Circulation Research. 2004;95:319-324
Published online before print June 24, 2004,
doi: 10.1161/01.RES.0000136519.84279.7a
(Circulation Research. 2004;95:319.)
© 2004 American Heart Association, Inc.
Ceramide Triggers WeibelPalade Body Exocytosis
Rinky Bhatia*,
Kenji Matsushita*,
Munekazu Yamakuchi,
Craig N. Morrell,
Wangsen Cao,
Charles J. Lowenstein
From the Division of Cardiology, Department of Medicine (R.B., K.M., M.Y., C.N.M., W.C., C.J.L.) and the Departments of Comparative Medicine and Pathology (C.N.M.), The Johns Hopkins University School of Medicine, Baltimore, Md.
Correspondence to Charles J. Lowenstein, 950 Ross Bldg, The Johns Hopkins University School of Medicine, 720 Rutland Ave, Baltimore, MD 21205. E-mail clowenst{at}jhmi.edu
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Abstract
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The sphingolipid ceramide mediates a variety of stress responses,
including vascular inflammation and thrombosis. Activated endothelial
cells release Weibel-Palade bodies, granules containing von
Willebrand factor (vWF) and P-selectin, which induce leukocyte
rolling and platelet adhesion and aggregation. We hypothesized
that ceramide induces vascular inflammation and thrombosis in
part by triggering Weibel-Palade body exocytosis. We added ceramide
to human aortic endothelial cells and assayed Weibel-Palade
body exocytosis by measuring the concentration of vWF released
into the media. Exogenous ceramide induces vWF release from
endothelial cells in a dose-dependent manner. Activators of
endogenous ceramide production, neutral sphingomyelinase, or
tumor necrosis factor-

also induce Weibel-Palade body exocytosis.
We next studied NO effects on ceramide-induced Weibel-Palade
body exocytosis because NO can inhibit vascular inflammation.
The NO donor
S-nitroso-
N-acetylpenicillamine decreases ceramide-induced
vWF release in a dose-dependent manner, whereas the NO synthase
inhibitor
NG-nitro-
L-arginine methyl ester increases ceramide-induced
vWF release. In summary, our findings show that endogenous ceramide
triggers Weibel-Palade body exocytosis, and that endogenous
NO inhibits ceramide-induced exocytosis. These data suggest
a novel mechanism by which ceramide induces vascular inflammation
and thrombosis.
Key Words: nitric oxide sphingomyelin granule endothelial cells N-ethylmaleimide sensitive factor
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Introduction
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Inflammation and thrombosis play major roles in atherosclerosis
pathogenesis. Activated endothelial cells release Weibel-Palade
bodies, granules that contain procoagulant and proinflammatory
substances including multimeric von Willebrand factor (vWF),
P-selectin, and CD63.
15 Interleukin-8 (IL-8), thromboplastinogen,
calcitonin generelated peptide, and endothelin have been
reported in Weibel-Palade bodies as well.
69 Exocytosis
of Weibel-Palade bodies is triggered by a variety of agonists,
including thrombin, histamine, complement, leukotrienes, superoxide
anions, epinephrine, adenosine, and vasopressin.
1015 WeibelPalade body exocytosis is mediated by calcium,
cAMP, and G-proteins.
10,11,15,16 After WeibelPalade body
exocytosis, P-selectin is translocated to the endothelial surface,
where it facilitates leukocyte rolling, and vWF is released
into the vessel lumen, where it mediates platelet adhesion and
aggregation.
17,18
NO is a messenger molecule that mediates vasodilation and inhibits vascular inflammation.1924 NO inhibits atherogenesis in mice, and lack of NO synthesis is associated with atherosclerosis in humans.2528 NO inhibits atherogenesis by multiple mechanisms such as blocking smooth muscle cell proliferation, decreasing leukocyte adhesion, and inhibiting platelet adhesion and aggregation.2935 NO blocks nuclear factor
B (NF-
B)directed transcription of proinflammatory molecules within endothelial cells.36 We showed recently that NO inhibits Weibel-Palade body exocytosis.37
Sphingolipids found in plasma membranes of all eukaryotic cells play an important signaling role in vascular inflammation and thrombosis.3841 The sphingolipid ceramide mediates a variety of stress responses.41 Ceramide is produced de novo from serine condensation with palmitoyl-coenzyme A in the endoplasmic reticulum or from hydrolysis of sphingomyelin by sphingomyelinase in the plasma membrane, cytosol, lysosomes, or endoplasmic reticulum.42 A variety of factors induce ceramide production, including tumor necrosis factor-
(TNF-
), IL-1ß, interferon-
, Fas ligand, B7, CD40 ligand, oxidized low-density lipoprotein (LDL), ischemia, radiation, and chemotherapeutic agents.3841 Ceramide and its metabolites serve as intracellular second messengers in pathways mediating inflammation, thrombosis, apoptosis, cell differentiation, proliferation, and vasomotor regulation by acting on a variety of phosphatases, proteases, kinases, phospholipases, and transcription factors (protein phosphatase [PP] 1, PP2A, cathepsin, protein kinases, endothelial differentiation gene receptors, NF-
B, mitogen-activated protein kinase, plasminogen activator inhibitor-1 (PAI-1), nicotinamide adenine dinucleotide phosphate oxidase, and endothelial NO synthase [NOS]).3641,4349 Ceramide can induce vascular inflammation by activating transcriptional pathways, but ceramide can also rapidly trigger vascular inflammation by nontranscriptional pathways, although the precise mechanism by which it does so is unclear.
We hypothesized that ceramide promotes rapid vascular inflammation in part by triggering Weibel-Palade body exocytosis. We furthermore proposed that NO will block ceramide-induced exocytosis.
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Materials and Methods
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Materials
Ceramide was purchased from Matreya; dihydroceramide and sphingosine
1-phosphate from Biomol; neutral sphingomyelinase from
Bacillus cereus, thrombin, histamine, acetylpenicillamine (AP), vascular
endothelial growth factor (VEGF),
NG-nitro-
L-arginine methyl
ester (
L-NAME), 1,2-bis(2-aminophenoxy)ethane-
N,
N,
N',
N'-tetraacetic
acid tetrakis (acetoxymethyl ester; BAPTA-AM), and TNF-

