Sheila Fatehpur1, Burkhard Feidicker2, Ralf Gerd Ritter3, Josefina Kusnirova1,
Johann Philipp Addicks4, Pouria Sabetian5, Muhammad Akram6 and Masoud
Mirzaie1*
1Department of Vascular Surgery, OWL University clinic, Campus Lemgo, Germany
2Department of Vascular Surgery, OWL University clinic, Campus EVKB, Germany
3Department of Vascular Surgery, OWL University clinic, Campus Clinic Bielefeld, Germany
4Institut of Neuroradiology, OWL, University clinic, Campus Lemgo, Germany
5Department of Vascular Surgery, Mönchengladbach Clinic, Germany
6Department of Eastern Medicine, Government College University Faisalabad, Pakistan
*Corresponding author:Masoud
Mirzaie, Department of Vascular Surgery,
OWL University clinic, Campus Lemgo,
Germanys
The transcription factor nuclear factor-κappa B (NF-κB) regulates cell growth and
maturation on the one hand, and NF-κB is a component of signaling pathways of immune
defense and inflammation on the other. After its activation, it migrates from the cytoplasm of
the cell to the nucleus. Activated via a variety of stimuli such as viruses, bacteria, cytokines,
free radicals, carcinogens, tumor promoters, and endotoxins, NF-κB regulates the expression
of nearly 400 different genes, including enzymes (COX-2 and iNOS), cytokines (TNF, IL-1, IL-
6, IL-8, and chemokines), which influence the production of adhesion molecules, cell cycle
regulatory molecules, viral proteins, and angiogenic factors. The reciprocal influence of NF-κB
and the genes activated by NF-κB is highly complex. For example, TNF-α activates NF-κB, which
itself transcriptionally induces TNF-α. A similarly complex induction pathway exists between
NF-κB and COX-2 prostaglandin E2-EP2-NF-κB pathway. COX-2 induced by hemodynamic
stress induces and produces prostaglandin E2, which further induces NF-κB. Constitutive
NFkB activation is involved in the pathogenesis of cancer, diabetes, allergy, rheumatoid
arthritis, Crohn’s disease, cardiovascular disease, atherosclerosis, and other diseases. Among
others, its role in various aneurysms has been highlighted. The present work provides some
complex interactions of NF-κB in the context of various aneurysms.
General inflammatory response
In the pathogenesis of aneurysms, vascular inflammation starting from activated stromal
cells represents a major pathomechanism [1]. In this process, the cytokines IL-6, IL-1β,
and the MCP-1 chemokine receptor CCR2 appear to play a central role [2-4]. In contrast,
deficiency of AT1aR (Ang-II type 1a receptor), pattern recognition receptor TLR4 (Toll-like
receptor 4), and adaptor protein MyD8836 exerts a protective effect, suggesting the key role
of proinflammatory transcription factor NF-κB/RelA [5,6]. In the Ang II model of AAA, an
interaction between proliferating resident adventitial fibroblasts with infiltrating monocytes
has been shown several times. This activates an ECM destruction-promoting cytokine
amplification loop. Therefore, loss of vascular integrity and aortic dilatation is preceded
by adventitial inflammation [7]. A subpopulation of fibroblasts, namely the specialized
myofibroblasts and Col1A-expressing synthetic VSMCs, plays an important role in fibrosis and
formation/remodeling of the aortic ECM [8,9]. Ang II leads to RelA
activation and IL-6 production in both the adventitial and medial
layers of the abdominal aorta [10].
Endothelial NF-κB signaling
Endothelial NF-κB signaling not only promotes leukocyteendothelium
interaction in the vasa vasorum, a necessary step
toward Ang II-induced aneurysms [11]. A significant association of
the common 1166C variant of the angiotensin II type 1a receptor
gene with AAA was demonstrated in 3 independent, geographically
distinct but ethnically similar case-control cohorts [12]. The
AGTR1 1166C risk association is not with peripheral or coronary
artery disease. Although AAA and atherosclerotic occlusive pAVD
represent distinct pathophysiological entities, a large association
of MMP9 C-1562T SNP and AGTR1 1166C genotypes was found
between AAA and patients with peripheral arterial disease [13].
NF-κB and the perivascular adipose tissue (PVAT)
A growing interest in large artery disease is the transcriptome
of Perivascular Adipose Tissue (PVAT), as this plays a basic role in
the regulation of vascular physiology and its dysfunction influences
the development of dilated and atherosclerotic aortic disease [14-
19]. Only by focusing research not only on the aortic wall but also
on the perivascular adipose tissue has it been possible to gain
insight into the complicated pathomechanism of AAA development.
