Journal of Applied Physiology AJP: Lung Cellular and Molecular Physiology
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J Appl Physiol 97: 1559-1566, 2004. First published June 18, 2004; doi:10.1152/japplphysiol.00221.2004
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HIGHLIGHTED TOPICS
Lung Growth and Repair

Lung-targeted VEGF inactivation leads to an emphysema phenotype in mice

Kechun Tang, Harry B. Rossiter, Peter D. Wagner, and Ellen C. Breen

Division of Physiology, Department of Medicine, University of California, San Diego, La Jolla, California 92093-0623

Submitted 27 February 2004 ; accepted in final form 9 June 2004


    ABSTRACT
 TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 GRANTS
 ACKNOWLEDGMENTS
 REFERENCES
 
To test the hypothesis that VEGF is important for the maintenance of alveolar structure and elastic properties in adult mice, lung-targeted ablation of the VEGF gene was accomplished through intratracheal delivery of an adeno-associated cre recombinase virus (AAV/Cre) to VEGFloxP mice, and the effects were followed for 8 wk. Control mice were similarly treated with AAV/Cre. Pulmonary VEGF levels were reduced by 86% at 5 wk postinfection but returned to normal levels by 8 wk. VEGF receptor VEGFR-2 levels were also reduced at 5 wk (by 51%) and returned to control values by 8 wk. However, alveolar septal wall destruction (increased mean linear intercept) and loss of lung elastic recoil (increased compliance) persisted for 8 wk. No decrease in alveolar cell proliferation was detected by Western blot or immunohistochemical analysis of proliferating cell nuclear antigen. Increased alveolar septal cell and bronchial epithelial cell apoptosis was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling analysis at 5 wk. Total lung caspase-3 levels and enzyme activity were also increased at 5 wk. No obvious accumulation of inflammatory cells was observed at any time after tracheal instillation of AAV/Cre. Thus a transient decrease in pulmonary VEGF leads to increased alveolar and bronchial cell apoptosis, air space enlargement, and changes in lung elastic recoil (processes that are characteristic of emphysema) that persist for at least 8 wk.

vascular endothelial growth factor; caspase; cre recombinase; apoptosis


THE LUNG ENCOMPASSES AN INTRICATE network of airway and vascular structures. The vast pulmonary capillary bed is crucial in allowing efficient gas exchange to occur between the alveoli and circulating blood supply. The lung is also among the organs with highest levels of vascular endothelial growth factor (VEGF) (26). This angiogenic growth factor is essential for pulmonary development and is well known to play an important role as a vascular permeability factor (10, 11, 23). An emerging concept in adult organisms is that VEGF may provide a protective function against injury or oxidative stress. Thus VEGF is decreased in the lungs of hyperoxia-exposed mice and increases above control levels during recovery in normoxia (20, 25). Furthermore, elevated VEGF levels have been reported in patients with acute respiratory distress syndrome and LPS-induced lung injury in mice (17, 31). Administration of VEGF to neonatal and preterm mice with respiratory distress syndrome, generated by hypoxia inducible factor (HIF)-2{alpha} knockout, increased surfactant biosynthesis and improved survival rates (6). Likewise, overexpression of pulmonary IL-13 protected mice from hyperoxic lung injury through a VEGF-dependent pathway, and adenoviral-delivered VEGF has been reported to increase survival from hypoxic pulmonary hypertension (7, 27). Thus VEGF appears to be an important factor in lung injury, repair, and survival.

VEGF protects endothelial cells from apoptotic cell death through the coordinate signaling of phosphatidyl 3-kinase/Akt and inhibition of p38 MAPK (12, 13). Furthermore, insufficient maintenance of VEGF levels has been reported to inhibit capillary formation in neonatal mice and to lead to regression of newly formed vessels in the retina, heart, and liver (3, 8, 11). A limited number of studies have examined the consequences of VEGF inactivation in adult organs (30). In patients with severe emphysema, VEGF levels are reduced in the bronchoalveolar lavage, sputum, and lung tissue (18, 21). These findings would suggest that insufficient pulmonary VEGF levels may impede the ability of pulmonary endothelial or epithelial cells to repair from injurious aldehydes and oxidants found in cigarette smoke. Recently, Kasahara and colleagues (19) blocked the action of a VEGF receptor VEGFR-2 (KDR/Flk-1) in rats through chronic administration of the chemical inhibitor SU5416. Loss of VEGFR-2 function resulted in increased alveolar size and septal cell apoptosis without a change in the inflammatory cell profile (5, 19). Furthermore, biopsies of human emphysema tissue revealed apoptosis of both alveolar epithelial and endothelial cells (18). Apoptotic cells have also been detected in mice with emphysema due to elastase instillation (24), and recently the direct administration of the apoptotic enzyme caspase-3 or nodularin, a proapoptotic serine/threonine kinase inhibitor, was found to rapidly and transiently (within hours) induce lung apoptosis that led to changes in alveolar structure and lung mechanics that persisted for 15 days (1).

