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(Hypertension. 1996;27:552-557.)
© 1996 American Heart Association, Inc.


Articles

cDNA Cloning and Gene Expression of Human Type I{alpha} cGMP-Dependent Protein Kinase

Naohisa Tamura; Hiroshi Itoh; Yoshihiro Ogawa; Osamu Nakagawa; Masaki Harada; Tae-Hwa Chun; Shin-ichi Suga; Takaaki Yoshimasa; Kazuwa Nakao

From the Department of Medicine and Clinical Science, Kyoto (Japan) University Graduate School of Medicine.

Correspondence to Hiroshi Itoh, MD, PhD, Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606, Japan. E-mail hiito@kuhp.kyoto-u.ac.jp.


*    Abstract
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*Abstract
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Abstract The type I cGMP-dependent protein kinase (cGK) is one of the major pathways for the cGMP cascade and has been demonstrated to inhibit platelet aggregation, relax smooth muscle cells, and control cardiocyte contractility. There are two subtypes of the type I cGK, cGKI{alpha} and cGKIß. The former is more sensitive to cGMP than the latter. In humans, cGKIß cDNA was isolated, but the full structure and tissue-specific gene expression of cGKI{alpha} have not been determined. The significance of cGK in human cardiovascular diseases has not been investigated at the molecular level. In the present study, we isolated the full-length human cGKI{alpha} cDNA (-36 to +2177; the translation start site: +1) encoding the 671–amino acid protein. Nucleotides +267 to +2177 of the isolated cDNA were identical to the corresponding nucleotides of human cGKIß cDNA. Southern blot analysis suggested that human cGKI{alpha} and cGKIß are generated by alternative splicing of a single gene assigned to chromosome 10. By Northern blot analysis, we detected abundant human cGKI{alpha} mRNA (7.0 kb) in the aorta, heart, kidneys, and adrenals. In contrast, human cGKIß mRNA (7.0 kb) was detected abundantly only in the uterus. In cultured vascular smooth muscle cells, the type I cGK mRNA concentration was reduced to 10% of the basal level by 4x10-10 mol/L platelet-derived growth factor. Angiotensin II (10-8 mol/L), transforming growth factor-ß (4x10-11 mol/L), and tumor necrosis factor-{alpha} (6x10-6 mol/L) also exhibited an inhibitory effect on type I cGK gene expression. These findings suggest a pathophysiological implication of the type I cGK in cardiovascular diseases, including hypertension and atherosclerosis.


Key Words: protein kinases • cloning, molecular • muscle, smooth, vascular • platelet-derived growth factor • angiotensin II • growth substances


*    Introduction
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up arrowAbstract
*Introduction
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Cyclic GMP–dependent protein kinase (cGK) is a serine-threonine protein kinase selectively activated by cGMP.1 2 cGK regulates cytoplasmic Ca2+ concentration by several pathways: inhibition of inositol 1,4,5-trisphosphate production and receptor activity, activation of Ca2+-ATPase, or modulation of the activity of the Ca2+-dependent K+ channel.3 4 5 Through these mechanisms, cGK is considered to relax VSMCs, reduce cardiocyte contractility, and inhibit platelet aggregation. There are two types of vertebrate cGK: the soluble type I, a homodimer, and the membrane-bound type II, a monomer.1 2 Type I cGK has two subtypes: I{alpha} and Iß.1 2 The apparent binding affinity of cGKI{alpha} for cGMP (10-4 mol/L) is about one tenth that of cGKIß (1.3x10-3 mol/L).2

The NP system consists of three endogenous ligands—atrial NP, brain NP, and C-type NP—and two types of receptors, the biologically active NP receptor, the particulate guanylate cyclase itself, and the clearance receptor.6 We and other investigators have elucidated that atrial NP and brain NP are mainly secreted from the atrium and ventricle, respectively, to act as cardiac hormones,7 8 whereas C-type NP is synthesized in and secreted from vascular endothelial cells to act as an endothelium-derived relaxing peptide.9 10 11 NPs elicit these biological actions by activating the biologically active NP receptor and elevating intracellular cGMP concentration.1 In contrast, the endothelium-derived relaxing factor, which has been identified as nitric oxide, activates the soluble guanylate cyclase.1 Thus, NP and nitric oxide share the common signaling pathway mediated by cGMP to elicit similar biological activities.

