosclerosis, Thrombosis, and Vascular Biology. 2008;28:1005-1011
Published online before print February 14, 2008, doi: 10.1161/ATVBAHA.108.162305
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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2008;28:1005.)
© 2008 American Heart Association, Inc.


Clinical and Population Studies

A Potential Role of the CXC Chemokine GRO{alpha} in Atherosclerosis and Plaque Destabilization

Downregulatory Effects of Statins

Unni M. Breland; Bente Halvorsen; Johanna Hol; Erik Øie; Gabrielle Paulsson-Berne; Arne Yndestad; Camilla Smith; Kari Otterdal; Ulf Hedin; Torgun Wæhre; Wiggo J. Sandberg; Stig S. Frøland; Guttorm Haraldsen; Lars Gullestad; Jan K. Damås; Gøran K. Hansson; Pål Aukrust

From the Research Institute for Internal Medicine (U.M.B., B.H., A.Y., C.S., K.O., T.W., W.J.S., S.S.F., J.K.D., P.A.), the Department of Pathology (J.H., G.H.), the Department of Cardiology (E.Ø., L.G.), the Institute for Surgical Research (E.Ø.), and the Section of Clinical Immunology and Infectious Diseases (S.S.F., J.K.D., P.A.), Rikshospitalet, University of Oslo, Norway; and the Department of Surgery (U.H.) and the Department of Medicine and Centre for Molecular Medicine (G.P.-B., G.K.H.), Karolinska University Hospital, Stockholm, Sweden.

Correspondence to Unni M. Breland, Research Institute for Internal Medicine, Rikshospitalet, N-0027 Oslo, Norway. E-mail Unni.Mathilde. Breland{at}rr-research.no


*    Abstract
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*Abstract
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Objective— We examined the role of the CXCR2 ligand growth-related oncogene (GRO) {alpha} in human atherosclerosis.

Methods and Results— GRO{alpha} levels were examined by enzyme immunoassay, real-time quantitative RT-PCR, and cDNA microarrays. The in vitro effect of statins on GRO{alpha} was examined in endothelial cells and THP-1 macrophages. Our main findings were: (1) GRO{alpha} was among the 10 most differentially expressed transcripts comparing peripheral blood mononuclear cells (PBMCs) from patients with coronary artery disease (CAD) and healthy controls. (2) Both patients with stable (n=41) and particularly those with unstable (n=47) angina had increased plasma levels of GRO{alpha} comparing controls (n=20). (3) We found increased expression of GRO{alpha} within symptomatic carotid plaques, located to macrophages and endothelial cells. (4) GRO{alpha} enhanced the release of matrix metalloproteinases in vascular smooth muscle cells, and increased the binding of acetylated LDL in macrophages. (5) Atorvastatin downregulated GRO{alpha} levels as shown both in vitro in endothelial cells and macrophages and in vivo in PBMCs from CAD patients. (6) The effect on GRO{alpha} in endothelial cells involved increased storage and reduced secretion of GRO{alpha}.

Conclusions— GRO{alpha} could be involved in atherogenesis and plaque destabilization, potentially contributing to inflammation, matrix degradation, and lipid accumulation within the atherosclerotic lesion.

The involvement of CXCR2 in atherogenesis is well recognized, thought to reflect interaction with interleukin-8. In the present study we found another CXCR2 ligand (ie, GRO{alpha}) to be significantly upregulated in human atherosclerosis both in circulating leukocytes and within the atherosclerotic lesion, potentially promoting matrix degradation, lipid accumulation, and inflammation.


Key Words: atherosclerosis • chemokines • inflammation • endothelium


*    Introduction
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up arrowAbstract
*Introduction
down arrowMaterials and Methods
down arrowResults
down arrowDiscussion
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Coronary artery disease (CAD) is a chronic progressive disorder where the pathogenesis is multifactorial and involves lipid deposition, thrombus formation, matrix degradation, and inflammation. In all steps of this process, regulation by inflammatory cytokines seems to play a central role, but there are still issues to be clarified, and the precise mechanisms of action of each of the inflammatory participants have not been elucidated.1