from
Sigma; DMEM, DMEM without calcium, PBS, and trypsin-EDTA from
GIBCO; vWF ELISA kit from American Diagnostica; dimethyl sulfoxide
from J.T. Baker;
S-nitroso-
N-acetylpenicillamine (SNAP) from
Cayman Chemical; and endothelium-based medium (EBM-2) with growth
factors (FBS, hydrocortisone, VEGF, R3-insulin-like growth factor
1, ascorbic acid, and heparin) and EBM-2 without growth factors
from Clonetics.
Cell Culture
Human aortic endothelial cells (HAECs) were obtained from Clonetics (Walkersville, Md) and grown in EGM-2 media with growth factors until 80% confluent. Cells were then washed with PBS, treated with trypsin-EDTA, and centrifuged at 1200 rpm for 5 minutes. The supernatant was removed, the cell pellet was resuspended in EBM-2 with growth factors, and 100 µL of the cell suspension was placed into each well of a 96-well plate and incubated for 24 hours at 37°C. The cells were then washed and reincubated in 100 µL of EBM-2 without growth factors.
Measurement of Ceramide-Induced Weibel-Palade Body Exocytosis
HAECs were pretreated or not with the NOS inhibitor L-NAME 1 mmol/L for 16 hours at 37°C, or with the NO donor SNAP or its control AP for 4 hours at 37°C, or with VEGF for 2 hours. Some HAECs were pretreated with BAPTA-AM or calcium-free media for 30 minutes, or with desipramine 5 µmol/L for 10 minutes.35 HAECs were then treated with various amounts of ceramide, neutral sphingomyelinase, or TNF-
for 1 hour. Supernatants were harvested, stored at 20°C, and later analyzed for vWF concentration using an ELISA (American Diagnostica). To confirm that the process of exocytosis was being studied, we also examined the ceramide-triggered release of IL-8. HAECs were stimulated with 10 µmol/L ceramide for 0 to 60 minutes, and the amount of IL-8 released into the media was measured by an ELISA (R&D Systems).
Statistical Analysis
Results were expressed as mean±SD. Significance between mean values was determined by the Student t test, with a value of P<0.05 considered significant.
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Results
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Ceramide Triggers Weibel-Palade Body Exocytosis
To explore the effect of ceramide on Weibel-Palade body exocytosis,
we treated HAECs with ceramide for 1 hour and measured the concentration
of vWF in the media by an ELISA. Ceramide activates vWF release
from endothelial cells in a dose-dependent manner (
Figure 1A).
Ceramide induces vWF release over time, starting within 5 minutes
of treatment and continuing through 60 minutes after treatment
(
Figure 1B). To confirm that ceramide activates exocytosis,
we studied the effect of ceramide on the release of IL-8, another
component of Weibel-Palade bodies. Ceramide activates endothelial
release of IL-8 (
Figure 1C). Ceramide is almost as effective
in stimulating endothelial cell exocytosis as classical triggers
of Weibel-Palade body release such as thrombin or histamine
(
Figure 1D). To confirm that ceramide does not damage endothelial
cells, we treated HAECs with increasing amounts of ceramide
for 24 hours and measured apoptosis by counting the number of
cells with fragmented chromatin. Ceramide does not activate
endothelial cell apoptosis (
Figure 1E).