Through the use of a Cre-LoxP strategy to site-specifically ablate the pulmonary VEGF gene, the importance of VEGF for the maintenance of alveolar structure and lung mechanics may be determined. We were, therefore, interested in the effects of long-term downregulation of pulmonary VEGF on the lung pressure-volume relationship, alveolar size, and apoptosis of alveolar septal cells. Permanent destruction of alveolar septal wall structures and decreased elastic recoil would be consistent with emphysema. As such, structural and mechanical measurements were made at 5 and 8 wk after-infection of VEGFloxP transgenic mouse lungs with an adeno-associated cre recombinase virus (AAV/Cre).


    MATERIALS AND METHODS
 TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 GRANTS
 ACKNOWLEDGMENTS
 REFERENCES
 
Animals.   The University of California San Diego Animal Subjects committee approved the reported study. Wild-type C57BL/6J (WT) and VEGFloxP mice, age 2–3 mo, were used throughout this study. To site-specifically inactivate the pulmonary VEGF gene in adult mice, we used a strategy in which cre recombinase was virally delivered with an adeno-associated viral (AAV) vector to mice with a floxed VEGF exon 3. The conditional VEGF knockout mouse was engineered by Dr. Napoleone Ferrara's group from Genentech (11). Briefly, VEGF genomic fragments containing exons 2, 3, and 4 were subcloned into a targeting vector that contains three loxP sites (TNLOX1–3). The targeting vector was designed so that LOX 1 and 2 sites flank a neomycin-resistant marker (PKG-NEO), and VEGF exon 3 was flanked by LOX sites 2 and 3. This construct was then electroporated into the embryonic stem cell line ESGS, and positive colonies were selected with G418. PKG-NEO sequence was subsequently deleted through transient expression of cre recombinase (pMC-CRE). Embryonic stem clones containing a floxed VEGF allele but lacking the PKG-NEO were identified by PCR analysis using a LOX 3-specific primer and were verified by nucleotide sequence analysis, Southern blot, and normal VEGF expression levels. Positive embryonic stem clones were microinjected into the blastocoele cavity of 3.5-day C57BL/6J blatocysts. Heterozygous VEGF-LOX males were bred to MX-1-CRE mice to generate VEGF-LOX (+/–), MX-1-CRE (+/+) mice. MX-1 refers to the interferon-inducible promoter. Mice were bred to homozygosity by brother-sister mating to achieve VEGF-LOX (+/+), MX-1-CRE (+/+) mice. In our experiment, we targeted VEGF inactivation to the lungs by intratracheal delivery of AAV/Cre. No interferon was administered to induce multiorgan VEGF inactivation throughout these mice. A VEGFloxP mouse colony is maintained at the University of California, San Diego.

Recombinant AAV/Cre construction and intratracheal delivery.   An AAV helper-free system (Stratagene, La Jolla, CA; Ref. 37) was used for the production of AAV, which expresses cre recombinase (AAV/Cre) or control viruses AAV/EGFP and AAV/LacZ. These recombinant viruses were generated by using the complete reading frame of the cre recombinase gene (14) or control genes in addition to the strong cytomegalovirus promoter and SV40 poly A sequence to create a pAAV-Cre plasmid that carries the gene cassette between two AAV2 long terminal repeats and allows recombinant AAV/Cre to be assembled in 293 packaging cells by a standard calcium phosphate transfection method (CalPhos mammalian transfection kit, BD Sciences Clontech, Palo Alto, CA). Two hundred ninety-three packaging cells were collected 4 days after plasmid transfection, and recombinant AAVs were released by use of a freeze-thaw cell lysis method. Viral titer was estimated by comparison of known amounts of pAAV-Cre plasmid and serial dilutions of slot-blotted viral supernatant hybridized to a {alpha}32P dCTP oligo-labeled pAAV-Cre plasmid probe (Prime-It II random primer labeling kit, Stratagene, La Jolla, CA).