Chemokines are thought to be important actors in the inflammatory process characterizing atherogenesis and plaque destabilization. Thus, increased expression of IL-82 and monocyte chemoattractant protein (MCP)-13 has been found within atherosclerotic plaques in humans, and targeted disruption of the genes for MCP-1,4 CCR2 (ie, MCP-1 receptor),5 and CXCR2,6 which binds IL-8, significantly decreases atherosclerotic lesion formation in mice prone to developing atherosclerosis. CXCR2 is 1 of 2 functional IL-8 receptors that also bind other CXC chemokines like growth-related oncogene (GRO){alpha}. As no murine IL-8 homologue has been described,7 but disruption of CXCR2 ameliorates murine atherosclerosis, we believe that other CXCR2 ligands are of importance in this process. This hypothesis is strengthened by the observation that GRO{alpha} rather than MCP-1 promotes monocyte arrest in inflamed endothelium in apolipoprotein E–/– mice.8 However, although there are several reports on IL-8 in human CAD, few studies have examined the role of other CXCR2 ligands in human atherosclerosis.

In the present study, we identified GRO{alpha} as a potentially important mediator of atherogenesis by using DNA microarrays to identify transcripts for cytokines in peripheral blood mononuclear cells (PBMCs) that were differently expressed in CAD patients and healthy controls. We further examined the possible role of this CXC chemokine in atherosclerosis by several approaches including clinical studies in CAD patients and experimental studies in cells with relevance to atherogenesis. We also examined the ability of statins to modulate the expression of GRO{alpha} in vitro and in vivo.


*    Materials and Methods
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up arrowIntroduction
*Materials and Methods
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Patients and Controls
In the initial screening experiments with DNA microarrays and subsequent real-time RT-PCR analyses, we used PBMCs from 13 CAD patients with previous myocardial infarction (MI). In a subsequent study we analyzed plasma samples from consecutively recruited angina patients undergoing clinically indicated coronary angiography (supplemental Table I, available online at http://atvb. ahajournals.org). A detailed description of the patient population and procedures for blood collection is given in the Data Supplemental file (available online at http://atvb.ahajournals.org).

Measurement of Matrix Metalloproteinases
Matrix metalloproteinase (MMP) levels in vascular SMC supernatants were measured by multiplex suspension array technology using the BioPlex (Bio-Rad). MMP-1, MMP-2, and MMP-3 multiplexable beads were purchased from R&D Systems.

Enzyme Immunoassay
Levels of GRO{alpha} were measured in duplicates by enzyme immunoassay (R&D Systems).

A detailed description of cell isolation, cell culture experiments, tissue sampling from carotid plaques, immunocytofluorescent staining and confocal microscopy, binding of Alexa-labeled acetylated low-density lipoprotein (acLDL), cDNA microarrays, real-time quantitative RT-PCR, immunohistochemistry, and statistical analyzes is given in the Data Supplemental file.


*    Results
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*Results
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GRO{alpha} Expression in CAD
To screen for genes that were regulated differently in CAD patients and healthy controls, we used oligonucleotide microarrays encoding 8500 human genes to analyze the gene expression profiles in PBMCs isolated from 4 healthy controls and 6 randomly selected patients from the CAD population. When analyzing cytokines or growth factors, GRO{alpha} was among the 10 most differentially expressed transcripts. The increased expression of GRO{alpha} in CAD patients was confirmed by real-time RT-PCR when analyzing PBMCs from 13 CAD patients and 9 healthy controls (Figure 1A). Several studies support a role of CXCR2 in atherogenesis,9 and interestingly, in the initial screening experiment by microarrays, also transcripts of the 2 other GRO-related chemokines (ie, GRO{gamma}, P=0.004 and GROβ, P=0.05) and IL-8 (P=0.05) was upregulated in PBMCs from CAD patients, underscoring the potential importance of GRO-related chemokines in human CAD. As for the other CXCR2 ligands (ie, neutrophil-activating peptide-2, epithelial neutrophil-activating peptide-78, granulocyte chemotactic protein-2, and migration inhibitory factor [MIF]), there were no significant increase in CAD patients as compared with controls.


Figure 1
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Figure 1. A, mRNA levels of GRO{alpha} in PBMCs from 9 controls and 13 CAD patients. **P<0.01 vs controls. B, Plasma levels of GRO{alpha} in 20 controls, 41 patients with stable angina (SAP), and 47 patients with unstable angina (UAP). ***P<0.001 vs controls and ###P<0.001 vs SAP. (For detailed figure legend, please see http://atvb.ahajournals.org).

