ARTICLE
Vulne abili y o p oge oid smoo h muscle cells o
biomechanical o ces is media ed by MMP13
Pa icia R. Pi ez 1,2, Luís Es onca1,2, Luís Miguel Mon ei o 1, Guillem Colell3, Helena Vazão1,
Deolinda San inha 1,2, Ka im Ha hou i 4, Daniel Tho n on5, Clai e Na a o 4,6, Anne-Lau e Egesipe7,
Tânia Ca alho 8, Rod igo L. Dos San os9, Nicolas Lé y4,10, James C. Smi h 11, João Ped o de Magalhães1,5,
Alessand o O i 12, And eia Be na do 11, Annachia a De Sand e-Gio annoli 4,10,13, Xa ie Nissan 7,
Anna Rosell3& Lino Fe ei a 1,2✉
Hu chinson-Gil o d P oge ia Synd ome (HGPS) is a p ema u e aging disease in child en ha
leads o ea ly dea h. Smoo h muscle cells (SMCs) a e he mos a ec ed cells in HGPS
indi iduals, al hough he eason o such ulne abili y emains poo ly unde s ood. In his
wo k, we de elop a mic ofluidic chip o med by HGPS-SMCs gene a ed om induced plu -
ipo en s em cells (iPSCs), o s udy hei ulne abili y o flow shea s ess. HGPS-iPSC SMCs
cul u ed unde a e ial flow condi ions de ach om he chip a e a ew days o cul u e; his
p ocess is media ed by he up egula ion o me allop o ease 13 (MMP13). Impo an ly,
double-mu an LmnaG609G/G609GMmp13−/−mice o LmnaG609G/G609GMmp13+/+mice ea-
ed wi h a MMP inhibi o show lowe SMC loss in he ao ic a ch han con ols. MMP13
up egula ion appea s o be media ed, a leas in pa , by he up egula ion o glycocalyx. Ou
HGPS-SMCs chip ep esen s a pla o m o de eloping ea men s o HGPS indi iduals ha
may complemen p e ious p e-clinical and clinical ea men s.
h ps://doi.o g/10.1038/s41467-020-17901-2 OPEN
1Cen e o Neu oscience and Cell Biology, Uni e si y o Coimb a, Coimb a, Po ugal. 2Facul y o Medicine, Uni e si y o Coimb a, Coimb a, Po ugal.
3Neu o ascula Resea ch Labo a o y, Vall d’Heb on Resea ch Ins i u e, Uni e si a Au ònoma de Ba celona, Passeig Vall d’Heb on 119-129, 08035
Ba celona, Spain. 4Aix Ma seille Uni , INSERM, MMG, Ma seille, F ance. 5In eg a i e Genomics o Ageing G oup, Ins i u e o Ageing and Ch onic Disease,
Uni e si y o Li e pool, Li e pool L7 8TX, UK. 6P ogeli e, Ma seille, F ance. 7CECS, I-STEM, AFM, Ins i u e o S em Cell The apy and Explo a ion o
Monogenic Diseases, E y Cedex, F ance. 8IMM, Ins i u o de Medicina Molecula , Uni e sidade de Lisboa, Lisbon, Po ugal. 925 Camb idge Science Pa k,
Mog i y L d, Mil on Road, Camb idge CB4 0FW, UK. 10 Molecula Gene ics Labo a o y, Depa men o Medical Gene ics, La Timone Child en’s Hospi al,
Ma seille, F ance. 11 De elopmen al Biology Labo a o y, F ancis C ick Ins i u e, London NW1 1AT, UK. 12 Leibniz Ins i u e on Aging - F i z Lipmann Ins i u e,
07745 Jena, Ge many. 13 CRB Assis ance Publique des Hôpi aux de Ma seille (CRB AP-HM, TAC), Ma seille, F ance. ✉email: [email p o ec ed]
NATURE COMMUNICATIONS | (2020) 11:4110 | h ps://doi .o g/10.1038/s41467-020-17901-2 | www.na u e.com/na u ecommunica ions 1
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Hu chinson–Gil o d P oge ia Synd ome (HGPS) is caused
by a single mu a ion in he lamin A/C gene (LMNA),
esul ing in he gene a ion o an abno mal lamin A p e-
cu so named p oge in1,2. One o he key easons o p ema u e
dea h is he loss o smoo h muscle cells (SMCs) in he medial
laye o la ge a e ies, ollowed by he appea ance o collagen and
ex acellula ma ix (ECM) and he de elopmen o a se e e
a e ioscle o ic p ocess ha leads o inc eased a e ial s i ness3–5.
The easons o SMC loss emain o be de e mined. I has been
sugges ed ha his may happen due o pa hophysiological
changes inhe en o p elamin A/p oge in accumula ion, such as
he accele a ion o ascula calcifica ion ia he ac i a ion o he
DNA damage esponse and senescence-associa ed sec e o y
pheno ypes in ascula SMCs6o he down egula ion o PARP17.
I has also been shown ha he combined e ec o p oge in
accumula ion and mechanical s ess in mouse SMCs o e -
exp essing p oge in p omo ed cell de achmen and dea h, while
he dis up ion o he linke be ween nucleoskele on and cy os-
kele on complex amelio a ed he oxic e ec s o p oge in8. Nei-
he o hese s udies ha e ully add essed he easons behind SMC
de achmen and hus which he apeu ic app oach could be
e ec i e o p e en SMC loss.
Induced plu ipo en s em cells (iPSCs) o e an unlimi ed
sou ce o SMCs o s udy HGPS. Recen s udies ha e gene a ed
iPSCs om fib oblas s ob ained om indi iduals wi h HGPS
(he ea e e e ed o as HGPS-iPSCs)9–11. S ikingly, HGPS-
iPSCs show low lamin A/C and p oge in p o ein exp ession in he
plu ipo en s a e. Howe e , he exp ession o p oge in is eac i-
a ed a e HGPS-iPSC di e en ia ion in o SMCs7,9. The di e -
en ia ed cells show nuclea dysmo phology, cell g ow h
e a da ion, suscep ibili y o apop osis, p oli e a ion educ ion,
and DNA- epai de ec s; howe e , SMC pe o mance unde flow
condi ions has no been e alua ed.
