Published online before print March 29, 2007
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Molecular Signaling Section, Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
1 Correspondence: NIH, NIAID, Bldg. 10, Rm. 11N113, Bethesda, MD 20892, USA. E-mail: pmm{at}nih.gov
ABSTRACT
Oxidative stress and inflammation are accepted as major factors in the pathogenesis of atherosclerosis, but how they interact to produce a plaque has not been delineated clearly. Recent data suggest that oxidized lipids may act in part by regulating production of chemokines and chemokine receptors, which in turn, may direct monocytes and other blood leukocytes to the vessel wall, where they may interact with endothelial cells and smooth muscle cells. The receptors may act at the level of recruitment, retention, and egress, not only through classic, chemotactic mechanisms but also through direct, intercellular adhesion. The results suggest a coordinated mechanism for inflammatory cell accumulation in plaque and identify novel targets, such as CCR2 and CX3CR1, for potential drug development in coronary artery disease.
Key Words: leukocytes atherogenesis
INTRODUCTION
Risk of coronary artery disease is determined by a complex combination of genetic and environmental factors. Against this background, atherogenic triggers are thought to include injury to vascular endothelium and local accumulation of oxidized low-density lipoprotein (oxLDL) in the large arteries. Each of the lipid constituents of LDL, including cholesteryl esters, phospholipids, sterols, and triglycerides, can undergo oxidation, and it is thought that oxLDL and/or its free lipid constituents induce factors that promote infiltration of vascular subendothelium by monocytes. There, the cells mature into lipid-laden, foamy macrophages. The foam cell is the principal leukocyte present in fatty streaks, the earliest pathologic sign of atherosclerosis. Invading monocytes release proinflammatory cytokines, chemoattractants, and enzymes, which degrade extracellular matrix components, thus allowing T lymphocytes, NK cells, dendritic cells (DC), mast cells, and smooth muscle cells (SMCs) to invade the vascular subendothelium. Inflammatory cytokines also activate resident cells in the lesion, which may contribute to plaque erosion and rupture, forming a surface on which activated platelets may initiate thrombosis and amplify inflammation, leading to the acute coronary syndrome [1 ].
Recent work has implicated specific cytokines, TLRs, adhesion molecules, and chemokines in atherogenesis. In some cases, evidence for plausible roles in pathogenesis has been obtained through associations of functional genetic polymorphisms in patients (Tables 1 and 2 ). Here, we focus our attention on the chemokines.
|
View this table: [in a new window] |
Table 1. Genetic Evidence Supporting Direct Roles of Chemokines and Chemokine Receptors in Atherogenesis in Mouse and Man
|
|
View this table: [in a new window] |
Table 2. Genetic Evidence Supporting Direct Roles of Cytokines, Adhesion Molecules, Toll-like Receptors and Matrix Metalloproteinases in Atherogenesis in Mouse and Man
|
42 human chemokines and at least 18 human chemokine receptors [61
]. In the context of atherosclerosis, it is currently thought that chemokines and chemokine receptors may coordinate communication between inflammatory cellular components of the peripheral blood and cellular components of the arterial wall, thereby regulating leukocyte influx, capture, efflux, activation, and gene regulation as well as proliferation and/or apoptosis of resident cells in the plaque (Fig. 1
).