GRO{alpha} Levels in Stable and Unstable Angina Patients
To examine GRO{alpha} levels in relation to plaque instability, we next analyzed plasma levels of GRO{alpha} in stable and unstable angina patients by means of enzyme immunoassay. Both patients with stable (n=41) and unstable (n=47) angina had increased plasma levels of GRO{alpha} compared to healthy controls (n=20), with particularly high levels in those with unstable disease (Figure 1B). Some of the patients had additional risk factors that could interfere with inflammatory responses (eg, diabetes and hypertension; supplemental Table I), but the same pattern of GRO{alpha} levels was observed even if these patients were excluded from the study. Moreover, although there were a higher proportion of women in the unstable angina group (supplemental Table I), we found the same pattern of GRO{alpha} levels in both genders.

To further examine the systemic expression of GRO{alpha} in angina patients, we analyzed mRNA levels of GRO{alpha} in T cells and monocytes from 14 of the patients with unstable angina, 14 of the patients with stable angina, and in 10 of the controls. As shown in supplemental Figure IA, monocytes from angina patients had increased mRNA levels of GRO{alpha} as compared with controls, reaching statistical significance in those with unstable disease. In contrast, T cells from unstable angina patients tended to express lower GRO{alpha} mRNA levels than T cells from healthy controls and stable angina patients (supplemental Figure IB).

Expression of GRO{alpha} in Human Atherosclerotic Lesions
To characterize GRO{alpha} expression within the atherosclerotic lesion, we analyzed the mRNA levels of GRO{alpha} in atherosclerotic tissue, collected from patients undergoing carotid endarterectomy (n=47), and in control tissue, obtained from iliac arteries of organ donors (n=10), by means of Affymetrix Gene Array analysis (Biobank of Karolinska Endarterectomies study).10 As depicted in supplemental Figure II, carotid plaques showed significantly elevated mRNA levels of GRO{alpha} as compared with control samples from nonatherosclerotic arteries ({approx}2.5 fold increase). Moreover, the expression of GRO{alpha} within the atherosclerotic plauqes was significantly correlated with mRNA levels of CD68 (r=0.29, P=0.04), suggesting that macrophages contribute to the increased expression of GRO{alpha} within these lesions. In line with this, when examining GRO{alpha} expression within the carotid lesions (n=4) by means of immuhistochemistry, we found immunostaining for GRO{alpha} located in lipid-rich areas with strong immunostaining against calprotectin-positive macrophages and within von Willebrand-positive endothelial cells (Figure 2). In nonatherosclerotic renal arteries (n=2) GRO{alpha} immunoreactivity was only seen within the endothelium (data not shown).


Figure 2
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Figure 2. Photomicrographs demonstrating an advanced atherosclerotic carotid lesion (A–D). A, Immunostaining against GRO{alpha}. The region with GRO{alpha} immunoreactivity corresponds both to the area with strong immunostaining against calpro- tectin-positive macrophages (B) and the area (*) with several von Willebrand factor (vWF)-positive endothelial cells (C) and scattered CD3-positive T cells (D). (For detailed figure legend, please see http://atvb.ahajournals.org).

The effect of GRO{alpha} on MMP Release in Vascular SMCs
Our findings so far suggest increased expression of GRO{alpha} in atherosclerotic disorders both systemically and within the plaque, with particularly high levels in those with unstable disease. We have previously reported increased expression of CXCR1 and CXCR2 (ie, the GRO{alpha} receptors) in SMCs and macrophages within human atherosclerotic lesions.11 To map any potential pathogenic consequences of the raised GRO{alpha} levels in atherosclerotic disorders, we therefore first examined the effect of GRO{alpha} on the release of MMP in vascular SMCs. Although GRO{alpha} had no effect on its own, it boosted the release of MMP-1 and MMP-3, induced by low levels of IL-1β (0.1 ng/mL, supplemental Figure III), an inflammatory cytokine that is increased in CAD.12 This enhancing effect was attenuated by adding anti-CXCR2 and anti-CXCR1, but not by control antibodies, suggesting that this GRO{alpha}-mediated effect may involve both CXCR1 and CXCR2 (supplemental Figure III).

GRO{alpha} Enhances Lipid Accumulation in THP-1 Macrophages
We next examined the ability of GRO{alpha} to modulate the interaction between macrophages and lipids. As depicted in Figure 3A and 3B, GRO{alpha} markedly increased the binding of fluorescence-labeled acLDL in THP-1 macrophages, suggesting that this chemokine could promote foam cell formation. AcLDL binds preferentially to SR-A,13 and interestingly, GRO{alpha} enhanced the mRNA levels of the scavenger receptors SR-A and CD36, but not the expression of LOX-1, in THP-1 macrophages (Figure 3C). The combined increase in SR-A and CD36 expression in GRO{alpha}-activated macrophages further support a role for GRO{alpha} in lipid accumulation and foam cell formation. Finally, the enhancing effect of GRO{alpha} on acLDL binding was nearly abolished by adding anti-CXCR2, with a moderate and not significant effect of anti-CXCR1 antibodies (Figure 3D).


