Skip to main content
  • American Heart Association
  • Science Volunteer
  • Warning Signs
  • Advanced Search
  • Donate

  • Home
  • About this Journal
    • Editorial Board
    • Meet the Editors
    • ATVB Journal History
    • General Statistics
  • All Issues
  • Subjects
    • All Subjects
    • Arrhythmia and Electrophysiology
    • Basic, Translational, and Clinical Research
    • Critical Care and Resuscitation
    • Epidemiology, Lifestyle, and Prevention
    • Genetics
    • Heart Failure and Cardiac Disease
    • Hypertension
    • Imaging and Diagnostic Testing
    • Intervention, Surgery, Transplantation
    • Quality and Outcomes
    • Stroke
    • Vascular Disease
  • Browse Features
    • Cover Art Award
    • ATVB Early Career Award
    • ATVB in Focus
    • Recent Brief Reviews of ATVB
    • Lecture Series
    • Collections
    • Recent Highlights of ATVB
    • Commentaries
    • Browse Abstracts
    • Insight into ATVB Authors
  • Resources
    • Instructions for Authors
    • Online Submission/Peer Review Site
    • Council on ATVB
    • Permissions and Rights Q&A
    • AHA Guidelines and Statements
    • Customer Service and Ordering Information
    • Author Reprints
    • International Users
    • AHA Newsroom
  • AHA Journals
    • AHA Journals Home
    • Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB)
    • Circulation
    • → Circ: Arrhythmia and Electrophysiology
    • → Circ: Genomic and Precision Medicine
    • → Circ: Cardiovascular Imaging
    • → Circ: Cardiovascular Interventions
    • → Circ: Cardiovascular Quality & Outcomes
    • → Circ: Heart Failure
    • Circulation Research
    • Hypertension
    • Stroke
    • Journal of the American Heart Association
  • Facebook
  • LinkedIn
  • Twitter

  • My alerts
  • Sign In
  • Join

  • Advanced search

Header Publisher Menu

  • American Heart Association
  • Science Volunteer
  • Warning Signs
  • Advanced Search
  • Donate

Arteriosclerosis, Thrombosis, and Vascular Biology

  • My alerts
  • Sign In
  • Join

  • Facebook
  • LinkedIn
  • Twitter
  • Home
  • About this Journal
    • Editorial Board
    • Meet the Editors
    • ATVB Journal History
    • General Statistics
  • All Issues
  • Subjects
    • All Subjects
    • Arrhythmia and Electrophysiology
    • Basic, Translational, and Clinical Research
    • Critical Care and Resuscitation
    • Epidemiology, Lifestyle, and Prevention
    • Genetics
    • Heart Failure and Cardiac Disease
    • Hypertension
    • Imaging and Diagnostic Testing
    • Intervention, Surgery, Transplantation
    • Quality and Outcomes
    • Stroke
    • Vascular Disease
  • Browse Features
    • Cover Art Award
    • ATVB Early Career Award
    • ATVB in Focus
    • Recent Brief Reviews of ATVB
    • Lecture Series
    • Collections
    • Recent Highlights of ATVB
    • Commentaries
    • Browse Abstracts
    • Insight into ATVB Authors
  • Resources
    • Instructions for Authors
    • Online Submission/Peer Review Site
    • Council on ATVB
    • Permissions and Rights Q&A
    • AHA Guidelines and Statements
    • Customer Service and Ordering Information
    • Author Reprints
    • International Users
    • AHA Newsroom
  • AHA Journals
    • AHA Journals Home
    • Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB)
    • Circulation
    • → Circ: Arrhythmia and Electrophysiology
    • → Circ: Genomic and Precision Medicine
    • → Circ: Cardiovascular Imaging
    • → Circ: Cardiovascular Interventions
    • → Circ: Cardiovascular Quality & Outcomes
    • → Circ: Heart Failure
    • Circulation Research
    • Hypertension
    • Stroke
    • Journal of the American Heart Association
Cell Biology/Signaling

MicroRNA-16 and MicroRNA-424 Regulate Cell-Autonomous Angiogenic Functions in Endothelial Cells via Targeting Vascular Endothelial Growth Factor Receptor-2 and Fibroblast Growth Factor Receptor-1

Aránzazu Chamorro-Jorganes, Elisa Araldi, Luiz O.F. Penalva, Devraj Sandhu, Carlos Fernández-Hernando, Yajaira Suárez
Download PDF
https://doi.org/10.1161/ATVBAHA.111.236521
Arteriosclerosis, Thrombosis, and Vascular Biology. 2011;31:2595-2606
Originally published October 19, 2011
Aránzazu Chamorro-Jorganes
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Elisa Araldi
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Luiz O.F. Penalva
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Devraj Sandhu
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Carlos Fernández-Hernando
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Yajaira Suárez
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Supplemental Materials
  • Info & Metrics
  • eLetters

Jump to

  • Article
    • Abstract
    • Introduction
    • Materials and Methods
    • Results
    • Discussion
    • Sources of Funding
    • Disclosures
    • Acknowledgments
    • References
  • Figures & Tables
  • Supplemental Materials
  • Info & Metrics
  • eLetters
Loading

Abstract

Objective—MicroRNAs play key roles in modulating a variety of cellular processes by posttranscriptional regulation of their target genes. Vascular endothelial growth factor (VEGF), VEGF receptor-2 (VEGFR2), and fibroblast growth factor receptor-1 (FGFR1) were identified by bioinformatic approaches and subsequently validated as targets of microRNA (miR)-16 and miR-424 in endothelial cells (ECs).

Methods and Results—Mimetics of these microRNAs reduced VEGF, VEGFR2, and FGFR1 expression, whereas specific antagonists enhanced their expression. Expression of mature miR-16 and miR-424 was upregulated on VEGF or basic fibroblast growth factor (bFGF) treatment. This upregulation was accompanied by a parallel increase in primary transcript (pri-miR)-16-1 and pri-miR-16-2 but not in pri-miR-424 levels, indicating a VEGF/bFGF-dependent transcriptional and posttranscriptional regulation of miR-16 and miR-424, respectively. Reduced expression of VEGFR2 and FGFR1 by miR-16 or miR-424 overexpression regulated VEGF and bFGF signaling through these receptors, thereby affecting the activity of downstream components of the pathways. Functionally, miR-16 or miR-424 overexpression reduced proliferation, migration, and cord formation of ECs in vitro, and lentiviral overexpression of miR-16 reduced the ability of ECs to form blood vessels in vivo.

Conclusion—We conclude that these miRNAs fine-tune the expression of selected endothelial angiogenic mediators in response to these growth factors. Altogether, these findings suggest that miR-16 and miR-424 play important roles in regulating cell-intrinsic angiogenic activity of ECs.

  • angiogenesis
  • endothelium
  • microRNAs

Introduction

Angiogenesis is a process by which new vessels are generated from preexisting vasculature.1 Endothelial cells (ECs) play a key role in this process, which depends on the proliferation, migration, and differentiation of these cells.2 A fine balance between positive and negative regulators controls angiogenesis.3 Although there are many angiogenic inducers, vascular endothelial growth factor (VEGF, also termed VEGF-A) and basic fibroblast growth factors (bFGFs, also termed fibroblast growth factor-2 [FGF2]) are probably the most critical and potent ones.4–6 The proangiogenic effect of VEGF and bFGF is mediated through the VEGF receptor-2 (VEGFR2, also termed Flk-1 or KDR), which is selectively expressed in vascular ECs,5 or fibroblast growth factor receptor 1 (FGFR1),6 respectively. Activation of these receptors stimulates the angiogenic cascade in vitro and in vivo.5–8 The regulation of these proangiogenic factors and the signal transduction pathways that regulate proliferation, migration, and differentiation of ECs on activation of their respective receptors has been well studied. However, comparatively less is known about the regulation of VEGFR2 and FGFR1 in ECs, particularly concerning their posttranscriptional regulation involving microRNAs (miRNAs).

