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Erythroid lineage Jak2V617F expression promotes atherosclerosis through erythrophagocytosis and macrophage ferroptosis
Wenli Liu, … , Alan R. Tall, Nan Wang
Wenli Liu, … , Alan R. Tall, Nan Wang
Published May 19, 2022
Citation Information: J Clin Invest. 2022;132(13):e155724. https://doi.org/10.1172/JCI155724.
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Research Article Vascular biology

Erythroid lineage Jak2V617F expression promotes atherosclerosis through erythrophagocytosis and macrophage ferroptosis

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Abstract

Elevated hematocrit is associated with cardiovascular risk; however, the causality and mechanisms are unclear. The JAK2V617F (Jak2VF) mutation increases cardiovascular risk in myeloproliferative disorders and in clonal hematopoiesis. Jak2VF mice with elevated WBCs, platelets, and RBCs display accelerated atherosclerosis and macrophage erythrophagocytosis. To investigate whether selective erythroid Jak2VF expression promotes atherosclerosis, we developed hyperlipidemic erythropoietin receptor Cre mice that express Jak2VF in the erythroid lineage (VFEpoR mice). VFEpoR mice without elevated blood cell counts showed increased atherosclerotic plaque necrosis, erythrophagocytosis, and ferroptosis. Selective induction of erythrocytosis with low-dose erythropoietin further exacerbated atherosclerosis with prominent ferroptosis, lipid peroxidation, and endothelial damage. VFEpoR RBCs had reduced antioxidant defenses and increased lipid hydroperoxides. Phagocytosis of human or murine WT or JAK2VF RBCs by WT macrophages induced ferroptosis, which was prevented by the ferroptosis inhibitor liproxstatin-1. Liproxstatin-1 reversed increased atherosclerosis, lipid peroxidation, ferroptosis, and endothelial damage in VFEpoR mice and in Jak2VF chimeric mice simulating clonal hematopoiesis, but had no impact in controls. Erythroid lineage Jak2VF expression led to qualitative and quantitative defects in RBCs that exacerbated atherosclerosis. Phagocytosis of RBCs by plaque macrophages promoted ferroptosis, suggesting a therapeutic target for reducing RBC-mediated cardiovascular risk.

Authors

Wenli Liu, Nataliya Östberg, Mustafa Yalcinkaya, Huijuan Dou, Kaori Endo-Umeda, Yang Tang, Xintong Hou, Tong Xiao, Trevor P. Fidler, Sandra Abramowicz, Yong-Guang Yang, Oliver Soehnlein, Alan R. Tall, Nan Wang

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Figure 6

Liprox-1 reverses VFEpoR-induced atherosclerosis progression.

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Liprox-1 reverses VFEpoR-induced atherosclerosis progression.
Control an...
Control and VFEpoR mice were fed a Western diet and treated with LDLR ASO and EPO for 12 weeks, with Liprox-1 (10 mg/kg, 3 times per week) or vehicle injection for the last 10 weeks. (A) Experiment timeline. (B) Representative C11 BODIPY staining histogram and quantification of C11 BODIPY CD11b+ cells as the percentage of total aortic CD11b+ cells. (C) H&E-stained images of aortic root sections. Necrotic core regions indicated by broken lines and quantification of total lesion area and necrotic core area are shown. Scale bar: 200 μm. (D) Aortic root sections were stained with Masson’s trichrome staining for fibrous cap (red, outlined by broken lines) and collagen (blue) content area, and then quantified as the ratio of total lesion area. Scale bar: 100 μm. (E) 4-HNE IHC in the aortic root cross sections. Scale bar: 100 μm. (F) Representative images of Perl’s blue plus DAB staining, IHC staining of RBCs (anti-Ter119), and macrophages (anti-Mac2) in aortic roots. Bar graph shows quantification of iron (II + III)–positive and erythrophagocytosis (Ter119+Mac2+) cell counts per section. Scale bar: 100 μm. (G) Immunofluorescence staining of TfR1 and macrophage (anti-Mac2), and quantification of TfR1 and macrophage costaining cell counts per section. Scale bar: 50 μm. (H) Evans blue intravital staining of arches and quantification of Evans blue extravasation. (I) L-selectin and CD11a expression levels in neutrophils and monocytes from peripheral blood assessed by flow cytometry. (J) VFEpoR mice were fed a Western diet and injected with LDLR ASO and EPO for 3 weeks, then divided into two groups, treated with Isotype or anti–Gr-1 mAb twice per week for another 4 weeks. In total 7 weeks WD and EPO injection. Evans blue intravital staining of arches and descending aorta, and quantification of extravasation. One-way ANOVA (B–D) or unpaired 2-tailed t test (E–J). *P < 0.05, **P < 0.01, ***P < 0.001.

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