Deletion polymorphism of glutathione S-transferase M1 (GSTM1), a phase II detoxification and antioxidant enzyme, increases susceptibility to end-stage renal disease (ESRD) as well as the development of cardiovascular diseases (CVD) among ESRD patients and leads to their shorter cardiovascular survival. The mechanisms by which GSTM1 downregulation contributes to oxidative stress and inflammation in endothelial cells in uremic conditions have not been investigated so far. Therefore, the aim of the present study was to elucidate the effects of GSTM1 knockdown on oxidative stress and expression of a panel of inflammatory markers in human umbilical vein endothelial cells (HUVECs) exposed to uremic serum. Additionally, we aimed to discern whether GSTM1-null genotype is associated with serum levels of adhesion molecules in ESRD patients. HUVECs treated with uremic serum exhibited impaired redox balance characterized by enhanced lipid peroxidation and decreased antioxidant enzyme activities, independently of the GSTM1 knockdown. In response to uremic injury, HUVECs exhibited alteration in the expression of a series of inflammatory cytokines including retinol-binding protein 4 (RBP4), regulated on activation, normal T cell expressed and secreted (RANTES), C-reactive protein (CRP), angiogenin, dickkopf-1 (Dkk-1), and platelet factor 4 (PF4). GSTM1 knockdown in HUVECs showed upregulation of monocyte chemoattractant protein-1 (MCP-1), a cytokine involved in the regulation of monocyte migration and adhesion. These cells also have shown upregulated intracellular and vascular cell adhesion molecules (ICAM-1 and VCAM-1). In accordance with these findings, the levels of serum ICAM-1 and VCAM-1 (sICAM-1 and sVCAM-1) were increased in ESRD patients lacking GSTM1, in comparison with patients with the GSTM1-active genotype. Based on these results, it may be concluded that incubation of endothelial cells in uremic serum induces redox imbalance accompanied with altered expression of a series of cytokines involved in arteriosclerosis and atherosclerosis. The association of GSTM1 downregulation with the altered expression of adhesion molecules might be at least partly responsible for the increased susceptibility of ESRD patients to CVD.
1. Introduction
Endothelial dysfunction is an underlying mechanism of cardiovascular diseases (CVD) which are the leading cause of death among patients with end-stage renal disease (ESRD) [1–4]. The vascular endothelium is likely the primary target of uremic toxins generated in ESRD. In these conditions, the endothelium is continuously exposed to accumulated uremic toxins hence inducing oxidative stress and inflammation, which can lead to endothelial impairment [2, 5–7].
Homozygous deletion of glutathione S-transferase M1 (GSTM1), which is a phase II detoxification enzyme, leads to accumulation of oxidative stress byproducts which indicates its role in antioxidant protection as well [8]. Between 30 to 50 percent of different human population are homozygous for GSTM1 deletion (usually denoted as GSTM1-null genotype), thus completely lacking the GSTM1 enzyme [9]. The GSTM1 deficiency is linked to higher susceptibility to CVD as individuals with GSTM1-null genotype were shown to have significantly increased risk for developing resistant hypertension [10], coronary artery disease/atherosclerosis [11, 12], and stroke [13, 14]. In addition, the GSTM1-null genotype increases susceptibility to ESRD and leads to shorter overall and cardiovascular survival of the patients on haemodialysis [8, 15–17]. The association between GSTM1 deletion and oxidative stress in ESRD patients was supported by our previous results that demonstrated elevated levels of several byproducts of protein and lipid oxidative damage in ESRD patients with GSTM1-null genotype compared to those with GSTM1-active genotype [8]. It has been suggested that in inflammatory and prooxidant environment observed in patients with ESRD, the endothelium responds by expressing intracellular and vascular cell adhesion molecules (ICAM-1 and VCAM-1) that facilitate migration and adhesion of leukocytes to the endothelial cells [18]. We have recently shown that soluble ICAM-1 and VCAM-1 (sICAM-1 and sVCAM-1) levels have a strong predictive role in terms of overall and cardiovascular survival in ESRD patients on haemodialysis [17]. Nevertheless, the potential influence of GSTM1 deletion on the aforementioned inflammatory markers has not been elucidated before in dialyzed patients or in endothelial cells exposed to uremic toxins commonly present in ESRD.
