Angiogenesis supports tumor growth and facilitates metastasis, the leading cause of patient mortality in breast and other types of solid tumors. Angiopoietin-2 (Ang-2) is an angiogenic factor whose overexpression is associated with increased tumor vascularity, metastasis, and decreased patient survival. We assessed the effects of Ang-2 on breast tumor vasculature by comparing vascular morphology and metastasis of orthotopically implanted metastatic breast carcinoma line MDA-MB-231 that either lacked or overexpressed Ang-2. Methods: Luciferase-tagged MDA-MB-231 breast carcinoma cells designated hAng2 were engineered to overexpress human Ang-2. The control line expressed hAng-2 in reverse orientation. Stable production of hAng-2 was confirmed by RT-PCR, qRT-PCR, Western blot, and ELISA. Functionality of recombinant hAng-2 was assessed by migration and proliferation assays. MDA-MB-231 tumors, hAng2 and control, were orthotopically implanted into female Nu/Nu and SCID mice. Metastasis to lymph node and lung were determined by measuring luciferase activity in tissue extracts. Tumor blood vessel morphology was analyzed by immunohistochemistry (IHC) using antibodies against MECA-32, smooth muscle actin (SMA-alpha), VEGFR-3 and Notch-1. Results: MDA-MB-231 hAng2 lines were stably generated to produce 0-370 ng/ml of hAng-2 while expression in control line was undetectable. Tumor-produced hAng-2 was functional as demonstrated by a dose-dependent induction of migration of lymphatic endothelial cells and mouse mesenchymal stem cells with a maximum increase of 3-fold. Overexpression of Ang-2 had no significant effect on proliferation of cultured MDA-MB-231 cells, growth rate of hAng2 tumors or blood vessel density. In contrast, we detected substantial differences in vascular morphology of Ang-2 overexpressing tumors including 1.7-fold increase in blood vascular area, 2.8-fold increase in number of vessels with open lumen, and 6-fold increase in lumens' cross-sectional area. Blood vascular pericyte coverage shown by SMA-α staining decreased (p>0.001) in hAng2 tumors, demonstrating vessel destabilization. Blood vascular invasion by tumor cells and pulmonary metastasis increased in Ang-2 overexpressing tumors by 500% and 1100%, as compared with control tumors. Blood vessels in hAng2 tumors, but not lymphatic vessels, displayed significantly upregulated Notch-1 and VEGFR-3 expression amplified by a 2.2-fold. Conclusions: These data suggest that Ang-2 increases metastasis because of suppression of pericytes' recruitment that leads to destabilization of the tumor vessels, which facilitates the entry of tumor cells into the vessels and increases metastatic spread. These effects are associated with up-regulation of Notch-1 and VEGFR-3 on tumor vasculature suggesting that signaling of these proteins underlie the morphologic changes in Ang-2 overexpressing tumors. This is consistent with prior data demonstrating up-regulation of VEGFR-3 on tumor blood vessels and association of both proteins with increased metastasis. This study demonstrates that Ang-2 plays a key role in hematogenous metastasis and suggests that Ang-2 might represent novel a target for inhibition of breast cancer metastasis.

No description available.

