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Hlutverk transforming Growth factor beta (TGFβ) í stofnfrumum úr fósturvísum músa og manna Útdráttur á íslensku Einangrun stofnfruma úr fósturvísum manna hefur opnað möguleika fyrir stofnfrumuígræðslu til lækninga á sjúkdómum, svo sem sykursýki, Parkinson og hjartabilum. Þau ræktunarskilyrði sem stuðla að endurnýjun eða sérhæfingu stofnfruma úr fóstuvísum músa (mES) og manna (hES) eru flókin og illa skilgreind. Til þess að hægt verði að nota hES frumur til lækninga á sjúkdómum er nauðsynlegt að skilja samspil þeirra þátta sem ákvarða endurnýjun og sérhæfingu. Flestar rannsóknir á þessu viðfangsefni hingað til, hafa verið gerðar á mES frumum en hES frumur staðið á hakanum. Samt sem áður er ljóst að vaxtarstjórnun hES fruma er ólík því sem gerist í mES frumum. Valið á milli þess hvort stofnfruma endurnýi sig eða sérhæfi er ákvarðað af ýmsum vaxtarþáttum, þekktum og óþekktum. Það er því brýnt að greina þessa vaxtarþætti og ákvarða hvernig innanfrumuboðleiðir þeirra eru virkjaðar. Fram til þessa hefur verið sýnt fram á að þrjár innanfrumuboðleiðir í stofnfrumum úr fósturvísum músa gegna hlutverki til að viðhalda sjálfendurnýjun. Þessar boðleiðir leiða til virkjunar umritunarþátta sem finnast bæði í mES- og hES frumum en hversu mikið boðleiðirnar skarast er ekki vitað. Tilgangur þessa verkefnis er að kanna hlutverk TGFβ stórfjölskyldunnar á umritunarþætti sem stjórna viðhaldi og sérhæfingu stofnfruma úr fósturvísum. Við athugun á vefjasérhæfðum ES frumum munu augu okkar beinast að æðaþelsfrumum (endothelial cells) og hjartavöðvafrumum (cardiomyocytes). Niðurstöður úr “knockout” músarannsóknum gefa til kynna að TGFβ vaxtarþátturinn hefur bein áhrif á fósturþroskun. Með þessum stofnfrumutilraunum er stefnt að því að kryfja til mergjar hvaða hlutverki TGFβ stórfjölskyldan gegnir í örlögum stofnfruma úr fósturvísum músa og manna. Markmið stofnfrumurannsókna er að nýta stofnfrumurnar sem ótakmarkaða uppsprettu til að sérhæfa þær í frumulínur sem nota mætti til að græða í skaddaðan vef. Niðurstöðurnar munu bæta við þekkingu okkar í stofnfrumulíffræði auk þess sem þær eru skref í framþróun stofnfrumulækninga á mönnum. Við munum bæði nota mES og hES frumulínur (D3 mES frumulínan og viðurkenndar hES frumulínur sem fást frá Dr. D. Melton). Samkvæmt lögum um tæknifrjóvgun (#55, maí, 1996) er notkun stofnfrumulína úr fósturvísum sem hafa verið útbúnar erlendis leyfð og hefur rannsakandi ennfremur fengið leyfi hjá Vísindasiðanefnd til að rækta þessar frumur. Origin of human embryonic stem cells and their potential Human embryonic stem cells (hES cells) are derived from embryos that are left over from in vitro fertilization treatments. 4-5 days after fertilization, the embryo has formed a blastocyst (fig. 1). The outer layer, trophoectoderm, gives rise to the extraembryonic tissues, such as the placenta (Smith, 2001). The inner cells give rise to all of the cells of the new individual. day 5 tr ICM Early blastocyst Figure 1. Human blastocyst 3 days after thawing at the 8-cell stage. The trophectoderm (tr) is removed to isolate the inner cell mass (ICM) which will grow out into ES-like colonies. If the inner cells are carefully separated from the trophoectoderm and cultured on feeder cells, stem cells will grow that retain their potency to form all cells of the body (Thomson et al., 1998). ES cells have the unique ability to propagate indefinitely in the primitive undifferentiated state while remaining pluripotent (Passier and Mummery, 2003). This unique ability has opened possibilities for using embryonic stem cells to treat diseases such as diabetes, Parkisons, Alzheimer and heart failure. Upscaling technology needs to be applied to both undifferentiated and differentiated hES cells before transplantation of differentiated hES cells comes to clinical reality. Undifferentiated/pluripotent state of embryonic stem cells In order to retain an undifferentiated pluripotent state in culture, ES cells depend on culture on feeder cell layers; in mouse embryonic stem cells (MESC), these feeder cells can be replaced by leukemia inhibitory factor (LIF), which acting through gp130, activates the transcription factor STAT3 (Smith, 2001). Importantly, LIF