Molecular and genetic basis of deep venous thrombosis

项目摘要 深静脉血栓形成(DVT)和继发性肺血栓形成影响0.1-0.2% 每年造成60,000-100,000人死亡，发病率和死亡率 与心肌梗死相似。1856年，病理学家鲁道夫·维肖 与DVT发病机制中静脉血流的变化有关，但一个分子和 血流动力学改变如何驱动DVT发病的遗传学基础尚不清楚 已确诊，目前的治疗仅限于静脉扩张的预防性措施 血液流动和全身抗凝。我们最近已经证明了 振荡OR激活内皮细胞GATA2-FOXC2-PROX1转录途径 逆流和刺激静脉和淋巴瓣膜的形成所需。 我们的初步研究表明，静脉瓣膜周围的内皮细胞 经历类似的振荡流表达GATA2-FOXC2-PROX1转录 程序伴随着强烈的抗凝血剂表型，以低vWF，高vWF为标志 EPCR、高TM、高TFPI表达。丢失这个转录程序 瓣膜周围内皮细胞内静脉血流改变或基因缺失导致血栓 在静脉瓣膜周围形成。我们假设内皮细胞GATA2-FOXC2- 振荡流刺激的PROX1表达维持抗凝内皮细胞 防止DVT形成所需的表型。这项提议将检验这一假设。 使用遗传方法的组合来特别删除 外科手术小鼠瓣膜周围内皮细胞GATA2/FOXC2/PROX1通路 减少小鼠静脉血流量的方法以及组织学和生理学研究 以测试这一机制是否在人类和 在深静脉血栓形成过程中丢失。这些研究有望建立一种遗传和 DVT发病的分子机制将成为新的 机械和分子疗法。

Project Summary Deep venous thrombosis (DVT) and secondary pulmonary embolism affect 0.1-0.2% of the population and cause 60,000-100,000 deaths annually, an incidence and mortality similar to that of myocardial infarction. In 1856 the pathologist Rudolph Virchow implicated changes in venous blood flow in DVT pathogenesis, but a molecular and genetic basis for how hemodynamic changes drive DVT pathogenesis has not been identified, and present therapy is restricted to prophylactic measures to augment venous blood flow and systemic anticoagulation. We have recently demonstrated that the endothelial GATA2-FOXC2-PROX1 transcriptional pathway is activated by oscillatory or reversing flow and required to stimulate the formation of venous and lymphatic valves. Our preliminary studies demonstrate that endothelial cells around venous valves that experience similar oscillatory flow express the GATA2-FOXC2-PROX1 transcriptional program in association with a strong anti-coagulant phenotype marked by low vWF, high EPCR, high TM, and high TFPI expression. Loss of this transcriptional program conferred by altered venous flow or genetic deletion in peri-valvular ECs results in clot formation around the venous valve. We hypothesize that endothelial GATA2-FOXC2- PROX1 expression stimulated by oscillatory flow maintains an anticoagulant endothelial phenotype required to prevent DVT formation. This proposal will test this hypothesis using a combination of genetic approaches to specifically delete the GATA2/FOXC2/PROX1 pathway in mouse peri-valvular endothelial cells, surgical approaches to reduce venous flow in the mouse, and histologic and physiologic studies of human venous valves to test whether this mechanism is conserved in humans and lost during DVT pathogenesis. These studies are expected to establish a genetic and molecular mechanism for DVT pathogenesis that will serve as the foundation for novel mechanical and molecular therapies.