VEGFloxP and C57BL/6J mice were anesthetized with halothane and tracheally instilled with 100 µl of AAV/Cre, AAV/EGFP, or AAV/LacZ supernatant (2 x 1010 total viral particles) suspended in MEM (Invitrogen Life Technologies, Carlsbad, CA) immediately followed with a 200-µl bolus of perflubron (Rimar 101, Miteni, Tissino, Italy) to aid in viral delivery and distribution throughout distal lung regions. The mice were then kept at a 45° angle for ~1 min, during which time supplemental 100% oxygen was administered. Mice generally awoke from anesthesia within 1–2 min of halothane being discontinued and were kept in an oxygenated (10 l/min) plastic chamber warmed to 37°C for at least 15 min to aid in recovery.

Lung VEGF, flk-1, PCNA, and caspase-3 levels.   Frozen lung samples were homogenized in 50 mM Tris·HCl, 150 mM NaCl, 1% Triton X-100, and protease inhibitor complete tablet with EDTA (Roche Diagnostics, Indianapolis, IN). Protein concentrations were measured using the Bio-Rad Dc protein assay (Bio-Rad, Hercules, CA). Fifty micrograms of lung protein were denatured in loading buffer (0.25 M Tris pH 6.8, 20% glycerol, 4% SDS, 0.2 M DTT, 0.1% {beta}-mercaptoethanol, and 0.05% bromophenol blue) by boiling for 5 min and were electrophoresed on a 12% polyacrylamide gel. After electrophoretic transfer to Immobilon-P membrane (Millipore, Bedford, MA), blots were probed with the following primary antibodies: rabbit polyclonal anti-VEGF (147) (sc-507, 1:500 dilution), rabbit polyclonal anti-Flk-1 (C-20) (sc-315, 1:200), goat polyclonal anti-PCNA (C-20, 1:500), or goat polyclonal anti-caspase-3 p20 (L-18) (sc-1225, 1:500), all purchased from Santa Cruz Biotechnologies (Santa Cruz, CA) and detected with either mouse anti-goat IgG-HRP (sc-2354, Santa Cruz Biotechnologies) or anti-rabbit IgG-HRP (NA934, Amersham Life Science, Arlington Heights, IL) and enhanced chemiluminescence Western blotting detection reagents (Amersham Pharmacia Biotech UK Limited, Little Chalfont, UK).

Immunohistochemical localization of VEGF, cre recombinase, and PCNA.   The same primary antibodies described above for use in Western analysis were used to detect localized expression by immunohistochemical assay. To prepare paraffin-embedded lung sections, mice were anesthetized with pentobarbital sodium (40 mg/ml ip) and ventilated with 100% oxygen for 10 min. Lungs were then carefully removed and fixed with 4% paraformaldehyde by tracheal instillation at a pressure of 20 cmH2O while simultaneously immersed in paraformaldehyde solution overnight. Fixed lungs were then paraffin embedded and 7-µm were sections prepared on Vectabond (Vector Laboratories, Burlingame, CA)-treated glass slides (Fisherbrand Superfrost/Plus microscope slides). For VEGF detection, sections were deparaffinized, rehydrated, and sequentially blocked with avidin and biotin solutions (Avidin-Biotin Blocking Kit, Vector Laboratories) and 2% normal goat serum (30 min) and incubated with mouse-specific VEGF antibody (1:50 dilution) for 2 h followed by biotinylated anti-rabbit IgG (heavy and light) (1:1,000 dilution, Vector Laboratories) for 30 min. Signal was detected with Vectastain Universal ABC-AP reagent (30 min) and Vector Red substrate (30 min). Sections were counterstained with aqueous hematoxylin (Biomedia, Foster City, CA), dehydrated, cleared, and mounted with VectaMount mounting medium.

