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Molecular Medicine |
From the Department of Medicine (S.W.K., A.C., R.C.N., A.G.M.), University of Alberta, Edmonton, Alberta; and the Departments of Pharmacology & Therapeutics and Medicine (M.D.H.), University of Calgary, Calgary, Alberta, Canada.
Correspondence to Allan G. Murray, Dept of Medicine, Rm 260F HMRC, University of Alberta, Edmonton, AB, Canada T6G 2S2. E-mail allan.murray{at}ualberta.ca
| Abstract |
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Key Words: vascular endothelium reperfusion injury thrombin receptors Rho-GTP-binding proteins
| Introduction |
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The proteinase activated receptors (PARs) are a novel family of G protein-coupled receptors that require proteolytic cleavage at the amino terminus to stimulate signaling (see review7). Cleavage allows the newly exposed tethered ligand to initiate an intramolecular interaction necessary for signal transduction, which can be mimicked by peptide analogues of the newly exposed N-terminus. The PAR family members, PAR14, are expressed constitutively on endothelial cells, and PAR2 and PAR4 are further upregulated on inflamed endothelium.8,9 PAR1, PAR3, and PAR4 are substrates for thrombin, whereas PAR2 can be stimulated by the activity of tryptase, a product of mast cell degranulation, and coagulation Factors VIIa and Xa.10,11
Stimulation of endothelial cells with thrombin or peptide analogues of the PAR1-tethered ligand (eg, TRAP or SFLLRN-NH2), results in reorganization of the cytoskeleton and discharge of endothelial storage granules, or Weibel-Palade bodies (WPBs). Exocytosis of WPBs plays a major role in the recruitment of leukocytes to sites of inflammation.12 WP body exocytosis releases stored IL-8 and mobilizes the adhesion molecule P-selectin to the lumenal surface of the endothelial cell.13,14 In addition, WPB exocytosis promotes platelet adhesion through the release of von Willebrands factor (vWF).13 Thrombin stimulation elicits capillary leak in vivo and increased endothelial monolayer permeability in vitro.15,16 PAR stimulation, then, promotes leukocyte adhesion to vascular endothelium and links inflammation and coagulation in a variety of pathological settings.
Stimulation of the PAR2 is also proinflammatory in vivo. Injection of selective peptide analogues of the PAR2 receptor tethered ligand is sufficient to initiate inflammation in vivo.17 Moreover, impaired inflammatory responses are observed in the PAR2-deficient mouse.18 In vitro, trypsin, like thrombin or TRAP, treatment elicits WPB exocytosis,19 but fails to induce monolayer permeability.20 However, the proteinases may act on surface proteins other than PARs,21 and the PAR1 agonist peptides modeled on the PAR1 tethered ligand activate both PAR1 and PAR2.22 Hence, characterization of the effects of selective endothelial PAR2 stimulation, and the signaling pathways recruited by PAR2 agonists to stimulate the endothelial cell remain to be explored.
| Materials and Methods |
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Endothelial Cell Culture
Human umbilical vein endothelial cells (HUVECs) were isolated from several umbilical cords, pooled, and cultured in complete media (M199 with 20% FBS, penicillin, streptomycin, and glutamine).23 Cells were serially passed in complete media supplemented with ECGS. HUVECs were cultured on a gelatin matrix and used in the experiments at passage 2 to 5. The passaged endothelial cells were harvested by washing twice with Hanks, then incubated with a nonenzymatic Cell Dissociation Solution (Sigma) until the ECs were seen to lift off the plate. For use in an experiment, the harvested cells were then replated onto fibronectin (Fn)-coated C6 wells and incubated at 37°C in complete medium for 24 to 48 hours until confluent.
Where indicated, Cytochalasin D (1 µmol/L), jasplakinolide (45 nmol/L), or DMSO vehicle were diluted in supplemented M199 and added to the existing media. After 1 hour of incubation at 37°C, the media was removed and discarded, and fresh complete media with the agonist or vehicle diluted to the desired concentration was applied to the HUVECs. To inhibit Rho-GTPases, HUVECs were pretreated with 50 µg/mL C3 exotoxin for 24 hours and a mobility shift of endothelial Rho on SDS-PAGE was confirmed as described previously.24 To inhibit rho-kinase, endothelial cells were pretreated with H-7 (0.5 µmol/L) or Y-27632 (15 µmol/L) for 120 minutes before stimulation. To stimulate WP body exocytosis, the following agonists were used: phorbal 12-myristate 13-acetate (PMA) at 100 nmol/L, PAR1 AP (TFLLR-NH2) at 30 µmol/L, PAR2 AP (SLIGRL-NH2) at 30 µmol/L, and Ionomycin at 1 µmol/L, except where otherwise specified.
