Statins exert pleiotropic effects on the cardiovascular system, in part through an increase in nitric oxide (NO) bioavailability. In this study, we examined the role of pravastatin in ischemia-induced angiogenesis. Unilateral hindlimb ischemia was surgically induced in C57BL/6J mice. Phosphorylation of AMP-activated protein kinase (AMPK), acetyl-CoA carboxylase (ACC) and endothelial NO synthase (eNOS) was increased in ischemic tissues. Furthermore, mice treated with pravastatin showed higher increases in phosphorylation than did untreated mice. Laser Doppler analysis has shown that pravastatin treatment accelerates the development of collateral vessels and angiogenesis in response to hindlimb ischemia. Capillary density in the ischemic hindlimb was also increased by pravastatin treatment. An in vitro study on human umbilical vein endothelial cells (HUVECs) revealed that pravastatin increased the phosphorylation of AMPK. Pravastatin-induced phosphorylation of eNOS, one of the downstreams of AMPK, was inhibited by compound C, an AMPK antagonist. The increased migration and tube formation of HUVECs by pravastatin were significantly blocked by compound C treatment. The accelerated angiogenesis by pravastatin after hindlimb ischemia was significantly reduced after treatment with compound C. Thus, ischemia induced AMPK phosphorylation in vivo. Furthermore, pravastatin could also activate AMPK in vivo and in vitro. Such phosphorylation results in eNOS activation and angiogenesis, which provide a novel explanation for one of the pleiotropic effects of statins that is beneficial for angiogenesis. Keywords: angiogenesis; endothelium; ischemia; nitric oxide synthase; statins
INTRODUCTIONThe AMP-activated protein kinase (AMPK) is a trimeric enzyme comprising a catalytic a-subunit and regulatory-b, g-subunits. AMPK was identified as an upstream kinase that phosphorylates and hence inactivates 3-hydroxy-3-methylglutaryl-coenzyme A reductase and acetyl-coenzyme A carboxylase (ACC), key enzymes that control choresterol/isoprenoid and fatty acid biosynthesis, respectively. AMPK is considered to be a cellular energy sensor that stimulates ATP-producing catabolic pathways and inhibits ATP-consuming anabolic pathways. 1 Thus, the AMPK pathway is thought to be a regulator of stress responses and cellular energy homeostasis. However, recent studies have shown that AMPK also plays an important role in maintaining endothelial functions. 2 AMPK activation has beneficial effects on endothelial functions and in antiatherogenesis. These effects include the induction of the endothelial nitric oxide synthase (eNOS) pathway to increase NO bioavailability; the suppression of endothelial reactive oxygen species production when stimulated by hyperglycemia or high free fatty acids to improve endothelial free fatty acid oxidation and limit lipid accumulation; the inhibition of apoptosis and inflammation; and the modulation of the vascular tone. 3,4