![]() View larger version (38K): [in a new window] |
Figure 1. Model for chemokine regulation of monocyte accumulation in atherosclerosis. LDL diffuses from the blood into the inner-most layer of the artery, where it undergoes oxidative modifications, forming randomly distributed, extracellular pools of oxLDL and its stable metabolites. Biologically active lipid deposits in the intima stimulate vascular endothelium to express and release adhesion molecules, proinflammatory cytokines, and chemoattractants. Circulating blood monocytes are captured by the endothelium and invade inflamed arteries through a multistep process, which includes selectin-mediated rolling, integrin-mediated firm arrest, spreading, and diapedesis. This classical model of leukocyte recruitment is in atherogenesis, supported by CXCR2-dependent capture of monocytes by activated endothelium and CCR2-dependent transendothelial migration. After entering the subendothelial space, monocytes differentiate into macrophages, and ingestion of lipids leads to foam cell formation. Foam cells are the predominant cell population in early lesions; however, macrophages and foam cells continue to secrete bioactive molecules such as growth factors and chemokines, which can recruit SMCs expressing CXCR4, CCR5, CX3CR1, or CCR2, and inflammatory cells including platelets, T cells, NK cells, NKT cells, B cells, and DC to the progressing plaques. Components of the oxLDL-rich environment silence macrophage CCR2 expression and up-regulate the adhesion chemokine receptor CX3CR1 and its ligand CX3CL1, promoting macrophage capture and retention in the plaque. Furthermore, numerous heterotypic and homotypic interactions, which are maintained by proadhesive CX3CL1-CX3CR1 contacts, may support organization of cells in the plaque. CCR7 may facilitate atheroregression. Rapid depletion of foam cells in the regression environment correlates with a substantial number of CCR7+CD68+ cells emigrating from the plaque to the local lymph nodes. Other chemoattractant receptors have been implicated in atherosclerosis (leukotriene B4 receptor, CCR5, CXCR4, CXCR3); however, their mechanisms of action have not been studied. Mo, Monocyte; M , macrophage.
|
The first chemokine implicated in atherogenesis was CCL2 (also known as MCP-1). CCL2 is not normally found in the vessel wall but is induced in the context of atherosclerosis [62 63 64 65 ]. CCL2 has been detected in macrophage-rich areas bordering the lipid core, as well as endothelial and SMCs in human, mouse, and rabbit atherosclerotic lesions [66 67 68 ]. CCL2 levels are also elevated in the systemic circulation of patients with acute coronary syndrome [69 ]. Moreover, there is genetic evidence in mouse and man to support a functional role for CCL2 in atherogenesis. In man, the SNP –2518G (alternatively –2578G) in the regulatory region of CCL2, which causes increased promoter activity, is associated with elevated, circulating levels of CCL2 [4 ] and increased risk of myocardial infarction [4 , 5 ]. In mouse, direct evidence supporting a role for CCL2 in atherogenesis has been obtained through targeted disruption of ccl2 in atherosclerosis-prone mouse strains (ldlr–/– or transgenic apoB), which resulted in a >60% decrease in lesion size and plaque macrophage content [2 , 3 ]. Conversely, overexpression of CCL2 accelerated atherosclerosis in irradiated hypercholesterolemic apoE–/– recipients [70 ].
Consistent with this, homozygous deletion of the mouse CCL2 receptor gene ccr2 abolishes CCL2-induced monocyte chemotaxis in vitro and reduced monocyte extravasation across and adhesion to vascular endothelium, which suggest a nonredundant role of CCR2 in monocyte recruitment during inflammation [71 ]. Furthermore, lack of CCR2 expression in the ccr2–/– apoE–/– mouse strain resulted in decreased susceptibility to atherosclerosis [11 ]. The importance of monocyte CCR2 in atherogenesis is supported further by studies in which transplantation of ccr2–/– bone marrow into irradiated atherosclerosis-prone apoE3-Leiden recipients strongly decreased the size of aortic root lesions [72 ]. The beneficial effect of genetic disruption of CCR2 in atherosclerosis was confirmed later at the pharmacological level using a dominant-negative, N-terminally truncated mutant of CCL2, designated 7ND, in apoE–/– mice. 7ND decreased lesion formation, macrophage accumulation, and proatherogenic cytokine production in this model [73 74 75 ].
Together, these results provide proof of principle that CCL2 induces monocyte recruitment into lesions in a CCR2-dependent manner in the mouse. In humans, CCR2 has been identified directly on foam cells [76 ]. Moreover, the CCR2-V64I SNP has been associated with increased risk of myocardial infarction and left ventricular heart failure. The significance of this result requires sharpening, as this polymorphism, which affects the coding region of CCR2, has been reported to alter receptor function in some [12 , 13 ] but not all [14] studies. Additional studies will be needed to further assess potential changes in CCR2 function as a result of this SNP and to evaluate whether it is inherited in linkage disequilibrium with other "functional" polymorphisms that may affect risk of atherosclerosis.
