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Molecular and Cellular Mechanisms of Angiogenesis The heparin-binding domain confers diverse functions of VEGF-A in development and disease: a structure–function study Dominik Krilleke, Yin-Shan Eric Ng and David T. Shima1 Ocular Biology and Therapeutics, UCL Institute of Ophthalmology, 11–43 Bath Street, London EC1V 9EL, U.K. Abstract The longer splice isoforms of VEGF (vascular endothelial growth factor)-A, including VEGF164(165) , contain a highly basic HBD (heparin-binding domain). This domain allows these isoforms to interact with and localize to the HS (heparan sulfate)-rich extracellular matrix, and bind to the co-receptor Nrp-1 (neuropilin-1). Heparin-binding VEGF-A isoforms are critical for survival: mice engineered to express exclusively the non-heparin-binding VEGF120 have diminished vascular branching during embryonic development and die from postnatal angiogenesis defects shortly after birth. Although it is thought that the HBD contributes to the diverse functions of VEGF-A in both physiological and pathological processes, little is known about the molecular features within this domain that enable these functions. In the present paper, we discuss the roles of the VEGF HBD in normal and disease conditions, with a particular focus on the VEGF164(165) isoform. Introduction VEGF (vascular endothelial growth factor)-A is the most prominent member of the PDGF (platelet-derived growth factor)/VEGF family of secreted dimeric growth factors, a family that consists of PlGF (placental growth factor), VEGF-B, VEGF-C, VEGF-D and the virus-derived VEGFE variants [1,2]. PDGF/VEGF growth factors are pivotal in regulating vascular development in the embryo, as well as the formation of new blood vessels and vessel homoeostasis in the adult [3]. VEGF-A is a potent chemoattractant for monocytes, a cell type implicated in pathological angiogenesis, and can activate and induce monocyte chemotaxis across endothelial cell monolayers [4]. Cellular responses to VEGF are primarily mediated by binding to VEGFR (VEGF receptor)1 [Flt-1 (Fms-like tyrosine kinase 1)] and VEGFR-2 [KDR (kinase insert domain receptor)/Flk-1 (fetal liver kinase 1)] [5], two structurally similar receptor tyrosine kinases predominantly expressed on vascular endothelial cells [6,7]. There is abundant evidence for unique receptor functions, and co-receptors such as Nrps (neuropilins) and HSPGs (heparan sulfate proteoglycans) can also modulate VEGF-A functions. VEGF exists as multiple biochemically distinct protein isoforms which differ mainly by their ability to interact with Nrps and HSPGs. The isoforms are produced as a result of alternative mRNA splicing of a common transcript from a single Vegf gene [8]. In humans, although multiple spliced isoforms have been identified, the most Key words: cancer, heparan sulfate proteoglycan, heparin-binding domain, leukostasis, retinal disorder, vascular endothelial growth factor-A (VEGF-A), vascular endothelial growth factor receptor (VEGFR). Abbreviations used: DR, diabetic retinopathy; HBD, heparin-binding domain; HS, heparan sulfate; HSPG, HS proteoglycan; ICAM-1, intercellular adhesion molecule-1; Nrp, neuropilin; PDGF, platelet-derived growth factor; ROP, retinopathy of prematurity; VEGF, vascular endothelial growth factor; VEGFR, VEGF receptor. 1 To whom correspondence should be addressed (email [email protected]). Biochem. Soc. Trans. (2009) 37, 1201–1206; doi:10.1042/BST0371201 common and well-studied isoforms are composed of 121, 165 and 189 amino acids, and the murine homologues lack one amino acid per isoform. All VEGF isoforms share the same N-terminal amino acid sequence, which contains the binding sites for VEGFR-1 and VEGFR-2, but they may or may not contain sequences encoded by exons 6 and 7 in the C-terminus (Figure 1). This C-terminal region encodes two HBDs (heparin-binding domains), each of which confers the ability to bind HS (heparan sulfate) and HSPGs on cell surfaces and basement membranes, thus determining the localization of the VEGF-A isoforms in the extracellular space [9,10]. VEGF121 , the shortest isoform, lacks an HBD and is freely diffusible upon secretion. In contrast, the longer splice form VEGF189 has two HBDs encoded by exon 6 and exon 7, and is almost completely sequestered in the extracellular matrix and on the cell surface [9,11]. VEGF165 , the prototypic and most abundant VEGF isoform, differs from VEGF121 by the inclusion of a basic peptide encompassing 44 residues encoded by exon 7. The moderate affinity for heparin enables VEGF165 to act as both a soluble and a cell-bound factor. This region also contains binding determinants for Nrp-1, a VEGF165 isoform-specific coreceptor that has been shown to be expressed on endothelial cells and certain tumour cells [12]. Nrp-1 is thought to associate with VEGFR-2 upon VEGF165 binding, enhancing VEGFR-2 activity and signalling [13]. The exact roles of Nrp-1 in VEGF-A function are poorly understood, but there is a growing body of evidence that Nrp-1 may participate in VEGF-A signalling independent of VEGFR-2 [14,15]. Modulation