TY - JOUR
T1 - The Aryl Hydrocarbon Receptor is a Critical Regulator of Tissue Factor Stability and an Antithrombotic Target in Uremia
AU - Shivanna, Sowmya
AU - Kolandaivelu, Kumaran
AU - Shashar, Moshe
AU - Belghasim, Mostafa
AU - Al-Rabadi, Laith
AU - Balcells, Mercedes
AU - Zhang, Anqi
AU - Weinberg, Janice
AU - Francis, Jean
AU - Pollastri, Michael P.
AU - Edelman, Elazer R.
AU - Sherr, David H.
AU - Chitalia, Vipul C.
N1 - Funding Information:
The authors acknowledge Dr. David Salant (Boston University School of Medicine [BUSM]) for helpful discussions throughout the development of this work and for reviewing the manuscript, and thank both Dr. Nigel Mackman (University of North Carolina) for the development of the procoagulant TF activity assay and Dr. A. Puga (University of Cincinnati) for providing AHR KO and KI cells. We acknowledge Drs. Grace Zhao, Tan Josenia, and Elena Metrikova for immunohistochemistry, Olga Novikov for RT-PCR (all at BUSM), and Fernando Polite(Universitat Ramon Llull, and Massachusetts Instituteof Technology) for their technical assistance. We thank Drs. William Chan (Pacific University) for bacloviral particles for AHR and Irene Bosch (Massachusetts Institute of Technology) and Nader Rahimi (BUSM) for bacloviral AHR protein production. We appreciate Jamaica Siwak (BUSM) for proofreading the manuscript. This work was funded in part by grant NIH/NIDDK K08-DK080946 (V.C.C.), grant P42-ES007381 and the Art BeCAUSE Breast Cancer Foundation (D.H.S.), a Sharon Anderson Research Fellowship grant award from the American Society of Nephrology (M.S.), an AHA Fellow to Faculty Transition grant 12FTF12080241 (K.K.), grant RO1GM-49039 (E.R.E.), and by grant BFU2009-09804 from Spain''s Ministerio de Ciencia e Innovación, by Posimat, and by Fundació Empreses IQS (M.B.). A part of this workwas submitted as an abstract at the 2015 Annual American Society of Nephrology meeting on November 4-8, San Diego, CA. V.C.C. and D.H.S designed the research, S.S., M.S., and L.A. performed the experiments, Mo.B. performed the immunofluorescence studies, K.K,Me.B., and E.R.E. designed and performed the flow loop experiments, and M.S. and J.F. collected and compiled the human data. A.Z. performed the metabolomics screen, J.W. guided the statistical analysis, S.S, M.S., Mo.B., and V.C.C prepared the figures, V.C.C, prepared the manuscript, and D.H.S., E.R.E, and K.K. edited the manuscript.
Publisher Copyright:
© 2016 by the American Society of Nephrology.
PY - 2016/1
Y1 - 2016/1
N2 - Patients withCKDsuffer high rates of thrombosis, particularly after endovascular interventions, yet few options are available to improve management and reduce thrombotic risk. We recently demonstrated that indoxyl sulfate (IS) is a potent CKD-specific prothrombotic metabolite that induces tissue factor (TF) in vascular smooth muscle cells (vSMCs), although the precisemechanismand treatment implications remain unclear. Because IS is an agonist of the aryl hydrocarbon receptor (AHR), we first examined the relationship between IS levels and AHR-inducing activity in sera of patients with ESRD. IS levels correlated significantly with both vSMC AHR activity and TF activity. Mechanistically, we demonstrated that IS activates the AHR pathway in primary human aortic vSMCs, and further, that AHR interacts directly with and stabilizes functional TF. Antagonists directly targetingAHRenhanced TF ubiquitination and degradation and suppressed thrombosis in a postinterventional model of CKD and endovascular injury. Furthermore, AHR antagonists inhibited TF in amanner dependent on circulating IS levels. In conclusion, we demonstrated that IS regulates TF stability through AHR signaling and uncoveredAHRas an antithrombotic target andAHRantagonists as a novel class of antithrombotics. Together, IS and AHR have potential as uremia-specific biomarkers and targets that may be leveraged as a promising theranostic platform to better manage the elevated thrombosis rates in patients with CKD.
AB - Patients withCKDsuffer high rates of thrombosis, particularly after endovascular interventions, yet few options are available to improve management and reduce thrombotic risk. We recently demonstrated that indoxyl sulfate (IS) is a potent CKD-specific prothrombotic metabolite that induces tissue factor (TF) in vascular smooth muscle cells (vSMCs), although the precisemechanismand treatment implications remain unclear. Because IS is an agonist of the aryl hydrocarbon receptor (AHR), we first examined the relationship between IS levels and AHR-inducing activity in sera of patients with ESRD. IS levels correlated significantly with both vSMC AHR activity and TF activity. Mechanistically, we demonstrated that IS activates the AHR pathway in primary human aortic vSMCs, and further, that AHR interacts directly with and stabilizes functional TF. Antagonists directly targetingAHRenhanced TF ubiquitination and degradation and suppressed thrombosis in a postinterventional model of CKD and endovascular injury. Furthermore, AHR antagonists inhibited TF in amanner dependent on circulating IS levels. In conclusion, we demonstrated that IS regulates TF stability through AHR signaling and uncoveredAHRas an antithrombotic target andAHRantagonists as a novel class of antithrombotics. Together, IS and AHR have potential as uremia-specific biomarkers and targets that may be leveraged as a promising theranostic platform to better manage the elevated thrombosis rates in patients with CKD.
UR - http://www.scopus.com/inward/record.url?scp=84954444245&partnerID=8YFLogxK
U2 - 10.1681/ASN.2014121241
DO - 10.1681/ASN.2014121241
M3 - Article
C2 - 26019318
AN - SCOPUS:84954444245
SN - 1046-6673
VL - 27
SP - 189
EP - 201
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 1
ER -