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Rapamycin reversal of VEGF-C–driven lymphatic anomalies in the respiratory tract
Peter Baluk, Li-Chin Yao, Julio C. Flores, Dongwon Choi, Young-Kwon Hong, Donald M. McDonald
Peter Baluk, Li-Chin Yao, Julio C. Flores, Dongwon Choi, Young-Kwon Hong, Donald M. McDonald
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Research Article Vascular biology

Rapamycin reversal of VEGF-C–driven lymphatic anomalies in the respiratory tract

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Abstract

Lymphatic malformations are serious but poorly understood conditions that present therapeutic challenges. The goal of this study was to compare strategies for inducing regression of abnormal lymphatics and explore underlying mechanisms. CCSP-rtTA/tetO-VEGF-C mice, in which doxycycline regulates VEGF-C expression in the airway epithelium, were used as a model of pulmonary lymphangiectasia. After doxycycline was stopped, VEGF-C expression returned to normal, but lymphangiectasia persisted for at least 9 months. Inhibition of VEGFR-2/VEGFR-3 signaling, Notch, β-adrenergic receptors, or autophagy and antiinflammatory steroids had no noticeable effect on the amount or severity of lymphangiectasia. However, rapamycin inhibition of mTOR reduced lymphangiectasia by 76% within 7 days without affecting normal lymphatics. Efficacy of rapamycin was not increased by coadministration with the other agents. In prevention trials, rapamycin suppressed VEGF-C–driven mTOR phosphorylation and lymphatic endothelial cell sprouting and proliferation. However, in reversal trials, no lymphatic endothelial cell proliferation was present to block in established lymphangiectasia, and rapamycin did not increase caspase-dependent apoptosis. However, rapamycin potently suppressed Prox1 and VEGFR-3. These experiments revealed that lymphangiectasia is remarkably resistant to regression but is responsive to rapamycin, which rapidly reduces and normalizes the abnormal lymphatics without affecting normal lymphatics.

Authors

Peter Baluk, Li-Chin Yao, Julio C. Flores, Dongwon Choi, Young-Kwon Hong, Donald M. McDonald

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Figure 5

Staining for p-mTOR, p-S6RP, and p-4E-BP1 in growing lymphatics.

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Staining for p-mTOR, p-S6RP, and p-4E-BP1 in growing lymphatics.
(A) Abs...
(A) Absence of p-mTOR staining in lymphatics of normal trachea. (B) Uniformly strong p-mTOR staining in lymphatics. The epithelium was excluded from the confocal projection of the tracheal whole mount. (C) Absence of p-S6RP staining in lymphatics of normal trachea. (D) Strong p-S6RP staining in lymphatic sprouts (arrows) in CCSP/VEGF-C mice after doxycycline (3 days). Arrowheads mark p-S6RP staining of other cell types. (E) Absence of p-4E-BP1 staining in lymphatics of normal trachea. (F) Strong p-4E-BP1 staining in a subset of lymphatic endothelial cells in CCSP/VEGF-C mice on doxycycline (3 days). (G) The boxed region in F shown at higher magnification. Arrowheads mark p-4E-BP1–positive cells. (H) Phospho-4E-BP1 staining in a lymphatic sprout (arrowhead) in CCSP/VEGF-C mice on doxycycline (2 days, P23). (I) Transient increase in number of p-4E-BP1–stained cells during doxycycline exposure (red boxes, P21–P28) and 14 days after withdrawal of doxycycline (red stripped box, P42). n = 3–10 mice/group. *P < 0.05 vs. vehicle, ANOVA. (J) BrdU labeling of p-4E-BP1–stained cells after doxycycline (3 days). BrdU labeling (green) in lymphatic endothelial cells is more abundant than p-4E-BP1 (red). Prox1 (white in bottom panels) is not restricted to the nuclei of dividing cells (arrowheads, left panels). Some p-4E-BP1–stained cells lack BrdU labeling (arrowheads, right panels). (K) Numerous p-4E-BP1–stained cells were observed after doxycycline alone (2 days, P21-P23) but not when doxycycline was given concurrently with rapamycin. (L) An increased number of p-4E-BP1–stained cells (red box) was observed after treatment with doxycycline (2 days, P21–P23). The increase was prevented when doxycycline was given concurrently with rapamycin (20 mg/kg, green box). *P < 0.05 vs. baseline, ANOVA, n = 5 mice/group. Scale bar: 50 μm (A–D, G, and K); 200 μm (E and F); 10 μm (H). Box and whisker plots show the median, first and third quartiles, and maximum and minimum.

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