Chemical inhibitors were used at concentrations that maintained HUVEC viability >85% of mock-treated controls as assessed by the XTT assay of mitochondrial activity.25
ELISA Assay of vWF
Supernatant from mock- or agonist-stimulated HUVECs was removed into separate tubes and kept on ice until analysis. The vWF concentration was determined by ELISA. Calibration was performed with a vWF standard (Human reference plasma, Precision Biologics). Regulated vWF release was calculated by subtracting the vWF concentration in unstimulated wells from the stimulated wells. The effect of the inhibitors was determined by comparing the mean vWF release to its control group. The mean difference of the treatment among several experiments, as noted in the figure legends, was calculated and tested for statistical significance (P<0.05) by ANOVA using SPSS (SPSS).
Endothelial Monolayer Permeability
HUVECs at passage 3 were plated onto fibronectin-coated polycarbonate membranes (5-um pore size Transwell, Costar) at 6x104 cells/cm2 in M199/20% FBS. The monolayers were cultured for 5 days with media changes every 2 days and were not disturbed for 24 hours before the experiment. Horse radish peroxidase (HRP, MW 44kDa, Sigma) was added to the upper chamber at a final concentration of 1 µg/ml, then the specific peptide agonist was added at the concentration indicated in the figure legends. Where indicated, the monolayers were pretreated as described in the figure legend. Medium was harvested from the lower chamber after 20 minutes, and the HRP activity was determined colorimetrically by absorbance at 490 nm of the o-phenyl diamine reaction product. The mean HRP concentration from triplicate experimental wells was compared with the HRP concentration in wells treated with ionomycin 10 µmol/L according to the formula: (experimental-media control)/(ionomyin-media control)x100=% maximum permeability.
The difference of the means between treatment and controls among several experiments was calculated and tested for statistical significance (P<0.05) by ANOVA using SPSS.
Affinity Precipitation of Rho-GTP
The RBD-GST fusion protein was prepared and isolated using glutathione beads (Amersham, Baie dUrfe, PQ), then used to affinity precipitate GTP-Rho as described previously.26 Rho was detected with anti-Rho mAb 26C4 then the blots were developed using chemiluminescence (Supersignal, Pierce). Images were acquired from film using a CCD camera and the density of the bands were quantitated using the Fluor-S Max software package (BioRad).
Transient Transfection of Endothelial Cells
Dominant-negative myc-tagged mutant Rac117N and Cdc4217N cDNA were generously provided by Dr Gary Bokoch (Scripps) then subcloned into pCSD7 (a gift of John Elliott, University of Alberta, Edmonton, Canada) for transfection of HUVECs. The cDNAs were sequenced to confirm the presence of the mutation before use. Briefly, HUVECs were plated at confluence on Fn matrix in C-6 plates in growth medium 1 day before transfection. The cells were washed with OptiMEM (Life Technologies), then 0.2 µg DNA/well was introduced into the cells using the Effectene kit (Qiagen) according to the instructions of the manufacturer. After 3 to 4 hours, the wells were washed and the media was replaced with M199/10% FBS and ECGS. Pilot experiments indicated that expression of the myc-tagged mutant GTPase was optimal at approximately 24 hours after transfection; therefore, the cells were used in the experiments as indicated at this time. Endothelial cell expression of the myc-tagged protein was confirmed in each experiment.
| Results |
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PAR2 Activation, Unlike PAR1, Fails to Increase Monolayer Permeability
We next examined if selective PAR2 stimulation altered endothelial monolayer integrity. Like the PAR1 agonist, the PAR2 agonist peptide induced actin stress fiber formation in confluent HUVECs (data not shown). Notwithstanding, unlike PAR1, PAR2 stimulation failed to increase monolayer permeability (Figure 2). Ionomycin stimulation elicited a marked increase in transfer of HRP across the monolayer (18±6 versus 68±7 ng/cm2 per hour; mean±SEM) and served as a comparator to which the effects of the PAR agonists were normalized. These data indicate that although PAR2, like PAR1 stimulation, is able to induce bundled f-actin stress fiber formation, unlike PAR1, PAR2 fails to induce pore formation.