is effective only in serum containing conditions but LIF in combination with BMP4 alone is sufficient to maintain the MESC in a pluripotent state and allow their de novo derivation in the absence of serum (Ying et al., 2003). In contrast to MESC, LIF has no effect on human embryonic stem cells (hES cells) renewal (Sato et al, 2004). It is essential that hES cells that will be used in human therapy will be free of animal culture systems, in which exposure to mouse retroviruses can be avoided. The factors produced by feeder cells, which are responsible for maintaining the hES cells in a pluripotent state are unknown although some candidates have been proposed. Amit and coworkers presented a novel feeder layer-free culture system for hES maintenance. This culture is based on a medium supplemented with 15 % serum replacement, a combination of growth factors including Transforming growth factor β1, LIF, basic fibroblast growth factor (bFGF) and fibronectin matrix (Amit et al., 2004). hES cells are known to express growth factor receptors including bFGF, stem cells factor (SCF) and fetal liver tyrosine kinase-3 ligand (Flt3L). Thus, Carpenter and colleges asked if these growth factors could maintain hES cells in an undifferentiated state in the absence of conditioned medium (CM). They concluded that bFGF supports undifferentiated hES cell growth without CM (Xu et al., 2005). Thomson et al. extended these findings and reported that bFGF and suppression of BMP signaling sustain undifferentiated proliferation in hES cells (Xu et al., 2005). Hayek et al. showed that ActivinA, a member of the TGFβ superfamily, is secreted by mouse embryonic feeders (MEFs) and that cultured medium enriched with ActivinA maintains HES cells undifferentiated without feeder layer conditioned medium from MEFs or STAT activation (Beattie et al., 2005). This data is supported by Hemmati-Brivanlou and colleges who reported that the TGFβ / Activin / nodal branch is activated through the transcription factors Smad2/3 in undifferentiated cells while the BMP branch is only activated in isolated mitotic cells (through the transcription factors Smad 1/5) (James et al., 2005; Besser, 2004). They extended their findings by showing that Smad 2/3 activation is required downstream of Wnt signaling, which they previously showed to be sufficient to maintain the undifferentiation state of hES cells. Taken together, bFGF, TGFβ branch activation Smad2/3 and Wnt signaling are all promising candidates in maintaining undifferentiation and pluripotency in hES cells. Recently, Nanog was identified as a transcription factor that maintains self-renewal in both mouse and human ES cells (Chambers et al., 2003; Mitsui et al. 2003; Sato et al., 2004). Even in the absence of LIF, ES cells overexpressing Nanog remain undifferentiated and they do not require addition of BMP. Overexpression of Nanog was shown to sustain Id3 at high levels in MESC, hence there may be a strong connection between the BMP signalling pathway and Nanog activity (Ying et al., 2003). The N-terminus of Nanog is rich in Ser/Thr residues, suggesting that it may be regulated by phosphorylation (Pan and Pei, 2003). Furthermore, it has recently been reported that human and mouse ES cells can maintain their pluripotency via activation of the Wnt signalling pathway and might be mediated by transcriptional regulation of Nanog (Sato et al., 2004). Transforming growth factor signal transduction Transforming growth factor beta (TGFβ) is a multipotent growth factor, acting throughout the body, where it affects most cell types. TGFβ has been implicated in regulating cell growth, differentiation, migration, extracellular matrix, deposition and apoptosis (Shi and Massague, 2003). TGFβ transduces signals from the membrane to the nucleus by binding to a heteromeric complex of serine/threonine kinase receptors known as TGFβ type I (TβRI) and type II (TβRII) receptors (figure 2). The type I receptor, also known as activin receptor-like kinase (ALK), acts downstream of the type II receptor and propagates the phosphorylation signal through specific downstream mediators of the Smad family, known as Smads receptorregulated R-Smads (Heldin et al, 1997; Shi og Massague, 