Original Contribution |
From the Departments of Cardiovascular Medicine (N.T., Y.S., K.T., T.K., Y.Y.) and Nephrology and Endocrinology (E.N.), Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo; Institute for Adult Diseases (N.T., Y.S.), Asahi Life Foundation, Shinjuku-ku, Tokyo; Department of Immunology (Y.S.), School of Medicine, Juntendo University, Bunkyo-ku, Tokyo; and Department of Molecular Biology (H.S.), Osaka BioScience Institute, Suita, Osaka, Japan.
Correspondence to Naoyuki Takahashi, Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail takan-tky{at}umin.ac.jp
| Abstract |
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Key Words: signal transduction growth substance cardiac myocyte cell adhesion
| Introduction |
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Adhesive interactions between cells and the extracellular matrix (ECM) are known to be mediated by the integrin family.11 The cell-ECM interaction plays a fundamental role in regulating cellular behaviors such as migration, proliferation, and differentiation, especially for cardiac myocytes to perform continuously repetitive contractions and to adapt to external stresses such as hypoxia.12 Recent studies suggest that integrins transduce extracellular signals across the plasma membrane.11 13 The identification of focal adhesion kinase (p125FAK) provided the first evidence for the activation of an intracellular signaling molecule by integrins.14 15 16 p125FAK is a nonreceptor protein tyrosine kinase that is widely expressed in different cell types and phosphorylated on tyrosine residues accompanied with formation of focal adhesions. p125FAK has also been proved to be involved in signal transduction from cell surface receptors for neuropeptides and growth factors.17 18 19 20 21 Recently, Abedi and Zachary22 have reported that VEGF induces tyrosine phosphorylation of p125FAK and paxillin, another focal adhesion protein, in endothelial cells, as well as increases immunofluorescent staining of them in focal adhesions, which suggests that adhesion between endothelial cells and ECM may be modulated by VEGF stimulation. In this study, we investigated whether VEGF modulates adhesion between cardiac myocytes and ECM, as is the case with endothelial cells, analyzing the activation of focal adhesion-related proteins, especially p125FAK, in cultured rat cardiac myocytes. To confirm that VEGF modulates cell adhesion, we evaluated the state of cell adhesion to ECM using an electric impedance sensor. Here we show that VEGF induces activation of p125FAK, accompanied by subcellular translocation of p125FAK from perinuclear sites to focal adhesions, as well as its increased association with adapter proteins GRB2-, Shc-, and nonreceptor-type tyrosine kinase p60c-src. VEGF also induced tyrosine phosphorylation of paxillin, a cytoskeletal component that localizes to the focal adhesions at the ends of actin stress fibers. Furthermore, VEGF definitely accelerated the adhesion of cardiac myocytes to the ECM.
| Materials and Methods |
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The percentage of myocytes was estimated to be
90%, as judged by
immunoperoxidase staining with a mouse anti-cardiac myosin heavy chain
monoclonal antibody (mAb) derived from the CMA-19 clone,24
followed by counterstaining with hematoxylin. Preparation of mouse
anti-cardiac myosin heavy chain mAb (CMA19) was previously
described.24 Contamination by endothelial
cells was estimated to be <1%, as judged by immunoperoxidase staining
with mouse monoclonal antifactor VIIIrelated antigen antibody
(Z002; Zymed Laboratories) (data not shown). Therefore, we concluded
that the rest of the contaminating nonmuscle cells (
10% of total
cells) mostly consisted of fibroblasts.
