Donate Help Contact The AHA Sign In Home
American Heart Association
Circulation Research
Search: search_blue_button Advanced Search
Circulation Research. 2001;89:1147-1154
Published online before print November 1, 2001, doi: 10.1161/hh2401.101070
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
89/12/1147    most recent
hh2401.101070v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Steitz, S. A.
Right arrow Articles by Giachelli, C. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Steitz, S. A.
Right arrow Articles by Giachelli, C. M.
Related Collections
Right arrow Smooth muscle proliferation and differentiation
Right arrow Mechanism of atherosclerosis/growth factors
(Circulation Research. 2001;89:1147.)
© 2001 American Heart Association, Inc.


Molecular Medicine

Smooth Muscle Cell Phenotypic Transition Associated With Calcification

Upregulation of Cbfa1 and Downregulation of Smooth Muscle Lineage Markers

Susie A. Steitz, Mei Y. Speer, Gabrielle Curinga, Hsueh-Ying Yang, Paul Haynes, Ruedi Aebersold, Thorsten Schinke, Gerard Karsenty, Cecilia M. Giachelli

From the Departments of Bioengineering (S.A.S., M.Y.S., H.-Y.Y., C.M.G.), Pathology (G.C.), and Molecular Biotechnology (P.H., R.A.), University of Washington, Seattle, Wash; and the Department of Molecular and Human Genetics (T.S., G.K.), Baylor College of Medicine, Houston, Tex. Present address for P.H. is Novartis Agricultural Discovery Institute, San Diego, Calif.

Correspondence to Cecilia M. Giachelli, Bioengineering Department, Box 351720, University of Washington, Okanogan Lane, Bagley Hall, Seattle, WA 98195. E-mail ceci{at}u.washington.edu


*    Abstract
up arrowTop
*Abstract
down arrowIntroduction
down arrowMaterials and Methods
down arrowResults
down arrowDiscussion
down arrowReferences
 
Bovine aortic smooth muscle cell (BASMC) cultures undergo mineralization on addition of the organic phosphate donor, ß-glycerophosphate (ßGP). Mineralization is characterized by apatite deposition on collagen fibrils and the presence of matrix vesicles, as has been described in calcified vascular lesions in vivo as well as in bone and teeth. In the present study, we used this model to investigate the molecular mechanisms driving vascular calcification. We found that BASMCs lost their lineage markers, SM22{alpha} and smooth muscle {alpha}-actin, within 10 days of being placed under calcifying conditions. Conversely, the cells gained an osteogenic phenotype as indicated by an increase in expression and DNA-binding activity of the transcription factor, core binding factor {alpha}1 (Cbfa1). Moreover, genes containing the Cbfa1 binding site, OSE2, including osteopontin, osteocalcin, and alkaline phosphatase were elevated. The relevance of these in vitro findings to vascular calcification in vivo was further studied in matrix GLA protein null (MGP-/-) mice whose arteries spontaneously calcify. We found that arterial calcification was associated with a similar loss in smooth muscle markers and a gain of osteopontin and Cbfa1 expression. These data demonstrate a novel association of vascular calcification with smooth muscle cell phenotypic transition, in which several osteogenic proteins including osteopontin, osteocalcin, and the bone determining factor Cbfa1 are gained. The findings suggest a positive role for SMCs in promoting vascular calcification.


Key Words: vascular calcification • smooth muscle cells • phenotype • core binding factor {alpha}1


*    Introduction
up arrowTop
up arrowAbstract
*Introduction
down arrowMaterials and Methods
down arrowResults
down arrowDiscussion
down arrowReferences
 
Mineralization of bones and teeth is an exquisitely regulated, cell-mediated process in which the tissue extracellular matrix is embedded with crystalline calcium phosphate deposits. This process gives rise to hard tissues endowed with the mechanical properties required to withstand their normal physiological functions. In contrast, mineralization of soft tissues occurs under pathological conditions with detrimental consequences, particularly when present in blood vessels and heart valves. Calcification of arterial plaques decreases vessel elasticity, augments plaque brittleness, leads to increased plaque rupture during angioplasty procedures,1,2 and is associated with increased risk of myocardial infarction and death.3,4,5

Despite its clinical significance, the molecular mechanisms regulating vascular calcification are unclear. Historically, ectopic calcification has been considered a passive process involving spontaneous calcium phosphate mineral precipitation in necrotic tissue. However, several lines of evidence have recently emerged supporting the concept that ectopic calcification, like mineralization of bones and teeth, is a cell-regulated process. Similarities between hard and soft tissue mineralization include the presence of an apatitic mineral phase, matrix vesicles,6 and noncollagenous bone proteins including osteopontin,7 bone acidic glycoprotein 75 (BAG 75),8 osteocalcin,9 osteonectin,10 and bone morphogenetic protein type 2.11 Furthermore, studies of mutant mice, including matrix GLA protein null (MGP-/-) mouse,12 klotho mouse,13 carbonic anhydrase II deficient mouse,14 and osteoprotegerin null mouse,15 have identified genes whose loss of function increases susceptibility to vascular calcification. Finally, outright ossification has been occasionally noted in extensively calcified vascular tissues.16 Taken together, these findings have greatly strengthened the theory that vascular calcification, like osteogenesis, is a delicately regulated balance between inducers and inhibitors.

The importance of vascular calcification in human disease has fueled interest in identifying both positive and negative mediators of vascular calcification. In this study, we have investigated the properties of arterial smooth muscle cells under mineralizing conditions. We provide evidence for a dramatic phenotypic transition associated with mineralization of bovine aortic smooth muscle cells (BASMCs) in vitro as well as with arteries of MGP-/- mice in vivo.


*    Materials and Methods
up arrowTop
up arrowAbstract
up arrowIntroduction
*Materials and Methods
down arrowResults
down arrowDiscussion
down arrowReferences
 
Cell Culture
Primary human osteoblasts (a generous gift from Dr Norman Wolf, University of Washington, Seattle, Wash) were maintained in DMEM containing 4.5 g/L glucose and 15% fetal calf serum (HyClone Laboratories Inc, Logan, Utah). Primary BASMCs were isolated as described previously,17 and cultured in DMEM supplemented with 4.5 g/L glucose, 15% fetal bovine serum, 1 mmol/L sodium pyruvate (Gibco BRL), 100 U/mL penicillin, and 100 mg/mL streptomycin (Gibco BRL). Cells used in the experiments were between passages 3 and 8. Calcification of BASMCs was induced, as described previously,18 by addition of 10 mmol/L ß-glycerophosphate (ßGP) or 5 mmol/L inorganic phosphate (Pi) to the medium. Extracellular calcium deposition was measured and normalized to cellular protein content.17,18

Protein Lysate Preparation and Immunoblotting
BASMC lysates and nuclear extracts were prepared as described.18,19 Arterial protein extracts were prepared by homogenizing the carotids of MGP wild-type (MGP+/+) and MGP-/- mice in 20 mmol/L Hepes containing 420 mmol/L sodium chloride, 1.5 mmol/L magnesium chloride, 0.2 mmol/L EDTA, 25% glycerol, 0.5 mmol/L dithiothreitol, 0.5 mmol/L phenylmethylsulfonylfluoride, and 10 µg/mL leupeptin, pH 7.9. Protein amounts of cell lysates, nuclear extracts, and arterial extracts were measured by the Micro BCA Assay (Pierce). Equal amounts of the proteins were separated by polyacrylamide gel electrophoresis followed by transfer to a 0.45 µm Nitro-Bind membrane (Micron Separations, Inc). Proteins of interest were then blotted using specific antibody, biotin-streptavidin amplification, and Western blot chemiluminescence detection (NEN). Antibodies used were as follows: mouse monoclonal antibody (mAb) against SM22{alpha} (gift from Dr S. Sartore, University of Padua, Italy), OP-199 against osteopontin, HHF35 against SM {alpha}-actin (gift from Dr Alan Gown, PhenoPath Labs, Seattle, Wash), mouse mAb against human bone alkaline phosphatase (B4-78, Developmental Studies Hybridoma Bank, University of Iowa), rabbit polyclonal antibody against bovine osteocalcin (LF-32, gift from Dr L.W. Fisher, National Institutes of Health, Bethesda, Md), and antibody against core binding factor {alpha}1 (Cbfa1) (generated from peptide MASNSLFSAVTPCQQSFFWDPSTSRR, representing amino acids 1 to 26 of the Cbfa1 open reading; Genosys Biotechnologies, Inc).