Angiopoietin-2 (Ang-2) wirkt gefäßdestabilisierend und ist Voraussetzung für das Aussprossen von Gefäßen am Anfang der angiogenen Kaskade. Die Expression des Antagonisten der endothelialen Rezeptor-Tyrosin-Kinase Tie-2 ist streng gewebsspezifisch reguliert. Trotz des Zusammenhangs von Ang-2 und pathologischer Angiogenese sind die molekularen Mechanismen der ang-2 Regulation noch unverstanden. Mittels Microarray wurden die genomweiten Expressionsänderungen in endothelialen Zellen nach Behandlung mit dem demethylierenden 5-Aza-2’-deoxycytidine (5-Aza-dC) untersucht. Unter den induzierten Genen wurde ang-2 mit dem Fokus auf angiogeneserelevante Gene identifiziert. Obwohl die Endothelzellen unter Kontrollbedingungen ang-2 exprimieren, wurde die Expression durch Demethylierung weiter gesteigert. Es wurden jedoch keine potentiellen CpG-Inseln in unmittelbarer Nähe des Transkriptionsstarts identifiziert. Diese Daten lassen auf einen methylierungsunabhängigen Effekt von 5-Aza-dC auf die ang-2 Expression schließen. Zur molekularen Untersuchung der ang-2 Expression wurden 3kb der 5´-flankierenden Sequenz des humanen ang-2 Gens kloniert und der Transkriptionsstartpunkt (TS) bestimmt. Durch funktionelle 5´-Deletionsanalyse und zielgerichtete Mutagenese wurden regulatorische Promotorelemente identifiziert. Die Promotorregion -105 bis +51 relativ zum TS war ausreichend für die Vermittlung der basalen ang-2 Expression. Mittels Bindungsstudien wurden die Transkriptionsfaktoren Sp1 und Sp3 als Proteine, die primär an den ang-2 Minimalpromotor binden, identifiziert. Die Basen -78 bis -74 relativ zum TS sind eine essentielle Sp-Bindestelle für die Regulation der ang-2 Expression. Durch Mutation von potentiellen Bindungsstellen für Proteine der ETS-Familie wurde die ang-2 Promotoraktivität signifikant reduziert. Jedoch konnte die Spezifität von ETS-Proteinen in Bindungsstudien nicht bestätigt werden. Die Ergebnisse dieser Arbeit haben neue Einblicke in die ang-2 Regulation offenbart und zeigen, dass die Sp1/Sp3-abhängige Aktivierung des proximalen Promotorbereichs (-105/-56) entscheidend für die transkriptionelle ang-2 Regulation in Endothelzellen ist. / Angiopoitein-2 (Ang-2) acts destabilizing on blood vessels and is mandatory for the onset of the angiogenic cascade. The expression of the antagonistic ligand of the endothelial cell tyrosine kinase receptor Tie-2 is tightly regulated. Despite the accumulating evidence confirming the involvement of Ang-2 in pathologic angiogenesis, the molecular mechanisms controlling ang-2 expression are still unclear. Using microarray analysis, the global changes of gene expression were investigated after treatment of endothelial cells with the demethylating agent 5-aza-2’-deoxycytidine (5-aza-dC). Focusing on angiogenesis related genes, ang-2 was identified among the upregulated ones. Although endothelial cells expressed ang-2 under control conditions already the expression was further increased by drug-induced demethylation. A screen for CpG-islands revealed no putative islands surrounding the transcription initiation site. These data indicate a methylation-independent effect of 5-aza-dC on the ang-2 expression. To elucidate underlying molecular mechanisms of ang-2 expression, 3kb of the human ang-2 gene were cloned and the transcription start site (TS) determined. Regulatory promoter elements were identified by functional 5’-deletion analysis and site-directed mutagenesis. The promoter region -105 to +51 relative to TS was recognized as sufficient and necessary for the ang-2 gene transcription. Electrophoretic Mobility Shift Assays revealed Sp1 and Sp3 as dominant nuclear proteins binding to the ang-2 promoter. The region spanning -78/-74 was identified as essential Sp1/3 site regulating ang-2 expression. The mutation of potential ETS-binding sites resulted in a significant decrease of ang-2 promoter activity. However, the binding of ETS-proteins could not be confirmed by means of EMSA. The results of this thesis revealed new insights of ang-2 regulation and strongly suggest that Sp1/Sp3-dependent activation of an upstream enhancer at -105 to -56 is crucial for the regulation of ang-2 expression in endothelial cells.

