Vascular Calcification Increased Cardiovascular Events ~ 20% ~ 60% ~ 90% Age. young middle elderly. 5-year mortality.

Size: px

Start display at page:

Download "Vascular Calcification Increased Cardiovascular Events ~ 20% ~ 60% ~ 90% Age. young middle elderly. 5-year mortality."

Rosemary Melton
5 years ago
Views:

1 Vascular Calcification Increased Cardiovascular Events ~ 2% ~ 6% ~ 9% young middle elderly Age 5-year mortality Framingham Risk

2 Women had a greater probabilityofdeath than men in each strata of vascular calcification. Raggi P. et al, Journal of Women s Health 13; 3 24

3 DM Accelerated Vascular Calcification! Calcification of the Aortic Arch Risk Factors and Association With Coronary Heart Disease, Stroke, and Peripheral Vascular Disease JAMA. 2;283: X2 X2.5

4 New Concept of Vascular Calcification Phenotype Change in VSMC Expression in atherosclerotic plaque Osteocalcin Bone sialoprotein Bone morphogenetic protein -2 and -4 Osteopontin Osteonectin Dhore R.C et al. ATVB. 21;21:

5 OPG RANKL RANK TRAF6 TRAF6 Ras csrc PI3K JNK ERK p38 NFκB Akt cfos cjun cbfa1 NFAT Mammary gland development Bone metabolism Signaling between T cell and dendritic cell

.. Med Med + RANKL HASMC 14 days Alizarin Red Staining Nodules /

6 RANKL increases calcification of HASMC Med Dexamethasone, β-glycerophosphate, Ascorbate... Med Med + RANKL HASMC 14 days Alizarin Red Staining Nodules / well No treat. Med. Med + RL ALP mrna (%Med) Med Med + RL Osakoet al. CircRes 21

7 RANKL system is present in vascular cells RANK HAEC HASMC OB RANKL OPG β-actin RANKL induces BMP-2 expression in HAEC: BMP-2 mrna (% No treat) No treat # RL RL + anti- OPG BMP-2 protein (pg / ml) No treat. RL RL + anti- OPG RANKL anti-opg Ab BMP-2 β-actin BMP-2 P <.1 vs No treat Osakoet al. CircRes 21

8 BMP-2 is a potent osteogenic inducer in HASMC OC / 18S mrna.16 BMP ALP / 18S mrna BMP OPN / 18S mrna BMP2 1 d 3 d HAEC Noggin P <.5 vs No treat VSMC BMP2 RANKL BMP-2 HASMC is treated the main with conditioned osteogenic medium protein of RANKL induced stimulated by RANKL HAEC Cbfa1 / 18S mrna3.5 RANKL anti-opg Noggin MSX2 / 18S mrna OC / 18S mrna ALP / 18S mrna Bone markers (osteogenesis) Osakoet al. CircRes 21

9 RANKL induces bone-related protein expression in HASMC MGP / 18S mrna No treat RL RL + anti- OPG anti- OPG Cbfa1 / 18S mrna No treat RL RL + anti- OPG anti- OPG Osterix / 18S mrna No treat RL RL+ anti- OPG anti OPG MGP MSX2 / 18S mrna No treat RL RL+ anti- OPG anti OPG OC / 18S mrna CT RL RL + anti- OPG No treat anti- OPG ALP / 18S mrna No treat RL RL+ anti anti- OPG OPG Bone markers (osteogenesis) Osakoet al. CircRes 21

10 High Fat Diet increases vascular calcification in Estrogen deficiency mice Oil Red Alizarin Red µm 2 Sham Atherosclerosis µm Calcification 1 5 Sham OVX OVX + E2 Sham OVX OVX + E2 Osakoet al. CircRes 21

11 RANK/ 18S mrna High fat diet increases RANKL system expression in aorta of Estrogen deficiency # RANK RANKL RANKL/ 18S mrna # OPN PECAM OPG/ 18S mrna HF OVX E # in situ hybridization 1 X Osakoet al. CircRes 21

