The main goal of this grant proposal titled ?Cellular and Circulating Fortilin in Vascular Diseases? is to test the central hypothesis that both cellular and circulating fortilin inhibit the TGF?1 pathway and promote atherosclerosis by binding and inhibiting the key intracellular and extracellular components of the pathway. The innovative hypothesis is well supported by abundant and exciting preliminary data. Atherosclerosis is the thickening of the wall of arteries that limits transport of oxygen-containing blood to vital organs and affects every level of the vasculature from the aorta and coronary arteries to capillaries and microcirculation. It remains one of the most serious health problems in the U.S. today and costs nearly $286 billion every year. Lowering of the low-density lipoprotein (LDL) levels alone does not eliminate atherosclerosis, as the Cochrane Organization showed that a drastic reduction of LDL by PCSK9 inhibitors only modestly decreased cardiovascular morbidity/mortality. Thus, new molecules, the targeting of which would lead to halting of the progression of atherosclerotic vasculopathy, must be identified. Fortilin is a 172-amino acid multi- functional protein that is not only abundantly expressed in atherosclerotic tissue but is also present in circulation (like cytokines and hormones) at higher levels in the presence of atherosclerosis. Fortilin is implicated in various biological functions but most notably in regulation of reactive oxygen species (ROS, redox), ER stress, and apoptosis. We found that when circulating fortilin was neutralized, hypercholesterolemic (HC) mice developed less atherosclerosis. In addition, we found that the deletion of fortilin in macrophages (M?) led to less atherosclerosis in HC mice. To explore the mechanism by which fortilin facilitates atherosclerosis, we performed a systematic, unbiased NGS RNA-Seq assay and found that the lack of M? fortilin robustly activated the anti-atherosclerotic TGF?1 pathway. Further studies showed that fortilin binds and inhibits the key molecules of the pathway?extracellular TGF?1 and intracellular Smad3?and kept M? in the pro-inflammatory, pro-atherosclerotic phenotype. In the current project, we will first test the hypothesis that circulating fortilin facilitates atherosclerosis by binding and inhibiting TGF?1 and by polarizing M? to the anti- inflammatory phenotype (Aim 1). We will then test the hypothesis that cellular fortilin in M? facilitates atherosclerosis by binding and inhibiting Smad3 and by polarizing M? to the anti-inflammatory phenotype (Aim 2). With all Aims successfully completed, the project will lead to two distinct and highly innovative strategies to halt atherosclerosis: (i) using ?-fortilin mAb to disrupt the interaction between circulating fortilin and TGF?1 in the extracellular space to free up anti-atherosclerotic TGF?1 from its inhibitor fortilin and (ii) generating and using small molecular weight (SMW) compounds that disrupt the fortilin-Smad3 interaction to allow Smad3 to be activated.

Public Health Relevance

Millions of Americans live with atherosclerotic vascular diseases, including coronary artery disease (CAD), which is the single most frequent cause of death in the U.S. Fortilin is a molecule that both circulates in the blood and is expressed at high levels in macrophages in patients with atherosclerosis. Here, we present a new therapeutic strategy to ameliorate atherosclerotic vascular diseases by blocking circulating and cellular fortilin.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
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Olive, Michelle
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University of Washington
Internal Medicine/Medicine
Schools of Medicine
United States
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Pinkaew, Decha; Chattopadhyay, Abhijnan; King, Matthew D et al. (2017) Fortilin binds IRE1? and prevents ER stress from signaling apoptotic cell death. Nat Commun 8:18
Pinkaew, Decha; Fujise, Ken (2017) Fortilin: A Potential Target for the Prevention and Treatment of Human Diseases. Adv Clin Chem 82:265-300
Chattopadhyay, Abhijnan; Pinkaew, Decha; Doan, Hung Q et al. (2016) Fortilin potentiates the peroxidase activity of Peroxiredoxin-1 and protects against alcohol-induced liver damage in mice. Sci Rep 6:18701
Sinthujaroen, Patuma; Wanachottrakul, Nattaporn; Pinkaew, Decha et al. (2014) Elevation of serum fortilin levels is specific for apoptosis and signifies cell death in vivo. BBA Clin 2:103-111
Pinkaew, Decha; Le, Rachel J; Chen, Yanjie et al. (2013) Fortilin reduces apoptosis in macrophages and promotes atherosclerosis. Am J Physiol Heart Circ Physiol 305:H1519-29