For cre recombinase detection in paraffin-embedded sections, an additional antigen retrieval step with 2.5 mg/ml pepsin-Tris solution, pH 2.0 (BioGenex, San Ramon, CA) for 5 min at 37°C was performed. Endogenous peroxides were quenched with 3% H2O2 in methanol (10 min); slides were sequentially blocked with avidin and biotin solutions and 5% normal goat serum and incubated for 1 h with rabbit polyclonal anti-cre antibody at 1:1,000 dilution (Novagen, Madison, WI), followed by anti-rabbit biotinylated secondary antibody. Signal was detected using Vectastain ABC reagent (30 min) and DAB (brown) substrate (6 min). PCNA detection was accomplished with a high-temperature (95°C) antigen-retrieval step with DAKO Target Retrieval Solution (DAKO, Carpinteria, CA) for 40 min. This step was again followed by avidin-biotin blocking steps and an additional block in 20% bovine serum-3% BSA-0.1 M Tris for 30 min. PCNA primary antibody was applied at a 1:25 dilution in 2% serum-1% BSA-PBS for 1.5 h. Specific antibody binding was detected with biotinylated anti-goat IgG (1:1,000), ABC-AP-0.1% Tween 20 reagent, and Vector Red substrate (30 min). Immunohistochemical analysis for each antibody was repeated with sections from three separate WT or VEGFloxP mice.

Estimation of air space enlargement by mean linear intercept.   A point-count morphometric technique was used to assess air space enlargement according to a modification of the method of Thurlbeck (32). Lungs from all mice were fixed at 20 cmH2O as described for immunohistochemical studies. Multiple digital images (at least 20 images per lung) were systematically taken at a x10 magnification of the entire cross section of paraformaldehyde-paraffin-embedded lungs. Images were overlaid with a 10 x 10 grid (1 mm2), and the mean linear intercept (MLI) was established from every second image (i.e., in a checkerboard fashion) such that 50% of the entire cross-sectional area was counted. Distribution of MLI for each mouse was assessed by frequency distribution analysis and characterized by use of a Gaussian model.

Evaluation of static lung mechanics.   The relationship between airway pressure and lung volume was measured in lungs isolated from WT and VEGFloxP mice at 5 and 8 wk postinfection. Mice were anesthetized with pentobarbital (40–60 mg/kg ip), the trachea was cannulated, the chest was opened, and heparin (100 units) was injected directly into the right ventricle. The heart and lungs were then carefully removed and suspended. Airway pressure was continuously monitored with a force-displacement transducer (Grass model F10E) and chart recorder. A 1-ml tuberculin syringe, graduated every 0.01 ml, was used to incrementally (0.05-ml increments) inflate and deflate the lungs. Airway pressure of 30 cmH2O was used as a target pressure for inflating control lungs, but VEGF-inactivated lungs could not withstand an airway pressure >20 cmH2O.

Caspase-3 enzyme activity.   Caspase-3 activity in lung homogenates was measured by using a caspase-specific peptide conjugated to the chromophore, {rho}-nitoanaline, and detected by spectrophotometer at 405 nm (Caspase-3 Colorimetric Kit, R & D Systems).

Apoptosis assay.   Lung paraffin sections were first labeled with the endothelial cell marker factor VIII-related antigen (Von Willebrand factor), before assay for apoptotic, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL)-positive cells. To allow antibody access, the slides were immersed for 5 min in DAKO target retrieval solution prewarmed to 95°C. As described above, sections were avidin-biotin blocked, PBS washed, blocked with 10% normal goat serum (10 min), and incubated with a rabbit polyclonal anti-factor VIII-related antigen (BioGenex, San Ramon, CA) diluted 1:10 in 5% goat serum (30 min). After primary antibody incubation, slides were PBS washed and incubated with biotinylated anti-rabbit antibody (1:500) for 10 min. Each section was again PBS rinsed and incubated with ABC-AP (twice the recommended concentration) for 10 min and detected with Vector Red substrate (30 min). Once a clear endothelial cell signal was confirmed by light microscopy, the slides were PBS rinsed and assayed for the presence of nuclear DNA fragmentation in situ. Each section was incubated with 50 µl of a TUNEL reaction mixture (2.5 µl of TUNEL enzyme, 2.5 µl of TUNEL dilution buffer and 45 µl of TUNEL label; Roche Diagnostics) for 30 min in a 37°C humid chamber. At the end of the labeling period, sections went through PBS rinse steps, were quenched with 3% H2O2, and were blocked in 20% serum-3% BSA-0.1 M Tris (20 min). TUNEL-positive signal was converted by use of a 1:2 dilution of TUNEL POD (Roche Diagnostics) in block solution and detected with a DAB (gray/black) substrate containing nickel (Vector Laboratories).

Statistical analysis.   A Student's t-test was used to compare control and experimental group densitometry readings from samples analyzed by Western blot. Control and experimental samples at each time point were electrophoresed on the same gel and transferred for antibody detection. Analysis of variance was used to determine MLI statistical differences between control and VEGF-inactivated lungs, and a Fishers post hoc test was used to distinguish statistical differences at each time point. P < 0.05 was considered significant for all analyses.


