The historical view of vascular smooth muscle cells (VSMCs) in atherosclerosis is that ‘aberrant’ proliferation of VSMCs promotes plaque formation, but that VSMCs in advanced plaques are entirely beneficial, for example preventing rupture of the fibrous cap. However, this view has been based on ideas that there is a homogenous population of VSMCs within the plaque, that can be identified separate from other plaque cells (particularly macrophages) using standard VSMC and macrophage immunohistochemical ‘markers’. More recent genetic lineage tracing studies have shown that VSMC phenotypic switching results in less differentiated forms that lack VSMC ‘markers’ including macrophage-like cells, and this switching directly promotes atherosclerosis. In addition, VSMC proliferation may be beneficial throughout atherogenesis, and not just in advanced lesions, whereas VSMC apoptosis, cell senescence, and VSMC-derived macrophage-like cells may promote inflammation. We review the effect of embryological origin on VSMC behavior in atherosclerosis, the role, regulation and consequences of phenotypic switching, the evidence for different origins of VSMCs, and the role of individual processes that VSMCs undergo in atherosclerosis in regard to plaque formation and the structure of advanced lesions. We believe there is now compelling evidence that a full understanding of VSMC behavior in atherosclerosis is critical to identifying therapeutic targets to both prevent and treat atherosclerosis.

Heterogeneity of embryological origins is a hallmark of vascular smooth muscle cells (SMCs), which may influence vascular disease development. Differentiation of human pluripotent stem cells (hPSCs) into developmental origin-specific SMC subtypes remains elusive. In this study, we have established a chemically defined protocol where hPSCs were initially induced to form neuroectoderm, lateral plate mesoderm or paraxial mesoderm. These intermediate populations were further differentiated towards SMCs (>80% MYH11+ and ACTA2+) which displayed contractile ability in response to vasoconstrictors and invested perivascular regions in vivo. Derived SMC subtypes recapitulated the unique proliferative and secretory responses to cytokines previously documented in studies using aortic SMCs of distinct origins. Importantly, this system predicted increased extracellular matrix degradation by SMCs derived from lateral plate mesoderm, which was confirmed using rat aortic SMCs from corresponding origins. Collectively, this work will have broad applications in modeling origin-dependent disease susceptibility and in bio-engineered vascular grafts for regenerative medicine.

Platelet-derived growth factor BB (PDGF-BB) has been shown to be an extremely potent negative regulator of smooth muscle cell (SMC) differentiation. Moreover, previous studies have demonstrated that the Kruppel-like transcription factor (KLF) 4 potently represses the expression of multiple SMC genes. However, the mechanisms whereby KLF4 suppresses SMC gene expression are not known, nor is it clear whether KLF4 contributes to PDGF-BB-induced down-regulation of SMC genes. The goals of the present studies were to determine the molecular mechanisms by which KLF4 represses expression of SMC genes and whether it contributes to PDGF-BB-induced suppression of these genes. Results demonstrated that KLF4 markedly repressed both myocardin-induced activation of SMC genes and expression of myocardin. KLF4 was rapidly up-regulated in PDGF-BB-treated, cultured SMC, and a small interfering RNA to KLF4 partially blocked PDGF-BB-induced SMC gene repression. Both PDGF-BB and KLF4 markedly reduced serum response factor binding to CArG containing regions within intact chromatin. Finally, KLF4, which is normally not expressed in differentiated SMC in vivo, was rapidly up-regulated in vivo in response to vascular injury. Taken together, results indicate that KLF4 represses SMC genes by both down-regulating myocardin expression and preventing serum response factor/myocardin from associating with SMC gene promoters, and suggest that KLF4 may be a key effector of PDGF-BB and injury-induced phenotypic switching of SMC.Alterations in the differentiated state of the smooth muscle cell (SMC), 1 or phenotypic switching, has been shown to play a key role in the repair of tissue damage and in the development of a variety of major human diseases, including atherosclerosis, restenosis, and asthma (1, 2). A hallmark feature of this phenotypic switching is coordinate repression of the expression of the normal repertoire of genes that distinguish differentiated mature SMC from other cell types. However, the mechanisms that regulate this process are very poorly understood. Indeed, major challenges for the field have been to define regulatory cis-elements within the promoter enhancer regions of SMC marker genes, such as SM ␣-actin, SM22␣, and SM myosin heavy chain, to identify factors that bind and regulate the activity of these regulatory regions and to elucidate environmental factors/cues that influence these regulatory processes in response to tissue injury and/or pathological circumstances. The model that has emerged is that regulation of SMC differentiation is extremely complex and involves constant interplay between environmental cues and the genetic program that controls the coordinate expression of genes characteristic of the SMC lineage (reviewed by Owens et al. (1)). It is of particular interest that expression of virtually all SMC marker genes characterized to date is dependent on CArG box elements and SRF (reviewed by Miano (3)). Moreover, an especially exciting recent discovery was the demonstration (by our laboratory and others (4 -8)) t...

