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Am J Physiol Lung Cell Mol Physiol 293: L245-L253, 2007. First published April 27, 2007; doi:10.1152/ajplung.00068.2007
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Mechanisms of induction of airway smooth muscle hyperplasia by transforming growth factor-beta

Shaoping Xie, Maria B. Sukkar, Razao Issa, Nadia M. Khorasani, and Kian Fan Chung

Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom

Submitted 20 February 2007 ; accepted in final form 19 April 2007


    ABSTRACT
 TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 GRANTS
 REFERENCES
 
Airway smooth muscle (ASM) hyperplasia is a characteristic feature of the asthmatic airway, but the underlying mechanisms that induce ASM hyperplasia remain unknown. Because transforming growth factor (TGF)-beta is a potent regulator of ASM cell proliferation, we determined its expression and mitogenic signaling pathways in ASM cells. We obtained ASM cells by laser capture microdissection of bronchial biopsies and found that ASM cells from asthmatic patients expressed TGF-beta1 mRNA and protein to a greater extent than nonasthmatic individuals using real-time RT-PCR and immunohistochemistry, respectively. TGF-beta1 stimulated the growth of nonconfluent and confluent ASM cells either in the presence or absence of serum in a time- and concentration-dependent manner. The mitogenic activity of TGF-beta1 on ASM cells was inhibited by selective inhibitors of TGF-beta receptor I kinase (SD-208), phosphatidylinositol 3-kinase (PI3K, LY-294002), ERK (PD-98059), JNK (SP-600125), and NF-{kappa}B (AS-602868). On the other hand, p38 MAPK inhibitor (SB-203580) augmented TGF-beta1-induced proliferation. To study role of the Smads, we transduced ASM cells with an adenovirus vector-expressing Smad4, Smad7, or dominant-negative Smad3 and found no involvement of these Smads in TGF-beta1-induced proliferation. Dexamethasone caused a dose-dependent inhibition in TGF-beta1-induced proliferation. Our findings suggest that TGF-beta1 may act in an autocrine fashion to induce ASM hyperplasia, mediated by its receptor and several kinases including PI3K, ERK, and JNK, whereas p38 MAPK is a negative regulator. NF-{kappa}B is also involved in the TGF-beta1 mitogenic signaling, but Smad pathway does not appear important.

laser capture microdissection; transforming growth factor-beta1 expression; airway smooth muscle cells; asthma; corticosteroids


INCREASED AIRWAY SMOOTH MUSCLE (ASM) mass is one of the characteristic structural changes of the asthmatic airway (11) that may contribute to the airflow obstruction of asthma (12). Indeed, both ASM hyperplasia and hypertrophy are observed in the airway wall remodeling present in asthma (12). The mechanisms that mediate these changes in ASM are little known. Transforming growth factor (TGF)-beta is a regulator of cell growth and differentiation with profibrotic properties (10, 32). Increased expression of TGF-beta has been detected in asthmatic bronchial biopsy specimens localized to inflammatory cells in airway mucosa such as eosinophils and to structural cells such as fibroblasts and epithelial cells; increased levels have also been measured in bronchoalveolar lavage fluid samples from patients with asthma (23, 31, 35). There has been little focus as to whether ASM cells from asthmatic patients have enhanced TGF-beta expression (35). Blockade of TGF-beta activity prevents airway wall remodeling features including ASM hyperplasia in rat and murine models of chronic allergen exposure (19, 21), implying that TGF-beta may be a potential mediator of ASM hyperplasia in asthma. TGF-beta stimulates human ASM cell growth in the presence of 5% FCS and EGF (9) and increases DNA synthesis of human or bovine ASM cells in the presence or absence of serum in a growth factor-independent manner (2, 7, 25). Paradoxically, TGF-beta has been reported to inhibit EGF- and thrombin-induced DNA synthesis of human ASM cells (8) and FBS-induced proliferation of bovine ASM cells (25). Furthermore, TGF-beta has also been shown to induce human ASM cell proliferation only in the presence of growth factors such as FGF-2 (3). These conflicting data may result from the use of different culture conditions, such as the presence of serum at varying concentrations, the degree of cell confluence, and the addition of different growth inducers.

The intracellular mechanisms that mediate TGFbeta-induced ASM cell proliferation have been the subject of recent investigation, but there are still areas of uncertainty. Phosphatidylinositol 3-kinase (PI3K) and MAPK may play an important role in the regulation of ASM growth (18, 26), since phosphorylation of the D3 position of the inositol ring of membrane phosphoinositides by PI3K is crucial for control of cell survival, division, and migration. PI3K has been implicated both in induction of cell growth and regulation of cyclin-dependent kinase activity. ERK plays an important role in ASM cell proliferation as well as in survival mediated by many growth factors, whereas JNK and p38 MAPK may regulate ASM cell growth and apoptosis (7). A role for Smads in mediating TGF-beta intracellular signaling has been identified in the induction of gene expression, cell proliferation, and differentiation (5, 15, 16, 24), but it is uncertain whether Smads mediate TGF-beta-induced ASM cell growth. The ubiquitous inflammatory transcription factor, NF-{kappa}B, modulates TGF-beta expression in airway epithelial cells and can functionally cooperate with TGF-beta/Smad signaling pathway (22). However, the role of NF-{kappa}B in TGF-beta-mediated ASM hyperplasia is not known.

In this study, we determined whether there is an increased TGF-beta1 expression in asthmatic ASM cells and its effects on ASM cell growth under different culture conditions, particularly in relation to the state of confluence of ASM cells in the absence or presence of a range of serum concentrations. To delineate the intracellular signaling pathways that mediate the growth regulatory effect of TGF-beta1, we investigated the role of TGF-beta receptor (TbetaR) kinase, PI3K, and MAPKs and explored whether NF-{kappa}B and Smads were involved in the mitogenic signaling.