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Effect of Cytochalasin D and Jasplakinolide on PAR2 Agonist Peptide-Stimulated Exocytosis
Both endothelial cell exocytosis and monolayer permeability changes are thought to require rearrangement of the f-actin cytoskeleton, hence we sought to determine if PAR2 stimulated f-actin reorganization. Cytochalasin D and jasplakinolide have been previously shown to depolymerize or stabilize the f-actin cytoskeleton, respectively.27,28 To determine if the endothelial cytoskeleton was reorganized in PAR2-stimulated regulated exocytosis, HUVECs were pretreated with either agent, then treated or not with peptide agonist. Neither agent changed constitutive vWF release. However, cytochalasin D pretreatment led to a modest augmentation of both PAR2- and PAR1-regulated WP body exocytosis (Figure 3). These data indicate that an intact cytoskeleton is not required for PAR-stimulated WP body exocytosis.
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Jasplakinolide was used to test the requirements of each agonist for remodeling of the intact cytoskeleton to elicit vWF release (Figure 3). HUVECs pretreated with jasplakinolide then stimulated with PAR1 agonist peptide, TFLLR-NH2, released 54±15% of vWF compared with mock-pretreated cells (P=0.03, n=6 experiments). Similarly, jasplakinolide inhibited vWF release on stimulation with PAR2 agonist peptide, SLIGRL-NH2, to 43±16% of mock-pretreatment release (P=0.05, n=5 experiments). These data indicate that PAR2-mediated exocytosis requires active remodeling of the endothelial f-actin cytoskeleton.
PAR2 Exocytosis Requires Intracellular Calcium
The initiation of a calcium flux has previously been identified to play a critical role in thrombin-stimulated WP body exocytosis and monolayer permeability.29,30 To determine if PAR2-stimulated exocytosis was similarly dependent on calcium-dependent signaling, HUVEC monolayers were pretreated with BAPTA-AM, then stimulated with the PAR agonist peptides. As noted in Figure 4A, PAR2-stimulated vWF release was markedly inhibited under these conditions. This indicates that WP body exocytosis, stimulated by either PAR1 or PAR2, is dependent on elevated intracellular calcium concentration.
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Our data suggest that both cytoskeletal reorganization and elevated intracellular calcium are required for efficient PAR-stimulated exocytosis. However, high concentrations of jasplakinolide may inhibit sustained intracellular calcium levels after stimulation via G protein-coupled receptors.31 Because a calcium flux is sufficient to induce WP body exocytosis,29 we sought to determine if calcium ionophore-induced vWF release was affected by jasplakinolide. First, HUVECs were stimulated with ionomycin to define a concentration-effect curve (data not shown). Ionomycin (1 µmol/L) induced vWF release comparable to that of the PAR-activating peptides at 30 to 50 µmol/L. Jasplakinolide pretreatment diminished ionomycin-induced vWF release to 52±13% (Figure 4B; P=0.02, n=5 experiments) of mock-pretreated controls. This observation indicates that the effect of jasplakinolide lies downstream of the generation of a calcium flux and suggests that PAR2 stimulation results in a calcium-dependent reorganization of the endothelial cytoskeleton.
Involvement of Rho-GTPase Signaling After PAR2 Stimulation
The Rho family of small GTP-binding proteins regulate the f-actin cytoskeleton and have been implicated in thrombin-stimulated increased endothelial monolayer permeability,16,32 and in exocytosis in a variety of other cell types.33,34 Rho kinase, a Rho-GTP-dependent serine/threonine kinase, acts to phosphorylate and inactivate myosin light chain phosphatase. Myosin light chain phosphorylation is also implicated in both thrombin-stimulated permeability and exocytosis.16,29 We therefore sought to determine if a Rho-GTPase-dependent signaling pathway was recruited after PAR2 stimulation.
We pretreated confluent HUVEC monolayers with TcdB toxin to selectively inhibit the small GTPases, Rho, Rac, and Cdc42. PAR2- and PAR1-mediated exocytosis were markedly inhibited (Figure 5A). This strongly suggests that Rho-GTPases serve a critically important function to effect PAR-stimulated exocytosis in endothelial cells.
