Cellular Biology |
From the Heart and Lung Institute and the Division of Cardiology, Department of Internal Medicine (N.I.M., P.J.G.-C.), and Neurobiotechnology Center (P.E.K, J.P.-T.), College of Medicine and Public Health, Ohio State University, Columbus, Ohio, and the Department of Pediatrics (S.D.S), Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
Correspondence to Nicanor I. Moldovan, PhD, Heart and Lung Institute, Department of Internal Medicine, College of Medicine and Public Health, The Ohio State University, Medical Research Facility, Room 546, 420 W 12th Ave, Columbus, OH 43210. E-mail moldovan-1{at}medctr.osu.edu Pascal J. Goldschmidt-Clermont, MD, Duke University Medical Center, Box 3845, Durham, NC 27710.
| Abstract |
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Key Words: monocytes metalloelastase angiogenesis ischemic heart disease
| Introduction |
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However, it has recently been shown that some rapidly growing tumors may rely on a different mechanism of blood supply, called "vascular mimicry," which consists in formation of periodic acid-Schiff (PAS)positive, endothelium-free "tunnels" apparently drilled within the tumoral matrix by the cancer cells themselves.10 This endothelial disguise may go so far that the epithelial tumor cell line T24/83 was for a long time mistaken for an EC line, ECV 304.11
In this study we present data that suggest a similar genesis of alternative microcirculation formation occurring in the ischemic myocardium, in which the native capillary network collapsed as a consequence of transgenically induced upstream occlusion due to thrombosis or other pathological processes and in which monocytes/macrophages (MCs/Mphs) are attracted by chemotaxis. In the myocardium, a dense matrix of extracellular proteins connects the cardiomyocytes (CMs) to form a compact tissue that is capable of generating force and sustaining substantial transmural pressures during systole. Chronic ischemia of the myocardium resulting from epicardial coronary atherosclerosis is associated, in a subset of patients, with the enlargement of existing arterioles (arteriogenesis)12 and the sprouting of new capillaries (angiogenesis, in its "classical" meaning)1 3 to generate a network of collateral vessels. The presence of such collaterals can markedly reduce damage to the myocardium that is produced by acute or chronic ischemia.
In such a setting, and because of the unique properties of the myocardial tissue, researchers had anticipated that the process of formation of new blood vessels might have particular characteristics, including the contribution of MCs/MPhs,12 13 and induction of adult-type vasculogenesis based on circulating precursor ECs.14 Data presented here suggest that in this instance, in addition to their secretion of endothelial growth factors,15 the inflammatory cells may contribute to a compensatory microcirculation with their ability to "tunnelize" the ischemic regions. The conduits thus created can facilitate the access of other blood components, setting up a tubular network prone to the re-establishment of a collateral microvascular system.
| Materials and Methods |
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, has been
described previously.16 Homozygous (4- to 6-month-old) and
heterozygous (8- to 10-month-old) MCP-1 mice or LacZ-Tie-2expressing
transgenic mice (The Jackson Laboratory) and age-matched wild type
controls were euthanized with CO2. The hearts
were collected, either cryofixed or fixed in buffered 10% formalin or
in methanol, and embedded in paraffin for sectioning and for further
histological and immunohistochemical staining. All
protocols were approved by the Ohio State University Institutional
Animal Care and Use Committee.
Histology and Ultrastructural Analysis
Paraffin sections were stained with hematoxylin and eosin (HE),
Weigerts elastic van Gieson (EVG), or PAS reagent with hematoxylin
counterstaining. For electron microscopy, the tissues were fixed with
3% glutaraldehyde in 0.1 mol/L phosphate buffer
supplemented with 10 mmol/L sucrose for 3 hours, postfixed in 1%
osmium tetraoxide, dehydrated in graded ethanol, and embedded in Spurr
resin. Ultramicrotome sections were counterstained with 2% uranyl
acetate and Reynolds lead citrate and examined with a Phillips CM-12
electron microscope operated at 60 kV.
Immunohistochemistry
Immunostaining was done on paraffin sections by
using the following antibodies: antismooth muscle
-actin (clone
1A4) from Sigma; anti-Thy-1, antiplatelet endothelial cell adhesion
molecule-1 (PECAM-1), antiendothelial NO
synthase (eNOS), and anti-Mac-3 from PharMingen; and rabbit anti-mouse
MC/Mph metalloelastase (MME), which was prepared as
described.17 The detection system for these antibodies
comprised Vectastain ABC-peroxidase and avidin/biotin blocking kits
from Vector Laboratories. The sections were counterstained with
hematoxylin. For the assessment of cell proliferation, mice were
implanted with osmotic minipumps (Alza Corp) releasing
5-bromo-2'-deoxyuridine (BrdU, Sigma) at a rate of 25 mg/kg per day for
10 days. Paraffin sections obtained from the labeled hearts were
immunostained for BrdU incorporation using a commercial kit
(Zymed Laboratories).
