In vitro pharmacological inhibition of human vascular smooth muscle cell proliferation for the prevention of hemodialysis vascular access stenosis

BACKGROUND: Vascular access for chronic hemodialysis often fails as a result of stenosis caused primarily by the proliferation of vascular smooth muscle cells (VSMC).Various drugs have been shown to inhibit the proliferation of VSMC under different conditions. METHODs: In this study, we compared the inhibitory effect of ten drugs on the proliferation of human aortic smooth muscle cells (SMC) in culture. Quiescent cells were cultured in the presence of growth factors, fetal bovine serum and incremental concentrations of the test drug. Cell proliferation was assessed by the MTT reduction assay. RESULTS: Aspirin, enalaprilat, heparin, hydroxyurea, indomethacin and tirofiban were ineffective. While dipyridamole, paclitaxel, tranilast and verapamil inhibited cell proliferation, the concentrations required were significantly higher than the clinical plasma levels achieved after systemic administration. CONCLUSION: Local delivery of these drugs to the target site may therefore be a more effective and appropriate strategy for the prevention of hemodialysis vascular access stenosis.     

Heterogeneity in the response of vascular smooth muscle to heparin: altered signaling in heparin-resistant cells

OBJECTIVE: Vascular smooth muscle cells show phenotypic heterogeneity in vivo that affects the extent to which they respond to the antimitogenic effects of heparin. In vitro, heparin-resistant cells are readily selected. This study was undertaken to determine whether differences in the antiproliferative response to heparin involve differences in activity of heparin-sensitive signal transduction pathways. METHODS: Rat thoracic aorta smooth muscle cells (ASMC) at early passage together with two established vascular smooth muscle lines, PAC-1 and A10, were examined before and after selection for growth in the presence of heparin (10 micrograms/ml). Cells were rendered quiescent and then stimulated with serum. RESULTS: The three cell types showed different sensitivities to the antimitogenic effects of heparin. With respect to [3H]thymidine incorporation, A10 cells were insensitive to 1 microgram/ml heparin whereas PAC-1 cells responded down to 0.05 microgram/ml and ASMC were of intermediate sensitivity. ASMC and PAC-1 cells but not A10 showed a decrease in c-fos mRNA in response to 1 microgram/ml heparin, and a decrease in the c-Fos content of AP-1 DNA binding activity. None of the cells had decreased c-jun mRNA in the presence of heparin. Although induction of c-fos by serum is thought to signal through the Erk mitogen activated protein kinase family, Erk activity was decreased more by 1 microgram/ml heparin in A10 cells than in PAC-1 or ASMC. When cells were selected by growth in the presence of 10 micrograms/ml heparin, A10 cells were unaffected but PAC-1 and ASMC showed a blunted effect of heparin on serum stimulation. In contrast to A10 and their controls not exposed to continuous heparin, heparin-selected PAC-1 and ASMC showed a diminished ability to induce c-fos in response to serum. CONCLUSIONS: Smooth muscle cell lines show different responses to the antimitogenic effects of heparin that correlate with the heparin sensitivity of c-Fos/c-Jun expression. Although Erk is implicated in c-fos induction, cells comparatively resistant to heparin still show heparin-dependent inhibition of Erk activation, suggesting that other pathways may be more important for heparin resistance. Furthermore, cells selected for heparin resistance may develop c-fos-independent pathways for proliferation.     

Do plasma and serum have different abilities to promote cell growth?

The abilities of plasma and serum to support the growth of vascular smooth muscle cells maintained on uncoated tissue culture dishes or dishes coated with an extracellular matrix (ECM) have been compared. Vascular smooth muscle cells maintained on plastic dishes and exposed to plasma proliferate poorly; when exposed to serum they proliferate actively. Addition of fibroblast growth factor (FGF) incrases the growth rate of the cultures in both cases. In contrast, when vascular smooth muscle cells are maintained on an ECM, they proliferate equally well exposed to either plasma or serum. Because the cultures had an average doubling time (15 hr) that was already at a minimum, FGF no longer had an effect on vascular smooth muscle cell proliferation. These results raise the possibility that the lack of response of vascular smooth muscle cells, as well as that of other cell types in vitro, to plasma factors is not an intrinsic property of the cells but is rather due to the substrate upon which the cells rest. Because cells maintained on an ECM respond to plasma factors, it is likely that the close contact of the cells with the ECM restores their sensitivity to physiological factors present in plasma.     

