Retrospective epidemiological studies have demonstrated that patients with chronic inflammatory skin disease have an increased risk for developing and dying of cardiovascular disease (CVD), including myocardial infarction and stroke. Inflammatory cascades that mediate skin disease and CVD have striking similarities including activation of antigen presenting cells and macrophages, involvement of Th1, Th17 and regulatory T cells, and critical roles for IL-12p40, IL-17 and TNF. Whether remote inflammation has the capacity to initiate atherosclerosis and/or thrombosis pathogenesis is as yet undetermined. To determine if remote inflammation can instigate co-morbid complications such as CVD, we engineered a tetracycline-repressible binary mouse model of chronic inflammation by ectopically expressing the angiopoeitin receptor, Tie2 exclusively to keratinocytes (KC). The KC-Tie2 mouse develops unremitting skin inflammation characterized by dermal infiltrating leukocytes and increased proinflammatory cytokines. Most significant for the current proposal is ~33% of KC-Tie2 mice on a wild type background spontaneously develop atherosclerotic plaque and have elevated levels of pro-atherogenic CD11b+Ly-6Chi monocytes. Moreover, the time to occlusive thrombus formation in KC-Tie2 animals is significantly shortened compared to control littermates. The opportunity to study a model of chronic skin-confined inflammation that develops CVD co-morbidities in the absence of any of the standard CVD risk factors (e.g. hyperlipidemia, hypertension, diabetes) provides an innovative preclinical opportunity to identify pro-atherogenic and pro-thrombotic cellular mechanism(s) mediated by long term non-vascular inflammation. We hypothesize that chronic inflammation increases circulating CD11b+Ly-6Chi monocytes and promotes atherothrombosis. Using a combination of mouse molecular genetics, therapeutic targeting strategies utilizing small molecule inhibitors and function blocking antibodies, coupled with bone marrow and skin transplant approaches we propose to identify pro-atherogenic and pro-thrombotic cellular mechanism(s) elicited by chronic skin-specific inflammation. Collectively, our studies will elucidate the cellular basis underlying chronic remot inflammation-mediated atherothrombosis. The results of these studies will provide insight into the etiology and development of novel therapies directed towards CVD co-morbidities associated with chronic inflammatory diseases including rheumatoid arthritis, colitis, gum disease, psoriasis and lupus.

Public Health Relevance

There is an increased prevalence of ischemic heart disease, cerebrovascular disease, peripheral artery disease and an increased risk of death in individuals suffering from chronic inflammatory diseases, such as rheumatoid arthritis (RA), colitis, gum disease, psoriasis and lupus. Understanding the cellular and molecular mechanisms linking remote inflammation and cardiovascular disease will provide new knowledge as to why this relationship exists and more importantly will provide novel therapeutic development strategies directed at the treatment of the cardiovascular co-morbidities associated with chronic inflammation.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
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Atherosclerosis and Inflammation of the Cardiovascular System Study Section (AICS)
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Cibotti, Ricardo
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Case Western Reserve University
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