Normal endothelial cell function is controlled in part by a tightly regulated balance between angiopoietin-1 and -2 (Ang-1 and Ang-2). Angiopoietin dysregulation (decreased Ang-1 and increased Ang-2) leads to an activated endothelium that is contractile, adhesive, and prothrombotic. Since an activated endothelial phenotype is seen in invasive group A streptococcal infection, E. coli O157:H7-induced hemolytic-uremic syndrome (HUS), and sepsis, we hypothesized that angiopoietin dysregulation might also be present in these syndromes, and to that end, measured angiopoietin levels in several well-characterized patient cohorts. Decreased Ang-1 and/or increased Ang-2 were found in all three syndromes, and were predictive of clinical outcome in HUS and sepsis. The prognostic utility of Ang-2 in sepsis was further enhanced by combination with biomarkers of inflammation. Angiopoietin dysregulation may therefore represent a shared final common pathway to endothelial activation as well as a clinically useful prognostic biomarker in streptococcal toxic shock, HUS, and sepsis.

Normal endothelial cell function is controlled in part by a tightly regulated balance between angiopoietin-1 and -2 (Ang-1 and Ang-2). Angiopoietin dysregulation (decreased Ang-1 and increased Ang-2) leads to an activated endothelium that is contractile, adhesive, and prothrombotic. Since an activated endothelial phenotype is seen in invasive group A streptococcal infection, E. coli O157:H7-induced hemolytic-uremic syndrome (HUS), and sepsis, we hypothesized that angiopoietin dysregulation might also be present in these syndromes, and to that end, measured angiopoietin levels in several well-characterized patient cohorts. Decreased Ang-1 and/or increased Ang-2 were found in all three syndromes, and were predictive of clinical outcome in HUS and sepsis. The prognostic utility of Ang-2 in sepsis was further enhanced by combination with biomarkers of inflammation. Angiopoietin dysregulation may therefore represent a shared final common pathway to endothelial activation as well as a clinically useful prognostic biomarker in streptococcal toxic shock, HUS, and sepsis.

RATIONALE - Metabolic enzymes, like pyruvate kinase M2 (PKM2), play an essential role in altering endothelial cell (EC) phenotypes and behavior. Extensive research has elucidated the function of PKM2, a rate-limiting glycolytic enzyme, in the context of cancer cells and in activated immune cells, but its role in EC biology is only newly emerging. Recent findings show PKM2 acts as a key regulator of angiogenesis. Where exogenous circulating PKM2 induces EC cell proliferation leading to increased tumor angiogenesis and growth. Also, PKM2 deficient ECs exhibit decreased proliferation and migration. The relevance of PKM2 in modulating vascular barrier function is yet to be defined. OBJECTIVE -This study attempts to elucidate the role of PKM2 in regulating vascular barrier function. METHODS AND RESULTS - In vivo, EC specific deletion of PKM2 promotes increased vascular permeability in pulmonary capillary vessels and increased VEGF-induced acute vessel permeability in mouse dermal vessels. Similarly, in vitro, PKM2 deficient ECs exhibit decreased electrical resistance, disrupted VE-cadherin junctions and gap formations (illustrated via florescent VE-cadherin staining and phosphorylation of VE- cadherin protein at tyrosine residue Y658). Mechanistically, the deletion of PKM2 in ECs leads to increased angiopoietin-2 (Ang-2) expression, a well-known modulator of vascular permeability. Also, deletion of Ang-2 was sufficient to attenuate vascular leakage in PKM2 deficient endothelium, indicating that vascular leaky phenotype observed in PKM2 deficient endothelium is mediated by increased Ang-2 expression. CONCLUSIONS - PKM2, by modulating Ang-2 expression, plays a vital role in maintaining vascular barrier function. / 2019-07-11T00:00:00Z