    MATERIALS AND METHODS
 TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 GRANTS
 REFERENCES
 
Materials

Recombinant human TGF-beta1 was purchased from R&D Systems (Abingdon, United Kingdom). PD-98059, SB-203580, and LY-294002 were obtained from Calbiochem (Nottingham, United Kingdom). SD-208 was a kind gift from Scios (Fremont, CA) and SP-600125 from Celgene (San Diego, CA). AS-602868 was from Serono. Primers for TGF-beta1 were obtained from Sigma-Genosys (Cambridgeshire, United Kingdom). RNase-free slides, reagents, and other materials for laser capture microdissection (LCM) were purchased from Arcturus (Hertfordshire, United Kingdom). Dexamethasone, crystal violet, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), FCS, BSA, and all other tissue culture reagents and media were from Sigma (Dorset, United Kingdom).

Cell Culture and Treatment

ASM cells were isolated from fresh lobar or main bronchus obtained from lung resection donors and cultured in DMEM supplemented with 10% FCS as described previously (39). ASM cell characteristics were identified by light microscopy with typical "hill and valley" appearance and by positive immunostaining of smooth muscle (SM) {alpha}-actin, SM myosin heavy chain, calponin, and SM-22. The cells were maintained in T-175 culture flasks at 37°C in a humidified atmosphere of 5% CO2. ASM cells were studied from passages 2 to 6.

Cells were trypsinized and subcultured in 24-well plates for cell proliferation assay. ASM cells were grown in 10% FCS/DMEM to reach 30% confluence, and then FCS concentration was changed to 0.1–10% in the presence or absence of TGF-beta1 or the appropriate test reagents. To test the effect of TGF-beta1 on confluent ASM cells, cells were grown in 10% FCS/DMEM to reach confluence before the treatments. For protein analyses by Western blotting, ASM cells were incubated in six-well plates in 10% FCS/DMEM to reach confluence before the treatments. Control cultures were incubated in the same medium containing vehicle alone. Cells were redosed in fresh medium every 2–3 days.

LCM

To examine the expression of TGF-beta1 in ASM, bronchial biopsies were obtained from 12 normal volunteers [age = 22 ± 3 yr, male/female = 8/4, forced expiratory volume in 1 s (FEV1) = 101 ± 15% of predicted] and 11 asthmatic patients (age = 33 ± 12 yr, male/female = 5/6, FEV1 = 84 ± 18% of predicted), using fiber optic bronchoscopy (33). The protocols have been approved by the local Ethics Committee and all subjects gave their informed consent. The airway biopsies were embedded in optimum cutting temperature compound (OCT) on dry ice and snap-frozen in liquid nitrogen before storage at –80°C. Frozen sections were cut at 6-µm thickness and mounted on LCM slides (Arcturus). The slides were immediately stored on dry ice and then at –80°C until used. Sections were fixed in 70% ethanol for 30 s and stained and dehydrated in a series of graded ethanol followed by xylene using HistoGene LCM frozen section staining kit (Arcturus) according to the manufacturer's instruction. ASM cells were captured onto the CapSure HS LCM caps (Arcturus) by a Pixcell II LCM system (Arcturus, Mountain View, CA), and total RNA was extracted by using a PicoPure RNA Isolation Kit (Arcturus) according to the manufacturer's instructions.

Real-Time PCR

Total RNA extracted from ASM cells collected by LCM was reverse-transcribed to cDNA (RoboCycler, Stratagene) using random hexamers and an avian myeloblastosis virus reverse transcriptase (Promega). cDNA was amplified by quantitative real-time PCR (Rotor-Gene 3000, Corbett Research) using SYBR Green PCR master mix reagent (Qiagen). The human TGF-beta1 forward and reverse primers were 5' -CCCAGCATCTGCAAAGCTC-3' and 5' -GTCAATGTACAGCTGCCGCA-3'. Each primer was used at a concentration of 0.5 µM in each reaction. Cycling conditions were as follows: step 1, 15 min at 95°C; step 2, 20 s at 94°C; step 3, 20 s at 60°C; step 4, 20 s at 72°C, with repeat from step 2 to step 4 40 times. Data from the reaction were collected and analyzed by the complementary computer software (Corbett Research). Relative quantitations of gene expression were calculated using standard curve and normalized to GAPDH in each sample (39).

Immunohistochemistry

Immunohistochemistry was performed to detect the expression of TGF-beta1 in human bronchial tissue sections. Bronchial biopsies were embedded in OCT and stored at –80°C before use. Frozen sections (6 µm) were cut and then fixed in cold acetone for 10 min. Sections were incubated in 10% normal horse serum to block nonspecific binding, followed by a mouse anti-human TGF-beta1 antibody (1 µg/ml, AbCam ab1279) for 1 h at room temperature. Control slides were performed with normal mouse immunoglobulin. Anti-mouse biotinylated secondary antibody (Vector ABC kit, Vector Laboratories) was applied to the sections for 1 h at room temperature, followed by 1.6% hydrogen peroxide to block endogenous peroxidase activity. Sections were incubated with the avidin/biotinylated peroxidase complex for 30 min, followed by chromogenic substrate diaminobenzidine for 3 min, and then counterstained in hematoxylin and mounted on aqueous mounting medium. Immunoreactivity for TGF-beta1 was expressed as intensity of staining that was graded from 0 to 3 (0, no staining; 1, weak staining; 2, moderate staining; 3, strong staining). The slides were coded, and the reader was unaware of the source of the biopsies.

Crystal Violet Proliferation Assay

Crystal violet assay (CVA) was used to determine ASM cell growth (40). On selected days, the cell layer was washed once with PBS. Cell were fixed and stained by 0.5% crystal violet solution in 25% methanol. After 10 min, the excess dye was removed by washing in tap water, and the cells were then air-dried for at least 20 h. Image processing was performed using an Axioplan microscope (Zeiss, Munich, Germany), and images were captured using an Axiocam digital camera (Zeiss). Then, the incorporated dye was solubilized in 1 ml of 0.1 M sodium citrate solution in 50% ethanol, and 100 µl was transferred to a 96-well plate. To determine cell number in each sample, the optical density (OD) was measured directly at a wavelength of 550 nm in a Spectramax Plus reader (Molecular Devices). The OD of each sample was then compared with a standard curve in which the OD was directly proportional to known cell number.

