title: Alternatively spliced tissue factor promotes plaque angiogenesis through the activation of hypoxia-inducible factor-1α and vascular endothelial growth factor signaling.
abstract: BACKGROUND
  Alternatively spliced tissue factor (asTF) is a novel isoform of full-length tissue factor, which exhibits angiogenic activity. Although asTF has been detected in human plaques, it is unknown whether its expression in atherosclerosis causes increased neovascularization and an advanced plaque phenotype.
  
  
  RESULTS
  Carotid (n=10) and coronary (n=8) specimens from patients with stable or unstable angina were classified as complicated or uncomplicated on the basis of plaque morphology. Analysis of asTF expression and cell type-specific expression revealed a strong expression and colocalization of asTF with macrophages and neovessels within complicated, but not uncomplicated, human plaques. Our results showed that the angiogenic activity of asTF is mediated via hypoxia-inducible factor-1α upregulation through integrins and activation of phosphatidylinositol-3-kinase/Akt and mitogen-activated protein kinase pathways. Hypoxia-inducible factor-1α upregulation by asTF also was associated with increased vascular endothelial growth factor expression in primary human endothelial cells, and vascular endothelial growth factor-Trap significantly reduced the angiogenic effect of asTF in vivo. Furthermore, asTF gene transfer significantly increased neointima formation and neovascularization after carotid wire injury in ApoE(-/-) mice.
  
  
  CONCLUSIONS
  The results of this study provide strong evidence that asTF promotes neointima formation and angiogenesis in an experimental model of accelerated atherosclerosis. Here, we demonstrate that the angiogenic effect of asTF is mediated via the activation of the hypoxia-inducible factor-1/vascular endothelial growth factor signaling. This mechanism may be relevant to neovascularization and the progression and associated complications of human atherosclerosis as suggested by the increased expression of asTF in complicated versus uncomplicated human carotid and coronary plaques.
authors.affiliation: From the AtheroThrombosis Research Unit (C.G., M.A., D.T.R., J.J.B.), Cardiovascular Research Institute (C.G., D.K.Y., D.J., J.C.K., T.W., R.J.H., V.F.), Translational and Molecular Imaging Institute (C.C., A.M., Z.A.F.), Department of Radiology (C.C., A.M., Z.A.F.), and Vascular Surgery (P.L.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Memorial Sloan-Kettering, New York, NY (G.A.S.); and CNIC, Madrid, Spain (V.F.). chiara.giannarelli@mssm.edu.
authors.forename: Chiara
authors.initials: C
authors.lastname: Giannarelli
authors.affiliation: From the AtheroThrombosis Research Unit (C.G., M.A., D.T.R., J.J.B.), Cardiovascular Research Institute (C.G., D.K.Y., D.J., J.C.K., T.W., R.J.H., V.F.), Translational and Molecular Imaging Institute (C.C., A.M., Z.A.F.), Department of Radiology (C.C., A.M., Z.A.F.), and Vascular Surgery (P.L.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Memorial Sloan-Kettering, New York, NY (G.A.S.); and CNIC, Madrid, Spain (V.F.).
authors.forename: Matilde
authors.initials: M
authors.lastname: Alique
authors.affiliation: From the AtheroThrombosis Research Unit (C.G., M.A., D.T.R., J.J.B.), Cardiovascular Research Institute (C.G., D.K.Y., D.J., J.C.K., T.W., R.J.H., V.F.), Translational and Molecular Imaging Institute (C.C., A.M., Z.A.F.), Department of Radiology (C.C., A.M., Z.A.F.), and Vascular Surgery (P.L.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Memorial Sloan-Kettering, New York, NY (G.A.S.); and CNIC, Madrid, Spain (V.F.).
authors.forename: David T
authors.initials: DT
authors.lastname: Rodriguez
authors.affiliation: From the AtheroThrombosis Research Unit (C.G., M.A., D.T.R., J.J.B.), Cardiovascular Research Institute (C.G., D.K.Y., D.J., J.C.K., T.W., R.J.H., V.F.), Translational and Molecular Imaging Institute (C.C., A.M., Z.A.F.), Department of Radiology (C.C., A.M., Z.A.F.), and Vascular Surgery (P.L.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Memorial Sloan-Kettering, New York, NY (G.A.S.); and CNIC, Madrid, Spain (V.F.).