Recently, evidence has accumulated suggesting that the NP or nitric oxide–cGMP-cGK cascade is involved in the regulation of cardiac contractility, vascular tone, and cardiovascular remodeling.12 13 Several pathways of the cGMP signaling cascade have been postulated: a cGMP-gated channel, cGMP-inhibited cAMP-phosphodiesterase, cGMP-stimulated cAMP-phosphodiesterase, and cGK.1 2 Recently in mammalian hearts and VSMCs, cGK was revealed to be the major pathway for the cGMP signaling cascade.14 Thus, the derangement of the cGMP cascade can lead to a number of cardiovascular disorders, including ischemic heart diseases, hypertensive cardiovascular diseases, and atherosclerosis. However, there is no information concerning cGK expression in cardiovascular lesions.

In cows, cGKI{alpha} and Iß cDNAs have been isolated,15 and in humans, cGKIß cDNA has been isolated.16 However, in humans, the full structure and tissue-specific gene expression of cGKI{alpha} have not been determined. Therefore, in the present study, to elucidate the pathophysiological significance of the cGMP cascade in cardiovascular disorders, we isolated the full-length human cGKI{alpha} cDNA, determined the chromosomal assignment of the human type I cGK gene, analyzed the gene expression in human tissues, and examined the regulation of the gene expression using cultured VSMCs.


*    Methods
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up arrowIntroduction
*Methods
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Preparation of RNA and DNA
Total RNA was extracted from human tissues and cultured VSMCs by the guanidinium thiocyanate/cesium chloride method.17 Human tissues were obtained at operation or autopsy. Informed consent was obtained from each patient or family, and the study was approved by the ethics committee on human research of Kyoto University (No. 61-98). Poly(A)+ RNA was extracted from total RNA by oligotex-dT30 Super (Japan Roche). Human genomic DNA was isolated from human white blood cells by the standard method.17

Isolation of Human cGKI{alpha} cDNA
Using a DNA synthesizer (model 381A, Applied Biosystems Inc), we synthesized primers P3 through P7 based on the bovine cGKI{alpha} cDNA sequence15 as shown in Fig 1ADown. Nucleotide sequences of these primers are as follows (built-in restriction endonuclease sites are underlined): P3 (sense), 5'-GAG- GTCGACAAGCGGCTGTCAGAGAAG-3'; P4 (antisense), 5'-TTGGTCGACTCTCTGTCGATCACAAGGCA-3'; P5 (sense), 5'-GAGGAATTCGCTATCCTTTACAACTGT-3'; P6 (antisense), 5'-TCTGAATTCCCACAAAAAGTCCATGTTTT-3'; and P7 (antisense), 5'-TGTGAGCTCAGCAATAAGTCCTAATGC-3'. By oligo(dT)-primed reverse transcription and PCR17 with these primers, cDNA fragments B (nucleotides +87 to +936; the translation start site is designated as nucleotide +1), C (+526 to +1539), and D (+526 to +2177) were amplified from the human aortic total RNA (Fig 1ADown). PCR was carried out under standard conditions (95°C for 0.5 minute, 60°C for 0.5 minute, 72°C for 2 minutes, 35 cycles) with Taq DNA polymerase (Perkin-Elmer Cetus).



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Figure 1. Structure of human cGKI{alpha} cDNA. A, Restriction endonuclease mapping of human cGKI{alpha} cDNA, PCR primers and amplified fragments, and structure of human cGKI{alpha}. Sites of selected endonucleases are denoted by vertical lines. Locations of PCR primers (arrows) and amplified fragments (shaded bars) are shown. Dim., indicates the dimerization domain; cGMP2 and cGMP1, cGMP binding domains; and ATP-binding/Catalytic, catalytic domain. Amino acid numbers at the end of each domain or of the I{alpha}-specific region are also shown. Locations of subdomains (I through XI) and consensus sequences in the catalytic domain are also indicated. B, Nucleotide and deduced amino acid sequences of human cGKI{alpha} cDNA. The deduced amino acid sequence is shown by the three-letter code above the nucleotide sequence (*** indicates the stop codon). The nucleotide numeration starts with +1 at the A of the translation initiation codon ATG. Nucleotide numbers are shown at the right of the nucleotide sequence. Amino acid numbers are shown in parentheses. The I{alpha}-specific region of the nucleotide sequence is underlined. Leucine and isoleucine residues of the dimerization domain (dotted) and the major autophosphorylation site (arrowhead) are denoted. The nucleotide sequence reported in this article will appear in the DDBJ, EMBL, and GenBank nucleotide sequence databases, accession number D45864.

