hypothesis a b,c d arterial dissection e f progesterone

1
Progesterone R. upregulation Arterial degredation Artery dissection Progesterone facilitates arterial extracellular matrix degradation and thereby dissection. Hypothesis male female 0 50 100 150 carotid male female 0.0 0.5 1.0 1.5 2.0 2.5 subclavia male female 0 50 100 150 arch ✱✱✱✱ male female 0 5 10 15 20 25 thoracic aorta male female 0 5 10 15 20 abdominal aorta male female 0.0 0.5 1.0 1.5 2.0 femoralis PRA PRB ß-Actin Healthy Aneurysm axa tava 0.000 0.005 0.010 0.015 Prab relative gene expression PGR axa tava 0.0000 0.0005 0.0010 0.0015 prb relative gene expression PGRB 12h 0h CTRL P4 ctrl p4 0 50 100 150 area total 12h area(p²) ✱✱✱ ctrl p4 0.0 0.1 0.2 0.3 0.4 0.5 woundhealing % woundhealing % ✱✱ Prg Prb Prg Prb Prg Prb Prg Prb Prg Prb Prg Prb Prg Prb Prg Prb Prg Prb 0.00 0.01 0.02 0.03 0.04 Progesterone receptor expression in VSMcs relative gene expression healthy aneurism C D B ctrl ctrl+p4 mcherry mxherry+p4 prg prg+p4 0 500000 1000000 1500000 2000000 Klf15 ✱✱ ctrl ctrl+p4 mcherry mxherry+p4 prg prg+p4 0 10 20 30 40 Foxo1 Foldchange relative to Control ✱✱✱✱ ctrl ctrl+p4 mcherry mxherry+p4 prg prg+p4 0 1000 2000 3000 4000 Bcl6 Foldchange relative to Control ✱✱ ns ECM linked transcription factors - ctrl ctrl+p4 mcherry mcherry+p4 Prog Prog+P4 0.0 0.5 1.0 1.5 FBN Foldchange relative to Control ns ✱✱✱ ctrl ctrl+p4 mcherry mcherry+p4 Prog Prog+P4 0 2 4 6 FN1 Foldchange relative to Control ns ctrl ctrl+p4 mcherry mcherry+p4 Prog Prog+P4 0 1 2 3 4 5 TGFb Foldchange relative to Control ✱✱✱ ✱✱✱ ns ns Dissection associated genes ctrl ctrl+p4 mcherry mcherry+p4 Prog Prog+P4 0.0 0.5 1.0 1.5 2.0 MMP2 Foldchange relative to Control ✱✱ ns ctrl ctrl+p4 mcherry mcherry+p4 Prog Prog+P4 0 2 4 6 8 10 ADAMTS4 Foldchange relative to Control ns ctrl ctrl+p4 mcherry mcherry+p4 Prog Prog+P4 0 2 4 6 8 ADAMTS5 Foldchange relative to Control ✱✱✱✱ ✱✱✱ ECM modulating genes A, We first demonstrate that the progesterone receptor (PGR) is not specific to organs of the reproductive system and can be found in vessels of male and female mice. B,C Vascular smooth muscle cells of Patients also harbour both populations of the progesterone receptor. Furthermore a trend wise increase of PGR can be seen in patients who suffered from an aneurism compared to healthy (HTX) controls. This suggest a link between PGR and vascular diseases. D , Activation of the progesterone receptor in vitro leads to decreased migration and proliferation of Vascular smooth muscle cells, a hallmark of impaired regeneration. Spontaneous coronary artery dissection (SCAD) is the primary cause of myocardial infarction in young and pregnant women. The Patho-mechanism of SCAD is still unknown. In the uterus the Progesterone receptor facilitates vessel softening to facilitate oocyte Implantation and pregnancy. Accordingly this receptor was recently found in arteries of patients suffering from SCAD. We thereby came up with our hypothesis, that the vascular progesterone receptor mediates arterial softening and thereby dissection. A E, Activation of the progesterone receptor leads to genetic responses targeted at the extracellular matrix (ECM). F, Viral overexpression of the progesterone receptor and subsequent treatment with progesterone reveals, transcriptomic chances in ECM linked transcription factors, ECM modulation genes and dissection associated genes. Showing a distinct role of the progesterone receptor in vessel constitution and makeup. E F Highlights The progesterone receptor is elevated in aneurismatic vessels, its activation inhibits regeneration, induces extracellular matrix degradation and is tied to dissection associated genes. PROGESTERONE PROMOTES SPONTANEOUS CORONARY ARTERY DISSECTION HIRSCH J, VOLLAND A, NIKOLAJEVIC A, GRABER M, PÖLZL L, NÄGELE F, HILBE R, LECHNER S, HACKL H, ENGLER C, TANCEVSKI , BEGLE J, GRIMM M, HOLFELD J, GOLLMANN-TEPEKÖYLÜ C.

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Page 1: Hypothesis A B,C D Arterial dissection E F Progesterone

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Progesterone R.upregulation

Arterialdegredation

Arterydissection

Progesterone facilitates arterial extracellular matrix degradation and thereby dissection.