Neovascularization, or the formation of blood vessels, is important in both normal physiological processes as well as pathophysiological processes. The main players in neovascularization, endothelial cells (EC), are highly influenced by hemodynamic shear stress and this may play an important role in neovascularization. Two typical types of shear stress found in the vascular system are a unidirectional laminar shear stress (LS) found in straight regions and a disturbed, oscillatory shear stress (OS) found at branches or curves. At the cellular level, LS is thought to promote EC quiescence whereas OS is thought to promote EC dysfunction. Oscillatory sheared EC are pro-proliferative, pro-migratory, and secrete growth factors, all functions important in neovascularization. There are several diseases that involve both disturbed shear stress and neovascularization, such as atherosclerosis, aortic valve disease, and occlusive vascular disease. In these pathophysiological scenarios fluid shear stress may provide a driving force for neovascularization. Therefore, we hypothesized that oscillatory shear stress promotes greater neovascularization compared to unidirectional laminar shear stress through the secretion of angiogenic factors, which play a physiological role in neovascularization in vivo. To test this hypothesis, we first performed tubule formation and migration assays, two important functions in neovessel formation. We found that OS promotes greater tubule formation and migration of EC as compared to LS and this was mediated through secreted factors. Using gene and protein array analysis, we identified Angiopoietin-2 (Ang2) as being upregulated by OS compared to LS in EC. We found that inhibiting Ang2 blocked OS-mediated tubule formation and migration and that LS-inhibited tubule formation could be rescued by addition of Ang2. In addition, Ang2 was found to be upregulated at sites of disturbed flow in vivo, implicating a physiological role for Ang2. To further investigate the physiological role of Ang2 in neovascularization, we examined the effects of inhibiting Ang2 in a mouse model of hindlimb ischemia, which involves both disturbed flow and neovascularization. We found that Ang2 was upregulated in the ischemic adductor muscle suggesting that it plays a role in recovery during hindlimb ischemia. In addition, we found that inhibiting Ang2 decreased blood flow recovery. Ang2 inhibition resulted in decreased smooth muscle cell coverage of vessels as well as decreased macrophage infiltration. These findings suggest that Ang2 promotes blood flow recovery through the recruitment of smooth muscle cells and formation of collaterals, as well as the recruitment of macrophages that secrete important growth factors and help degrade the extracellular matrix in order for neovascularization to occur. In conclusion, this work illustrates the shear stress regulation of neovessel formation through the expression of Ang2, and the role of Ang2 in neovascularization in vivo. By understanding how angiogenic factors are regulated and what role they play in vivo, we can better understand human disease and develop important therapeutic targets.

Orientador: Erich Vinicius de Paula / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T13:46:04Z (GMT). No. of bitstreams: 1 Alves_BrunnaEulalio_D.pdf: 4762678 bytes, checksum: 34eea414d90830a52ed9c9b044538888 (MD5) Previous issue date: 2011 / Resumo: Pacientes portadores de neoplasia hematológica e neutropenia febril representam um grupo de risco elevado de sepse e choque séptico. Nas últimas décadas, estratégias terapêuticas alvo-específicas para a sepse não modificaram de forma significativa a sobrevida dos pacientes e o tratamento permanece baseado em antibioticoterapia e cuidados de suporte, com altas taxas de mortalidade. A quebra da barreira endotelial é um evento fundamental na fisiopatologia do choque séptico e a compreensão dos mecanismos envolvidos neste evento tem o potencial de auxiliar na identificação de novos biomarcadores de gravidade e de novos alvos terapêuticos para estes pacientes. Estudos recentes demonstraram a participação do fator de crescimento do endotélio vascular (VEGF-A), do seu receptor solúvel (sFlt-1) e das angiopoietinas 1 e 2, proteínas envolvidas na angiogênese e na regulação da integridade da barreira endotelial na fisiopatogenia do choque séptico em pacientes não oncológicos internados em unidade de terapia intensiva. Neste trabalho, avaliamos prospectivamente a cinética do VEGF-A, do sFlt-1 e das angiopoietinas 1 e 2 durante as 48 horas inicias da neutropenia febril em 41 pacientes portadores de neoplasia hematológica submetidos a quimioterapia intensiva ou a regime de condicionamento para transplante de células progenitoras hematopoiéticas, através da dosagem dos mesmos por ensaio imuno-enzimático. Exploramos