See accompanying article on page 2367

miRNAs play central roles in a broad range of biological processes,9 and in many cases, they have been shown to modulate intracellular signaling pathways in animal cells.10–12 miRNAs are initially transcribed as large primary transcripts (pri-miRNAs) that are matured through sequential steps to give rise to a heteroduplex RNA (mature miRNA). They regulate gene expression by inhibiting translation or promoting mRNA degradation mostly through canonical base paring between the seed sequence of the miRNA and its complementary seed match sequence, present in the 3′ untranslated regions (UTRs).13

Reduction of miRNAs by small interfering RNA–mediated knockdown of Dicer in human ECs14,15 or by knockout or conditional inactivation of Dicer in murine endothelium has revealed the importance of endothelial miRNAs in angiogenesis.16,17 To date, several miRNAs have been shown to participate in the control of angiogenesis.18–22 In addition, very recent data also demonstrate that growth factors or cytokines can differentially regulate miRNA expression in ECs. In this scenario, they provide a first line of response following cytokine stimulation, promoting the modulation of EC targets involved in expression programs that control angiogenic responses.16,23

Angiogenesis plays a crucial role in numerous normal physiological processes, such as embryonic development, wound healing, and the menstrual cycle, as well as in various pathological conditions, such as ischemic vascular diseases, diabetic retinopathy, rheumatoid arthritis, and the development of cancer.24 Recent insights suggest that future cancer therapies are likely to consist of a combination of antiangiogenic agents (eg, VEGF inhibitors) and cytotoxic chemotherapies as a venue to inhibit tumor growth. Therefore, the use of miRNAs mimics to regulate both angiogenesis and tumor cell survival might be an important finding in the research and development of effective therapeutic agents.25 In different cancer cells, microRNA (miR)-15a/16-1 and miR-15b/16-2 clusters have been shown to play very important roles in regulating cell proliferation and apoptosis by targeting genes involved in cell cycle progression,26–28 as well as antiapoptotic proteins.29 Interestingly, miR-15b and miR-16 have been shown to control the expression of VEGF in a carcinoma cell line.30 In addition, miR-15b and miR-16 have also been shown to be differentially expressed in endometriosis, in which angiogenesis may be involved in the growth of the endothelium.31,32 Moreover, miR-424 has been reported to be downregulated in senile hemangioma, which is a common vascular anomaly associated with abnormal angiogenesis.33 Altogether, these reports indicate the in vivo relevance of miR-15b, miR-16, and miR-424 in diseases associated with vascular defects. However, the direct effect of these miRNAs on ECs has not been demonstrated. miR-15a, -15b, -16, -195, -424, and -497 have different genomic locations but possess the same seed sequence, which implies that these miRNAs share most of their target genes13 and, furthermore, may strongly influence the expression of their common targets if coexpressed. In the present work, we investigated the role miR-16 and miR-424 in the cell-intrinsic angiogenic activity of ECs and determined their effects on neovascularization in vivo.

Materials and Methods

Bioinformatic analysis, 3′UTR luciferase reporter assays, Western blot analysis, quantitative real-time polymerase chain reaction, cell number assessment, crystal violet staining method, cord formation assay, migration experiments, lentivirus and EC transduction, flow cytometry, and immunofluorescence analyses are described in the supplemental data, available online at http://atvb.ahajournals.org.

Cell Culture

Human umbilical vascular ECs (HUVECs) were purchased from the tissue culture core laboratory of the Vascular Biology and Therapeutics program (Yale University) and serially cultured on 0.1% gelatin-coated flasks in M199/20% FBS supplemented with l-glutamine, penicillin/streptomycin (Gibco), and EC growth supplement (BD Biosciences) with heparin from porcine intestines as described.15,34,35 Bovine aortic ECs and human aortic ECs were purchased from Lonza and cultured in Dulbecco's modified Eagle's medium/10% FBS and EBM-2/20% FBS, respectively.

Mice

All animal experiments were approved by the Institutional Animal Care Committee of New York University Medical Center. Twelve-week-old C.B-17-SCID beige mice were obtained from the Jackson Laboratory.

MicroRNA Transfection

HUVECs, bovine aortic ECs, or human aortic ECs were transfected with 30 nmol/L miRNA mimics (miR-16 and miR-424) or with 60 nmol/L miRNA inhibitors (anti-miR-16 and anti-miR-424) (Dharmacon) using Oligofectamine (Invitrogen) as previously described.15,16,35 The dose of mimics and inhibitors was selected based on dose response experiments. All experimental control samples were treated with an equal concentration of a nontargeting control mimic sequence or inhibitor negative control sequence, for use as controls for nonsequence-specific effects in miRNA experiments. Mock-transfected control (transfection reagent) did not produce any significant effect on any of the parameters analyzed. The efficiency of transfection was greater than 95%, as assessed by transfection with fluorescently labeled miRIDIAN miRNA mimic (miRNA mimic–Alexa Fluor 555) (Dharmacon) for 12 hours, and visualized by fluorescence microscopy 12 hours after transfection. Verification of the degree of miRNA overexpression and inhibition was determined using quantitative reverse transcription–polymerase chain reaction.

In Vivo Analysis of EC Angiogenesis

Human microvessels were generated and implanted in the subcutaneous position on the abdominal wall of C.B-17-SCID beige mice as previously described.34,36 Briefly, transduced HUVECs with scrambled miRNA (scr-miR) or miR-16 were harvested and counted. Then, 3.5×105 cells were suspended in a rat tail type I collagen-human plasma fibronectin gel, and approximately 1 mL of the cell suspension was gently poured into a single well of a 6-well tissue culture plate. The protein gel was polymerized at 37°C, and an equal volume of M199/20% FBS supplemented with endothelial cell growth supplement was added to the well. Eighteen hours after gel polymerization, the gels were removed, bisected, and implanted in the subcutaneous position on the abdominal wall. Two weeks after implantation, half of the animals were euthanized, and the grafts were harvested for analysis of the human microvasculature. Recovered gels and surrounding soft tissue were snap frozen in Tissue-Tek OCT (Sakura Finetek) and used to prepare 6-μm cryosections, which were subsequently stained with hematoxylin and eosin. Sections were also stained with anti-human platelet endothelial cell adhesion molecule-1 (eBioscience) or TRITC-conjugated Ulex europaeus agglutinin (Sigma).

Statistical Analysis

All data are expressed as means±SEM. Statistical differences were measured by either the Student t test or 2-way ANOVA with Bonferroni correction for multiple comparisons when appropriate. A value of P≤0.05 was considered statistically significant. Data analysis was performed using the Prism program (Statistical Graphics).

Results

Prediction of miRNA Targets That Regulate Cell-Intrinsic Angiogenic Activity of ECs

We investigated the possible role of miR-16 and miR-424 in cell-intrinsic angiogenic activity of ECs. A direct effect of these miRNAs as regulators of angiogenesis in ECs has not been studied so far. miR-15a, -15b, -16 (including 16-1 and 16-2, which have the same whole mature sequence), -195, -497, and -424 have different genomic locations but possess the same seed sequence nucleotides 2 to 8 at their 5′ end (Supplemental Figure IA and IB), which implies that these miRNAs share most of their target genes.13,26–29,37 Therefore, to simplify, here we refer to these targets as “miR-16 predicted targets.” Perfect sequence complementarity to nucleotides 2 to 8 at the 5′ end of the miRNA, called the seed sequence, is the strongest characteristic for targeting activity and holds true for the majority of targets characterized to date.38 Other characteristics, such as site location within the 3′UTR, flanking region, and conservation across multiple species, greatly increase the probability of a predicted target site being real.13 By combining these characteristics, numerous computational approaches have been developed to predict miRNA targets.13,38 By using these bioinformatic tools, we determined whether miR-16 predicted targets were preferentially connected to any specific biological process (Supplemental Material and Methods, Bioinformatic Analysis). We saw enrichment for genes implicated in the control of transcription, as well as in important cellular functions, such as proliferation, cycle progression, and apoptosis, the last 2 of which were in agreement with the predictions and validated target genes reported by others.26,27,29 Interestingly, we also observed enrichment for genes regulating angiogenesis and its related functions (proliferation, cell migration, cell differentiation, and morphogenesis, as well as relevant transcriptional regulators). Analysis of the predicted targets involved in angiogenesis revealed that the majority of them (81%) were positive regulators of angiogenesis (Supplemental Figure II). Among the predicted targets found, of note were VEGFR2 (also known as KDR) and FGFR1 because of their important role in the regulation of angiogenic functions of ECs.8 These 2 genes, along with VEGF, which was previously reported to be a target for miR-16,30,39 were selected for further analysis.

miR-16 and miR-424 Regulate VEGFR2, FGFR1, and VEGF Expression by Targeting the VEGFR2, FGFR1, and VEGF 3′UTRs

First, we analyzed the expression of the selected miRNAs (ie, miR-16 and miR-424) in ECs. As shown in Supplemental Figure IIIA, the relative levels of these miRNAs in human primary ECs (HUVECs and human aortic ECs) were very similar to those of other human primary cells, such as vascular smooth muscle cells and fibroblasts, but they were very highly expressed in HeLa cells (a highly proliferative tumor cell line). Because these miRNAs play very important roles in regulating cell and cell cycle progression,26 the reduced levels of miR-16/424 would allow HeLa cells to maintain a highly proliferative state with respect to the primary cell lines analyzed, including ECs.

We then analyzed whether “miR-16-like miRNAs” participate in the regulation of VEGFR2, FGFR1, and VEGF. Specifically, we analyzed the effect of miR-16 and miR-424 on VEGFR2, FGFR1, and VEGF. miR-16 was chosen as a representative member of miR-15 family. miR-424, although not a member of miR-15 family, was chosen because it shares the seed sequence with all the members of the miR-15 family but has a more divergent 3′ end (Supplemental Figure IB). We identified a putative binding site in the 3′UTR of VEGFR2 (Figure 1A). The miR-16/-424 predicted site is a canonical 7mer-m8 site (Supplemental Figure IC). In the specific case of miR-424, this site is supported by an additional 3′ pairing optimally centered on miRNA nucleotides 13 to 1813 (Supplemental Figure IC). The seed region of miR-16/-424 complementary to the sequence in the VEGFR2 3′UTR is conserved across species (not shown) and extends in humans from nucleotides 44 to 50 (Figure 1A and Supplemental Figure IC). In the FGFR1 3′UTR, we found 3 predicted sites for miR-16/-424, the first of which is a conserved canonical 7mer-m8 located in the center of the FGFR1 3′UTR (Figure 1A and Supplemental Figure IC). This site is supported by an additional 3′ pairing for miR-16 but not for miR-424 (Supplemental Figure IC). The second site is located at the end of the FGFR1 3′UTR (Figure 1A and Supplemental Figure IC) and is a 7mer-8m8 for both miR-16 and miR-424 (Supplemental Figure IC). The third site is a 3′ compensatory site, or an imperfect match to the seed13; however, we did not consider this site in our studies. The site predicted in the 3′UTR of VEGFA was previously reported30,39 (Figure 1A) and is a conserved 8mer with an additional 3′ pairing for miR-16 but not for miR-424 (Supplemental Figure IC).

