Atorvastatin and Conditioned Media from Atorvastatin-Treated Human Hematopoietic Stem/Progenitor-Derived Cells Show Proangiogenic Activity In Vitro but Not In Vivo

Myeloid angiogenic cells (MAC) derive from hematopoietic stem/progenitor cells (HSPCs) that are mobilized from the bone marrow. They home to sites of neovascularization and contribute to angiogenesis by production of paracrine factors. The number and function of proangiogenic cells are impaired in patients with diabetes or cardiovascular diseases. Both conditions can be accompanied by decreased levels of heme oxygenase-1 (HMOX1), cytoprotective, heme-degrading enzyme. Our study is aimed at investigating whether precursors of myeloid angiogenic cells (PACs) treated with known pharmaceuticals would produce media with better proangiogenic activity in vitro and if such media can be used to stimulate blood vessel growth in vivo. We used G-CSF-mobilized CD34+ HSPCs, FACS-sorted from healthy donor peripheral blood mononuclear cells (PBMCs). Sorted cells were predominantly CD133+. CD34+ cells after six days in culture were stimulated with atorvastatin (AT), acetylsalicylic acid (ASA), sulforaphane (SR), resveratrol (RV), or metformin (Met) for 48 h. Conditioned media from such cells were then used to stimulate human aortic endothelial cells (HAoECs) to enhance tube-like structure formation in a Matrigel assay. The only stimulant that enhanced PAC paracrine angiogenic activity was atorvastatin, which also had ability to stabilize endothelial tubes in vitro. On the other hand, the only one that induced heme oxygenase-1 expression was sulforaphane, a known activator of a HMOX1 inducer—NRF2. None of the stimulants changed significantly the levels of 30 cytokines and growth factors tested with the multiplex test. Then, we used atorvastatin-stimulated cells or conditioned media from them in the Matrigel plug in vivo angiogenic assay. Neither AT alone in control media nor conditioned media nor AT-stimulated cells affected numbers of endothelial cells in the plug or plug’s vascularization. Concluding, high concentrations of atorvastatin stabilize tubes and enhance the paracrine angiogenic activity of human PAC cells in vitro. However, the effect was not observed in vivo. Therefore, the use of conditioned media from atorvastatin-treated PAC is not a promising therapeutic strategy to enhance angiogenesis.

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Kaposi sarcoma-associated herpesvirus (KSHV) induces heme oxygenase-1 expression and activity in KSHV-infected endothelial cells

Blood ◽

10.1182/blood-2003-08-2781 ◽

2004 ◽

Vol 103 (9) ◽

pp. 3465-3473 ◽

Cited By ~ 63

Author(s):

Shane C. McAllister ◽

Scott G. Hansen ◽

Rebecca A. Ruhl ◽

Camilo M. Raggo ◽

Victor R. DeFilippis ◽

...

Keyword(s):

Endothelial Cells ◽

Heme Oxygenase ◽

Cell Biology ◽

Molecular Mechanisms ◽

Expression Profiles ◽

Kaposi Sarcoma ◽

Heme Oxygenase 1 ◽

Spindle Cell Proliferation

Abstract Kaposi sarcoma (KS) is the most common AIDS-associated malignancy and is characterized by angiogenesis and the presence of spindle cells. Kaposi sarcoma-associated herpesvirus (KSHV) is consistently associated with all clinical forms of KS, and in vitro infection of dermal microvascular endothelial cells (DMVECs) with KSHV recapitulates many of the features of KS, including transformation, spindle cell proliferation, and angiogenesis. To study the molecular mechanisms of KSHV pathogenesis, we compared the protein expression profiles of KSHV-infected and uninfected DMVECs. This comparison revealed that heme oxygenase-1 (HO-1), the inducible enzyme responsible for the rate-limiting step in heme catabolism, was up-regulated in infected endothelial cells. Recent evidence suggests that the products of heme catabolism have important roles in endothelial cell biology, including apoptosis and angiogenesis. Here we show that HO-1 mRNA and protein are up-regulated in KSHV-infected cultures. Comparison of oral and cutaneous AIDS-KS tissues with normal tissues revealed that HO-1 mRNA and protein were also up-regulated in vivo. Increased HO-1 enzymatic activity in vitro enhanced proliferation of KSHV-infected DMVECs in the presence of free heme. Treatment with the HO-1 inhibitor chromium mesoporphyrin IX abolished heme-induced proliferation. These data suggest that HO-1 is a potential therapeutic target for KS that warrants further study. (Blood. 2004;103: 3465-3473)

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Colony Forming Unit-Endothelial Cells (CFU-EC) Are Derived from CD14+ Cells and Need Support by CD14− Cells.