    RESULTS
 TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 GRANTS
 ACKNOWLEDGMENTS
 REFERENCES
 
Lung-specific VEGF inactivation in AAV/Cre-infected VEGFloxP mice.   Five weeks after AAV/Cre lung infection, there was an 86% decrease in the level of VEGF164 [WT 65.4 ± 16 densitometry units (du) vs. VEGFloxP 6.8 ± 4 du, P < 0.05] and 76% decrease in VEGF188 (WT 27.3 ± 13.5 du vs. VEGFloxP 6.5 ± 4.3 du, P < 0.05). Both VEGF isoform levels returned to control values by 8 wk (Fig. 1A). The level of VEGF receptor, VEGFR-2 (Flk-1/KDR), was also evaluated by Western blot at 5 and 8 wk postinfection with AAV/Cre. It was significantly decreased, by 51%, in VEGFloxP mice at 5 wk (WT 103.9 ± 14.2 du vs. VEGFloxP 51.3 ± 5.5 du, P < 0.05), but not at 8 wk (Fig. 1B). No change in {beta}-actin levels was observed at either time point (Fig. 1C). In WT mice (Fig. 1Da), VEGF could be detected by immunohistochemistry in large airway epithelial cells and pulmonary artery smooth muscle cells. In the parenchymal region it was seen mostly in the alveolar epithelial cells with less intense expression in fibroblasts. In VEGFloxP mice (Fig. 1Db), diffuse regions of the parenchyma displayed an absence or decreased expression of VEGF compared with WT. By using an anti-cre antibody to detect the distribution of virus-infected cells (Fig. 1E), cre expression was found to be similar in AAV/Cre-infected WT and VEGFloxP mouse lungs with a uniform signal detected throughout the parenchyma and high levels of cre recombinase detected in the large airways (Fig. 1E, a and b). No cre expression was observed in the lungs of mice infected with an adeno-associated virus expressing the enhanced green fluorescent protein (AAV/EGFP, Fig. 1Ec).



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Fig. 1. Decreased VEGF and VEGF receptor VEGFR-2 levels in adeno-associated cre combinase virus (AAV/Cre) tracheally instilled mouse lung. A: Western analysis of mouse lung tissue reveals VEGF188 and VEGF164 isoforms. VEGF is decreased in lungs isolated from VEGFloxP mice compared with wild-type (WT) mouse lungs after in vivo lung specific infection with AAV/Cre at 5 wk (arrow). B: VEGFR-2 levels per total lung protein were also decreased at 5 wk but not at 8 wk postinfection of VEGFloxP mice with AAV/Cre compared with WT. C: {beta}-actin levels were equivalent in all groups. D: immunohistochemical detection of VEGF regional expression reveals positive staining in the large airways and alveolar epithelial cells and fibroblasts in WT lungs (a). Regions of AAV/Cre-infected VEGFloxP lungs demonstrate a decrease in VEGF positive cells throughout the parenchyma (b). Sections incubated without primary antibody reveal no nonspecific staining (c). E: Cre-positive cells are widely detected throughout both WT (a) and VEGFloxP lungs (b) of mice infected with AAV/Cre but not mice infected with AAV/EGFP (c).

 
Morphometric analysis of air space enlargement.   Histological sections revealed air space enlargement in VEGFloxP mice (Fig. 2). This corresponded to a greater MLI. Both findings were noted at 5 and 8 wk. The distribution analysis of MLI revealed no differences between AAV/Cre-infected WT mice at either time point (MLI: 27.9 ± 3.4 and 28.1 ± 3.0 µm at 5 and 8 wk, respectively). At 5 wk, VEGFloxP mice showed a dramatically increased MLI of 40.6 ± 5.0 µm, an increase of 41%. It is salient that the standard deviation of the Gaussian distribution was also significantly increased, reflecting the "patchy" nature of the changes. The difference between MLI in VEGFloxP and WT mice remained significant (P < 0.05) at 8 wk, at 36.6 µm, as did the high standard deviation (4.7 µm). No significant difference in MLI was detected between 5- and 8-wk AAV/Cre-infected VEGFloxP lungs.