Tranilast inhibits the proliferation of human coronary smooth muscle cell through the activation of p21waf1

Restenosis after percutaneous transluminal coronary angioplasty (PTCA) occurs due to vascular smooth muscle cell proliferation and migration. Recently, tranilast, an anti-allergic drug, has been used for the prevention of restenosis after PTCA. To determine the molecular mechanism involved, the effect of tranilast on the proliferation of human coronary smooth muscle cells (SMCs) was investigated. Tranilast arrested the proliferation of human coronary SMCs at the G0/G1 phase of the cell cycle. In association with this inhibitory effect, tranilast increased p21waf1 and p53 tumor suppressor factor, and decreased cyclin-dependent kinase 2 (CDK2) activity. These results suggest that tranilast inhibits the proliferation of human coronary SMCs during restenosis after PTCA via an induction of p21waf1 and p53. Tranilast may thus allow us to prevent restenosis after PTCA by interfering with this mechanism.     

Human vascular smooth muscle cells both express and respond to heparin-binding growth factor I (endothelial cell growth factor).

The control of vascular endothelial and smooth muscle cell proliferation is important in such processes as tumor angiogenesis, wound healing, and the pathogenesis of atherosclerosis. Class I heparin-binding growth factor (HBGF-I) is a potent mitogen and chemoattractant for human endothelial cells in vitro and will induce angiogenesis in vivo. RNA gel blot hybridization experiments demonstrate that cultured human vascular smooth muscle cells, but not human umbilical vein endothelial cells, express HBGF-I mRNA. Smooth muscle cells also synthesize an HBGF-I-like polypeptide since (i) extract prepared from smooth muscle cells will compete with 125I-labeled HBGF-I for binding to the HBGF-I cell surface receptor, and (ii) the competing ligand is eluted from heparin-Sepharose affinity resin at a NaCl concentration similar to that required by purified bovine brain HBGF-I and stimulates endothelial cell proliferation in vitro. Furthermore, like endothelial cells, smooth muscle cells possess cell-surface-associated HBGF-I receptors and respond to HBGF-I as a mitogen. These results indicate the potential for an additional autocrine component of vascular smooth muscle cell growth control and establish a vessel wall source of HBGF-I for endothelial cell division in vivo.     

Heparin stimulates proteoglycan synthesis by vascular smooth muscle cells while suppressing cellular proliferation.

We studied the effect of heparin on proteoglycan synthesis by bovine aortic smooth muscle cells in culture. Confluent, growth-arrested cells were incubated with [35S]sulfate, [3H]glucosamine or [3]serine in the presence of 0-600 micrograms/ml heparin. Metabolically labeled proteoglycans secreted into the culture medium and associated with the cell layer were analyzed. In cultures treated with heparin there was a dose-dependent increase in [35S]sulfate incorporation into secreted proteoglycans which reached a maximum (35% above controls) at 100 micrograms/ml heparin. At higher concentrations of heparin, the stimulatory activity declined and finally disappeared. Radioactivity in cell-associated proteoglycans increased significantly (16% above controls) only in cultures treated with 100 micrograms/ml heparin. Heparin also produced similar increases in the incorporation of [3H]glucosamine and [3H]serine into secreted and cell-associated proteoglycans. While chondroitin sulfate, dermatan sulfate and heparan sulfate were elevated in the media, only chondroitin sulfate and heparan sulfate were increased in the cell layer. Heparin did not alter the degradation of proteoglycans. Heparin, while inhibiting the proliferation of subconfluent smooth muscle cells, also stimulated to a greater extent the incorporation of [35S]sulfate into proteoglycans. Other glycosaminoglycans, such as heparan sulfate, dermatan sulfate, heparin hexasaccharide and Sulodexide caused a significant but lesser stimulation of proteoglycan synthesis, while chondroitin sulfates and hyaluronic acid had no effect. Gel filtration chromatography of proteoglycans and their constituent glycosaminoglycans from heparin-treated and untreated cultures showed no differences in their molecular size. The results indicate that heparin can stimulate proteoglycan synthesis by vascular smooth muscle cells irrespective of their state of proliferation. This might have implications in vessel wall repair and arterial wall lipid deposition.     