In his wo k, we de elop an in i o cell sys em comp ising
SMCs de i ed om HGPS-iPSCs cul u ed unde flow condi ions
in a mic ofluidic de ice. We iden i y MMP13 as a media o o
SMC de achmen using chemical and gene ic assays. The gene -
a ed double-mu an LmnaG609G/G609GMmp13−/−mice show an
inc ease in SMCs in he ao ic a ch and a dec ease in p oge in-
posi i e cells. In addi ion, he inhibi ion o MMP13 in
LmnaG609G/G609G mice by Ba imas a , a d ug ha has been p e-
iously es ed in clinical ials in cance pa ien s, educes SMC
loss. The esul s p esen he e open pe spec i es o HGPS
ea men .
Resul s
SMCs de i ed om HGPS-iPSCs a e unc ional and sha e
simila ea u es o p oge in-exp essing cells. iPSCs we e gen-
e a ed om HGPS skin fib oblas s and cha ac e ized as p e-
iously desc ibed10. iPSCs gene a ed om non-disease cells (N-
iPSCs), HGPS skin fib oblas s, and non-disease soma ic human
ascula smoo h muscle cells (hVSMCs) we e used as con ols.
The mu a ion in he LMNA gene, bo h in HGPS skin fib oblas s
and HGPS-iPSCs, was confi med by Sange sequencing (Sup-
plemen a y Fig. 1). As expec ed, undi e en ia ed HGPS-iPSCs
exp essed low le els o HGPS ma ke s, such as p oge in, as well as
low le els o SMC ma ke s, such as α-SMA and SMα-2212,13
(Supplemen a y Fig. 2a). To induce he di e en ia ion o HGPS-
iPSCs o N-iPSCs in o SMCs, CD34+cells we e isola ed by
magne ic-ac i a ed cell so ing om emb yoid bodies (EBs) cul-
u ed o 10 days in suspension (Fig. 1a)14. A his s age, HGPS-
CD34+cells al eady exp ess highe le els o p oge in mRNA
ansc ip s ela i e o N-iPSCs bu ela i ely low le els o SMC
mRNA ansc ip s compa ed wi h soma ic hVSMCs (Supple-
men a y Fig. 2b). HGPS-CD34+cells we e hen cul u ed in SMC
induc ion media (Supplemen a y Fig. 3) ollowed by SMC
ma u a ion media (Supplemen a y Fig. 4) o an addi ional ou
passages. Ma u ed SMCs a e e e ed o as HGPS-iPSC SMCs o
N-iPSC SMCs based on hei pheno ype, geno ype, and unc-
ional p ope ies (see below). Bo h HGPS-iPSC SMCs and N-
iPSC SMCs ha e simila o highe exp ession o SMC mRNA
ansc ip s han soma ic hVSMCs (Supplemen a y Fig. 4a).
G ea e han 95% o bo h di e en ia ed cells exp ess α-SMA,
smoo h muscle myosin hea y chain (SMMHC), and calponin
p o eins (Fig. 1b). Mo eo e , HGPS-iPSC SMCs exp ess p oge in
mRNA ansc ip s (Fig. 1c) and p oge in p o ein (Supplemen a y
Fig. 4b, c). Simila esul s we e ob ained o SMCs de i ed om
HGPS-iPSCs gene a ed om a second P oge ia indi idual; how-
e e , he di e en ia ed cells showed highe p oge in p o ein le els
han he fi s P oge ia indi idual (Supplemen a y Fig. 5).
Impo an ly, HGPS-iPSC SMCs and N-iPSC SMCs a e unc ional
as hey espond o asoac i e agen s such as his amine and
angio ensin (Supplemen a y Fig. 4d) and hey con ac a e
exposu e o ca bachol (Supplemen a y Fig. 4e).
SMCs de i ed om HGPS-iPSCs sha e simila ea u es o
p oge in-exp essing cells. Cell lines o ced o exp ess p oge in
show he ac i a ion o se e al NOTCH signaling pa hway
e ec o s15. Indeed, ou esul s showed ha HGPS-iPSC CD34+
cells had highe exp ession o NOTCH signaling pa hway mRNA
ansc ip s han N-iPSC CD34+cells (Supplemen a y Fig. 6).
Ma u e HGPS-iPSC SMCs also exp essed highe le els o NOTCH
ligand and ecep o s han N-iPSC SMCs (Supplemen a y Fig. 6a).
In addi ion, HGPS-iPSC SMCs esponded o a nesyl ans e ase
inhibi o s, as has been shown in o he P oge ia cell models16–18.
In he cu en wo k, HGPS-iPSC SMCs ea ed wi h lona a nib o
48 h accumula ed nuclea p elamin A and showed a dec ease in
nuclea shape abno mali ies and nuclea blebbing (Supplemen a y
Fig. 7a–c). Taken oge he , he cells di e en ia ed om HGPS-
iPSCs-exp essed SMC and p oge oid ma ke s, a e unc ional and
exhibi physiological esponses.
HGPS-iPSC SMCs a e ulne able o a e ial shea s ess. SMCs
di e en ia ed om N-iPSCs o HGPS-iPSCs we e seeded in a
mic ofluidics sys em and cul u ed unde flow condi ions o up o
7 days (Fig. 1d). Because SMCs om la ge a e ies a e he mos
a ec ed in blood essels in HGPS, we used a flow o 20 dyne/cm2,
which is ypically ound in a e ial blood essels19. N-iPSC SMCs
(Fig. 1g), hVSMCs, o HGPS fib oblas s (80% o which exp ess
p oge in) (Fig. 1e, g) can be cul u ed in he mic ofluidics sys em
o a leas 7 days wi hou a isible loss in cell numbe . In con-
as , HGPS-iPSC SMCs cul u ed unde flow condi ions o med
cell clumps o e ime (Fig. 1 ), and mos o he cells de ached om
he subs a e a day 4 as confi med by cell numbe (Fig. 1g) and
me abolic analyses (Fig. 1h). Du ing his ime pe iod, he pe -
cen age o cells exp essing p oge in and displaying nuclea
abno mali ies inc eased significan ly un il day 4 (Supplemen a y
Fig. 8). Ou esul s indica e ha SMC de achmen is media ed by
p oge in accumula ion, as he inhibi ion o p oge in by an isense
mo pholinos20 significan ly dec eased HGPS-iPSC SMC de ach-
men (Supplemen a y Fig. 9). In addi ion, we showed ha HGPS-
iPSC SMCs wi h high p oge in exp ession (30% o he cells
exp ess p oge in a day 0) de ached om he su ace o he
mic ofluidics sys em in a sho ime (<12 h) (Supplemen a y
Fig. 5g). To confi m ha p oge in accumula ion is esponsible o
SMC loss, a ameshi mu an s em cell line was gene a ed
(HGPSΔ2-iPSCs) o knockou he HGPS mu an allele and gen-
e a ed a disease cell line, as p e iously desc ibed in he mouse21
(Fig. 2a and Supplemen a y Fig. 10). Specifically, a wo-base pai
dele ion on exon 11, ups eam o he HGPS poin mu a ion
(1814C>T), was gene a ed. No ably, HGPSΔ2-iPSCs exp essed
ARTICLE NATURE COMMUNICATIONS | h ps://doi.o g/10.1038/s41467-020-17901-2
2NATURE COMMUNICATIONS | (2020) 11:4110 | h ps://doi.o g/10.1038/s41467-020-17901-2 | www.na u e.com/na u ecommunica ions
li le o no p oge in upon di e en ia ion in o SMCs as demon-
s a ed a he ansc ip and p o ein le els and did no de ach
unde flow cul u e condi ions (Fig. 2).