To obtain the 5'-terminal region of human cGKI{alpha} cDNA, we performed inverse PCR.18 We synthesized antisense primer IP1 (5'-CGATACTAGTCGAGGGCACTGGGAGCACC-3', +163 to +135) based on the obtained human cGKI{alpha} cDNA sequence. The double-stranded cDNA was generated from the human aortic RNA by reverse transcription with primer P4 (Fig 1AUp) and the Gubler and Hoffman method,17 circularized by intramolecular ligation, and subjected to PCR with primers IP1 and P5 (Fig 1AUp). Based on the newly obtained sequence, we synthesized primers P1 (sense, 5'-TCAGTCGACAAATGAGCGAGCTAGAGG-3', -11 to +16) and P2 (antisense, 5'-CTTGTCGACTTGGTGAACTTCCGGAATGC-3', +266 to +238), and with these primers, we amplified fragment A (-2 to +257, Fig 1AUp).

PCR products were subcloned into pBluescript vector (Stratagene) and sequenced by the dideoxy chain-termination method.17 To exclude the possibility of misincorporation by Taq DNA polymerase, we sequenced three to seven clones for every fragment.

Southern Blot Analysis
DNA (10 µg) from the human and hamster genomes and human-rodent somatic cell hybrids (Coriell Institute) was digested by EcoRI, Pst I, or HindIII restriction endonucleases and subjected to Southern blot analysis.17 Fragment A of the isolated human cGKI{alpha} cDNA (Fig 1AUp) and the PCR-amplified human cGKIß cDNA fragment (+1 to +311) specific for cGKIß16 were labeled with [{alpha}-32P]dCTP by the random priming method17 and used as probes for the chromosomal assignment of the gene for cGKI{alpha} and Iß, respectively. The Pst I–HindIII fragment (+925 to +1317) of the isolated human cGKI{alpha} cDNA, identical to the corresponding fragment of human cGKIß cDNA, was used for determination of the copy number of the type I cGK gene in the human genome.

Northern Blot Analysis
Northern blot analysis was performed following the standard method.17 For detection of cGKI{alpha} and Iß mRNAs in human tissues and VSMCs, fragment A (Fig 1AUp) and the human cGKIß cDNA fragment (+1 to +311)16 were used as probes, respectively. For detection of the type I cGK mRNA in rat cultured VSMCs, the Pst I–HindIII fragment (+925 to +1317) of the human cGKI{alpha} cDNA was used as a probe. For detection of ß-actin mRNA, as an internal control, a human ß-actin genomic probe (Wako Pure Chemical Industries) was used.

VSMC Culture
Human aortic VSMCs were purchased from Kurabo and were grown in RPMI-1640 medium (Nissui Pharmaceutical) supplemented with 10% fetal calf serum (Hazleton Biologics) at 37°C in a humidified atmosphere containing 5% CO2. Cells at the sixth passage grown to confluence in 100-mm culture dishes were used for the experiment. The medium was changed to RPMI-1640 with or without 10-3 mol/L 8-bromo-cGMP (Sigma Chemical Co) in the presence of 10% fetal calf serum. After a 12-hour incubation, cells were harvested for RNA preparation. The experiment was performed in triplicate.

Rat VSMCs were isolated from thoracic aortas of male Wistar rats as previously described9 and grown in Dulbecco's modified Eagle's medium (GIBCO/BRL) supplemented with 10% fetal calf serum. Cells at the seventh passage grown to subconfluence in 100-mm culture dishes were used for the experiment. The medium was changed to Dulbecco's modified Eagle's medium/Ham's F-12 (GIBCO/BRL) without fetal calf serum containing 8x10-7 mol/L bovine insulin, 6x10-11 mol/L transferrin, and 3x10-8 mol/L sodium selenite. After a 48-hour incubation, 4x10-10 mol/L PDGF-BB (BACHEM Feinchemikalien AG), 10-8 mol/L Ang II (Peptide Institute, Inc), 4x10-11 mol/L transforming growth factor-ß (R&D Systems, Inc), 6x10-6 mol/L tumor necrosis factor-{alpha} (Dainihon Pharmaceutical Co), or vehicle was added. Before (0 hour) and 6, 24, and 48 hours after the addition of these reagents, cells were harvested for RNA preparation.