Figure 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1.

MicroRNA (miR)-16 and miR-424 regulate vascular endothelial growth factor receptor-2 (VEGFR2), fibroblast growth factor receptor-1 (FGFR1), and vascular endothelial growth factor (VEGF) expression by targeting the VEGFR2, FGFR1, and VEGF 3′ untranslated regions (UTRs). A, Predicted target sites (indicated in blue) for miR-16 and miR-424 in the 3′UTRs of human VEGFR2, FGFR1, and VEGF 3′UTR. PM (indicated in red) indicates mutation of the predicted miR-16/-424 seed region in the 3′UTRs of human VEGFR2, FGFR1, and VEGF 3′UTR. B to D, COS-7 cells were cotransfected with the indicated constructs (containing or not containing the above-mentioned PM) and with 30 nmol/L of miR-16, miR-424, or control mimic (CM). Data are expressed as relative luciferase activity to control samples cotransfected with an equal concentration of CM and correspond to the mean±SEM of 3 experiments performed in duplicate. *Significantly different from cells cotransfected with CM, #significantly different from cells cotransfected with miR-16 or miR-424 and control 3′UTR (P≤0.05). ORF indicates open reading frame.

To validate the predicted miRNA/mRNA interactions, the VEGFR2, FGFR1, and VEGF 3′UTRs were subcloned in a luciferase reporter vector. The resultant constructs were cotransfected into COS cells along with miR-16 or miR-424 mimic oligonucleotides or a nontargeting control mimic. Transfection with the control luciferase reporter without any 3′UTR (empty vector) did not affect luciferase activity (data not shown). Interestingly, the relative luciferase activity was significantly reduced (≈20%) when cells were cotransfected with VEGFR2 3′UTR and miR-16 or miR-424 but not with control mimic (Figure 1B). Both miR-16 or miR-424 markedly repressed FGFR1 (Figure 1C) 3′UTR activity (≈50%); this effect was likely due to the presence of 3 binding sites.13 Our data also indicate that miR-16, as well as miR-424, significantly reduced (≈20%) VEGF 3′UTR activity (Figure 1D), in agreement with previous reports.30,39 In all cases, when the miRNAs were transfected together, there was no difference in the overall luciferase activity as compared with their individual effect (data not shown). This is likely due to the identical seed sequences displayed by these miRNAs. Confirming the initial results, mutation of the miR-16/-424 site abrogated the repression of VEGFR2, and VEGF 3′UTR activity, consistent with a direct interaction of miR-16/-424 with the studied sites (Figure 1B–1D). As indicated in Figure 1A, we found 3 predicted sites for miR-16/-424 in the FGFR1 3′UTR. Two of them had perfect sequence complementarities to the seed sequence, which is the strongest characteristic for targeting activity13 and more likely to provide the strongest effects. Mutation of these sites (sites 1 and 2) produced a partial recovery of luciferase activity, therefore indicating that the effect of site 3 was not eliminated.

We further examined the effects of miR-16/-424 on VEGFR2, FGFR1, and VEGF expression in ECs (Figure 2 and Supplemental Figure IV). We first analyzed miRNA levels after transfection with miRNA mimics or inhibitors to measure transfection efficiency in ECs. As shown in Supplemental Figure IIIB, overexpression with both miR-16 and miR-424 mimics in HUVECs efficiently increased the levels of these miRNAs, and more importantly, overexpression of one of them did not affect the expression of the other. Furthermore, inhibition of endogenous miR-16 and miR-424 with specific inhibitors reduced their intracellular levels in a specific manner (Supplemental Figure IIIC). Finally, we analyzed the effect of miR-16/-424 on VEGFR2, FGFR1, and VEGF expression. HUVECs were transfected with miR-16 or miR-424 mimics, and the effects on protein and mRNA levels were analyzed 36 hours posttransfection. As shown in Figure 2A to 2C, both miR-16 and miR-424 significantly decreased VEGFR2, FGFR1, and VEGF protein and mRNA levels. Importantly, inhibition of endogenous miR-16 or miR-424 increased the expression of VEGFR2, FGFR1, and VEGF at both the protein and mRNA levels (Figure 2B–2D). The targeting activity of these miRNAs on VEGFR2 and FGFR1 was also relevant for human aortic ECs (data not shown), a human adult EC type from a different vascular bed than HUVECs. In addition, and consistent with the conservation of these sites across species, similar results were obtained using bovine aortic ECs (Supplemental Figure IV).

Figure 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 2.

MicroRNA (miR)-16 and miR-424 modulate vascular endothelial growth factor receptor-2 (VEGFR2), fibroblast growth factor receptor-1 (FGFR1), and vascular endothelial growth factor (VEGF) expression in endothelial cells (ECs). Human umbilical vascular ECs (HUVECs) were transfected for 12 hours with miR-16, miR-424, or control mimic (CM) (A and C) or with inhibitor miR-16 (I-miR-16), inhibitor miR-424 (I-miR-424), or control inhibitor (CI) (B and D). In both cases, cells were harvested 36 hours posttransfection. A and B, Protein levels of VEGFR2, FGFR1, and VEGF were detected by Western blot. Heat shock protein-90 (HSP-90) was used as a loading control. In the quantification (right graphs), data are expressed as relative total protein levels and correspond to mean±SEM of 3 experiments. C and D, mRNA expression of VEGFR2, FGFR1, and VEGF was quantified by quantitative reverse transcription–polymerase chain reaction. Data are expressed as relative expression and correspond to mean±SEM of 3 experiments. *Significantly different from cells transfected with CM or CI, P≤0.05.

VEGF- and bFGF-Regulated Expression of miR-16 and miR-424 Is Relevant for the Targeting of VEGFR2 and FGFR1 in ECs

It has been well established that both the VEGFR2 and FGFR1 signaling pathways play crucial roles in angiogenesis. Interestingly, accumulating evidence has now implicated endothelial miRNAs in this process. To examine the potential relationship between VEGFR2 and FGFR1 signaling and miR-16 or miR-424, we asked whether VEGF or bFGF modulated the cell-intrinsic expression of miR-16/-424 in HUVECs. As shown in Figure 3A, both cytokines regulated the expression of the mature form of miR-16 and miR-424. To identify whether these cytokines regulated the expression of these miRNAs at the transcriptional level, we examined the expression of primary transcripts containing the stem loop of the miRNA of interest. As shown in Figure 3B, both VEGF and bFGF increased the expression of pri-miR-16-1 (detects stem loops of miR-15b and miR-16-1 transcribed from chromosome 13) and, modestly, pri-miR-16-2 (detects stem loops of miR-15b and miR-16-1 transcribed from chromosome 3), suggesting a transcriptional regulation of these 2 clusters by these cytokines. In contrast, the expression of pri-miR-424 remained essentially unchanged, suggesting that VEGF and bFGF likely modulate the processing of miR-424 from the preexisting primary transcript (ie, the increase in the mature form, Figure 3A) without affecting its transcriptional expression.

Figure 3.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 3.

Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) regulate microRNA (miR)-16 and miR-424 expression in endothelial cells. A and B, Human umbilical vascular endothelial cells (HUVECs) were starved (0.1% bovine serum albumin [BSA]) for 12 hours and then treated with VEGF (50 ng/mL), bFGF (25 ng/mL) or non treated (NT) for the indicated times. Mature miR-16 and miR-424 (A) and primary transcript (pri-miR)-16-1/-2 and pri-miR-424 (B) expression was quantified by quantitative reverse transcription–polymerase chain reaction. Data are expressed as relative expression and correspond to mean±SEM of 3 experiments. *Significantly different from cells without treatment, P≤0.05. C, HUVECs were transfected for 6 hours with empty vector, vascular endothelial growth factor receptor-2 (VEGFR2), or fibroblast growth factor receptor-1 (FGFR1) 3′ untranslated region (UTR) construct; 12 hours posttransfection, cells were starved (0.1% BSA) for 12 hours and then treated with VEGF for the indicated times. D, HUVECs were transfected as above in the presence or not of 60 nmol/L inhibitor miR-16 (I-miR-16), inhibitor miR-424 (I-miR-424), or control inhibitor (CI). Thirty-six hours posttransfection, cells were starved (0.1% BSA) for 12 hours and then treated with VEGF for the indicated times. Data are expressed as luciferase activity relative to control samples cotransfected with an equal concentration CI and correspond to the mean±SEM of 3 experiments performed in duplicate. *Significantly different from cells cotransfected with CI and VEGF 3′UTR, #significantly different from cells cotransfected with CI and VEGF 3′UTR plus VEGF treatment, P≤0.05.