Dual effect of heparin and low molecular weight heparin on cultured smooth muscle cells.

The effects of heparin and low molecular weight heparin (LMWH) on the growth of cultured human aortic smooth muscle cells (hASMCs) were studied. The fourth-passage hASMCs were planted onto a 24-well plate (5 wells for each concentration of heparin or LMWH) and cultured by DMEM containing 5% either old or fresh human serum (HS), 10% fetal calf serum (FCS), and differing concentrations of heparin or LMWH (heparin and LMWH were presented as hexuronic acid) together with corresponding control groups (without heparin or LMWH) for 24h. hASMCs growth was estimated both morphologically and by 3H-TdR incorporation. The results revealed that both heparin and LMWH inhibited the proliferation of healthy growth hASMCs, but promoted the proliferation of weak growth hASMCs. These results suggest for the first time that heparin and LMWH have a dual regulative role (inhibition and promotion) in hASMCs growth and indicate that they may play an important role in controlling the proliferation of vascular smooth muscle cells and maintaining the integrity of vascular structure.     

东菱克栓酶对球囊损伤后大鼠主动脉血管细胞增殖的影响

本文在大鼠胸主动脉球囊内皮剥脱术后血管平滑肌细胞增殖模型上,用东菱克栓酶治疗,可有效地降低血浆纤维蛋白原的浓度,抑制损伤血管壁的细胞计数增加和内膜增殖,降低血管壁组织(3)~H-胸腺嘧啶的参入增加程度.实验结果提示东菱克栓酶对于防治球囊成形术后血管再狭窄的发生可能具有潜在临床应用前景.     

Blood serum atherogenicity associated with coronary atherosclerosis. Evidence for nonlipid factor providing atherogenicity of low-density lipoproteins and an approach to its elimination

To reveal the presence of atherogenic potential in the blood serum obtained from patients with angiographically assessed coronary atherosclerosis we used primary cultures of subendothelial cells isolated by collagenase from unaffected human aortic intima. Earlier, we have demonstrated that such cultures are made up mostly of typical and modified smooth muscle cells. Within 24 hours of cultivation with a 40% sera of patients suffering from coronary atherosclerosis, the total intracellular cholesterol level increased twofold to fivefold. Cultivation with the sera of healthy subjects had no effect on the intracellular cholesterol level. The sera of patients were separated by ultracentrifugation into two fractions: total lipoprotein fraction containing the main classes of lipoproteins and a lipoprotein-deficient fraction. The former, but not the lipoprotein-deficient fraction, was characterized by atherogenicity (i.e., the ability to induce the accumulation of intracellular cholesterol). Lipoproteins of the patients' serum were separated into main classes: low density lipoproteins (LDL), very low density lipoproteins (VLDL), and high density lipoproteins (HDL2 and HDL3). An atherogenic component of the serum capable of stimulating the deposition of intracellular cholesterol was represented by LDL and, in one case, by VLDL, but not by other classes of lipoproteins. LDL and other lipoproteins isolated from the blood serum of healthy subjects failed to raise the cholesterol content in cultured cells; that is, they were nonatherogenic.(ABSTRACT TRUNCATED AT 250 WORDS)     

Insights into coronary angioplasty-induced restenosis from examination of atherogenesis

Atherogenesis is a complex tissue reaction involving both vascular and circulating cells and components. The former include endothelial and smooth muscle cells, the latter circulating monocytes, platelets and lipoproteins. The role of growth factors secreted by platelets and all the cells involved in setting into motion a fibrocellular vascular reaction has been recently elucidated. Repeated injury or the presence of hyperlipidemia leads to occlusive disease. Many of these cellular events are also likely to be stimulated by the vascular injury that occurs as part of the angioplasty procedure. Restenosis, a major complication of the latter, may reflect the vascular response to iatrogenic injury. Progress in understanding the mechanisms involved in restenosis should also clarify important aspects of atherogenesis.     