Protein Identification by Mass Spectroscopy
Cell lysates from BASMC cultures grown in the presence or absence of ßGP were prepared and their protein amounts were quantified as described. Twenty-five micrograms of each lysate was separated by a 10% SDS-polyacrylamide gel. The protein with a molecular weight of approximately 25 kDa was excised from the gel and digested with trypsin. Peptides obtained were separated by a gradient capillary LC system using a C18 column (100 mm IDx4 cm). The capillary LC system eluate was directed to a Finnigan MAT TSQ 7000 triple quadrupole mass spectrometer (Finnigan Corporation) using a microelectrospray ionization source constructed in the laboratory. The spray voltage was +1.3 kV and the heated capillary set at 200°C. Collision-induced dissociation (CID) of selected peptide ions was achieved using 3.5 mTorr of Argon in the second quadrupole. Spectra were scanned over the range 400 to 2000 mass units at 1.6-second intervals. Automated peak recognition and daughter ion scanning were performed using the built-in Instrument Control Language (ICL) as described previously.20 Tandem mass spectra were analyzed using the SEQUEST computer program that allows the correlation of observed CID spectra with theoretical spectra generated from known protein sequences.21 The criteria used for a positive peptide identification were a correlation factor (Xcorr) greater than 2.5, a {delta} cross-correlation factor greater than 0.1 (indicating a significant difference between the best match reported and the next best match), and a high preliminary score. At least 2 positive peptide identifications are considered necessary to unambiguously identify a protein.22 All spectra were searched against the OWL protein database.23

Electrophoretic Gel Mobility Shift Assay
Double-stranded oligonucleotides containing the Cbfa1 DNA binding site (OSE2) from osteopontin promoter (5'-CGCTCTTTGTGC- AAACCACACAG-3') were synthesized by Gibco BRL and end-labeled with [{gamma}32P] ATP, as directed by Promega. The [{gamma}32P]-labeled OSE2 probe was purified using a Sephadex G-25 column (Pharmacia Biotech, Inc). To detect Cbfa1 binding activity, 6 µg of nuclear extract was incubated at room temperature for 10 minutes with 5 fmol of the labeled OSE2 probe and 133 µg/mL of poly dIdC.dIdC (Sigma). The mixture was then applied onto a 5% polyacrylamide gel to separate the proteins at 100 V for 4 hours. The gels were then dried and the specific protein shifts were visualized by autoradiography. As parallel controls, the nuclear extracts were preincubated for 20 minutes at room temperature with either 50 fmol unlabeled OSE2 probe, nonspecific probe (Osteopontin E-box: 5'-GGAGCAGGTGGCCGGCCGTGG-3'), anti-Cbfa1antibody, or normal rabbit serum (Vector Laboratories, Inc, Burlingame, Calif) prior to addition of the labeled probes.

Reverse Transcriptase–Polymerase Chain Reaction and DNA Sequencing
cDNA reverse transcribed from the RNA of day 10 ßGP-treated BASMCs was amplified by Taq DNA polymerase as described by Komori et al,24 using the following Cbfa1 specific primers: 5'CCGCACGACAACCGCACCAT-3' and 5'-CGCTCCGGC-CCACAAATCTC-3'. The resulting 284 base pair fragment was cloned into pcDNA 3.1 vector and confirmed as the bovine homologue of mouse Cbfa1 using the Dye Terminator DNA cycle sequencing kit (Perkin Elmer).

Northern Analyses
Total RNA isolated from BASMC cultures grown in either the presence or absence of ßGP was transferred to a nylon membrane and hybridized overnight at 42°C with either 32P-labeled bovine Cbfa1 or 32P-labeled bovine osteopontin cDNA. The specific bands were visualized by autoradiography, and the relative band intensities were measured by NIH Image Program.

Tissue Preparation and Histochemistry
MGP-/- and MGP+/+ mice were generated by mating of C57BL/6J MGP heterozygous mice, and genotypes were determined as previously described.12 At the indicated ages, the mice were given a lethal intraperitoneal injection of nembutol (0.3 mg/g mouse), and the carotids and aortas were excised, fixed for 18 to 24 hours in methyl Carnoys fixative (3:1, methanol to acetic acid), and embedded in paraffin. Five-micrometer sections were used for histological analysis. Alizarin Red S (0.5%, pH 9.0; Sigma) and Von Kossa staining were used to detect calcification. For immunohistochemical analysis, sections were first blocked in PBS containing 10% goat serum, 1% bovine serum albumin (BSA), and avidin blocking reagent (Vector Laboratories, Inc). Polyclonal rabbit anti-osteopontin antibody (LF123; gift from Dr L. Fisher) was used to detect osteopontin, mouse monoclonal anti–{alpha}-actin antibody (1A4; Sigma) to detect SM {alpha}-actin, and polyclonal rabbit anti-SM22{alpha} antibody (gift from Dr Michael Parmacek, University of Pennsylvania, Philadelphia, Pa) to detect SM22{alpha}.25 After incubation at room temperature for 1 hour, the sections were incubated with biotinylated anti-rabbit or anti-mouse antibodies (Vector Laboratories, Inc) prior to streptavidin-conjugated peroxidase staining. Sections were counter-stained with methyl green (2% methyl green, 2% pyronin Y; Sigma).


*    Results
up arrowTop
up arrowAbstract
up arrowIntroduction
up arrowMaterials and Methods
*Results
down arrowDiscussion
down arrowReferences
 
Mineralizing BASMCs Lose Smooth Muscle Lineage Markers In Vitro
We previously characterized the morphology and ultrastructure of calcifying BASMC cultures in vitro.17 BASMC cultures grown in the presence of ßGP developed widespread matrix mineralization. Ultrastructural analysis confirmed the presence of hydroxyapatite, calcifying collagen, extracellular matrix vesicles, and nodular calcification, similar to that observed in calcified atherosclerotic plaques and heart valves in vivo. Thus, this in vitro model represents a useful tool to further investigate mechanisms of vascular calcification. As shown in Figure 1A, the accumulation of calcium phosphate mineral on BASMC monolayers grown in the presence of ßGP was observed by light microscopy within 10 days of culture. The mineral was deposited diffusely throughout the culture and localized to the extracellular matrix. The time course by which BASMC monolayers deposit calcium phosphate mineral in the presence of ßGP was also established (Figure 1B). Within 7 days of culture, ßGP-treated BASMCs showed significantly more calcium deposition than vehicle-treated controls, and a 5- to 6-fold increase in mineral deposition was further observed by day 10. The effect of ßGP on mineral deposition was previously shown to depend on alkaline phosphatase-mediated generation of inorganic phosphate in the culture.17 Consistent with those findings, identical results were obtained when ßGP was replaced with 5 mmol/L inorganic phosphate (data not shown).



View larger version (74K):
[in this window]
[in a new window]
 
Figure 1. BASMC cultures accumulate extracellular calcium phosphate mineral on exposure to ßGP. BASMC monolayers were cultured in the presence (+) or absence (-) of ßGP. A, Mineralization was visualized by light microscopy. B, Calcium deposition was quantified at the indicated culture times. Values are mean±SD, n=3.

A comparison of proteins extracted from day 10 cultures showed differences between BASMCs grown under normal or calcifying conditions. One very dramatic difference was the loss of a protein band migrating at an apparent molecular weight of 25 kDa in the ßGP-treated extracts (Figure 2A). This protein band, which was strongly expressed in control extracts, was trypsin-digested and analyzed by ESI-tandem mass spectroscopy, and was found to contain 3 peptides that were identified as tryptic fragments of bovine smooth muscle protein SM22{alpha}.26 The 3 peptides identified were KYDEELEER, AAEDYGVTK, and EFTESQLQEGK, corresponding to amino acids 1 to 9, 77 to 85, and 133 to 143 of the SM22{alpha}, respectively.26,27 A fourth peptide, LVNSLYPDGSKPVK, was also identified and shown to correspond to the known sequence of the chicken SM22{alpha} protein (amino acids 66 to 79) but coincided with a region containing sequence ambiguities in the bovine homologue.26,27,28 On the basis of this data, the 25-kDa Coomassie blue–stained band was identified as the bovine homologue of SM22{alpha}, a specific marker of smooth muscle cells. The identity of this protein was confirmed by SM22{alpha} immunoblotting. As shown in Figure 2B, SM22{alpha} expression was strikingly decreased in calcified BASMC cultures by day 7, and was barely detectable by day 10. This observation encouraged us to investigate whether another smooth muscle lineage marker, SM {alpha}-actin, was also lost during the mineralization process. Indeed, there was a parallel loss of SM {alpha}-actin in mineralizing BASMC cultures (Figure 2B). The time course of SM {alpha}-actin and SM22{alpha} loss mimicked calcium phosphate mineral deposition in BASMC cultures (Figures 1B and 2B).