MTT Assay

MTT assay was used to determine cell viability and proliferation. On selected days, the culture medium was removed, and ASM cells were incubated with 1 mg/ml MTT solution in an incubator at 37°C for 10–30 min. After removing MTT solution, 300 µl of DMSO was added to each well of 24-well plate, and 100 µl was transferred to a 96-well plate. Absorbency at 550-nm OD was detected. The OD of each sample was then compared with a standard curve in which the OD was directly proportional to known cell numbers.

Smad Transduction

Smad-expressing adenoviruses were a kind gift from Dr. Aristidis Moustakas (17). Adenoviruses carrying the vector-expressing Flag-tagged Smad4, Smad7, dominant-negative Smad3 (DNS3), or beta-galactosidase (the null) were titered by endpoint dilution and plaque assay to determine plaque-forming units. Viruses were diluted in 10% FBS/DMEM to a multiplicity of infection of 30 (30 viruses per cell) before infection of ASM cells. This dose of virus had no effect on cell viability, and ~95% transduction efficiencies in ASM cells was obtained as detected by green fluorescent protein-expressing adenoviruses (6). The adenovirus-mediated expression of Smads in the infected ASM cells was confirmed by Western blots using an anti-Flag monoclonal antibody (Sigma). In cell growth assays, the adenovirus-containing medium was removed 24 h after infection, and cells were stimulated with TGF-beta1 in the presence of 2.5% FCS/DMEM. For induction of the expression of connective tissue growth factor (CTGF), which was used as a positive control in this study as it is a target gene of TGF-beta, the adenovirus-containing medium was removed 24 h after infection, and cells were stimulated with TGF-beta1 under serum-free condition for a further 3 days (39).

Western Blotting

As described previously (39), total cell protein was extracted and fractionated by SDS-PAGE on a 10% Tris-glycine precast gel (Invitrogen), followed by transfer to a nitrocellulose membrane (Amersham). The membrane was incubated overnight at 4°C with an antibody for CTGF (0.5 µg/ml, Abcam). The next day, the membrane was incubated for 1 h with a horseradish peroxidase-conjugated secondary antibody raised against rabbit IgG (1:2,000, Cell Signaling Technology) at room temperature. Antibody-bound proteins were visualized by enhanced chemiluminescence. The membranes were stripped and then reprobed with a mouse anti-GAPDH monoclonal antibody (1:5,000; Biogenesis, Poole, United Kingdom) to control for the loading. Relevant band intensities were quantified by scanning densitometric analysis using software from Ultra-Violet Products (Cambridge, United Kingdom). Densitometric data were normalized for GAPDH values.

Data Analysis

Data were analyzed by ANOVA or t-test (Mann-Whitney U test for immunohistochemistry). Results are expressed as means ± SD and are representative of at least three separate experiments from three ASM cell donors. P < 0.05 was taken as statistically significant.


    RESULTS
 TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 GRANTS
 REFERENCES
 
TGF-beta1 mRNA and Protein Expression in ASM Cells of Asthmatic Patients

To determine whether human ASM cells express TGF-beta1 mRNA in situ, LCM was performed on sections of human bronchial biopsies obtained from four normal volunteers and three asthmatic patients. Quantitative real-time RT-PCR revealed that in situ ASM cells from asthmatics expressed higher levels of TGF-beta1 mRNA than those from nonasthmatic volunteers (P = 0.029; Fig. 1A) .


Figure 1
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Fig. 1. Increased expression of transforming growth factor (TGF)-beta1 mRNA and protein in asthmatic airway smooth muscle (ASM) cells. Sections from human bronchial biopsies were prepared. A: laser capture microdissection (LCM) was performed to collect ASM cells. TGF-beta1 and GAPDH mRNA expression was analyzed by real-time RT-PCR from 4 normal controls and 3 asthmatics. Data are expressed as a ratio of target gene-to-GAPDH mRNA control. B: TGF-beta1 protein was detected by immunohistochemistry. C: immunostaining intensity was detected from 10 normal controls and 8 asthmatics. *P < 0.05, **P < 0.01 compared with control.

 
Immunohistochemistry of human bronchial biopsy samples (obtained from 10 normal and 8 asthmatic donors) showed weak intensity of immunostaining for TGF-beta1 in ASM cells of control samples (Fig. 1B). Compared with the controls, TGF-beta1 expression of ASM cells was significantly increased in asthmatic patients (P = 0.002; Fig. 1, B and C). There was no staining in the negative control sections in which the mouse anti-TGF-beta1 antibody was replaced by normal mouse immunoglobulin (data not shown).

TGF-beta1 and ASM Cell Growth

TGF-beta1 stimulates nonconfluent ASM cell growth in serum-containing media. To investigate the effect of TGF-beta1 on growth of nonconfluent ASM cells undergoing an exponential growth, cells were incubated in 24-well plates with 10% FCS to 30% confluence and then exposed to TGF-beta1 (10 ng/ml) in the presence of 0.1–10% FCS. Cell growth (Fig. 2, A and B) was detected after 6 days of treatment by CVA. TGF-beta1 increased ASM cell growth by two- to fivefold in the presence of 0.1–5% FCS with no effect at 10% FCS compared with the controls (Fig. 2B). Similar results were obtained using MTT assay (data not shown). The mitogenic effect of TGF-beta1 was time dependent, evident after 3 days of the treatment, and maintained until day 7 (Fig. 2C). In the absence of TGF-beta1, cells were reduced with 0.1–0.5% FCS after 3–5 days, and cell growth was almost stopped with 1% FCS over 3–7 days (Fig. 2C). However, in the presence of 2.5% FCS, ASM cells not only had a marked growth-stimulatory response to TGF-beta1, but also kept an autonomous growth. Therefore, 2.5% FCS was chosen for subsequent studies. The effect of TGF-beta1 on ASM cell growth was concentration-dependent over the range of 0.1–10 ng/ml with 2.5% FCS after 5 days of treatment (Fig. 2D).