Exposure of MCP-1 Hearts to Circulating, Labeled
Endothelial Progenitor Cells
To perfuse chronically the MC-tunneled tissues with mouse blood
containing labeled progenitor ECs,18 the MCP-1 hearts were
transplanted heterotopically19 to syngeneic
recipients transgenically modified to express ß-galactosidase under
the control of the endothelial marker
Tie-2.20 The data presented were obtained from a
nonrejected (beating) MCP-1 heart, which was harvested 5 days after
transplantation, included in OCT, cryosectioned, and stained for
ß-galactosidase activity.
| Results |
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With the advancement of the cardiomyopathic process, we
observed on microscopic sections a multitude of tunnels within the
myocardium of MCP-1 mice, which had not been recognized in
our previous study of this model (Figures 1
, 3
, and 4
). Therefore, we
addressed the hypothesis that MCs/Mphs might be using potent
metalloproteinases to infiltrate the myocardial tissue. The
broad-spectrum mouse metalloelastase MME21 was
immunodetected as being associated with MCs/Mphs and lining empty
cylindrical spaces (tunnels) found in longitudinal and transversal
sections of MCP-1 myocardium (Figures 1A
and 1C
through 1G). A particular feature, present in 2 of
6 examined specimens, was a higher intensity of the
immunostaining in the subendocardial
myocardium (Figure 1A
), suggesting a likely,
although indirect, association between tunneling and ischemia
in this model. MME positivity was not present in the endocardium of
control, wild-type littermates (Figure 1B
).
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MME is a proteinase specific to MCs/Mphs21 and,
together with the Mac-3 antigen, was used here to confirm the MC/Mph
phenotype of tunnel-forming, infiltrating mononuclear cells
(Figure 1H
). MME staining was also present in the avascular
tissue of cardiac valves (Figure 1F
) but was absent within
native microvessels (Figure 1G
). These observations suggest that
the tunnels and the capillaries are distinct entities.
The concurrent finding of extravascular structures staining for MME and
of MME-positive MCs/Mphs (Figures 1C
, 1E
, and 4A
)
within these tunnels strongly suggest, although do not definitively
prove, the implication of MCs/Mphs in the process of tunnel formation.
Indeed, MCs/Mphs displaying migratory, elongated morphology could be
detected within these tunnels (Figures 1E
and 1H
).
Ischemia of the MCP-1 Hearts
Cross sections of failing MCP-1 mouse hearts revealed both intact
epicardial coronary vessels (Figure 2B
) and vessels affected by an occlusive
vasculopathy (Figure 2A
), with destruction of the elastic lamina
and thrombotic complications. Moreover, many small arterioles were
occluded, either by cellular (Figure 2C
) or thrombotic (not
shown) elements.
|
Downstream from the obstructed and thrombosed coronary arteries
within the hearts of MCP-1 mice, signs of ischemic
cardiomyopathic changes could be observed. Although the
recruitment of MCs/Mphs to the myocardium per se could have
contributed to the myocardial damage, we have accumulated evidence that
loss of functional blood vessels may have also contributed to the
cardiomyopathic process. We detected typical
contraction bands (Figure 2D
), whereas ultrastructural
analysis of MCP-1 hearts by electron microscopy demonstrated
swollen mitochondria with electron-dense deposits (Figure 2E
),
myofibril breakdown, and Z-band disorganization within CMs (Figure 2F
). Myocytolysis with extensive CM loss was detected as well
(Figures 1H
, 3G
, and 4F
). These changes
were consistent with the expected findings for an
ischemic cardiomyopathy
model.22 23
Blood Elements Are Found in Tunnels, Which May Contribute to
Neovascularization
A detailed histological examination of MCP-1
hearts confirmed the presence of a network of tunnels of fairly uniform
diameter, usually devoid of ECs (Figure 3A
). PAS staining of MCP-1 hearts
revealed PAS-positive structures of which the distribution was similar
to that of MME-positive tunnels (Figure 3C
), as well as
occasional PAS-positive mononuclear cells (Figure 3C
, arrowhead). Well-organized tunnel-like structures (PAS- and
MME-positive), the detection of which is possibly facilitated by an
increased incidence of edema, were found exclusively in
MCP-1expressing hearts and were largely absent from the hearts of
nontransgenic littermates (Figures 3B
and 3D
), ruling out
the possibility of processing artifacts.