Blood ◽

10.1182/blood.v106.11.3685.3685 ◽

2005 ◽

Vol 106 (11) ◽

pp. 3685-3685

Author(s):

Rachel T. Van Beem ◽

Willy A. Noort ◽

Marion Kleijer ◽

Jaap Jan Zwaginga ◽

C. Ellen Van Der Schoot

Keyword(s):

Endothelial Cells ◽

Colony Formation ◽

Mononuclear Cells ◽

Cellular Therapy ◽

Selective Medium ◽

Cell Populations ◽

Peripheral Blood Mononuclear ◽

Paracrine Factors

Abstract Since endothelial progenitor cells (EPC) were found in adult blood, active interferences of vascular diseases by cellular therapy with EPC were initiated. However, controversies exist on the identity of the EPC, e.g. concerning phenotype before and after culture, in vitro and in vivo behavior, as well as on quantities and differentiation. EPC can be quantified in vitro by culturing CFU-EC. In order to clarify which cells are essential and which are facilitating the formation of CFU-EC, we determined the contribution of several cell types to the formation of colonies. Peripheral blood mononuclear cells were isolated and were either positively selected or depleted for several cell populations (CD34+/KDR+/CD146+, CD3+, CD14+, CD19+ or CD56+). Subsequently the cells were labeled with PKH2 or irradiated (40Gy) to determine the contribution to colony formation. The purity of the cell populations was determined by flow cytometry. From these cell populations, CFU-EC were cultured on fibronectin-coated tissue culture plates, in endothelial selective medium EndoCultTM (Stem Cell Technologies). After 2 days of culture, non-adherent cells were subsequently cultured for an additional 3 days to form colonies. To determine the contribution of soluble factors to colony formation, transwells (0.8 μm pore size) were used to separate the cell populations during culture. CFU-EC are not derived from mature endothelial cells nor from immature EPC, as similar number of colonies per well were found when the starting population was depleted for CD146+/CD34+/KDR+ cells (18±9 vs. 20±14 in controls; n=4). In contrast, when CD14+ cells were depleted from the starting population, no CFU-EC were formed (0±0 vs. 29±23 in controls; n=7, p<0.02). After depletion of CD3+, CD19+ or CD56+ cells, CFU-EC were formed similarly as compared to controls. To investigate whether the CD14+ cells were the clonogenic cells, or whether they are facilitating the formation of colonies, monocytes were labeled with phagocyte specific PKH2 or irradiated and combined with untreated CD14− cells. Labeled cells were found in the colonies and among the spindle shaped cells surrounding the colonies. Hardly any colony formation was found after irradiating CD14+ cells (4.5±1 vs. 34±9 in controls), indicating that proliferating monocytes are necessary for CFU-EC formation. Culturing CD14+ cells alone did not result in a similar number of colonies as compared to the control (4±4 vs. 29±23, in controls; n=7, p<0.03). This indicates that CD14− cells are important in outgrowth of CFU-EC from monocytes. To test if this is due to paracrine factors, CD14− cells were cultured in a transwell insert above the >95% CD14+ fraction. This resulted in an increase in colony formation (>95% monocytes: 2±1; with insert: 10±9, n=2). In conclusion, CFU-EC are derived from CD14+ cells, but need the presence of CD14− cells, which is in part due to paracrine factors secreted by CD14− cells. This study further clarifies the identity of the EPC as determined by CFU-EC, and may give more insight to the role of several cell populations in vascular repair.

