Arterial calcification is a highly regulated form of biomineralization that proceeds via mechanisms resembling membranous and endochondral bone formation. Reactive oxygen species (ROS), arising from the low grade inflammation of diabetes and dyslipidemia, initiate osteogenic signals that promote valve and arterial calcium accrual. Msx2 -- Wnt cascades are recruited to direct osteogenic lineage allocation of vascular myofibroblasts;this is amplified by osteochondrogenic trans-differentiation of vascular smooth muscle cells (VSMCs) - a characteristic change with hyperphosphatemia and atherosclerosis. In patients with type II diabetes (T2DM), medial artery calcification is a powerful index of lower extremity amputation risk;arteriosclerotic medial calcification is a much more ominous predictor of amputation than atherosclerotic calcification. Strategies that reduce aortofemoral arteriosclerosis and maintain vascular compliance will improve tissue perfusion, and mitigate amputation risk. Previously, we examined the impact of inflammation, teriparatide (suppresses vascular Msx2), and osteopontin (OPN) on aortic structure, calcification, and compliance. OPN actions emerged as biologically complex and stage-specific. Diabetic LDLR-/- mice null for OPN exhibit reduced aortic macrophage content, inflammation, and ROS - yet exhibit increased aortic stiffness even without calcification. Although initially reduced, aortic calcium load subsequently becomes more severe in diabetic OPN-null mice with disease progression. A protease-liberated OPN fragment promotes vascular ROS and MMP9 activation. Thus, OPN is an inflammatory pro-hormone as well as a mineralization inhibitor and adhesion molecule. A better understanding of OPN and Msx2 in the biology of diabetic arterial calcification is needed. Therefore, specific aims are:
Aim 1 : "To define the roles of VSMC vs. macrophage OPN in regulation of diabetic aortic calcification and compliance, using SM22- OPNTg(+);OPN-/-;LDLR-/- and SRA-OPNTg(+);OPN-/-;LDLR-/- mice as models for study." We study OPN actions in VSMC (SM22) and the monocyte/macrophage lineage (scavenger receptor A promoter), evaluating the impact on mural inflammation, macrophage accumulation, matrix remodeling, aortic structure, arterial calcium accrual, and aortic compliance.
Aim 2 : "To establish the role of vascular Msx2 on diabetic aortic calcification, evaluating diabetic SM22- CreTg(+);Msx2(flox/flox);LDLR-/- mice as a model for study." The identification of distinct phases of initiation vs. progression in diabetic arterial calcification has significant implications for vascular health management. Thus, we evaluate the roles of vascular Msx2 and OPN on initiation vs. progression phases of diabetic arteriosclerotic disease.

Public Health Relevance

Project Lay Narrative: Arterial hardening in diabetes increases the risk for heart attacks &foot amputation. This occurs in part via metabolic &inflammatory signals that induce bone-like calcification in large arteries. We test whether regulation of these signals reduces arterial hardening, decreases cardiac workload, and improves blood flow to the foot.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Atherosclerosis and Inflammation of the Cardiovascular System Study Section (AICS)
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Srinivas, Pothur R
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Washington University
Internal Medicine/Medicine
Schools of Medicine
Saint Louis
United States
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Towler, Dwight A (2016) AMPKα1: SUMO Wrestling Runx2 as a Strategy to Inhibit Arteriosclerotic Calcification. Circ Res 119:398-400
Cheng, Su-Li; Ramachandran, Bindu; Behrmann, Abraham et al. (2015) Vascular smooth muscle LRP6 limits arteriosclerotic calcification in diabetic LDLR-/- mice by restraining noncanonical Wnt signals. Circ Res 117:142-56
Towler, Dwight A (2015) Arteriosclerosis, bone biology, and calciotropic hormone signaling: learning the ABCs of disease in the bone-vascular axis. J Am Soc Nephrol 26:243-5
Towler, Dwight A (2015) Arteriosclerotic Calcification: A Serpi(n)ginous Path to Cardiovascular Health? Circ Res 117:744-6
Cheng, Su-Li; Behrmann, Abraham; Shao, Jian-Su et al. (2014) Targeted reduction of vascular Msx1 and Msx2 mitigates arteriosclerotic calcification and aortic stiffness in LDLR-deficient mice fed diabetogenic diets. Diabetes 63:4326-37
Towler, Dwight A (2014) The platelet: sensing shear and the endocrine regulation of cardiovascular sclerosis. Arterioscler Thromb Vasc Biol 34:1803-5
Towler, Dwight A (2013) Molecular and cellular aspects of calcific aortic valve disease. Circ Res 113:198-208
Towler, Dwight A (2013) Chronic kidney disease: the "perfect storm" of cardiometabolic risk illuminates genetic diathesis in cardiovascular disease. J Am Coll Cardiol 62:799-801
Cheng, Su-Li; Shao, Jian-Su; Behrmann, Abraham et al. (2013) Dkk1 and MSX2-Wnt7b signaling reciprocally regulate the endothelial-mesenchymal transition in aortic endothelial cells. Arterioscler Thromb Vasc Biol 33:1679-89
Towler, Dwight A (2013) Mitochondrial ROS deficiency and diabetic complications: AMP[K]-lifying the adaptation to hyperglycemia. J Clin Invest 123:4573-6

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