HGPS-iPSC SMC de achmen does no seem o be media ed by
cell apop osis. Be o e cell de achmen , HGPS-iPSC SMCs showed:
(i) poo p oli e a ion (as moni o ed by Ki67 s aining) confi ming
hei con ac ile pheno ype (Fig. 1i), (ii) simila le els o apop osis
as N-iPSC SMCs as confi med by caspase-9 ac i i y (Fig. 1j), (iii)
an os eogenic di e en ia ion p og am (Supplemen a y Fig. 11a,
b), (i ) inc eased DNA damage6(Supplemen a y Fig. 12), and ( )
down egula ion o NOTCH15,22 (Supplemen a y Fig. 13) signal-
ing pa hways. Because he in i o shea s ess om blood flow is
no di ec ly sensed by SMCs bu by endo helial cells (ECs), we co-
cul u ed SMCs di e en ia ed om HGPS-iPSCs (di ec ly
a ached o he mic ofluidics subs a e) wi h human umbilical
a e y ECs (HUAECs, on op o he SMCs) unde flow condi ions.
Ini ially, we sc eened di e en cul u e condi ions and we ound
ha endo helial g ow h media-2 (EGM-2) medium was a sui able
medium o suppo bo h cells (Supplemen a y Fig. 14). Then, we
co-cul u ed HUAECs and HGPS-iPSC SMCs a di e en a ios
(1.6, 1, and 0.6) unde flow condi ions. In all he a ios es ed, we
had a monolaye o HUAECs (Supplemen a y Fig. 15a) and
HGPS-iPSC SMCs a ime ze o. A e 6 days in flow condi ions, a
significan pe cen age (>40%) o HGPS-iPSC SMCs was los
(Supplemen a y Fig. 15b). Fo he highes a io es ed (1.6), he
loss o HGPS-iPSC SMCs occu ed wi hou isible loss o ECs.
Ye , o EC:SMC a ios below 1, pa o ECs also de ached om
he mic ofluidic chambe indica ing ha , a low ECs densi y,
may u n ECs ulne able o flow condi ions. Impo an ly, cell
ulne abili y o flow condi ions was only obse ed in co-cul u es
***
**
101
100
10–1
10–2
10–3
10–4
10–5
Rela i e gene exp ession
LMNA
LMNB1
P oge in
N-iPSC-SMCs
HGPS-iPSC-SMCs
HGPS ib oblas s
*
**** ****
****
246
0
10,000
20,000
30,000
40,000
0
5
10
15
Cell clumps
A ea o cell clumps
Time (days)
A ea o cell clumps (μm
2
)
Cell clumps (numbe /μm
2
)(x10
6
)
04 04 04
0
50
100
No malized caspase 9 ac ici y
HGPS-iPSC SMCs
N-iPSC SMCs
HGPS ib oblas s
Time (days)
****
*
**
p < 0.0001
p = 0.0123
p = 0.0084
0246
0.0
0.5
1.0
1.5
2.0
Time in low shea
s ess (days)
No malized cell numbe
HGPS-iPSCs-SMCs
HGPS ib oblas s
hVSMCs
N-iPSCs-SMCs
***
0246
0.0
0.2
0.4
0.6
0246
Cell me abolism
Cell p oli e a ion
Cell apop osis
Time in low shea
s ess (days)
Me abolic ac i i y
hVSMCs
HGPS-iPSCs-SMCs
N-iPSCs-SMCs
HGPS ib oblas s
***
e
h
Day 1 Day 4 Day 6
Day 1
HGPS Fib oblas s
Day 7
HGPS-iPSC SMCs
hVSMCs
Day 8
g
0
20
40
60
80
% Ki67 posi i e cells
N-iPSCs-SMCs
HGPS-iPSCs-SMCs
HGPS ib oblas s
04 04 40
Time (days)
****
****
*
p < 0.0001
p < 0.0001
p = 0.0305
ij
d
a
Days
Cell coun ing
0
20
40
60
80
100
120
% o cells
N-iPSC-SMCs
HGPS-iPSC-SMCs
α-SMA
SMMHC
Calp
b
Di e en ia ion
in suspension
CD34+ cells
Undi e en ia ed
cell colony
4 Passages (≈15 d)
Induc i e media
4 Passages (≈15 d)
Ma u a ion media
HGPS-iPSC SMCs
N-iPSC SMCs
c
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NATURE COMMUNICATIONS | (2020) 11:4110 | h ps://doi .o g/10.1038/s41467-020-17901-2 | www.na u e.com/na u ecommunica ions 3
o HGPS-iPSC SMCs bu no N-iPSC SMCs (Supplemen a y
Fig. 15c).
I has been shown ha a knock-in mouse line ca ying a
homozygous Lmna c.1827C>T;p.Gly609Gly mu a ed allele
(LmnaG609G/G609G) ecapi ula es mos o he desc ibed al e a ions
associa ed wi h HGPS, including he loss o SMCs20. Thus, o
alida e he esul s ob ained o he HGPS-iPSC SMCs, we
isola ed SMCs om wild- ype (WT mSMC) and homozygous
LmnaG609G/G609G (HOZ mSMC) mice. Bo h cells exp essed
calponin and α-SMA, while HOZ mSMCs, bu no WT SMCs,
showed dysmo phic nuclei and nuclea blebbing (Fig. 3a, b). WT
mSMCs we e cul u ed unde flow condi ions (120 dyne/cm2 o
mimic mice a e ial flow shea s ess23,24) o up o 26 days
wi hou isible loss o cells (Fig. 3c). In con as , HOZ mSMCs
de ached om he subs a e a e 8–9 days. These esul s confi m
ha HOZ mSMCs a e ulne able o flow shea s ess simila o
HGPS-iPSC SMCs. O e all, ou esul s indica e ha HGPS-iPSC
SMCs a e ulne able o flow shea s ess, as in he case o SMCs
isola ed om mice ca ying a HGPS-like mu a ion in he Lmna
gene.
