Angiotensin II (Ang II) promotes vascular disease and hypertension in part by the formation of pro-inflammatory cytokines, oxidative stress and inflammation. Signal transducer and activator of transcription 3 (STAT3) is a transcription factor known to play key roles in cytokine signaling and growth in immune cells. We tested the hypothesis that STAT3 plays an essential role in Ang II-induced vascular dysfunction and hypertension. Responses of carotid arteries from C57BL6 mice were examined in vitro after 22-hour incubation with vehicle or Ang II (10 nM) in the presence or absence of a small molecule inhibitor of STAT3 activation, S3I-201. The endothelium-dependent agonist acetylcholine (Ach) produced relaxation in arteries treated with vehicle and the response was inhibited by ~50% by Ang II (P<0.01). S3I-201 (10 πM) co-incubation prevented the Ang II-induced dysfunction. Relaxation to nitroprusside, an endothelium-independent agonist, was not altered in any group. Ang II increased vascular superoxide more than 2-fold (P<0.05) measured by chemiluminescence. S3I-201 (10 πM) prevented the Ang II induced increase of superoxide. Similar findings were obtained with STATTIC, a second small molecule inhibitor of STAT3 activation. In contrast to these findings, lipopolysaccharide (0.5 πg/ml)-induced endothelial dysfunction was not altered by S3I-201. Blood pressure and responses of carotid arteries and small resistance arteries within the brain were examined in C57BL6 mice with either saline or Ang II (1000 ng/kg/min) infused for 14 days via osmotic minipump, which were also treated with dimethyl sulfoxide (vehicle) or S3I-201 (5 mg/kg, IP, every two days). Infusion with Ang II increased systolic blood pressure compared to saline-infused animals (155±2 and 112±2 mmHg, respectively; P<0.001). S3I-201 reduced pressure slightly in saline infused mice but protected against Ang II-induced increase in pressure at 14 days (102±2 and 114±3 mmHg, respectively). Following systemic treatment with Ang II, carotid artery relaxation responses to Ach were significantly impaired compared to vehicle infused mice (72±3% and 101±1%, respectively, P<0.05). S3I-201 treatment significantly prevented Ang II-induced impairment (94±4%, P<0.05). Ang II treated mice exhibited 55% impaired dilator responses to Ach in small resistance arteries within the brain studied in vitro and S3I-201 treatment prevented most of this impairment (P<0.05). Vasorelaxation to nitroprusside was not altered in any group. In summary, these findings provide the first evidence that STAT3 plays an essential role in Ang II-induced vascular dysfunction and hypertension. Targeting STAT3 with small molecule inhibitors or other approaches may have beneficial effects during hypertension and other disease states in which Ang II contributes to vascular dysfunction (e.g. diabetes and aging).

VEGF is a main driver of tumor angiogenesis, playing an important role not only in the formation of new blood vessels, but also acts as a factor for cell migration, proliferation, survival and apoptosis. Angiogenesis is a universal function shared by most solid tumors and its inhibition was thought to have the potential to work across a broad patient population. Clinical evidence has shown that inhibiting pathological angiogenesis only works in a subset of patients and the identification of those patients is an important step towards personalized cancer care. The first approved antiangiogenic therapy was bevacizumab (Avastin®), a monoclonal antibody targeting VEGF in solid tumors including CRC, BC, NSCLC, RCC and others. In addition to endothelial cells, VEGF receptors are present on a number of different cell types including tumor cells, monocytes and macrophages. The work presented in this thesis looked at the in vitro cellular changes in tumor cells and leukocytes in response to the inhibition of VEGF signaling with the use of bevacizumab. In the initial experiments, VEGF was induced by hypoxia in tumor cells to evaluate changes in survival, proliferation, migration and changes in gene or protein expression. There was a minimal direct response of VEGF inhibition in tumor cells that could be attributed to bevacizumab treatment, with minor variations in some of the cell lines screened but no uniform or specific response noted. MMR deficiency often results in microsatellite instability (MSI) in tumors, as opposed to microsatellite stable (MSS) tumors, and accounts for up to 15% of colorectal carcinomas (CRCs). It has been suggested in clinical data that MMR deficient tumors responded better to bevacizumab regimens, therefore further research used isogenic paired CRC tumor cell lines (MMR deficient and proficient). Furthermore, a DNA damaging agent was added to the treatment regimen, the topoisomerase inhibitor SN-38 (the active metabolite of irinotecan). Inhibiting VEGF using bevacizumab significantly inhibited the ability of MMR deficient tumor cells to form anchor dependent colonies, however conversely, bevacizumab treatment before damaging cells with SN-38, showed a significant increase in colony numbers. Moreover, VEGF inhibition by bevacizumab pretreatment also significantly increased the mutation fraction in MMR deficient cells as measured by transiently transfecting a dinucleotide repeat construct, suggesting VEGF signaling may have an intrinsic role in MMR deficient cells. A number of pathways were analyzed in addition to changes in gene expression profiles resulting in the identification of JNK as a possible VEGF targeted pathway. JUN expression was also