of VEGF-A function by HSPG The mechanisms by which HSPGs and certain GAGs (glycosaminoglycans) regulate the activity of heparin-binding VEGF-A isoforms have proven to be complex, as these matrix C The C 2009 Biochemical Society Authors Journal compilation 1201 1202 Biochemical Society Transactions (2009) Volume 37, part 6 Figure 1 Human VEGF-A isoforms Schematic representation of the three major VEGF isoforms depicted as monomers. The eight exons of the human VEGF-A are alternatively spliced to produce several distinct isoforms that differ in the presence or absence of exon 6 and 7, the HBDs. Binding sites for heparin and the different receptors are indicated. Arrowhead, plasmin cleavage site. Exons are not drawn to scale. molecules can bind to both VEGF-A and its receptors [16]. In the presence of HSPGs, VEGF165 , VEGFR-2 and Nrp-1 are thought to form an as-yet undefined signalling complex through intermediate HS molecules [13,17]. The observed regulatory effects of heparin or HSPGs on receptor binding and activation by VEGF are affected by various experimental factors [18]. Whereas heparin strongly potentiates 125 Ilabelled VEGF165 binding to VEGFR-2 in a cell-free assay, the equivalent amount of heparin inhibits the binding to NIH 3T3 cells overexpressing VEGFR-2 [19]. Heparin augments VEGF-A binding to cells in which VEGFR-2 is endogenously expressed [20]. In the case of VEGFR-1, both VEGF121 and VEGF165 binding are reduced by exogenous heparin [21,22]. Furthermore, binding to heparin also increases the stability of VEGF-A, thereby controlling VEGF-A activities by modulating its bioavailability and protein half-life [23]. Further study will be needed to clarify the effects of HSPGs on VEGF-A signalling activity. in vitro, is not sufficient to drive extension of endothelial tip cell filopodia and proper vascular branching. Normal vessel architecture is fully restored, however, in mice engineered to solely express VEGF164 (Vegf 164/164 ) or a combination of both VEGF120 and VEGF188 (Vegf 120/188 ) [26,27]. Thus VEGF164 appears to be sufficient for normal vascular development, but VEGF120 , which lacks certain functional properties provided by the HBD in the longer isoforms, is not. The Vegf 120/120 mice also exhibit specific defects in developmental bone vascularization [28] and in postnatal angiogenesis of the myocardium [25], embryonic retina [27] and kidney glomerulus [29]. VEGF164 has previously been shown to participate in neuronal patterning in vivo. Using mouse genetics and explant cultures, Schwarz et al. [30] showed that VEGF164 is both necessary and sufficient for the correct migration of facial motor neuron somata by acting as a guidance cue for Nrp-1-expressing motor neurons. This study confirms the importance of the HBD in VEGF-A-mediated vascular and neuronal development. Role of heparin-binding VEGF isoforms in normal development: lessons from mouse studies Role of heparin-binding VEGF-A isoforms in cancer Bioavailability and spatial distribution of VEGF-A can be controlled via production of both soluble and matrix-bound isoforms. A finely balanced VEGF-A concentration gradient consisting of isoforms with differential heparin-binding affinities is necessary for proper blood vessel branching morphogenesis in mice [24]. In the Vegf 120/120 mice, which were generated by targeted deletion of exons 6 and 7 of the vegf gene and consequently are devoid of heparin-binding VEGF-A variants [25], the naturally occurring chemotactic VEGF-A gradient and matrix-derived chemoattractive signals of VEGF-A are lacking. As a consequence, migration of sprouting vessel tips is defective, branching complexity is decreased and capillaries are enlarged compared with wildtype animals [24]. VEGF120 , despite showing similar potency to VEGF164 in promoting endothelial cell proliferation Deregulated VEGF-A expression contributes to the development of solid tumours by promoting tumour angiogenesis [31]. The pathophysiological roles of the different VEGF-A isoforms appear to be affected significantly by the microenvironment, such as expression of VEGF-A receptors and extracellular matrix components at different anatomical sites of tumours [32]. Various studies have shown that soluble VEGF121 is less effective than heparin-binding VEGF-A isoforms in supporting the neovascularization needed for tumour survival. For example, human glioma cells overexpressing VEGF121 fail to induce tumour progression when implanted in the subcutaneous space in mice, whereas overexpression of VEGF165 and VEGF189 strongly augments neovascularization and tumour growth relative to parental cells [32]. VEGF120 is also incapable of supporting maximal C The C 2009 Biochemical Society Authors Journal compilation Molecular and Cellular Mechanisms of Angiogenesis Figure 2 Structural fold of the VEGF165 HBD (A) Ribbon diagram with secondary structure elements of the 55-residue HBD (residues 111–165 of VEGF165 ). The cysteine residues shown are all involved in the formation of disulfide bonds. Charged residues are colour-coded, with basic and acidic amino acids depicted in blue and in