HGPS-iPSC SMCs ha e significan changes in ex acellula
ma ix (ECM) sec e ion and MMP exp ession. To gain insigh s
in o he mechanism behind SMC de achmen , we pe o med
mic oa ay analyses on HGPS-iPSC SMCs and N-iPSC SMCs a
days 0 and 4 (be o e cell de achmen ). A day 0, 2084 genes we e
di e en ially exp essed (Log2FC ≥1; p< 0.05) in HPGS-iPSC
SMCs s. N-iPSC SMCs. O hese genes, 51 genes we e associa ed
wi h cell senescence, as de e mined by he in e sec ion o all he
di e en ially exp essed genes wi h he CellAge da abase25 (279
genes) (Supplemen a y Da a 1). A he p o ein le els, HGPS-iPSC
SMCs exp essed highe le els o p21 and SA-β-galac osidase han
N-iPSCs-SMCs and he le el o senescence ma ke s inc eased
a e cul u e o HGPS-iPSC SMCs in flow condi ions (Supple-
men a y Fig. 16a and Supplemen a y Da a 5). We nex pe o med
pa hway analysis on he di e en ially exp essed genes om
HGPS-iPSC SMCs a day 0 s. day 4 (Supplemen a y Fig. 17 and
Supplemen a y Da a 2, 3). In gene al, ECM ac i a ion, sec e ion,
and cell adhesion pa hways we e up egula ed, whe eas cell cycle
and DNA eplica ion pa hways we e down egula ed unde
a e ial flow condi ions a day 4. Among he fi y-se en genes ha
we e a leas h ee old down- o up egula ed compa ed wi h day 0
(p< 0.001) (Fig. 4a), fi e we e ela ed o ECM sec e ion (COL6A3,
IBSP, BGN, SGCG, and EPPK1) and one o me allop o eases
(MMP13). The exp ession o hese genes, as well as o he s, was
confi med by qRT-PCR (Fig. 4a), and he molecula ne wo k o
genes ha we e di e en ially exp essed be ween days 0 and 4 in
he HGPS-SMCs was examined by Ingenui y Pa hway Analysis
(Supplemen a y Fig. 17). In e es ingly, pa hway analysis sug-
ges ed ha MMP13 is ei he a di ec o indi ec a ge o mul iple
genes up egula ed a day 4. Mo eo e , MMP13 ansc ip le els
a e ele a ed in HGPS-iPSC SMCs when compa ed wi h SMCs
gene a ed om he a enua ed disease e sion o his line
(HGPSΔ2-iPSC SMCs), specially pos shea s ess (Fig. 2g).
To u he explo e he gene a ay esul s, we e alua ed whe he
he p esence o ECM sec e ed by hVSMCs could p e en he
de achmen o HGPS-iPSC SMCs unde a e ial flow condi ions.
Thus, we cul u ed HGPS-iPSC SMCs on decellula ized ECM
deposi ed by hVSMCs o di ec ly on op o mi o ically inac i a ed
hVSMCs (Supplemen a y Fig. 18). Bo h condi ions we e unable
o p e en HGPS-iPSC SMC de achmen . Nex , we es ed whe he
condi ioned media collec ed om HGPS-iPSC SMCs in flow
condi ions o 4 days could induce he de achmen o flow shea
s ess-insensi i e hVSMCs (Fig. 4b). Su p isingly, hVSMCs
de ach a e pe usion wi h HGPS-iPSC SMC-condi ioned media
bu no wi h N-iPSC SMC-condi ioned media (Fig. 4c). Following
hese esul s and gi en ha MMP13 appea s o be he
downs eam e ec o o he genes mis egula ed a day 4
(Supplemen a y Fig. 17b) we decided o quan i y he concen a-
ion o MMP13 in HGPS-iPSC SMC and N-iPSC SMC cul u e
media a e flow shea s ess. Rema kably, MMP13 le els
inc eased 30- old in he HGPS-iPSC SMC cul u e media, bu
no in he con ol cell cul u e media (Fig. 4d). Simila ly, highe
MMP13 le els we e obse ed in media collec ed om HOZ
mSMCs unde flow shea s ess, when compa ed wi h media om
WT mSMCs (Fig. 3d). Because MMP13 is p oduced by cells as an
inac i e o m (p oMMP13), which is hen ac i a ed by cell
memb ane MMPs, namely MMP14 (also called MT1-MMP) and
MMP2 (also called gela inase A)26, he ca aly ic ac i i y o
MMP13 sec e ed by HGPS-iPSC SMCs was analyzed (Supple-
men a y Fig. 19). The concen a ion o p oMMP13 and ac i e
MMP13 inc eased app oxima ely eigh - and fi e- old, espec-
i ely, in cul u e media o HGPS-iPSC SMCs cul u ed in flow
condi ions om day 0 o day 4. Mo eo e , he concen a ion o
p oMMP13 and ac i e MMP13 in cell cul u e media collec ed
om N-iPSC SMCs cul u ed in flow condi ions o 4 days was
mo e han ou old lowe han he one obse ed wi h HGPS-iPSC
SMCs. Al oge he , ou esul s indica e ha HGPS-iPSC SMCs
cul u ed unde flow condi ions showed inc eased cell senescence,
ECM ac i a ion, sec e ion, and cell adhesion pa hways up egula-
ion and dys egula ion in he exp ession o MMP13.
Fig. 1 Vulne abili y o HGPS-iPSC SMCs o a e ial flow condi ions. a Schema ic ep esen a ion o he me hodology used o di e en ia e iPSCs in o
SMCs. bExp ession o SMC ma ke s on iPSC-de i ed SMCs. Pe cen age o posi i e cells exp essing SMC ma ke s as e alua ed by immunofluo escence (a
leas 100 cells we e coun ed pe each ma ke ). Resul s a e mean ± SEM (n=3 independen expe imen s). cExp ession o p oge ia ma ke s on iPSC-
de i ed SMCs. Gene exp ession by qRT-PCR (gene exp ession was no malized by he housekeeping gene GAPDH). HGPS fib oblas s we e used as con ol.