The possible existence of 2 distinct microvascular structures in MCP-1
hearts was also suggested by immunostaining for 2
endothelial markers, eNOS and PECAM-1.
Erythrocyte-filled, eNOS-negative tunnels were detected in MCP-1 hearts
along with eNOS-positive microvessels (Figure 3E
). In the
wild-type control mice, all erythrocytes were confined to a
high-density network of eNOS-positive capillaries (Figure 3F
).
This result was confirmed by the distribution of PECAM-1
immunoreactivity, which was found to be almost absent in the tunnel
containing MCP-1 hearts (Figure 3G
), whereas PECAM-1 was
present in the wild-type controls at comparable levels with eNOS
immunostaining (Figure 3H
).
Some nonendothelialized tunnels contained blood
components, such as MCs (Figures 1E
and 4A
) and
erythrocytes (Figures 3A
, 3E
, and 4C
), whereas
other tunnels were apparently colonized by EC-like cells (Figures 4A
, 4B
, and 4E
). This
finding is consistent with, although it does not prove, a
process in which MC-/Mph-drilled tunnels can evolve to become
neocapillaries if connected by a still-unknown mechanism to the
microcirculatory system.
To collect additional support for this hypothesis, we stained
paraffin sections from MCP-1 hearts with an antibody to Thy-1, a marker
of hematopoietic stem cells, which is believed to be expressed also on
ECs during adult neovascularization.24 Clusters of small
vessels and incidental mononuclear cells were positive for Thy-1
staining (Figure 4F
). In other microscopic fields, we found a
patchy staining for Thy-1 within the contour of a single capillary
(N.I. Moldovan, unpublished data, 2000).
An active angiogenic process was also indicated by the finding that
many cells with EC morphology lining the tunnels displayed signs of DNA
synthesis as assessed by BrdU incorporation (Figure 4B
). The
endothelial nature of the cells found within the
tunnels was further supported by ultrastructural analysis,
which revealed the presence of large vacuoles (Figure 4E
),
presumably the precursors of capillary lumens, as shown for sprouting
ECs.25
Moreover, when transplanted in recipients transgenically expressing
ß-galactosidase under an active endothelium-specific
Tie-2 promoter (Figure 4D
), MCP-1 hearts displayed a sparse
infiltration with mononuclear, ß-galactosidasepositive, presumably
precursor ECs, both in capillaries and in tunnel-like structures
(Figure 4C
).
| Discussion |
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We have accumulated the following evidence that the infiltrating mononuclear cells produced these tunnels using the proteolytic activity localized at their surface: (1) MME-positive cells were found in tunnels, (2) the cross-sectional size of tunnels is in the range of diameters of mononuclear cells, (3) regions where MCs/Mphs are present display increased MME immunostaining, and (4) the finding of empty MME-positive tunnels suggests that they are produced by migrating MCs/Mphs.
MME, the mouse homologue of human matrix metalloprotease 12, is a broad-spectrum metalloprotease specifically produced by mononuclear phagocytic cells.21 Its expression correlates with MC/Mph activation status.26 MME is differentially expressed and clustered around vascular structures during experimental angiogenesis in the mouse.27 MME was shown to be necessary for the penetration of basement membranes by MCs/Mphs in vivo and in vitro and for degradation of extracellular matrix proteins.28 Although direct evidence is lacking, correlative data suggest that tissular activity of metalloelastases is downregulated in some instances by tissue inhibitors of metalloproteinases29 and possibly stimulated by urokinase-type plasminogen activator.30 Both of these regulators are known to be modulated by ischemic conditions.31 32
Therefore, the preferential immunostaining for MME found within the subendocardial region of MCP-1 hearts supports the possibility of an ischemia-driven activation of MCs/MPhs and, consequently, an MME-based proteolytic activity. In view of the report that MME production is not affected by MCP-1 levels,33 our finding that MME activity and MC-/MPh-based tunneling are associated with the advanced stages of ischemic cardiomyopathy in this model might suggest that ischemia itself, or other factors related to ischemia, may contribute to the observed tunneling, although a more direct role for MCP-1 in this process cannot be ruled out.