View larger version (58K):
[in this window]
[in a new window]
 
Figure 2. BASMC calcification is associated with loss of SMC markers in vitro. BASMC monolayers were cultured for the indicated times in either the presence (+) or absence (-) of ßGP. A, Day 10 cell lysates, polyacrylamide gel electrophoresis followed by Coomassie blue staining. Note the loss of the 25-kDa protein (arrow) in calcified BASMC cultures. Figure shows results from 2 independent experiments. B, Immunoblotting of SM22{alpha} and SM {alpha}-actin at indicated days of culture.

Mineralizing BASMCs Develop an Osteogenic Phenotype In Vitro
Because it has been recently shown that vascular calcification in vivo shares similarities with bone mineralization, we investigated whether bone-associated molecules were present during mineralization of BASMCs in vitro. A temporal analysis of alkaline phosphatase and osteocalcin proteins showed expression by day 10 in calcifying cultures, whereas neither protein was detected at any time point tested in the nontreated controls (Figure 3A). Consistent with reports by Shioi et al,18 osteopontin transcripts were dramatically increased in ßGP-treated cultures and were conversely lost in the control cultures by day 10 (Figure 3B). By Western blot analysis, no collagen type II expression (indicative of the chondrocyte lineage) was observed at any time point tested (data not shown).



View larger version (80K):
[in this window]
[in a new window]
 
Figure 3. Mineralizing BASMCs display a unique osteogenic phenotype in culture. BASMC monolayers were grown in the presence (+) or absence (-) of 5 mmol/L Pi (A) or ßGP (B) for the indicated times. A, Immunoblotting of alkaline phosphatase and osteocalcin. Identical gel was stained with Coomassie blue as a loading control. B, Northern blot of total RNA isolated from BASMCs using 32P-labeled bovine osteopontin cDNA. 18S ribosomal RNA was probed as a loading control.

Because osteocalcin and osteopontin are regulated by the bone determining transcription factor Cbfa1,29 we examined the expression and activity of this factor in mineralizing versus nonmineralizing BASMCs. Using runt homology domain oligonucleotide primers targeted to the conserved DNA-binding domain and RNA extracted from day 10 calcifying BASMCs, a 284 base pair band was amplified by reverse transcriptase–polymerase chain reaction (RT-PCR) (Figure 4A). This band was subcloned into the pcDNA3.1 sequencing vector and, by sequence analysis, was found to be 97% and 93% identical to the runt domain of human and mouse Cbfa1 genes, respectively. Thus, the insert was excised, 32P-labeled, and used as a probe for temporal analysis of Cbfa1 transcripts in calcifying and noncalcifying BASMCs. As shown in Figures 4B and 4C, Cbfa1 transcripts were expressed by day 3 in calcifying cultures with a 5- to 6-fold increase over control cultures by day 10. The presence of this factor was also confirmed at the protein level using a human Cbfa1-specific antibody (gift from Dr S. Hiebert, Mt. Sinai School of Medicine, New York, NY, data not shown).



View larger version (36K):
[in this window]
[in a new window]
 
Figure 4. Mineralizing BASMCs express the transcription factor, Cbfa1. Total RNA was extracted from BASMCs grown in either the presence (+) or absence (-) of ßGP for the indicated times. A, Day 10 calcified cultures (+), oligonucleotide primers directed to the runt homology domain of mouse Cbfa1 amplified a 284-bp band by RT-PCR. O represents an osteoblast positive control. B, Northern blot using 32P-labeled Cbfa1 cDNA probe and 18S ribosomal RNA probe. C, Cbfa1 transcript levels were determined and normalized to those of 18S transcripts using the NIH Image Program.

In addition to Cbfa1 mRNA and protein expression, Cbfa1 DNA binding activity was examined by electrophoretic gel mobility shift assay. Using an OSE2-containing oligonucleotide from the human osteopontin gene promoter, we found a specific increase in Cbfa1 OSE2 DNA binding activity under calcifying conditions. The activity of this factor paralleled the appearance of BASMC culture mineralization with elevated OSE-2 binding activity observed by day 7 and highest at day 10 in ßGP-treated cells (Figure 5A; arrow). The specificity of this interaction was demonstrated by the potent ability of unlabeled OSE2 (S) and the inability of a nonspecific upstream osteopontin E-box–containing oligonucleotide (NS) to compete for binding of this factor to labeled OSE2 (Figure 5B; arrow). To definitively identify the factor as Cbfa1, the OSE2-protein complex was super-shifted with a Cbfa1-specific antibody (Figure 5B; high molecular weight smear above Cbfa1-OSE2 band in lane Cb). Antibodies directed against the 2 other Cbfa family members, Cbfa2 and Cbfa3, did not result in a super-shift of the OSE2-binding complex (data not shown).



View larger version (46K):
[in this window]
[in a new window]
 
Figure 5. Mineralizing BASMCs have increased Cbfa1-mediated OSE2 binding activity. A, Nuclear extracts were prepared from BASMC monolayers grown in the presence (+) or absence (-) of ßGP for the indicated times, and electrophoretic gel mobility shift assay was performed using a double-stranded 32P-labeled OSE2 probe. Note the increment of Cbfa1 OSE2 DNA binding activity (arrow). P represents 32P-OSE2 alone. B, Nuclear extracts prepared from day 10 BASMCs in the presence (+) or absence (-) of ßGP were preincubated with either normal rabbit serum (N), a Cbfa1-specific rabbit antibody (Cb), unlabeled specific OSE2 (S), or nonspecific E-box (NS) oligomers prior to addition of 32P-labeled OSE2 probe. Note the disappearance of Cbfa1 OSE2 DNA binding activity in the presence of unlabeled OSE2 (arrow) and the supershift in the presence of Cbfa1 antibody.

Characterization of Smooth Muscle and Osteogenic Markers in Vascular Calcification In Vivo
To determine whether the loss of the smooth muscle lineage markers and the gain of osteogenic markers observed in vitro also occurred in vivo, we examined arteries from MGP-/- mice that develop spontaneous arterial calcification within 2 weeks of birth.12 At various ages carotids and aortas were collected and examined for calcium deposition, SM {alpha}-actin, SM22{alpha}, and osteopontin expression. At one month of age, MGP-/- arteries were extensively calcified as demonstrated by positively stained arterial media with Alizarin Red S and Von Kossa (Figure 6A, panels b and j). This calcification was concomitant with a loss of SM {alpha}-actin and SM22{alpha} expression and a gain of osteopontin expression (Figure 6A, panels d, f, and h). In addition, osteopontin was found deposited extracellularly and appeared to coat the mineral as well as colocalize to the cells of the calcified medial layer (Figure 6A, panels h and i). Interestingly, BM8 staining of the vessel sections indicated that the osteopontin expressing media cells were not macrophages (data not shown).



View larger version (43K):
[in this window]
[in a new window]
 
Figure 6. Calcified arterial smooth muscle cells of MGP-/- mice lose smooth muscle markers and gain Cbfa1 expression in vivo. A, Carotid arteries of 1-month-old MGP-/- mice (b, d, f, h, i, and j) and MGP+/+ littermates (a, c, e, and g) were examined for calcium deposition by Alizarin Red S (a and b) and Von Kossa (j) staining, and for osteopontin (g, h, and i), SM {alpha}-actin (c and d), and SM22{alpha} (e and f) by immunohistochemistry. Bars a through h=200 µm, and bars i and j=50 µm. B, Aortas of 2-week old MGP-/- mice; a and d, Alizarin Red S; b and e, SM {alpha}-actin; c and f, SM22{alpha}. Bars a through c=100 µm, and d through f, 50 µm. C, Protein extracts were prepared from carotid arteries of 1-month-old MGP+/+ and MGP-/- mice, and were analyzed for osteopontin, SM {alpha}-actin, and Cbfa1 by immunoblotting. O represents osteoblast positive control.

Conversely, arteries examined from MGP+/+ littermates had no Alizarin Red S or osteopontin staining in the media, but strong SM {alpha}-actin and SM22{alpha} staining in normal looking smooth muscle as expected (Figure 6A, panels a, g, c, and e). The loss of SM {alpha}-actin and SM22{alpha} expression in MGP-/- mice is not believed to be a consequence of cellular deficiency because counterstaining of the tissue sections with methyl green positively identified numerous nuclei in the calcified region (Figure 6A, panels i and j). Furthermore, partially calcified arteries from 2-week-old MGP-/- mice retained SM {alpha}-actin– and SM22{alpha}-expressing medial cells in the areas that had not yet undergone mineralization, indicating that the MGP-/- mice do not have a deficit in SM marker expression or smooth muscle cell differentiation (Figure 6B). Similar to 1-month MGP-/- mice (Figure 6A, panels b and h), osteopontin was found to colocalize with mineral and the cells of calcified area. (data not shown). Finally, no collagen II staining or areas resembling cartilaginous metaplasia were observed in arteries of either 2-week or 1-month-old MGP-/- mice (data not shown).