Resul s a e mean ± SEM (n=4 echnical eplica es om a pool o h ee independen expe imen s). *, **, ***, **** deno e s a is ical significance (p< 0.05,
p< 0.01, p< 0.001, p< 0.0001). S a is ical analyses we e pe o med by one-way ANOVA ollowed by Newman–Keuls’s pos es . dSchema ic
ep esen a ion o he p o ocol used. Cells we e cul u ed o 6–8 days in a e ial flow condi ions (20 dyne/cm2). eLigh mic oscopy images o HGPS
fib oblas s, hVSMCs, o HGPS-iPSC SMCs (10% o he cells accumula e p oge in p o ein) a di e en cul u e days. Only HGPS-iPSC SMCs de ached om
he mic ofluidic sys em a day 4. Scale ba is 50 μm. Numbe and a ea o cell clumps in HGPS-iPSC SMCs a di e en imes (a leas wo images (×10)
ha e been quan ified pe ime). Fo a ea o cell clumps n> 2 images examined o e h ee independen expe imen s; o cell clumps, n=3 independen
expe imen s. gNumbe o cells pe su ace a ea (mm2) du ing cell cul u e unde a e ial flow (a leas h ee images (×10) ha e been quan ified pe ime;
n=3–7 independen expe imen s). Cell numbe was no malized by he numbe o cells p esen a day 0. hCell me abolism e alua ed by he P es o Blue
assay. Abso bance a 570 nm was measu ed and no malized o he 600-nm alues o he expe imen al wells. n=3 independen expe imen s. iExp ession
o nuclea p oli e a ion ma ke , Ki67 (a leas h ee images (×10) ha e been quan ified pe ime). The pe cen age o Ki67 posi i e cells was e alua ed by
immunofluo escence. n> 3 images examined o e h ee independen expe imen s. jCell apop osis e alua ed by caspase-9 ac i i y. Resul s we e
no malized by cell numbe . n=3 independen expe imen s. F om c o g, esul s a e mean ± SEM. *, **, ***, **** deno e s a is ical significance (p< 0.05, p<
0.01, p< 0.001, p< 0.0001). S a is ical analyses we e pe o med by a wo- ailed unpai ed S uden ’s es iand j.
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MMP13 media es HGPS-iPSC SMC loss unde flow condi ions.
Nex , we es ed whe he he chemical inhibi ion o MMPs could
p e en HGPS-iPSC SMC de achmen . Fo his pu pose, we used
Ba imas a (BB-94)27, a b oad spec um ma ix me allop o ease
inhibi o (IC50 =33 nM o MMP1328), and a specific MMP13
inhibi o py imidine-4,6-dica boxylic acid, bis-(4-fluo o-3-
me hyl-benzylamide) (IC50 =8 nM)29. Rema kably, bo h inhi-
bi o s significan ly dec eased he de achmen o HGPS-iPSC
SMCs cul u ed unde a e ial flow condi ions (a leas un il day
12) (Fig. 4e), and his e ec was much supe io o ha o lona-
a nib (Supplemen a y Fig. 7d) o inhibi ion h ough he py -
ophospha e calcifica ion p ocess30 (Supplemen a y Fig. 11c). To
confi m hese esul s, HGPS-iPSC SMCs we e subjec ed o siRNA
knockdown o MMP13 and cul u ed unde a e ial flow condi-
ions o 10 days (Fig. 4 , g). Ou esul s show ha he knock-
down o MMP13 in SMCs inc eased he s abili y o HGPS-iPSC
SMCs in flow cul u e condi ions compa ed wi h non- ea ed
cells. We also analyzed he e ec s o MMP13 and BB94 inhibi ion
in HOZ mSMCs (Fig. 3e). Simila o wha was obse ed wi h
HGPS-iPSC SMCs, he de achmen was significan ly delayed
when one o he inhibi o s was used. To u he demons a e he
impo ance o MMP13 in HGPS-iPSC SMC de achmen , we
en o ced he exp ession o MMP13 in soma ic SMCs (hVSMCs)
and cul u ed he modified cells in flow cul u e condi ions
0246
0.0
0.5
1.0
1.5
2.0
No malized cell numbe
(by day 0)
Time (days)
HGPS-iPSC SMCs
HGPSΔ2-iPSC SMCs
****
Calp
SMMHC
0
30
60
90
120
% o cells
Lamin A
P oge in
D.Nuclei
Blebbing
0
30
60
90
120
% o cells
LMNA G608G exp ession
****
HGPS ib oblas s
HGPS-iPSC SMCs
HGPSΔ2-iPSC SMCs
p < 0.0001
Mo phology Nuclei Lamin A Nuclei P oge in
bNuclei SMMHC Nuclei Calponin
cd
e
a
100
10–1
10–2
10–3
100
10–1
10–2
10–3
10–4 10–4
MMP13 exp ession
HGPS-iPSC SMCs
LMNA gene locus
Exon 11
HGPS allele
HGPS Poin Mu a ion Si e
Ch omosome 1
sgRNA
PAM
5’
3’ 5’
3’
3’
3’
3’
3’
3’
3’
5’
5’
5’
5’
5’
5’
WT allele
N-iPSCHGPS-iPSC
HGPSΔ2-iPSC
WT allele
WT allele
WT allele
HGPS allele
HGPSΔ2-iPSC SMCs
04
Time (days)
**
**
***
p = 0.0035
p = 0.0002
p = 0.0016
g
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Fig. 2 Exp ession o p oge ia and SMC ma ke s in HGPSΔ2-iPSC SMCs. a gRNA di ec s Cas9 nuclease agains mu a ed exon 11 o LMNA gene, ups eam
he HGPS mu a ion, dis up ing p oge in, wi hou al e ing lamin A and lamin C. Sange sequencing o LMNA (NM_170707.4 ansc ip ) exon 11 was
pe o med o : N-iPSCs, HGPS-iPSCs and HGPSΔ2-iPSCs, confi ming he dele ion o wo-base pai s in he HGPSΔ2-iPSCs. bExp ession o lamin A,
p oge in, and SMC p o eins moni o ed by immunofluo escence. Scale ba is 100 μm. n=6 independen expe imen s. cExp ession o p oge in (LMNA
G608G gene) in HGPS and HGPSΔ2 cell lines. Resul s a e mean ± SEM (n=4 echnical eplica es om a pool o h ee independen expe imen s).
S a is ical analyses we e pe o med by a wo- ailed unpai ed S uden ’s es . dQuan ifica ion o lamin A, p oge in, dysmo phic nuclei, and nuclei blebbing.
