Abstract
Background: Pigment epithelial-derived factor (PEDF) is protectively involved in atherosclerosis induced by hyperlipidemia, but expression characteristics of PEDF and the role of PEDF in the later stage of progressive atherosclerosis remain unclear. Methods: Circulating PEDF were analyzed in patients with atherosclerotic cardiovascular disease (ASCVD) and in murine models of wildtype (WT) mice and ApoE-/- mice under long-term high-fat diet (HFD). PEDF-/-/ ApoE-/- mice and matching PEDF+/+/ ApoE-/- mice fed with HFD for 24, 36 and 48 weeks, combined with injections of adeno-associated virus encoding PEDF (AAV-PEDF) in ApoE-/-/PEDF-/- mice were used to investigate the effects of PEDF knockdown on vascular function and structure. Experiments in vitro and in vivo were applied to identify PEDF regulate vascular endothelial growth factor (VEGFB) signaling pathway mediated endothelial fatty acid (FA) uptake. Findings: Circulating PEDF was increased in ASCVD patients compared to normal individuals, while decreasing trends were confirmed in murine models of WT mice and ApoE-/- mice on long-term HFD. ApoE-/-/PEDF-/- mice placed on HFD were fatter and had accelerated atherosclerotic formation, as evidenced by higher serum lipid levels, increased atherosclerotic plaques, pronounced vascular dysfunction and increased lipid accumulation in peripheral tissues, whereas injections of AAV-PEDF in ApoE-/-/PEDF-/- mice significantly improved. Mechanistically, PEDF deletion activated VEGFB paracrine signaling by upregulating expressions of VEGFB in peripheral tissues and its downstream targets on endothelial cells, including its receptors, namely VEGFR1 and neuropilin-1, and fatty acid transport protein 3 and 4 to enhance FA uptake. Interpretation: Decreasing expression of PEDF may decompensate to aggravate atherosclerosis. Funding: National Nature Science Foundation of China, Science and Technology Project of Guangzhou. Declaration of Interest: The authors declare no conflict of interest. Ethical Approval: The study was approved by the ethical committees of Sun Yat-sen Memorial Hospital and Sun Yat-sen University.
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