The dramatic protein expression changes seen in vivo were further characterized by immunoblotting. Protein lysates were prepared from carotids of 4-week-old MGP-/- or MGP+/+ mice, and analyzed for SM {alpha}-actin and osteopontin expression. As shown in Figure 6C, loss of SM {alpha}-actin and gain of osteopontin expression mirrored and thereby confirmed the histological findings. Because antibodies to Cbfa1 for use in immunohistochemical studies are not yet available, we examined expression of this protein by Western blot analysis. We found that Cbfa1 protein expression was greatly enhanced in lysates prepared from calcified carotids of MGP-/- mice and not detectable in those of MGP+/+ (Figure 6C). These in vivo observations further support the concept resulting from the in vitro data that arterial calcification is associated with a dramatic alteration in smooth muscle cell phenotype, and this alteration may be involved in positively regulating vascular calcification via expression of osteogenic proteins.


*    Discussion
up arrowTop
up arrowAbstract
up arrowIntroduction
up arrowMaterials and Methods
up arrowResults
*Discussion
down arrowReferences
 
We have identified a smooth muscle cell phenotypic transition associated with vascular calcification in vitro and in vivo. Using a BASMC culture model, we found that smooth muscle lineage markers SM22{alpha} and SM {alpha}-actin were dramatically reduced on mineralization. Conversely, genes normally restricted to mineralized tissue such as bones and teeth, including alkaline phosphatase, osteocalcin, and osteopontin, were increased in these cells. The most interesting finding supporting a phenotype transition was the observation that mRNA and binding activity of Cbfa1, a transcription factor essential for bone morphogenesis, was elevated on smooth muscle cell calcification. The relevance of this smooth muscle phenotype transition was tested in vivo using MGP-/- mice that spontaneously develop calcification in all major arteries. The calcified arteries of MGP-/- mice showed a substantial loss of SM {alpha}-actin and SM22{alpha} in the calcified medial layer and an upregulation of osteopontin. Finally, Cbfa1 protein expression was induced in the calcified MGP-/- arteries but undetected in noncalcified wild type arteries. The combination of smooth muscle marker loss, osteogenic molecule gain, and expression and activity of the transcription factor Cbfa1 characterizes a distinct smooth muscle cell phenotype in calcified vasculature.

Our studies are in agreement with those of Shioi et al,18 who described increases in osteopontin transcripts and reduction in SM {alpha}-actin protein levels using a ßGP-induced BASMC calcification model. In the same model, levels of MGP mRNA were decreased during BASMC calcification and were inversely correlated to calcification.30 An increase in osteopontin, alkaline phosphatase,31 and osteocalcin32 expression was also observed in spontaneously calcifying vascular cells derived from bovine aortic media (CVC) when compared with nonmineralizing BASMCs. In addition, Cbfa1 transcripts were present in CVC but were unchanged with mineralization as measured by RT-PCR analysis;32 however, neither Cbfa1 DNA binding activity nor identification of the specific Cbfa1 splice variant was determined, making comparison to the present study difficult. CVC also expressed SM {alpha}-actin prior to mineralization, but the effect of mineral deposition on levels of this smooth muscle marker were not investigated.

In contrast, Proudfoot et al33 described an increase in smooth muscle cell markers and low osteopontin expression associated with mineralization of cultured human aortic vascular smooth muscle cells. In those studies, SM {alpha}-actin, SM22{alpha}, and calponin mRNA levels as measured by Northern blot analysis were higher in cultures containing calcifying nodules when compared with noncalcifying monolayers. However, the immunocytochemical analysis of SM {alpha}-actin shown in that report indicated that cells surrounding the mineralizing nodules, rather than those within the nodules, contained the SM {alpha}-actin protein. In fact, the mineralizing nodules themselves were devoid of SM {alpha}-actin, similar to our findings. Thus, an alternative interpretation of the data is that cells within the relatively rare mineralizing nodules have dramatically lost their {alpha}-actin expression, whereas cells in the surrounding nonmineralized monolayer maintained expression, thus accounting for the Northern blot results observed in that report.

The plasticity of the smooth muscle cell phenotype is well documented.34 Although most cell types undergo terminal differentiation, vascular smooth muscle cells do not. This smooth muscle cell trait contributes to the ability of vascular tissue to adapt to various environmental stimuli including pressure and injury. Two characteristic phenotypes of vascular smooth muscle cells include a fibroblastic, synthetic phenotype and a mature, contractile phenotype. In response to vascular injury and/or disease, smooth muscle cells undergo a transition from the contractile phenotype to the synthetic phenotype. The mineralizing SMC phenotype observed in the present study shares some features with the synthetic phenotype of SMCs, including loss of smooth muscle lineage markers and upregulation of osteopontin.35 However, it also differs in a number of important ways, including lack of enhanced proliferation of SMCs11,17,18,31 and elevation of Cbfa1 levels, a transcription factor that is predominantly restricted to bone and cartilage.36 Taken together, these data argue that we have identified a novel SMC phenotype associated with mineralization.

The finding of Cbfa1 expression in calcifying smooth muscle cells is of particular interest. To date, Cbfa1 functional analyses have been primarily limited to the studies of skeletal ontogeny. Developmental studies have shown that Cbfa1 is expressed in the common precursor to osteoblasts and chondroblasts, the osteochondroprogenitor.29,37 The requirement for Cbfa1 in osteoblast differentiation was substantiated by the finding that mice containing a homozygous mutation in the Cbfa1 gene are completely devoid of bone and mature osteoblasts.36,38 More recent studies also indicate that Cbfa1 is involved in chondrogenesis. In addition to osteoblast defects, Cbfa1-deficient mice have reduced numbers of hypertrophic chondrocytes.37 Moreover, continuous expression of Cbfa1 in nonhypertrophic chondrocytes induces differentiation to hypertrophic chondrocytes in vitro and partially rescues Cbfa1 null mice.38 Thus, Cbfa1 appears to be important in the development of both cartilage and bone.

These findings are relevant to our localization of Cbfa1 to the calcified arteries of MGP-/- mice. We observed arterial mineralization concomitant with increases in Cbfa1 and osteopontin protein levels by Western blotting. However, no morphological changes resembling bone or cartilage were observed at the time points studied (2 and 4 weeks), despite extensive mineralization of the arterial medias. In addition, there was no collagen type II present as determined by immunostaining at these time points. Similarly, no type II collagen was expressed in mineralizing BASMCs in vitro. In contrast, calcified arterial medial layers of older (6 to 8 weeks old) MGP-/- mice were found to acquire chondrocytic features including a chondrocyte-like cell morphology, type II collagen fibrils, and proteoglycans reminiscent of cartilage extracellular matrix.12 These findings suggest that the early SMC phenotypic transition observed in the MGP-/- mouse may allow for the development of cartilaginous structures over time. On the other hand, no evidence of bone formation has thus far been noted in the MGP-/- mouse by ourselves or others.12 The absence of bone formation may be because of the fact that MGP-/- mice die suddenly of arterial rupture between 6 and 8 weeks of age, thereby precluding development of this tissue from cartilage as is seen in endochondral bone formation.

Taken together, our findings suggest that, in response to mineralization, SMCs of the arterial wall undergo phenotypic transition to Cbfa1-positive, osteochondroprogenitor-like cells, similar to those identified in early mesenchymal condensations that give rise to the chondrocytes and osteoblasts of the skeleton. These findings may explain the presence of bone- and chondrocyte-related factors, as well as the occasional presence of ossified tissue, in calcified vascular tissues.


*    Acknowledgments
 
This work was supported by NIH Grant HL40079-6A2 (to C.M. Giachelli), NIH Training Grant GM07037 (to S.A. Steitz), NIH Grant AR45548 (to G. Karsenty), NIH Grant AR43655 (to G. Karsenty), a grant from Eli Lilly and Company (to G. Karsenty), and the National Science Foundation Science and Technology Center for Molecular Biotechnology BIR 9214821 AM04 (to R. Aebersold). Dr Giachelli is an Established Investigator of the American Heart Association.