2003). Phosphorylated R-Smads form complexes with the common partner (Co)- Smad, and accumulate in the nucleus where they regulate transcriptional activity of their target genes (Derynck et al., 1997). The Inhibitory Smads (I-Smads) prevent activation of R- and Co-Smads by occupying the phosphorylation site of the TβRI. Other members of the TGF-β superfamily are BMP that lead to activation of Smad 1/5/8 through BMP type I and type II receptors and activin leading to Smad 2/3 activation through activin type I and type II receptors. TGFβ Cytoplasm Type II TypeI P Smad4 P P R-Smad P P R-Smad Smad4 P P Nucleus R-Smad Smad4 TF P 4 ad Sm ad Sm R p300/CBP Figure 2. The TGFβ signal transduction pathway Bone Morphogenetic Proteins (BMPs) are members of the TGFβ superfamily. The BMP ligands and their downstream effectors, named Smads, play an essential role in determining ES cell fate not only by facilitating self-renewal but, in the absence of JAK/STAT activation, causing them to adopt a mesodermal fate instead of differentiating into the ectodermal lineage (Johansson and Wiles, 1995; Monteiro et al., 2004). BMPs have been shown to phosphorylate Smad1/5 in both human and mouse ES cells (Pera et al., 2004; Ying et al., 2003) and, at least in MESC, to upregulate Id proteins (Ying et al., 2003). The effect on MESC cells appears to be specific for BMPs/Smad1/5 since TGFβ is apparently without effect (Ying et al., 2003) although a trivial point may be that they lack specific TGFβ type II binding receptors (Goumans et al., 1998). BMPs have been shown to upregulate Id proteins (Inhibitors of differentiation), which in turn inhibit bHLH transcription factors, thereby blocking differentiation of embryonic stem cells (Hollnagel et al., 1999) and exogenous expression of Id mimicked effects of BMP on MESC. This effect has not been shown in hES cells and in fact Thomson and colleges have shown that repression of BMP sustains undifferentiated hES cells. Additionally, they have shown that BMP stimulation in hES cells in conditioned medium containing bFGF promotes trophoblast differentiation. Pera and colleges reported that blocking BMP activity in serum does not maintain hES cell self-renewal, but instead enhances primitive endoderm differentiation (Pera et al., 2004). Transcriptional regulation in embryonic stem cells The choice that a stem cell makes to undergo either differentiation or self-renewal is decided by cues of growth factors or inhibitors present in the stem cell niche. It is an emerging concept that the response of a cell not only relies on a particular signalling pathway but rather on the integration of signals from multiple pathways. It is therefore essential to understand how their signalling transduction machinery is activated by means of their downstream transcription factors that regulate target gene expression in order to maintain the ES cells' pluripotency or to manipulate them to differentiate into the required cell type for the development of cell based transplantation therapy. In particular, mechanism of cross-talk between the different signal transduction pathways has been poorly investigated although its importance is clearly illustrated by the striking result that simultaneous activation of the JAK/STAT and the Smad pathways by exogenous LIF and BMP, respectively, is sufficient to maintain pluripotency, at least of MESC, as described above. For mouse embryonic stem (ES) cells, self-renewal is dependent on signals from the cytokine leukaemia inhibitory factor (LIF) and from either serum or bone morphogenetic proteins (BMPs). In addition to the extrinsic regulation of gene expression, intrinsic transcriptional determinants are also required for maintenance of the undifferentiated state. These include Oct4, a member of the POU family of homeodomain proteins (Tomilin et al., 1998) and a second recently identified homeodomain protein, Nanog (Chambers et al., 2003)(figure 3). A number of other genes have been implicated as markers for pluripotency, including Cripto (Xu et al., 1999) and UTF-1 (Okuda et al., 1998). However, these genes are not expressed exclusively by the inner cell mass of the blastocyst and their exact roles in ES cells still remains to be determined. Interestingly, it