In this regard, an altered immune response in the perivascular
adipose tissue represents a crucial pathogenetic element for
the development of AAA [20-22]. Reconstruction of regulatory
networks shows that the combination of multiple pathobiological
factors (disease genes, hubs) in complex relationships with each
other lead to the development of AAA [23]. Thus, in addition
to SPIB and TBP (i.e., “hub” TFs), NFKB1 has been identified as
the major regulator of the resulting gene regulatory network
because it exhibits the greatest connectivity with co-expressed
genes associated with diseased PVAT [22]. Most importantly, on
the one hand, the NFKB1 transcriptional cluster leads to positive
regulation of lymphocyte proliferation and, together with TBP, to
the expression of genes involved in the innate immune response,
i.e., Toll-Like Receptor (TLR) signaling [22,24,25].
In addition, NFKB1, REL, and RELA may affect T-cell
proliferation, macrophage infiltration, and osteoclastogenic
dehydration in different ways. At the end of this activation chain
is the inflammatory response in vascular smooth muscle cells
and mesenchymal cells [26-30]. In addition, the protein kinases
MAPK1 and GSK3B and the nuclear receptor RXRA (a type of
retinoid X receptor) play critical roles in the pathogenesis of
AAA. Directly, MAPKs and GSK3s are mainly involved in innate
immunity including TLR-related signaling, including TLR-related
signaling that modulates the activity of matrix metalloproteinases
during AAA formation [31,32]. Regulation of the ERK1 and ERK2
cascade in the perivascular adipose tissue transcriptome via the
NFKB1, SPIB, and TBP transcriptional clusters highlights the role
of NFKB1 and protein kinases in aneurysm formation [33,34].
Although inhibition of angiotensin type 1 receptor in vascular
smooth muscle cells by activation of retinoid X receptors (RXR
activation) may influence AAA development, this mechanism is not
considered to be important [35-37]. Other protein kinases, albeit
with less importance in the regulatory network, such as histone
deacetylase 1 (HDCA1), may also directly interact with NFKB1
and with TBP to influence AAA development [38,39]. In close
interaction, perivascular adipocytes secrete soluble factors e.g.,
adipokines, chemokines, or proinflammatory, which may lead to
NF-kB activation [40,41].
NF-κB and hub genes
Molecular Complex Detection (MCODE) identified a total of 55
hub genes, of which the genes for positive regulation of cytosolic
calcium ion concentration, lymphocyte activation, and regulation
of cytosolic calcium ion concentration were found to be the most
important for the development of AAA [42]. The hub genes in
MCODE 6, hsa04064, R-HSA-5668541, and R-HSA-5676594 can
activate the NF-kappa B pathway via tumor necrosis factor (TNF)
[42,43]. The other three genes lymphotoxin-α and -β (LTA=TNF-β
and LTB) and TNF receptor-associated factor 3 (TRAF3) can lead
to NF-kappa B activation [44-46]. Angiotension II (Ang II) is able
to increase the expression of phospho-p65 P65 subunit of NF-kB,
which itself has been shown to induce a pro-inflammatory state
leading to the increased expression of MMP9, MCP1, VCAM1,
ICAM1, and IL1beta [47-49]. Direct interaction of FKBP11 with the
NF-kB p65 subunit promotes endothelial inflammation through
secretion of pro-inflammatory cytokines [49].
NF-κB and ALOX5
The reciprocal action of ALOX5 and Nfkb contributes
significantly to the formation of AAA. ALOX5 encodes the enzyme
arachidonate-5-lipoxygenase in the eicosanoid synthesis pathway,
which, in conjunction with the ALOX5AP protein [24], catalyzes
the conversion of 5-HPETE to leukotriene A4 (LTA4) [50]. This
in turn promotes proinflammatory leukotriene biosynthesis
[51]. Increasing leukotriene B4 signaling increases immune cell
infiltration [52]. Cathepsin K (CTSK) is also modulated by ALOX5,
which directly affects AAA development through collagen turnover,
T-cell proliferation, and apoptosis [53-55]. Down-regulation of
miRNA-125b-5p and miR-193a-3p in AAA tissues leads to upregulation
of the ALOX5 gene, which initiates primary aortic wall
inflammation in AAA development via leukotriene production
[56,57]. As a general inflammatory response, increased expression
of 5-LOX, NF-κB, and iNOS has already been found in ischemic
cerebral ischemia [58-60]. Inhibition of NF-κB luciferase activity
in vitro and translocation of p65 to the nucleus by the 5-LOX
inhibitor BW-B 70C reinforces the hypothesis that 5-LOX/NF-κB
signaling results from its direct interaction with the p65 subunit of
NF-κB [57,61,62]. Decreased iNOS expression by BW-B 70C argues
for primary activation of 5-LOX upon inflammation, which then
initiates NF-κB and iNOS expression [57].
NF-κB and cyclooxygenase 2 (COX-2)
Cyclooxygenase 2 (COX-2), known as prostaglandin synthase-2,
catalyzes the isomerization of the COX product prostaglandin H2 to
prostaglandin E2, which itself initiates nuclear factor-κB expression
via activation from the endothelial prostaglandin receptor [61-67].