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Figure 1. Exogenous ceramide activates Weibel-Palade body exocytosis. A, Dose-response. Increasing amounts of ceramide were added to HAECs for 1 hour, and the concentration of vWF released into the media was measured by an ELISA (n=2±SD; *P=0.01 compared with 0 µmol/L; this experiment was repeated 3x with similar results). B, Time course; 1 U/mL thrombin or 10 µmol/L ceramide or its negative control 10 µmol/L dihydroceramide was added to HAECs for 1 hour, and the concentration of vWF released into the media was measured by an ELISA (n=2±SD; *P<0.01 compared with 0 µmol/L). C, Ceramide activates IL-8 exocytosis over time; 1 U/mL thrombin or 10 µmol/L ceramide was added to HAECs for 1 hour, and the concentration of IL-8 released into the media was measured by an ELISA (n=3±SD; *P<0.01 compared with 0 µmol/L). D, Comparison with other agonists of exocytosis; 10 µmol/L ceramide, 1 mmol/L histamine, 1 U/mL thrombin, or media alone was added to HAECs for 1 hour, and the concentration of vWF released into the media was measured by an ELISA (n=2±SD; *P<0.01 compared with media). E, Ceramide has an insignificant effect on endothelial apoptosis. HAECs were treated with ceramide for 24 hours, and apoptosis levels were measured by 4',6-diamidino-2-phenylindole staining for fragmented chromatin (black bars; n=4±SD). As a positive control, HAECs were treated with 1 mmol/L hydrogen peroxide for 24 hours (gray bars; n=2±SD; *P<0.01 compared with media). F, Ceramide effects on total vWF in endothelial cells. HAECs were treated with 10 µmol/L ceramide, 1 U/mL thrombin, or 10 µmol/L cycloheximide (CHX) for 1 hour. Cells were washed, and vWF concentrations in cell lysates were measured by an ELISA (n=3±SD; *P<0.05 vs Control).
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The effect of endogenous ceramide on Weibel-Palade body exocytosis was evaluated by adding to HAECs various concentrations of neutral sphingomyelinase, which hydrolyzes sphingomyelin to ceramide. The concentration of vWF in the media was measured 1 hour later using an ELISA. Sphingomyelinase activates vWF release from endothelial cells in a dose-dependent manner (Figure 2).

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Figure 2. Endogenous ceramide induces Weibel-Palade body exocytosis. Neutral sphingomyelinase was added in increasing doses (0, 0.01, 0.1, and 1 U/mL) to HAECs for 1 hour, and vWF release was measured as above (n=3±SD; *P<0.01 vs 0 U/mL).
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To examine the effect of endogenous sphingomyelinase on ceramide-induced exocytosis, we added various doses of TNF-
, an activator of sphingomyelinase, to HAECs for 1 hour. TNF-
stimulates vWF release in a dose-dependent manner (Figure 3A). This effect was partially blocked by desipramine, an inhibitor of acidic sphingomyelinase (Figure 3B). The addition of an inhibitor of neutral sphingomyelinase has no effect. Together, these data suggest that endogenous ceramide synthesis activates endothelial exocytosis.
Calcium plays a role in exocytosis of Weibel-Palade bodies. To determine whether ceramide induces exocytosis of Weibel-Palade bodies in a calcium-dependent manner, we pretreated HAECs with BAPTA or calcium-free media for 30 minutes and then incubated HAECs with 1 µmol/L ceramide for 1 hour. Pretreatment with BAPTA partially decreases ceramide-induced exocytosis, whereas pretreatment with calcium-free media does not affect Weibel-Palade body exocytosis (Figure 4). Pretreatment with BAPTA and calcium-free media also decreases Weibel-Palade body exocytosis (Figure 4). These data suggest that intracellular calcium pools mediate ceramide induction of endothelial cell exocytosis.

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Figure 4. Calcium and ceramide activation of Weibel-Palade body exocytosis. HAECs were pretreated with BAPTA-AM or incubated in calcium-free media and then stimulated with 1 µmol/L ceramide for 1 hour, and vWF release was measured as above (n=3±SD; *P<0.01 vs ceramide or ceramide+Ca-free).
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NO Blocks Ceramide-Induced Weibel-Palade Body Exocytosis
To measure the effects of exogenous NO on ceramide-induced exocytosis of Weibel-Palade bodies, HAECs were pretreated with the NO donor SNAP or its negative control AP at different concentrations for 4 hours before 1 µmol/L ceramide was added. SNAP decreases ceramide-induced vWF release in a dose-dependent manner (Figure 5A). Different classes of NO donors inhibit ceramide-induced Weibel-Palade body exocytosis (data not shown).