*    Results
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up arrowIntroduction
up arrowMethods
*Results
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Cloning of Human cGKI{alpha} cDNA
Using the PCR technique, we obtained cDNA fragments of cGKI{alpha} from human aortic total RNA (Fig 1Up). Fig 1BUp shows the nucleotide and deduced amino acid sequences of human cGKI{alpha} cDNA. The cDNA obtained in the present study consisted of 2213 bp (-36 to +2177) and contained an open reading frame of 2013 bp. In the coding region, the homology between bovine15 and human cGKI{alpha} cDNAs was 94%. Human cGKI{alpha} consisted of 671 amino acids with a molecular mass of 76 418 D. There were two amino acid substitutions between bovine15 and human cGKI{alpha}: Lys265 to Thr265 and Asn275 to Ser275 (bovine to human sequences). Nucleotides +267 to +2177 of human cGKI{alpha} cDNA were identical to nucleotides +312 to +2222 of human cGKIß cDNA16 (Fig 1BUp). There was 56% homology between nucleotides -36 to +266 of human cGKI{alpha} cDNA and nucleotides -58 to +311 of human cGKIß cDNA.16 Amino acids 90 to 671 of human cGKI{alpha} were identical to amino acids 105 to 685 of human cGKIß.16 The homology between amino acid sequences of specific regions of human cGKI{alpha} (amino acids 1 to 89) and cGKIß (amino acids 1 to 104)17 was 36%. In the I{alpha}-specific region, the "leucine-isoleucine zipper" and autophosphorylation sites1 2 were conserved between bovine and human cGKI{alpha} (Fig 1AUp).

Chromosomal Assignment and Copy Number of Human Type I cGK Gene
By Southern blot analysis using EcoRI-digested DNAs from the human-rodent somatic cell hybrids with the cGKI{alpha} probe (fragment A) or the human cGKIß probe, the human-specific hybridization signal (10 kb for I{alpha} or 7 kb for Iß) was detected only in the DNA from the hybrid containing human chromosome 10 (GM10926B, Fig 2Down). In Southern blot analysis using as a probe the Pst I–HindIII fragment (+925 to +1317) of the isolated human cGKI{alpha} cDNA, which is identical to the corresponding fragment of human cGKIß cDNA, the EcoRI-, Pst I–, and HindIII-digested human genomic DNAs showed 4-, 2-, and 5-kb single hybridization signals, respectively (Fig 3Down).



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Figure 2. Chromosomal assignment of human cGKI{alpha} and Iß gene. Shown are results of Southern blot analyses using EcoRI-digested DNAs from a human parental cell (IMR-91) (lane 1), a hamster parental cell (RJK88) (lane 2), and a human-hamster somatic cell hybrid containing human chromosome 10 (GM10926B) (lane 3) with the human cGKI{alpha}-specific probe (fragment A) (A) or the human cGKIß-specific probe (nucleotides +1 to +311 of human cGKIß cDNA) (B). Human-specific hybridization signals for cGKI{alpha} and Iß are indicated by closed triangles. Ten micrograms of DNA was applied to each lane.



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Figure 3. Southern blot analysis of human type I cGK gene. Shown are results of Southern blot analyses using EcoRI-, Pst I–, and HindIII-digested human genomic DNAs with the Pst I–HindIII fragment (+925 to +1317) of the isolated human cGKI{alpha} cDNA, in which human cGKI{alpha} and Iß sequences are identical, as a probe. Ten micrograms of DNA was applied to each lane.

Gene Expressions of cGKI{alpha} and Iß in Human Tissues
By Northern blot analysis, cGKI{alpha} mRNA was detected as a single 7.0-kb band at high concentrations in the aorta, cardiac atrium and ventricle, kidneys, and adrenals; at moderate concentrations in the cerebellum, lungs, spleen, duodenum, colon, and placenta; and at low concentrations in the ileum and uterus (Fig 4Down). cGKI{alpha} mRNA was not detected in the cerebrum, thymus, and liver (Fig 4Down). By contrast, cGKIß mRNA was detected as a single 7.0-kb band at a high concentration in the uterus and at low concentrations in the aorta, kidneys, adrenals, spleen, duodenum, ileum, and colon (Fig 4Down). In other tissues, cGKIß mRNA was not detected (Fig 4Down).