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Fig. 2. Evidence of air space enlargement in VEGF-deficient lungs. Top: the mean linear intercept frequency distribution for WT and VEGFloxP transgenic mice, which express cre recombinase for 5 or 8 wk. Values represent the distribution of chord lengths from VEGFloxP and WT mice at 5 and 8 wk (n = 5–6 mice). VEGFloxP chord lengths at 5 and 8 wk are significantly different from corresponding WT values, *P < 0.05. Bottom: representative hematoxylin-stained lung sections from WT and VEGFloxP mouse lungs 5 wk post-AAV/Cre infection.

 
Decreased elastic recoil in VEGF-deficient mouse lung.   The pressure-volume relationship showed an increase in lung compliance concomitant with decreased pulmonary VEGF expression at 5 wk. Thus at 5 wk there was a shift in the deflation limb of the pressure-volume curve to the left (Fig. 3). VEGF-deficient lungs were not able to maintain high airway pressures with increasing lung volumes and ruptured above ~20 cmH2O. At 5 wk, a lung volume of 0.5 ml corresponded to an airway pressure of 21.3 ± 4 cmH2O in WT mice but to only 11.8 ± 3.3. cmH2O in VEGFloxP mouse lungs. At 8 wk postinfection, despite a return in the level of VEGF comparable to WT, lung compliance remained raised, consistent with the increased MLI still observed at this time point. In addition, the variability between animals was reduced compared with that at 5 wk. At 8 wk, inflation to a lung volume of 0.5 ml produced airway pressures of 25.7 ± 2.9 cmH2O in AAV/Cre-infected WT mice, 22.0 ± 0.6 cmH2O in VEGFloxP mouse lungs infected with the reporter virus (AAV/EGFP) and significantly lower values of 9.2 ± 0.3 cmH2O in AAV/Cre-infected VEGFloxP mouse lungs. Thus the AAV/Cre-infected VEGFloxP mouse lungs were inflated to a larger lung volume than control groups at a given pressure at both 5 and 8 wk.



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Fig. 3. Decreased elastic recoil in AAV/CRE-infected VEGFloxP mouse lung. The pressure-volume relationship was measured in lungs isolated from AAV/Cre-infected WT mice ({blacklozenge}), AAV/Cre-infected VEGFloxP transgenic mice ({blacksquare}), AAV/enhanced green fluorescent protein-infected WT mice ({blacktriangleup}), and noninfected WT mice ({bullet}) 5 (A) and 8 (B) wk after viral delivery. Data represent means ± SD of the pressure-volume value measured during lung deflation; n = 3–4 separate mouse lungs.

 
Increased apoptosis in VEGF-deficient mouse lung.   No change in the level of PCNA was observed at 5- and 8-wk time points (Fig. 4A). This was corroborated in the similar distribution of PCNA-positive cells between AAV/Cre-infected WT and VEGFloxP mouse lungs at 5 wk (Fig. 4B). Evidence of apoptosis in VEGF-deficient lungs, evaluated by the level of the active caspase-3 subunit by Western blot, revealed a 5.2-fold increase (P < 0.05) at 5 wk compared with WT. No difference between WT and VEGFloxP lung caspase-3 levels was seen at 8 wk after viral delivery (Fig. 5A). Changes in total caspase-3 levels corresponded to a 2.5-fold increase in caspase-3 enzyme activity (Fig. 5C). Lung sections were also costained for the endothelial marker, von Willebrand factor, and TUNEL-positive, apoptotic cells. An increased number of apoptotic cells were present in the alveolar wall and endothelial cells of small arteries in VEGFloxP mouse lungs compared with WT controls. TUNEL-positive cells were also observed in the epithelial cells of large airways in VEGFloxP mouse lungs (Fig. 5C). No influx of inflammatory cells was observed by light microscopy of hematoxylin-stained sections or after immunohistochemistry with an anti-mouse CD11b (Mac-1)-specific antibody in any study group.



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Fig. 4. Pulmonary VEGF inactivation did not alter proliferation. A: Western analysis of PCNA levels from WT and VEGFloxP mice at 5 and 8 wk postinfection with AAV/Cre revealed no change. B: this is reflected in a similar distribution of PCNA detected by immunoassay in 7-µm sections from both AAV/Cre-infected WT (a) and VEGFloxP (b) mice.