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Heme Oxygenase-1 Deficiency and Oxidative Stress: A Review of 9 Independent Human Cases and Animal Models

International Journal of Molecular Sciences ◽

10.3390/ijms22041514 ◽

2021 ◽

Vol 22 (4) ◽

pp. 1514 ◽

Cited By ~ 1

Author(s):

Akihiro Yachie

Keyword(s):

Oxidative Stress ◽

Animal Models ◽

Heme Oxygenase ◽

Inflammatory Diseases ◽

Cell Types ◽

Pharmacological Intervention ◽

Heme Oxygenase 1 ◽

Inflammatory Reactions

Since Yachie et al. reported the first description of human heme oxygenase (HO)-1 deficiency more than 20 years ago, few additional human cases have been reported in the literature. A detailed analysis of the first human case of HO-1 deficiency revealed that HO-1 is involved in the protection of multiple tissues and organs from oxidative stress and excessive inflammatory reactions, through the release of multiple molecules with anti-oxidative stress and anti-inflammatory functions. HO-1 production is induced in vivo within selected cell types, including renal tubular epithelium, hepatic Kupffer cells, vascular endothelium, and monocytes/macrophages, suggesting that HO-1 plays critical roles in these cells. In vivo and in vitro studies have indicated that impaired HO-1 production results in progressive monocyte dysfunction, unregulated macrophage activation and endothelial cell dysfunction, leading to catastrophic systemic inflammatory response syndrome. Data from reported human cases of HO-1 deficiency and numerous studies using animal models suggest that HO-1 plays critical roles in various clinical settings involving excessive oxidative stress and inflammation. In this regard, therapy to induce HO-1 production by pharmacological intervention represents a promising novel strategy to control inflammatory diseases.

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Heme oxygenase-1 induction by hemin prevents oxidative stress-induced acute cholestasis in the rat

Clinical Science ◽

10.1042/cs20180675 ◽

2019 ◽

Vol 133 (1) ◽

pp. 117-134 ◽

Cited By ~ 7

Author(s):

Pamela L. Martín ◽

Paula Ceccatto ◽

María V. Razori ◽

Daniel E.A. Francés ◽

Sandra M.M. Arriaga ◽

...

Keyword(s):

Oxidative Stress ◽

Heme Oxygenase ◽

Bile Flow ◽

Driving Forces ◽

Membrane Lipids ◽

Ex Vivo ◽

Heme Oxygenase 1 ◽

Canalicular Transporters

Abstract We previously demonstrated in in vitro and ex vivo models that physiological concentrations of unconjugated bilirubin (BR) prevent oxidative stress (OS)-induced hepatocanalicular dysfunction and cholestasis. Here, we aimed to ascertain, in the whole rat, whether a similar cholestatic OS injury can be counteracted by heme oxygenase-1 (HO-1) induction that consequently elevates endogenous BR levels. This was achieved through the administration of hemin, an inducer of HO-1, the rate-limiting step in BR generation. We found that BR peaked between 6 and 8 h after hemin administration. During this time period, HO-1 induction fully prevented the pro-oxidant tert-butylhydroperoxide (tBuOOH)-induced drop in bile flow, and in the biliary excretion of bile salts and glutathione, the two main driving forces of bile flow; this was associated with preservation of the membrane localization of their respective canalicular transporters, bile salt export pump (Bsep) and multidrug resistance-associated protein 2 (Mrp2), which are otherwise endocytosed by OS. HO-1 induction counteracted the oxidation of intracellular proteins and membrane lipids induced by tBuOOH, and fully prevented the increase in the oxidized-to-total glutathione (GSHt) ratio, a sensitive parameter of hepatocellular OS. Compensatory elevations of the activity of the antioxidant enzymes catalase (CAT) and superoxide dismutase (SOD) were also prevented. We conclude that in vivo HO-1 induction protects the liver from acute oxidative injury, thus preventing consequent cholestasis. This reveals an important role for the induction of HO-1 and the consequently elevated levels of BR in preserving biliary secretory function under OS conditions, thus representing a novel therapeutic tool to limit the cholestatic injury that bears an oxidative background.