The favored mechanistic model of atherogenesis combines the response-to-injury and oxidative stress theories. Although the response-to-injury theory suggests that vascular injury-related events induce leukocyte infiltration into inflamed arteries [77
, 78
], the oxidative stress theory supports the notion that modified LDL in the vessel wall may be important for initiating leukocyte recruitment [79
]. In this regard, monocyte CCR2 expression is elevated in hypercholesterolemic patients, and normal human monocytes treated with LDL in vitro have increased expression of CCR2 and increased chemotactic responses to CCL2 [80
, 81
]. In contrast, stimulation of human monocytes with oxLDL or end-point oxidation derivatives of linoleic acid found in human atherosclerotic lesions [9-hydroxy-10E,12Z-octadecadienoic acid ester (9-HODE) and 13-hydroxy-9Z,11E-octadecadienoic acid ester (13-HODE)] down-regulated CCR2 expression through a peroxisome-proliferator-activated receptor
(PPAR
)-dependent pathway [82
] (Fig. 2
), a mechanism that may be considered to abort CCR2-dependent chemotaxis, promoting retention of monocytes within the lesion (Fig. 1
). This observation establishes a functional, proatherogenic link between oxLDL and CCR2.
![]() View larger version (8K): [in a new window] |
Figure 2. oxLDL and its oxidized linoleic acid-containing lipids induce a chemokine receptor switch: CCR2 off, CX3CR1 on. The atheromatous microenvironment, containing a mixture of oxLDL and its end-point oxidation products (9-HODE, 13-HODE), promotes PPAR -dependent silencing of CCR2 and increased expression of CX3CR1 on monocytes infiltrating the vascular subendothelium. This proadhesive chemokine receptor switch may prevent CCR2-dependent migration and may induce CX3CR1-dependent retention mechanisms, which together, may promote macrophage accumulation in the vessel wall.
|
Two additional chemokine receptors, CXCR2 and CX3CR1, have been implicated in monocyte/macrophage accumulation in the atherosclerotic plaque but through distinct mechanisms. The CX3CR1 ligand, CX3CL1, is an atypical, multimodular chemokine, which exists in membrane-tethered and shed forms. The immobilized form consists of a chemokine domain anchored to the plasma membrane through an extended, mucin-like stalk, a transmembrane helix, and an intracellular domain [83 ]. Full-length transmembrane CX3CL1 functions as an intercellular adhesion molecule, which mediates integrin-independent cell capture by binding to CX3CR1 on target cells [84 ]. Following disintegrin-like metalloproteinase-mediated release of the chemokine domain [85 , 86 ], CX3CL1 may also promote recruitment of CX3CR1+ monocytes, platelets, NK cells, NK-T cells, T cells, and DC to sites of inflammation [84 ]. In the CNS, CX3CL1 is constitutively expressed on neurons and CX3CR1 on microglial cells. In mouse and man, CX3CL1 is the only known ligand for CX3CR1 [61 ].
Neither CX3CL1 nor CX3CR1 has been found in normal mouse or human arterial wall; however, in the context of atherosclerosis, both molecules are expressed on foam cells and coronary artery SMCs in both species [20 , 87 ]. Targeted disruption of cx3cl1 or cx3cr1 does not affect viability or fertility or lead to spontaneous infections in mice. However, deletion of cx3cr1 in apoE–/– mice or cx3cl1 in ldlr–/– or apoE–/– mice decreases susceptibility to atherosclerosis. Although two independently derived lines of cx3cr1–/–apoE–/– mice showed decreased lesion formation, and fewer macrophages infiltrated plaque in the aortic root, the cx3cl1–/–apoE–/– strain had decreased atherosclerosis in the brachiocephalic artery, and cx3cl1–/–ldlr–/– mice displayed smaller lesions in the aortic root and the brachiocephalic artery [10 , 20 , 21 ]. These data suggest that in the mouse, CX3CL1 interaction with CX3CR1 promotes atherogenesis.