Figure 3
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Figure 3. A, Binding of Alexa-labeled acLDL in THP-1 macrophages. B, Morphological evaluation of 1 representative experiment. C, The effect of GRO{alpha} on mRNA levels of SR-A, LOX-1, and CD36 in THP-1 macrophages. D, The ability of neutralizing antibodies (Ab) against CXCR1 and CXCR2 to attenuate the GRO{alpha}-mediated effect on acLDL binding. (For detailed figure legend, please see http://atvb.ahajournals.org).

Effects of Statins on GRO{alpha} in Endothelial Cells
Experimental and some clinical data indicate that statins may confer some of their cardiovascular benefits by modulating the inflammatory arm of atherosclerosis.14 We therefore next examined the ability of the atorvastatin metabolite ortho-hydroxy atorvastatin to modulate the levels of GRO{alpha} in endothelial cells and macrophages, both cell types showing strong GRO{alpha} immunoreactivity within the atherosclerotic carotid plaques. To mimic the in vivo situation in atherosclerosis, the cells were stimulated for 20 hours with IL-1β (5 ng/mL). Ortho-hydroxy atorvastatin induced a modest, but significant decrease in GRO{alpha} release from IL-1β–activated HUVECs, and this inhibition was attenuated by the addition of mevalonate, suggesting that this effect of statin may be operative at the cellular level (supplemental Figure IVA). In contrast, ortho-hydroxy atorvastatin had no effect on gene expression of GRO{alpha} in resting or IL-1–activated HUVECs, suggesting that ortho-hydroxy atorvastatin inhibits GRO{alpha} release from endothelial cells at the post-transcriptional level (supplemental Figure IVB). This observation combined with our recent demonstration that GRO{alpha} can be stored in small secretagogue-responsive cytoplasmic granules15 led us to perform paired immunostaining and confocal analysis, showing that ortho-hydroxy atorvastatin in a dose-dependent manner significantly increased GRO{alpha} staining in IL-1β-activated HUVECs (Figure 4). Signal was detected in the Golgi apparatus and in cytoplasmic granula that with ortho-hydroxy atorvastatin treatment became larger and more numerous (Figure 4). These findings suggest that ortho-hydroxy atorvastatin inhibits exocytosis of IL-1β–induced GRO{alpha}, but not the transcription of this chemokine.


Figure 4
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Figure 4. Immunostaining of GRO{alpha} in HUVECs, pretreated with ortho-hydroxy atorvastatin at 0 µmol/L (A), 1 µmol/L (B), 10 µmol/L (C), and 33 µmol/L (D), followed by stimulation with IL-1β (5 ng/mL) in the presence of atorvastatin. Ortho-hydroxy atorvastatin caused a dose-dependent increase in total fluorescence per cell (E). (For detailed figure legend, please see http://atvb.ahajournals.org).

Effects of Statins on the Release of GRO{alpha} in Macrophages
The release of GRO{alpha} was markedly increased during differentiation of THP-1 cells from monocytes to macrophages (data not shown), and ortho-hydroxy atorvastatin significantly reduced the IL-1β–induced (10 ng/mL) secretion of GRO{alpha} in THP-1 macrophages after culturing for 24 hours (Figure 5A). However, in contrast to HUVECs, this downregulatory effect of ortho-hydroxy atorvastatin was also seen at mRNA level, and this effect was reversed by mevalonate (Figure 5B).


Figure 5
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Figure 5. THP-1 macrophages were incubated with ortho-hydroxy atorvastatin (10 µmol/L), IL-1β (10 ng/mL), or a combination thereof and assessed for GRO{alpha} at the protein (A) and mRNA (B) levels. In B, mevalonate (100 µmol/L) was also included. ***P<0.001 vs unstimulated (Unstim) cells. #P<0.05 vs cells stimulated with IL-1β alone. (For detailed figure legend, please see http://atvb.ahajournals.org).