Received March 20, 2000; revision received October 19, 2001; accepted October 19, 2001.


*    References
up arrowTop
up arrowAbstract
up arrowIntroduction
up arrowMaterials and Methods
up arrowResults
up arrowDiscussion
*References
 
1. Fitzpatrick PJ, Ports TA, Yock PG. Contribution of localized calcium deposits to dissection after angioplasty: an observational study using intravascular ultrasound. Circulation. 1992; 86: 64–70.

2. Rumberger JA, Schwartz RS, Simons DB, Sheedy PF, Edwards WD, Fitzpatrick LA. Relation of coronary calcium determined by electron beam computed tomography and lumen narrowing determined by autopsy. Am J Cardiol. 1994; 73: 1169–1173.

3. Beadenkopf WG, Daoud AS, Love BM. Calcification in the coronary arteries and its relationship to arteriosclerosis and myocardial infarction. Am J Roentgenol. 1964; 92: 865–871.

4. Loecker TH, Schwartz RS, Cotta CW, Hickman JR. Fluoroscopic coronary artery calcification and associated coronary disease in asymptomatic young men. J Am Coll Cardiol. 1992; 19: 1167–1172.

5. Puentes G, Detrano R, Tang W, Wong N, French W, Narahara K, Brundage B, Baksheshi H. Estimation of coronary calcium mass using electron beam computed topography: a promising approach for predicting coronary events? Circulation. 1995; 92 (suppl 1): I-313.Abstract.

6. Kim KM. Calcification of matrix vesicles in human aortic valve and aortic media. Fed Proc. 1976; 35: 156–162.

7. Giachelli CM. Ectopic calcification: gathering hard facts about soft tissue mineralization. Am J Pathol. 1999; 154: 671–675.

8. Gura TA, Wright KL, Veis A, Webb CL. Identification of specific calcium-binding noncollagenous proteins associated with glutaraldehyde-preserved bovine pericardium in the rat subdermal model. J Biomed Mater Res. 1997; 35: 483–495.

9. Levy RJ, Gundberg C, Scheinman R. The identification of vitamin K-dependent bone protein osteocalcin as one of the {gamma}-carboxyglutamic acid containing proteins present in calcified atherosclerotic plaque and mineralized heart valves. Atherosclerosis. 1983; 46: 49–56.

10. Hirota S, Imakita M, Kohri K, Ito A, Morii E, Adachi S, Kim H-M, Kitamura Y, Yutani C, Nomura S. Expression of osteopontin messenger RNA by macrophages in atherosclerotic plaques: a possible association with calcification. Am J Pathol. 1993; 143: 1003–1008.

11. Bostrom K, Watson KE, Horn S, Wortham C, Herman IM, Demer LL. Bone morphogenetic protein expression in human atherosclerotic lesions. J Clin Invest. 1993; 91: 1800–1809.

12. Luo G, Ducy P, McKee MD, Pinero GJ, Loyer E, Behringer RR, Karsenty G. Spontaneous calcification of arteries and cartilage in mice lacking matrix GLA protein. Nature. 1997; 386: 78–81.

13. Kuroo M, Matsumura Y, Aizawa H, Kawaguchi H, Suga T, Utsugi T, Ohyama Y, Kurabayashi M, Kaname T, Kume E, Iwasaki H, Iida A, ShirakiIida T, Nishikawa S, Hagai R, Abeshima Y. Mutations of the klotho gene leads to a syndrome resembling aging. Nature. 1997; 390: 45–51.

14. Spicer SS, Lewis SE, Tashian RE, Schulte BA. Mice carrying a CAR-2 null allele lack carbonic anhydrase II immunohistochemically and show vascular calcification. Am J Pathol. 1989; 134: 947–954.

15. Bucay N, Sarosi I, Dunstan CR, Morony S, Tarpley J, Capparelli C, Scully S, Tan HL, Xu W, Lacey DL, Boyle WJ, Simonet WS. Osteoprotegerin-deficient mice develop early onset osteoporosis and arterial calcification. Genes Dev. 1998; 12: 1260–1268.

16. Bostrom K, Watson K, Stanford WP, Demer LL. Atherosclerotic calcification: relation to developmental osteogenesis. Am J Cardiol. 1995; 75: 88B–91B.

17. Wada T, McKee MD, Steitz S, Giachelli CM. Calcification of vascular smooth muscle cell cultures: inhibition by osteopontin. Circ Res. 1998; 84: 166–178.

18. Shioi A, Nishizawa Y, Jono S, Koyama H, Hosoi M, Morii H. ß-Glycerophosphate accelerates calcification in cultured bovine vascular smooth muscle cells. Arterioscler Thromb Vasc Biol. 1995; 15: 2003–2009.

19. Lee KA, Bindereif A, Green MR. A small scale procedure for preparation of nuclear extracts that support efficient transcription and pre-mRNA splicing. Gene Anal Tech. 1988; 5: 22–31.

20. Ducret A, Van Oostveen I, Eng JK, Yates III JR, Aebersold R. High throughput protein characterization by automated reverse-phase chromatography/electrospray tandem mass spectrometry. Protein Sci. 1998; 7: 706–719.

21. Eng J, McCormack AL, Yates III JR. An approach to correlate tandem mass spectral data of peptides with amino acid sequences in a protein database. J Am Soc Mass Spectrom. 1994; 5: 976–989.

22. Haynes PA, Fripp N, Aebersold R. Identification of gel separated proteins by liquid chromatography-electrospray tandem mass spectrometry: comparison of methods and their limitations. Electrophoresis. 1998; 19: 939–945.

23. Bleasby AJ, Akrigg D, Attwood TK. OWL: a nonredundant composite protein sequence database. Nucl Acids Res. 1994; 22: 3574–3577.

24. Komori T, Yagi H, Nomura A, Yamaguchi A, Sasaki K, Deguchi K, Shimizu Y, Bronson RT, Gao Y-H, Inada M, Sato M, Okamoto R, Kitamura Y, Yoshiki S, Kishimoto T. Targeted disruption of Cbfa1 results in a complete lack of bone formation owing to maturational arrest of osteoblasts. Cell. 1997; 89: 755–764.

25. Zhang JC, Kim S, Helmke BP, Yu WW, Du KL, Lu MM, Strobeck M, Yu Q, Parmacek MS. Analysis of SM22{alpha}-deficient mice reveals unanticipated insights into smooth muscle cell differentiation and function. Mol Cell Biol. 2001; 21: 1336–1344.

26. Lees-Miller JP, Heeley D, Smillie LB. An abundant and novel protein of 22 kDa (SM22) is widely distributed in smooth muscles. Biochem J. 1987; 244: 705–709.

27. Kobayashi R, Kubota T, Hidaka H. Purification, characterization, and partial sequence analysis of a new 25-kDa actin binding protein from bovine aorta: a SM22 homologue. Biochem Biophys Res Commun. 1994; 198: 1275–1280.

28. Pearlstone JR, Weber M, Lees-Miller JP, Carpenter MR, Smillie LR. Amino acid sequence of chicken gizzard smooth muscle SM22{alpha}. J Biol Chem. 1991; 130: 297–302.

29. Ducy P, Zhang R, Geoffroy V, Ridall AL, Karsenty G. Osf2/Cbfa1: a transcriptional activator of osteoblast differentiation. Cell. 1997; 89: 747–754.

30. Mori K, Shioi A, Jono S, Nishizawa Y, Morii H. Expression of matrix Gla protein (MGP) in an in vitro model of vascular calcification. FEBS Lett. 1998; 433: 19–22.

31. Watson KE, Bostron K, Ravindranath R, Lam T, Norton B, Demer LL. TGF-ß and 25-hydrocholesterol stimulate osteoblast-like vascular cells to calcify. J Clin Invest. 1994; 93: 2105–2113.

32. Tintut Y, Parhami F, Bostrom K, Jackson SM, Demer LL. cAMP stimulates osteoblast-like differentiation of calcifying vascular cells: potential signaling pathway for vascular calcification. J Biol Chem. 1998; 273: 7547–7553.

33. Proudfoot D, Skeeper JN, Shanahan CM, Weissberg PL. Calcification of human vascular cells in vitro is correlated with high levels of matrix Gla protein and low levels of osteopontin expression. Arterioscler Thromb Vasc Biol. 1998; 18: 379–388.

34. Katoh Y, Periasamy M. Growth and differentiation of smooth muscle cells during vascular development. Trends Cardiovasc Med. 1996; 6: 100–106.