reduced in these conditions reinforcing this hypothesis, however the intricate molecular mechanisms remain to be elucidated. In order to remain focused on the clinical application of the findings, it was noted that some cytokines were differentially regulated by bevacizumab between MMR proficient and deficient cells. Treatment regimens employed in vitro attempted to mimic the clinical setting by inducing DNA damage, then allowing cells to recover with or without VEGF using bevacizumab treatment. Inflammatory cytokines, CCL7 and CCL8, were found to have higher expression in the MMR deficient cell line with bevacizumab after DNA damage, therefore the cross talk via tumor derived factors to myeloid cells was analyzed. Gene expression changes in monocytes induced by tumor conditioned media showed CCL18 to be a bevacizumab regulated gene by MMR deficient cells and less so in MMR proficient cells. CCL18 has been described as a prognostic marker in gastric, colorectal and ovarian cancers, however the significance is dependent on tumor type. CCL18 primarily exerts its function on the adaptive immune system to trigger a TH2 response in T cells, but is also described to increase non-specific phagocytosis. The results of this study did show an increase in the phagocytic activity of macrophages in the presence of bevacizumab that was significantly more apparent in MMR deficient cells. Furthermore, after DNA damage MMR deficient cells treated with bevacizumab released a cytokine mix that induced monocyte migration in a bevacizumab dependent manner, showing a functional response with the combination of MMR deficiency and bevacizumab. In summary, the work in this thesis has shown evidence of immune cell modulation that is specific to MMR deficient tumor cells that may translate into a marker for the administration of bevacizumab in a clinical setting. VEGF ist ein zentraler Regulator der Tumor-Angiogenese, und spielt eine wichtige Rolle nicht nur in der Bildung von neuen Blutgefäßen, sondern ist auch für die Migration, Proliferation, das Überleben und Apoptose von Tumorzellen essentiell. Angiogenese ist eine der universellen Funktionen, welche das Wachstum der meisten soliden Tumoren charakterisiert. Eine der klassischen therapeutischen Ideen wurde auf der Basis entwickelt, dass die spezifische Hemmung der Angiogenese das Potenzial hat in einer breiten Patientenpopulation einen klinischen Effekt zu zeigen. Die klinische Erfahrung und Anwendung hat jedoch gezeigt, dass die Hemmung der pathologischen Angiogenese nur in einem Teil der Patienten einen therapeutischen Nutzen aufweist. Somit stellt die Identifikation derjenigen Patienten, welche von der anti-angiogenen Therapie profitieren, einen wichtiger Schritt zur personalisierten Krebsbehandlung dar. Die erste zugelassene antiangiogene Therapie war Bevacizumab (Avastin®), ein monoklonaler Antikörper gegen VEGF, welcher unter anderem in soliden Tumoren wie CRC, BC, nicht-kleinzelligem Lungenkrebs (NSCLC) und dem Nierenzellkarzinom angewandt wird. VEGF-Rezeptoren befinden sich nicht nur auf Endothelzellen, sondern sind auch auf einer Anzahl von verschiedenen Zelltypen, einschließlich Tumorzellen, Monozyten und Makrophagen nachweisbar. Die in dieser Arbeit vorgestellten Ergebnisse befassen sich mit den zellulären Veränderungen an Tumorzellen und Leukozyten als Reaktion auf die Hemmung der VEGF-Signalkaskade durch Bevacizumab in-vitro. In den Initialen Experimenten wurde VEGF durch Hypoxie in Tumorzellen induziert und Veränderungen der Überlebensrate, der Proliferation, Migration als auch in der Gen- oder Protein-Expression gemessen. Es konnte eine minimale direkte Reaktion der VEGF-Hemmung auf Tumorzellen beobachtet werden, welche auf die Bevacizumab Behandlung zurückgeführt werden könnte. Es zeigten sich aber auch geringfügige Abweichungen in einigen der verwendeten Zellinien, die keine einheitliche Interpretation erlauben oder auf eine uniformelle Reaktion hinweisen würden. Das phänotypische Korrelat einer „Mismatch“ Reparatur (MMR)-Defizienz ist die Mikrosatelliteninstabilität im Gegensatz zu mikrosatellitenstabilen Tumoren und findet sich bei bis zu 15% der kolorektalen Karzinomen (CRC) wieder. Klinischen Daten deuten daraufhin, dass Bevacizumab besser in MMR-defizienten Tumoren wirkt. Daher wurden die weiteren Untersuchungen in gepaarten MMR stabilen und MMR instabilen CRC-Tumorzelllinien (MMR defizient und kompetent) durchgeführt. Weiterhin wurde ein DNA-schädigendes Agens, SN-38, ein Topoisomerase-Inhibitor (der aktive Metabolit von Irinotecan) dem Behandlungsschema zugefügt. Es zeigte sich, dass die Hemmung von VEGF mittels Bevacizumab die Fähigkeit der MMR defizienten Tumorzellen Kolonien zu bilden signifikant inhibiert. Im Gegensatz dazu, hatte die Behandlung von Bevacizumab vor der Zugabe des DNA schädigenden Agens zu einer vermehrten Kolonienzahl geführt. Außerdem erhöhte die Vorbehandlung mit Bevacizumab deutlich die Mutationsrate in MMR-defizienten Zellen, was durch die transiente Transfektion eines Dinukleotid-Repeat-Konstrukts nachgewiesen werden konnte. Dies deutete darauf hin, dass VEGF eine intrinsische Rolle in der Signalkaskade des MMR-Systems haben könnte. Deshalb wurde eine Anzahl von Signalalkaskaden zusätzlich zu Veränderungen von Genexpressionsprofilen untersucht und JNK als mögliche Verbindungsstelle der beiden Signalkaskaden, VEGF und MMR, identifiziert. Diese Hypothese wurde zusätzlich unterstützt durch die Tatsache, dass die JUN Expression unter diesen experimentellen Bedingungen reduziert war. Die Aufklärung der komplexen