Figure 2
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Fig. 2. Stimulation of nonconfluent ASM cell growth by TGF-beta1 in the presence of serum. A and B: image of ASM cells stained by crystal violet (A) and data from crystal violet assay (CVA) after nonconfluent ASM cells were incubated with 0.1–10% FCS in the presence or absence of TGF-beta1 (10 ng/ml) for 6 days (B). C: time-dependent stimulation by 10 ng/ml TGF-beta1 with 0.1–10% FCS for 3–7 days. D: concentration-dependent stimulation by TGF-beta1 (0.1–10 ng/ml) with 2.5% FCS for 5 days. Cell growth was assessed by CVA. Results are the means ± SD of triplicate measurements and representative from 3–5 ASM cell donors. *P < 0.05, **P < 0.01 compared with no TGF-beta.

 
TGF-beta1 stimulates nonconfluent ASM cell growth in serum-free medium. ASM cells were incubated in 24-well plates with 10% FCS to 30% confluence and then treated with 10 ng/ml TGF-beta1 in serum-free medium with 0.5% BSA. Cell growth was detected after 3–7 days of the treatment. TGF-beta1 in the absence of serum induced a 30–40% growth stimulation after 5 days of treatment, and this was maintained until day 7 (Fig. 3A).


Figure 3
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Fig. 3. Stimulation of nonconfluent and confluent ASM cell growth by TGF-beta1 in the presence or absence of serum. A: nonconfluent ASM cells were treated with 10 ng/ml TGF-beta1 for 3–7 days in serum-free medium containing 0.5% BSA. B: ASM cells were grown in 10% FCS/DMEM to confluence and then incubated in 0.5% BSA, 0.5% FCS, or 2.5% FCS/DMEM with 10 ng/ml TGF-beta1 for 2–6 days. Cell growth was assessed by CVA. Results are the means ± SD of triplicate measurements and representative from 3 ASM cell donors. The data are expressed as the percentage of the medium alone for B. *P < 0.05, **P < 0.01 compared with no TGF-beta or medium alone.

 
TGF-beta1 stimulates confluent ASM cell growth in the presence or absence of serum. We next examined the effect of TGF-beta1 on confluent ASM cells as most of the previous studies have been reported on confluent cells. ASM cells were grown in 24-well plates with 10% FCS to confluence and then exposed to 10 ng/ml TGF-beta1 in the presence of 0.5% or 2.5% FCS or 0.5% BSA. Cell number was detected after 2–6 days of the treatment. There was 35–70% growth stimulation with 0.5% FCS, 35–50% with 0.5% BSA, and up to 25% with 2.5% FCS following 2–6 days of treatment (Fig. 3B). The stimulatory effect of TGF-beta1 was almost negligible when ASM cells were too confluent such as after 6 days in 2.5% FCS/DMEM.

Mediation of TGF-beta1-Induced ASM Cell Growth by TGF-beta Receptor I Kinase and PI3K

ASM cells were grown in 24-well plates with 10% FCS to 30% confluence and were pretreated for 1 h with a selective inhibitor for either TbetaRI kinase, SD-208 (0.1–1 µM; Ref. 34), or for PI3K, LY-294002 (1–10 µM), in 2.5% FCS/DMEM and then cotreated with 5 ng/ml TGF-beta1 for 6 days before detecting cell growth. Both SD-208 (Fig. 4A) and LY-294002 (Fig. 4B) induced a concentration-dependent inhibition in TGF-beta1-stimulated cell growth. However, LY-294002 also inhibited autonomous growth at 10 µM, the highest concentration used.


Figure 4
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Fig. 4. Inhibition of TGF-beta1-stimulated ASM cell growth by TGF-beta receptor I (TbetaRI) kinase blocker SD-208 (SD) and PI3K blocker LY-294002 (LY). ASM cells were pretreated for 1 h with SD-208 (A) or LY-294002 (B) at the indicated concentrations and then cotreated with 5 ng/ml TGF-beta1 for 6 days in 2.5% FCS medium. Cell growth was assessed by CVA. The data are expressed as the percentage of TGF-beta1 alone and are the means ± SD of triplicate measurements and representative from 3 ASM cell donors. **P < 0.01 compared with TGF-beta1 alone.

 
Regulation TGF-beta1-Induced ASM Cell Growth by MAPKs, NF-{kappa}B, and Glucocorticosteroid Receptor Agonist

ASM cells were pretreated for 1 h with specific inhibitors for MAPKs (PD-98059 for ERK, SP-600125 for JNK, SB-203580 for p38 MAPK) and for NF-{kappa}B (AS-602868 for IKK2) or with the glucocorticosteroid receptor agonist, dexamethasone, and then cotreated with 5 ng/ml TGF-beta1 for 6 days before assessing cell growth. PD-98059 (1–50 µm) inhibited TGF-beta1-induced growth in a dose-dependent manner with a significant effect at ≥10 µM (Fig. 5A). SP-600125 also inhibited the mitogenic activity of TGF-beta1, but a significant effect was achieved at ≥25 µM (Fig. 5B). In contrast, SB-203580 induced a concentration-dependent increase in TGF-beta1-stimulated cell growth with a 45% maximal enhancement (Fig. 5C). The IKK2 inhibitor, AS-602869, significantly inhibited the ASM cell growth by TGF-beta1 at 2.5 µM (Fig. 6A). Dexamethasone (0.01–1 µM) downregulated TGF-beta1-stimulated ASM cell growth down to 40% (Fig. 6B).