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Figure 5. NO inhibits ceramide-induced Weibel-Palade body exocytosis. A, Exogenous NO dose response. HAECs were pretreated with the NO donor SNAP for 4 hours and stimulated with 1 µmol/L ceramide, and released vWF was measured as above (n=2±SD; *P<0.01 vs 0 µmol/L SNAP). B, Endogenous NO. HAECs were pretreated with 1 mmol/L L-NAME for 16 hours and stimulated with 1 µmol/L ceramide, and released vWF was measured as above (n=2±SD; *P<0.01 for Ceramide vs Ceramide+L-NAME).
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To measure endogenous NO effects on ceramide-induced exocytosis, we pretreated HAECs with the NOS inhibitor L-NAME for 16 hours before the addition of 1 µmol/L ceramide. L-NAME increases ceramide-induced vWF release (Figure 5B). Together, these data suggest that endogenous NO inhibits exocytosis of Weibel-Palade bodies induced by ceramide.
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Discussion
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The major finding of this study is that endogenous ceramide
activates Weibel-Palade body exocytosis. Furthermore, NO inhibits
ceramide-induced exocytosis.
Ceramide mediates a variety of stress responses including vascular inflammation.38,41 Multiple physical and biological stimuli activate ceramide synthesis, including ischemia and reperfusion, oxidized LDL, and inflammatory cytokines.3841,50,51 Ceramide and its metabolites mediate vascular inflammation by increasing endothelial cell expression of E-selectin, vascular cell adhesion molecule-1, and intercellular adhesion molecule, thereby inducing leukocyte and monocyte adhesion to the vascular wall.5254 These activated leukocytes and macrophages secrete cytokines, which further induce inflammation and ceramide production. Ceramide also mediates lipoprotein accumulation in the vascular wall, and ceramide levels are increased in atherosclerotic plaques compared with the normal vessel wall.5558 In addition, ceramide has been implicated in pathways leading to proliferation of smooth muscle cells.50,51,59 Ceramide is also involved in generation of reactive oxygen species, which leads to further inflammation and tissue injury.59 Our data show a novel mechanism by which ceramide might rapidly activate vascular inflammation. By triggering Weibel-Palade body exocytosis, ceramide increases endothelial P-selectin expression, which can induce leukocyte adhesion and aggregation to the vascular wall.
Ceramide also activates multiple pathways leading to vascular thrombosis. The ceramide metabolite sphingosine 1-phosphate induces platelet aggregation.60 In addition, ceramide induces endothelial cell release of prothrombotic tissue factor and PAI-1.61,62 Ceramide and its metabolites promote apoptosis of endothelial cells, which may play a role in plaque erosion and further thrombosis.6365 Our data show a novel mechanism by which ceramide might induce thrombosis. By activating Weibel-Palade body exocytosis, ceramide induces vWF release, which can lead to platelet adhesion and aggregation.
Ceramide has 2 opposing effects on endothelial cells. In addition to triggering proinflammatory and prothrombotic pathways, ceramide and its metabolite sphingosine 1-phosphate also activate endothelial NOS (NOS3).4349 NO has multiple effects on the vasculature, including inhibition of vascular inflammation and thrombosis.1923 One mechanism by which NO decreases vascular inflammation is blocking Weibel-Palade body exocytosis.37 We found that ceramide activates a greater release of vWF when NOS is inhibited (Figure 5B). One possible explanation for this phenomenon is that ceramide normally activates exocytosis and NOS, and NO then inhibits further exocytosis. Our results might partially explain why patients with endothelial dysfunction who cannot synthesize normal levels of NO have higher levels of vascular inflammation and a greater risk for atherosclerosis than patients with normal endothelial function and normal NO production.
In conclusion, our study shows that ceramide triggers Weibel-Palade body exocytosis and that NO blocks ceramide-induced exocytosis. These data suggest a novel mechanism by which ceramide induces vascular inflammation and thrombosis.
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Acknowledgments
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This research was supported in part by American Heart Association
Established Investigator Grant EIG 0140210N (C.J.L.); National
Institutes of Health grants P01 HL56091, P01 HL65608, NIH R01
HL53615, R01 HL63706 (C.J.L.); RR07002, and HL074945 (to C.M.);
the Ciccarone Center for the Prevention of Heart Disease (C.J.L.);
and the Cora and John H. Davis Foundation (C.J.L.).
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Footnotes
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*These authors contributed equally to this work.

This manuscript was sent to Donald Heistad, Consulting Editor, for review by expert referees, editorial decision, and final disposition.
Original received September 22, 2003; resubmission received May 3, 2004; revised resubmission received June 3, 2004; accepted June 11, 2004.
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