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To determine if RhoA activity elicited by PAR2 stimulation was involved in exocytosis, we tested the effect of specific inhibitors of the RhoA signaling pathway. First, we inhibited Rho activity with C3 exotoxin.24 C3 pretreatment did not inhibit vWF release using the PAR2 agonist peptide to stimulate endothelial cell exocytosis (Figure 5A). We similarly observed that inhibition of Rho-kinase with either Y-27632 or H-7 (data not shown) failed to inhibit, and tended to augment, PAR-stimulated vWF release. In contrast, PAR1 stimulation of monolayer permeability was markedly attenuated by inhibition of Rho kinase with Y-27632 (Figure 2). These data indicate that RhoA-GTPase signaling is not required for PAR2-stimulated exocytosis and suggest that other Rho-GTPase family members account for the TcdB-mediated inhibition.
To identify the Rho-GTPase family member involved in PAR-stimulated exocytosis, we expressed dominant-negative mutant Rac117N or Cdc4217N in the endothelial cells. Both PAR2- and PAR1-stimulated exocytosis was inhibited in HUVEC-expressing Cdc4217N but not Rac117N (Figure 5B). Taken together these observations indicate that stimulation of either endothelial PAR receptor recruits a signal that is dependent on Cdc42 activity to elicit exocytosis.
PAR2 Stimulation Elicits Weak RhoA Activity
PAR1-stimulated monolayer permeability depends on Rho kinase activity (Figure 2), hence we directly assessed RhoA activation after PAR2 stimulation to determine if the failure of PAR2 to elicit pore formation correlated with RhoA-GTP. As shown in Figure 6, RhoA-GTP was robustly activated by PAR1 stimulation, but only weakly by PAR2 stimulation at receptor-selective concentrations of the agonist peptides. To determine if the weak RhoA-GTP stimulation by PAR2 could account for the failure of pore formation through failing to increase cell contractility, we examined myosin light chain phosphorylation. Both PAR2 and PAR1 agonist peptides induced phosphorylation of myosin light chain, with a much greater effect of PAR1 (Figure 7). Interestingly, stimulation of MLC phosphorylation by either agonist peptide was inhibited by pretreatment of the HUVECs with Y27632 (data not shown). These observations indicate that the failure of PAR2 stimulation to elicit monolayer pore formation correlates with weak signaling through RhoA.
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| Discussion |
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We studied selective agonists of both the PAR2 and PAR1 G protein-coupled receptors and observed that each stimulated similar amounts of vWF release from the endothelial cell storage pool. The use of a selective activator of PAR2 indicates that the PAR2 system can have as great an impact on Weibel-Palade body exocytosis and hence lumenal display of P-selectin as the thrombin-regulated PAR1 system. Interestingly, like PAR1, PAR2-mediated exocytosis required f-actin reorganization, and involves a calcium-dependent rather than a cAMP-dependent second messenger. A similar requirement for f-actin reorganization was observed using ionomycin to mimic the calcium flux initiated by the PAR receptors, indicating that the requirement for f-actin remodeling likely occurred downstream of the PAR-stimulated calcium signal. These observations are in agreement with previous work that inferred activation of the PAR2 receptor using trypsin to stimulate Weibel-Palade body exocytosis19 and that detected a calcium flux in endothelial cells after trypsin stimulation.35
Coupling of PAR2 to endothelial cytoskeletal-associated proteins has not been examined previously. However, regulated exocytosis by mast cells or pancreatic acinar cells can be facilitated by dissolution of the cortical actin barrier and is thought to be a prerequisite for vesicle fusion to the plasma membrane.36,37 The endothelial PAR2 stimulated calcium signal is required for exocytosis and may regulate disassembly of cortical f-actin,38 for example by augmenting the activity of actin-severing proteins.39 The sensitivity of PAR2 stimulated exocytosis to the actin-stabilizing effect of jasplakinolide is consistent with this model.
Regulation of f-actin reorganization occurs under the influence of the Rho family of monomeric GTP-binding proteins.40 For example, Rac1 is linked to PAR signaling pathways that regulate stress fiber induction and cortical actin remodeling.32 In addition, GTP-
S-induced exocytosis in permeabilized mast cells is inhibited by C3 exotoxin, which specifically ADP-ribosylates and inactivates Rho.33 Rac and Cdc42 activity are also implicated in regulated exocytosis in basophilic leukemic cells and pancreatic ß-cells.34,41,42 Our observation that pretreatment of the HUVECs with TcdB, to inactivate Rho, Rac, and Cdc42, markedly inhibits PAR-stimulated vWF release, clearly implicating Rho-GTPases in both the PAR2 and PAR1 signaling pathways that direct Weibel-Palade body exocytosis.