has been suggested that UTF-1 is a target of a TGFβ superfamily member, which might connect the puzzling data of the role of the TGFβ family in pluripotency and differentiation as well as the discrepancy between mouse and human ES cells together. TGFβ/Activin/Nodal BMP Wnt LIF P-Smad1/5 Figure 3. Signalling pathways that maintain pluripotency in ES cells. LIF and BMP enhance self-renewal in mouse ES cells, Wnt and TGFβ/Activin enhance self-renewal in human ES cells. STAT3 P-Smad2/3 β-catenin Id1/3 Nanog Oct3/4 UTF-1 Differentiation of embryonic stem cells The cascade of events involving sequential gene activation taking place during human embryonic development is hindered by the unavailability of postimplantation embryos at different stages of development. Fortunately, spontaneous differentiation of hES cells can occur by means of the formation of embryoid bodies (EBs), which resemble early embryos in some aspects. ES cells can be induced to differentiate by replacing the conditioned medium (conditioned on fibroblasts overnight with addition of bFGF) to an unconditioned medium (including knockout serum replacement) and allowing them to grow on a monolayer (Xu et al., 2005) or as aggregates in suspension and form EBs, which contain a heterogenous mixture of cell types (Feraud and Vittet, 2003); this provides an easy in vitro model for studying the molecular mechanisms controlling differentiation and early stages of development normally inaccessible in mammals, particularly humans. Since Thomson and colleges succeeded in deriving hES cells, it has been shown that they can terminally differentiate into many cell types in vitro, including insulin producing cells, heart cells, bone cells, blood cells and liver cells. Differentiation of ES cells into endothelial cells and cardiomyocytes In the embryo, vasculogenesis is the process in which blood vessel formation occurs by differentiation of vascular endothelial cells (ECs) from angioblastic precursors, which in turn expand and coalesce to give rise to the primitive vascular plexus (Risau, 1997). In contrast, angiogenesis refers to the process in which sprouting occurs from preexisting vessels or split to form new vessels (Carmeliet, 2000). During vasculogenesis, embryonic vessels are thought to be formed by endothelial cells that arise from Flk1-expressing (Flk1+) mesoderm cells, surrounded by mural cells derived from mesoderm, neural crest, or epicardial cells. It was believed that endothelial and vascular smooth muscle cells (VSMC) arise from separate precursors. However, recent findings have shown that embryonic vascular progenitor cells are capable of differentiating into both mural and endothelial cells. (Yamashita et al., 2000; Gerecht-Nir et al., 2004). Furthermore, bone marrow derived vascular progenitors circulating in adult peripheral blood have been shown to include progenitors that can give rise to both types of cells and contribute to tumour angiogenesis. Tumour-derived angiogenic factors attract these circulating endothelial precursors (CEPs) to the growing new blood vessels, where they become incorporated into the growing vasculature (Asahara et al., 1997). Additionally, mature vascular endothelium has been shown to give rise to SMC via transdifferentiation, co-expressing both endothelial and SMC-specific markers (DeRuiter et al., 1997). Endothelial embryonic cells have also been shown to transdifferentiate into cardiac muscle cells under specific conditions (Condorelli et al., 2001). However the molecular mechanisms that regulate their differentiation and proliferation remains to be elucidated. It has been shown that members (Watabe et al., 2003) of the TGFβ superfamily play important roles during differentiation of vascular progenitor cells derived from the mES cells as well as in mouse embryonic endothelial cells (Goumans et al, 2002, 2003). Interaction between endothelial cells and mural cells (pericytes and vascular smooth muscle cells) is essential for development of vascular tissues and maintenance of their homeostasis in both embryonic and adult tissues (Folkman and D’Amore, 1996). TGFβ superfamily members and Platelet derived growth factor (PDGF) have been implicated among the cytokines