Consistent with this, analysis of human CX3CR1 has identified two SNPs common in all racial groups in the coding region, I249V and T280M, which have been associated with decreased risk of atherosclerosis. In retrospective cohort studies, these polymorphisms, which are in complete linkage disequilibrium, have been associated consistently with reduced prevalence of disease endpoints, including coronary endothelial dysfunction and physical coronary artery stenosis in a National Heart, Lung and Blood Institute cardiac catheterization cohort [22 ], reduced prevalence of acute coronary events in the ACABI cohort [23 ], and reduced progression of carotid atherosclerosis [24 ]. Association with lower risk of cardiovascular events was also observed in the population-based prospective, Framingham Heart Study Offspring Cohort [25 ]. The variant receptor will be referred to here as CX3CR1-M280. Further investigations exploring putative mechanisms of action demonstrated that CX3CR1-M280 mediated decreased CX3CL1-induced chemotaxis of primary NK cells from homozygotes. In studies of the variant receptor expressed in transfected cells, defects were observed in the on rate for binding the iodinated chemokine domain of CX3CL1 and in immobilized CX3CL1-dependent adhesion under conditions of physiologic shear [25 ]. It is important to note that in an independent study, Daoudi et al. [88 ] were unable to confirm this and in contrast, showed that CX3CR1-M280, tested in transfected cells and at natural abundance in primary cells from homozygotes, promotes substantially greater intercellular CX3CL1-dependent adhesion than wild-type CX3CR1. Subsequently, the claim of an impaired adhesion phenotype for CX3CR1-M280 was reproduced independently by David McDermott (Laboratory of Molecular Immunology, NIAID, NIH), working in the authors laboratory (unpublished data). Further work will be needed to clarify this discrepancy; however, regardless of whether CX3CR1-M280 functions as a gain- or loss-of-function mutant, it has been reported consistently to function abnormally and to be associated consistently with reduced risk of cardiovascular disease in man with odds ratios ranging from 0.56 to 0.7. This is consistent with loss-of-function protection from atherosclerosis in multiple independent models using two different strains of knockout mice targeting the receptor and one targeting the ligand.
Recently, biochemical and functional experiments have suggested that modulation of expression of CX3CL1 and CX3CR1 in the context of atherosclerosis may be important [89
]. In contrast to CCR2, oxLDL and its oxidized linoleic acid metabolites are able to specifically induce differentiation of human CX3CR1low monocytes to CX3CR1high macrophages, which adhere strongly to CX3CL1+ primary human coronary artery SMCs under static conditions. Blocking experiments indicated that adhesion was mediated directly and predominantly by CX3CR1. Effects of oxLDL and its end-point oxidation products on CX3CR1 expression were mediated by PPAR
, as targeting the PPAR
gene with small interfering RNA reduced receptor expression and macrophage adhesion to coronary artery SMCs [89
].
The data suggest that in atherogenesis, oxidized lipid-driven activation of macrophage PPAR
in the intima results in a proadhesive chemokine receptor switch—CCR2 off, CX3CR1 on—causing cessation of CCR2-dependent migration and activation of CX3CR1-dependent retention mechanisms, which together, promote macrophage accumulation in the vessel wall (Fig. 1
). The presence of distinct cell types in atherosclerotic lesions, which express the ligand and the receptor, indicates that homotypic and heterotypic cell–cell interactions are possible. In this regard, chemokine–chemokine receptor interactions not only may promote leukocyte infiltration into lesions but may also be important for anchorage, retention, and interaction with other cell types in plaque, which could be important for modulation of function. These results are in agreement with the oxidative and inflammatory hypotheses of atherosclerosis, as they pinpoint oxLDL and its derivatives as major inducers of inflammatory stimuli. More broadly, the data identify macrophage binding to coronary artery SMCs as a primary cell setting, in which CX3CR1 functions as the major adhesion system.