Resul s a e mean ± SEM (n=6 independen expe imen s). **** deno es s a is ical significance (p< 0.0001). ePe cen age o cells ha ha e been
di e en ia ed om HGPSΔ2-iPSCs ha exp ess SMC ma ke s a p o ein le el. Resul s a e mean ± SEM (n=5–6 independen expe imen s). Numbe o
cells pe su ace (mm2) as quan ified by high-con en mic oscopy (a leas h ee images (×10) ha e been quan ified pe ime). The numbe o cells was
e alua ed a e 6 days unde a e ial flow and was no malized by he numbe o cells p esen a day 0. n> 3 images examined o e h ee independen
expe imen s. gMMP13 mRNA ansc ip s quan ified by qRT-PCR analyses in HGPS-iPSC SMCs o HGPSΔ2-iPSC SMCs cul u ed unde flow condi ions.
MMP13 mRNA ansc ip s we e no malized by GAPDH.n=4 echnical eplica es om a pool o h ee independen expe imen s. **, *** deno e s a is ical
significance (p< 0.01, p< 0.001). S a is ical analyses we e pe o med by a wo- ailed unpai ed S uden ’s es .
08 08
0.00
0.01
0.02
0.03
Concen a ion o MMP13 (pg/cell)
**
HOZ mSMCs
WT mSMCs
Time (days)
p = 0.0022
D. Nuclei
Blebbing
Calponin
α-SMA
0
20
40
60
80
100
0
20
40
60
80
100
% o cells
% o cells wi h o ganized ibe s
ab
WT mSMCs HOZ mSMCs
0 5 10 15
0
20
40
60
80
100
120
Time (days)
% o adhe ed cells
HOZ
HOZ MMP13i
HOZ BB94
d
Lamin A α-SMA
0
20
40
60
80
100
120
% o adhe ed cells
Time (days)
03926
HOZ mSMC
WT mSMC
****
ce
Fig. 3 Cha ac e iza ion and impac o flow shea s ess in SMCs isola ed om wild- ype (WT) and homozygous (HOZ) LmnaG609G/G609G mice. a
Mouse SMCs we e cul u ed o 9–26 days in a e ial flow condi ions (120 dyne/cm2). Immunofluo escence analyses pe o med on mouse SMCs (6-week-
old WT and HOZ Lmna G609G/G609G mice) a passage 4 o α-SMA and Lamin A. Nuclei we e s ained wi h DAPI. Scale ba is 20 µm. n=3–4 images
examined o e h ee independen expe imen s. bPe cen age o dysmo phic nuclei, nuclei blebbing, and SMC o ganized fibe s in mSMCs (assessed in
s a ic condi ions). n=3-4 images examined o e h ee independen expe imen s. cPe cen age o adhe ed cells o e ime. Cells we e cul u ed unde
flow condi ions. n=3–4 independen expe imen s. S a is ical analyses we e pe o med by one-way ANOVA ollowed by Newman–Keuls’s pos es .
dQuan ifica ion o MMP13 in HOZ mSMCs and WT mSMCs. Cells we e analyzed a day 0 and day 8 unde flow. Fluo escence signal was no malized by
cell numbe . n=3–4 independen expe imen s. S a is ical analyses we e pe o med by a wo- ailed unpai ed S uden ’s es . ePe cen age o adhe ed cells
o e ime. Cells we e cul u ed unde flow condi ions. n=5–6 independen expe imen s. In g aphs b–e, esul s a e mean ± SEM. *,**,***,**** deno e
s a is ical significance (p< 0.05, p< 0.01, p< 0.001, p< 0.0001).
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(Supplemen a y Fig. 19). No ably, he numbe o cells obse ed a
day 7 is lowe han he one obse ed in WT cells indica ing ha
some o he modified cells we e los du ing he flow cul u e
condi ions.
We hen asked whe he he modula ion o MMP13 ac i i y
could a ec p oge in exp ession associa ed wi h he ulne abili y
o HGPS-iPSC SMCs o flow shea s ess. In e es ingly, chemical
inhibi ion o MMP13 in HGPS-iPSC SMCs cul u ed o 7 days in
flow condi ions educed he pe cen age o p oge in-posi i e cells
(Fig. 4h); howe e , i did no dec ease p oge in exp ession in cells
wi h high le els o p oge in, such as HGPS fib oblas s. In
addi ion, he chemical inhibi ion o MMP13 did no educe he
ac i i y o alkaline phospha ase in HGPS-iPSC SMCs cul u ed o
7 days in flow condi ions (Fig. 4i). O e all, he esul s ob ained
012 24 36 48
0
25
50
75
100
125
150
Time (h)
% o adhe ed hVSMCs
HGPS-iPSC SMC CM
N-iPSC SMC CM
Non- ea ed
BB94
MMP13i
BB94
MMP13i
0.0
04040404
0.5
1.0
1.5
2.0
No malized cell numbe
o day 0
d7 d12
****
****
****
****
0
50
100
150
% o cells wi h p oge in
HGPS ib oblas s
HGPS-iPSC SMCs
MMP13 inhibi ion
–+–
+
****
p < 0.0001
0.00
0.01
0.02
0.03
0.04
Rela i e gene exp ession
***
No ans ec ion
siRNA con ol
siRNA MMP13
***
0
2
4
6
8
Concen a ion o
MMP13 (x10–4, pg/cell)
****
*
*
Time (days)
HGPS-iPSC SMCs
N-iPSC SMCs
hVSMCs
HGPS ib oblas s
p < 0.0001
p = 0.0156
p = 0.0417
EPS8
NR4A3
PXK
OLFML2A
LIPH
AMTN
TNFAIP6
ANGPTL4
EPPK1
SESN2
SGCG
MMP13
IBSP
HAS3
COL6A3
BGN
–4
–2
0
2
4
6
8
10
12
14
Fold change
HGPS-iPSC SMCs
N-iPSC SMCs
***
****
***
** ***
****
**
*
**
** ***
**
****
*
****
p = 0.0023
–6–4–20246
10–7
10–6
10–5
10–4
10–3
10–2
10–1
100
Log2 ( old change)
4 days Concen a ion o MMP13
E ec o media in he de achmen o hVSMCs
MMP13 inhibi ion
4 – 12 days
Cell de achmen
P oge in accumula ion
Alkaline phospha ase ac i i y
ec
b
d
710
0
10
20
30
40
Time (days)
Fold o con ol
( ans ec ed wi h con ol siRNA)
hi
0
1
2
3
4
5
Alkaline phospha ase ac i i y
no malized by cell numbe
MMP13 inhibi ion
+–
a
p- alue
g
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a e chemical and gene ic inhibi ion, he inc ease o MMP13
a e flow shea s ess and he e ec o HGPS-iPSC SMC-
condi ioned media on cell de achmen , indica e ha MMP13
media es SMC loss.