red respectively. (B) Surface topology model showing the distribution of electrostatic potential and potential heparin-binding sites on the surface. The structural model is shown at two angles rotated by 180◦ about the vertical axis. The diagram was produced using PyMOL software (DeLano Scientific; http://pymol.sourceforge.net/) based on published NMR data [49] (Protein Data Bank code 1KMX). growth of tumour cells in mice receiving allografts of VEGFA-null embryonic fibroblasts stably expressing individual VEGF isoforms [33]. In this study, the diffusible VEGF120 recruited peripheral vessels, but was incapable of vascularizing the tumour itself. In contrast, VEGF164 induced both internal and external tumour vascularization, fully rescuing growth of the angiogenesis-deficient parental tumour cells. Furthermore, heparin-binding isoforms may confer a growth advantage in certain human tumours, as altered VEGF-A expression patterns in favour of the longer isoforms have been associated with tumorigenesis and poorer outcomes in certain cancers [34,35]. These data suggest that heparinbinding VEGF-A isoforms may be particularly important in tumour angiogenesis, and that isoform-specific antagonists may specifically target tumour angiogenesis [33,36]. Intraocular disease and the predominant role of the VEGF165(164) isoform Many studies suggest a causal role of VEGF-A activity in proliferative neovascular pathologies of the eye [37]. In DR (diabetic retinopathy), ROP (retinopathy of prematurity) and the wet form of AMD (age-related macular degeneration), abnormal VEGF-A expression causes uncontrolled neovascular growth and promotes vascular haemorrhages and leakage, conditions that eventually lead to irreversible retinal damage and blindness [37]. During pathological proliferative retinopathy, hypoxia-induced VEGF-A production by ischaemic retinal cells results in aberrant vessel growth that can extend beyond the retinal surface into the vitreous cavity. Among the various isoforms, VEGF164 appears to be preferentially involved in pathological retinal neovasculariz- ation. This isoform selectively accumulates in the ischaemic retina in a commonly used animal model of ROP [26,38]. Indeed, VEGF164 isoform-specific inhibition in this model has been shown to be as effective as pan-VEGF-A blockade in preventing neovascularization [26,38]. Although VEGF120 and VEGF164 are equally potent at rescuing retinal neuronal cell apoptosis when injected intraocularly after ischaemic injury, VEGF164 causes oedema and haemorrhage that is not detected in retinas treated with VEGF120 [39]. Taken together, these studies strongly suggest a pathological role for heparin-binding VEGF164 in retinal disorders. The mechanism by which VEGF164 exerts its pathological function in ischaemic retinal disease may be related to the proinflammatory actions of VEGF-A in the presence of the HBD [26]. VEGF164 is likely to be the most pro-inflammatory isoform in the eye, capable of inducing leucocyte recruitment (leukostasis) to the limbal and retinal vascular endothelium [26,40]. On an equimolar basis, VEGF164 more potently induces retinal leukostasis and corneal inflammation than does VEGF120 [40,41]. A comparison of VEGF120 with VEGF164 demonstrated that VEGF164 more potently induces both expression of ICAM-1 (intercellular adhesion molecule-1) and translocation of P-selectin to the surface of HUVECs (human umbilical vein endothelial cells) [40]. Both ICAM-1 and P-selectin are important mediators of vascular inflammation. In the retina, increased levels of VEGF-A and ICAM-1 have been shown to coincide with elevated leucocyte counts during experimental diabetes, with the VEGF164 isoform accounting for 80 % of total VEGF-A detected [42,43]. VEGF-A may also act directly on certain cells of the immune system, including monocytes, lymphocytes and dendritic cells, as C The C 2009 Biochemical Society Authors Journal compilation 1203 1204 Biochemical Society Transactions (2009) Volume 37, part 6 these cells have been shown to express active VEGF-A receptors [44,45]. Retinal inflammation and vessel leakage in both early and established diabetes can be significantly reduced when VEGF164 is inhibited by an isoform-specific aptamer antagonist [41]. This is not surprising, given that VEGF165(164) expression predominates over other isoforms in patients with DR and in an animal model of this disease [43,46]. Taken together, these observations suggest that VEGF165(164) is proinflammatory and the major pathological isoform in models of neovascular eye disease and in human DR, although the exact mechanistic roles of the HBD remain to be determined. Molecular characterization of the VEGF164 HBD The differential functions of the VEGF isoforms suggest that the HBD plays a critical role in modulating VEGF-A isoform activity. Neither the sequence nor the structure of this domain (residues 111–165 of VEGF165 ) bears any similarity to known heparin-binding proteins outside the VEGF family of growth factors [47]. The HBD comprises 55 residues, with clearly defined N-terminal and C-terminal subdomains (residues 1–29 and 