Figure 5
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Fig. 5. Regulation of TGF-beta1-stimulated ASM cell growth by MAPK inhibitors. ASM cells were pretreated for 1 h with the inhibitor for ERK, PD-98059 (PD; A), for JNK, SP-600125 (SP; B), or for p38 MAPK, SB-203580 (SB; C) at the indicated concentrations and then cotreated with 5 ng/ml TGF-beta1 for 6 days in 2.5% FCS medium. Cell growth was assessed by CVA. The data are expressed as the percentage of TGF-beta1 alone and are the means ± SD of triplicate measurements and representative from 3 ASM cell donors. *P < 0.05, **P < 0.01 compared with TGF-beta alone.

 

Figure 6
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Fig. 6. Downregulation of TGF-beta1-stimulated ASM cell growth by NF-{kappa}B signaling inhibition and corticosteroid. ASM cells were pretreated for 1 h with IKK2 inhibitor, AS-602869 (AS; A), or with the corticosteroid, dexamethasone (Dex; B), at the indicated concentrations and then cotreated with 5 ng/ml TGF-beta1 for 6 days in 2.5% FCS medium. Cell growth was assessed by CVA. The data are expressed as the percentage of TGF-beta1 alone and are the means ± SD of triplicate measurements and representative from 3 ASM cell donors. *P < 0.05, **P < 0.01 compared with TGF-beta1 alone.

 
TGF-beta1-Induced ASM Cell Growth is Smad Independent

ASM cells were grown to 30–40% confluence with 10% FCS and were infected with the Smad-expressing adenoviruses for 24 h in 2.5% FCS/DMEM. Cell growth was assessed after 4–6 days of the treatment with TGF-beta1 (5 ng/ml) in fresh 2.5% FCS/DMEM (Fig. 7A). Transfection of Smad4, Smad7, or DNS3 did not affect the TGF-beta1-stimulated ASM cell growth after 4 days of treatment (Fig. 7A). Similar results were seen after 6-day treatment with the growth factor (data not shown). To determine the efficacy of the transfection, we show that inhibition of Smad signaling by infection of cells with DNS3 or Smad7-expressing virus downregulated TGF-beta1-induced CTGF protein expression, and enhancement of Smad signaling by introducing increasing amounts of adenovirus-mediated Smad4 into cells upregulated the CTGF expression as analyzed by Western blotting (Fig. 7B).


Figure 7
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Fig. 7. Role of Smad pathway in TGF-beta1-induced ASM cell growth and connective tissue growth factor (CTGF) expression. ASM cells were infected with the adenoviruses expressing dominant-negative Smad3 (DNS3), Smad7, or Smad4 before treatment with TGF-beta1 (5 ng/ml) for 4 days to assess cell growth by CVA (A) or for 3 days to analyze CTGF protein expression by Western blotting (B). Control cells were noninfected cells treated with TGF-beta1. The data are expressed as the percentage of control and are the means ± SD from 3 ASM cell donors. **P < 0.01 compared with control and Null, +P < 0.05 compared with Null; Null, beta-galactosidase vector.

 

    DISCUSSION
 TOP
 ABSTRACT
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 GRANTS
 REFERENCES
 
In this study, we analyzed TGF-beta1 mRNA expression of in situ bronchial ASM cells collected by LCM and found that the levels of expression were increased in patients with asthma compared with nonasthma controls. This is also accompanied by an increase in TGF-beta1 immunoreactive protein expression in asthmatic ASM. To elucidate the effect of TGF-beta1 on ASM hyperplasia, we examined its activity on ASM cell proliferation. TGF-beta1 stimulated ASM cell growth that is mediated through TbetaRI kinase and by the activation of a series of other kinases including PI3K, ERK, and JNK. Activation of p38 MAPK was associated with an inhibition of TGF-beta1-induced growth. The mitogenic signaling of TGF-beta1 also involved the inflammatory transcription factor, NF-{kappa}B, but is not dependent on the elements of Smad pathway.

Previous studies have reported conflicting effects of TGF-beta1 on ASM cell proliferation (2, 3, 79), which may be related to different culture conditions used. Our study shows that TGF-beta1 retains its proliferative effects under different culture conditions such as the degree of confluence or the presence of varying concentrations of FCS (0.1–5% FCS) or absence of serum without addition of any other growth factor or stimulator. Treatment of nonconfluent ASM cells with TGF-beta1 stimulated a two- to fivefold increase in cell growth in the presence of 0.1–5% FCS, and the effect was time- and concentration-dependent. Our data support the study by Black et al. (2) who showed that TGF-beta increased nonconfluent bovine ASM cell number in the presence of 2% FBS. TGF-beta has also been reported to increase cell growth and DNA synthesis of confluent ASM cells at lower serum concentrations (7). We have shown that TGF-beta1 stimulated up to 70% increase in confluent ASM cell growth with lower serum concentrations. The mitogenic effect of TGF-beta1 on nonconfluent cells was greater than on confluent cells, which may be due to the higher growth rate of nonconfluent cells undergoing exponential growth; in addition, TGF-beta released by nonconfluent ASM cells is much higher than confluent cells (10). TGF-beta1 also stimulated nonconfluent and confluent ASM cell growth in serum-free medium as has been previously reported (7, 25), but the activity is lower than that in serum-containing medium. Although the focus of this work is on hyperplasia, we also observed ASM hypertrophy when ASM cells were treated after 2–3 days in the absence of serum as has been recently reported (14).