Despite the convincing findings in human cohorts showing the importance of GSTM1 deletion on susceptibility and development of CVD among dialyzed patients [15, 16, 19, 20], its role in the vascular pathophysiology has not been established yet. A functional role of GSTM1 was investigated in vascular smooth muscle cells (VSMC), showing that the reduction in GSTM1 expression in these cells caused increased cell proliferation, oxidative stress, and migration [21]. However, the mechanisms associated with GSTM1 downregulation in endothelial cells in uremic conditions have not been investigated so far.
Therefore, the aim of the present study was to elucidate the effects of GSTM1 knockdown on oxidative stress and expression of a panel of inflammatory markers in human umbilical vein endothelial cells (HUVECs) exposed to uremic serum. Additionally, we aimed to discern whether the GSTM1-null genotype is associated with serum levels of adhesion molecules in ESRD patients.
2. Materials and Methods
2.1. Cell Cultures
HUVECs (ATCC Manassas, Virginia, USA) were seeded on 0.2% gelatine-coated culture plates and grown in a MV2 growth medium (Endothelial Cell Growth Medium MV2, PromoCell, Germany) under standard cell culture conditions (humidified atmosphere, 5% CO2, 37°C). Cells were seeded in gelatine-coated plates for viability assays, Western blot analyses, oxidative stress measurements, and assessment of cytokine expression. HUVECs were incubated in a pool of human serums obtained from either healthy volunteers (control serum, ) or ESRD patients on haemodialysis (uremic serum, ). All patients underwent haemodialysis 3 times a week for at least 3 months before the study onset using polysulfone dialysis membranes and conventional bicarbonate-buffered dialysate. Participants with any form of malignancy, autoimmune disease, or infectious comorbidities (HIV, HBV, or HCV infections) were excluded. The blood was taken from patients prior to a haemodialysis session at the Center for the Renal Diseases, Zvezdara University Medical Center, Belgrade. All patients signed informed consent agreeing to participate in the study. This study was approved by the Ethical Committee of the Faculty of Medicine, University of Belgrade (No. 1550/V-30), and conducted in accordance with the Helsinki Declaration from 2013.
2.2. Cell Viability Assay
Cell viability was assessed by a colorimetric method based on measuring mitochondrial dehydrogenase activity, using the MTS Cell Proliferation Assay Kit (Abcam, UK), according to the manufacturer’s protocol. 5000 cells/well were cultured in a 96-well plate. After 24 h, growth media were discarded and cells were treated with media, 10%, 20%, or 30% control or uremic serum for 4 h and 6 h. The formazan salt produced by viable cells was quantified by measuring the absorbance at 490 nm on the FLUOstar® Omega plate reader (BMG Labtech, Germany). The viability of cells incubated in pooled human sera for 6 h did not change significantly compared to the cells incubated in the normal growth medium (Figure 1S A&B, Supplement). Therefore, all further HUVEC treatments were performed using 30% control or uremic serum-containing media for 6 h, before cytokine expression and oxidative stress measurements were performed.
2.3. GSTM1 Knockdown Using siRNA in HUVECs
To silence GSTM1 protein expression, HUVECs were seeded at a density of cells per well in 6-well plates and grown in a MV2 growth medium. The following day, cells were transfected with 100 nM GSTM1 small interfering RNA (siRNA) (Thermo Fisher Scientific, UK) using the DharmaFECT transfection reagent (GE Healthcare, USA) or treated with DharmaFECT as a control. Ninety-six hours posttransfection, the silencing effect was confirmed by Western blot.