Activation of MCs/MPhs increases their ability to invade the extracellular matrices in vitro as well, producing lasting tunnels similar to those described here.34 Moreover, phorbol 12-myristate 13-acetate, an MC/MPh activator responsible for this effect, is also known as an inducer of MME.26
Previous studies suggested that MME might be anti-angiogenic, because of its ability to form angiostatin from plasminogen in vitro35 and to form endostatin from collagen XVIII.36 If this were the case, one would expect that the inhibition of MME would stimulate angiogenesis. In fact, MME displays an exquisite sensitivity to downregulation by dexamethasone,26 27 but contrary to expectations, this effect actually parallels a reduction, not the stimulation of angiogenic process in a murine wound-healing model in vivo.27 Moreover, the mere presence of an MME antigen lining the tunnels, presumably representing MME molecules or fragments thereof (supposedly shed during MC/Mph migration), does not necessarily imply that the enzyme is still active. Actually, the limited and fairly uniform diameter of tunnels argues that MME activity is tightly regulated by local inhibitors.
In longitudinal, oblique, and transversal cross sections (as required in a critique of the tumor-associated PAS-positive "channels,"37 which were recently described as a form of "vascular mimicry"10 ), we found PAS-staining material lining some of the endothelium-free tunnels, which might contribute to the retention and possibly to the differentiation of circulating EC progenitor cells.
In tunnels found in MCP-1 hearts, we could detect blood products such as erythrocytes and EC-like (ie, attached to tunnels walls) cells. This observation raises the intriguing possibility that some MC-/Mph-produced tunnels, if connected to a blood supply, can be colonized in a later stage by circulating precursor ECs displaying heightened mitotic activity.18 We were able to confirm the availability of circulating precursor ECs by Tie-2 cell tagging of the infiltrate of the MCP-1 myocardium and by the presence of immature ECs, by electron microscopy.
We consider it improbable that the infiltrating, Tie-2driven, ß-galactosidasepositive ECs could have migrated within the transplanted myocardium as a result of a sprouting process, given the distance from the sutures between the recipients ß-galactosidasepositive endothelia and the actual places where we observed the tagged cells in the transplanted heart, as well as their individualized, single-cell localization. Furthermore, it is known that the re-endothelialization of grafts proceeds through the "fallout" of blood-derived, proliferating, BrdU-positive endothelial precursors.38 However, we do not rule out that blue cells originated from the recipient vessels and renested in the graft capillaries.
Discontinuity ("spottiness") of the covering with ECs along a given
tunnel, and of the labeling for markers of neoangiogenesis within and
among microvessels (Figure 4
), makes the sprouting an unlikely
mechanism of re-endothelialization in our model of
ischemic heart failure. One would expect ECs occurring by
sprouting to be in contact with one another (contiguous) and of similar
phenotype. New endothelial covering of former
de-endothelialized capillaries may be ruled out as well
on the basis of the MME positivity of the tunnels. Therefore, our
findings can be better interpreted within the new paradigm of adult
vasculogenesis14 18 on the basis of the dissemination of
circulating precursor ECs. In this respect, the data reported in this
study may contribute to understanding the mechanism of engrafting of
circulating endothelial precursors within the
ischemic tissue.
One may consider the presence of erythrocytes within endothelium-free tunnels in MCP-1 hearts as a manifestation of the leakiness of defective or immature capillaries. However, to our knowledge this type of leakiness was convincingly demonstrated mostly in the microcirculation of some tumors.39 Otherwise, what is generally considered "leakiness" of new capillaries refers mostly to an increased molecular permeability to solutes, which might be the effect of vascular endothelial growth factor (also known as the "vascular permeability factor") on the transcellular diffusion of macromolecules rather than creation of large interendothelial junctional defects.40 41
The limited amount of blood we found in tunnels may be explained either by the variable extension of their connection to the bona fide blood conduits or by the postmortem washing out of blood. However, in an in vitro model, we have been able to demonstrate the formation of tunnels by MCs/Mphs in extracellular matrices, the stimulating effect of MCP-1 on this process, and the ability of these tunnels to be filled by blood-derived erythrocytes (N.I. Moldovan, unpublished data, 2000).
In conclusion, with the availability of a transgenic model in which the development of a dilated ischemic cardiomyopathy can be reliably reproduced by targeted expression of MCP-1 in the myocardium, we made a series of observations that are shedding light on a possible novel mechanism of neovasculogenesis as it takes place in the ischemic myocardium and on the role of MCs/Mphs in this process, indicating new strategic targets for therapeutic angiogenesis.
| Acknowledgments |
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Received June 6, 2000; revision received July 11, 2000; accepted July 11, 2000.
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