molekularen Mechanismen der potentiellen Interaktion bleibt zukünftigen Untersuchungen vorbehalten. In Hinblick auf die klinische Konsequenz der erhaltenen Ergebnisse war es auffällig, dass einige Zytokine durch Bevacizumab in den MMR defizienten Zellen im Gegensatz zu den MMR kompetenten Zellen unterschiedlich reguliert wurden. Die in-vitro verwendeten Behandlungsschemata waren den klinisch zur Anwendung kommenden Protokollen nachempfunden. Zuerst wurde ein DNA-Schaden gesetzt, und den Zellen ermöglicht, sich mit oder ohne Bevacizumab zu erholen. Es konnte gezeigt werden, dass die inflammatorischen Zytokine CCL7 und CCL8 eine höhere Expression in der MMR-defiziente Zelllinie in Kombination mit Bevacizumab aufweisen. Daher wurde ein möglicher Crosstalk zwischen von Tumorzellen sezernierten Faktoren und myeloischen Zellen weiter verfolgt. Veränderungen der Genexpression in Monozyten durch Tumorzell- konditionierte Medien zeigte CCL18 als ein Bevacizumab reguliertes Gen in MMR-defizienten Zellen, aber nicht in MMR kompetenten Zellen. CCL18 übt seine Funktion primär im adaptiven Immunsystems aus um eine TH2-Antwort in T-Zellen auszulösen Ausserdem wird eine Erhöhung der nicht-spezifische Phagozytose als weitere Funktion beschrieben. CCL18 wurde bereits als prognostischer Marker in Magen-, Dickdarm- und Eierstockkrebsarten beschrieben; die klinische Bedeutung ist jedoch abhängig von Tumortyp. Die Ergebnisse dieser Arbeit zeigen, dass eine Erhöhung der phagozytischen Aktivität von Makrophagen in Gegenwart von Bevacizumab wesentlich deutlicher in MMR-defizienten Zellen ausgeprägt war. Weiterhin wurde gefunden, dass nach DNA-Schädigung in Bevacizumab behandelten MMR-defizienten Zellen Zytokine freigesetzt werden, welche eine Monozytenmigration in einer Bevacizumab-abhängigen Weise induzieren. Dies weist auf eine funktionelle Interaktion von MMR-Defizienz und Bevacizumab hin. Zusätzlich zeigen die Ergebnisse dieser Arbeit eine Immunzellmodulation, die spezifisch für Mismatch-Reparatur defiziente Tumorzellen ist und in der klinischen Praxis als Marker für die Verabreichung von Bevacizumab verwendet werden könnte. / VEGF ist ein zentraler Regulator der Tumor-Angiogenese, und spielt eine wichtige Rolle nicht nur in der Bildung von neuen Blutgefäßen, sondern ist auch für die Migration, Proliferation, das Überleben und Apoptose von Tumorzellen essentiell. Angiogenese ist eine der universellen Funktionen, welche das Wachstum der meisten soliden Tumoren charakterisiert. Eine der klassischen therapeutischen Ideen wurde auf der Basis entwickelt, dass die spezifische Hemmung der Angiogenese das Potenzial hat in einer breiten Patientenpopulation einen klinischen Effekt zu zeigen. Die klinische Erfahrung und Anwendung hat jedoch gezeigt, dass die Hemmung der pathologischen Angiogenese nur in einem Teil der Patienten einen therapeutischen Nutzen aufweist. Somit stellt die Identifikation derjenigen Patienten, welche von der anti-angiogenen Therapie profitieren, einen wichtiger Schritt zur personalisierten Krebsbehandlung dar. Die erste zugelassene antiangiogene Therapie war Bevacizumab (Avastin®), ein monoklonaler Antikörper gegen VEGF, welcher unter anderem in soliden Tumoren wie CRC, BC, nicht-kleinzelligem Lungenkrebs (NSCLC) und dem Nierenzellkarzinom angewandt wird. VEGF-Rezeptoren befinden sich nicht nur auf Endothelzellen, sondern sind auch auf einer Anzahl von verschiedenen Zelltypen, einschließlich Tumorzellen, Monozyten und Makrophagen nachweisbar. Die in dieser Arbeit vorgestellten Ergebnisse befassen sich mit den zellulären Veränderungen an Tumorzellen und Leukozyten als Reaktion auf die Hemmung der VEGF-Signalkaskade durch Bevacizumab in-vitro. In den Initialen Experimenten wurde VEGF durch Hypoxie in Tumorzellen induziert und Veränderungen der Überlebensrate, der Proliferation, Migration als auch in der Gen- oder Protein-Expression gemessen. Es konnte eine minimale direkte Reaktion der VEGF-Hemmung auf Tumorzellen beobachtet werden, welche auf die Bevacizumab Behandlung zurückgeführt werden könnte. Es zeigten sich aber auch geringfügige Abweichungen in einigen der verwendeten Zellinien, die keine einheitliche Interpretation erlauben oder auf eine uniformelle Reaktion hinweisen würden. Das phänotypische Korrelat einer „Mismatch“ Reparatur (MMR)-Defizienz ist die Mikrosatelliteninstabilität im Gegensatz zu mikrosatellitenstabilen Tumoren und findet sich bei bis zu 15% der kolorektalen Karzinomen (CRC) wieder. Klinischen Daten deuten daraufhin, dass Bevacizumab besser in MMR-defizienten Tumoren wirkt. Daher wurden die weiteren Untersuchungen in gepaarten MMR stabilen und MMR instabilen CRC-Tumorzelllinien (MMR defizient und kompetent) durchgeführt. Weiterhin wurde ein DNA-schädigendes Agens, SN-38, ein Topoisomerase-Inhibitor (der aktive Metabolit von Irinotecan) dem Behandlungsschema zugefügt. Es zeigte sich, dass die Hemmung von VEGF mittels Bevacizumab die Fähigkeit der MMR defizienten Tumorzellen Kolonien zu bilden signifikant inhibiert. Im Gegensatz dazu, hatte die Behandlung von Bevacizumab vor der Zugabe des DNA schädigenden Agens zu einer vermehrten Kolonienzahl geführt. Außerdem erhöhte die Vorbehandlung mit Bevacizumab deutlich die Mutationsrate in MMR-defizienten Zellen, was durch die transiente Transfektion eines Dinukleotid-Repeat-Konstrukts nachgewiesen werden konnte. Dies deutete darauf hin, dass VEGF eine intrinsische Rolle in der Signalkaskade des MMR-Systems haben könnte. Deshalb wurde eine Anzahl von Signalalkaskaden zusätzlich zu Veränderungen von Genexpressionsprofilen