2.4. Western Blot Analysis
HUVECs were lysed in a RIPA buffer (50 mM Tris-HCL pH 8.0, 150 mM NaCl, 1% IGEPAL, 0.5% sodium deoxycholate, and 10% SDS) supplemented with protease inhibitor cocktail (Roche, UK). After extraction, protein concentrations were determined by the Bicinchoninic Acid Protein Assay kit (BCA, Thermo Fisher Scientific, UK). An equal amount of proteins was loaded on 10% polyacrylamide gel, and electrophoresis was performed at 80 V for 10 min, then 100 V for 90 min. After wet transfer, nitrocellulose membranes were blocked in 5% nonfat milk (Bio-Rad, UK) for 1 h at room temperature and then incubated overnight at 4°C with primary antibodies: monoclonal mouse anti-GSTM1 (1 : 1000, R&D Systems, USA), monoclonal mouse anti-ICAM1 (1 : 200, Santa Cruz, USA), polyclonal goat anti-VCAM1 (1 : 200, Santa Cruz, USA), and monoclonal mouse anti-β actin (1 : 10 000, Thermo Fisher Scientific, UK). The following day, membranes were incubated with appropriate HRP-conjugated secondary antibodies: anti-mouse 1 : 5000 (Abcam, UK) and anti-goat 1 : 1000 (RayBiotech, USA) for 1 h at room temperature. Chemiluminescent bands were detected using the West Femto Maximum sensitivity substrate (Thermo Fisher Scientific, UK) on the G-box (Kodak, UK) or ChemiDoc (BioRad, USA). Densitometry analysis was performed using ImageJ software (National Institutes of Health, Bethesda, USA).
2.5. Measurement of the Activity of Antioxidant Enzymes in HUVECs
The activity of antioxidant enzymes, superoxide dismutase (SOD) and glutathione peroxidase (GPX), in cell lysates was determined by spectrophotometric methods. SOD activity was assessed as previously described by Misra and Fridovich [22]. This method is based on the ability of SOD to inhibit the autoxidation of adrenaline at pH 10.2. The production of colored adrenochrome in reaction mixtures with cell protein extracts (sample) or without them (control) was followed at 480 nm. Activity of SOD was expressed as the percentage of inhibition of adrenaline autoxidation. GPX activity was assessed as reported by Günzler et al. [23]. GPX activity was assayed by the subsequent oxidation of NADPH at 340 nm with t-butyl-hydroperoxide as the substrate. One unit of enzyme activity was expressed as nmol NADPH oxidized per minute, assuming /l/mol/cm to be the molar absorbance of NADPH at 340 nm.
2.6. Measurement of Malondialdehyde Levels in HUVECs
Malondialdehyde (MDA) levels in cell lysates were measured using the competitive ELISA kit (Elabscience, Wuhan, China) in accordance with the manufacturer’s instructions. In brief, 50 μl of standards, samples, and blanks was added to each well of the MDA precoated ELISA plate with consecutive addition of 50 μl biotinylated antibody. After the 45 min of incubation, wells were washed in order to eliminate excess conjugate and unbound sample or standard, and HRP-conjugated antibody was added. The color change was measured spectrophotometrically at a wavelength of 450 nm.
2.7. Measurement of Total Reactive Oxygen Species in HUVECs
The total reactive oxygen species (ROS) production was assessed by flow cytometry (FACS) using 2,7-dichlorodihydrofluorescein diacetate (H2DCFDA; Invitrogen, California, USA) stain. HUVECs were seeded in 6-well plates ( cells/well) and transfected with GSTM1 siRNA as described above. After 90 h incubation, the transfection solution was discarded, and cells were incubated for the next 6 h with the 30% control or uremic serum-containing media. Treatments were removed, and cells were trypsinised. Cell pellets were resuspended in 5 ml flow cytometry buffer (1% FBS in PBS) and incubated with 5 μl H2DCFDA stain for 30 min at 37°C. FACS tubes were centrifuged at 400 g for 8 min, supernatants were removed, and cells were allowed to recover for 15 min at 37°C in 1 ml of MV2 growth media. In the final step, cells were resuspended in 500 μl FACS buffer, and 5 μl 7-AAD-viability staining solution (eBioscience, San Diego, USA) was added prior to performing measurements on the Attune NxT Acoustic Focusing Flow Cytometer (Invitrogen, California, USA). The results were analysed using FlowJo, ver. 10.4 (Stanford Jr. University, USA).