The In Vivo Effects of Statins on GRO{alpha} Expression in PBMCs
To examine the in vivo relevance of the statin-mediated effects on GRO{alpha} in vitro, we analyzed the mRNA levels of GRO{alpha} by real time RT-PCR in PBMCs before and after 6 months of atorvastatin therapy (80 mg qd). We have previously reported the effect of low-dose simvastatin and high-dose atorvastatin on inflammatory markers in CAD patients without previous statin treatment,16 and from this study, PBMCs were available from 8 patients (age 60.3±3.1 years, 1 woman and 7 men) randomly assigned to atorvastatin treatment. The decrease in lipid parameters during statin therapy (data not shown) was accompanied by a significant decrease in gene expression of GRO{alpha} in PBMCs (Figure 6A). However, there was no significant correlation between the decrease in LDL cholesterol and the decrease in GRO{alpha} expression during statin therapy (Figure 6B), suggesting that the decrease in GRO{alpha} may not be secondary to lipid lowering. Finally, based on Affymetrix gene array data from PBMCs in 6 CAD patients before and 6 months after initiating therapy, we found a downregulatory effect of atorvastatin not only on GRO{alpha}, but also on the 2 other members of the GRO family (ie, GROβ and GRO{gamma}, P<0.03 for both), underscoring the ability of atorvastatin to downregulate GRO-related chemokines in CAD.


Figure 6
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Figure 6. A, mRNA levels of GRO{alpha} in PBMCs from 8 CAD patients at baseline and after 6 months (mo) of Atorvastatin (80 mg/d) therapy. B, Correlation between changes in GRO{alpha} mRNA levels in PBMCs and changes in serum LDL cholesterol during the study. (For detailed figure legend, please see http://atvb.ahajournals.org).


*    Discussion
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up arrowAbstract
up arrowIntroduction
up arrowMaterials and Methods
up arrowResults
*Discussion
down arrowReferences
 
High-level expression of CXCR2 by macrophages has been detected in advanced atherosclerotic lesions of patients11 and LDL receptor (LDLR)-deficient mice.6 CXCR2 expression has also been shown to be proatherogenic in that CXCR2 deficiency significantly reduces the progression of advanced atherosclerosis in mice.6 Although most attention has been directed against IL-8 as a CXCR2 ligand in this process, there are also reports of increased GRO{alpha} expression in relation to atherogenesis. To this end, inflammatory cytokines (eg, IL-1 and tumor necrosis factor [TNF] {alpha}), thrombin, oxidized LDL (oxLDL), and shear stress have all been found to induce GRO{alpha} expression in endothelial cells.17–21 Shear stress has also been reported to induce GRO{alpha} expression in murine atherosclerosis,22 and we have previously reported raised plasma levels of GRO{alpha} in angina patients.23 Herein, we extend these findings by identifying GRO{alpha} as one of the most strongly induced cytokines in PBMCs from CAD patients when compared to healthy individuals. Upregulation of GRO{alpha} was also related to plaque instability as shown by particularly elevated GRO{alpha} expression in unstable angina, as demonstrated both at the protein (plasma) and mRNA (monocytes) level. The relevance of our findings to human atherosclerosis was further supported by observing increased expression of GRO{alpha} within symptomatic carotid plaques, primarily located to macrophages and endothelial cells. These data indicate that GRO{alpha} should be added to the list of CXCR2 ligands that could be involved in atherogenesis and plaque destabilization in man.

In the present study we found increased expression of GRO-related chemokines (ie, GRO{alpha}, GROβ, and GRO{gamma}) and IL-8, but not of the other CXCR2 ligands, in PBMCs from CAD patients. This, however, does not exclude an important role for other CXCR2 ligands in atherogenesis. Hence, deficiency in leukocyte CXCR2 was recently reported to have more profound effects on atherogenesis in LDLR–/– mice than deficiency in GRO{alpha}, supporting the importance of additional CXCR2 ligands.24 Moreover, MIF, a recently described functional noncognate ligand for CXCR2,25 has been shown to be crucial for plaque progression and an unstable plaque phenotype.25,26 However, these data are based on in vitro experiments and studies in animal models, and the relative importance of the various CXCR2 ligands in atherogenesis and plaque destabilization in human will have to be further elucidated.