 


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Fig. 5. Increased apoptosis in VEGF-inactivated mouse lung. A: the active subunit of the apoptotic cysteine protease, caspase-3, was measured as an indication of increased apoptosis. Caspase-3 levels are increased in Western blots of AAV/CRE-VEGFloxP mouse lung protein compared with AAV/Cre-WT lung 5 wk postinfection. Caspase-3 levels were unchanged at 8 wk. B: immunohistochemical analysis with an endothelial cell marker, von Willebrand factor, and detection of deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL)-positive, apoptotic cells revealed increased apoptosis in VEGFloxP mouse lung small arteries and throughout the parenchyma (b), as indicated by arrows, with little presence of apoptotic cells in control lungs (a). Numerous apoptotic, TUNEL-positive cells are also present in the large airway epithelial (d) compared with control (c). C: increased caspase-3 activity was observed in AAV/CRE-VEGFloxP lungs compared with adeno-associated LacZ virus (AAV/LacZ)-infected VEGF lungs at 5 wk.

 

    DISCUSSION
 TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 GRANTS
 ACKNOWLEDGMENTS
 REFERENCES
 
Pathological consequences of partial, transient VEGF inactivation.   The main conclusion from this study is that partial, transient inactivation of the pulmonary VEGF gene leads to apoptosis of alveolar septal wall cells, air space enlargement, and increased lung compliance. The apoptotic cells are presumably cleared by normal and efficient apoptotic pathways, but for at least 8 wk the lung is ineffective in regenerating the damaged alveolar wall, leading to increases in alveolar size and decreased elastic recoil. These structural changes persisted despite the restoration of normal cellular levels of pulmonary VEGF.

In the present experiment, the VEGF gene itself [and not the receptor, as in Kasahara et al. (19)] was inactivated through delivery of cre recombinase to the pulmonary airways. VEGF is a well-known and potent mitogen for endothelial cells and has additionally been reported to regulate epithelial cell proliferation (4, 23). Thus both VEGF-producing cells and VEGF-receptor-presenting target cells have the potential of being affected by VEGF-dependent signaling. In the present study, apoptosis was observed in both bronchial epithelial cells and alveolar septal wall cells. This occurred without an accompanying change in cell proliferation. Thus an increase in the rate of cell death without a change in proliferative response led to a net loss of pulmonary cells and an emphysema-like phenotype.

VEGF withdrawal and capillary regression in the lung.   Withdrawal of VEGF from newly formed vessels in developing and postnatal organs including the retina, heart, and liver leads to endothelial cell apoptosis and regression of capillary structures (3, 8, 11). The formation of mature vessels (refractory to the withdrawal of VEGF) in the retina is thought to occur through incorporation of pericytes or smooth muscle cells around nascent vessels (3). In addition, we have recently demonstrated in adult mouse skeletal muscle that VEGF is necessary to maintain capillary number under normal activity conditions (30). The present study demonstrates that the lung, an organ containing one of the most abundant amounts of VEGF (26), also requires a sufficient amount of VEGF to continuously maintain the vast network of small blood vessels and capillaries throughout the lung parenchyma. Furthermore, it is the alveolar structures that appear to be most susceptible to the loss of VEGF in this lung-targeted model.

Changes in alveolar structure.   Emphysema is characterized by the permanent change in alveolar structure distal to the terminal bronchioles. The transient decrease in VEGF and its receptor VEGFR-2 (KDR) also leads to a concomitant increase in caspase-3 activity and presence of TUNEL-positive cells. Although apoptosis did not persist up to 8 wk after AAV/Cre delivery, changes in alveolar structure (reflected by increased MLI, MLI distribution, and lung compliance) remained. This observation raises the possibility that apoptosis may be a critical step in the development of emphysema. More direct evidence for apoptosis to lead to permanent changes in lung structure was recently reported by Aoshiba et al. (1). Direct delivery of caspase-3 or nodularin (a proapoptotic serine/threonine kinase inhibitor) to the airways led to the rapid initiation of alveolar septal cell apoptosis that was detectable by 2 h and rapidly cleared by 6 h (1). This very transient apoptotic episode resulted in enlargement of the air spaces that lasted for 15 days with only a very modest 14% recovery in mean chord length. Thus lung alveolar septal cell apoptosis possibly due to deficient VEGF levels in emphysema patients may be an early event in the development of air space enlargement and decrease in lung elastic recoil (18, 21, 28).