12 What triggers RANKL activation in vasculature? RANK OVX/ High Fat Diet ApoE -/- RANKL 5 µm OPN 3 months 5 µm RANKL RANK BMP-2 5 µm RANKL system BMP-2 MGP Calcification RANKL Estrogen cbfa1, msx2 ALP, OPN, OC

13 Calcification induction in VSMC by. Inhibition of RANKL decreases the effect of in calcification Osakoet al. ATVB 213

14 Vascular calcification after infusion in ovariectomizedapoe -/- mice. exacerbates the calcification incidence in this HF/OVX ApoE -/- The ARB (Olmesartan3 mg/kg/day) treatment inhibits calcification and calcification-related gene expression Osakoet al. ATVB 213

15 RANKL induces AT1R and ACE expression via ERK phosphorylation. RANKL RANK ACE perk AT1R Cbfa1, msx2 Calcification, Osakoet al. ATVB 213

16 Ca2PO4 MGP Activated Endothelium RANKL BMP2 Endothelium Media layer RAS Calcification: Osteoblast-like cell ALP, OPN, OC Osakoet al. ATVB 213

17 Clinical Evidence: ARB inhibits vascular calcification ACE-I/ARB treatment in type 1 diabetes patients with albuminuria is associated with lower odds of progression of coronary artery calcification Maahs et al. Journal of Diabetes and Its Complications 21 (27) Prognostic factors for progression of early-and late-stage calcific aortic valve disease in Japanese: The Japanese Aortic Stenosis Study (JASS) Retrospective Analysis Yamamoto et al. Hypertension Research 33 (21) Calcific aortic valve disease Initiation of ARB treatment during the early stage may be effective

18 What is unmet medical needs in Adult Common Diseases? 1) Do we need drugs forever? 2) Should we take drugs everyday? 3) Can we prevent the onset of DM, hypertension.? 4) Is cost expensive to take DPP4 inhibitors, ARBs, even if these drugs work as organ protective? Answer is No!!, if vaccine would become realm.

19 Design of DPP-4 Peptide Vaccine Food intake GLP-1 DPP-4 Insulin Plasma glucose DPP-4 inhibitor Blockade of DPP-4 by anti-dpp-4 antibody DPP-4 vaccine (E1, E2 E3 antrigen as candidates)

Screening of DPP-4 antigen (E1, E2, and E3)

(2 µg) E2 (2 µg) E3 (2 µg) E1 (2 µg) E2 (2

25kD 12kD 1kD 1 2 3 4 1 2 3 41 2 3 41 2 3 4

20 Screening of DPP-4 antigen (E1, E2, and E3) ELISA Titer (OD5%) 25, 2, 15, 1, 5, KLH E1 (2 µg) E2 (2 µg) E3 (2 µg) E1 (2 µg) E2 (2 µg) E3 (2 µg) day14 day28 day42 day56 day7 25kD 12kD 1kD E1 serum E3 serum KLH C-anti-DPP4 Ab 1: Marker 2: recombinant DPP4 3:BSA-E1 4:BSA-E3 E1 or E3 antigen can increase anti-dpp-4 titer.

21 E3 antigen decreased DPP-4 activity and increased GLP Plasma GLP-1 level pm 5 Plasma DPP4 % Inhibiton ug/mouse 2 2 ug/mouse E1 E3 1 Antibody of neutralization % Inhibition

22 DPP-4 vaccine did not affect body weight and food consumption in C57Bl/6 mice DPP4 vaccine DPP4 vaccine Day after vaccination Day after vaccination Bodyweight(g) Food consumption (g)

23 DPP-4 vaccine attenuated plasma glucose level evaluated by Meal Tolerance Test d8 High fat diet d d14 d28 d84 d119 Plasma glucose level(mg/ml) Immunization Meal Tolerance Test DPP4 vaccine KLH Lean control min PLasma glucose AUC (mgmin/d) P<.5 vs. KLH MTT ITT Lean control AUC KLH DPP4 vaccine P<.5 vs. Lean