Regardless of whether the effect is at the transcriptional or posttranscriptional level, both VEGF and bFGF have similar effects (stimulation) on miR-16 and miR-424 mature expression. We then investigated whether VEGF directly regulated VEGFR2 or FGFR1 3′UTRs via miR-16 in ECs. For these experiments, we used the luciferase reporter assay, described above, directly in HUVECs. As shown in Figure 3C, stimulation of HUVECs with VEGF reduced both VEGFR2 and FGFR1 3′UTR activity, whereas no effect was observed when cells were transfected with the empty vector control, indicating that some endogenous miRNAs involved in the regulation of VEGFR2 and FGFR1 were induced to regulate their expression under stimulated conditions. Interestingly, endogenous inhibition of miR-16 or miR-424 before VEGF stimulation restored VEGFR2 and FGFR1 3′UTR activity (Figure 3D), indicating that these effects are likely to be mediated by miR-16 and miR-424 upregulation in ECs.

miR-16 and miR-424 Reduce Proliferation and Migration and Impair EC Cord Formation

Next, we tested whether the effects observed on VEGFR2, FGFR1, and VEGF expression were functional. To this end, we examined the effects of miR-16 and miR-424 on 3 angiogenic phenotypes of ECs, namely proliferation, migration, and morphogenesis (cord formation). Previous results have shown that both miR-16 and miR-424 regulate cell proliferation in different cell types.26–28,33 In agreement with these data, we observed that miR-16 or miR-424 had a negative effect on cell proliferation. As seen in Figure 4A, overexpression of miR-16 or miR-424 reduced cell proliferation in HUVECs without a significant induction of apoptosis assessed by induction of caspase-3 cleavage or increase in sub-G0/G1 population by flow cytometry (Supplemental Figure VA and VB, respectively). Moreover, under stress conditions, such as prolonged serum starvation,40 both miR-16 and miR-424 further reduced the number of cells assessed by crystal violet staining (Figure 4B). Interestingly, 9 additional hours in the absence of VEGF diminished the cell number in both control mimic and miRNA-overexpressing cells. Treatment with exogenous VEGF produced partial rescue in control cells without affecting miRNA-overexpressing cells (Figure 4B), suggesting an altered response to VEGF in cells overexpressing miR-16 or miR-424. Next, we examined the effects of these miRNAs on EC migration. Overexpression of miR-16 or miR-424 reduced basal migration, as well as VEGF- or bFGF-induced migration, in bovine aortic ECs (Figure 4C). miR-16 and miR-424 overexpression in HUVECs also resulted in significant impairment of cord formation under basal conditions and following stimulation with VEGF or bFGF (Figure 4D). Converse effects on migration and cord formation were obtained when the endogenous levels of these miRNAs were inhibited (Supplemental Figure VI). Importantly, we also overexpressed either VEGFR2 or FGFR1 cDNA together with a miR-16 mimic in HUVECs and evaluated their effect on EC migration in response to VEGF or bFGF (Supplemental Figure VII). As shown in Supplemental Figure VIIA, transfection of HUVECs with VEGFR2 or FGFR1 cDNA (without the respective 3′UTR) for 24 hours was very efficient, and in both cases, high levels of VEGFR2 and FGFR1 were obtained. Interestingly, VEGFR2 or FGFR1 overexpression rescued the inhibitory effect of miR-16 in EC migration. Altogether, these data indicate that miR-16/-424 regulates cell-intrinsic angiogenic responses in vitro and are consistent with their targeting activity on VEGFR2, FGFR1, and VEGF in ECs.

Figure 4.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 4.

MicroRNA (miR)-16 and miR-424 reduce proliferation and migration and impair endothelial cell cord formation. A, Human umbilical vascular endothelial cells (HUVECs) were transfected for 12 hours with miR-16, miR-424, or control mimic (CM). Cells were harvested and counted 36 hours posttransfection. Data are expressed as relative number of cells and correspond to mean±SEM of 3 experiments performed in duplicate. B, HUVECs were transfected as indicated in A. Thirty-six hours posttransfection, cells were starved (0.1% bovine serum albumin [BSA]) for 16 hours and then treated or not with vascular endothelial growth factor (VEGF) for an additional 9 hours. Cells were washed and stained by crystal violet as indicated in the Materials and Methods section. Data are expressed as cell survival and correspond to mean±SEM of 3 experiments. C, Bovine aortic endothelial cells (BAECs) were transfected as indicated in A. Thirty-six hours posttransfection, migration in response to VEGF or basic fibroblast growth factor (bFGF) was quantified as described in the Materials and Methods section. The average number of cells from 5 randomly chosen fields on the lower side of the membrane of each well was counted. Data are expressed as migrated cells and correspond to mean±SEM of 3 experiments performed in duplicate. D, HUVECs were transfected as indicated in A. Thirty-six hours posttransfection, cells were counted and seeded on growth factor–reduced Matrigel in the presence of 0.1% FBS (basal, left), 0.1% FBS+VEGF (VEGF stimulated, middle), and 0.1% FBS+bFGF (bFGF stimulated, right). Cumulative sprout length of capillary-like structures was measured by light microscopy after 12 hours. Representative micrographs and quantification are shown. Scale bars=100 μmol/L. Data are expressed as cumulative tube lengths and correspond to mean±SEM of 3 experiments performed in duplicate. *Significantly different from cells transfected with CM, #significantly different from basal conditions, P≤0.05.

miR-16 and miR-424 Regulate VEGF and bFGF Signaling Through VEGFR2 and FGR1

To test the potential involvement of these miRNAs on VEGFR2 and FGFR1 signaling more directly, we examined the effect of the reduction of VEGFR2 and FGFR1 via miR-16 overexpression on v-akt murine thymoma viral oncogene (Akt) and tracellular signal-regulated kinase 1/2 (ERK1/2) activation because these downstream effectors (namely the phosphatidylinositol 3-kinase/Akt and Ras/Raf/Erk pathways) are activated after VEGF or bFGF stimulation in ECs. As seen in Figure 5A and 5B, Akt and ERK1/2 phosphorylation were reduced in response to VEGF or bFGF stimulation (Figure 5A and 5B, respectively) in ECs transfected with miR-16. Similar results were obtained when cells were transfected with miR-424 (Supplemental Figure VIII). Interestingly, when cells were stimulated with sphingosine-1-phosphate, which signals primarily through a family of 5 G-protein-coupled receptors (EDG receptors),41 Akt and ERK1/2 activation was not significantly affected by miR-16 overexpression (Figure 5C). Altogether, these data suggest that these miRNAs are likely to control proliferation, migration, and differentiation of ECs by regulation of VEGF and bFGF signaling through VEGFR2 and FGFR1.

Figure 5.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 5.

MicroRNA (miR)-16 modulates vascular endothelial growth factor (VEGF) signaling. Bovine aortic endothelial cells (BAECs) were transfected for 12 hours with miR-16 or control mimic (CM). Thirty-six hours posttransfection, cells were starved (0.1% bovine serum albumin) for 12 hours and then treated with VEGF (50 ng/mL) (A), basic fibroblast growth factor (bFGF) (25 ng/mL) (B), or sphingosine-1-phosphate (S1P) (400 nmol/L) (C) for the indicated times. Phospho (P)-v-akt murine thymoma viral oncogene homolog (AKT) (Ser-473) and phospho-tracellular signal-regulated kinase (ERK) (Thr202/Tyr204) protein levels were detected by Western blot. Blots for vascular endothelial growth factor receptor-2 (VEGFR2) and fibroblast growth factor receptor-1 (FGFR1) are shown as control of miR-16 action. Heat shock protein-90 (HSP-90) was used as loading control. In the quantification (graphs, right) data are expressed as fold activation over control and correspond to mean±SEM of 3 experiments. *Significantly different from cells without VEGF or bFGF treatment, P≤0.05.

miR-16 Reduces Blood Vessel Formation In Vivo

In a final series of experiments, we evaluated the effect of miR-16 on the ability of human ECs to form capillary-like structures in vivo using a previously described model for forming tubes within a 3-dimensional gel with cultured HUVECs.34,42 We used lentiviral vectors to manipulate the levels of miRNAs in vivo as reported previously.43 HUVECs were efficiently transduced with a miR-16 lentiviral vector or scr-miR (Figure 6A) and then suspended in collagen-fibronectin protein gels.34,36,42 These gels were then implanted into the abdominal wall of immunocompetent mice. Consistent with previous reports, HUVEC-derived cords formed in vitro survive and evolve into tubes that inosculated with the host microcirculation.34,42 Grafts were explanted for evaluation at 14 and 21 days. Interestingly, 7 days after implantation, HUVECs transduced with either scr-miR or miR-16 that were kept in culture in parallel maintained green fluorescent protein expression (Figure 6B). Moreover, miR-16 transduced HUVECs presented increased levels of miR-16 (Figure 6C) and, as expected, a concomitant decrease in the expression of VEGFR2, FGFR1, and VEGF (Figure 6D). Gross visualization of constructs harvested 14 days after implantation appeared to be blood-perfused by mouse circulation; however, those containing miR-16 transduced HUVECs seemed to be, in general, less efficiently perfused and cellularized and slightly smaller than scr-miR implants (Figure 6). Moreover, miR-16 implants contained significantly fewer capillary structures (Figure 6F), as assessed by both human platelet endothelial cell adhesion molecule-1 or Ulex europaeus agglutinin-1 lectin staining (reacts with the blood group ABH expressed on human EC) for detection of human EC-lined vessels within engrafted protein gels, respectively. In both cases, the majority of the structures were wholly composed of human ECs, as anti-mouse platelet endothelial cell adhesion molecule-1 antibodies reacted with fewer than 1% of the vascular profiles within the constructs (data not shown), confirming that the vessel-like structures detected were not formed by mouse neovascularization of the gel and consistent with previous reports of this model.42 After 21 days of implantation, platelet endothelial cell adhesion molecule-1-positive structures were present throughout the collagen-fibronectin gel of scr-miR implants; however, they were largely absent in the gels containing miR16-HUVECs (Supplemental Figure IX). Altogether, these data indicate that miR-16 participates in the regulation of neovascularization in vivo by controlling the cell-intrinsic angiogenic activity of ECs.