authors.forename: Dong Kwon
authors.initials: DK
authors.lastname: Yang
authors.affiliation: From the AtheroThrombosis Research Unit (C.G., M.A., D.T.R., J.J.B.), Cardiovascular Research Institute (C.G., D.K.Y., D.J., J.C.K., T.W., R.J.H., V.F.), Translational and Molecular Imaging Institute (C.C., A.M., Z.A.F.), Department of Radiology (C.C., A.M., Z.A.F.), and Vascular Surgery (P.L.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Memorial Sloan-Kettering, New York, NY (G.A.S.); and CNIC, Madrid, Spain (V.F.).
authors.forename: Dongtak
authors.initials: D
authors.lastname: Jeong
authors.affiliation: From the AtheroThrombosis Research Unit (C.G., M.A., D.T.R., J.J.B.), Cardiovascular Research Institute (C.G., D.K.Y., D.J., J.C.K., T.W., R.J.H., V.F.), Translational and Molecular Imaging Institute (C.C., A.M., Z.A.F.), Department of Radiology (C.C., A.M., Z.A.F.), and Vascular Surgery (P.L.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Memorial Sloan-Kettering, New York, NY (G.A.S.); and CNIC, Madrid, Spain (V.F.).
authors.forename: Claudia
authors.initials: C
authors.lastname: Calcagno
authors.affiliation: From the AtheroThrombosis Research Unit (C.G., M.A., D.T.R., J.J.B.), Cardiovascular Research Institute (C.G., D.K.Y., D.J., J.C.K., T.W., R.J.H., V.F.), Translational and Molecular Imaging Institute (C.C., A.M., Z.A.F.), Department of Radiology (C.C., A.M., Z.A.F.), and Vascular Surgery (P.L.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Memorial Sloan-Kettering, New York, NY (G.A.S.); and CNIC, Madrid, Spain (V.F.).
authors.forename: Randolph
authors.initials: R
authors.lastname: Hutter
authors.affiliation: From the AtheroThrombosis Research Unit (C.G., M.A., D.T.R., J.J.B.), Cardiovascular Research Institute (C.G., D.K.Y., D.J., J.C.K., T.W., R.J.H., V.F.), Translational and Molecular Imaging Institute (C.C., A.M., Z.A.F.), Department of Radiology (C.C., A.M., Z.A.F.), and Vascular Surgery (P.L.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Memorial Sloan-Kettering, New York, NY (G.A.S.); and CNIC, Madrid, Spain (V.F.).
authors.forename: Antoine
authors.initials: A
authors.lastname: Millon
authors.affiliation: From the AtheroThrombosis Research Unit (C.G., M.A., D.T.R., J.J.B.), Cardiovascular Research Institute (C.G., D.K.Y., D.J., J.C.K., T.W., R.J.H., V.F.), Translational and Molecular Imaging Institute (C.C., A.M., Z.A.F.), Department of Radiology (C.C., A.M., Z.A.F.), and Vascular Surgery (P.L.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Memorial Sloan-Kettering, New York, NY (G.A.S.); and CNIC, Madrid, Spain (V.F.).
authors.forename: Jason C
authors.initials: JC
authors.lastname: Kovacic
authors.affiliation: From the AtheroThrombosis Research Unit (C.G., M.A., D.T.R., J.J.B.), Cardiovascular Research Institute (C.G., D.K.Y., D.J., J.C.K., T.W., R.J.H., V.F.), Translational and Molecular Imaging Institute (C.C., A.M., Z.A.F.), Department of Radiology (C.C., A.M., Z.A.F.), and Vascular Surgery (P.L.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Memorial Sloan-Kettering, New York, NY (G.A.S.); and CNIC, Madrid, Spain (V.F.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Weber
authors.affiliation: From the AtheroThrombosis Research Unit (C.G., M.A., D.T.R., J.J.B.), Cardiovascular Research Institute (C.G., D.K.Y., D.J., J.C.K., T.W., R.J.H., V.F.), Translational and Molecular Imaging Institute (C.C., A.M., Z.A.F.), Department of Radiology (C.C., A.M., Z.A.F.), and Vascular Surgery (P.L.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Memorial Sloan-Kettering, New York, NY (G.A.S.); and CNIC, Madrid, Spain (V.F.).