também a associação dos níveis séricos destes biomarcadores com a gravidade da sepse através da correlação com o MASCC, um índice desenvolvido para identificar pacientes com neutropenia febril de baixo risco, e com o SOFA, um escore de avaliação de disfunção orgânica em pacientes com sepse, ambos amplamente aceitos. A evolução para choque séptico foi associada a níveis significativamente maiores de VEGF-A, sFlt-1 e angiopoietina-2 48 horas após o início da neutropenia febril quando comparado aos valores em pacientes com sepse não complicada e a estimativa da acurácia diagnóstica sugere a capacidade de discriminar os pacientes que evoluíram com choque séptico. Estes biomarcadores também apresentaram correlação com os escores gravidade, sugerindo a relevância biológica da associação. Em conclusão, nossos achados sugerem que a avaliação destes biomarcadores em pacientes com neutropenia febril deve ser avaliada em estudos com maior número de pacientes, quanto ao seu potencial de incorporação na prática clínica. Além disso, os resultados reforçam o potencial terapêutico da intervenção nestas vias para o tratamento da sepse / Abstract: Patients with hematologic malignancy and neutropenia represent a group at high risk of sepsis and septic shock. In recent decades, target-specific therapeutic strategies for sepsis did not change significantly the survival of patients and treatment is still based on antibiotic therapy and supportive care, with high mortality rates. The breakdown of the endothelial barrier is a key event in the pathophysiology of septic shock and understanding of the mechanisms involved in this event has the potential to assist in the identification of new biomarkers and severity of new therapeutic targets for these patients. Recent studies have demonstrated the involvement of endothelial growth factor (VEGF-A), its soluble receptor (sFlt-1) and angiopoietins 1 and 2, proteins involved in angiogenesis and in regulation of endothelial barrier integrity in the pathogenesis of shock septic patients without cancer admitted to the intensive care unit. In this study, we prospectively evaluated the kinetics of VEGF-A, sFlt-1 and angiopoietins 1 and 2 during the initial 48 hours of febrile neutropenia in 41 patients with hematological malignancy undergoing intensive chemotherapy or conditioning regimen for stem cell transplantation hematopoietic cells by the same dosage by enzyme immunoassay. We also explored the association of serum levels of these biomarkers with the severity of sepsis through correlation with the MASCC, an index developed to identify patients with febrile neutropenia at low risk, and the SOFA score for assessment of organ dysfunction in patients with sepsis, both widely accepted. Progression to septic shock was associated with significantly higher levels of VEGF-A, sFlt-1 and angiopoietin-2 48 hours after the onset of febrile neutropenia when compared to values in patients with uncomplicated sepsis and the estimation of diagnostic accuracy suggests the ability to discriminate among patients who developed septic shock. These biomarkers also correlated with the severity scores, suggesting the biological relevance of the association / Doutorado / Clinica Medica / Doutor em Clínica Médica

L’angiogenèse est le processus biologique par lequel de nouveaux vaisseaux sanguins se forment à partir du réseau vasculaire pré-existant. Sa première étape, l’activation endothéliale, est caractérisée par la prolifération des cellules endothéliales, la sécrétion de facteurs pro-angiogéniques comme l’Angiopoïétine-2 (Ang-2) et la relocalisation de la nucléoline du noyau vers la surface cellulaire. Dans les vaisseaux matures, les cellules endothéliales sont quiescentes et l’endothélium est recouvert de péricytes. L’activation endothéliale induit un détachement des péricytes favorisant le remodelage du réseau vasculaire. L’objectif de cette thèse est d’étudier les mécanismes de l’activation endothéliale au cours de l’angiogenèse physiologique et d’évaluer les effets de son inhibition dans un contexte d’angiogenèse tumorale. Des études in vivo dans la rétine de souris et in vitro sur des cellules endothéliales humaines ont montré que le VEGF régule l’exocytose des Corps de Weibel et Palade (WPBs), des compartiments cytoplasmiques spécifiques des cellules endothéliales pouvant contenir de l’Ang-2. Ce travail suggère