Nevertheless, there is evidence that CXCL8 and its receptor CXCR2 [90 , 91 ] may also promote atherosclerosis through effects on cell–cell adhesion. CXCL8 and CXCR2 have been detected in macrophage-rich, atherosclerotic plaque [92 , 93 ]. Best known as a major neutrophil chemoattractant, CXCL8 has also been reported to function as a monocyte and T cell agonist under certain conditions. A CXCL8 homologue does not exist in the mouse, but its functions are replaced by other mouse chemokines, including MIP-2 and keratinocyte-derived chemokine (KC) [94]. Irradiated ldlr–/– mice, fed an atherogenic diet after receiving bone marrow from cxcr2–/– animals, develop smaller lesions, containing fewer macrophages and SMCs than lesions of ldlr–/– recipients, which were repopulated with cxcr2+/+ bone marrow [18 ], indicating that mouse CXCR2 is an atherogenic chemokine receptor. How CXCR2 and its ligands promote atherogenesis is unclear; however, evidence shows that in atherosclerotic carotid arteries isolated from apoE–/– mice, CXCL8 mouse homologues triggered VLA-4-dependent monocyte arrest to endothelium under flow conditions [95 ]. Moreover, stimulation of human monocytes with oxLDL increased CXCR2-dependent adhesion of cells to the endothelial cell line ECV304 [96 ]. Thus, in addition to recruitment, CXCL8 and CXCR2 may promote atherogenesis by mediating adhesion of infiltrating monocytes to inflamed vascular endothelium. This notion has not yet been translated clearly to humans. There is evidence that serum levels of CXCL8 are elevated in patients with myocardial infarction [97 ], and CXCL8 and CXCR2 are strongly up-regulated following exposure of monocytes to oxLDL [96 , 98 ]. However, genetic studies in man using CXCL8 SNPs (–A353G, +T1530C, +A3331G) and CXCR2 SNPs (+C785T and +T1208C), which are suggested to increase release of CXCL8 and expression of CXCR2 [99 ], have not been associated with cardiovascular disease.
CHEMOKINES AND MECHANISMS OF ATHEROREGRESSION
Although atherosclerosis has been perceived to be a relentlessly progressive disease, studies in humans have demonstrated that at least partial regression can be achieved, e.g., in the case of simvastatin therapy and carotid plaque [100 , 101 ] and infusions of apoA–IMilano and coronary atherosclerosis [102 , 103 ]. Furthermore, transplantation of a segment of atherosclerotic aorta from hyperlipidemic apoE–/– mice to normolipidemic wild-type recipients resulted in marked plaque regression [104 , 105 ]; regression mechanisms have not been defined in these settings but may include egress of foam cells from plaques to local lymph nodes [106 ]. In this regard, it has been shown recently that emigration of CD68+ inflammatory cells from the atherosclerotic plaque is abrogated in vivo by treatment of mice with antibodies to the CCR7 ligands CCL19 and CCL21. These data suggest that egress of cells and regression mechanisms may be CCR7-dependent (Fig. 1 ) [107 ]. Given the important role of macrophages in atherogenesis, finding ways to promote their exit is of great therapeutic interest.
CHEMOKINES AND ATHEROPROTECTION
CXCL16 is the second of two atypical, multimodular chemokines, which are known, having a structure similar to CX3CL1 [108 ]. Like CX3CL1, CXCL16 may function as a membrane-tethered adhesion molecule [109 ]. It can also be shed from the plasma membrane by cleavage of the stalk, which is mediated by ADAM 10 [110 ], and thereby functions as a chemoattractant, promoting migration of T cells, NK cells, and NK-T cells to sites of infection and inflammation by triggering its private receptor CXCR6 [108 ]. CXCL16 also functions as a scavenger receptor, specifically for phosphatidylserine and oxLDL [111 ], and was originally named scavenger receptor for phosphatidylserine and oxidized lipoprotein (SR-PSOX) [112 ]. Enhanced expression of membrane-bound CXCL16 has been found in human and mouse atherosclerotic plaque, colocalizing with lipid-laden, intimal macrophages and lesional SMCs, suggesting a role in the pathogenesis of cardiovascular disease [112 113 114 ]. CXCR6 has also been detected in human and mouse atherosclerotic plaques on foam cells, T cells, and SMCs [114 ].