Rho-GTP rapidly increases after stimulation of HUVECs with either the PAR2 or PAR1 agonist. To determine the participation of Rho directly in PAR-stimulated WP body exocytosis, we used the C3 exotoxin to selectively modify and abrogate interaction of Rho with downstream effector molecules. We found no consistent inhibitory effect of C3 exotoxin when used at concentrations known to markedly ADP-ribosylate endothelial Rho proteins.24 Moreover, inhibition of Rho kinase with Y27632 also fails to block PAR-stimulated exocytosis. This result indicates that neither RhoA nor Rho kinase activity is required for WP body exocytosis after stimulation of either PAR, and confirm recent data examining the role of RhoA in thrombin-stimulated exocytosis.43 In contrast, we observed that expression of the Cdc4217N mutant significantly decreased PAR-stimulated Weibel-Palade body exocytosis. Because the transfection efficiency in these experiments was approximately 30% to 50%, diminished Cdc42 activity likely accounts for much of the inhibition observed with TcdB treatment. Taken together these experiments implicate an obligatory role for Cdc42 activity in the cascade of events leading to endothelial exocytosis downstream of either proteinase activated receptor. However, we cannot exclude that Rho-GTPase family members function partially redundantly in this system.
Interestingly, despite the ability to mobilize intracellular calcium and elicit f-actin remodeling and myosin light chain phosphorylation, PAR2 signaling, in contrast with PAR1, fails to increase endothelial monolayer permeability. Our observations confirm and extend those of Compton et al20 who observed no endothelial monolayer permeability change after trypsin stimulation. We observe that PAR1-mediated monolayer permeability required Rho-GTP and Rho kinase activity for this event and demonstrate that PAR2 recruited Rho-GTP, albeit only weakly. These results indicate that unlike PAR1, PAR2 fails to sufficiently activate the RhoA, and possibly other, signal transduction pathways necessary for monolayer pore formation.
In summary, we describe a role for cytoskeleton remodeling and the Rho family of GTP-binding proteins in both PAR1 and PAR2 signaling to endothelial Weibel-Palade body exocytosis. The signal involves Cdc42 GTP-binding protein acting independently of Rho kinase or Rac1. Our data are consistent with a model of Cdc42 GTP-binding protein-dependent cortical cytoskeletal remodeling. However, in comparison with PAR1, PAR2 elicits less RhoA-GTP and MLC phosphorylation and does not elicit increased monolayer permeability.
| Acknowledgments |
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| Footnotes |
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Received February 14, 2002; revision received December 20, 2002; accepted January 10, 2003.
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J. Suzuki, Z.-G. Jin, D. F. Meoli, T. Matoba, and B. C. Berk Cyclophilin A Is Secreted by a Vesicular Pathway in Vascular Smooth Muscle Cells Circ. Res., March 31, 2006; 98(6): 811 - 817. [Abstract] [Full Text] [PDF] |
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D. Mehta and A. B. Malik Signaling Mechanisms Regulating Endothelial Permeability Physiol Rev, January 1, 2006; 86(1): 279 - 367. [Abstract] [Full Text] [PDF] |
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E. A. Lidington, R. Steinberg, A. R. Kinderlerer, R. C. Landis, M. Ohba, A. Samarel, D. O. Haskard, and J. C. Mason A role for proteinase-activated receptor 2 and PKC-{epsilon} in thrombin-mediated induction of decay-accelerating factor on human endothelial cells Am J Physiol Cell Physiol, December 1, 2005; 289(6): C1437 - C1447. [Abstract] [Full Text] [PDF] |
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T. A. Khan, C. Bianchi, E. Araujo, P. Voisine, S.-H. Xu, J. Feng, J. Li, and F. W. Sellke Aprotinin Preserves Cellular Junctions and Reduces Myocardial Edema After Regional Ischemia and Cardioplegic Arrest Circulation, August 30, 2005; 112(9_suppl): I-196 - I-201. [Abstract] [Full Text] [PDF] |