29–55 respectively), each containing a two-stranded, antiparallel, β-sheet and two disulfide bonds which dominate the fold. In addition, a single α-helix is located in the C-terminal subdomain, where it is packed against the β-sheet. The charge of this overall highly basic domain (pI ∼11) is distributed rather unevenly across the surface, with a surplus of positively or negatively charged amino acids on each side of the domain (Figure 2). The loop region at the interface of the two subdomains (residues 11–17) and the relative orientation of the subdomains within the HBD remain poorly defined. The increased flexibility of this domain compared with the rest of the protein complicates accurate prediction of heparinbinding sites within the HBD. Using a mutagenesis approach to identify residues that are critical for mediating heparin binding, a principal heparin-binding site consisting of Arg13 , Arg14 and Arg49 (corresponding to Arg123 , Arg124 and Arg159 respectively of VEGF165 ) has recently been proposed [48]. The residues, although non-contiguous in sequence, are located along the interface of the clearly defined N-terminal and C-terminal subdomains, where they form a continuous binding surface. This model is supported by a refined NMR solution structure showing that the heparin-binding residues are in close contact with each other [49]. Spatial proximity of heparin-binding residues in a three-dimensional context is characteristic for many heparin-binding proteins [50]. Mutant VEGF164 variants in which Arg13 , Arg14 or Arg49 have been replaced with alanine are severely compromised in their ability to bind to heparin and HS/HSPGs, although they retain wild type-like potency in inducing endothelial gene expression in vitro and angiogenesis in an ex vivo aortic ring assay (Figure 3) [48]. Binding to Nrp-1 was only minimally reduced, so these mutants might provide a tool to help differentiate between Nrp-1 and HS/HSPG effects on VEGF-A signalling. The VEGF164 mutants exhibited similar C The C 2009 Biochemical Society Authors Journal compilation Figure 3 VEGF164 heparin-binding deficient mutants display wild-type-like capacity in inducing angiogenesis ex vivo (A) The VEGF164 HBD mutants do not bind heparin. [3 H]Heparin was incubated with increasing concentrations of VEGF variants in the presence of 0.15 M NaCl for 1 h, after which VEGF–heparin complexes were recovered using a nitrocellulose-binding assay. VEGF-bound [3 H]heparin was quantified in a liquid-scintillation counter. The GraphPad Prism program was used to generate a logarithmic curve fit according to the one-site binding model and to calculate the dissociation constants. The mutants were generated by arginine-to-alanine mutations of the indicated amino acids of the proposed heparin-binding site. (B) Left-hand panel: freshly prepared rat aortic rings were incubated with serum-free medium in the presence of equimolar concentrations of native VEGF isoforms or selected VEGF164 heparin-binding-deficient mutants for 7 days, and microvessel sprouts were stained with Isolectin B4. Right-hand panel: representative images of aorta explants captured using epifluorescence microscopy (magnification ×5). Blood vessels were traced for quantification using Photoshop (Adobe). Adapted from [48]. affinity towards VEGFR-2 [48]. These results suggest that activation of VEGFR-2 is responsible for the proliferative activities of VEGF-A on endothelial cells, and that the HBD does not play a direct role in VEGFR-2 activation. However, Molecular and Cellular Mechanisms of Angiogenesis the mutants exhibited a reduced binding affinity for VEGFR1, which is also expressed by leucocytes and mediates VEGFinduced migration [44]. The increased affinity of VEGF164 for VEGFR-1 relative to VEGF120 has previously been linked to the presence of the HBD [10], and the data from the HBD mutants confirm such a functional connection. It is possible that the HBD contributes to the binding energy of the VEGFR-1–VEGF-A interaction. VEGF-A, in particular the isoforms containing the HBD, may act as a chemoattractant for inflammatory cells by ligating and stimulating VEGFR-1. As a result, elevated local VEGF164(165) concentrations may provide recruitment signals for VEGFR-1-expressing inflammatory cells. It will be interesting to see whether the non-heparin-binding VEGF164 HBD mutants, which bind to VEGFR-1 with lower affinity, have reduced proinflammatory activities compared with wild-type VEGF164 and activities similar to VEGF120 in various disease models. Conclusions The studies described above highlight the importance of understanding the specific contributions and interplay of the different VEGF-A isoforms in normal physiology and in vascular pathologies. The pathobiology of the VEGF-A HBD remains a matter of considerable interest, and there is growing evidence that the heparin-binding isoforms have additional functions beyond the endothelium, influencing neural and immune cells. The HBD may represent a suitable therapeutic target for pathologies associated with VEGF165 overexpression. 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