TGF-beta signal transduction is first initiated by binding to two cell membrane serine-threonine kinase receptors, termed TbetaRI and TbetaRII, followed by their phosphorylation. Two TbetaRII subunits phosphorylate or activate two TbetaRI. TGF-beta1-stimulated ASM cell growth is directly mediated by its receptor, as inhibition of TbetaRI kinase by SD-208 blocked the mitogenic effect of TGF-beta1, indicating that the phosphorylation of TbetaRI by TGF-beta1 is necessary for the mitogenic signaling. The Smad family of proteins are the primary substrates of the phosphorylated TbetaRI. Phosphorylation of Smad2 and Smad3 leads to the formation of heteromeric complexes with Smad4. These complexes then translocate to the nucleus and regulate gene transcription by binding DNA directly or in association with other transcriptional factors, whereas Smad7 acts as negative regulator of the Smad signaling (24). The Smad pathway is involved in TGF-beta-stimulated vascular SM cell growth (16) and mediates TGF-beta-enhanced serum response factor-dependent transcription in ASM cells (4). We have previously shown that TGF-beta1 induces Smad2/3 phosphorylation and CTGF expression in ASM cells (39), but, in the present study, inhibition of Smad signaling by the virus-mediated expression of DNS3 or Smad7 or activation through the expression of a constitutively active Smad4 did not affect TGF-beta1-induced cell growth but regulated TGF-beta1-induced CTGF expression. This indicates that TGF-beta1-induced ASM cell growth is mediated through Smad-independent pathways. TGF-beta has also been shown to activate p21-activated kinase-2 (PAK2) through Smad-independent signaling pathway in the growth-stimulated fibroblastic cells (37).

Evidence from a previous report showed that TGF-beta1 activates PI3K via its type I receptor (41) and that PI3K upregulates cyclin D1 expression in ASM cells (28) and mediates mitogen-induced ASM cell proliferation (18). We also found that PI3K is essential for both TGF-beta1-induced and autonomous ASM cell growth because TGF-beta1-stimulated ASM cell growth was completely inhibited by the PI3K blocker, LY-294002, which also decreased the autonomous cell growth. MAPK pathways have been implicated in both positive and negative regulation of TGF-beta signaling (7, 38). TGF-beta induces the activation of ERK, JNK, and p38 MAPK pathways in ASM cells (7) possibly through the upstream mediators RhoA and Ras and via TGF-beta-activated kinase (1). We showed that ERK and JNK pathways positively regulated TGF-beta1-induced ASM cell growth as inhibition of these kinase activation by the specific inhibitors PD-98059 and SP-25600 downregulated the mitogenic activity of TGF-beta1. ERK is a mitogenic signaling pathway for thrombin and basic FGF as well as TGF-beta1 in ASM cells (7, 30), and JNK has also been shown to mediate TGF-beta1-induced expression of the target gene, CTGF, in ASM cells (39). Interestingly, inhibition of p38 MAPK activity by the specific inhibitor, SB-203580, enhanced TGF-beta1-induced ASM cell growth, which may be associated with the observation that p38 MAPK negatively regulates cyclin D1 expression in ASM cells (27). On the other hand, ERK increased cyclin D1 expression in ASM cells (29), illustrating the differential involvement of the different MAPK pathways in TGF-beta-induced growth regulation in ASM cells.

TGF-beta may activate the inflammatory transcription factor NF-{kappa}B (20), and TGF-beta signaling has functional cooperation with NF-{kappa}B signaling (22). For the first time, we found that inhibition of NF-{kappa}B activation by the IKK2 inhibitor, AS-602869, significantly attenuated TGF-beta1-stimulated cell growth, indicating that NF-{kappa}B signaling is required for the TGF-beta1 mitogenic activity.

Corticosteroids are anti-inflammatory drugs used for the treatment of asthma and inhibit mitogen-stimulated ASM cell proliferation (13, 36). We observed marked downregulation of TGF-beta1-stimulated ASM cell growth by the glucocorticoid, dexamethasone, an effect that could occur through reduction of cyclin D1 levels and inhibition of retinoblastoma protein phosphorylation (13). However, one of the mechanisms could be through the inhibition of NF-{kappa}B activation. Thus corticosteroid treatment may lead to inhibition of ASM hyperplasia in asthma, an effect that has yet to be confirmed in vivo in asthmatic patients treated with inhaled corticosteroids.

In conclusion, increased TGF-beta1 expression is observed in ASM of patients with asthma. TGF-beta1 induces ASM hyperplasia that is initially mediated by membrane TbetaR via TbetaRI phosphorylation and regulated positively by downstream kinases, PI3K, ERK, and JNK, and negatively by p38 MAPK. We also provide evidence that TGF-beta1 mitogenic signaling is through NF-{kappa}B-dependent but Smad-independent pathways. We speculate that blockage of TGF-beta1 activity or signaling may be a therapeutic strategy in asthma to inhibit ASM hyperplasia.


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This work was supported by a Wellcome Trust United Kingdom grant.


    FOOTNOTES
 

Address for reprint requests and other correspondence: K. F. Chung, National Heart and Lung Institute, Imperial College London, Dovehouse St., London SW3 6LY, United Kingdom

The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.