35. Giachelli CM, Liaw L, Murry CE, Schwartz SM, Almeida M. Osteopontin expression in cardiovascular diseases. Ann N Y Acad Sci. 1995; 760: 109–26.

36. Otto F, Thornell AP, Crompton T, Denzel A, Gilmour KC, Rosewell AR, Stamp GWH. Cbfa1, a candidate gene for cleidocranial dysplasia syndrome is essential for osteoblast differentiation and bone formation. Cell. 1997; 89: 765–771.

37. Kim IS, Otto F, Zabel B, Mundlos S. Regulation of chondrocyte differentiation by Cbfa1. Mech Dev. 1999; 80: 159–170.

38. Takeda S, Bonnamy JP, Own MJ, Ducy P, Karsenty G. Continuous expression of Cbfa1 in nonhypertrophic chondrocytes uncovers its ability to induce hypertrophic chondrocyte differentiation and partially rescues Cbfa1-deficient mice. Genes Dev. 2001; 15: 467–481.




This article has been cited by other articles:


Home page
Nephrol Dial TransplantHome page
B. A. Vervaet, A. Verhulst, P. C. D'Haese, and M. E. De Broe
Nephrocalcinosis: new insights into mechanisms and consequences
Nephrol. Dial. Transplant., July 1, 2009; 24(7): 2030 - 2035.
[Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
T. Shimizu, T. Tanaka, T. Iso, H. Doi, H. Sato, K. Kawai-Kowase, M. Arai, and M. Kurabayashi
Notch Signaling Induces Osteogenic Differentiation and Mineralization of Vascular Smooth Muscle Cells: Role of Msx2 Gene Induction via Notch-RBP-Jk Signaling
Arterioscler. Thromb. Vasc. Biol., July 1, 2009; 29(7): 1104 - 1111.
[Abstract] [Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
M. Mizobuchi, D. Towler, and E. Slatopolsky
Vascular Calcification: The Killer of Patients with Chronic Kidney Disease
J. Am. Soc. Nephrol., July 1, 2009; 20(7): 1453 - 1464.
[Abstract] [Full Text] [PDF]


Home page
Nephrol Dial TransplantHome page
E. Neven, G. Dams, A. Postnov, B. Chen, N. De Clerck, M. E. De Broe, P. C. D'Haese, and V. Persy
Adequate phosphate binding with lanthanum carbonate attenuates arterial calcification in chronic renal failure rats
Nephrol. Dial. Transplant., June 1, 2009; 24(6): 1790 - 1799.
[Abstract] [Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
A. Zarjou, V. Jeney, P. Arosio, M. Poli, P. Antal-Szalmas, A. Agarwal, G. Balla, and J. Balla
Ferritin Prevents Calcification and Osteoblastic Differentiation of Vascular Smooth Muscle Cells
J. Am. Soc. Nephrol., June 1, 2009; 20(6): 1254 - 1263.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
R. Villa-Bellosta and V. Sorribas
Phosphonoformic Acid Prevents Vascular Smooth Muscle Cell Calcification by Inhibiting Calcium-Phosphate Deposition
Arterioscler. Thromb. Vasc. Biol., May 1, 2009; 29(5): 761 - 766.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Cell Physiol.Home page
D. A. Prosdocimo, D. C. Douglas, A. M. Romani, W. C. O'Neill, and G. R. Dubyak
Autocrine ATP release coupled to extracellular pyrophosphate accumulation in vascular smooth muscle cells
Am J Physiol Cell Physiol, April 1, 2009; 296(4): C828 - C839.
[Abstract] [Full Text] [PDF]


Home page
Nephrol Dial TransplantHome page
N. Koleganova, G. Piecha, E. Ritz, P. Schirmacher, A. Muller, H.-P. Meyer, and M.-L. Gross
Arterial calcification in patients with chronic kidney disease
Nephrol. Dial. Transplant., March 27, 2009; (2009) gfp137v1.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
M. Y. Speer, H.-Y. Yang, T. Brabb, E. Leaf, A. Look, W.-L. Lin, A. Frutkin, D. Dichek, and C. M. Giachelli
Smooth Muscle Cells Give Rise to Osteochondrogenic Precursors and Chondrocytes in Calcifying Arteries
Circ. Res., March 27, 2009; 104(6): 733 - 741.
[Abstract] [Full Text] [PDF]


Home page
Vasc MedHome page
E. Adiguzel, P. J Ahmad, C. Franco, and M. P Bendeck
Collagens in the progression and complications of atherosclerosis
Vascular Medicine, February 1, 2009; 14(1): 73 - 89.
[Abstract] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
R. N. Foley, A. J. Collins, C. A. Herzog, A. Ishani, and P. A. Kalra
Serum Phosphorus Levels Associate with Coronary Atherosclerosis in Young Adults
J. Am. Soc. Nephrol., February 1, 2009; 20(2): 397 - 404.
[Abstract] [Full Text] [PDF]


Home page
J. Appl. Physiol.Home page
J. Atkinson
Age-related medial elastocalcinosis in arteries: mechanisms, animal models, and physiological consequences
J Appl Physiol, November 1, 2008; 105(5): 1643 - 1651.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
J. D. Miller, Y. Chu, R. M. Brooks, W. E. Richenbacher, R. Pena-Silva, and D. D. Heistad
Dysregulation of Antioxidant Mechanisms Contributes to Increased Oxidative Stress in Calcific Aortic Valvular Stenosis in Humans
J. Am. Coll. Cardiol., September 2, 2008; 52(10): 843 - 850.
[Abstract] [Full Text] [PDF]


Home page
Rheumatology (Oxford)Home page
G. Marhaug, V. Shah, R. Shroff, H. Varsani, L. R. Wedderburn, C. A. Pilkington, and P. A. Brogan
Age-dependent inhibition of ectopic calcification: a possible role for fetuin-A and osteopontin in patients with juvenile dermatomyositis with calcinosis
Rheumatology, July 1, 2008; 47(7): 1031 - 1037.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
L. L. Demer and Y. Tintut
Vascular Calcification: Pathobiology of a Multifaceted Disease
Circulation, June 3, 2008; 117(22): 2938 - 2948.
[Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
S. Mathew, K. S. Tustison, T. Sugatani, L. R. Chaudhary, L. Rifas, and K. A. Hruska
The Mechanism of Phosphorus as a Cardiovascular Risk Factor in CKD
J. Am. Soc. Nephrol., June 1, 2008; 19(6): 1092 - 1105.
[Abstract] [Full Text] [PDF]


Home page
J. Biol. Chem.Home page
C. H. Byon, A. Javed, Q. Dai, J. C. Kappes, T. L. Clemens, V. M. Darley-Usmar, J. M. McDonald, and Y. Chen
Oxidative Stress Induces Vascular Calcification through Modulation of the Osteogenic Transcription Factor Runx2 by AKT Signaling
J. Biol. Chem., May 30, 2008; 283(22): 15319 - 15327.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
Y. Yao, A. Shahbazian, and K. I. Bostrom
Proline and {gamma}-Carboxylated Glutamate Residues in Matrix Gla Protein Are Critical for Binding of Bone Morphogenetic Protein-4
Circ. Res., May 9, 2008; 102(9): 1065 - 1074.
[Abstract] [Full Text] [PDF]


Home page
CJASNHome page
P. Raggi and M. Kleerekoper
Contribution of Bone and Mineral Abnormalities to Cardiovascular Disease in Patients with Chronic Kidney Disease
Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 836 - 843.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
Y. Bosse, P. Mathieu, and P. Pibarot
Genomics: The Next Step to Elucidate the Etiology of Calcific Aortic Valve Stenosis
J. Am. Coll. Cardiol., April 8, 2008; 51(14): 1327 - 1336.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
Z. Awan, K. Alrasadi, G.A. Francis, R.A. Hegele, R. McPherson, J. Frohlich, D. Valenti, B. de Varennes, M. Marcil, C. Gagne, et al.
Vascular Calcifications in Homozygote Familial Hypercholesterolemia
Arterioscler. Thromb. Vasc. Biol., April 1, 2008; 28(4): 777 - 785.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
K. A. Johnson, M. Polewski, and R. A. Terkeltaub
Transglutaminase 2 Is Central to Induction of the Arterial Calcification Program by Smooth Muscle Cells
Circ. Res., March 14, 2008; 102(5): 529 - 537.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
M. Liberman, E. Bassi, M. K. Martinatti, F. C. Lario, J. Wosniak Jr, P. M.A. Pomerantzeff, and F. R.M. Laurindo
Oxidant Generation Predominates Around Calcifying Foci and Enhances Progression of Aortic Valve Calcification
Arterioscler. Thromb. Vasc. Biol., March 1, 2008; 28(3): 463 - 470.
[Abstract] [Full Text] [PDF]