Analyses of Phosphotyrosine Content of KDR/Flk-1,
p125FAK, and Paxillin
The cells were treated with 22.8 pmol/L (1.0 ng/mL) recombinant
human VEGF (rhVEGF; Upstate Biotechnology, Inc) for various times as
indicated, and then they were frozen in liquid nitrogen and lysed on
ice with NP-40 buffer containing (in mmol/L) Tris/HCl 25 (pH 7.6),
NaCl 25, Na3VO4 1, sodium
pyrophosphate 10, EGTA 0.5, and phenylmethylsulfonyl fluoride
1; 10 nmol/L okadaic acid; and 1% NP-40. The cell lysates were
centrifuged, and the supernatants containing detergent-soluble
proteins were collected. Proteins were immunoprecipitated at 4°C
overnight with mouse anti-phosphotyrosine mAb (PY20; Transduction
Laboratories) and protein GSepharose (Pharmacia LKB). The
immunoprecipitates were subjected to SDS-PAGE and then transferred onto
polyvinylidene difluoride transfer membranes (NEN Research
Products). Polyvinylidene difluoride membranes were blocked
with 1% BSA in PBS and then incubated overnight at 4°C with rabbit
polyclonal anti-KDR/Flk-1 antibody (C20; Santa Cruz Biotechnology),
rabbit polyclonal anti-p125FAK
antibody,25 or mouse anti-paxillin mAb (349; Transduction
Laboratories). The preparation of rabbit polyclonal
anti-p125FAK antibody was previously
described.25 After incubation with alkaline
phosphataseconjugated anti-rabbit or anti-mouse IgG antibody (both
antibodies from Vector Laboratories), the blots were developed with a
chemiluminescence detection kit (New England Biolabs). Tyrosine
phosphorylation of p125FAK was
confirmed by immunoprecipitation using
anti-p125FAK polyclonal antibody followed by
Western blotting with anti-phosphotyrosine mAb (4G10; Upstate
Biotechnology, Inc) or anti-p125FAK polyclonal
antibody. The increase in tyrosine phosphorylation of
KDR/Flk-1 was quantified by scanning densitometry. For analysis
of expression of VEGF receptors, total cell lysates in Laemmli sample
buffer were electrophoresed and immunoblotted using rabbit
polyclonal anti-KDR/Flk-1 antibody or rabbit polyclonal anti-Flt-1
antibody (C-17; Santa Cruz Biotechnology).
Kinase Assay of p125FAK
Cardiac myocytes were treated with rhVEGF (22.8 pmol/L) for
various times as indicated, and then they were frozen in liquid
nitrogen. Immune complex tyrosine kinase assays of
p125FAK were performed with a nonradioactive
isotope solid-phase ELISA kit using the exogenous substrate
poly(Glu-Tyr)15 26 27 (Universal Tyrosine Kinase Assay
Kit, Takara Shuzou Co Ltd) according to the manufacturer's
instructions. Briefly, the cell lysates were centrifuged and
the supernatants were immunoprecipitated with rabbit polyclonal
anti-p125FAK antibody. The immunoprecipitates
were incubated with ATP in the microtiter plate onto which
poly(Glu-Tyr) had been precoated. The amount of
phosphorylated poly(Glu-Tyr) was measured by ELISA
using a horseradish peroxidaselinked anti-phosphotyrosine (PY20)
antibody.
Analyses of the Effects of Tyrosine Kinase
Inhibitors on Phosphorylation of
p125FAK
Cells were preincubated for 30 minutes with or without either of
the tyrosine kinase inhibitors genistein28
(37 µmol/L) and tyrphostin29 (50 µmol/L)
(both from GIBCO-BRL), and then they were stimulated with 22.8 pmol/L
rhVEGF. The cell lysates were immunoprecipitated with mouse
anti-phosphotyrosine mAb (PY20) and subjected to Western
analysis using rabbit polyclonal
anti-p125FAK antibody. The increase in tyrosine
phosphorylation at the 125-kDa band was quantified by
scanning densitometry.
Analyses of Association of p125FAK With
p60c-src, GRB2, or Shc
After stimulation with 22.8 pmol/L rhVEGF for various times as
indicated, the cell lysates were immunoprecipitated with mouse
anti-v-Src mAb 2-17 (LA074; Quality Biotech), rabbit polyclonal
anti-GRB2 antibody (Santa Cruz Biotechnology), or mouse monoclonal
anti-Shc antibody (PG-797; Santa Cruz Biotechnology) along with protein
GSepharose and subjected to Western analysis using rabbit
polyclonal anti-p125FAK antibody.
