High Circulating Angiopoietin-2 Levels Exacerbate Pulmonary
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Thorax Online First, published on September 25, 2017 as 10.1136/thoraxjnl-2017-210413 Pulmonary vasculature Thorax: first published as 10.1136/thoraxjnl-2017-210413 on 25 September 2017. Downloaded from ORIGINAL artiCLE High circulating angiopoietin-2 levels exacerbate pulmonary inflammation but not vascular leak or mortality in endotoxin-induced lung injury in mice Kenny Schlosser,1 Mohamad Taha,1,2 Yupu Deng,1 Lauralyn A McIntyre,3 Shirley H J Mei,1 Duncan J Stewart1,2,4 ► Additional material is ABSTRACT published online only. To view Background Elevated plasma levels of angiopoietin-2 Key messages please visit the journal online (http:// dx. doi. org/ 10. 1136/ (ANGPT2) have been reported in patients with acute thoraxjnl- 2017- 210413). lung injury (ALI); however, it remains unclear whether What is the key question? this increase contributes to, or just marks, the underlying ► Elevated plasma levels of angiopoietin-2 1Regenerative Medicine vasculopathic inflammation and leak associated with (ANGPT2) in acute lung injury (ALI)/acute Program, Ottawa Hospital ALI. Here we investigated the biological consequences respiratory distress syndrome patients are Research Institute , University associated with poor prognosis; however, of Ottawa, Ottawa, Ontario, of inducing high circulating levels of ANGPT2 in a mouse Canada model of endotoxin-induced ALI. it remains unclear whether these elevated 2Department of Cellular and Methods Transgenic mice (ANGPT2OVR) with elevated circulating levels are just a marker or mediator Molecular Medicine, University circulating levels of ANGPT2, achieved through of underlying pulmonary vascular dysfunction. of Ottawa, Ottawa, Ontario, conditional hepatocyte-specific overexpression, Canada What is the bottom line? 3 were examined from 3 to 72 hours following Clinical Epidemiology Program, ► For the first time, this study demonstrates Ottawa Hospital Research lipopolysaccharide (LPS)-induced ALI. An aptamer-based that elevated plasma levels of ANGPT2 play Institute, Ottawa, Canada inhibitor was used to neutralise the effects of circulating 4 a context-dependent role in fine-tuning the Department of Medicine, ANGPT2 in LPS-exposed ANGPT2OVR mice. Division of Cardiology, inflammatory response to ALI. University of Ottawa, Ottawa, Results Total cells, neutrophils and macrophages, Ontario, Canada as well as inflammatory cytokines, were significantly Why read on? OVR higher in bronchoalveolar lavage (BAL) of ANGPT2 ► The isolated elevation of circulating ANGPT2 Correspondence to versus littermate controltTA mice at 48 hours and 6 hours via hepatocyte-specific overexpression and Dr Duncan J Stewart, post-LPS, respectively. In contrast, LPS-induced vascular secretion exacerbated pulmonary inflammation, Regenerative Medicine, Ottawa leak, evidenced by total BAL protein levels and lung but not vascular leak, and did not alter Hospital Research Institute & OVR University of Ottawa, Ottawa, wet/dry ratio, was unchanged between ANGPT2 and mortality in a murine model of bacterial tTA http://thorax.bmj.com/ Ontario K1H8L6, Canada; controls , while BAL levels of IgM and albumin were endotoxin-induced ALI. djstewart@ ohri. ca decreased in ANGPT2OVR mice between 24 hours and 48 hours suggesting a partial attenuation of vascular Received 18 April 2017 Revised 3 August 2017 leak. There was no significant difference in LPS-induced OVR tTA (ANGPT2) are ligands for the endothelial cell Accepted 29 August 2017 mortality between ANGPT2 and controls . An ANGPT2-neutralising aptamer partially attenuated (EC)-enriched TIE2 receptor tyrosine kinase. Para- alveolar cell infiltration while exacerbating vascular crine release of ANGPT1 from pericytes promotes leak in LPS-exposed ANGPT2OVR mice, supported TIE2 receptor phosphorylation and downstream on October 1, 2021 by guest. Protected copyright. by underlying time-dependent changes in the lung activation of signalling pathways that protect 3 4 5–7 transcriptional profiles of multiple genes linked to against inflammation and vascular leak. neutrophil recruitment/adhesion and endothelial In contrast, ANGPT2 (stored in Weibel-Palade integrity. bodies of ECs) has been shown to competitively Conclusions Our findings suggest that high inhibit ANGPT1-induced TIE2 phosphorylation circulating ANGPT2 potentiates endotoxin-induced lung in vitro, and its transgenic overexpression in the inflammation but may also exert other pleiotropic effects mouse embryo has been reported to cause defects to help fine-tune the vascular response to lung injury. in vascular development mimicking those seen in ANGPT1 and TIE2 knockout animals.8–10 While these early observations support the classic view of ANGPT2 as a natural TIE2 antagonist