untersucht und JNK als mögliche Verbindungsstelle der beiden Signalkaskaden, VEGF und MMR, identifiziert. Diese Hypothese wurde zusätzlich unterstützt durch die Tatsache, dass die JUN Expression unter diesen experimentellen Bedingungen reduziert war. Die Aufklärung der komplexen molekularen Mechanismen der potentiellen Interaktion bleibt zukünftigen Untersuchungen vorbehalten. In Hinblick auf die klinische Konsequenz der erhaltenen Ergebnisse war es auffällig, dass einige Zytokine durch Bevacizumab in den MMR defizienten Zellen im Gegensatz zu den MMR kompetenten Zellen unterschiedlich reguliert wurden. Die in-vitro verwendeten Behandlungsschemata waren den klinisch zur Anwendung kommenden Protokollen nachempfunden. Zuerst wurde ein DNA-Schaden gesetzt, und den Zellen ermöglicht, sich mit oder ohne Bevacizumab zu erholen. Es konnte gezeigt werden, dass die inflammatorischen Zytokine CCL7 und CCL8 eine höhere Expression in der MMR-defiziente Zelllinie in Kombination mit Bevacizumab aufweisen. Daher wurde ein möglicher Crosstalk zwischen von Tumorzellen sezernierten Faktoren und myeloischen Zellen weiter verfolgt. Veränderungen der Genexpression in Monozyten durch Tumorzell- konditionierte Medien zeigte CCL18 als ein Bevacizumab reguliertes Gen in MMR-defizienten Zellen, aber nicht in MMR kompetenten Zellen. CCL18 übt seine Funktion primär im adaptiven Immunsystems aus um eine TH2-Antwort in T-Zellen auszulösen Ausserdem wird eine Erhöhung der nicht-spezifische Phagozytose als weitere Funktion beschrieben. CCL18 wurde bereits als prognostischer Marker in Magen-, Dickdarm- und Eierstockkrebsarten beschrieben; die klinische Bedeutung ist jedoch abhängig von Tumortyp. Die Ergebnisse dieser Arbeit zeigen, dass eine Erhöhung der phagozytischen Aktivität von Makrophagen in Gegenwart von Bevacizumab wesentlich deutlicher in MMR-defizienten Zellen ausgeprägt war. Weiterhin wurde gefunden, dass nach DNA-Schädigung in Bevacizumab behandelten MMR-defizienten Zellen Zytokine freigesetzt werden, welche eine Monozytenmigration in einer Bevacizumab-abhängigen Weise induzieren. Dies weist auf eine funktionelle Interaktion von MMR-Defizienz und Bevacizumab hin. Zusätzlich zeigen die Ergebnisse dieser Arbeit eine Immunzellmodulation, die spezifisch für Mismatch-Reparatur defiziente Tumorzellen ist und in der klinischen Praxis als Marker für die Verabreichung von Bevacizumab verwendet werden könnte.

Le rejet aigu humoral (RAH) est une complication post-transplantation qui peut conduire à la dysfonction puis la perte du greffon. Le RAH est caractérisé, au niveau histologique, par la présence de lésions endothéliales et d’un infiltrat de macrophages intravasculaires. Cette étude avait pour objectif d’identifier les mécanismes et voies de signalisation impliqués dans l’altération des cellules endothéliales (CE) au cours du RAH et de nouvelles molécules régulatrices. Nous montrons que l’induction du ligand de la voie Notch Dll4 dans les CE et les macrophages est caractéristique du RAH dans les greffons cardiaques. L’expression endothéliale de Dll4et la sécrétion de l’IL-6 par les CE induit la polarisation des macrophages vers un profil pro-inflammatoire de type M1. Nous identifions aussi Dll4 comme un régulateur négatif et pro-apoptotique de la différentiation vers un phénotype suppressif de typeM2. Nous montrons que les cellules microvasculaires sont les cibles cellulaires privilégiées des anticorps non HLA préformés associés à certains RAH en transplantation rénale. Enfin, nous avons mis en évidence l’activité d’une famille de coumarines issues de végétaux sur l’expression endothéliale de molécules de l’inflammation et de l’immunité. Pour conclure,notre étude montre l’importance de la voie Notch dansl’inflammation liée au RAH et identifie DLL4 et IL-6comme de nouveaux médiateurs de l’inflammation et d’une interaction spatiale et fonctionnelle des CE et des macrophages. Ces travaux proposent donc DLL4 etl’IL-6 comme des cibles moléculaires et les coumarines comme nouvelles molécules bioactives pour le contrôle de l’inflammation et du RAH en transplantation. / Acute humoral rejection (RAH) is a post-transplantcomplication that can lead to dysfunction and graftloss. RAH is characterized histologically by thepresence of endothelial lesions and of an infiltrate ofintravascular macrophages. This study aimed toidentify the mechanisms, the signaling pathwaysinvolved in the alteration of endothelial cells (EC) upon RAH as well as new regulatory molecules fortherapeutic approaches. Here, we show that theinduction of the Notch ligand DLL4 in both the EC andmacrophages is a feature of RAH in cardiac allografts.The expression of Dll4 and secretion of IL-6 inducedpolarization of macrophages into proinflammatory M1-type. We further identify Dll4 as a negative and pro-apoptoticregulator of macrophage differentiation towards a suppressive phenotype M2-type. We foundthat glomerular microvascular cells are the cell targetsof preformed non HLA antibodies causing RAH inkidney transplantation. Finally, we have demonstratedthe inhibitory activity of a series of coumarins issued from plants on the endothelial expression of a panel of inflammation and immunity molecules. In conclusion,our study shows the importance of the Notch pathwayin inflammation-related RAH and identifies DLL4 and IL-6 as new mediators of inflammation and spatial andfunctional interaction of the EC and macrophages. Thiswork therefore propose DLL4 and IL-6 as moleculartargets and coumarins as new bioactive molecules forthe control of inflammation and RAH.