Subcellular Fractionation
After stimulation with 22.8 pmol/L rhVEGF for various times as
indicated, cytosolic and membrane fractions were prepared from cardiac
myocytes according to modified methods previously
described.30 31 Briefly, cells were washed twice with PBS
and then harvested in a buffer containing 20 mmol/L HEPES and
250 mmol/L sucrose (pH 7.4) followed by centrifuging at
1000g for 3 minutes. The supernatant was discarded, and the
pellet was suspended in hypotonic Tris buffer containing (in
mmol/L) Tris (pH 7.5) 10, MgCl2 1,
phenylmethylsulfonyl fluoride 1, and
Na3VO4 1, and 100
µmol/L leupeptin. The pellet was homogenized by 80
strokes of Dounce homogenizer. The
homogenate was centrifuged at 1000g for
15 minutes to remove nuclei and debris. The supernatant was
centrifuged at 48 000g for 30 minutes, resulting in
a pellet, which was resuspended in hypotonic Tris buffer containing 1%
NP-40 and stored as a membrane fraction, and the supernatant, which was
recentrifuged at 246 000g for 90 minutes to remove
the microsome-rich fraction. The resulting supernatant was
stored as a cytosolic fraction. All of the above steps were carried out
at 4°C unless otherwise indicated. Protein estimation was
carried out using the BCA protein assay reagent (Pierce). The fractions
were suspended in Laemmli sample buffer and incubated at 37°C
for 30 minutes, and then their aliquots were subjected to
SDS-PAGE followed by immunoblotting with polyclonal
anti-p125FAK antibody or rabbit polyclonal
antirat Na,K-ATPase
1 fusion protein
(Upstate Biotechnology, Inc).
Immunocytochemistry
To investigate whether subcellular distribution of
p125FAK in cardiac myocytes and fibroblasts is
altered in response to VEGF, we performed double staining for
p125FAK and cardiac myosin heavy chain.
rhVEGF-treated (60 minutes) or untreated cardiac myocytes were fixed in
acetone for 5 minutes at room temperature. The cells were incubated
first with rabbit polyclonal anti-p125FAK
antibody for 1 hour at 37°C and then incubated sequentially with
biotinylated anti-rabbit IgG (Vector Laboratories) for 1 hour at 37°C
and FITC-conjugated avidin D (Vector Laboratories) for 30 minutes at
37°C. The cells were then incubated sequentially with mouse
anti-cardiac myosin heavy chain mAb (CMA-19) for 1 hour at 37°C and
TRITC-conjugated anti-mouse IgG1 antibody (Chemicon International, Inc)
for 30 minutes at 37°C. To investigate the relationship between the
immunofluorescent staining of p125FAK and
focal adhesions in rhVEGF-treated (60 minutes) cells, we performed
double staining for p125FAK and vinculin.
rhVEGF-treated (60 minutes) cells were first stained with rabbit
polyclonal anti-p125FAK antibody and then were
stained sequentially with biotinylated anti-rabbit IgG and
FITC-conjugated avidin D as described above. The cells were then
incubated with mouse anti-vinculin mAb (V-4505; Sigma) for 1 hour at
37°C and TRITC-conjugated anti-mouse IgG1 antibody for 30 minutes at
37°C. The sections were examined and photographed under a
fluorescence microscope (Microphoto-FX, Nikon).
Cell-Substrate Adhesion Assays
Cell-substrate adhesion was measured using the electric
cell-substrate impedance sensing system (Applied BioPhysics, Inc)
previously reported by Giaever and Keese32 33 and Ghosh et
al.34 In this system, the cells were cultured on a small
gold electrode (area,
104
cm2) deposited on the bottom of tissue culture
vessels. A small alternating current signal (1 µA) at a frequency of
4000 Hz was passed between the small electrode and a larger counter
electrode (area,
101
cm2) placed at a distance. The voltage between
the small and large electrodes was monitored. As cell membranes have
very high impedance, the attachment of cells to the small electrode
blocks the current, forcing it to flow under the cells, causing
an increase in the impedance. Primary cultures of
ventricular cardiac myocytes were prepared as above.
Cardiac myocytes were seeded on gelatin-precoated electrodes and
cultured for 2 days in DMEM supplemented with 10% FBS, 50 U/mL
penicillin, and 34 µmol/L streptomycin. They were starved for 24
hours and then stimulated with rhVEGF (34.2 pmol/L). The resistance,
which reflects the extent of cell-substrate adhesion, was monitored as
described previously.35 36
| Results |
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VEGF Phosphorylates p125FAK and
Paxillin
To examine whether VEGF can stimulate tyrosine
phosphorylation of a focal adhesion-associated protein
tyrosine kinase p125FAK, quiescent rat cardiac
myocytes were treated with rhVEGF for various time periods and lysed.