Inhibi ion o MMP13 in LmnaG609G/G609G mice significan ly
inc eased he numbe o SMCs in ao ic a ch.Toconfi m he
impo ance o MMP13 dys egula ion in p oge oid animal models,
we quan ified MMP13 in he plasma o LmnaG609G/G609G and WT
mice (Fig. 5a). The esul s showed ha he le els o MMP13 we e
highe in mu an mice (Fig. 5b). Then, we asked whe he he
inhibi ion o MMP13 in LmnaG609G/G609G mice could dec ease
SMC loss. Fo his pu pose, we gene a ed double-mu an lines,
LmnaG609G/G609GMmp13−/−and LmnaG609G/G609GMmp13+/−
(Supplemen a y Fig. 20), and e alua ed he hea a e and SMC loss
in he ao ic a ch20 o hese mice a week 10 (Fig. 5a). Hea a e
waschosenasameasu eo heo e allheal hs a uso heHGPS
model and he de i ed double-mu an lines, gi en ha b adyca dia
was a clinical abno mali y e idenced in bo h LmnaG609G/G609G
mouseaswellasZmps e24
−/−p oge ia mouse models20,31.
Bo h double-mu an mice showed highe hea a es (Fig. 5d)
and numbe s o SMCs (Fig. 5c, e) in he ao ic a ch han
LmnaG609G/G609G Mmp13+/+mice. In e es ingly, LmnaG609G/G609G
Mmp13−/−and LmnaG609G/G609GMmp13+/−mice showed a lowe
numbe o p oge in-posi i e cells in he ao ic a ch han non-
mu a ed mice (Fig. 5c, ). In addi ion, LmnaG609G/G609GMmp13+/−
mice (bu no LmnaG609G/G609GMmp13−/−mice) showed an
inc ease o he ao ic media hickness being simila o he non-
mu a ed mice (Fig. 6a), as confi med by o cein s aining. We
pe o med p o eomic analyses o ao ic a ches om mu a ed and
non-mu a ed mice (n≥5 mice pe s ain) using da a independen
acquisi ion mass spec ome y32,33. P incipal componen analysis
based on 2260 p o eins de ec ed showed ha he p o eome p ofiles
o ao ic a ches om LmnaG609G/G609GMmp13+/−mice we e mo e
closely ela ed o he p ofile o WT mice o ha o LmnaG609G/
G609G Mmp13+/+mice (Fig. 6c). F om he 161 p o eins di e en-
ially exp essed be ween he mu an and WT mice ao ic a ches (q
<0.05andabs(log
2
old change) > 0.58), ~25% o he p o eins had
simila exp ession in LmnaG609G/G609GMmp13+/−mice and WT
mice (Fig. 6c and Supplemen a y Da a 4).
Mo i a ed by hese esul s, we hen es ed a he apeu ic
app oach o educe SMC loss in LmnaG609G/G609G Mmp13+/+
mice. Fo his pu pose, we used Ba imas a because human
sa e y has been p e iously demons a ed in clinical ials34.
LmnaG609G/G609G Mmp13+/+mice a week 5 we e in ape i oneal
(IP) injec ed fi e imes a week (Fig. 7a). A week 10, Ba imas a -
ea ed LmnaG609G/G609G Mmp13+/+mice had simila hea a es
o non- ea ed animals (Fig. 7c); howe e , hey showed highe
SMCs in he ao ic a ch han non- ea ed mice, as confi med by
cell nuclei coun s and e ified by he inc ease le els o SMC
ma ke s de e mined by qRT-PCR analyses (Fig. 7b, d, e). No
di e ences we e obse ed be ween non- ea ed and Ba imas a -
ea ed mice ega ding p oge in accumula ion in he ao ic a ch
(Supplemen a y Figs. 20c). O e all, ou da a shows ha he
in i o inhibi ion o MMP13 by gene ic o chemical in e en ions
yielded mice ha ing significan ly highe numbe s o SMCs in he
ao ic a ch.
Ac i a ion o MMP13 is media ed by he ac i a ion o he
glycocalyx. The glycocalyx is a su ace laye o p o eoglycans and
glycosaminoglycans ha a e immobilized in he cell memb ane.
Glycocalyx componen s ha e been shown o be in ol ed in flow
shea s ess sensing by SMCs35,36. To iden i y he mechanism
unde lying he up egula ion o MMP13 in HGPS-iPSC SMCs
cul u ed unde a e ial flow, we analyzed glycocalyx gene mRNA
ansc ip s (Fig. 8b). In e es ingly, glycocalyx ansc ip s we e
up egula ed in HGPS-iPSC SMCs cul u ed unde flow condi ions
o 4 days (Fig. 8b). F om hese up egula ed genes, syndecan 2
gene (SDC2), which encodes he ansmemb ane ( ype I) hepa an
sul a e p o eoglycan, was also up egula ed in hVSMCs o N-iPSC
SMCs cul u ed o 4 days in flow condi ions (Supplemen a y
Fig. 21). Because no all he glycocalyx mRNA ansc ip s we e
up egula ed in hVSMCs and N-iPSC SMCs, he esul s sugges
ha he composi ion o glycocalyx is likely di e en in hese cells
when compa ed wi h HGPS-iPSC SMCs. Nex , we analyzed he
exp ession o hepa an sul a e a he p o ein le el. In con as o
con ol cells, he exp ession o hepa an sul a e inc eased when
HGPS-iPSC SMCs we e cul u ed unde flow condi ions (Fig. 8a).
Impo an ly, he enzyma ic clea age o hepa an sul a e by
hepa inase III (Supplemen a y Fig. 22) dec eased MMP13 con-
cen a ion in he cell cul u e media (Fig. 8c) and significan ly
dec eased he de achmen o HGPS-iPSC SMCs cul u ed unde
flow condi ions (Fig. 8d). Mo eo e , he enzyma ic clea age o
hepa an sul a e sligh ly dec eased alkaline phospha ase ac i i y
(Fig. 8e).