authors.forename: Peter L
authors.initials: PL
authors.lastname: Faries
authors.affiliation: From the AtheroThrombosis Research Unit (C.G., M.A., D.T.R., J.J.B.), Cardiovascular Research Institute (C.G., D.K.Y., D.J., J.C.K., T.W., R.J.H., V.F.), Translational and Molecular Imaging Institute (C.C., A.M., Z.A.F.), Department of Radiology (C.C., A.M., Z.A.F.), and Vascular Surgery (P.L.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Memorial Sloan-Kettering, New York, NY (G.A.S.); and CNIC, Madrid, Spain (V.F.).
authors.forename: Gerald A
authors.initials: GA
authors.lastname: Soff
authors.affiliation: From the AtheroThrombosis Research Unit (C.G., M.A., D.T.R., J.J.B.), Cardiovascular Research Institute (C.G., D.K.Y., D.J., J.C.K., T.W., R.J.H., V.F.), Translational and Molecular Imaging Institute (C.C., A.M., Z.A.F.), Department of Radiology (C.C., A.M., Z.A.F.), and Vascular Surgery (P.L.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Memorial Sloan-Kettering, New York, NY (G.A.S.); and CNIC, Madrid, Spain (V.F.).
authors.forename: Zahi A
authors.initials: ZA
authors.lastname: Fayad
authors.affiliation: From the AtheroThrombosis Research Unit (C.G., M.A., D.T.R., J.J.B.), Cardiovascular Research Institute (C.G., D.K.Y., D.J., J.C.K., T.W., R.J.H., V.F.), Translational and Molecular Imaging Institute (C.C., A.M., Z.A.F.), Department of Radiology (C.C., A.M., Z.A.F.), and Vascular Surgery (P.L.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Memorial Sloan-Kettering, New York, NY (G.A.S.); and CNIC, Madrid, Spain (V.F.).
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Hajjar
authors.affiliation: From the AtheroThrombosis Research Unit (C.G., M.A., D.T.R., J.J.B.), Cardiovascular Research Institute (C.G., D.K.Y., D.J., J.C.K., T.W., R.J.H., V.F.), Translational and Molecular Imaging Institute (C.C., A.M., Z.A.F.), Department of Radiology (C.C., A.M., Z.A.F.), and Vascular Surgery (P.L.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Memorial Sloan-Kettering, New York, NY (G.A.S.); and CNIC, Madrid, Spain (V.F.).
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
authors.affiliation: From the AtheroThrombosis Research Unit (C.G., M.A., D.T.R., J.J.B.), Cardiovascular Research Institute (C.G., D.K.Y., D.J., J.C.K., T.W., R.J.H., V.F.), Translational and Molecular Imaging Institute (C.C., A.M., Z.A.F.), Department of Radiology (C.C., A.M., Z.A.F.), and Vascular Surgery (P.L.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Memorial Sloan-Kettering, New York, NY (G.A.S.); and CNIC, Madrid, Spain (V.F.).
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Badimon
mesh_terms: D017398:Alternative Splicing / Q000502:physiology*; D000818:Animals; D001057:Apolipoproteins E / Q000172:deficiency / Q000235:genetics; D002339:Carotid Arteries / Q000473:pathology / Q000503:physiopathology; D003331:Coronary Vessels / Q000473:pathology / Q000503:physiopathology; D004195:Disease Models, Animal; D004730:Endothelium, Vascular / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D051795:Hypoxia-Inducible Factor 1, alpha Subunit / Q000502:physiology*; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D058426:Neointima / Q000503:physiopathology; D009389:Neovascularization, Pathologic / Q000503:physiopathology*; D058226:Plaque, Atherosclerotic / Q000473:pathology / Q000503:physiopathology*; D015398:Signal Transduction / Q000502:physiology*; D013925:Thromboplastin / Q000502:physiology*; D015854:Up-Regulation / Q000502:physiology; D042461:Vascular Endothelial Growth Factor A / Q000502:physiology*
chemical_list: D001057:Apolipoproteins E; C497442:HIF1A protein, human; D051795:Hypoxia-Inducible Factor 1, alpha Subunit; D042461:Vascular Endothelial Growth Factor A; D013925:Thromboplastin
keywords: alternative splicing; atherosclerosis; hypoxia-inducible factor 1; neovascularization, physiologic procoagulant, tissue factor; thromboplastin; vascular endothelial growth factors