Figure 6.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 6.

MicroRNA (miR)-16 reduces microvessel formation in vivo. A, Human umbilical vascular endothelial cells (HUVECs) were transduced with miR-16 or scrambled miRNA (scr-miR) as indicated in Material and Methods section. Green fluorescent protein (GFP) expression (FL1-H) was analyzed by flow cytometry prior gel implantation. B to D, HUVECs that were transduced with either miR-16 and scr-miR as above indicated were kept in culture 7 days after implantation. B, Representative fluorescence micrographs of GFP detection are shown. Magnification ×20. C and D, Mature miR-16 (C) and mRNA expression of vascular endothelial growth factor receptor-2 (VEGFR2), fibroblast growth factor receptor-1 (FGFR1), and vascular endothelial growth factor (VEGF) (D) was quantified by quantitative reverse transcription–polymerase chain reaction. Data are expressed as relative expression and correspond to mean±SEM *Significantly different from cells transduced with scr-miRNA, P≤0.05. Grafts from miR-16 or scr-miR-transduced HUVECs were isolated 14 days after implantation. E, Representative micrographs of the gel implants and hematoxylin/eosin staining are shown. Magnification ×0.5 (left) and ×10 (right). F, Grafts from miR-16- or scr-miR-transduced HUVECs were isolated 14 days after implantation. Representative platelet endothelial cell adhesion molecule-1 (PECAM-1) and Ulex europaeus agglutinin (UEA)-1 staining is shown. Scale bars=100 μmol/L. In the quantification, data are expressed as PECAM-1- or UEA-1-positive capillary structures of 2 to 4 images from 5 sections per animal and correspond to mean±SEM (n=5 animals per group). *Significantly different from cells transduced with scr-miRNA, P≤0.05.

Discussion

A growing body of evidence indicates that miRNAs actively participate in the control of angiogenesis.12,18–22,33 In the present study, we have investigated the function of miR-16 and miR-424, as representative members of a group of miRNAs that share the same seed sequence, in different aspects of EC biology pertinent to angiogenesis. Seed sequences of miRNAs are arranged between the second and eighth nucleotide in the 5′ end and are the most critical determinants of miRNA targeting activity.13 miR-15a, -15b, -16 (1 and 2), -195, -424, and -497 have different genomic locations but possess the same seed sequence, implying that these miRNAs share most of their target genes.13 In agreement with previous experimental data,26–29,37 our analysis showed that indeed, these miRNAs share most of their targets. Therefore, the slight differences observed in target prediction by using other bioinformatic algorithms were likely due to differences at the level of the pairing to the miRNA 3′ end or the degree of binding site conservation across species.13 Functional annotation of the predicted targets for miR-15a, -15b, -16, -195, -424, and -497 suggests that these miRNAs control a complex network of genes involved in cell cycle, proliferation, apoptosis, and survival.26,27,29 More appealing to us was the identification of target genes connected to angiogenesis and their related functions (proliferation, cell migration, cell differentiation, and morphogenesis, as well as cell signaling and relevant transcriptional regulators),2 suggesting that miR-16 and its related miRNAs may participate in the control of angiogenesis in multiple ways. Given their important role in the regulation of angiogenic functions in ECs,2,5–7 of special interest was the identification of VEGFR2, FGFR1, and VEGF as target genes for miR-16.

Interestingly, miR-15b and miR-16 have been shown to control the expression of VEGF in a carcinoma cell line30 and in a human breast cancer cell line.39 In agreement with these previous reports, our studies also indicate that miR-16, as well as miR-424, significantly reduced VEGF 3′UTR activity and therefore targeted VEGF. However, a key difference between these experiments and those previously reported30,39 is that in those reports, researchers tested the fragments of the 3′UTR containing the target sequence, whereas here we tested the sequence in the context of the entire 3′UTR. There is increasing evidence that contextual features of the 3′UTR, such as secondary structures or local AU-rich regions, among others, can govern miRNA/mRNA interactions.13 This approach, together with the mutation of the predicted binding site (also in the context of the complete 3′UTR), shows more unequivocally that this interaction is, indeed, functional. Because VEGFR2 and FGFR1 play key roles in angiogenesis5,6 and little is known about their posttranscriptional regulation by miRNAs, we additionally validated VEGFR2 and FGFR1 as targets for miR-16 and miR-424. Moreover, we provide evidence that these interactions are relevant in an EC context, because both gain- and loss-of-function experiments revealed that these miRNAs regulate the expression of VEGFR2, FGFR1 and VEGF. Therefore, it appears likely that miR-16 related miRNAs participate in the regulation of angiogenesis in the context of ECs, at least in part by the modulation of these receptors together with the regulation of endothelial VEGF.

VEGF has been recognized as a paracrine factor in both developmental and pathological settings.44 However, a critical role of endogenous VEGF expression in EC functions related to viability and survival has been demonstrated.40 Interestingly, our data show that miR-16/-424 overexpression reduced EC growth in both basal and stressed conditions and that exogenous VEGF could not rescue compromised survival of ECs overexpressing miR-16. A similar phenotype was observed in VEGFEC knockout cells40; however, in our case, these effects may also be explained by the miR-16-mediated reduction of VEGFR2 protein levels in ECs, which compromises its activation and thus the survival-promoting activity of exogenous VEGF through the activation of the phosphatidylinositol 3-kinase–Akt pathway.45 Additionally, and in agreement with the regulation of FGFR1 by miR-16, we found that miR-16/-424 also diminished bFGF signaling through FGFR1. Moreover, migration and cord formation was significantly reduced in miR-16/-424-overexpressing cells in response to exogenous VEGF of bFGF. Altogether, our data indicate that these miRNAs affect the activity of downstream components of the pathways that regulate proliferation, migration, and cord formation of ECs in vitro by regulating the expression of key endothelial angiogenic proteins (ie, VEGFR2, FGFR1).

Previous reports have shown that in different cell types, miR-15a/16-1 and miR-15b/16-2 clusters, in addition to miR-195 and miR-424, play very important roles in regulating cell proliferation and apoptosis by targeting cell cycle progression proteins.26–29,33,46 Consistent with these findings, it has recently been shown that the downregulation of miR-424 in senile hemangioma contributes to abnormal angiogenesis.33 Specifically, the authors showed that miR-424 negatively regulates the proliferative activity of human endothelial microvascular cells via mitogen-activated protein kinase kinase (MAP2K1/MEK1) and cyclin E1.26–29,33,46 Altogether, these data, in addition to the new functions we describe here for miR-16 and miR-424, indicate that these miRNAs participate in the regulation of the angiogenic functions of ECs. In contrast, a recent report shows that miR-424 expression is upregulated in HUVECs by hypoxia, thereby promoting angiogenesis by targeting cullin 2 and increasing hypoxia-inducible factor 1α levels.47 However, under standard culture conditions (normoxia) the authors showed that overexpression of miR-424 stimulates proliferation, migration and cord formation,47 which is contrary to both our findings and the data reported by Nakashima et al.33 In our experimental conditions, miR-424 overexpression is performed by using microRNA mimics, which are double-stranded RNA oligonucleotides that supplement miRNA activity by effectively mimicking the endogenous mature miRNA function. Unlike the endogenous miRNA duplex, however, the active strand of the miRNA mimic is preferentially incorporated into the RNA-induced silencing complex-like complex, whereas the passenger strand is excluded through chemical modification. In their transient expression studies, miR-424 was polymerase chain reaction amplified from human genomic DNA and cloned into the EcoRI-BamHI sites of the pGSU6 vector and then transfected into HUVECs. In this scenario, the passenger strand could potentially be selected; therefore, the authors cannot rule out the effect of miR-424* passenger strand. By using gain- and loss-of-function approaches (using mimics or inhibitors for these miRNAs), we have shown that their targeting activity toward VEGFR2, FGFR1, and VEGF is indeed relevant in the context of ECs. Furthermore, we obtained the same results using a lentiviral approach to overexpress miR-16. In our in vivo model, we introduced stably transduced HUVECs with miR-16 into a synthetic vascular bed to specifically address the effect of miR-16 in regulating the cell-intrinsic angiogenic activity of ECs and avoid the effect of overexpression of the microRNA in other cell types, which cannot be ruled out in the Gosh et al47 in vivo studies. Our data indicate that miR-16 regulates capillary tube formation of human ECs in vivo. Although we have not performed the experiments to test the effect of miR-424 in vivo, our in vitro data suggest that miR-424 has the same functions as miR-16 in ECs (ie, targeting VEGFR2, FGFR1, and VEGF in ECs and negatively regulating proliferation, migration, and cord formation), and therefore, similar results would be expected.