On the one hand, COX-2 expression is initiated by the involvement
of protein kinase C (PKC), Ras, and Wnt signaling pathways through
the activation of mitogen-activated protein kinase (MAPK), kinase
family proteins such as extracellular-signal-regulated kinas (ERK),
C-Jun N-terminal cinase (JNK), and p38 [68-72]. On the other
hand, DNA binding sites for transcription factors NF-κB, AP1,
cAMP response element-binding protein (CREB C/EBP), NF-IL6,
MEF2, and transcription factor 4/LEF1 in the COX-2 promoter
indicate their functional regulation of COX-2 transcription [73,74].
Nuclear factor-κB (NF-κB) plays a key role in both the initiation
and progression of intracerebral aneurysms, in which macrophage
recruitment via activation of inflammatory genes [75], vascular cell
adhesion protein (VCAM)-1 and monocyte chemoattractant protein
(MCP)-1 trigger endothelial dysfunction and initiate endothelial
cell membrane (ECM) degradation through interleukin [IL]-1β-
mediated downregulation of procollagen genes [76-80]. Besides,
tumor necrosis factor-α, mitogen-activated protein kinases, ANRIL,
also called CDKN2B-AS, CDKN2A/B, Krüppel-like factor 2, caspase
recruitment domain family, member 8, etc., contribute a major part
in the development of cerebral aneurysms [81-99].
NF-κB polymorphisms
Several NFKB polymorphisms can lead to the initiation of
cardiovascular disease. One of the best known and regulating NF-
κB expression and activity polymorphisms within the promoter
of the NFKB1 gene is -94 ins/del ATTG rs28362491 [100], which
show increased susceptibility to atherosclerosis. The (rs696)
polymorhism in the 3’UTR region of the NFKBIA gene leads to an
alteration in the expression of IκBα protein, an inhibitory version
of NF-κB protein, which is also encoded by NFKB1A [101]. In
apolipoprotein E (ApoE)-deficient mice, expression of the NF-κB
inhibitor IκBα-superrepressor (DNIκBα) resulted in inhibition of
atheromatous plaque development [102].
NF-κB and microRNAs
The role of microRNAs (mi RNAs) in the regulation of gene
expression involved in inflammation is moving to the center of
the etiology of cardiovascular disease [103,104]. In particular, mi-
146a, an NF-κB target gene, is thought to play an essential role
in inflammatory cardiovascular disease [105]. Single nucleotide
polymorphisms (SNPs) of pre-miR-146a, for example, can modify
the expression level of mature miRNA-146a and influence the
progression of cardiovascular disease [106-108]. Based on
this assumption, downregulation of miR-146a expression via
interleukin-1 receptor-associated kinase 1 (IRAK-1), TNF receptorassociated
factor 6 (TRAF6), and toll-like receptor -4 (TLR-4) by
angiotensin receptor blockers and statins has been suggested
[109,110]. A similar effect with delay of miR-146a expression
has been attributed to estrogens and progesterone [111,112].
This may provide an explanation for the gender difference in the
occurrence of aneurysms. Drugs in the statin group may have led to
suppression of both miR-126-3p and miR-146a expression levels,
thereby preventing aortic disease [113].
Other miRs have also been implicated in the very complex AAA
development. Whereas miR-146a-5p is overexpressed in AAA tissue
samples, miR 146a regulates inflammation in the AAA via CARD10
[114]. MiR-144-3p regulates ABCA1 in macrophages and influences
the production of proinflammatory cytokines and thus plaque
morphology through inhibition from reverse cholesterol transport
[115-119]. In this context, the expressions of individual miR in
AAA tissues and plasma of patients with AAA are controversial
and also different. In this regard, some research groups found
downregulation of miR-133b, miR-29b-3p, and miR-27b-3p in AAA
tissues [120-124], whereas other authors found upregulation of the
same [113,125]. Different plasma and AAA tissue levels of miR were
pointed out several times for miR-221-3p and miR-27b-3p, among
others [112,113,126-129]. However, miR-195 and miR-29b can also
suppress AAA development via the TNF-α/NF-κB and VEGF/PI3K/
Akt signaling pathways [130-132]. Surprisingly, the missing -94Ins/
DelATTG promoter polymorphism in the transcription factor NFKb
in patients with popliteal aneurysm has been recently reported,
opening new molecular biological aspects in the development of
aneurysms [133].
Nfkb as one of the main factors is involved in AAA development
in many mutual complex processes, based on which new therapy
approaches are being tested.
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Professor, Chief Doctor, Director of Department of Pediatric Surgery, Associate Director of Department of Surgery, Doctoral Supervisor Tongji hospital, Tongji medical college, Huazhong University of Science and Technology
Senior Research Engineer and Professor, Center for Refining and Petrochemicals, Research Institute, King Fahd University of Petroleum and Minerals (KFUPM), Dhahran, Saudi Arabia
Interim Dean, College of Education and Health Sciences, Director of Biomechanics Laboratory, Sport Science Innovation Program, Bridgewater State University