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In Vitro and In Vivo Evidence That Ex Vivo Cytokine Priming of Donor Marrow Cells May Ameliorate Posttransplant Thrombocytopenia

Blood ◽

10.1182/blood.v91.1.353 ◽

1998 ◽

Vol 91 (1) ◽

pp. 353-359 ◽

Cited By ~ 34

Author(s):

Mariusz Z. Ratajczak ◽

Janina Ratajczak ◽

Boguslaw Machalinski ◽

Rosemarie Mick ◽

Alan M. Gewirtz

Keyword(s):

Mononuclear Cells ◽

Recovery Period ◽

Hematopoietic Stem ◽

Platelet Recovery ◽

Serum Free ◽

Cd34 Cells ◽

In Vivo Animal Model ◽

Marrow Cells

AbstractThrombocytopenia is typically observed in patients undergoing hematopoietic stem cell transplantation. We hypothesized that delayed platelet count recovery might be ameliorated by increasing the number of megakaryocyte colony- forming units (CFU-Meg) in the hematopoietic cell graft. To test this hypothesis, we evaluated cytokine combinations and culture medium potentially useful for expanding CFU-Meg in vitro. We then examined the ability of expanded cells to accelerate platelet recovery in an animal transplant model. Depending on the cytokine combination used, we found that culturing marrow CD34+cells for 7 to 10 days in serum-free cultures was able to expand CFU-Meg ∼40 to 80 times over input number. Shorter incubation periods were also found to be effective and when CD34+ cells were exposed to thrombopoietin (TPO), kit ligand (KL), interleukin-1α (IL-1α), and IL-3 in serum-free cultures for as few as 48 hours, the number of assayable CFU-Meg was still increased ∼threefold over input number. Of interest, cytokine primed marrow cells were also found to form colonies in vitro more quickly than unprimed cells. The potential clinical utility of this short-term expansion strategy was subsequently tested in an in vivo animal model. Lethally irradiated Balb-C mice were transplanted with previously frozen syngeneic marrow mononuclear cells (106/mouse), one tenth of which (105) had been primed with [TPO, KL, IL-1a, and IL-3] under serum-free conditions for 36 hours before cryopreservation. Mice receiving the primed frozen marrow cells recovered their platelet and neutrophil counts 3 to 5 days earlier than mice transplanted with unprimed cells. Mice which received marrow cells that had been primed after thawing but before transplantation had similar recovery kinetics. We conclude that pretransplant priming of hematopoietic cells leads to faster recovery of all hematopoietic lineages. Equally important, donor cell priming before transplant may represent a highly cost-effective alternative to constant administration of cytokines during the posttransplant recovery period.

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Evaluation of Angiogenesis Assays

Biomedicines ◽

10.3390/biomedicines7020037 ◽

2019 ◽

Vol 7 (2) ◽

pp. 37 ◽

Cited By ~ 14

Author(s):

Zachary I. Stryker ◽

Mehdi Rajabi ◽

Paul J. Davis ◽

Shaker A. Mousa

Keyword(s):

Endothelial Cells ◽

Tube Formation ◽

Angiogenic Activity ◽

In Vitro Methods ◽

Current State ◽

Angiogenesis Process ◽

Pertinent Information ◽

Exogenous Factors

Angiogenesis assays allow for the evaluation of pro- or anti-angiogenic activity of endogenous or exogenous factors (stimulus or inhibitors) through investigation of their pro-or anti- proliferative, migratory, and tube formation effects on endothelial cells. To model the process of angiogenesis and the effects of biomolecules on that process, both in vitro and in vivo methods are currently used. In general, in vitro methods monitor specific stages in the angiogenesis process and are used for early evaluations, while in vivo methods more accurately simulate the living microenvironment to provide more pertinent information. We review here the current state of angiogenesis assays as well as their mechanisms, advantages, and limitations.

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Study of pro-angiogenic activity of astilbin on human umbilical vein endothelial cells in vitro and zebrafish in vivo

RSC Advances ◽

10.1039/c9ra01673b ◽

2019 ◽

Vol 9 (40) ◽

pp. 22921-22930 ◽

Cited By ~ 1

Author(s):

Kongpeng Lv ◽

Qin Ren ◽

Xingyan Zhang ◽

Keda Zhang ◽

Jia Fei ◽

...

Keyword(s):

Endothelial Cells ◽

Umbilical Vein ◽

Angiogenic Activity ◽

Human Umbilical Vein ◽

Umbilical Vein Endothelial Cells

Pro-angiogenic activity of astilbin on endothelial cells in vitro and zebrafish in vivo.

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Alleviation of Cartilage Destruction by Sinapic Acid in Experimental Osteoarthritis

BioMed Research International ◽

10.1155/2019/5689613 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Dawei Cai ◽

Thomas W. Huff ◽

Jun Liu ◽

Tangbo Yuan ◽

Zijian Wei ◽

...

