Calcific aortic valve disease (CAVD) is highly prevalent during aging. CAVD initiates with endothelial dysfunction, leading to lipid accumulation, inflammation, and osteogenic transformation. Integrin-linked kinase (ILK) participates in the progression of cardiovascular diseases, such as endothelial dysfunction and atherosclerosis. However, ILK role in CAVD is unknown. First, we determined that ILK expression is downregulated in aortic valves from patients with CAVD compared to non-CAVD, especially at the valve endothelium, and negatively correlated with calcification markers. Silencing ILK expression in human valve endothelial cells (siILK-hVECs) induced endothelial-to-mesenchymal transition (EndMT) and promoted a switch to an osteoblastic phenotype; SiILK-hVECs expressed increased RUNX2 and developed calcified nodules. siILK-hVECs exhibited decreased NO production and increased nitrosative stress, suggesting valvular endothelial dysfunction. NO treatment of siILK-hVECs prevented VEC transdifferentiation, while treatment with an eNOS inhibitor mimicked ILK-silencing induction of EndMT. Accordingly, NO treatment inhibited VEC calcification. Mechanistically, siILK-hVECs showed increased Smad2 phosphorylation, suggesting a TFG-β-dependent mechanism, and NO treatment decreased Smad2 activation and RUNX2. Experiments performed in eNOS KO mice confirmed the involvement of the ILK-eNOS signaling pathway in valve calcification, since aortic valves from these animals showed decreased ILK expression, increased RUNX2, and calcification. Our study demonstrated that ILK endothelial expression participates in human CAVD development by preventing endothelial osteogenic transformation.
Introduction: Calcific aortic valve disease (CAVD) is the most common valvular heart disease in the aging population. CAVD is a highly active ossification process originated in valvular interstitial cells which differentiate towards an osteoblastic phenotype. However, the role of valvular endothelial cells in CAVD has not been fully explored. We previously demonstrated that ILK expression in vascular endothelium plays an essential cardioprotective role. Hypothesis: Endothelial ILK plays a protective role in human valvular endothelial cells osteogenesis. Methods and Results: Human aortic valves were obtained from 52 patients with calcific aortic stenosis compared with 16 non-calcified aortic valves and ILK levels were analyzed. Our study showed a significant relationship between the degree of AV calcification and decreased ILK expression detected by IHQ and qPCR (p< 0,013). Moreover, decreased ILK expression correlated with BMP2 and Runx2, two markers of valvular calcification (p<0.01). Human valvular endothelial cells (hVECs) isolated from non-calcified controls display the ability to calcify when cultured in pro-calcifiying conditions and ILK levels were unaffected by the pro-calcifiying conditions. However, silencing ILK expression in hVECs resulted in decreased NO production, increased expression of calcific disease markers Runx2, BMP2, and osteopontin. ILK silencing in hVECs induced calcium deposition, determined by alizarin red staining, when cultured in pro-calcifiying conditions. Thus, our results suggest that decreased ILK expression could promote endothelial to osteogenic phenotype transition. Restoring nitric oxide levels by DETA-NONOate treatment in ILK silenced hVEC was able to reverse those effects partially. Conclusions: Collectively, our results point to a crucial role of ILK in maintaining human valve endothelial cell function preventing valvular calcification.
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