Doctor of Philosophy (Medicine) / Background: Diabetic vascular complications affect both the macro- and microvasculature. Microvascular pathology in diabetes may be mediated by biochemical factors that precipitate cellular changes at both the gene and protein levels. In the diabetic retina, vascular pathology is found mainly in microvessels, including the retinal precapillary arterioles, capillaries and venules. Macular oedema secondary to breakdown of the inner blood-retinal barrier is the most common cause of vision impairment in diabetic retinopathy. Müller cells play a critical role in the trophic support of retinal neurons and blood vessels. In chronic diabetes, Müller cells are increasingly unable to maintain their supportive functions and may themselves undergo changes that exacerbate the retinal pathology. The consequences of early diabetic changes in retinal cells are primarily considered in this thesis. Aims: This thesis aims to investigate the effect of perivascular cells (Müller cells, RPE, pericytes) on retinal endothelial cell permeability using an established in vitro model. Methods: Immunohistochemistry, cell morphology and cell growth patterns were used to characterise primary bovine retinal cells (Müller cells, RPE, pericytes and endothelial cells). An in vitro model of the blood-retinal barrier was refined by coculturing retinal endothelial cells with perivascular cells (Müller cells or pericytes) on opposite sides of a permeable Transwell filter. The integrity of the barrier formed by endothelial cells was assessed by transendothelial electrical resistance (TEER) measurements. Functional characteristics of endothelial cells were compared with ultrastructural morphology to determine if different cell types have barrier-enhancing effects on endothelial cell cultures. Once the co-culture model was established, retinal endothelial cells and Müller cells were exposed to different environmental conditions (20% oxygen, normoxia; 1% oxygen, hypoxia) to examine the effect of perivascular cells on endothelial cell permeability under reduced oxygen conditions. Barrier integrity was assessed by TEER measurements and permeability was measured by passive diffusion of radiolabelled tracers from the luminal to the abluminal side of the endothelial cell barrier. A further study investigated the mechanism of laser therapy on re-establishment of retinal endothelial cell barrier integrity. Müller cells and RPE, that comprise the scar formed after laser photocoagulation, and control cells (Müller cells and pericytes, RPE cells and ECV304, an epithelial cell line) were grown in long-term culture and treated with blue-green argon laser. Lasered cells were placed underneath confluent retinal endothelial cells growing on a permeable filter, providing conditioned medium to the basal surface of endothelial cells. The effect of conditioned medium on endothelial cell permeability was determined, as above. Results: Co-cultures of retinal endothelial cells and Müller cells on opposite sides of a permeable filter showed that Müller cells can enhance the integrity of the endothelial cell barrier, most likely through soluble factors. Low basal resistances generated by endothelial cells from different retinal isolations may be the result of erratic growth characteristics (determined by ultrastructural studies) or the selection of vessel fragments without true ‘barrier characteristics’ in the isolation step. When Müller cells were co-cultured in close apposition to endothelial cells under normoxic conditions, the barrier integrity was enhanced and permeability was reduced. Under hypoxic conditions, Müller cells had a detrimental effect on the integrity of the endothelial cell barrier and permeability was increased in closely apposed cells. Conditioned medium from long-term cultured Müller cells and RPE that typically comprise the scar formed after lasering, enhanced TEER and reduced permeability of cultured endothelial cells. Conclusions: These studies confirm that bovine tissues can be used as a suitable model to investigate the role of perivascular cells on the permeability of retinal endothelial cells. The dual effect of Müller cells on the retinal endothelial cell barrier under different environmental conditions, underscores the critical role of Müller cells in regulating the blood-retinal barrier in health and disease. These studies also raise the possibility that soluble factor(s) secreted by Müller cells and RPE subsequent to laser treatment reduce the permeability of retinal vascular endothelium. Future studies to identify these factor(s) may have implications for the clinical treatment of macular oedema secondary to diseases including diabetic retinopathy.

Experiments described in this thesis address the pathogenesis of aortic valve sclerosis/stenosis using a bench to bedside approach. In particular, the thesis begins with development of a technique using ultrasonic backscatter analyses to quantitate the early stages of aortic stenosis. Subsequent chapters utilized this methodology to quantitate aortic valve structural changes in a model and intervention study of aortic stenosis in rabbits. The last chapters are human studies designed to identify factors associated with presence of aortic sclerosis/stenosis; with particular interest in potential association of endothelial dysfunction/inflammation/platelet aggregation with abnormal aortic valve structure quantitated by ultrasonic backscatter. In Chapter 1 (Introduction) the relevant literature is reviewed. Development of ultrasonic backscatter to quantitate aortic sclerosis (Chapter 2) Aortic valve sclerosis (ASc) is detected when there is visual assessment of focal increases in echogenicity of the aortic valve most commonly assessed by echocardiography. However, there is no previously described method to quantitate degree of aortic valve structural abnormality as ASc is not associated with marked hemodynamic obstruction quantifiable by Doppler echocardiography. The current study used ultrasonic backscatter to quantitate aortic valve structural abnormality in patients assessed as having ASc based on valve appearances, compared to young healthy volunteers with normal aortic valves. The results of the study indicate: 1) that the mean levels of aortic valve backscatter in ASc patients are approximately 60% greater than in young healthy volunteers (ie aortic valve backscatter scores ≥ 16dB are not consistent with normal aortic valve structure), 2) ultrasonic backscatter scores in ASc patients are directly correlated with subjective scoring of sclerosis and with a positive trend with transvalvular pressure gradients in patients with mild-moderate aortic stenosis, and most importantly, 3) ultrasonic backscatter is a reproducible technique, with mean differences between estimates based on repeat echocardiograms of 2.3 ± 1.7 (9.1%). These results indicate that ultrasonic backscatter could be used as a quantitative measure of aortic valve structural abnormality in epidemiology and for examination of interventions. In vivo studies Development of an animal model of aortic stenosis with vitamin D2 (Chapter 3) The aim of the study was to develop an appropriate animal model for AS. The study used vitamin D2 alone at 25,000IU/4 days weekly (vit-D2) for 8 weeks to induce AS in rabbits. Results showed that: 1) rabbits in the vit-D2 group had significantly increased in transvalvular velocity and pressure gradients compared to rabbits in the control group (normal chow + drinking water); this was consistent for aortic valve ultrasonic backscatter scores; 2) aortic valve immunohistochemistry/histology showed marked calcification, neutral