Keyword(s):

Heme Oxygenase ◽

Nuclear Translocation ◽

Sinapic Acid ◽

Heme Oxygenase 1 ◽

Related Factor ◽

Transactivation Activity ◽

Nrf2 Signaling Pathway ◽

Primary Mouse

Sinapic acid (SA) modulates the nuclear factor-erythroid 2-related factor 2 (Nrf2) signaling pathway in chondrocytes. In order to test the hypothesis that SA is protective against the development of osteoarthritis (OA), primary mouse chondrocytes were treated in vitro with SA and the promoter transactivation activity of heme oxygenase 1 (HO-1), nuclear translocation of Nrf2, and protein expression of HO-1 were assayed. To test the hypothesis in vivo, a destabilization of the medial meniscus (DMM) model was used to induce OA in the knees of mice and SA was delivered orally to the experimental group. The chondrocytes were harvested for further analysis. The expression of HO-1 was similarly upregulated in cartilage from both the experimental mice and human chondrocytes from osteoarthritic knees. SA was found to enhance the promoter transactivation activity of heme oxygenase 1 (HO-1) and increase the expression of Nrf2 and HO-1 in primary chondrocytes. Histopathologic scores showed that the damage induced by the DMM model was significantly lower in the SA treatment group. The addition of a HO-1 inhibitor with SA did not show additional benefit over SA alone in terms of cartilage degradation or histopathologic scores. The expression of TNF-α, IL-1β, IL-6, MMP-1, MMP-3, MMP-13, ADAMTS4, and ADAMTS5 was significantly reduced both in vitro and in vivo by the presence of SA. Protein expressions of HO-1 and Nrf2 were substantially increased in knee cartilage of mice that received oral SA. Our results suggest that SA should be further explored as a preventative treatment for OA.

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Heme Oxygenase-1, a Key Enzyme for the Cytoprotective Actions of Halophenols by Upregulating Nrf2 Expression via Activating Erk1/2 and PI3K/Akt in EA.hy926 Cells

Oxidative Medicine and Cellular Longevity ◽

10.1155/2017/7028478 ◽

2017 ◽

Vol 2017 ◽

pp. 1-13 ◽

Cited By ~ 6

Author(s):

Xiu E. Feng ◽

Tai Gang Liang ◽

Jie Gao ◽

De Peng Kong ◽

Rui Ge ◽

...

Keyword(s):

Heme Oxygenase ◽

Antioxidant Activities ◽

Heme Oxygenase 1 ◽

Protective Effects ◽

Key Enzyme ◽

Ea.Hy926 Cells ◽

Anti Inflammatory ◽

Mechanistic Basis

Increasing evidence has demonstrated that heme oxygenase-1 (HO-1) is a key enzyme triggered by cellular stress, exhibiting cytoprotective, antioxidant, and anti-inflammatory abilities. Previously, we prepared a series of novel active halophenols possessing strong antioxidant activities in vitro and in vivo. In the present study, we demonstrated that these halophenols exhibited significant protective effects against H2O2-induced injury in EA.hy926 cells by inhibition of apoptosis and ROS and TNF-αproduction, as well as induction of the upregulation of HO-1, the magnitude of which correlated with their cytoprotective actions. Further experiments which aimed to determine the mechanistic basis of these actions indicated that the halophenols induced the activation of Nrf2, Erk1/2, and PI3K/Akt without obvious effects on the phosphorylation of p38, JNK, or the expression of PKC-δ. This was validated with the use of PD98059 and Wortmannin, specific inhibitors of Erk1/2 and PI3K, respectively. Overall, our study is the first to demonstrate that the cytoprotective actions of halophenols involve their antiapoptotic, antioxidant, and anti-inflammatory abilities, which are mediated by the upregulation of Nrf2-dependent HO-1 expression and reductions in ROS and TNF-αgeneration via the activation of Erk1/2 and PI3K/Akt in EA.hy926 cells. HO-1 may thus be an important potential target for further research into the cytoprotective actions of halophenols.

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Two Classes of Progenitor Cells in Patients with Myeloproliferative Disorders Are Capable of Generating JAK2V617F+CD31+CD144+ Endothelial Cells.

Blood ◽

10.1182/blood.v110.11.261.261 ◽

2007 ◽

Vol 110 (11) ◽

pp. 261-261

Author(s):

Selcuk Sozer ◽

Takefumi Ishii ◽

Wei Zhang ◽

Jiapeng Wang ◽

Mingjiang Xu ◽

...