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 ABSTRACT
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 RESULTS
 DISCUSSION
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  1. Bhowmick NA, Ghiassi M, Bakin A, Aakre M, Lundquist CA, Engel ME, Arteaga CL, Moses HL. Transforming growth factor-beta1 mediates epithelial to mesenchymal transdifferentiation through a RhoA-dependent mechanism. Mol Biol Cell 12: 27–36, 2001.[Abstract/Free Full Text]
  2. Black PN, Young PG, Skinner SJ. Response of airway smooth muscle cells to TGF-beta1: effects on growth and synthesis of glycosaminoglycans. Am J Physiol Lung Cell Mol Physiol 271: L910–L917, 1996.[Abstract/Free Full Text]
  3. Bosse Y, Thompson C, Stankova J, Rola-Pleszczynski M. Fibroblast growth factor 2 and transforming growth factor beta1 synergism in human bronchial smooth muscle cell proliferation. Am J Respir Cell Mol Biol 34: 746–753, 2006.[Abstract/Free Full Text]
  4. Camoretti-Mercado B, Fernandes DJ, Dewundara S, Churchill J, Ma L, Kogut PC, McConville JF, Parmacek MS, Solway J. Inhibition of transforming growth factor beta-enhanced serum response factor-dependent transcription by SMAD7. J Biol Chem 281: 20383–20392, 2006.[Abstract/Free Full Text]
  5. Camoretti-Mercado B, Solway J. Transforming growth factor-beta1 and disorders of the lung. Cell Biochem Biophys 43: 131–148, 2005.[CrossRef][ISI][Medline]
  6. Catley MC, Sukkar MB, Chung KF, Jaffee B, Liao SM, Coyle AJ, Haddad el-B, Barnes PJ, Newton R. Validation of the anti-inflammatory properties of small-molecule IkappaB Kinase (IKK)-2 inhibitors by comparison with adenoviral-mediated delivery of dominant-negative IKK1 and IKK2 in human airways smooth muscle. Mol Pharmacol 70: 697–705, 2006.[Abstract/Free Full Text]
  7. Chen G, Khalil N. TGF-beta1 increases proliferation of airway smooth muscle cells by phosphorylation of MAP kinases. Respir Res 7: 2, 2006.[CrossRef][Medline]
  8. Cohen MD, Ciocca V, Panettieri RA Jr. TGF-beta 1 modulates human airway smooth-muscle cell proliferation induced by mitogens. Am J Respir Cell Mol Biol 16: 85–90, 1997.[Abstract]
  9. Cohen P, Rajah R, Rosenbloom J, Herrick DJ. IGFBP-3 mediates TGF-beta1-induced cell growth in human airway smooth muscle cells. Am J Physiol Lung Cell Mol Physiol 278: L545–L551, 2000.[Abstract/Free Full Text]
  10. Coutts A, Chen G, Stephens N, Hirst S, Douglas D, Eichholtz T, Khalil N. Release of biologically active TGF-beta from airway smooth muscle cells induces autocrine synthesis of collagen. Am J Physiol Lung Cell Mol Physiol 280: L999–L1008, 2001.[Abstract/Free Full Text]
  11. Davies DE, Wicks J, Powell RM, Puddicombe SM, Holgate ST. Airway remodeling in asthma: new insights. J Allergy Clin Immunol 111: 215–225, 2003.[CrossRef][ISI][Medline]
  12. Ebina M, Takahashi T, Chiba T, Motomiya M. Cellular hypertrophy and hyperplasia of airway smooth muscles underlying bronchial asthma. A 3-D morphometric study. Am Rev Respir Dis 148: 720–726, 1993.[ISI][Medline]
  13. Fernandes D, Guida E, Koutsoubos V, Harris T, Vadiveloo P, Wilson JW, Stewart AG. Glucocorticoids inhibit proliferation, cyclin D1 expression, and retinoblastoma protein phosphorylation, but not activity of the extracellular-regulated kinases in human cultured airway smooth muscle. Am J Respir Cell Mol Biol 21: 77–88, 1999.[Abstract/Free Full Text]
  14. Goldsmith AM, Bentley JK, Zhou L, Jia Y, Bitar KN, Fingar DC, Hershenson MB. Transforming growth factor-beta induces airway smooth muscle hypertrophy. Am J Respir Cell Mol Biol 34: 247–254, 2006.[Abstract/Free Full Text]
  15. Groneberg DA, Witt H, Adcock IM, Hansen G, Springer J. Smads as intracellular mediators of airway inflammation. Exp Lung Res 30: 223–250, 2004.[CrossRef][ISI][Medline]
  16. Ikedo H, Tamaki K, Ueda S, Kato S, Fujii M, Ten Dijke P, Okuda S. Smad protein and TGF-beta signaling in vascular smooth muscle cells. Int J Mol Med 11: 645–650, 2003.[ISI][Medline]
  17. Kaivo-Oja N, Bondestam J, Kamarainen M, Koskimies J, Vitt U, Cranfield M, Vuojolainen K, Kallio JP, Olkkonen VM, Hayashi M, Moustakas A, Groome NP, Ten Dijke P, Hsueh AJ, Ritvos O. Growth differentiation factor-9 induces Smad2 activation and inhibin B production in cultured human granulosa-luteal cells. J Clin Endocrinol Metab 88: 755–762, 2003.[Abstract/Free Full Text]
  18. Krymskaya VP, Penn RB, Orsini MJ, Scott PH, Plevin RJ, Walker TR, Eszterhas AJ, Amrani Y, Chilvers ER, Panettieri RA Jr. Phosphatidylinositol 3-kinase mediates mitogen-induced human airway smooth muscle cell proliferation. Am J Physiol Lung Cell Mol Physiol 277: L65–L78, 1999.[Abstract/Free Full Text]
  19. Leung SY, Niimi A, Noble A, Oates T, Williams A, Medicherla S, Protter AA, Chung KF. Effect of TGF-beta receptor I kinase inhibitor, SD-208, in chronic allergic airway inflammation and remodeling. J Pharmacol Exp Ther 319: 586–594, 2006.[Abstract/Free Full Text]
  20. Lu T, Burdelya LG, Swiatkowski SM, Boiko AD, Howe PH, Stark GR, Gudkov AV. Secreted transforming growth factor beta2 activates NF-kappaB, blocks apoptosis, and is essential for the survival of some tumor cells. Proc Natl Acad Sci USA 101: 7112–7117, 2004.[Abstract/Free Full Text]