que l’exocytose des WPBs induite par le VEGF régule la sécrétion de l’Ang-2 par les cellules endothéliales activées et que l’Ang-2 sécrétée régule à son tour le recrutement des péricytes sur les vaisseaux. Le ciblage de la nucléoline dans un modèle de cancer du pancréas a inhibé l’activation endothéliale et cette inhibition a diminué la croissance et l’angiogenèse tumorales tout en favorisant le recrutement des péricytes et la normalisation des vaisseaux tumoraux. La normalisation vasculaire induite par l’inhibition de l’activation endothéliale via le ciblage de la nucléoline représente une stratégie prometteuse pour le traitement de pathologies associées à une dérégulation de l’angiogenèse comme les cancers ou les rétinopathies. / Angiogenesis is the biological process of new blood vessel formation from the pre-existing vascular network. Its first step, endothelial activation, is characterized by endothelial cell proliferation, the secretion of pro-angiogenic factors such as Angiopoietin-2 (Ang-2) and the relocation of nucleolin from the nucleus to the cell surface. In the mature vessels, endothelial cells are quiescent and the endothelium is covered by pericytes. Endothelial activation induces pericyte detachment which promotes the remodeling of the vascular network. The aim of this thesis is to study the mechanisms of endothelial activation during physiological angiogenesis and to evaluate the effects of its inhibition in a context of tumor angiogenesis. In vivo studies in mouse retina and in vitro studies on human endothelial cells showed that VEGF regulates the exocytosis of Weibel-Palade bodies (WPB), cytoplasmic compartments specific for endothelial cells that may contain Ang-2. This work suggests that the exocytosis of WPBs induced by VEGF regulates the secretion of Ang-2 by activated endothelial cells and that secreted Ang-2 regulates the recruitment of pericytes on the vessels. Nucleolin targeting in a pancreatic cancer model inhibited endothelial activation and this inhibition decreased tumor growth and angiogenesis while promoting recruitment of pericytes and normalization of tumor vessels. Vascular normalization induced by the inhibition of endothelial activation via nucleolin targeting may be a promising strategy for the treatment of pathologies associated with dysregulation of angiogenesis, such as cancers or retinopathies.

Im Rahmen der vorliegenden Dissertation wurde die prognostische Relevanz von Angiopoietin-2 (Ang-2) und Fibroblast Growth Factor 23 (FGF-23) als Prädiktor der 30-Tages sowie Ein-Jahres Mortalität bei Patienten im infarktbedingten kardiogenen Schock (CS) untersucht und dargestellt. Das betrachtete Patientenkollektiv dieser Substudie rekrutierte sich dabei aus den 218, im Rahmen der IABP- SHOCK II Studie in Leipzig eingeschlossenen Patienten. Nach Hospitalisierung und Randomisierung in den jeweiligen Therapiearm (IABP, Nicht-IABP) erfolgte eine prospektiv geplante Blutentnahme an den Tagen eins bis drei. Zur laborchemischen Bestimmung der Serum-, beziehungsweise Plasma Proteinkonzentration mittels ELISA von Ang-2 standen 189, für das Phosphathormon FGF-23 182 Blutproben zur Verfügung. Die 30-Tages Mortalität der untersuchten Substudien-Kohorte betrug 40%, die Ein-Jahres Mortalität 57%. Die vorliegende Arbeit bestätigt Ang-2 als einen starken und unabhängigen negativen Prädiktor des Kurz- und Langzeitverlaufs bei Patienten im CS auf Grund eines akuten Myokardinfarks. Weiterhin zeigt die Auswertung, dass die prognostische Relevanz des betrachteten Biomarkers im zeitlichen Verlauf signifikant zunimmt und verschiedene klinische Parameter wie beispielsweise eine akut eingeschränkte Nierenfunktion oder Blutungskomplikationen unabhängig mit erhöhten Ang-2 Konzentrationen assoziiert sind. Somit sind im infarktbedingten CS hohe Werte von Ang-2 unabhängig mit einem schlechteren klinischen Verlauf des Patienten, sowie dem Reperfusionserfolg und weiteren Komplikationen assoziiert. Patienten der Substudien-Kohorte im infarktbedingten CS waren durch signifikant erhöhte Konzentrationen von FGF-23 charakterisiert. Weiterhin zeigte sich, dass diese signifikant erhöhten Werte unabhängig mit einer deutlich schlechteren Prognose der 30-Tages und Ein-Jahres Mortalität verbunden sind. Diese Assoziation konnte jedoch ausschließlich bei Patienten mit eingeschränkter Nierenfunktion nachgewiesen werden.