Previous studies have shown that GRO{alpha} can support monocyte arrest to endothelium in models of inflammation.19 The relevance of this to atherosclerosis was recently shown by Boisvert et al demonstrating that deficiency of murine GRO{alpha} was associated with a loss of intimal macrophages and attenuated disease progression in LDLR–/– mice.24 In the present study, we show that the proatherogenic effects of GRO{alpha} may not be limited to chemotactic and firm adhesion-activating properties. We found that this CXC chemokine also has the ability to enhance IL-1–driven MMP secretion in vascular SMCs, potentially transforming these cells into a secretory phenotype thought to affect the vulnerability of the plaque. Although GRO{alpha} had no MMP-inducing effect alone, it is reasonable to assume that within an atherosclerotic plaque, GRO{alpha} interacts with other inflammatory mediators that most likely include low levels of IL-1β.12 Moreover, whereas GRO{alpha} has been reported to promote macrophage accumulation within atherosclerotic lesions in murine models,24 we show that GRO{alpha} also enhanced the binding of acLDL to THP-1 macrophages in a CXCR2-dependent manner, potentially promoting foam cell formation. Thus, although oxLDL has been shown to induce GRO{alpha} expression in endothelial cells24 and PBMCs,27 our present findings indicate that GRO{alpha} in turn may enhance the accumulation of modified LDL in macrophages. If such mechanisms operate in vivo within an atherosclerotic lesion, they could be part of a pathogenic loop, representing a molecular link between inflammation, lipid accumulation, and matrix degradation during atherogenesis.

Several reports suggest that statins may confer cardiovascular benefits in addition to their lipid lowering activity, at least partly by modulating the inflammatory arm of atherosclerosis.14,28 In the present study, we demonstrated downregulatory effects of atorvastatin on GRO{alpha} levels as shown both in vitro in endothelial cells and macrophages and in vivo in PBMCs from CAD patients. However, the mechanism by which atorvastatin inhibits GRO{alpha} release seems to differ between endothelial cells and macrophages. Thus, whereas the atorvastatin-mediated downregulation of GRO{alpha} in macrophages was seen both at the protein and mRNA levels, the effect on GRO{alpha} release in endothelial cells appears to operate at the posttranscriptional level and involves increased storage and reduced secretion of GRO{alpha}. Lipophilic statins have previously been reported to suppress NK cell activity through inhibition of the exocytosis pathway,29 and Yamakuchi et al30 reported that simvastatin suppresses exocytosis of Weibel-Palade bodies by endothelial cells. We have recently showed that GRO{alpha} is stored in endothelial cells and released from an intracellular compartment distinct from the IL-8/eotaxin-3-containing Weibel-Palade bodies,15 and our findings suggest that statins may enhance sorting of these granules but inhibit secretion. Inhibition of endothelial cell exocytosis could represent a novel mechanism by which statins reduce vascular inflammation involving decreased release of chemokines such as GRO{alpha}.

Several lines of evidence support a pathogenic role of chemokines in atherogenesis and plaque destabilization.31 Our present findings suggest that the CXC chemokine GRO{alpha} could be an important mediator in these processes, potentially contributing to inflammation, matrix degradation, and lipid accumulation within the atherosclerotic lesion. The gradual increase in GRO{alpha} levels in relation to plaque instability, potentially at least partly reflecting increased release from the plaque, suggest that forthcoming studies should explore the potential role of GRO{alpha} as a prognostic marker in atherosclerosis. Our demonstration of increased GRO{alpha} expression both in the circulation and within the atherosclerotic lesion in patients with atherosclerotic disorders also underscores that the proatherogenic effects of GRO{alpha} are operational in vivo, potentially representing a novel therapeutic target in atherosclerosis.


*    Acknowledgments
 
The authors thank Ellen Lund Sagen and Morten Mattingsdal (Joint Centre for Bioinformatics, Oslo) for excellent technical assistance.

Sources of Funding

This work was supported by grants from the Norwegian Council of Cardiovascular Research, Research Council of Norway, University of Oslo, Medinnova Foundation, Helse Sør, Rikshospitalet, Swedish Medical Research Council, and Swedish Heart-Lung Foundation.

Disclosures

None.


*    Footnotes
 
B.H. and J.H. contributed equally to this study.

Original received October 24, 2007; final version accepted January 29, 2008.


*    References
up arrowTop
up arrowAbstract
up arrowIntroduction
up arrowMaterials and Methods
up arrowResults
up arrowDiscussion
*References
 
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P. Aukrust, B. Halvorsen, A. Yndestad, T. Ueland, E. Oie, K. Otterdal, L. Gullestad, and J. K. Damas
Chemokines and Cardiovascular Risk
Arterioscler Thromb Vasc Biol, November 1, 2008; 28(11): 1909 - 1919.
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