and vascular INTRODUCTION destabilising factor,9 there is increasing evidence Acute respiratory distress syndrome (ARDS) is that ANGPT2 may also function as a TIE2 agonist a life-threatening condition for which there is and vasculoprotective factor in a context-dependent currently no specific pharmacological treatment.1 manner. A number of in vitro studies have shown To cite: Schlosser K, Taha M, Pulmonary inflammation and vascular leak are that ANGPT2 can activate the TIE2 receptor under Deng Y, et al. Thorax Published Online First: [please hallmarks of acute lung injury (ALI) seen in ARDS, various circumstances including in non-ECs lacking 11 include Day Month Year]. which may be mediated in part through dysregu- inhibitory coreceptors, over extended periods of doi:10.1136/ lation of the angiopoietin–Tie2 signalling axis.2 time12 or at very high concentrations.13 14 In vivo thoraxjnl-2017-210413 Angiopoietin-1 (ANGPT1) and angiopoietin-2 studies in mice have also shown that ANGPT2 Schlosser K, et al. Thorax 2017;0:1–14. doi:10.1136/thoraxjnl-2017-210413 1 Copyright Article author (or their employer) 2017. Produced by BMJ Publishing Group Ltd (& BTS) under licence. Pulmonary vasculature Thorax: first published as 10.1136/thoraxjnl-2017-210413 on 25 September 2017. Downloaded from can inhibit vascular leak induced by inflammatory stimuli such confirmed by PCR genotyping using DNA extracted from ear as mustard oil.15 Thus, the role of ANGPT2 may vary widely biopsies and transgene-specific primers as described previously.23 from vasculopathic to vasculoprotective factor depending on the Mice were on a CD1 genetic strain background. ANGPT2OVR specific biological context. mice were indistinguishable in size and appearance from litter- In clinical settings, plasma levels of ANGPT2 have been mate controls and represented approximately 25% of each litter. shown to be elevated in patients with inflammatory disorders, 16–20 in particular ALI/ARDS and sepsis, and in some cases were LPS-induced model of ALI 21 17 associated with the severity of lung injury and mortality. Mice received an intratracheal instillation of LPS (Esche- However, while these observational studies establish the clinical richia coli 055:B5; 1 mg/kg or 500 000 EU/kg body weight relevance of ANGPT2 and suggest a potential role as a prog- in normal saline; Sigma), and blood, bronchoalveolar lavage nostic biomarker, they provide limited information on whether (BAL) and lungs were collected after 3 hours, 6 hours, 24 hours, the elevated circulating levels contribute causally to underlying 48 hours and 72 hours. Of note, data for each time point repre- disease activity in ALI. To date, and to the best of our knowledge, sent a separate set of mice rather than serial measurements from no study has directly interrogated the potential contributory role a single set of mice. An LPS dose of 10 mg/kg was used in exper- of high circulating levels of ANGPT2 in an animal model of ALI. iments to assess LPS-induced mortality. Here, we hypothesised that endotoxin-induced ALI would be exacerbated by systemic ANGPT2 overexpression. High plasma Anti-ANGPT2 aptamer treatment in ANGPT2OVR mice levels of ANGPT2 were induced in transgenic mice (ANGP- The anti-ANGPT2 RNA aptamer, which binds to hANGPT2 T2OVR) independent of lung injury, via conditional hepato- protein, was developed previously.24 The aptamer and a scram- cyte-driven overexpression and secretion, and the effects on bled sequence control RNA were synthesised by Samchully pulmonary vascular inflammation, permeability and mortality Pharmaceutical (Seoul, Korea), with 2′-fluoropyrimidines and were then evaluated in the lipopolysaccharide (LPS)-induced terminal 3′−3′ inverted deoxythymidine caps for nuclease resis- model of ALI. Neutralisation of the circulating ANGPT2 in tance. The non-functional control RNA was composed of the ANGPT2OVR mice, via aptamer-based inhibition, was used to same number and type of chemically modified nucleotides, but further probe the potential causal role of ANGPT2 on pulmo- the sequence of nucleotides was randomly scrambled. Aptamer nary inflammation and leak and identify molecular pathways or scrambled-sequence control RNA (0.1 mg/kg, dissolved in involved in ANGPT2-mediated pulmonary transcriptional phosphate buffered saline (PBS)) were injected in ANGPT2OVR reprogramming. mice via tail vein injection by an operator that was blinded to the treatment status. No transfection agent was used with the MATERIALS AND METHODS aptamer or scrambled control RNA to minimise the potential Peripheral blood samples from healthy subjects were obtained for cellular uptake. All mice were then given LPS (1 mg/kg) via with informed written consent between years 2011 and 2014 intratracheal instillation (within 5 min). Mice were euthanised at a single centre,