Organ culture of human coronary artery following balloon angioplasty

Intimal smooth muscle cell proliferation is the primary cause of restenosis following balloon angioplasty. Its underlying basis and progression remain unclear. The authors developed an organ culture of human coronary artery subjected to balloon angioplasty in order to investigate the cellular and molecular basis of intimal proliferation in a preparation that maintained the anatomic relationships of the vessel wall. Artery segments obtained from the explanted hearts of transplant recipients were maintained at 37°C in culture medium containing 30% fetal bovine serum for fourteen days. Balloon angioplasty produced partial endothelial denudation and medial smooth muscle cell damage, both of which tended to be reversed after fourteen days in culture. Transverse histologic sections of cultured artery showed the development of a new intima containing smooth muscle cells identified by immunocytochemistry with anti-α-actin. Labeling of cultures with [³H] thymidine showed proliferating cells in the neointima. The data demonstrate that intimal proliferation occurs in organ culture of human coronary artery subjected to balloon angioplasty. They also suggest the possibility that the smooth muscle cells in the neointimal layer are the result of both migration and proliferation. This work was supported by grants from the National Heart Research Fund and the British Heart Foundation. Presented at the 34th Annual Congress, International College of Angiology, Budapest, Hungary, July 1992     

Acidic fibroblast growth factor promotes vascular repair.

Intravascular injury to arteries can result in thickening of the intimal smooth muscle layer adjacent to the lumen by migration and proliferation of cells from the underlying medial smooth muscle layer accompanied by deposition of extracellular matrix. This pathological response, which decreases lumen diameter, might, in part, be the result of the access of smooth muscle cells to plasma and platelet-derived growth factors as a consequence of denudation of the overlying confluent monolayer of vascular endothelial cells. Injured rat carotid arteries were treated by i.v. administration of acidic fibroblast growth factor, a heparin-binding protein that is chemotactic and mitogenic for vascular endothelial cells. The growth factor treatment resulted in dose-dependent inhibition of intimal thickening with parallel promotion of endothelial regeneration over the injured area. Therefore, acidic fibroblast growth factor might be efficacious in the prevention of restenosis caused by intimal thickening following angioplasty in humans.     

Inability of serum from abetalipoproteinemic subjects to stimulate proliferation of human smooth muscle cells and dermal fibroblasts in vitro.

Serum from two patients with abetalipoproteinemia, a rare disorder of lipid metabolism characterized by the absence of chylomicrons and very low density and low density lipoproteins, did not stimulate the proliferation and growth of human smooth muscle cells or dermal fibroblasts in vitro as effectively as normal serum. The growth-promoting activity of this serum was comparable to that observed for lipoprotein-deficient plasma from normolipidemic subjects. Although the mitogenic effect of abetalipoproteinemic serum was improved with supplementation of low density lipoproteins, it was still about half the activity achieved with normal serum. However, the growth-promoting activity of this serum was completely restored to normal levels after addition of a lysate of normal platelets. In contrast, the mitogenic activity of lipoprotein-deficient plasma remained unchanged after addition of a lysate from abetalipoproteinemic platelets, whereas a similar supplementation of normal platelets completely restored its growth-promoting activity to normal. Thus, the inability of abetalipoproteinemic serum to promote growth appears to be due both to a deficiency of a platelet-releasable growth factor(s) and to the absence of serum lipoproteins.     