Several lines of evidence indicate that the regulation of miRNA levels by different stimuli may serve as points of cross-talk between signaling pathways, thereby contributing to the regulation of the specific stimulus-induced responses.10 Recent insights indicate that signal transduction pathways are prime candidates for miRNA-mediated regulation in animal cells and therefore are ideal targets for specific fine-tuned cell responses.10 miR-16/-424 regulation of VEGFR2, FGFR1, and VEGF, as we present in this report, could be considered an example of the multigene regulatory capacity of miRNAs to remodel the signaling landscape in an effective and timely manner.10 In fact, our data indicate that angiogenic growth factors, such as VEGF and bFGF, stimulate the expression of mature miR-16 and miR-424 in HUVECs to fine-tune the levels of angiogenic mediators in ECs (ie, VEGFR2, FGFR1, and VEGF), thereby participating in the maintenance of EC steady state conditions and conferring signal robustness.10 miRNA processing is faster than protein translation, allowing miRNAs to affect gene expression with shorter delay than transcriptional repressors, conferring exquisite temporal and quantitative precision over cell signaling. Given their essential roles in multiple processes,9 miRNA expression needs to be tightly regulated.10 Thus, the identification of the elements implicated in their regulation is essential to dissect the role of miRNAs in signaling networks.10 miRNA abundance can be controlled at the level of transcription of the pri-miRNA, during the maturation steps, or through turnover of the mature miRNA. Our data underlie the complexity of the regulation of miRNAs, whereas miR-16 seems to be regulated by VEGF/bFGF at the level of transcription; increased levels of miR-424 after VEGF/bFGF stimulation are likely due to a positive regulation of miRNA maturation/processing from the preexisting primary transcript (ie, the increase in the mature) without affecting its expression (ie, no change in pri-miR-424). These data highlight the different mechanisms by which miRNAs can be regulated. The importance of understanding how these stimuli might affect miRNA levels in ECs needs further investigation.

miRNAs have tremendous therapeutic potential for the treatment of vascular diseases associated with aberrant pathological angiogenesis.19 In addition to their roles as potent regulators of cell proliferation in different cancer cell lines,26–28,46 of interest are the miRNAs encoded by the miR-17 to -92 cluster. These miRNAs are known to act as oncogenes but also have essential functions in tumor formation and normal development of the heart, lungs, and immune system. Although other cell types, such as vascular smooth muscle cells and circulating progenitors, play an important role in neovascularization, in the context of ECs they have been shown to provide cell-intrinsic antiangiogenic activity.22 The miR-15 family members may also be implicated in the noncell-autonomous,30,48 as well as in the cell-autonomous, regulation of angiogenesis, as we show here. Therefore, the identification of miRNAs regulating both angiogenesis and tumor cell survival might be a meaningful approach for cancer therapy. In fact, miR-15a and miR-16-1 expression results in growth arrest, apoptosis, and marked regression of prostate tumor xenografts,49 and miR-16 and 15a have been recently reported to act as tumor suppressors both in tumor and stromal cells by targeting FGFR1.48 Thus, we hypothesize that the use of miRNA mimics of miR-16 may be an attractive antiangiogenesis strategy that could target tumor cell survival and proliferation while disrupting cell-intrinsic angiogenic activity of ECs. Interestingly, there is now direct evidence that synthetic miRNA mimics can be systemically delivered and support the promise of miRNAs as a future targeted therapy for cancer.25

Although we have begun to appreciate the importance of miRNAs in the regulation of angiogenic signaling in ECs, much work remains to be done to determine the miRNAs involved and the target pathways affected.19

Sources of Funding

This work was supported by scientist development grant-AHA 0835481N (to Y.S.) and 0835585D (to C.F.-H.); National Institutes of Health 1P30HL101270-01; and National Heart, Lung, and Blood Institute R01-HL105945 (to Y.S.) and R01-HL107953 and R01-HL16063 (to C.F.-H.).

Disclosures

None.

Acknowledgments

We thank Dr B.R. Shepherd for helpful comments and advice for the in vivo study, Dr M.V. Guijarro for assistance with immunofluorescent microscopy, and Leigh Goedeke for the editing work on the manuscript.

  • Received April 11, 2011.
  • Accepted August 22, 2011.
  • © 2011 American Heart Association, Inc.