2.8. Analysis of Cytokine Expression in HUVECs
To explore the effect of uremic serum and GSTM1 silencing on endothelial cell inflammation, the relative expression of 105 cytokines was assessed simultaneously in cell protein extracts using the Proteome Profiler™ Human XL Cytokine Array Kit (R&D Systems, UK) according to the manufacturer’s instruction. HUVECs were seeded in 6-well Petri dishes at a density of cells per well. Following the transfection, GSTM1+/+ and GSTM1+/- cells were incubated in 30% control or uremic serum-containing media for 6 h. After the incubation time expired, treatments were removed and cells were rinsed with PBS. Cells were then scraped in a lysis buffer 17 (R&D Systems, UK), supplemented with 10 μg/ml aprotinin, 10 μg/ml leupeptin, and 10 μg/ml pepstatin. Cell lysates were obtained after centrifugation at 14 000 g for 5 min. Pooled cell lysates (/group) were probed on four separate nitrocellulose membranes. Each membrane contained capture and control antibodies spotted in duplicate, which allowed simultaneous measuring of 105 cytokine expressions. Chemiluminescent spots were visualised on the G-box (Kodak, UK). Results were quantified using HLimage++ software and normalized to the reference spots positioned at three of the corners of each blot (Western Vision Software, US).
2.9. Analysis of Circulating Adhesion Molecules in Plasma of ESRD Patients
Circulating adhesion molecules were determined in plasma of ESRD patients by enzyme immunoassays, according to the manufacturer’s protocols. The description of a cohort of 199 ESRD patients involved in this study has been described in details previously [17]. sICAM-1 was assayed by commercial solid-phase sandwich ELISA (Thermo Fisher Scientific, Waltham, Massachusetts, USA). sVCAM-1 was determined by a solid-phase sandwich ELISA kit (Novex, Life Technologies). Absorbances were read at 450 nm on the LKB 5060-006 Micro Plate Reader (Vienna, Austria). sICAM concentrations were expressed as pg/ml, and sVCAM levels were expressed as ng/ml.
3. Statistical Analysis
Statistical analysis was performed using the SPSS version 17.0 statistical package (IBM SPSS Statistics). All analysed parameters were tested for normality of the data using the Shapiro-Wilk test. For normally distributed data, differences between the groups were evaluated by the independent sample -test or one-way ANOVA with Fisher’s least significant difference (LSD) post hoc. For non-normally distributed data, the Mann-Whitney or Kruskal-Wallis test was used. The results were considered statistically significant if .
4. Results
To determine the effects of GSTM1 expression on oxidative stress and expression of a panel of inflammatory markers, we used specific siRNA to silence GSTM1 gene in HUVECs. Following 96 h of transfection, diminished GSTM1 expression was confirmed by immunoblotting which showed around ~90% reduction in GSTM1 protein levels in HUVECs treated with GSTM1 siRNA (GSTM1+/-) compared to the control (GSTM1+/+) (; Figure 2S, Supplement).
4.1. The Influence of Uremic Serum and GSTM1 Knockdown on Biomarkers of Oxidative Stress (SOD, GPX, MDA, and ROS) in HUVECs
Antioxidant enzyme activity and byproducts of oxidative stress were assessed in GSTM1+/+ and GSTM1+/- HUVECs incubated in control or uremic serum-containing media. The incubation of HUVECs with uremic serum led to a significant decrease in the activity of SOD and GPX antioxidant enzymes in GSTM+/+ HUVECs compared to control serum conditions (; Figures 1(a) and 1(b)). To determine the extent of GSTM1 activity loss on redox status of HUVECs, we silenced the GSTM1 gene by corresponding siRNA. Silencing of the GSTM1 gene did not affect antioxidant enzyme activity in any of the observed settings (Figures 1(a) and 1(b)). With respect to oxidative stress byproducts, the exposure to the uremic serum led to the significantly higher MDA concentrations () in GSTM1+/+ HUVECs compared to their counterparts incubated in control serum (Figures 1(c) and 1(d)). However, the GSTM1 knockdown did not have statistically significant impact on total oxidative stress byproducts in HUVECs in either control or uremic serum (Figures 1(c) and 1(d)). Only a trend towards increased MDA levels was observed in GSTM1+/- HUVECs compared to GSTM1+/+ HUVECs in control serum ().
(a)