Molecular mechanisms controlling the proliferation of aortic smooth muscle cells in spontaneously hypertensive rats

In order to define the molecular mechanisms involved in the hypertrophy of the arterial walls observed in essential hypertension, vascular smooth muscle cells were isolated from aortas of spontaneously hypertensive (SHR) and control (WKY) rats, and cultured (until the 4th sub-culture) in the presence of growth factors (foetal calf serum: FCS) and various vasoactive drugs. Growth rate was determined by cell counting and measurement of nuclear thymidine incorporation, and activation of phospholipase C by measurement of the inositol phosphates formed from preincorporated tritiated myo-inositol; the expression of the cellular oncogenes, c-fos and c-myc was visualized by hybridization of Northern blots performed from total RNA. In the presence of low concentrations of FCS (2 p. 100, 5 p. 100) angiotensin II (10(-7)M) and bradykinin (3 X 10(-6)M) increase the growth of both kind of cells. The inositol phosphate formation and the expression of c-fos and c-myc are also dose-dependently stimulated by these vasoactive drugs, and the cultures from SHR are more responsive than those from WKY rats. Phospholipase C hyperreactivity therefore appears to be involved in the increased proliferative ability of vascular smooth muscle cells from SHR. However other molecular processes may be involved, as suggested by the growth inhibition exerted by heparin without any action on PLC activity.     

Local heparin delivery for prevention of second in-stent restenosis. Acute and long-term results in 47 consecutive cases

BACKGROUND: Heparin has been shown to reduce intimal thickening after arterial wall injury by inhibiting vascular smooth muscle cell proliferation and migration. The authors studied the acute and longterm results after local delivery of heparin after balloon angioplasty for in-stent restenosis. METHODS AND RESULTS: Forty-seven instent restenosis cases, 32 of them longer than 1 cm, were enrolled. After angioplasty local heparin delivery was performed using the Dispatch coronary infusion catheter (Scimed Life Systems/Boston Scientific Corp, Natick, MA, USA); the infu-sion rate was 99.9 ml per hour and a target dosage of 4000 iu heparin per site was intended to be delivered. In nine cases (19.15%) heparin delivery had to be stopped because of ischemia. One patient died six days after intervention. After a follow-up interval of 6-12 months target vessel revascularization rate was 28.26%. CONCLUSIONS: For the protocol used ischemia occurred more often than previously reported. Considering the fact that most patients had diffuse in-stent restenosis, the target revascularization rate at follow-up was acceptable. (Int J Cardiovasc Intervent 2000; 3: 181-184)     

Effect of glycated collagen on proliferation of human smooth muscle cells in vitro

Summary While non-enzymatic glycation of long-lived tissue proteins such as collagen has been implicated in chronic complications of diabetes mellitus, its role in the aetiology of diabetic macroangiopathy has not been elucidated. To test the hypothesis that glycation of collagen abolishes the inhibitory effect of native collagen on the proliferation of human smooth muscle cells, we obtained smooth muscle cells from human gastric arteries and cultured them on dishes coated with glycated or non-glycated collagen. The proliferation of human smooth muscle cells in the presence of 10 % fetal calf serum or platelet derived growth factor-BB (10 ng/ml) was inhibited by type 1 collagen coated on the dishes. Glycation of collagen with glucose 6-phosphate for 7 days abolished the growth-inhibitory effect of native collagen. Succinylation of collagen, which like glycation blocked the lysyl residues in collagen, also abolished the growth-inhibitory effect. Adhesion of human smooth muscle cells to collagen-coated dishes was not affected by glycation of collagen. Addition of glycated albumin to the medium did not affect the growth of human smooth muscle cells on plastic dishes. The inhibition of human smooth muscle cell proliferation by collagen was not reversed by the glycation of collagen in the presence of aminoguanidine. Results suggest that early glycation abolishes the inhibitory effect of collagen on human smooth muscle cell proliferation and may thus participate in the progression of macroangiopathy in diabetes. [Diabetologia (1996) 39: 800–806] Received: 22 August 1995 and in revised form: 19 February 1996     

New antithrombotic therapy approaches in coronary heart disease--prospects for gene therapy