that mediate such interaction (Carmeliet, 2000). Since Thomson and colleges succeeded in deriving hES cells, it has been shown that they can terminally differentiate into many cell types, including ECs (Levenberg et al., 2002). Spontanously differentiated ECs were isolated from EBs using an endothelial specific marker. These sorted cells had purity of 80 % and showed endothelial characteristics, such as vessellike formation both in vitro and in vivo. The expression kinetics of specific endothelial markers during spontaneous hEB formation were analysed (Levenberg et al., 2002). The levels of endothelial markers increased during the first two weeks of hEB differentiation, reaching a maximum on days 13-15 and indicating a differentiation process toward ECs. Gerecht-Nir and colleagues explored the genes that were upregulated during 4 weeks of development of EBs focusing on vascular development. Among the upregulated genes were the members of the TGFβ superfamily, TGFβ3, TβRII, Endoglin as well as PDGFB and PDGFRβ known to mediate the binding of SMC and ECs (Gerecht-Nir et al., 2005). In contrast to mES cells, Flk-1 was shown to be expressed in undifferentiated hES cells (Levenberg et al., 2002). Hence, different markers seem to play a different role in human and mouse vasculogenesis, meaning that murine systems are not necessarily predictive of human systems. Our previous findings show that in endothelial cells (ECs), TGFβ can activate two distinct type I receptor/Smad signalling pathways with opposite cellular responses. In most cell types, TGFβ signals via the TGFβ type I receptor, ALK5. However, ECs express a predominant endothelial type I receptor, named ALK1. Whereas the TGFβ/ALK1 signalling leads to activation, the TGFβ/ALK5 pathway results in an inhibition of the activation state. This suggests that TGFβ regulates the activation state of the endothelium via a fine balance between these two pathways (Goumans et al., 2002, 2003). We identified genes that are specifically induced by TGFβ mediated ALK1 or ALK5 activation. Id1 was found to be the target gene of the ALK1/Smad1/5 pathway while induction of plasminogen activator inhibitor-1 was activated only by ALK5/Smad2 pathway. Bone morphogenetic protein (BMP) is a member of the TGFβ superfamily and signals through Smad1/5. The BMP/Smad1/5 pathway was found to potently activate the endothelium. Id1 was identified as an important BMP target gene in ECs and was sufficient and necessary for BMP-induced EC migration (Valdimarsdottir et al., 2002). The isolation of endothelial cells from hES cells could prove to have potential therapeutic implications, including cell transplantation for repair of ischemic tissues and tissue engineering of vascular grafts. In transplantations, the newly grafted tissue needs to be surrounded by capillaries to survive. It is therefore critical to isolate human embryonic endothelial cells (ECs) or their precursors for such applications. Our focus The TGFβ superfamily members have enormous influence on ES fate decision, not only by enhancing self-renewal but also to direct their differentiation into mesodermal lineage. This study will be undertaken to analyze hES cells as an in vitro model for human vascular development and further to evolve the techniques used to simplify vascular cell derivation for future clinical applications. Because of their importance, we will use TGFβ superfamily members to study their role on the regulation of downstream target genes and their function in self-renewal and differentiation of hES cells into mesodermal-derived endothelial cells. REFERENCES Amit M, Shariki C, Margulets V, Itskovitz-Eldor J (2004) Feeder layer- and serum-free culture of human embryonic stem cells. Biol. Reproduction. 70: 837-845. Asahara T, Masuda H, Takahashi T, Kalka C, Pastore C, Silver M, Kearne M, Magner M, Isner JM (1999) Bone marrow origin of endothelial progenitor cells responsible for postnatal vasculogenesis in physiological and pathological neovascularization. Circ Res 85: 221-228. Beattie GM, Lopez AD, Bucay N, Hinton A, Firpo MT, King CC, Hayek A (2005) Activin A maintains pluripotency of human embryonic stem cells in the absence of feeders layers. Stem Cells. 