24 DPP-4 vaccine improved insulin resistance evaluated by ITT or HOMA-IR d8 High fat diet d d14 d28 d84 d119 Immunization MTT ITT Plasma glucose level(mg/ml) ITT DPP4 vaccine KLH min P<.5 vs. KLH HOMA-IR KLH HOMA-IR DPP4 vaccine P<.5 vs. KLH

25 DPP-4 vaccine improved glucose metabolism in KKAy mice (type 2 diabetes model) 35, Plasma gluocose mg/dl KLH E3 vaccine Plsma glucose AUC mgmin/dl 3, 25, 2, 15, 1, 5, 2. KLH E3 vaccine min P<.5 vs. KLH Plasma insulin ng/ml KLH E3 vaccine

26 DPP-4 vaccine increased insulin-positive cells in islet in KKAy mice (type 2 diabetes model) Insulin Insulin Ki67 KLH E3 vaccine Ki67 positivecell / islet KLH E3 vaccine

27 Vaccine for Hypertension Drug Renin Inhibitor ACE inhibitor ARB iotensinogen I AT 1 R Renin ACE Peptide vaccine Renin vaccine (Discontinued) I vaccine vaccine (Phase ) AT1R vaccine Peptide vaccines for I, and AT1R lowered BP in animal model.

28 DNA vaccine system 1. Activation of innate immunity 2. T cell response: CTL and hepler T cells 3. B cell response: antibody production Adaptation of DNA vaccine for common diseases (i.e. hypertension, DM)

DNA Vaccine Using Hepatitis Virus B core

Intervirology 21 Present target molecule On

Self-aggregation Secretion of Sphere formation

DRVYIHPF HBc-C iotensin This system provides

29 DNA Vaccine Using Hepatitis Virus B core protein (HBc) Target peptide Intervirology 21 Intervirology 21 Present target molecule On the surface of Sphere J of Virology 21 Self-aggregation Secretion of Sphere formation HBc- fusion protei HBc-N -I-T- -G-A-T- DRVYIHPF HBc-C iotensin This system provides higher immunogenisity as an antigen and efficient antibody production.

30 Needleless Injection for High Transfection Efficiency Shima Jet Kunugiza et al, Gene Therapy 26

Anti- antibody was elevated for 6 months Injection 4 8

31 Anti- antibody was elevated for 6 months Injection Weeks Anti- antibody was crossreacted with I,

32 Decrease in BP was continued up to 6M! SHR Life Span of rats is about 2 years. 6 months might be equivalent to 2 years in human!?

33 DNA Vaccine Decreased Myocardial Infarction & Cerebral Infarction Size Myocardial Infarction Control vaccine Cerebral Infarction Control Area of fibrosis (%) Control 2 vaccine

The role of Lp(a) in CVD Elevated Serum lipoprotein(a) concentration is an independent risk factor for Atherosclerotic disease, such as CHD, PAD, restenosis after aingioplasty.

34 The role of Lp(a) in CVD Elevated Serum lipoprotein(a) concentration is an independent risk factor for Atherosclerotic disease, such as CHD, PAD, restenosis after aingioplasty. CHD PAD 5,436 patients in 17 prospective studies Circulation. 2 Sep 5;12(1): PAD patient / 213 control At present, no pharmacotherapy to decrease Lp(a) is not existed. Clinical Chemistry 53: (27) 126,634 participants in 36 prospective studies. Under a wide range of circumstances, there are continuous, independent, and modest associations it is quite of Lp(a) difficult concentration to develop with risk the of specific CHD and stroke drug that to decrease appear exclusive Lp(a) to vascular outcomes. Since the homology of apo (a) is too close to that of plasminogen, alone. JAMA. 29 Jul 22;32(4):