lipids, macrophage, and leukocyte infiltrations for rabbits in the vit- D2 group (ie consistent with histology of human AS); 3) significant elevation of asymmetric dimethylarginine (ADMA) concentrations in the vit-D2 group occurred compared to controls over the 8 weeks treatment period; the change in ADMA concentrations correlated significantly with the change in transvalvular pressure gradients for rabbits in the vit-D2 group; 4) rabbits in the vit-D2 group had significantly impaired endothelium-dependent acetylcholine-induced aortic relaxation, and this effect was completely abolished by the nitric oxide synthase inhibitor (L-NAME); 5) the addition of 0.5% cholesterol-supplemented diet to the vitamin D2 regimen did not accentuate the development of AS. Thus, treatment with vitamin D2 at 25,000IU/4 days weekly for 8 weeks significantly induced AS with similar aortic valve pathology to that of human AS; therefore, the model is suitable for use in examining potential therapeutic interventions in AS. Effects of ramipril on development of AS in rabbits (Chapter 4) Using this animal model, this study aimed to examine the effects of the angiotensinconverting enzyme inhibitor (ACEi) ramipril on development of AS. Rabbits (n=28) treated for 8 weeks were divided into 2 groups: (a) vitamin D2 alone (n=10) (normal chow + 25,000IU vitamin D2 in drinking water); (b) vitamin D2/Ramipril (n=12) (normal chow+25,000IU vitamin D2/Ramipril (0.5mg/kg) in drinking water). Six further rabbits constituted a normal reference group (no treatment was given). The results for comparisons between vitamin D2/ramipril vs vitamin D2 alone were as follows: 1) ramipril-treated rabbits had significantly less severe hemodynamic obstructions (p<0.05, for both) as assessed by transvalvular velocity, and aortic valve area; with borderline reduction in aortic valve backscatter (p=0.08); 2) ramipril significantly reduced plasma ADMA concentrations; 3) there was improvement in acetylcholine-induced aortic relaxation (p=0.056), with significant improvement in sodium nitroprusside-induced relaxation (p<0.05); 4) there was a strong inverse correlation between acetylcholineinduced aortic relaxation and aortic valve backscatter score (0<0.001), thus providing further evidence of the potential role of nitric oxide in retarding the development of AS in this model. These data provide a strong rationale for the inception of a randomized trial of ACE inhibition as a strategy for limitation of AS progression in humans. Human studies Aortic stenosis is associated with elevated plasma levels of asymmetric dimethylarginine (ADMA) concentrations in humans (Chapter 5). Given the findings that aortic stenosis induced by vitamin D2 in rabbits also caused elevation of plasma ADMA concentrations, a physiological inhibitor of nitric oxide synthase, a mediator and marker of endothelial dysfunction and an indicator of incremental cardiovascular risk. The study sought to determine whether plasma ADMA concentrations are elevated independently of pre-existing coronary risk factors in subjects with at least moderate aortic stenosis (n=42) compared to age-matched patients with normal aortic valves (n=42): as determined both by visual assessment and with aortic valve backscatter scores < 16dB. Results for this study were as follows: 1) plasma ADMA concentrations were not statistically different between the AS and non-AS group (median 0.59 vs 0.54 µmol/L, p=0.13, Mann-Whitney test) on univariate analysis; 2) backward stepwise multiple linear regression showed the presence of AS was a significant predictor of elevated ADMA concentrations (p=0.04, 95% CI =0.001, 0.072). 3) in addition, elevated plasma ADMA concentrations were also associated with history of atrial fibrillation (p=0.009, 95% CI=0.015, 0.100), and negatively associated with creatinine clearance (p=0.01, 95% CI=-0.002, 0.000), and the use of statin therapy (p=0.01, 95% CI=-0.081, -0.011). Therefore, in conclusion, this study found that AS is independently associated with elevation of ADMA concentrations, beyond that implied by “conventional” risk factors for endothelial dysfunction. The clinical status of AS as an incremental marker of cardiovascular risk may reflect ADMA-mediated endothelial dysfunction. Assessment of factors associated with ASc in a random ageing population study (Chapter 6). There have been few clinical studies of factors associated with ASc. Previous population studies have established that ASc is an independent correlate of incremental risk of coronary events. Having established that patients with AS have increased plasma ADMA concentrations (Chapter 5), it was now aimed to determine whether subjects with increased aortic valve backscatter scores (ASc) also have other markers of endothelial dysfunction/NO effects, independent of preexisting coronary risk factors. The study was designed to identify such anomalies, if they existed, on an incremental basis to other putative correlates of ASc, including coronary risk factors, renal dysfunction and vitamin D levels. Random selected subjects (n=253) aged between 51 to 77 years were evaluated. All patients underwent transthoracic echocardiography examination; aortic valve ultrasonic backscatter score (AVBS), was used to quantitate echogenicity of the aortic valve. Conventional coronary risk factors were identified on history. Integrity of NO generation/response was assessed via (i) plasma ADMA concentrations; (ii) inhibition of platelet aggregation by the NO donor sodium nitroprusside (SNP); (iii) aortic augmentation index (AIx), a measure of arterial stiffness/wave reflection. All putative correlations with AVBS were examined by univariate and stepwise multiple linear regression analyses. On the basis of echocardiographic appearances, ASc was present in 63 subjects (25.4%); mean AVBS scores was 14.9±4.6dB (SD) vs 11.2±3.9dB (SD) in the presence vs absence of ASc (p<0.001). Univariate analyses revealed that platelet responsiveness to NO was inversely correlated with AVBS (β=-0.16, p=0.02); but [ADMA] and AIx were not. On multiple linear regression, significant correlates of increased AVBS were: (i) advanced age (β=0.21, p=0.003), (ii) low body mass index (β=-0.23, p=0.001); and (iii) impaired platelet responsiveness to NO (β=-0.16, p=0.02). In Chapter 7, the implications of the overall findings in this thesis are discussed in relation to future perspective. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1309350 / Thesis(Ph.D.) -- School of Medicine, 2008

<p>The aim of this study was to examine the expression of Thrombomodulin, Tissue Factor, Tissue Factor Pathway Inhibitor and Endothelial Protein C Receptor in placenta throughout the three phases of the third trimester in the normal placenta and in IUGR placenta from full term.</p><p>Twenty-five normal placenta samples and twenty-five IUGR placenta samples were obtained and each sample was stained by immunohistochemistry using monoclonal antibodies. Each antibody was optimised for antigen retrieval method and for optimal dilution, before been applied to the test tissue.</p><p>The results showed that each of the antibodies mentioned was expressed in normal placenta and in IUGR placenta.</p><p>No significant difference could be established concerning the expression of each antibody mentioned between normal and IUGR placenta.</p>