Keyword(s):

Endothelial Cells ◽

Progenitor Cells ◽

Mononuclear Cells ◽

Vascular Endothelial Cells ◽

Inverse Correlation ◽

Primary Myelofibrosis ◽

Myeloproliferative Disorders ◽

Growth Media

Abstract Patients with myeloproliferative disorders (MPD) are at a high risk of developing thrombotic events. We hypothesize that one of the contributory factors to this thrombotic tendency is the involvement of vascular endothelial cells (EC) by the malignant process. In vitro and in vivo assays were used to determine the involvement of EC in patients with MPD. Endothelial progenitor cells (EPC) were assayed from the peripheral blood (PB) mononuclear cells (MNCs) of 3 normal controls (NC) and 16 patients with MPD (12 polycythemia vera (PV), 4 primary myelofibrosis (PMF). MNC were cultured for 2 days in EC growth media on fibronectin(FN)-coated plates. The non-adherent cells were then harvested and transferred to a secondary FN-coated plate for additional 5–14 days. EC colonies were identified by their morphological appearance. The colonies were plucked and analyzed for PECAM-1(CD31), VE-Cadherin(CD144), VEGFR-2, vWF, Endoglin(CD105), ULEX-1, CD45, CD14 by flow cytometry and acetylated LDL(Ac-ADL) uptake. EC colonies were CD31+CD144+VEGFR2+ULEX-1+vWF+CD105+CD45+CD14+ and capable of taking up Ac-LDL and when exposed to TNF-α and IL-1β, expressing ICAM(CD54) and E-selectin(CD62e). MPD MNC formed fewer numbers of EC colonies than normal MNC (31.1±34.2 vs 78.8±28.9; p<0.01) and required more prolonged periods of culture (14 vs 5days). MPD EC colonies were also analyzed for JAK2V617F(JAK2VF) by nested-PCR. 74.6% of MPD EC colonies were homozygous(homo) JAK2VF, 14.9% were heterozygous(hetero) JAK2VF and 10.4% were wild type(wt) JAK2. Interestingly, MNCs from JAK2VF−MPD(148±47) formed greater numbers of EC colonies than NC MNC (78.8±28.9; p≤0.01). MNC from patients with a high burden of JAK2VF alleles (10.3±18.5; p<0.01) formed fewer EC colonies than NC or patients with a low burden of JAK2VF (65.9±28.15; p≤0.01). These EPC assayed in vitro which produced cells with both myeloid and endothelial markers are likely due either to contamination with JAK2VF myeloid cells or the result of the transdifferentiation of myeloid progenitor cells into EC (Bailey A, et al. PNAS.2006,103:13156). The inverse correlation between the JAK2VF burden and the ability of MPD MNC to form EC colonies is possibly a consequence of the increased sensitivity of EC to apoptosis due to the constitutive activation of JAK2 (Neria F, et al. Am J Physiol Cell Physiol.2007, 292:1123). In order to assay for more primitive EPC, 2 cord blood, and 16 JAK2VF+ MPD CD34+ (10 PV, 6 PMF) cells were transplanted into sublethally irradiated NOD/SCID mice. After 8 weeks, EC-rich organs (heart, lung, liver, vessels) were harvested, single cell suspensions were positively selected for either human(h) CD31+or hCD144+ cells by immunomagnetic cell sorting and analyzed for hVEGFR2, CD144, vWF, CD45, CD14 mRNA expression and JAK2VF. These CD31+or CD144+ cells contained transcripts for CD144, vWF, VEGFR2 but not CD45 and CD14. In 77.7% of the cases the hCD31+ or hCD144+ cells were homo JAK2VF, 5.5% were hetero JAK2VF and 16.6% were wt JAK2 and these CD31+or CD144+ cells composed ≤1% of the cells within the respective tissues. hCD144+ cells were also cultured with EC growth media for 7 days and displayed EC morphology and were shown to contain JAK2VF+ cells. These CD31+CD144+JAK2VF+CD14−CD45−cells likely represent the progeny of a malignant EPC which is distinct from an HSC. The involvement of EC by the malignant process in MPD might contribute to the development of thrombosis in MPD.

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