Home page
IBMS BoneKEyHome page
D. A. Towler
Vascular Calcification: A Perspective On An Imminent Disease Epidemic
IBMS BoneKEy, February 1, 2008; 5(2): 41 - 58.
[Abstract] [Full Text] [PDF]


Home page
Mol. Cell. Biol.Home page
T. Tanaka, H. Sato, H. Doi, C. A. Yoshida, T. Shimizu, H. Matsui, M. Yamazaki, H. Akiyama, K. Kawai-Kowase, T. Iso, et al.
Runx2 Represses Myocardin-Mediated Differentiation and Facilitates Osteogenic Conversion of Vascular Smooth Muscle Cells
Mol. Cell. Biol., February 1, 2008; 28(3): 1147 - 1160.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
E. Aikawa, M. Nahrendorf, J.-L. Figueiredo, F. K. Swirski, T. Shtatland, R. H. Kohler, F. A. Jaffer, M. Aikawa, and R. Weissleder
Osteogenesis Associates With Inflammation in Early-Stage Atherosclerosis Evaluated by Molecular Imaging In Vivo
Circulation, December 11, 2007; 116(24): 2841 - 2850.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
Z. Al-Aly, J.-S. Shao, C.-F. Lai, E. Huang, J. Cai, A. Behrmann, S.-L. Cheng, and D. A. Towler
Aortic Msx2-Wnt Calcification Cascade Is Regulated by TNF-{alpha} Dependent Signals in Diabetic Ldlr / Mice
Arterioscler. Thromb. Vasc. Biol., December 1, 2007; 27(12): 2589 - 2596.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
M. Scatena, L. Liaw, and C. M. Giachelli
Osteopontin: A Multifunctional Molecule Regulating Chronic Inflammation and Vascular Disease
Arterioscler. Thromb. Vasc. Biol., November 1, 2007; 27(11): 2302 - 2309.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Renal Physiol.Home page
J. R. Wu-Wong, M. Nakane, J. Ma, X. Ruan, and P. E. Kroeger
Elevated phosphorus modulates vitamin D receptor-mediated gene expression in human vascular smooth muscle cells
Am J Physiol Renal Physiol, November 1, 2007; 293(5): F1592 - F1604.
[Abstract] [Full Text] [PDF]


Home page
FASEB J.Home page
M. Eijken, S. Swagemakers, M. Koedam, C. Steenbergen, P. Derkx, A. G. Uitterlinden, P. J. van der Spek, J. A. Visser, F. H. de Jong, H. A. P. Pols, et al.
The activin A-follistatin system: potent regulator of human extracellular matrix mineralization
FASEB J, September 1, 2007; 21(11): 2949 - 2960.
[Abstract] [Full Text] [PDF]


Home page
IOVSHome page
W. Xue, N. Comes, and T. Borras
Presence of an Established Calcification Marker in Trabecular Meshwork Tissue of Glaucoma Donors
Invest. Ophthalmol. Vis. Sci., July 1, 2007; 48(7): 3184 - 3194.
[Abstract] [Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
J. R. Stubbs, S. Liu, W. Tang, J. Zhou, Y. Wang, X. Yao, and L. D. Quarles
Role of Hyperphosphatemia and 1,25-Dihydroxyvitamin D in Vascular Calcification and Mortality in Fibroblastic Growth Factor 23 Null Mice
J. Am. Soc. Nephrol., July 1, 2007; 18(7): 2116 - 2124.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Pathol.Home page
A. Simionescu, D. T. Simionescu, and N. R. Vyavahare
Osteogenic Responses in Fibroblasts Activated by Elastin Degradation Products and Transforming Growth Factor-{beta}1: Role of Myofibroblasts in Vascular Calcification
Am. J. Pathol., July 1, 2007; 171(1): 116 - 123.
[Abstract] [Full Text] [PDF]


Home page
Nephrol Dial TransplantHome page
R. Westenfeld, C. Schafer, R. Smeets, V. M. Brandenburg, J. Floege, M. Ketteler, and W. Jahnen-Dechent
Fetuin-A (AHSG) prevents extraosseous calcification induced by uraemia and phosphate challenge in mice
Nephrol. Dial. Transplant., June 1, 2007; 22(6): 1537 - 1546.
[Abstract] [Full Text] [PDF]


Home page
Arch Intern MedHome page
R. N. Foley
Phosphorus Comes of Age as a Cardiovascular Risk Factor
Arch Intern Med, May 14, 2007; 167(9): 873 - 874.
[Full Text] [PDF]


Home page
J. Histochem. Cytochem.Home page
M. T. Kaartinen, M. Murshed, G. Karsenty, and M. D. McKee
Osteopontin Upregulation and Polymerization by Transglutaminase 2 in Calcified Arteries of Matrix Gla Protein-deficient Mice
J. Histochem. Cytochem., April 1, 2007; 55(4): 375 - 386.
[Abstract] [Full Text] [PDF]


Home page
Stem CellsHome page
J. van Tuyn, D. E. Atsma, E. M. Winter, I. van der Velde-van Dijke, D. A. Pijnappels, N. A.M. Bax, S. Knaan-Shanzer, A. C. Gittenberger-de Groot, R. E. Poelmann, A. van der Laarse, et al.
Epicardial Cells of Human Adults Can Undergo an Epithelial-to-Mesenchymal Transition and Obtain Characteristics of Smooth Muscle Cells In Vitro
Stem Cells, February 1, 2007; 25(2): 271 - 278.
[Abstract] [Full Text] [PDF]


Home page
Nephrol Dial TransplantHome page
I. Nikolov, N. Joki, T. Drueke, and Z. Massy
Beyond phosphate--role of uraemic toxins in cardiovascular calcification
Nephrol. Dial. Transplant., December 1, 2006; 21(12): 3354 - 3357.
[Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
S. G. Achinger and J. C. Ayus
Left Ventricular Hypertrophy: Is Hyperphosphatemia among Dialysis Patients a Risk Factor?
J. Am. Soc. Nephrol., December 1, 2006; 17(12_suppl_3): S255 - S261.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
R. C. Johnson, J. A. Leopold, and J. Loscalzo
Vascular Calcification: Pathobiological Mechanisms and Clinical Implications
Circ. Res., November 10, 2006; 99(10): 1044 - 1059.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
B. J. Bennett, M. Scatena, E. A. Kirk, M. Rattazzi, R. M. Varon, M. Averill, S. M. Schwartz, C. M. Giachelli, and M. E. Rosenfeld
Osteoprotegerin Inactivation Accelerates Advanced Atherosclerotic Lesion Progression and Calcification in Older ApoE-/- Mice
Arterioscler. Thromb. Vasc. Biol., September 1, 2006; 26(9): 2117 - 2124.
[Abstract] [Full Text] [PDF]


Home page
J. Pharmacol. Exp. Ther.Home page
J. R. Wu-Wong, W. Noonan, J. Ma, D. Dixon, M. Nakane, A. L. Bolin, K. A. Koch, S. Postl, S. J. Morgan, and G. A. Reinhart
Role of Phosphorus and Vitamin D Analogs in the Pathogenesis of Vascular Calcification
J. Pharmacol. Exp. Ther., July 1, 2006; 318(1): 90 - 98.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
J.-S. Shao, J. Cai, and D. A. Towler
Molecular Mechanisms of Vascular Calcification: Lessons Learned From The Aorta
Arterioscler. Thromb. Vasc. Biol., July 1, 2006; 26(7): 1423 - 1430.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
X. Li, H.-Y. Yang, and C. M. Giachelli
Role of the Sodium-Dependent Phosphate Cotransporter, Pit-1, in Vascular Smooth Muscle Cell Calcification
Circ. Res., April 14, 2006; 98(7): 905 - 912.
[Abstract] [Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
J. L. Reynolds, J. N. Skepper, R. McNair, T. Kasama, K. Gupta, P. L. Weissberg, W. Jahnen-Dechent, and C. M. Shanahan
Multifunctional Roles for Serum Protein Fetuin-A in Inhibition of Human Vascular Smooth Muscle Cell Calcification
J. Am. Soc. Nephrol., October 1, 2005; 16(10): 2920 - 2930.
[Abstract] [Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
J. C. Ayus, M. R. Mizani, S. G. Achinger, R. Thadhani, A. S. Go, and S. Lee
Effects of Short Daily versus Conventional Hemodialysis on Left Ventricular Hypertrophy and Inflammatory Markers: A Prospective, Controlled Study
J. Am. Soc. Nephrol., September 1, 2005; 16(9): 2778 - 2788.
[Abstract] [Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
M. M. Mitsnefes, T. R. Kimball, J. Kartal, S. A. Witt, B. J. Glascock, P. R. Khoury, and S. R. Daniels
Cardiac and Vascular Adaptation in Pediatric Patients with Chronic Kidney Disease: Role of Calcium-Phosphorus Metabolism
J. Am. Soc. Nephrol., September 1, 2005; 16(9): 2796 - 2803.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
K. A. Hruska, S. Mathew, and G. Saab
Bone Morphogenetic Proteins in Vascular Calcification
Circ. Res., July 22, 2005; 97(2): 105 - 114.
[Abstract] [Full Text] [PDF]