To u he in es iga e a po en ial ECM a ge o MMP13 in
SMCs, we moni o ed he exp ession o ECM componen s in
hVSMCs, HUAECs, N-iPSC SMCs, and HGPS-iPSC SMCs. Ou
Fig. 4 MMP13 ac i i y in HGPS-iPSC SMCs cul u ed unde flow shea s ess. a Volcano plo ep esen ing di e en ially exp essed genes in HGPS-iPSC-
SMC cul u ed unde flow condi ions a day 0 and 4. Each poin ep esen s one o 53,617 genes. 26 and 31 genes we e up egula ed ( ed; old change ≥3;
p< 0.001) and down egula ed (yellow; old change ≤3; p< 0.001), espec i ely. G aph shows qRT-PCR alida ion o 16 genes wi h old changes >3. Fold
change was be ween days 0 and 4. Gene exp ession was no malized by he housekeeping gene GAPDH. Resul s a e mean ± SEM, n=4 echnical eplica es
om a pool o h ee independen expe imen s. S a is ical analyses we e pe o med by a wo- ailed unpai ed S uden ’s es . bSchema ic ep esen a ion o
he expe imen al p o ocol used. cE ec o HGPS-iPSC SMC o N-iPSC SMCs condi ioned media (in bo h cases ob ained a e 4 days unde flow
condi ions) on hVSMCs cul u ed unde flow condi ions. n=1–5 images examined o e h ee independen expe imen s. dQuan ifica ion o MMP13 ac i i y
(cell cul u e media) by ELISA. Cells we e analyzed a days 0 and 4 unde flow. Fluo escence signal was no malized by cell numbe . n=3 independen
expe imen s. S a is ical analyses we e pe o med by a wo- ailed unpai ed S uden ’s es . eE ec o MMP13 o BB94 inhibi ion in HGPS-iPSC SMC
de achmen . The numbe o cells was e alua ed a e 7 and 12 days unde a e ial flow and was no malized by he numbe o cells p esen a day 0. n=3–5
images examined o e h ee independen expe imen s. S a is ical analyses we e pe o med by one-way ANOVA ollowed by Newman–Keuls’s pos es .
MMP13 knockdown by siRNA in HGPS-iPSC SMCs. MMP13 mRNA ansc ip s we e quan ified by qRT-PCR and no malized by GAPDH.Mean±SEM(n=4
echnical eplica es om a pool o h ee independen expe imen s). S a is ical analyses we e pe o med by one-way ANOVA ollowed by Newman–Keuls’s
pos es . gNumbe o cells pe mic ofluidic a ea du ing cul u e unde flow shea condi ions no malized by he numbe o cells in con ol expe imen al
g oups (i.e., cells ans ec ed wi h con ol siRNA). n=7 independen expe imen s o day 7 and n=6 independen expe imen s o day 10. hPe cen age o
p oge in-posi i e cells a e 7 days unde flow condi ions wi h SmGM-2 media supplemen ed o no wi h MMP13 inhibi o . n=1–5 images examined o e
h ee independen expe imen s. S a is ical analyses we e pe o med by a wo- ailed unpai ed S uden ’s es . iAc i i y o alkaline phospha ase in HGPS-
iPSCs-SMC no malized by cell numbe pe mm2, in cells cul u ed 4 days unde flow condi ions. Cells we e ea ed o no wi h MMP13 inhibi o . n=3
independen expe imen s. In g aphs a–h, esul s a e mean ± SEM. *, **, ***, **** deno e s a is ical significance (p< 0.05, p< 0.01, p< 0.001, p< 0.0001).
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0
10
20
30
40
50
Concen a ion o MMP13
no malize by weigh
***
KiW
W W
p = 0.0001
d
W W KiW
e
a
KiH
α-SMA Nuclei
c
555
P oge in NucleiHS Nuclei
0
200
400
600
Hea a e (bpm)
W W
KiW
KiH
KiKO
**
*
b
0.0
0.5
1.0
1.5
2.0
2.5
In ensi y HS (a.u.)/cell numbe
(no malized by W W )
KiKO
g
0.0
0.5
1.0
1.5
2.0
2.5
α-SMA-posi i e cell nuclei/mm2
(no malized by W W )
*
*
**
p = 0.003
p = 0.0343
p = 0.0142
0
2
4
6
8
10
% P oge in posi i e cells
(no malized by W W )
****
*
*
**
**
Lmna+/+ = W W
LmnaG609G/G609G Mmp13+/+ = KiW
LmnaG609G/G609G Mmp13+/– = KiH
LmnaG609G/G609G Mmp13–/– = KiKo
Age: 10 weeks Hea a e
Immunohis ochemis y
Fig. 5 MMP13 inhibi ion significan ly inc eases SMC numbe in ao ic a ch o LmnaG609G/G609G mice. a Schema ic ep esen a ion o he animal p o ocol.
W W , KiW , KiH , and KiKo mice (age: 10 weeks) we e e alua ed. bQuan ifica ion o MMP13 ac i i y (plasma om W W , n=9, and KiW , n=6, mice)
by ELISA. Fluo escence signal was no malized by mice weigh . S a is ical analyses we e pe o med by a wo- ailed unpai ed S uden ’s es . c
Immunofluo escence analyses in he ao ic a ch o α-SMA, p oge in, and hepa an sul a e (HS). Cell nuclei we e s ained wi h DAPI. Scale ba is 100 µm o
α-SMA s aining and 50 µm o p oge in and hepa an sul a e s aining. Fo α-SMA s aining, n=5 animals, excep o KiH ( ou animals). Fo p oge in
s aining, n=5 animals, excep o KiH ( h ee animals). Fo hepa an sul a e n=6 W W , n=6 KiW , n=4 KiH , and n=5 o KiKo. dHea a es in mice
(n=8 W W , n=6 KiW , n=7 KiH , and n=5 KiKo). S a is ical analyses we e pe o med by one-way ANOVA ollowed by Newman–Keuls’s pos es .
eNumbe o SMC nuclei in ao ic a ch pe issue a ea (mm2)(n=2–3 slides examined o e fi e animals, excep o KiH ( ou animals)). S a is ical
analyses we e pe o med by a wo- ailed unpai ed S uden ’s es . Pe cen age o p oge in-posi i e cells in SMCs. n=5 animals, excep o KiH ( h ee
animals). S a is ical analyses we e pe o med by one-way ANOVA ollowed by Newman–Keuls’s pos es . gExp ession o hepa an sul a e as e alua ed by
immunofluo escence. In ensi y o hepa an sul a e was calcula ed in each pic u e (a leas 16 pic u es pe condi ion) and no malized by cell numbe mice
(n=6 W W , n=6 KiW , n=4, KiH and n=5 KiKo). In b,d–g, esul s a e mean ± SEM. *, **, ***, **** deno e s a is ical significance (p< 0.05, p< 0.01,
p< 0.001, p< 0.0001).
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