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X. Su, E. Camerer, J. R. Hamilton, S. R. Coughlin, and M. A. Matthay Protease-Activated Receptor-2 Activation Induces Acute Lung Inflammation by Neuropeptide-Dependent Mechanisms J. Immunol., August 15, 2005; 175(4): 2598 - 2605. [Abstract] [Full Text] [PDF] |
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J. N. McLaughlin, L. Shen, M. Holinstat, J. D. Brooks, E. DiBenedetto, and H. E. Hamm Functional Selectivity of G Protein Signaling by Agonist Peptides and Thrombin for the Protease-activated Receptor-1 J. Biol. Chem., July 1, 2005; 280(26): 25048 - 25059. [Abstract] [Full Text] [PDF] |
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N Vergnolle CLINICAL RELEVANCE OF PROTEINASE ACTIVATED RECEPTORS (PARS) IN THE GUT Gut, June 1, 2005; 54(6): 867 - 874. [Full Text] [PDF] |
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J.-P. Fortin, G. E. Rivard, A. Adam, and F. Marceau Studies on rabbit natural and recombinant tissue factors: intracellular retention and regulation of surface expression in cultured cells Am J Physiol Heart Circ Physiol, May 1, 2005; 288(5): H2192 - H2202. [Abstract] [Full Text] [PDF] |
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C. Feistritzer and M. Riewald Endothelial barrier protection by activated protein C through PAR1-dependent sphingosine 1-phosphate receptor-1 crossactivation Blood, April 15, 2005; 105(8): 3178 - 3184. [Abstract] [Full Text] [PDF] |
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M. Steinhoff, J. Buddenkotte, V. Shpacovitch, A. Rattenholl, C. Moormann, N. Vergnolle, T. A. Luger, and M. D. Hollenberg Proteinase-Activated Receptors: Transducers of Proteinase-Mediated Signaling in Inflammation and Immune Response Endocr. Rev., February 1, 2005; 26(1): 1 - 43. [Abstract] [Full Text] [PDF] |
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R. Bhatia, K. Matsushita, M. Yamakuchi, C. N. Morrell, W. Cao, and C. J. Lowenstein Ceramide Triggers Weibel-Palade Body Exocytosis Circ. Res., August 6, 2004; 95(3): 319 - 324. [Abstract] [Full Text] [PDF] |
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X. Shi, B. Gangadharan, L. F. Brass, W. Ruf, and B. M. Mueller Protease-Activated Receptors (PAR1 and PAR2) Contribute to Tumor Cell Motility and Metastasis Mol. Cancer Res., July 1, 2004; 2(7): 395 - 402. [Abstract] [Full Text] [PDF] |
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J. Ahamed and W. Ruf Protease-activated Receptor 2-dependent Phosphorylation of the Tissue Factor Cytoplasmic Domain J. Biol. Chem., May 28, 2004; 279(22): 23038 - 23044. [Abstract] [Full Text] [PDF] |
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G. M. Hjortoe, L. C. Petersen, T. Albrektsen, B. B. Sorensen, P. L. Norby, S. K. Mandal, U. R. Pendurthi, and L. V. M. Rao Tissue factor-factor VIIa-specific up-regulation of IL-8 expression in MDA-MB-231 cells is mediated by PAR-2 and results in increased cell migration Blood, April 15, 2004; 103(8): 3029 - 3037. [Abstract] [Full Text] [PDF] |
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B. H. Rauch, E. Millette, R. D. Kenagy, G. Daum, and A. W. Clowes Thrombin- and Factor Xa-Induced DNA Synthesis Is Mediated by Transactivation of Fibroblast Growth Factor Receptor-1 in Human Vascular Smooth Muscle Cells Circ. Res., February 20, 2004; 94(3): 340 - 345. [Abstract] [Full Text] [PDF] |
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T. Minami, A. Sugiyama, S.-Q. Wu, R. Abid, T. Kodama, and W. C. Aird Thrombin and Phenotypic Modulation of the Endothelium Arterioscler. Thromb. Vasc. Biol., January 1, 2004; 24(1): 41 - 53. [Abstract] [Full Text] [PDF] |
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P. E. Szmitko, C.-H. Wang, R. D. Weisel, G. A. Jeffries, T. J. Anderson, and S. Verma Biomarkers of Vascular Disease Linking Inflammation to Endothelial Activation: Part II Circulation, October 28, 2003; 108(17): 2041 - 2048. [Full Text] [PDF] |
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