23: 489-495. Besser D. Expression of nodal, lefty-a, and lefty-B in undifferentiated human embryonic stem cells requires activation of Smad2/3. J Biol Chem 2004; 279(43):45076-45084. Carmeliet P (2000) Mechanisms of angiogenesis and arteriogenesis. Nat Med 6: 389-395. Chambers I, Colby D, Robertson M, Nichols J, Lee S, Tweedie S, Smith A (2003) Functional expression cloning of Nanog, a pluripotency sustaining factor in embryonic stem cells. Cell 113: 643-655. Condorelli G, Borello U, De Angelis L, Latronico M, Sirabella D, Coletta M, Galli R, Balconi G, Follenzi A, Frati G, Cusella De Angelis MG, Gioglio L, Amuchastegui S, Adorini L, Naldini L, Vescovi A, Dejana E, Cossu G (2001) Cardiomyocytes induce endothelial cells to trans-differentiate into cardiac muscle: implications for myocardium regeneration. PNAS. 98: 10733-10738. Cowan CA, Klimanskaya I, McMahon J, Atienza J, Witmyer J, Zucker JA, Wang S, Morton CC, McMahon AP, Powers D, Melton DA (2004) Derivation of embryonic stem-cell lines from human blastocysts. N. Engl. J. Med. 350: 1353-1356. DeRuiter MC, Poelman RE, VanMunsteren JC, Mironov V, Markwald RR, Gittenberger-de Groot AC (1997) Embryonic endothelial cells transdifferentiate into mesenchymal cells expressing smooth muscle actins in vivo and in vitro. Circ Res . 80: 473-481. Derynck R, Feng XH. TGF-beta receptor signaling. Biochim Biophys Acta 1997; 1333(2):F105-F150. Feraud O and Vittet D (2003) Murine embryonic stem cell in vitro differentiation: applications to the study of vascular development. Histol. Histopathol. 18: 191-199. Folkman J. and d’Amore PA (1996) Blood vessel formation: what is its molecular basis? Cell. 87: 1153-1155. Fong S, Itahana Y, Sumida T, Singh J, Coppe JP, Liu Y, Richards PC, Bennington JL, Lee NM, Debs RJ, Desprez PY (2003) Id-1 as a molecular target in therapy for breast cancer cell invasion and metastasis. Proc Natl Acad Sci U S A 100: 13543-13548. Gerecht-Nir S, Osenberg S, Nevo O, Ziskind A, Coleman R, Itskovitz-Eldor J (2004) Vascular development in early human embryos and in teratomas derived from human embryonic stem cells. Biol. Reprod. 71: 2029-2036. Gerecht-Nir S, Dazard JE, Golan-Mashiach M, Osenberg S, Botvinnik A, Amariglio N, Domany E, Rechavi G, Itskovitz-Eldor J (2005) Vascular gene expression and phenotypic correlation during differentiation of human embryonic stem cells. Dev. Growth Differ. 47: 295-306. Goumans M.J, Ward-van Oostwaard D, Wianny F, Savatier P, Zwijsen A, Mummery C (1998) Mouse embryonic stem cells with aberrant tranforming growth factor beta signalling exhibit impaired differentiation in vitro and in vivo. Differentiation. 63: 101-113. Goumans M.J, Valdimarsdottir G, Itoh, S, Rosendahl A, Sideras P, ten Dijke P (2002) Balancing the activation state of the endothelium via two distinct TGFβ type I receptors. EMBO J. 21: 1743-1753. Goumans M-J, Valdimarsdottir G, Itoh S, Lebrin F, Larsson J, Mummery C, Karlsson S, ten Dijke P (2003) Activin Receptor-like Kinase (ALK)1 is an Antagonistic Mediator of Lateral TGFβ/ALK5 Signaling. Mol. Cell. 12: 817828. Heldin CH, Miyazono K, ten Dijke P. TGF-beta signalling from cell membrane to nucleus through SMAD proteins. Nature 1997; 390(6659):465-471. Hollnagel A, Oehlmann V, Heymer J, Ruther U, Nordheim, A (1999) Id genes are direct targets of bone morphogenetic protein induction in embryonic stem cells. J Biol. Chem. 274: 19838-19845. James D, Levine AJ, Besser D, Hemmati-Brivanlou A (2005) TGFβ/activin/nodal signaling is necessary for the maintenance of pluripotency in human embryonic stem cells. Development. 132: 1273-1282. Johansson B and Wiles MV (1995) Evidence for involvement of Activin A and Bone Morphogenetic Protein 4 in Mammalian Mesoderm and Hematopoietic Development. Mol. Cell. Biol. 15: 141-151. Kim TH, Barrera LO, Zheng M, Qu C, Singer MA, Richmond TA, Wu Y, Green RD, Ren B (2005) A high-resolution map of active promoters in the human genome. Nature. In Press. Klug MG, Soompaa MH, Koh GY, Field LJ (1996) Genetically selected cardiomyocytes from differentiating embryonic stem cells form stable intracardiac grafts. J. Clin. Invest. 