Absence of pulmonary inflammation.   Cigarette smoke-induced emphysema is characterized by a robust inflammatory response. Current hypotheses implicate matrix metalloproteinase-12 and/or additional matrix metalloproteinases released from macrophages, which initiate release of TNF-{alpha}, expression of vascular adhesion molecules (e-selectin and VCAM-1), and subsequent neutrophil influx (5, 15). Activation and release of neutrophil elastase then contributes to the breakdown of the extracellular matrix (5). However, similar to experimental VEGFR-2 blockade with the tyrosine kinase inhibitor SU5416 (19) or caspase-3 administration (1), we did not observe an inflammatory response after gene inactivation of pulmonary VEGF. Apoptosis itself would not be expected to generate an immune response. Programmed cell death, or apoptosis, targets cells for phagocytosis as a normal part of development or tissue remodeling in adult organisms. Critical steps in the apoptotic process include DNA fragmentation, cell condensation, and presentation of phosphatidylserine on the membrane surface (9, 16). Recognition of phosphatidylserine by bridging molecules such as SP-A, SP-D, and C1q, along with cells that express phosphatidylserine receptor, allows efficient clearance of apoptotic cells before complete lysis and release of proinflammatory mediators (35). Moreover, in addition to bypassing the innate immune response, apoptotic signals upregulate anti-inflammatory mediators such as transforming growth factor-{beta}1 and prostaglandin E2 to suppress inflammation. Our findings suggest that apoptosis without necrosis-triggered inflammation (2) is sufficient to initiate lung remodeling and alter pulmonary mechanics.

It is unclear at this time whether the VEGF deficiency observed in the lungs of cigarette smoke-induced emphysema patients is the cause of apoptosis that leads to alveolar septal wall destruction or is a consequence of cigarette smoke-induced transcriptional inhibition, possibly through reactive oxygen species or toxic aldehyde signaling (22, 29). Toxic agents in cigarette smoke could lead to necrosis and release of proinflammatory agents (36). However, persistent apoptosis could also progress into postapoptotic necrosis, possibly through protease cleavage or oxidative modification of the phosphatidylserine receptor resulting in inefficient cell clearance (16, 34, 35). Furthermore, it is unknown how VEGF inactivation may limit vascular permeability, usually associated with inflammation, and potentially prevent the access of antiproteases (i.e., {alpha}1-anti-trypsin, secretory leukocyte proteinase inhibitor, or elafin) that could moderate extracellular matrix breakdown.

An imbalance of proteases and antiproteases in this model of pulmonary VEGF inactivation has yet to be established. However, the role of oxidants has been addressed in the SU5416 VEGFR-2 blockade model. Experiments presented by Tuder et al. (33) suggest that alveolar wall destruction resulting from VEGFR-2 inhibition can be prevented by reducing oxidative stress with the superoxide dismutase mimetic M40419. Antioxidant-dependent preservation of lung structure in SU5416-treated mice was accompanied by increased septal cell proliferation and enhanced phosphorylation of the anti-apoptotic kinase Akt (33). Thus oxidants could influence several cellular pathways with low levels of reactive oxygen species signaling VEGF transcription and cell proliferation and excessive oxidant levels promoting the destructive path to emphysema in the absence of VEGF protection (22, 29, 33).

Overall, this study suggests that VEGF is an important growth factor for the maintenance and protection of normal adult mouse lung. Substantial VEGF gene reduction in adult mice using a Cre-LoxP strategy leads to an emphysema-like phenotype that persisted for at least 8 wk postdeletion. The mechanism by which pulmonary VEGF inactivation leads to permanent changes in lung structure and the contribution of VEGF to cigarette smoke-induced emphysema remains to be fully elucidated.


    GRANTS
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 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 GRANTS
 ACKNOWLEDGMENTS
 REFERENCES
 
This study was funded by National Heart, Lung, and Blood Institute Grant PPG 5P01HL17731 and the Tobacco-Related Disease Research Program Grant 12RT-0063. H. B. Rossiter is a Fellow of the Wellcome Trust UK 064898.


    ACKNOWLEDGMENTS
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 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 GRANTS
 ACKNOWLEDGMENTS
 REFERENCES
 
We thank Dr. Napoleone Ferrara from Genentech, South San Francisco, CA for providing the VEGFLoxP transgenic mouse strain.


    FOOTNOTES
 

Address for reprint requests and other correspondence: E. C. Breen, Univ. of California, San Diego, Dept. of Medicine 0623A, 9500 Gilman Dr., La Jolla, CA 92093-0623 (E-mail: ebreen{at}ucsd.edu).

The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.


    REFERENCES
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 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 GRANTS
 ACKNOWLEDGMENTS
 REFERENCES
 

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