The cell lysates from the treated myocytes were immunoprecipitated with
anti-p125FAK polyclonal antibody followed by
Western blotting with anti-phosphotyrosine mAb (4G10) or
anti-p125FAK polyclonal antibody. Conversely,
immunoprecipitates with anti-phosphotyrosine mAb (PY20) were also
analyzed by Western blotting with
anti-p125FAK antibody. As shown in Figure 3A
and 3B
(top panel), VEGF significantly
increased tyrosine phosphorylation of
p125FAK, which peaked at 5 to 10 minutes after
addition of rhVEGF. We confirmed that almost equal amounts of
p125FAK protein were electrophoresed in each
reaction (Figure 3A
, bottom panel). We also investigated whether
VEGF caused tyrosine phosphorylation of paxillin,
another focal adhesion-associated protein, which interacts with several
proteins, including p125FAK, members of the src
family of tyrosine kinases, the transforming protein v-crk, and the
cytoskeletal protein vinculin. Immunoprecipitates with
anti-phosphotyrosine mAb (PY20) from the stimulated cardiac myocytes
were analyzed by Western blotting with anti-paxillin mAb. As
shown in Figure 3B
(bottom panel), VEGF also caused a
significant increase in the tyrosine phosphorylation of
paxillin. The tyrosine phosphorylation of paxillin
reached a maximum level at 5 to 10 minutes after addition of VEGF and
decreased subsequently.
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VEGF Stimulates Protein Tyrosine Kinase Activity of
p125FAK
To examine whether the catalytic activity of
p125FAK is stimulated by VEGF, kinase activity of
p125FAK immunoprecipitates from untreated or
rhVEGF-treated cardiac myocytes was assayed using poly(Glu-Tyr) as
substrate. As shown in Figure 4
, VEGF
induced activation of p125FAK as early as 2
minutes, peaking at 5 minutes, which paralleled its tyrosine
phosphorylation.
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Tyrosine Kinase Inhibitors Partially Inhibit
VEGF-Induced Activation of p125FAK
Next, to examine whether VEGF-induced tyrosine
phosphorylation of p125FAK was
dependent on tyrosine kinase activity, the cardiac myocytes were
pretreated with or without either of the tyrosine kinase
inhibitors genistein (37 µmol/L) and tyrphostin
(50 µmol/L) before addition of VEGF.
Representative results of 1 of 3 independent
experiments are shown in Figure 5
.
Both genistein and tyrphostin at least partially inhibited VEGF-induced
increase in tyrosine phosphorylation of
p125FAK at 5 minutes.
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VEGF Induces Association of p125FAK With Shc, GRB2,
and p60c-src
To determine whether c-Src plays a role in VEGF-induced tyrosine
phosphorylation of p125FAK,
immunoprecipitates with anti-v-Src mAb were subjected to SDS-PAGE
followed by immunoblotting with
anti-p125FAK antibody. As shown in Figure 6a
, VEGF caused a significant increase in
the association of p60c-src with
p125FAK, which peaked at 5 to 10 minutes after
addition of VEGF. To determine whether the VEGF-activated
p125FAK signaling complexes contained other known
Src homology (SH) 2containing proteins, such as the SH2/SH3 adapter
proteins GRB2 and Shc, we examined the VEGF-induced association of
p125FAK with these adapter proteins.
Immunoprecipitates with either anti-GRB2 polyclonal antibody or
anti-Shc mAb from VEGF-stimulated cardiac myocytes were subjected to
SDS-PAGE followed by immunoblotting with
anti-p125FAK polyclonal antibody. As shown in
Figure 6b
and 6c
, VEGF caused a significant increase in the
association of Shc and GRB2 with p125FAK. The
association peaked at 5 to 10 minutes after addition of VEGF.
|
VEGF Induces Subcellular Translocation of p125FAK in
Cardiac Myocytes and Fibroblasts
It has been shown that cell adhesion to ECM, such as fibronectin,
through integrins causes increased tyrosine
phosphorylation of p125FAK as
well as accumulation of p125FAK in focal
adhesions.13 44 45 46 We examined the effects of VEGF on
subcellular localization of p125FAK in cardiac
myocytes and nonmuscle cells (which mostly consisted of fibroblasts).