Abstract-The interactions between serum response factor (SRF) and CArG elements are critical for smooth muscle cell (SMC) marker gene transcription. However, the mechanisms whereby SRF, which is expressed ubiquitously, contributes to SMC-specific transcription are unknown. Myocardin was recently cloned as a coactivator of SRF in the heart, but its role in regulating CArG-dependent expression of SMC differentiation marker genes has not been clearly elucidated. In this study, we examined the expression and the function of myocardin in SMCs. In adult mice, myocardin mRNA was expressed in multiple smooth muscle (SM) tissues including the aorta, bladder, stomach, intestine, and colon, as well as the heart. Myocardin was also expressed in cultured rat aortic SMCs and A404 SMC precursor cells. Of particular interest, expression of myocardin was induced during differentiation of A404 cells, although it was not expressed in parental P19 cells from which A404 cells were derived. Cotransfection studies in SMCs revealed that myocardin induced the activity of multiple SMC marker gene promoters including SM ␣-actin, SM-myosin heavy chain, and SM22␣ by 9-to 60-fold in a CArG-dependent manner, whereas myocardin short interfering RNA markedly decreased activity of these promoters. Moreover, adenovirus-mediated overexpression of a dominant-negative form of myocardin significantly suppressed expression of endogenous SMC marker genes, whereas adenovirus-mediated overexpression of wild-type myocardin increased expression. Taken together, results provide compelling evidence that myocardin plays a key role as a transcriptional coactivator of SMC marker genes through CArG-dependent mechanisms. Key Words: smooth muscle cells Ⅲ transcriptional coactivator Ⅲ serum response factor Ⅲ CArG element P henotypic modulation of vascular smooth muscle cells (SMCs) is a key factor in the development of atherosclerosis and restenosis after balloon angioplasty. 1 Dedifferentiated SMCs in the intima show a more proliferative and synthetic phenotype than differentiated medial SMCs, which are highly specialized for contraction. 2 To fully understand the control of SMC differentiation, it is important to elucidate the molecular mechanisms that control the transcription of genes encoding proteins necessary for the differentiated function of SMCs.Smooth muscle (SM) ␣-actin, SM-myosin heavy chain (MHC), and SM22␣ are useful markers for studying the control of SMC differentiation. 2 Their expression levels are high in differentiated medial SMCs, whereas they are low in dedifferentiated intimal SMCs. 2 These SMC-selective genes have a conserved DNA recognition element known as a CArG element, which has the general sequence motif, CC(A/ T-rich) 6 GG. 3 The CArG element was first identified as the core sequence of the serum response element (SRE) within the early-response gene, c-fos. 3 Whereas there is only one SRE/CArG element in the c-fos gene, each of the SMC marker genes contains at least two CArG elements located in the 5Ј promoter region and the fir...

The treatment of common bile duct (CBD) disorders, such as biliary atresia or ischemic strictures, is restricted by the lack of biliary tissue from healthy donors suitable for surgical reconstruction. Here we report a new method for the isolation and propagation of human cholangiocytes from the extrahepatic biliary tree in the form of extrahepatic cholangiocyte organoids (ECOs) for regenerative medicine applications. The resulting ECOs closely resemble primary cholangiocytes in terms of their transcriptomic profile and functional properties. We explore the regenerative potential of these organoids in vivo and demonstrate that ECOs self-organize into bile duct-like tubes expressing biliary markers following transplantation under the kidney capsule of immunocompromised mice. In addition, when seeded on biodegradable scaffolds, ECOs form tissue-like structures retaining biliary characteristics. The resulting bioengineered tissue can reconstruct the gallbladder wall and repair the biliary epithelium following transplantation into a mouse model of injury. Furthermore, bioengineered artificial ducts can replace the native CBD, with no evidence of cholestasis or occlusion of the lumen. In conclusion, ECOs can successfully reconstruct the biliary tree, providing proof of principle for organ regeneration using human primary cholangiocytes expanded in vitro.

Organoid technology holds great promise for regenerative medicine but has not yet been applied to humans. We address this challenge using cholangiocyte organoids in the context of cholangiopathies, which represent a key reason for liver transplantation. Using single-cell RNA sequencing, we show that primary human cholangiocytes display transcriptional diversity that is lost in organoid culture. However, cholangiocyte organoids remain plastic and resume their in vivo signatures when transplanted back in the biliary tree. We then utilize a model of cell engraftment in human livers undergoing ex vivo normothermic perfusion to demonstrate that this property allows extrahepatic organoids to repair human intrahepatic ducts after transplantation. Our results provide proof of principle that cholangiocyte organoids can be used to repair human biliary epithelium.

Marfan syndrome (MFS) is a heritable connective tissue disorder caused by mutations in FBN1, which encodes the extracellular matrix protein fibrillin-1. To investigate the pathogenesis of aortic aneurysms in MFS, we generated a vascular model derived from human induced pluripotent stem cells (MFS-hiPSCs). Our MFS-hiPSC-derived smooth muscle cells (SMCs) recapitulated the pathology seen in Marfan aortas, including defects in fibrillin-1 accumulation, extracellular matrix degradation, transforming growth factor-β (TGF-β) signaling, contraction and apoptosis; abnormalities were corrected by CRISPR-based editing of the FBN1 mutation. TGF-β inhibition rescued abnormalities in fibrillin-1 accumulation and matrix metalloproteinase expression. However, only the noncanonical p38 pathway regulated SMC apoptosis, a pathological mechanism also governed by Krüppel-like factor 4 (KLF4). This model has enabled us to dissect the molecular mechanisms of MFS, identify novel targets for treatment (such as p38 and KLF4) and provided an innovative human platform for the testing of new drugs.

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