References

  1. 1.↵
    1. Carmeliet P
    . Angiogenesis in life, disease and medicine. Nature. 2005;438:932–936.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Folkman J
    . What is the role of endothelial cells in angiogenesis? Lab Invest. 1984;51:601–604.
    OpenUrlPubMed
  3. 3.↵
    1. Iruela-Arispe ML,
    2. Dvorak HF
    . Angiogenesis: a dynamic balance of stimulators and inhibitors. Thromb Haemost. 1997;78:672–677.
    OpenUrlPubMed
  4. 4.↵
    1. Leung DW,
    2. Cachianes G,
    3. Kuang WJ,
    4. Goeddel DV,
    5. Ferrara N
    . Vascular endothelial growth factor is a secreted angiogenic mitogen. Science. 1989;246:1306–1309.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Olsson AK,
    2. Dimberg A,
    3. Kreuger J,
    4. Claesson-Welsh L
    . VEGF receptor signalling: in control of vascular function. Nat Rev Mol Cell Biol. 2006;7:359–371.
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Presta M,
    2. Dell'Era P,
    3. Mitola S,
    4. Moroni E,
    5. Ronca R,
    6. Rusnati M
    . Fibroblast growth factor/fibroblast growth factor receptor system in angiogenesis. Cytokine Growth Factor Rev. 2005;16:159–178.
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Ferrara N
    . Role of vascular endothelial growth factor in regulation of physiological angiogenesis. Am J Physiol Cell Physiol. 2001;280:C1358–C1366.
    OpenUrlAbstract/FREE Full Text
  8. 8.↵
    1. Gerwins P,
    2. Skoldenberg E,
    3. Claesson-Welsh L
    . Function of fibroblast growth factors and vascular endothelial growth factors and their receptors in angiogenesis. Crit Rev Oncol Hematol. 2000;34:185–194.
    OpenUrlCrossRefPubMed
  9. 9.↵
    1. Bushati N,
    2. Cohen SM
    . MicroRNA functions. Annu Rev Cell Dev Biol. 2007;23:175–205.
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Inui M,
    2. Martello G,
    3. Piccolo S
    . MicroRNA control of signal transduction. Nat Rev Mol Cell Biol. 2010;11:252–263.
    OpenUrlCrossRefPubMed
  11. 11.↵
    1. Small EM,
    2. O'Rourke JR,
    3. Moresi V,
    4. Sutherland LB,
    5. McAnally J,
    6. Gerard RD,
    7. Richardson JA,
    8. Olson EN
    . Regulation of PI3-kinase/Akt signaling by muscle-enriched microRNA-486. Proc Natl Acad Sci U S A. 2010;107:4218–4223.
    OpenUrlAbstract/FREE Full Text
  12. 12.↵
    1. Wurdinger T,
    2. Tannous BA,
    3. Saydam O,
    4. Skog J,
    5. Grau S,
    6. Soutschek J,
    7. Weissleder R,
    8. Breakefield XO,
    9. Krichevsky AM
    . miR-296 regulates growth factor receptor overexpression in angiogenic endothelial cells. Cancer Cell. 2008;14:382–393.
    OpenUrlCrossRefPubMed
  13. 13.↵
    1. Bartel DP
    . MicroRNAs: target recognition and regulatory functions. Cell. 2009;136:215–233.
    OpenUrlCrossRefPubMed
  14. 14.↵
    1. Kuehbacher A,
    2. Urbich C,
    3. Zeiher AM,
    4. Dimmeler S
    . Role of Dicer and Drosha for endothelial microRNA expression and angiogenesis. Circ Res. 2007;101:59–68.
    OpenUrlAbstract/FREE Full Text
  15. 15.↵
    1. Suarez Y,
    2. Fernandez-Hernando C,
    3. Pober JS,
    4. Sessa WC
    . Dicer dependent microRNAs regulate gene expression and functions in human endothelial cells. Circ Res. 2007;100:1164–1173.
    OpenUrlAbstract/FREE Full Text
  16. 16.↵
    1. Suarez Y,
    2. Fernandez-Hernando C,
    3. Yu J,
    4. Gerber SA,
    5. Harrison KD,
    6. Pober JS,
    7. Iruela-Arispe ML,
    8. Merkenschlager M,
    9. Sessa WC
    . Dicer-dependent endothelial microRNAs are necessary for postnatal angiogenesis. Proc Natl Acad Sci U S A. 2008;105:14082–14087.
    OpenUrlAbstract/FREE Full Text
  17. 17.↵
    1. Yang WJ,
    2. Yang DD,
    3. Na S,
    4. Sandusky GE,
    5. Zhang Q,
    6. Zhao G
    . Dicer is required for embryonic angiogenesis during mouse development. J Biol Chem. 2005;280:9330–9335.
    OpenUrlAbstract/FREE Full Text
  18. 18.↵
    1. Suarez Y,
    2. Sessa WC
    . MicroRNAs as novel regulators of angiogenesis. Circ Res. 2009;104:442–454.
    OpenUrlAbstract/FREE Full Text
  19. 19.↵
    1. Fish JE,
    2. Srivastava D
    . MicroRNAs: opening a new vein in angiogenesis research. Sci Signal. 2009;2:pe1.
    OpenUrlAbstract/FREE Full Text
  20. 20.↵
    1. Fish JE,
    2. Santoro MM,
    3. Morton SU,
    4. Yu S,
    5. Yeh RF,
    6. Wythe JD,
    7. Ivey KN,
    8. Bruneau BG,
    9. Stainier DY,
    10. Srivastava D
    . miR-126 regulates angiogenic signaling and vascular integrity. Dev Cell. 2008;15:272–284.
    OpenUrlCrossRefPubMed
  21. 21.↵
    1. Wang S,
    2. Aurora AB,
    3. Johnson BA,
    4. Qi X,
    5. McAnally J,
    6. Hill JA,
    7. Richardson JA,
    8. Bassel-Duby R,
    9. Olson EN
    . The endothelial-specific microRNA miR-126 governs vascular integrity and angiogenesis. Dev Cell. 2008;15:261–271.
    OpenUrlCrossRefPubMed
  22. 22.↵
    1. Doebele C,
    2. Bonauer A,
    3. Fischer A,
    4. Scholz A,
    5. Reiss Y,
    6. Urbich C,
    7. Hofmann WK,
    8. Zeiher AM,
    9. Dimmeler S
    . Members of the microRNA-17–92 cluster exhibit a cell-intrinsic antiangiogenic function in endothelial cells. Blood. 2010;115:4944–4950.
    OpenUrlAbstract/FREE Full Text
  23. 23.↵
    1. Dentelli P,
    2. Rosso A,
    3. Orso F,
    4. Olgasi C,
    5. Taverna D,
    6. Brizzi MF
    . MicroRNA-222 controls neovascularization by regulating signal transducer and activator of transcription 5a expression. Arterioscler Thromb Vasc Biol. 2010;30:1562–1568.
    OpenUrlAbstract/FREE Full Text
  24. 24.↵
    1. Carmeliet P,
    2. Jain RK
    . Angiogenesis in cancer and other diseases. Nature. 2000;407:249–257.
    OpenUrlCrossRefPubMed
  25. 25.↵
    1. Trang P,
    2. Wiggins JF,
    3. Daige CL,
    4. Cho C,
    5. Omotola M,
    6. Brown D,
    7. Weidhaas JB,
    8. Bader AG,
    9. Slack FJ
    . Systemic delivery of tumor suppressor microRNA mimics using a neutral lipid emulsion inhibits lung tumors in mice. Mol Ther. 2011;19:1116–1122.
    OpenUrlCrossRefPubMed
  26. 26.↵
    1. Linsley PS,
    2. Schelter J,
    3. Burchard J,
    4. Kibukawa M,
    5. Martin MM,
    6. Bartz SR,
    7. Johnson JM,
    8. Cummins JM,
    9. Raymond CK,
    10. Dai H,
    11. Chau N,
    12. Cleary M,
    13. Jackson AL,
    14. Carleton M,
    15. Lim L
    . Transcripts targeted by the microRNA-16 family cooperatively regulate cell cycle progression. Mol Cell Biol. 2007;27:2240–2252.
    OpenUrlAbstract/FREE Full Text
  27. 27.↵
    1. Liu Q,
    2. Fu H,
    3. Sun F,
    4. Zhang H,
    5. Tie Y,
    6. Zhu J,
    7. Xing R,
    8. Sun Z,
    9. Zheng X
    . miR-16 family induces cell cycle arrest by regulating multiple cell cycle genes. Nucleic Acids Res. 2008;36:5391–5404.
    OpenUrlAbstract/FREE Full Text
  28. 28.↵
    1. Bandi N,
    2. Zbinden S,
    3. Gugger M,
    4. Arnold M,
    5. Kocher V,
    6. Hasan L,
    7. Kappeler A,
    8. Brunner T,
    9. Vassella E
    . miR-15a and miR-16 are implicated in cell cycle regulation in a Rb-dependent manner and are frequently deleted or down-regulated in non-small cell lung cancer. Cancer Res. 2009;69:5553–5559.
    OpenUrlAbstract/FREE Full Text
  29. 29.↵
    1. Cimmino A,
    2. Calin GA,
    3. Fabbri M,
    4. Iorio MV,
    5. Ferracin M,
    6. Shimizu M,
    7. Wojcik SE,
    8. Aqeilan RI,
    9. Zupo S,
    10. Dono M,
    11. Rassenti L,
    12. Alder H,
    13. Volinia S,
    14. Liu CG,
    15. Kipps TJ,
    16. Negrini M,
    17. Croce CM
    . miR-15 and miR-16 induce apoptosis by targeting BCL2. Proc Natl Acad Sci U S A. 2005;102:13944–13949.
    OpenUrlAbstract/FREE Full Text
  30. 30.↵
    1. Hua Z,
    2. Lv Q,
    3. Ye W,
    4. Wong CK,
    5. Cai G,
    6. Gu D,
    7. Ji Y,
    8. Zhao C,
    9. Wang J,
    10. Yang BB,
    11. Zhang Y
    . miRNA-directed regulation of VEGF and other angiogenic factors under hypoxia. PLoS ONE. 2006;1:e116.
    OpenUrlCrossRefPubMed
  31. 31.↵
    1. Ohlsson Teague EM,
    2. Van der Hoek KH,
    3. Van der Hoek MB,
    4. Perry N,
    5. Wagaarachchi P,
    6. Robertson SA,
    7. Print CG,
    8. Hull LM
    . MicroRNA-regulated pathways associated with endometriosis. Mol Endocrinol. 2009;23:265–275.
    OpenUrlCrossRefPubMed
  32. 32.↵
    1. Ramon LA,
    2. Braza-Boils A,
    3. Gilabert-Estelles J,
    4. Gilabert J,
    5. Espana F,
    6. Chirivella M,
    7. Estelles A
    . MicroRNAs expression in endometriosis and their relation to angiogenic factors. Hum Reprod. 2011;26:1082–1090.
    OpenUrlAbstract/FREE Full Text
  33. 33.↵
    1. Nakashima T,
    2. Jinnin M,
    3. Etoh T,
    4. Fukushima S,
    5. Masuguchi S,
    6. Maruo K,
    7. Inoue Y,
    8. Ishihara T,
    9. Ihn H
    . Down-regulation of mir-424 contributes to the abnormal angiogenesis via MEK1 and cyclin E1 in senile hemangioma: its implications to therapy. PLoS One. 2010;5:e14334.
    OpenUrlCrossRefPubMed
  34. 34.↵
    1. Suarez Y,
    2. Shepherd BR,
    3. Rao DA,
    4. Pober JS
    . Alloimmunity to human endothelial cells derived from cord blood progenitors. J Immunol. 2007;179:7488–7496.
    OpenUrlAbstract/FREE Full Text
  35. 35.↵
    1. Suarez Y,
    2. Wang C,
    3. Manes TD,
    4. Pober JS
    . Cutting edge: TNF-induced microRNAs regulate TNF-induced expression of e-selectin and intercellular adhesion molecule-1 on human endothelial cells: feedback control of inflammation. J Immunol. 2010;184:21–25.
    OpenUrlAbstract/FREE Full Text
  36. 36.↵
    1. Shepherd BR,
    2. Enis DR,
    3. Wang F,
    4. Suarez Y,
    5. Pober JS,
    6. Schechner JS
    . Vascularization and engraftment of a human skin substitute using circulating progenitor cell-derived endothelial cells. FASEB J. 2006;20:1739–1741.
    OpenUrlAbstract/FREE Full Text
  37. 37.↵
    1. Nishi H,
    2. Ono K,
    3. Iwanaga Y,
    4. Horie T,
    5. Nagao K,
    6. Takemura G,
    7. Kinoshita M,
    8. Kuwabara Y,
    9. Mori RT,
    10. Hasegawa K,
    11. Kita T,
    12. Kimura T
    . MicroRNA-15b modulates cellular ATP levels and degenerates mitochondria via Arl2 in neonatal rat cardiac myocytes. J Biol Chem. 2010;285:4920–4930.
    OpenUrlAbstract/FREE Full Text
  38. 38.↵
    1. Alexiou P,
    2. Maragkakis M,
    3. Papadopoulos GL,
    4. Reczko M,
    5. Hatzigeorgiou AG
    . Lost in translation: an assessment and perspective for computational microRNA target identification. Bioinformatics. 2009;25:3049–3055.
    OpenUrlAbstract/FREE Full Text
  39. 39.↵
    1. Yamagata K,
    2. Fujiyama S,
    3. Ito S,
    4. Ueda T,
    5. Murata T,
    6. Naitou M,
    7. Takeyama K,
    8. Minami Y,
    9. O'Malley BW,
    10. Kato S
    . Maturation of microRNA is hormonally regulated by a nuclear receptor. Mol Cell. 2009;36:340–347.
    OpenUrlCrossRefPubMed
  40. 40.↵
    1. Lee S,
    2. Chen TT,
    3. Barber CL,
    4. Jordan MC,
    5. Murdock J,
    6. Desai S,
    7. Ferrara N,
    8. Nagy A,
    9. Roos KP,
    10. Iruela-Arispe ML
    . Autocrine VEGF signaling is required for vascular homeostasis. Cell. 2007;130:691–703.
    OpenUrlCrossRefPubMed
  41. 41.↵
    1. Hla T,
    2. Lee MJ,
    3. Ancellin N,
    4. Paik JH,
    5. Kluk MJ
    . Lysophospholipids: receptor revelations. Science. 2001;294:1875–1878.
    OpenUrlAbstract/FREE Full Text
  42. 42.↵
    1. Schechner JS,
    2. Nath AK,
    3. Zheng L,
    4. Kluger MS,
    5. Hughes CC,
    6. Sierra-Honigmann MR,
    7. Lorber MI,
    8. Tellides G,
    9. Kashgarian M,
    10. Bothwell AL,
    11. Pober JS
    . In vivo formation of complex microvessels lined by human endothelial cells in an immunodeficient mouse. Proc Natl Acad Sci U S A. 2000;97:9191–9196.
    OpenUrlAbstract/FREE Full Text
  43. 43.↵
    1. Rayner KJ,
    2. Suarez Y,
    3. Davalos A,
    4. Parathath S,
    5. Fitzgerald ML,
    6. Tamehiro N,
    7. Fisher EA,
    8. Moore KJ,
    9. Fernandez-Hernando C
    . miR-33 contributes to the regulation of cholesterol homeostasis. Science. 2010;328:1570–1573.
    OpenUrlAbstract/FREE Full Text
  44. 44.↵
    1. Ferrara N
    . Vascular endothelial growth factor and the regulation of angiogenesis. Recent Prog Horm Res. 2000;55:15–35; discussion 35–16.
    OpenUrlPubMed
  45. 45.↵
    1. Gerber HP,
    2. McMurtrey A,
    3. Kowalski J,
    4. Yan M,
    5. Keyt BA,
    6. Dixit V,
    7. Ferrara N
    . Vascular endothelial growth factor regulates endothelial cell survival through the phosphatidylinositol 3′-kinase/Akt signal transduction pathway: requirement for Flk-1/KDR activation. J Biol Chem. 1998;273:30336–30343.
    OpenUrlAbstract/FREE Full Text
  46. 46.↵
    1. Xu T,
    2. Zhu Y,
    3. Xiong Y,
    4. Ge YY,
    5. Yun JP,
    6. Zhuang SM
    . MicroRNA-195 suppresses tumorigenicity and regulates G1/S transition of human hepatocellular carcinoma cells. Hepatology. 2009;50:113–121.
    OpenUrlCrossRefPubMed
  47. 47.↵
    1. Ghosh G,
    2. Subramanian IV,
    3. Adhikari N,
    4. Zhang X,
    5. Joshi HP,
    6. Basi D,
    7. Chandrashekhar YS,
    8. Hall JL,
    9. Roy S,
    10. Zeng Y,
    11. Ramakrishnan S
    . Hypoxia-induced microRNA-424 expression in human endothelial cells regulates HIF-α isoforms and promotes angiogenesis. J Clin Invest. 2010;120:4141–4154.
    OpenUrlCrossRefPubMed
  48. 48.↵
    1. Musumeci M,
    2. Coppola V,
    3. Addario A,
    4. Patrizii M,
    5. Maugeri-Sacca M,
    6. Memeo L,
    7. Colarossi C,
    8. Francescangeli F,
    9. Biffoni M,
    10. Collura D,
    11. Giacobbe A,
    12. D'Urso L,
    13. Falchi M,
    14. Venneri MA,
    15. Muto G,
    16. De Maria R,
    17. Bonci D
    . Control of tumor and microenvironment cross-talk by miR-15a and miR-16 in prostate cancer. Oncogene. 2011. [Epub ahead of print May 2, 2011].
  49. 49.↵
    1. Bonci D,
    2. Coppola V,
    3. Musumeci M,
    4. Addario A,
    5. Giuffrida R,
    6. Memeo L,
    7. D'Urso L,
    8. Pagliuca A,
    9. Biffoni M,
    10. Labbaye C,
    11. Bartucci M,
    12. Muto G,
    13. Peschle C,
    14. De Maria R
    . The miR-15a-miR-16–1 cluster controls prostate cancer by targeting multiple oncogenic activities. Nat Med. 2008;14:1271–1277.
    OpenUrlCrossRefPubMed
View Abstract
Back to top
Previous ArticleNext Article