To distinguish cardiac myocytes from nonmuscle cells, we performed
double staining for cardiac myosin heavy chain and
p125FAK by
immunofluorescence. Figures 7B
and 7D
show that myofibrils of cardiac
myocytes were strongly stained, making it easy to distinguish cardiac
myocytes from fibroblasts. As shown in Figure 7A
, p125FAK predominantly localized in the
perinuclear region in nonstimulated cardiac myocytes. Only weak
fluorescent dots of p125FAK were seen in
some nonstimulated fibroblasts (Figure 7A
, arrows).
Fluorescent dots of p125FAK, which mostly
localized in the central regions at a higher density, appeared to
scatter to the peripheral cytoplasm in cardiac myocytes
stimulated with rhVEGF for 60 minutes (Figure 7C
, arrowheads).
In fibroblasts stimulated with VEGF for 60 minutes, fluorescent
dots of p125FAK were observed to be concentrated
in the patchy arrowhead-like structures at the peripheral
cytoplasm reminiscent of focal adhesions (Figure 7C
, arrow). To
compare the localization of p125FAK staining to
focal adhesions in VEGF-treated cells, we performed double staining for
p125FAK (Figure 7E
) and vinculin (Figure 7F
) by immunofluorescence.
Fluorescent dots of p125FAK showed
localization similar to that of vinculin in cardiac myocytes (Figure 7E
and 7F
, arrowheads), which suggests that
p125FAK was localized to focal adhesions in
response to VEGF, although the rest of the
p125FAK remained in cytoplasm. In fibroblasts,
the patchy arrowhead-like fluorescent dots of
p125FAK were clearly observed with higher
resolution (Figure 7E
, arrow). Incubation of cardiac myocytes
with control nonimmune rabbit serum yielded no significant staining
(data not shown).
|
Next, to confirm that VEGF induces subcellular translocation of
p125FAK, we analyzed
p125FAK content in subcellular fractions by
Western analysis with and without VEGF stimulation. As shown in
Figure 8
, the amount of
p125FAK in the membrane fraction was increased in
response to rhVEGF (Figure 8b
, top panel), whereas that in the
cytosolic fraction remained almost unchanged (Figure 8a
). We
confirmed that almost equal amounts of the membrane fraction were
electrophoresed in each reaction by Western analysis using
antiNa,K ATPase
1 subunit antibody (Figure 8b
, lower panel).
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VEGF Strengthens Adhesion of Cardiac Myocytes to the ECM
To assess the effects of VEGF on the extent of cell-substrate
adhesion, we monitored changes in cell-substrate resistance after
addition of rhVEGF, using an electric cell-substrate impedance sensor.
Typical results are shown in Figure 9A
.
The extent of cell-substrate adhesion is expressed as "normalized"
resistance, which was defined as a ratio of the resistance to the
initial value before addition of rhVEGF. VEGF induced a significant
increase in normalized resistance, indicating strengthening of the
cell-substrate adhesion at 3 hours after addition of rhVEGF (Figure 9B
).
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| Discussion |
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p125FAK is a widely expressed nonreceptor protein tyrosine kinase that localizes to focal adhesion structures. p125FAK is thought to be one of the key elements in the signal transduction pathway underlying changes in cell behavior induced by diverse stimuli, including integrin engagement; oncogenic transformation; and mitogenic neuropeptides such as bombesin, endothelin, vasopressin, angiotensin, platelet-derived growth factor, and lysophosphatidic acid.14 15 17 18 19 20 21 49 It was shown that tyrosine-phosphorylated pp125FAK directly interacts with pp60c-src and pp59fyn as one of their major substrates.27 50 Indeed, tyrosine phosphorylation of p125FAK by Src-family kinases has been shown to be directly correlated with increased protein tyrosine kinase activity, which is an important step in the formation of an active signaling complex.15 Paxillin is a cytoskeletal protein involved in actin-membrane attachment at sites of cell adhesion to the ECM, which has also been demonstrated to be one of the major substrates of pp60c-src in Rous sarcoma virustransformed cells as p125FAK.51 It becomes tyrosine phosphorylated concomitantly with p125FAK in response to multiple stimuli, including integrin-mediated cell adhesion, several neuropeptide growth factors, and platelet-derived growth factor.52 53 54
In the present study, we have shown that VEGF stimulated tyrosine phosphorylation and activation of p125FAK in cultured cardiac myocytes, peaking at 2 to 10 minutes. Although the time courses of the change in tyrosine phosphorylation and the activation of the kinase activity were similar, the extent of p125FAK activation seemed to be smaller than that expected from the increase in its tyrosine phosphorylation. The kinase activity assayed with exogenous substrate poly(Glu-Tyr) reflected only the ability to phosphorylate downstream substrates, including other kinases. On the other hand, tyrosine phosphorylation of p125FAK results not only from autophosphorylation but also from phosphorylation by other upstream protein kinases, including Src family kinases.27 50 The contribution from the latter might be relatively large compared with that from the former. This may be the reason for the discrepancy between the extent of its activation measured with the exogenous substrate and tyrosine phosphorylation.