A human epidemiologic study found that a polymorphic variant of CXCL16, CXCL16-A181V, is associated with increased coronary artery stenosis in postinfarction patients [9 ]. The mutated amino acid is located in the mucin-like, extracellular stalk of CXCL16. This is only a single study, with an odds ratio of 1.7, built on undefined plausibility, as the effect of the mutation on CXCL16 expression, shedding, and function has not been determined. In a human biomarker study, patients with stable angina pectoris, unstable angina pectoris, and myocardial infarction were surprisingly shown to have significantly lower systemic CXCL16 levels compared with healthy controls, which counterintuitively suggests that soluble CXCL16 may be atheroprotective [115 ]. It is important to note, however, that the sample size in this study was small, and potential mechanisms of action have not been defined [116]. Nevertheless, strong evidence consistent with this has been obtained in the mouse, in which cxcl16 disruption on a ldlr–/– genetic background resulted in accelerated atherosclerosis as a result of enhanced macrophage recruitment to the aortic arch [8].
CHEMOKINE-INDUCED SMC ACTIVATION AND PROLIFERATION ACCELERATE ATHEROSCLEROSIS
Although most chemokines and chemokine receptors involved in atherogenesis are expressed predominantly on leukocyte subsets infiltrating or residing in atherosclerotic plaque, recent studies have demonstrated that chemokines and their receptors may also be present on other cell types, such as SMC [117
], which constitute the major cellular component of the arterial wall and are located predominantly in the arterial media. In healthy arteries, SMCs function to regulate vascular tone. In response to vascular injury, however, SMCs proliferate, promoting hypertension, and migrate to form part of the intimal plaque [118
]. Although a variety of growth factors and cytokines found in atherosclerotic lesions and in the injured arterial wall have been shown to function as agonists for SMCs, stimulating their growth, proliferation, and migration [119
], chemokine receptors, including CCR5, CCR2, and CX3CR1, add activation of additional stimulus strength, which may promote pathological responses. CCR5 has been shown to colocalize with the SMC marker
-actin in the fibrous cap, necrotic core, and atherosclerotic media [120
]; CCR2 has been shown to play an important role in mediating SMC proliferation and intimal hyperplasia in a nonhyperlipidemic model of acute arterial injury [121
, 122
]; and CX3CR1, which is expressed by SMCs in human and mouse atherosclerotic plaques [20
, 21
, 123
], has been reported to promote SMC proliferation and intimal accumulation in an endothelial denudation injury model [124
]. Although the importance of the CCR8-CCL1 axis in atherogenesis awaits testing in animal models and epidemiologic studies, receptor and ligand are abundant in atherosclerotic plaques and are induced in the arterial media in mouse models of femoral arterial injury [125
, 126
]. CXCL8 has also been shown to induce activation, proliferation, and chemotaxis of SMCs [127
]. Recent evidence suggests that SMCs not only contribute to intimal hyperplasia and plaque formation but also may be capable of internalizing oxLDL, as they express membrane-tethered CXCL16 [114
, 128
].
CHEMOKINE REGULATION OF T CELL RECRUITMENT AND FUNCTION IN ATHEROSCLEROSIS
The role of T cells and adaptive immunity in atherogenesis has been the subject of several excellent recent reviews [129, 130]. Briefly, fatty streaks in apoE–/– animals contain small numbers of
β TCR-expressing CD4+ T cells, which undergo oligoclonal expansion in response to a limited set of local antigens; the frequency of CD8+ T cells is also low. The ratio of CD4+:CD8+ T cells in advanced plaque resembles that found in peripheral blood. CD4+ T cells isolated from human plaques are mostly CD45RO-expressing memory and/or effector T cells. Many potential antigens have been investigated in the context of atherosclerosis. APCs selectively internalize oxLDL through the scavenger receptor-dependent pathway. APC-processed fragments of apoLDL, referred to as "atheroantigens," bind MHC Class II and traffic to the cell surface. T cells do not react to native LDL. However, oxidative modifications of LDL, scavenger receptor endocytosis of oxLDL, and APC-dependent presentation of atheroantigens represent a sequence of events that may break T cell tolerance. This may result in differentiation of oxLDL-reactive T cells, which localize in plaque, lymph node, and blood of patients with atherosclerosis. An additional factor stimulating T cell differentiation in plaques is continuous presence of TH1 cytokines [129
, 130
].