This Issue

Arteriosclerosis, Thrombosis, and Vascular Biology
November 2011, Volume 31, Issue 11
  • Table of Contents
Previous ArticleNext Article

Jump to

  • Article
    • Abstract
    • Introduction
    • Materials and Methods
    • Results
    • Discussion
    • Sources of Funding
    • Disclosures
    • Acknowledgments
    • References
  • Figures & Tables
  • Supplemental Materials
  • Info & Metrics
  • eLetters

Article Tools

  • Print
  • Citation Tools
    MicroRNA-16 and MicroRNA-424 Regulate Cell-Autonomous Angiogenic Functions in Endothelial Cells via Targeting Vascular Endothelial Growth Factor Receptor-2 and Fibroblast Growth Factor Receptor-1
    Aránzazu Chamorro-Jorganes, Elisa Araldi, Luiz O.F. Penalva, Devraj Sandhu, Carlos Fernández-Hernando and Yajaira Suárez
    Arteriosclerosis, Thrombosis, and Vascular Biology. 2011;31:2595-2606, originally published October 19, 2011
    https://doi.org/10.1161/ATVBAHA.111.236521

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
  •  Download Powerpoint
  • Article Alerts
    Log in to Email Alerts with your email address.
  • Save to my folders

Share this Article

  • Email

    Thank you for your interest in spreading the word on Arteriosclerosis, Thrombosis, and Vascular Biology.

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    MicroRNA-16 and MicroRNA-424 Regulate Cell-Autonomous Angiogenic Functions in Endothelial Cells via Targeting Vascular Endothelial Growth Factor Receptor-2 and Fibroblast Growth Factor Receptor-1
    (Your Name) has sent you a message from Arteriosclerosis, Thrombosis, and Vascular Biology
    (Your Name) thought you would like to see the Arteriosclerosis, Thrombosis, and Vascular Biology web site.
  • Share on Social Media
    MicroRNA-16 and MicroRNA-424 Regulate Cell-Autonomous Angiogenic Functions in Endothelial Cells via Targeting Vascular Endothelial Growth Factor Receptor-2 and Fibroblast Growth Factor Receptor-1
    Aránzazu Chamorro-Jorganes, Elisa Araldi, Luiz O.F. Penalva, Devraj Sandhu, Carlos Fernández-Hernando and Yajaira Suárez
    Arteriosclerosis, Thrombosis, and Vascular Biology. 2011;31:2595-2606, originally published October 19, 2011
    https://doi.org/10.1161/ATVBAHA.111.236521
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo

Related Articles

Cited By...

Subjects

  • Basic, Translational, and Clinical Research
    • Vascular Biology
    • Angiogenesis

Arteriosclerosis, Thrombosis, and Vascular Biology

  • About ATVB
  • AHA CME
  • Meeting Abstracts
  • Permissions
  • Email Alerts
  • Open Access Information
  • AHA Journals RSS
  • AHA Newsroom

Contact the Editorial Office:
email: atvb@atvb.org

Information for:
  • Advertisers
  • Subscribers
  • Subscriber Help
  • Institutions / Librarians
  • Institutional Subscriptions FAQ
  • International Users
American Heart Association Learn and Live
National Center
7272 Greenville Ave.
Dallas, TX 75231

Customer Service

  • 1-800-AHA-USA-1
  • 1-800-242-8721
  • Local Info
  • Contact Us

About Us

Our mission is to build healthier lives, free of cardiovascular diseases and stroke. That single purpose drives all we do. The need for our work is beyond question. Find Out More about the American Heart Association

  • Careers
  • SHOP
  • Latest Heart and Stroke News
  • AHA/ASA Media Newsroom

Our Sites

  • American Heart Association
  • American Stroke Association
  • For Professionals
  • More Sites

Take Action

  • Advocate
  • Donate
  • Planned Giving
  • Volunteer

Online Communities

  • AFib Support
  • Garden Community
  • Patient Support Network
  • Professional Online Network

Follow Us:

  • Follow Circulation on Twitter
  • Visit Circulation on Facebook
  • Follow Circulation on Google Plus
  • Follow Circulation on Instagram
  • Follow Circulation on Pinterest
  • Follow Circulation on YouTube
  • Rss Feeds
  • Privacy Policy
  • Copyright
  • Ethics Policy
  • Conflict of Interest Policy
  • Linking Policy
  • Diversity
  • Careers

©2018 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited. The American Heart Association is a qualified 501(c)(3) tax-exempt organization.
*Red Dress™ DHHS, Go Red™ AHA; National Wear Red Day ® is a registered trademark.

  • PUTTING PATIENTS FIRST National Health Council Standards of Excellence Certification Program
  • BBB Accredited Charity
  • Comodo Secured