98: 216-224. Levenberg S, Golub JS, Amit M, Itskovitz-Eldor J, Langer R (2002) Endothelial cells derived from human embryonic stem cells. PNAS. 99: 4391-4396. Mitsui K, Tokuzawa Y, Itoh H, Segawa K, Murakami M, Takahashi K, Maruyama M, Maeda M, Yamanaka S (2003) The homeoprotein Nanog is required for maintenance of pluripotency in mouse epiblast and ES cells. Cell 113: 631-642. Monteiro RM, Chuva de Sousa Lopes SM, Korchynskyi O, ten Dijke P, Mummery CL (2004) Spatio-temporal activation of Smad1 and Smad5 in vivo: monitoring transcriptional activity of Smad proteins. J. Cell Sci: 117: 4653-4663. Mummery C, Ward-van Oostwaard D, Doevendans P, Spijker R, van den Brink S, Hassink R, van der Heyden M, Opthof T, Pera M, Brutel de la Riviere A, Passier R, Tertoolen L (2003) Differentiation of human embryonic stem cells to cardiomyocytes - Role of coculture with visceral endoderm-like cells. Circulation 107: 2733-2740. Okuda A, Fukushima A, Nishimoto M, Orimo A, Yamagishi T, Nabeshima Y et al. UTF1, a novel transcriptional coactivator expressed in pluripotent embryonic stem cells and extra-embryonic cells. EMBO J 1998; 17(7):20192032. Pan GJ, Pei DQ (2003) Identification of two distinct transactivation domains in the pluripotency sustaining factor nanog. Cell research 13: 499-502. Passier R, Mummery C (2003) Origin and use of embryonic and adult stem cells in differentiation and tissue repair. Cardiov. res. 58: 324-335. Pera MF, Andrade J, Houssami S, Reubinoff B, Trounson A, Stanley EG, Ward-van Oostwaard D, Mummery C (2004) Regulation of human embryonic stem cell differentiation by BMP-2 and its antagonist noggin. J. Cell Sci. 117: 1269-1280. Risau W (1997) Mechanisms of angiogenesis. Nature 386: 671-674 Sato N, Meijer L, Skaltsounis L, Greengard P, Brivanlou AH (2004) Maintenance of pluripotency in human and mouse embryonic stem cells through activation of Wnt signaling by a pharmacological GSK-3-specific inhibitor. Nat Med. 10: 55-63. Schuldiner M, Yanuka O, Itskovitz-Eldor J, Melton DA, Benvenisty N (2000) Effects of eight growth factors on the differentiation of cells derived from human embryonic stem cells. PNAS 97: 11307-11312. Shi Y, Massague J (2003) Mechanisms of TGF-beta signaling from cell membrane to the nucleus. Cell 113: 685-700 Smith A (2001) Embryo derived stem cells: Of mice and men. Annu. Rev. Cell Dev. Biol. 17: 435-462. Tomilin A, Vorob'ev V, Drosdowsky M, Seralini GE (1998) Oct3/4-associating proteins from embryonal carcinoma and spermatogenic cells of mouse. Mol. Biol. Rep. 25: 103-109. Valdimarsdottir G, Goumans M.J, Rosendahl A, Brugman M, Itoh S, Lebrin F, Sideras P, ten Dijke P (2002) Stimulation of Id1 expression by bone morphogenetic protein (BMP) is sufficient and necessary for BMPinduced activation of endothelial cells. Circulation. 106: 2263-2270. Valdimarsdottir G. (2004) TGF-beta signal transduction in endothelial cells. Thesis book. Uppsala University. Thomson JA, Itskovitz-Eldor J, Shapiro SS, Waknitz MA, Swiergiel JJ, Marshall VS, Jones JM (1998) Embryonic stem cell lines derived from human blastocysts. Science 282: 1145-1147. Watabe T, Nishihara A, Mishima K, Yamashita J, Shimizu K, Miyazawa K, Nishikawa S, Miyazono K (2003) TGF-beta receptor kinase inhibitor enhances growth and integrity of embryonic stem cell-derived endothelial cells. J. Cell. Biol. 163: 1303-1311. Xu C, Inokuma MS, Denham J, Golds K, Kundu P, Gold JD, Carpenter MK (2001) Feeder-free growth of undifferentiated human embryonic stem cells. Nat. Biotechnology. 19: 971-974. Xu C, Rosler E, Jiang J, Lebkowski JS, Gold JD, O’Sullivan C, Delavan-Boorsma K, Mok M, Bronstein A, Carpender MK (2005) Basic fibroblast growth factor supports undifferentiated human embryonic stem cell growth without conditioned medium. Stem Cells. 23: 315-323. Xu R-H, Peck RM, Li DS, Feng X, Ludwig T. Thomson JA (2005) Basic FGF and suppression of BMP signaling sustain undifferentiated proliferation of human ES cells. Nature Methods. 2: 185-190. Yamashita J, Itoh H, Hirashima M, Ogawa M, Nishikawa S, Yurugi T, Naito M, Nakao K (2000) Flk-1 positive cells derived from embryonic stem cells serve as vascular progenitors. Nature. 408: 92-96. Ying Q-L, Nichols J, Chambers I, Smith A (2003) BMP induction of Id proteins suppresses differentiation and sustains embryonic stem cell self-renewal in collaboration with STAT3. Cell 115: 281-292.