Consistent with this, IFN-
-inducible chemokines CXCL9, CXCL10, and CXCL11 [131
] have been detected in endothelial cells, SMCs, and macrophages in atheromas, and the receptor for these chemokines, CXCR3, has been observed on lesional T cells [132
]. CXCL10 deficiency in apoE–/– animals results in decreased accumulation of CD4+ T cells in lesions, and the number and activity of regulatory T cells (Tregs) increase, suggesting that CXCL10 likely stimulates atherogenesis by regulating the local balance of effectors and Tregs [7
]. CXCR3 may have a pathogenic role in early stages of atherosclerosis, as cxcr3–/–apoE–/– animals compared with apoE–/– mice show decreased size of early but not advanced plaques. The nonredundant role of CXCR3 was also shown in the ccr2–/–cxcr3–/–apoE–/– model, in which lesion formation, inflammatory cell infiltration, and proinflammatory chemokine production were all decreased in triple knockout as compared with apoE–/– mice or deletion of either receptor in apoE–/– mice [19
].
The precise role of CXCR3 and its chemokine ligands in atherogenesis in man remains uncertain. CXCL9, CXCL10, and CXCL11 as well as CXCR3 are all polymorphic; however, the functional effect of polymorphism and associations of polymorphism with cardiovascular disease have not yet been delineated [133 134 135 ].
CCL5 AND CCL5 RECEPTORS IN ATHEROGENESIS
A role in atherogenesis for CCL5 must also be considered, as it is expressed in large amounts by foam cells and activated T cells in mouse and human atheromas [136
137
138
]. Two gain-of-function polymorphisms in the human CCL5 promoter (C28G, G403A) have been identified [139
, 140
], one of which, CCL5-G403A, has been associated with increased risk of coronary artery disease in a single study [6
]. Consistent with this, administration of Met-CCL5, which acts as a potent antagonist of the CCL5 receptors CCR5 and CCR1, but not CCR3, into ldlr–/– animals, inhibited atherosclerosis partially by decreasing plaque formation and infiltration of macrophages and T cells into lesions [136
]. Moreover, the major HIV/AIDS restriction mutation CCR5
32, which causes truncation and loss-of-function of CCR5, has been associated with decreased risk of myocardial infarction in some [17
] but not all cohorts studied to date [22
, 141
]. The initial study determining the role of CCR5 in atherogenesis showed that CCR5 deficiency in apoE–/– mice was not found to alter susceptibility to atherosclerosis after 16 weeks [15
]. However, in a follow-up study, in which progression of atherosclerosis in ccr5–/–apoE–/– was monitored for 10 and 12 weeks, lack of CCR5 expression decreased lesion formation by
50%. Furthermore, animals followed longer, out to 22 weeks on a high-fat diet or to 26 weeks on a chow diet, were reported to be protected against lesion formation [16
], suggesting that CCR5 may promote progression of atherosclerosis. Taken together, the human and mouse data provide suggestive evidence for a role for CCL5 and CCL5 receptors in atherogenesis, but additional work will be needed to explain at a mechanistic level the discrepant results from different cohorts and different mouse protocols.
CONCLUSIONS
Atherosclerosis is a multifactorial disease, in which combinatorial effects of proinflammatory cytokines, MMPs, TLRs, adhesion molecules, chemokines, and other chemoattractants may determine the outcome. Although strong data implicating specific chemokines and chemokine receptors in atherogenesis are now emerging, there are still major gaps in knowledge before this can be translated to the clinic. First, most of the research has been focused on the role of chemokines and chemokine receptors in early stages of atherosclerosis. Roles of the chemokine system in progression and regression of disease remain unknown. Second, the lack of good, surrogate markers makes measurement of efficacy for any potential treatment targeting chemokine action at the vessel wall difficult. Third, interaction of the atheromatous environment and cardiovascular drugs with chemokines and chemokine receptors is poorly understood. Further research in these areas may provide new opportunities to understand chemokine regulation of atherogenesis and to apply this knowledge to the treatment of atherosclerotic cardiovascular disease.