  21. McMillan SJ, Xanthou G, Lloyd CM. Manipulation of allergen-induced airway remodeling by treatment with anti-TGF-beta antibody: effect on the Smad signaling pathway. J Immunol 174: 5774–5780, 2005.[Abstract/Free Full Text]
  22. Mikami F, Lim JH, Ishinaga H, Ha UH, Gu H, Koga T, Jono H, Kai H, Li JD. The transforming growth factor-beta-Smad3/4 signaling pathway acts as a positive regulator for TLR2 induction by bacteria via a dual mechanism involving functional cooperation with NF-kappaB and MAPK phosphatase 1-dependent negative cross-talk with p38 MAPK. J Biol Chem 281: 22397–22408, 2006.[Abstract/Free Full Text]
  23. Minshall EM, Leung DY, Martin RJ, Song YL, Cameron L, Ernst P, Hamid Q. Eosinophil-associated TGF-beta1 mRNA expression and airways fibrosis in bronchial asthma. Am J Respir Cell Mol Biol 17: 326–333, 1997.[Abstract/Free Full Text]
  24. Moustakas A, Souchelnytskyi S, Heldin CH. Smad regulation in TGF-beta signal transduction. J Cell Sci 114: 4359–4369, 2001.[ISI][Medline]
  25. Okona-Mensah KB, Shittu E, Page C, Costello J, Kilfeather SA. Inhibition of serum and transforming growth factor beta (TGF-beta1)-induced DNA synthesis in confluent airway smooth muscle by heparin. Br J Pharmacol 125: 599–606, 1998.[CrossRef][ISI][Medline]
  26. Orsini MJ, Krymskaya VP, Eszterhas AJ, Benovic JL, Panettieri RA Jr, Penn RB. MAPK superfamily activation in human airway smooth muscle: mitogenesis requires prolonged p42/p44 activation. Am J Physiol Lung Cell Mol Physiol 277: L479–L488, 1999.[Abstract/Free Full Text]
  27. Page K, Li J, Hershenson MB. p38 MAP kinase negatively regulates cyclin D1 expression in airway smooth muscle cells. Am J Physiol Lung Cell Mol Physiol 280: L955–L964, 2001.[Abstract/Free Full Text]
  28. Page K, Li J, Wang Y, Kartha S, Pestell RG, Hershenson MB. Regulation of cyclin D(1) expression and DNA synthesis by phosphatidylinositol 3-kinase in airway smooth muscle cells. Am J Respir Cell Mol Biol 23: 436–443, 2000.[Abstract/Free Full Text]
  29. Ramakrishnan M, Musa NL, Li J, Liu PT, Pestell RG, Hershenson MB. Catalytic activation of extracellular signal-regulated kinases induces cyclin D1 expression in primary tracheal myocytes. Am J Respir Cell Mol Biol 18: 736–740, 1998.[Abstract/Free Full Text]
  30. Ravenhall C, Guida E, Harris T, Koutsoubos V, Stewart A. The importance of ERK activity in the regulation of cyclin D1 levels and DNA synthesis in human cultured airway smooth muscle. Br J Pharmacol 131: 17–28, 2000.[CrossRef][ISI][Medline]
  31. Redington AE, Madden J, Frew AJ, Djukanovic R, Roche WR, Holgate ST, Howarth PH. Transforming growth factor-beta 1 in asthma. Measurement in bronchoalveolar lavage fluid. Am J Respir Crit Care Med 156: 642–647, 1997.[Abstract/Free Full Text]
  32. Sporn MB, Roberts AB. Transforming growth factor-beta: recent progress and new challenges. J Cell Biol 119: 1017–1021, 1992.[Free Full Text]
  33. Torrego A, Hew M, Oates T, Sukkar M, Chung KF. Expression and activation of TGF-beta isoforms in acute allergen-induced remodelling in asthma. Thorax 62: 307–313, 2007.[Abstract/Free Full Text]
  34. Uhl M, Aulwurm S, Wischhusen J, Weiler M, Ma JY, Almirez R, Mangadu R, Liu YW, Platten M, Herrlinger U, Murphy A, Wong DH, Wick W, Higgins LS, Weller M. SD-208, a novel transforming growth factor beta receptor I kinase inhibitor, inhibits growth and invasiveness and enhances immunogenicity of murine and human glioma cells in vitro and in vivo. Cancer Res 64: 7954–7961, 2004.[Abstract/Free Full Text]
  35. Vignola AM, Chanez P, Chiappara G, Merendino A, Pace E, Rizzo A, la Rocca AM, Bellia V, Bonsignore G, Bousquet J. Transforming growth factor-beta expression in mucosal biopsies in asthma and chronic bronchitis. Am J Respir Crit Care Med 156: 591–599, 1997.[Abstract/Free Full Text]
  36. Vlahos R, Lee KS, Guida E, Fernandes DJ, Wilson JW, Stewart AG. Differential inhibition of thrombin- and EGF-stimulated human cultured airway smooth muscle proliferation by glucocorticoids. Pulm Pharmacol Ther 16: 171–180, 2003.[CrossRef][ISI][Medline]
  37. Wilkes MC, Murphy SJ, Garamszegi N, Leof EB. Cell-type-specific activation of PAK2 by transforming growth factor beta independent of Smad2 and Smad3. Mol Cell Biol 23: 8878–8889, 2003.[Abstract/Free Full Text]
  38. Xiao YQ, Malcolm K, Worthen GS, Gardai S, Schiemann WP, Fadok VA, Bratton DL, Henson PM. Cross-talk between ERK and p38 MAPK mediates selective suppression of pro-inflammatory cytokines by transforming growth factor-beta. J Biol Chem 277: 14884–14893, 2002.[Abstract/Free Full Text]
  39. Xie S, Sukkar MB, Issa R, Oltmanns U, Nicholson AG, Chung KF. Regulation of TGF-beta1-induced connective tissue growth factor expression in airway smooth muscle cells. Am J Physiol Lung Cell Mol Physiol 288: L68–L76, 2005.[Abstract/Free Full Text]
  40. Xie SP, James SY, Colston KW. Vitamin D derivatives inhibit the mitogenic effects of IGF-I on MCF-7 human breast cancer cells. J Endocrinol 154: 495–504, 1997.[Abstract]
  41. Yi JY, Shin I, Arteaga CL. Type I transforming growth factor beta receptor binds to and activates phosphatidylinositol 3-kinase. J Biol Chem 280: 10870–10876, 2005.[Abstract/Free Full Text]



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