Hypothesis

male female0

50

100

150

carotid

male female0.0

0.5

1.0

1.5

2.0

2.5

subclavia male female0

50

100

150

arch✱✱✱✱

male female0

5

10

15

20

25

thoracic aorta

male female0

5

10

15

20

abdominal aorta✱

male female0.0

0.5

1.0

1.5

2.0

femoralis

PRAPRB

ß-Actin

Healthy Aneurysm

axa tava0.000

0.005

0.010

0.015

Prab

rela

tive

gene

exp

ress

ion

PGR

axa tava0.0000

0.0005

0.0010

0.0015

prb

rela

tive

gene

exp

ress

ion

PGRB

12h

0h

CTRL P4

ctrl p40

50

100

150

area total 12h

area

(p²)

✱✱✱

ctrl p40.0

0.1

0.2

0.3

0.4

0.5

woundhealing %

wou

ndhe

alin

g %

✱✱Prg Prb Prg Prb Prg Prb Prg Prb Prg Prb Prg Prb Prg Prb Prg Prb Prg Prb

0.00

0.01

0.02

0.03

0.04

single groups

Progesterone receptor expression inVSMcs

rela

tive

gene

exp

ress

ion axa4

axa5axa6axa7tava 1tava5tava 12tava13tava25

healthyaneurism

C

DB

ctrl

ctrl+p4

mcherr

y

mxherr

y+p4

prg

prg+p40

500000

1000000

1500000

2000000

Klf15

Fold

chan

gere

lativ

e to

Con

trol

✱✱

ctrl

ctrl+p4

mcherr

y

mxherr

y+p4

prg

prg+p40

10

20

30

40

Foxo1

Fold

chan

gere

lativ

e to

Con

trol

✱✱✱✱

ctrl

ctrl+p4

mcherr

y

mxherr

y+p4

prg

prg+p40

1000

2000

3000

4000

Bcl6

Fold

chan

gere

lativ

e to

Con

trol

✱✱

ns

ECM

link

edtr

ansc

riptio

nfa

ctor

s

-

ctrl

ctrl+p4

mcherr

y

mcherr

y+p4

Prog

Prog+P40.0

0.5

1.0

1.5

FBN

Fold

chan

gere

lativ

e to

Con

trol

ns✱✱✱

ctrl

ctrl+p4

mcherr

y

mcherr

y+p4

Prog

Prog+P40

2

4

6

FN1

Fold

chan

gere

lativ

e to

Con

trol

ns

ctrl

ctrl+p4

mcherr

y

mcherr

y+p4

Prog

Prog+P40

1

2

3

4

5

TGFb

Fold

chan

gere

lativ

e to

Con

trol

✱✱✱✱✱✱

ns ns

Diss

ectio

nas

socia

ted

gene

s

ctrl

ctrl+p4

mcherr

y

mcherr

y+p4

Prog

Prog+P40.0

0.5

1.0

1.5

2.0

MMP2

Fold

chan

gere

lativ

e to

Con

trol

✱✱ns

ctrl

ctrl+p4

mcherr

y

mcherr

y+p4

Prog

Prog+P40

2

4

6

8

10

ADAMTS4

Fold

chan

gere

lativ

e to

Con

trol

✱ns

ctrl

ctrl+p4

mcherr

y

mcherr

y+p4

Prog

Prog+P40

2

4

6

8

ADAMTS5

Fold

chan

gere

lativ

e to

Con

trol

✱✱✱✱✱✱✱

ECM

m

odul

atin

g ge

nes

A, We first demonstrate that the progesterone receptor (PGR) is not specific to organs of the reproductive system andcan be found in vessels of male and female mice. B,C Vascular smooth muscle cells of Patients also harbour bothpopulations of the progesterone receptor. Furthermore a trend wise increase of PGR can be seen in patients whosuffered from an aneurism compared to healthy (HTX) controls. This suggest a link between PGR and vasculardiseases. D , Activation of the progesterone receptor in vitro leads to decreased migration and proliferation of Vascularsmooth muscle cells, a hallmark of impaired regeneration.

Spontaneous coronary artery dissection (SCAD) is the primary cause of myocardial infarction inyoung and pregnant women. The Patho-mechanism of SCAD is still unknown. In the uterus theProgesterone receptor facilitates vessel softening to facilitate oocyte Implantation andpregnancy. Accordingly this receptor was recently found in arteries of patients suffering from SCAD.We thereby came up with our hypothesis, that the vascular progesterone receptor mediates arterialsoftening and thereby dissection.

A

E, Activation of the progesterone receptor leads to genetic responses targeted at the extracellular matrix (ECM). F,Viral overexpression of the progesterone receptor and subsequent treatment with progesterone reveals,transcriptomic chances in ECM linked transcription factors, ECM modulation genes and dissection associated genes.Showing a distinct role of the progesterone receptor in vessel constitution and makeup.

E F

Highlights

The progesterone receptor is elevated in aneurismatic vessels, its activation inhibits regeneration,

induces extracellular matrix degradation and is tied to dissection associated genes.

PROGESTERONE PROMOTES SPONTANEOUS CORONARY ARTERY DISSECTIONHIRSCH J, VOLLAND A, NIKOLAJEVIC A, GRABER M, PÖLZL L, NÄGELE F, HILBE R, LECHNER S, HACKL H,

ENGLER C, TANCEVSKI , BEGLE J, GRIMM M, HOLFELD J, GOLLMANN-TEPEKÖYLÜ C.