Received December 24, 2006; revised February 1, 2007; accepted February 6, 2007.
REFERENCES
} in atherosclerotic lesions plays a central role in macrophage accumulation and lesion progression Am. J. Pathol. 168,1385-1395
potentiates atherosclerosis in ApoE knock-out mice J. Clin. Invest. 99,2752-2761[Medline]
deficiency exerts gender-specific effects on atherogenesis in apolipoprotein E–/– mice J. Interferon Cytokine Res. 22,661-670[CrossRef][Medline]
] and atherosclerosis: pro- or anti-atherogenic? Cardiovasc. Res. 67,11-20
} reduces atherosclerosis in apolipoprotein E knockout mice Arterioscler. Thromb. Vasc. Biol. 24,2137-2142
}2 subunit of platelet {
}2{β}1 is associated with increased risk of cardiovascular mortality in high-risk women Circulation 102,1645-1650
2 gene coding sequence T807/A873 of the platelet collagen receptor integrin
2β 1 might be a genetic risk factor for the development of stroke in younger patients Blood 93,3583-3586
} J. Clin. Invest. 106,793-802[Medline]
-converting enzyme (ADAM17) mediates the cleavage and shedding of fractalkine (CX3CL1) J. Biol. Chem. 276,37993-38001
}-dependent pathway Circulation 114,807-819
and oxidized phospholipids Arterioscler. Thromb. Vasc. Biol. 21,1585-1591
}-regulated chemokine and scavenger receptor expressed in atherosclerotic lesions Arterioscler. Thromb. Vasc. Biol. 24,750-755
] Biochem. Biophys. Res. Commun. 325,1187-1193[CrossRef][Medline]This article has been cited by other articles:
![]() |
S. Apostolakis, K. Vogiatzi, V. Amanatidou, and D. A. Spandidos Interleukin 8 and cardiovascular disease Cardiovasc Res, December 1, 2009; 84(3): 353 - 360. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. D. Westmuckett and K. L. Moore Lack of Tyrosylprotein Sulfotransferase Activity in Hematopoietic Cells Drastically Attenuates Atherosclerosis in Ldlr-/- Mice Arterioscler Thromb Vasc Biol, November 1, 2009; 29(11): 1730 - 1736. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. L. Gautier, C. Jakubzick, and G. J. Randolph Regulation of the Migration and Survival of Monocyte Subsets by Chemokine Receptors and Its Relevance to Atherosclerosis Arterioscler Thromb Vasc Biol, October 1, 2009; 29(10): 1412 - 1418. [Abstract] [Full Text] [PDF] |
||||
![]() |
M. Gouwy, S. Struyf, H. Verbeke, W. Put, P. Proost, G. Opdenakker, and J. Van Damme CC chemokine ligand-2 synergizes with the nonchemokine G protein-coupled receptor ligand fMLP in monocyte chemotaxis, and it cooperates with the TLR ligand LPS via induction of CXCL8 J. Leukoc. Biol., September 1, 2009; 86(3): 671 - 680. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. Barlic, W. Zhu, and P. M. Murphy Atherogenic Lipids Induce High-Density Lipoprotein Uptake and Cholesterol Efflux in Human Macrophages by Up-Regulating Transmembrane Chemokine CXCL16 without Engaging CXCL16-Dependent Cell Adhesion J. Immunol., June 15, 2009; 182(12): 7928 - 7936. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. S. Plump and P. Y. Lum Genomics and cardiovascular drug development. J. Am. Coll. Cardiol., March 31, 2009; 53(13): 1089 - 1100. [Abstract] [Full Text] [PDF] |
||||
![]() |
P. Aukrust, B. Halvorsen, A. Yndestad, T. Ueland, E. Oie, K. Otterdal, L. Gullestad, and J. K. Damas Chemokines and Cardiovascular Risk Arterioscler Thromb Vasc Biol, November 1, 2008; 28(11): 1909 - 1919. [Abstract] [Full Text] [PDF] |
||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||