Selection of the epitope Ⅳtype2 Ⅳtype2 Ⅳtype2 Ⅳtype2 Ⅳtype2 Ⅳtype2 LDL Lp(a) Low homology to plasminogen with high antigenicity (12 amino acids:eapseqapteqr) ApoB S S Ⅳ:kringl Ⅳ like domain Ⅴ:kringle

35 Selection of the epitope Ⅳtype2 Ⅳtype2 Ⅳtype2 Ⅳtype2 Ⅳtype2 Ⅳtype2 LDL Lp(a) Low homology to plasminogen with high antigenicity (12 amino acids:eapseqapteqr) ApoB S S Ⅳ:kringl Ⅳ like domain Ⅴ:kringle Ⅴ like domain Ⅳtype1 Ⅳtype2 Ⅳtype2 Ⅳtype3 Ⅳtype4 Ⅳtype5 Ⅳtype6 Ⅳtype7 Ⅳtype8 Ⅳtype9 Ⅳtype1 Ⅴ protease like domain variable repeats Construct of DNA vaccine for Lp(a) plasminogen kringle Ⅰ kringle Ⅱ kringle Ⅲ kringle Ⅳ kringle Ⅴ protease like domain Pcmv HBc Monomer Pcmv HBc-N Apo(a) HBc-C Amp pcdna3.1-hbc 5523+bp SV4 ori puc HBc Neo HBc-N -I-T- -G-A-T- EAPSEQAPTEQR Apo(a) 12a.a. HBc-C pcdna3.1-hbc-apo(a) Amp 5523+bp SV4 ori puc HBc-apo(a) Kyutoku M et al. Scientific Reports 213 Neo

36 High titer of anti-apo(a) antibody was observed only in HBc-apo(a) group and additional immunization raised the titer of anti-apo(a) antibody. Titer (total IgG) 6w w 3 Anti-apo(a) IgG OD 45 nm Anti-apo(a) IgG OD 45 nm HBc-apo(a) HBc Saline HBc-apo(a) HBc Saline 6w 4 12w 4 Anti-plasminogen IgG OD 45 nm n.s. Anti-plasminogen IgG OD 45 nm n.s. HBc -apo(a) HBc Saline PLG Ab HBc -apo(a) HBc Saline PLG Ab Kyutoku M et al. Scientific Reports 213

Carotid Ligation Model -2w w 2w 4w 6w 1w 12w 13w 16w OVX Ligation HE stain

37 Apo(a) vaccination attenuated neointima formation in carotid artery ligation model. Carotid Ligation Model -2w w 2w 4w 6w 1w 12w 13w 16w OVX Ligation HE stain Intima / Media 7 mm Immunized [HBc-apo(a)] 7 mm Control [HBc & Saline] ratio Immunized p <.5 Control Kyutoku M et al. Scientific Reports 213

Treatment with apo(a) DNA vaccine inhibited the

Control [HBc& Saline] IHC [MOMA-2] 2 mm 2 mm

38 Treatment with apo(a) DNA vaccine inhibited the deposition of Lp(a) & Migration of macrophases in blood vessels. IHC [Lp(a)] 2 µm 2 µm Immunized [HBc-apo(a)] Control [HBc& Saline] IHC [MOMA-2] 2 mm 2 mm Immunized [HBc-apo(a)] Control [HBc& Saline] Kyutoku M et al. Scientific Reports 213

39 DNA vaccine system 1. Activation of innate immunity 2. T cell response: CTL and hepler T cells 3. B cell response: antibody production Adaptation of DNA vaccine for common diseases (i.e. hypertension, DM)

조현재 서울대학교병원순환기내과, 심혈관연구실,

Molecular Mechanism of Vascular Calcification 2010. 4. 17. 조현재 서울대학교병원순환기내과, 심혈관연구실, 서울대학교병원심혈관센터 Vascular calcification : clinical hurdles Vascular calcification : clinical significance! Clinical consequences