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Figure 4. Gene expressions of cGKI{alpha} and Iß in normal human tissues. Results of Northern blot analyses of cGKI{alpha} and Iß and ß-actin as an internal control are shown in the top, middle, and bottom panels, respectively. Three micrograms of poly(A)+ RNA or 20 µg of total RNA was applied to each lane as indicated.

cGK Gene Expression in Cultured VSMCs
In cultured human aortic VSMCs at the sixth passage, cGKI{alpha} mRNA was abundantly detected (Fig 5Down). The cGKI{alpha} mRNA concentration in human VSMCs was almost equal to that in human aorta and was not altered by the addition of 10-3 mol/L 8-bromo-cGMP (Fig 5Down).



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Figure 5. cGKI{alpha} gene expression in cultured human aortic VSMCs. Shown are results of Northern blot analyses of cGKI{alpha} using RNAs from confluent cultured human aortic VSMCs at the sixth passage exposed to vehicle (lane 1) or 10-3 mol/L 8-bromo-cGMP (lane 2) for 12 hours as well as RNA from human aorta (lane 3). Hybridization signals for ß-actin as an internal control are also shown. The experiment was performed in triplicate; representative results are shown. Twenty micrograms of total RNA was applied to each lane.

In cultured rat aortic VSMCs at the seventh passage, the type I cGK mRNA was detected abundantly, as clearly shown in Fig 6Down. There were no significant changes in type I cGK mRNA concentrations in vehicle-treated cells from 0 to 48 hours of incubation after the addition (Fig 6Down). By the addition of 4x10-10 mol/L PDGF-BB, the type I cGK mRNA concentration was drastically decreased to about 10% of the basal level 6 hours after the addition of PDGF-BB and returned to the basal level after a 24-hour incubation (Fig 6Down). The addition of 10-8 mol/L Ang II, 4x10-11 mol/L transforming growth factor-ß, or 6x10-6 mol/L tumor necrosis factor-{alpha} also caused significant reductions in the type I cGK mRNA concentration to about 40% of the basal level 6 hours after the addition (Fig 6Down). Twenty-four hours after the addition of these reagents, the type I cGK mRNA concentration returned to the basal level (Fig 6Down).



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Figure 6. Regulation of type I cGK gene expression in cultured rat VSMCs. Shown are results of Northern blot analyses of type I cGK using RNAs from subconfluent cultured rat VSMCs at the seventh passage before (0 hour) and 6, 24, and 48 hours after addition of vehicle (control), PDGF-BB (4x10-10 mol/L), Ang II (10-8 mol/L), transforming growth factor-ß (TGF-ß, 4x10-11 mol/L), or tumor necrosis factor-{alpha} (TNF-{alpha}, 6x10-6 mol/L). Hybridization signals of ß-actin mRNA are also shown. Before addition of each reagent, VSMCs were preconditioned to be quiescent (see "Methods").


*    Discussion
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up arrowIntroduction
up arrowMethods
up arrowResults
*Discussion
down arrowReferences
 
The present study demonstrated that the amino acid sequence from amino acid 90 to the COOH-terminus of human cGKI{alpha} is identical to the amino acid sequence from 105 to the COOH-terminus of human cGKIß. In the NH2-terminal specific region, which contains the dimerization domain and autophosphorylation sites, the homology between amino acid sequences of human cGKI{alpha} and Iß is 36%. The difference in NH2-terminal regions should be responsible for the difference in affinities of cGKI{alpha} and Iß for cGMP.2 There were only two amino acid substitutions between bovine cGKI{alpha} reported previously15 and the protein encoded in the cDNA obtained in the present study, and the substituted amino acids were not contained within consensus sequences in the catalytic domain (Fig 1BUp). This observation suggests that the cDNA obtained in the present study should be human cGKI{alpha} cDNA. To verify that the isolated cDNA really encodes cGK, we are now carrying out an overexpression experiment in culture cells using our cDNA clone. The strong conservation in amino acid sequences of bovine and human cGKI{alpha} indicates the significance of this enzyme in the cGMP signaling cascade.