Home page
QJMHome page
D. Hamerman
Osteoporosis and atherosclerosis: biological linkages and the emergence of dual-purpose therapies
QJM, July 1, 2005; 98(7): 467 - 484.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
M. Rattazzi, B. J. Bennett, F. Bea, E. A. Kirk, J. L. Ricks, M. Speer, S. M. Schwartz, C. M. Giachelli, and M. E. Rosenfeld
Calcification of Advanced Atherosclerotic Lesions in the Innominate Arteries of ApoE-Deficient Mice: Potential Role of Chondrocyte-Like Cells
Arterioscler. Thromb. Vasc. Biol., July 1, 2005; 25(7): 1420 - 1425.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
G.D.M. Collett and A.E. Canfield
Angiogenesis and Pericytes in the Initiation of Ectopic Calcification
Circ. Res., May 13, 2005; 96(9): 930 - 938.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
M. Y. Speer, Y.-C. Chien, M. Quan, H.-Y. Yang, H. Vali, M. D. McKee, and C. M. Giachelli
Smooth muscle cells deficient in osteopontin have enhanced susceptibility to calcification in vitro
Cardiovasc Res, May 1, 2005; 66(2): 324 - 333.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
C. M. Giachelli, M. Y. Speer, X. Li, R. M. Rajachar, and H. Yang
Regulation of Vascular Calcification: Roles of Phosphate and Osteopontin
Circ. Res., April 15, 2005; 96(7): 717 - 722.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
K. Johnson, M. Polewski, D. van Etten, and R. Terkeltaub
Chondrogenesis Mediated by PPi Depletion Promotes Spontaneous Aortic Calcification in NPP1-/- Mice
Arterioscler. Thromb. Vasc. Biol., April 1, 2005; 25(4): 686 - 691.
[Abstract] [Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
C. M. Giachelli
Vascular Calcification Mechanisms
J. Am. Soc. Nephrol., December 1, 2004; 15(12): 2959 - 2964.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
J. W. Fischer, S. A. Steitz, P. Y. Johnson, A. Burke, F. Kolodgie, R. Virmani, C. Giachelli, and T. N. Wight
Decorin Promotes Aortic Smooth Muscle Cell Calcification and Colocalizes to Calcified Regions in Human Atherosclerotic Lesions
Arterioscler. Thromb. Vasc. Biol., December 1, 2004; 24(12): 2391 - 2396.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
C. Farrington-Rock, N.J. Crofts, M.J. Doherty, B.A. Ashton, C. Griffin-Jones, and A.E. Canfield
Chondrogenic and Adipogenic Potential of Microvascular Pericytes
Circulation, October 12, 2004; 110(15): 2226 - 2232.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
M. Dupuis, F. Soubrier, I. Brocheriou, S. Raoux, M. Haloui, L. Louedec, J.-B. Michel, and S. Nadaud
Profiling of Aortic Smooth Muscle Cell Gene Expression in Response to Chronic Inhibition of Nitric Oxide Synthase in Rats
Circulation, August 17, 2004; 110(7): 867 - 873.
[Abstract] [Full Text] [PDF]


Home page
Endocr. Rev.Home page
T. M. Doherty, L. A. Fitzpatrick, D. Inoue, J.-H. Qiao, M. C. Fishbein, R. C. Detrano, P. K. Shah, and T. B. Rajavashisth
Molecular, Endocrine, and Genetic Mechanisms of Arterial Calcification
Endocr. Rev., August 1, 2004; 25(4): 629 - 672.
[Abstract] [Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
G. M. London, C. Marty, S. J. Marchais, A. P. Guerin, F. Metivier, and M.-C. de Vernejoul
Arterial Calcifications and Bone Histomorphometry in End-Stage Renal Disease
J. Am. Soc. Nephrol., July 1, 2004; 15(7): 1943 - 1951.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
M. Abedin, Y. Tintut, and L. L. Demer
Vascular Calcification: Mechanisms and Clinical Ramifications
Arterioscler. Thromb. Vasc. Biol., July 1, 2004; 24(7): 1161 - 1170.
[Abstract] [Full Text] [PDF]


Home page
Clin. Chem.Home page
H.-P. Wang, X.-J. Feng, B.-D. Gou, T.-L. Zhang, S.-J. Xu, and K. Wang
Effects of LDL, Cholesterol, and Their Oxidized Forms on the Precipitation Kinetics of Calcium Phosphates
Clin. Chem., December 1, 2003; 49(12): 2027 - 2036.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
Y. Tintut, Z. Alfonso, T. Saini, K. Radcliff, K. Watson, K. Bostrom, and L. L. Demer
Multilineage Potential of Cells From the Artery Wall
Circulation, November 18, 2003; 108(20): 2505 - 2510.
[Abstract] [Full Text] [PDF]


Home page
Nephrol Dial TransplantHome page
G. M. London, A. P. Guerin, S. J. Marchais, F. Metivier, B. Pannier, and H. Adda
Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality
Nephrol. Dial. Transplant., September 1, 2003; 18(9): 1731 - 1740.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
H. Hao, G. Gabbiani, and M.-L. Bochaton-Piallat
Arterial Smooth Muscle Cell Heterogeneity: Implications for Atherosclerosis and Restenosis Development
Arterioscler. Thromb. Vasc. Biol., September 1, 2003; 23(9): 1510 - 1520.
[Abstract] [Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
E. Slatopolsky
New Developments in Hyperphosphatemia Management
J. Am. Soc. Nephrol., September 1, 2003; 14(90004): S297 - 299.
[Full Text]


Home page
J. Am. Soc. Nephrol.Home page
C. M. Giachelli
Vascular Calcification: In Vitro Evidence for the Role of Inorganic Phosphate
J. Am. Soc. Nephrol., September 1, 2003; 14(90004): S300 - 304.
[Abstract] [Full Text]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
K. L. Tyson, J. L. Reynolds, R. McNair, Q. Zhang, P. L. Weissberg, and C. M. Shanahan
Osteo/Chondrocytic Transcription Factors and Their Target Genes Exhibit Distinct Patterns of Expression in Human Arterial Calcification
Arterioscler. Thromb. Vasc. Biol., March 1, 2003; 23(3): 489 - 494.
[Abstract] [Full Text] [PDF]


Home page
J. Biol. Chem.Home page
M. Bidder, J.-S. Shao, N. Charlton-Kachigian, A. P. Loewy, C. F. Semenkovich, and D. A. Towler
Osteopontin Transcription in Aortic Vascular Smooth Muscle Cells Is Controlled by Glucose-regulated Upstream Stimulatory Factor and Activator Protein-1 Activities
J. Biol. Chem., November 8, 2002; 277(46): 44485 - 44496.
[Abstract] [Full Text] [PDF]


Home page
JEMHome page
M. Y. Speer, M. D. McKee, R. E. Guldberg, L. Liaw, H.-Y. Yang, E. Tung, G. Karsenty, and C. M. Giachelli
Inactivation of the Osteopontin Gene Enhances Vascular Calcification of Matrix Gla Protein-deficient Mice: Evidence for Osteopontin as an Inducible Inhibitor of Vascular Calcification In Vivo
J. Exp. Med., October 21, 2002; 196(8): 1047 - 1055.
[Abstract] [Full Text] [PDF]


Home page
Nephrol Dial TransplantHome page
T. B. Drueke and S. G. Rostand
Progression of vascular calcification in uraemic patients: can it be stopped?
Nephrol. Dial. Transplant., August 1, 2002; 17(8): 1365 - 1368.
[Full Text] [PDF]


This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
89/12/1147    most recent
hh2401.101070v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Steitz, S. A.
Right arrow Articles by Giachelli, C. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Steitz, S. A.
Right arrow Articles by Giachelli, C. M.
Related Collections
Right arrow Smooth muscle proliferation and differentiation
Right arrow Mechanism of atherosclerosis/growth factors