<p>The mechanisms behind many important aspects of blood- and lymphatic vessel formation have yet not been elucidated in detail. The primary objectives of this thesis have therefore been to study the effects of hypoxia, platelet-derived growth factor (PDGF) and vascular endothelial growth factors (VEGFs) on vascular development and function. </p><p>In conditions of low oxygen pressure, hypoxia, the survival of the organism is critically dependent on the ability to compensate for the reduced oxygen levels by promoting blood vessel growth and oxygen-independent energy production. Many direct effects of hypoxia in cells are attributed to the induction of a family of hypoxia-inducible transcription factors (HIFs) which control the expression of specific target genes. We found that capillary endothelial cells (ECs) respond to hypoxia with upregulation of genes involved in growth and remodeling of blood vessels. On the other hand, vein ECs responded to hypoxia with increased expression of genes involved in lymphatic vessel growth. Using differentiating embryonic stem (ES) cells, we have shown that hypoxia upregulates expression of VEGF receptor-3 (VEGFR-3) on blood vascular ECs. Furthermore, we have provided evidence for a critical role of VEGFR-3 in hypoxia-induced blood vessel development. </p><p>Activation of PDGF receptor-β (PDGFR-β) on early vascular progenitors in differentiating ES cells or in mice induces blood vessel differentiation, while negatively influencing early hematopoiesis. PDGFR-β expression on vascular progenitors may therefore play a role in guiding differentiation of the vascular lineages. </p><p>We have investigated the usefulness of differentiating ES cells as a model to study early lymphatic development. Administration of VEGF-C and VEGF-A induced formation of lymphatic vessel-like structures that seemed connected to the blood vasculature, supporting the general view that lymphatic ECs are derived from blood vascular ECs.</p><p>In summary, this thesis has provided new insights in the contribution of different growth factors in hematopoietic, blood- and lymphendothelial development. </p>

Substanzen der pharmazeutischen und chemischen Industrie müssen nach internationalen Richtlinien auf deren Toxizität gegenüber Mensch und Umwelt geprüft werden. Dazu gehören u. a. Prüfungen zur Vorhersage des embryotoxischen Potentials, die am lebenden Organismus durchgeführt werden. Mit dem Ziel die Anzahl der Tierversuche zu verringern, die notwendig sind um das toxikologische Profil einer Prüfsubstanz zu bestimmen, wurde der Embryonale Stammzelltest (EST) entwickelt. Als Grundlage des EST dienen embryonale Stammzellen (ES-Zellen) einer Zelllinie. ES-Zellen sind Zellen, die sich in der frühen embryonalen Entwicklung in die Zellen der Keimblätter entwickeln können. Daraus wiederum differenzieren die vielen verschiedenen, unterschiedlich spezialisierten Zelltypen des komplexen Organismus. Im EST wird die Konzentration einer Prüfsubstanz bestimmt, bei der die Differenzierung von ES-Zellen zu Herzmuskelzellen zu 50 % inhibiert wird. Zusätzlich wird die Konzentration der Prüfsubstanz bestimm&#176;t, bei der 50 % der ES-Zellen (IC50D3) bzw. Fibroblastenzellen (IC503T3) absterben. Die allgemeine Toxizität ist damit von der spezifischen Toxizität der Prüfsubstanz auf die ES-Zellen und deren Differenzierung unterscheidbar. Die Parameter fliessen in ein biostatistisches Modell zur Prädiktion des embryotoxischen Potentials der Prüfsubstanzen ein. <br><br> Es wurde ein Versuchsprotokoll entwickelt, wonach die ES-Zellen sich verstärkt zu Endothelzellen differenzieren. Die Endothelzellen, die im lebenden Organismus die Wand der späteren Blutgefässe, wie Venen und Arterien bilden, wurden mittels molekularbiologischer Methoden auf der RNA- und der Protein-Ebene nachgewiesen und quantifiziert. Verschiedene Zellkulturmethoden, Wachstumsfaktoren, als auch Wachstumsfaktorkonzentrationen wurden auf deren Vermögen die Differenzierung der ES-Zellen zu Endothelzellen zu induzieren, untersucht. Nach der Etablierung des Differenzierungsprotokolls wurden sieben Substanzen auf deren Vermögen geprüft, die Differenzierung von ES-Zellen zu Endothelzellen zu inhibieren. Die Endothelzellen wurden dabei über die Expression der RNA von zwei endothelzellspezifischen Genen quantifiziert. Im Vergleich dazu wurden die IC50D3 und die IC503T3 der Prüfsubstanz bestimmt, um eine Abschätzung des embryotoxischen Potentials der Prüfsubstanz zu ermöglichen. Die Ergebnisse zeigten, dass eine Abschätzung des embryotoxischen Potentials der sieben Prüfsubstanzen in nicht-, schwach- oder stark embryotoxisch vorgenommen werden konnte. Es ist zu schlussfolgern, dass der weiterentwickelte in vitro Embryotoxizitätsassay sensitiv und reproduzierbar ist. Mit der Verwendung von verschiedenen Differenzierungsendpunkten kann die Prädiktionskraft des Assays deutlich verbessert, und die Anzahl von Tierversuchen verringert werden. Durch die Verwendung von molekularbiologischen Markern kann der Assay einem Hochdurchsatzscreening zugängig gemacht werden und damit die Anzahl von Prüfsubstanzen deutlich erhöht werden. / Compounds of the pharmaceutical and chemical industry need to be tested for their toxicological potential with regard to humans and environment following international guidelines. Tests for the prediction of the embryotoxic potential executed on living organisms are examples of these guidelines. In order to reduce the number of animal experiments necessary for the assessment of the toxicological profile of compounds the embryonic stem cell test (EST) was developed. Embryonic stem cells (ES-cells) of a cell line are used as the basis of the EST. ES-cells are cells which develop at the early embryonic development into cells of the germ layers. Out of these the many different specialized cell types of the complex organism can differentiate. With the EST this concentration of a test compound will be determined where a 50 % inhibition of the differentiation of ES-cells into cardiomyocytes can be detected. Additionally, the concentration of a test compound which is cytotoxic to 50 % of the ES-cells (IC50D3) and to 50 % of fibroblasts (IC503T3) will be determined. Therefore, general toxicity caused by the test compound on ES-cells and its differentiation can be distinguished from specific toxicity of the test compound. Determined parameters will be included into a biostatistical model for the subsequent predicition of the embryotoxic potential of test compounds. <br><br> A protocol was developed whereby the differentiation of ES-cells into endothelial cells is induced. Endothelial cells which make up the walls of blood vessels, such as arteries and veins, were detected and quantified at the RNA and the protein level applying molecular biological methods. Different cell culture methods, growth factors and growth factor concentrations were studied for their ability to induce the differentiation of ES-cells into endothelial cells. Applying the developed differentiation protocol seven compounds were tested for their potential to inhibit the differentiation of ES-cells into endothelial cells. Endothelial cells were quantified by the RNA-expression of two endothelial-specific genes. In comparison to the expression levels the IC50D3 and the IC503T3 were determined in order to assess the embryotoxic potential of the test compound. The results showed that an assessment of the embryotoxic potential of the seven test compounds into non-, weakly- and strongly embroytoxic was possible. It can be concluded that the improved in vitro embryotoxicity assay is sensitive and reproducible. With the use of different differentiation endpoints the power of predicitivity of this assay can be significantly increased and the number of animal experiments can be reduced. With the application of molecular biological markers this assay can be applied as a high througput screening and therefore the number of test compounds can be strongly increased.