Southern blot analysis using DNAs from human-rodent somatic cell hybrids revealed that in humans, the gene for cGKI{alpha} and Iß is assigned to chromosome 10 (Fig 2Up). Southern blot analysis of the human genome suggested that the human type I cGK gene has only one copy (Fig 3Up). We showed in the present study that nucleotides +267 to +2177 of human cGKI{alpha} cDNA are identical to nucleotides +312 to +2222 of human cGKIß cDNA. The gene for human cGKIß was partially isolated, and it has been demonstrated that the specific and identical regions of human cGKIß are encoded in separate exons.19 These findings suggest that human cGKI{alpha} and Iß are generated by alternative splicing of a single gene assigned to chromosome 10.

The present study revealed that in humans, cGKI{alpha} is highly expressed in the aorta, heart, kidneys, and adrenals and moderately expressed in the cerebellum and lungs (Fig 4Up). These findings are compatible with previous reports that type I cGK activity is detected in VSMCs, somatic smooth muscle cells, cerebellar Purkinje cells, and platelets.2 The present study demonstrated that in human tissues, including cardiovascular tissues, type I cGK is expressed mainly as cGKI{alpha} (Fig 4Up). Only in the uterus was cGKIß mRNA detected abundantly, and its concentration was higher than the cGKI{alpha} mRNA concentration (Fig 4Up). Further investigation on tissue specificity in the alternative splicing pattern of the type I cGK gene in humans is required.

In the present study, we observed that in cultured human VSMCs, cGKI{alpha} gene expression was not reduced by 10-3 mol/L 8-bromo-cGMP (Fig 5Up). This indicates that in VSMCs, the downregulation of cGKI{alpha} gene expression by the elevation of the intracellular cGMP concentration does not substantially occur.

The cGMP signaling cascade inhibits VSMC growth. We and other investigators elucidated that the elevation of intracellular cGMP concentration induced by NPs and nitric oxide inhibits the mitogenesis and proliferation of VSMCs.12 13 The VSMCs transfected with the cDNA encoding the catalytic domain of bovine cGKI{alpha}, which is the constitutive active enzyme, have been reported to display morphological changes: synthetic phenotype to contractile phenotype.20 In the present study, we demonstrated that by the addition of PDGF-BB, Ang II, transforming growth factor-ß, or tumor necrosis factor-{alpha}, the type I cGK gene expression in rat VSMCs was transiently decreased 6 hours after the addition of these reagents and returned to basal levels after 24 hours of incubation. Among these reagents, PDGF-BB potently decreased the type I cGK mRNA concentration to about 10% of the basal level. Therefore, the suppression of the gene expression of the type I cGK, which decelerates VSMC growth, can be one of the common features and/or prerequisites of the stimulation of VSMC growth by these factors. We are currently examining the exact changes of cGK activity along with the type I cGK mRNA concentration. Although further study is required to clarify the molecular mechanisms of the reduction of the cGK gene expression and its significance for actual VSMC growth, the present findings suggest the pathophysiological significance of cGK in vascular remodeling.

In conclusion, we cloned the full-length human cGKI{alpha} cDNA, demonstrated cGKI{alpha} gene expression in human tissues, and examined the pathophysiological and clinical implication of cGK in human cardiovascular diseases at the molecular level.


*    Selected Abbreviations and Acronyms
 
Ang II = angiotensin II
cGK = cGMP-dependent protein kinase
NP = natriuretic peptide
PCR = polymerase chain reaction
PDGF = platelet-derived growth factor
VSMC = vascular smooth muscle cell


*    Acknowledgments
 
This work was supported in part by research grants from the Japanese Ministry of Education, Science, and Culture; the Japanese Ministry of Health and Welfare; the Uehara Memorial Foundation; the Salt Science Research Foundation (92041); the Smoking Research Foundation; the Yamanouchi Foundation for Research on Metabolic Disorders; and the Japanese Society for Cardiovascular Research. We thank Dr Yoshihiro Miyamoto for his technical advice. We also thank Mihoko Shida, Hisayo Kitoh, Ayumi Takakoshi, Chizu Kawahara, and Yuko Mori for their secretarial assistance.


*    References
up arrowTop
up arrowAbstract
up arrowIntroduction
up arrowMethods
up arrowResults
up arrowDiscussion
*References
 
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