We also showed that VEGF also stimulated tyrosine phosphorylation of paxillin, and VEGF-induced tyrosine phosphorylation of p125FAK was inhibited at least partially by the tyrosine kinase inhibitors genistein and tyrphostin. Moreover, VEGF caused increased association of p125FAK with pp60c-src concomitantly with increased tyrosine phosphorylation of p125FAK. Recently, Abedi and Zachary22 have reported that VEGF induces tyrosine phosphorylation of p125FAK and paxillin in endothelial cells, suggesting that they are components in a VEGF-stimulated signaling pathway. Our results indicate that tyrosine phosphorylation of p125FAK and paxillin is also a part of the signal transduction by VEGF in cardiac myocytes as in endothelial cells, resulting in organization of the cytoskeleton. Tyrosine kinases, especially p60c-src, might take some part in VEGF-induced tyrosine phosphorylation and activation of p125FAK in cardiac myocytes.
Transduction of various mitogenic signals from the cell membrane to the nucleus involves the adapter proteins Shc and GRB2, which mediate activation of the Ras/MAPK pathway.55 56 57 Shc is an immediate substrate of receptor tyrosine kinase activity and serves to physically link activated receptors to downstream signaling components.58 59 GRB2 is a ubiquitously expressed-24 kDa mammalian protein, which directly binds autophosphorylated tyrosine kinase receptors as well as phosphorylated Shc proteins and p125FAK through its SH2 domain.55 56 60 61 It is well known that activation of insulin receptor results in interaction of the GRB2-Sos complex with insulin receptor substrate-1 and Shc via the SH2 domain of GRB2.59 62 The tyrosine kinaseShcGRB2Sos pathway was shown also to be involved in signal transduction from Gq proteincoupled angiotensin II receptor leading to activation of p21ras in cardiac myocytes.63 It has also been demonstrated that adhesion of fibroblasts to fibronectin promotes SH2-domainmediated association of GRB2 and p60c-src with p125FAK in vivo, resulting in activation of MAPK.60 In the present study, we demonstrated VEGF-induced association of p125FAK with GRB2 and Shc, occurring concomitantly with increased tyrosine phosphorylation of p125FAK. This strongly suggests that 2 ubiquitously expressed adapter proteins, GRB2 and Shc, play a role in VEGF-induced signal transduction involving the MAPK pathway in cardiac myocytes, as we previously reported.10
Furthermore, the immunocytochemical study demonstrated that VEGF stimulation significantly altered the subcellular localization of p125FAK from the perinuclear region to the peripheral cytoplasm in cardiac myocytes and increased accumulation of p125FAK in the patchy arrowhead-like structures at the peripheral cytoplasm (ie, focal adhesions) in cardiac myocytes as well as in fibroblasts. In addition, we confirmed quantitatively by Western analysis that the amount of p125FAK in the membrane-rich fraction significantly increased in response to VEGF. These results indicate that p125FAK translocates to focal adhesions in response to VEGF. Taken together, VEGF causes activation as well as subcellular translocation of p125FAK to focal adhesions, where it works. Activation and accumulation of p125FAK in focal adhesions strongly suggests that adhesive interaction between cardiac myocytes and ECM may be strengthened in response to VEGF. Using an electric cell-substrate impedance sensor, we confirmed that VEGF induced significant increase in adhesion between cardiac myocytes and ECM. Whether this may reflect one of the cardiac adaptive responses in vivo in situations such as acute ischemia, in which cardiac myocytes are exposed to high levels of VEGF, is unknown and remains to be clarified.
| Acknowledgments |
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| Footnotes |
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Received June 8, 1998; accepted February 11, 1999.
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