Despite considerable progress, pharmacological therapies have not provided a complete solution for common cardiovascular problems, including recurrent thrombosis, restenosis, and vein graft deterioration. Optimal drug dosage, reproducing plasma concentrations achieved in animal studies establishing proof-of-principle, would often be too toxic to administer. Local gene therapy aims at overexpressing proteins that regulate the cell cycle of vascular smooth muscle cells, inhibit vascular smooth muscle cell migration, endow the endothelium with enhanced vasoprotective properties. Alternatively, some approaches tend to suppress gene expression of proteins believed to promote vascular smooth muscle cell proliferation and migration. In sharp contrast to drug treatments, local gene therapy limits expression of the beneficial agent to the injured vascular site, where it can extend the presence of this agent to weeks and, with some gene vectors, to many months. This review summarizes and discusses antithrombotic gene therapy approaches for the prevention of restenosis and late thrombosis after catheter-based revascularizations.     

The retardation of vasculopathy induced by attenuation of insulin resistance in the corpulent JCR:LA-cp rat is reflected by decreased vascular smooth muscle cell proliferation in vivo

Proliferation in vivo of vascular smooth muscle cells occurs early in the course of atherosclerosis. Cultured smooth muscle cells (SMCs) explanted from aortas of JCR:LA-cp corpulent rats known to exhibit metabolic derangements and insulin resistance typical of type II diabetes early in life and to develop atherosclerosis later in life exhibit increased proliferation compared with SMCs from lean, normal rats. Vascular smooth muscle proliferation in vitro was found to be positively and significantly correlated with plasma insulin levels in vivo. Proliferation of aortic SMCs from JCR:LA-cp cp/cp corpulent rats cultured in vitro exhibited increased proliferation in the presence of exogenous insulin. Exercise and diet, selected as interventions designed to ameliorate the insulin resistance and hyperinsulinemia in the JCR:LA-cp cp/cp rat, effectively lowered blood insulin levels and decreased subsequent proliferation in vitro of aortic SMCs explanted from these animals. The results indicate that assessment of proliferation of vascular smooth muscle cells ex vivo may provide insight into the presence and severity of atherogenicity in association with insulin resistance in diverse species under diverse circumstances. Accordingly, with appropriate controls, it may be possible to use SMC proliferation ex vivo as a marker of the extent to which an intervention such as administration of insulin sensitizers to experimental animals and human subjects results in a change in behavior of vessel wall elements potentially indicative of amelioration of atherogenicity and detectable as judged from reduced proliferative rates of the cells ex vivo when they have been harvested from vessels exposed to a milieu in which insulin resistance has been attenuated.     

多沙唑嗪对血管狭窄和血清一氧化氮的影响

目的探讨多沙唑嗪对兔腹主动脉球囊损伤后血管狭窄的影响,及其与血清一氧化氮、血管内膜中膜平滑肌细胞增生的关系。方法23只新西兰兔随机分为正常对照组、球囊损伤组、多沙唑嗪组。正常对照组不予任何方式处理。另两组行腹主动脉球囊损伤术,同时多沙唑嗪组应用多沙唑嗪控释片4mg/d,观察各组血清一氧化氮以及血管损伤处血管狭窄、血管内膜中膜增殖细胞核抗原(PCNA)的变化。结果应用多沙唑嗪4周后多沙唑嗪组血清一氧化氮含量增高,血管损伤处血管内膜、外膜增生减轻,新生内膜面积减少,管腔面积增加,内弹力层和外弹力层包围面积增加,血管内膜中膜PCNA阳性平均灰度降低。结论多沙唑嗪可以抑制球囊损伤后兔腹主动脉血管的狭窄,抑制血管内膜中膜平滑肌细胞增殖,增加血清一氧化氮含量。     

药物支架的不良反应及临床应用局限性

药物支架主要包括雷帕霉素洗脱支架和紫杉醇洗脱支架两大类,作用机制均为通过抑制平滑肌细胞的增殖来防止再狭窄的形成,由于其对细胞增殖的抑制作用为非选择性,可能影响内皮细胞的再生和内皮层的修复,因此存在一系列不良反应及临床应用局限性。