Delta-like 1 Homologue (DLK1), a transmembrane protein of 383 amino acids, belongs to a family of epidermal growth factor (EGF)-like repeat-containing proteins that include Notch/Delta/Serrate, which are involved in cell fate determination. DLK1 is also known as preadipocyte factor-1, pG2, and FA-1, which are identical or polymorphic products of a single gene. Structural analysis revealed that DLK1 consists of an extracellular domain with six EGF-like repeats, a transmembrane domain, and an intracellular domain. The extracellular EGF-like region of DLK1 (DLK1-EC) can be released to the medium by the action of tumor necrosis factor alpha converting enzyme (TACE). DLK1 participates in various differentiation processes including adipogenesis, hematopoiesis, and adrenal gland differentiation. Besides, DLK1 overexpression was observed in patients with biliary atresia and in glioblastoma. Recently, the extracellular domain of thrombomodulin, which also contains six EGF¡Vlike structures, has been delineated to stimulate angiogenesis in vitro and in vivo. This prompted us to investigate whether DLK1-EC played a role in angiogenesis. To test such hypothesis, recombinant DLK1-EC was expressed and purified in E. coli. Adding DLK1-EC recombinant protein inhibited the adipogenesis of adipocytes-derived stem cells in a dose-dependent manner. Despite marginal effect on matrix-metalloproteinase secretion, exogenous DLK1-EC significantly stimulated the proliferation, motility and tube-forming capability of cultured endothelial cells. Above all, implantation of DLK1-EC-containing hydron pellets induced cornea neovascularization in a dose-dependent manner. Western blot analysis revealed that exogenous DLK1-EC induced angiogenesis through Notch1 activating downstream gene Hes1 and subsequently signaling such as Akt/eNOS, p38 MAPK, and ERK pathway to perform its function. Indeed, blockade of Notch1 signaling using £^-secretase inhibitor leads to decreased angiogenesis and inhibits DLK1 EC-induced endothelial cell tubular formation in vitro and in vivo. These findings indicate that DLK1-EC induced Notch1 activation mediated by £^-secretase and tansactivation Akt/eNOS pathway and that Notch1 is critical for DLK1 EC-induced angiogenesis. These results may bring further insights into the physiological and pathological functions of DLK1

Hepatocellular carcinoma (HCC) is one of the most prevalent cancers worldwide. Current therapeutic approaches for HCC including surgical resection and trans-arterial embolization (TAE) remain largely ineffective, underscoring the need for development of novel therapeutic strategies. Because HCC is high vascularized, continuous administration angiogenesis inhibitor using gene therapy approach may facilitate long-term blockade tumor vasculature, thereby perturbing the growth of HCC. Vasostatin 112 (VS112) encodes an alternatively spliced fragment of angiogenesis inhibitor vasostatin, which encompasses residues 1-64 and 133-180 of calreticulin. In this study, recombinant adenovirus encoding VS112 (Ad-VS112) was generated to evaluate its potential for suppression of orthotopic Novikoff hepatoma in syngenic Sprague-Dawley (SD) rats. Adenovirus-mediated VS112 overexpression significantly inhibited the migration and tube formation of endothelial cells, indicating the anti-angiogenic potency of VS112 gene delivery. However, VS112 overexpression had no influence on the viability of N1-S1 Novikoff hepatoma cells. To investigate the prophylactic effect of VS112 expression on hepatoma growth, N1-S1 cells were infected with Ad-VS112 or adenovirus encoding green fluorescent protein (Ad-GFP) then implanted into the liver of SD rats. After 14 days, rats implanted with VS112-expressing showed significantly reduced incidence and size of hepatoma compared with those implanted with Ad-GFP-infected cells. To investigate the therapeutic efficacy of VS112 gene delivery, the SD rats were implanted with N1-S1 cells on day 0, treated with adenovirus vectors (2 x 1010 plaques forming units) via intravenous route on day 1, then sacrificed on day 14 to monitor hepatoma growth. By measuring tumor weight, it was found that Ad-VS112-treated rats exhibited significantly decreased tumor burden compared with control groups, which was in accordance with their lower serum GOT level. Histological analysis revealed a significant reduction of vWF-positive blood vessels in Ad-VS112-treated tumors, which was accompanied with a decrease in Ki-67-positive proliferating cells and an increase in TUNEL-positive apoptotic cells. Moreover, the expression of pro-inflammatory nuclear factor kappa B (NF£eB) and cyclooxgenase II (COXII) was also effectively attenuated in Ad-VS112-treated hepatoma. In conclusion, prior or post VS112 gene delivery potently suppresses the growth of orthotopic hepatoma,thereby holding promises for future treatment of HCC.