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Expression and role of factor inhibiting hypoxia-inducible factor-1 in pulmonary arteries of rat with hypoxia-induced hypertension

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Acta Biochim Biophys

Sin 2008, 40: 883-892

doi:10.1111/j.1745-7270.2008.00464.x

Expression and role of factor

inhibiting hypoxia-inducible factor-1 in pulmonary arteries of rat with

hypoxia-induced hypertension

Daiyan Fu1,2, Aiguo Dai1*, Ruicheng Hu1, Yunrong Chen1, and Liming Zhu1

1

Department of

Respiratory Medicine, Hunan Institute of Gerontology, Hunan Province Geriatric

Hospital, Changsha 410016, China

2

Graduate School of

University of South China, Hengyang 421001, China

Received: May 22,

2008       

Accepted: July 21,

2008

This work was

supported by grants from the National Natural Science Foundation of China (No.

30570815), the Natural Science Foundation of Hunan Province (Nos. 05JJ30073 and

07JJ3035), and the China Postdoctoral Science Foundation (No. 2003033436)

*Corresponding

author: Tel, 86-731-4762793; Fax, 86-731-4735215; E-mail, [email protected]

Hypoxia-inducible

factor-1a subunit (HIF-1a) plays a pivotal role

during the development of hypoxia-induced pulmonary hypertension (HPH) by

transactivating it’s target genes. As an oxygen-sensitive attenuator, factor

inhibiting HIF-1 (FIH) hydroxylates a conserved asparagine residue within the

C-terminal transactivation domain of HIF-1a under normoxia and

moderate hypoxia. FIH protein is downregulated in response­ to hypoxia, but its

dynamic expression and role during­ the development of HPH remains unclear. In

this study, an HPH rat model was established. The mean pulmonary arterial­

pressure increased significantly after 7 d of hypoxia. The pulmonary artery

remodeling index became evident after­ 7 d of hypoxia, while the right

ventricular hypertrophy index became significant after 14 d of hypoxia. The

messenger RNA (mRNA) and protein expression of HIF-1a and vascular

endothelial­ growth factor (VEGF), a well-characterized target­ gene of

HIF-1a,

were

markedly upregulated after exposure to hypoxia in pulmonary arteries. FIH

protein in lung tissues declined after 7 d of hypoxia and continued to decline

through the duration of hypoxia. FIH mRNA had few changes after exposure

to hypoxia compared with after exposure to normoxia. In hypoxic rats, FIH

protein showed significant negative correlation­ with VEGF mRNA and VEGF

protein. FIH protein­ was negatively correlated with mean pulmonary arterial

pressure, pulmonary artery remodeling index and right ventricular­ hypertrophy

index. Taken together, our results suggest that, in the pulmonary arteries of

rat exposed to moderate­ hypoxia, a time-dependent decrease in FIH protein may

contribute to the development of rat HPH by enhancing the transactivation of

HIF-1a target genes

such as VEGF.

Keywords    hypoxia-inducible factor-1a

subunit; factor inhibiting hypoxia-inducible factor-1; asparaginyl hydroxylase;

hypertension; pulmonary; transactivation

It has been established that chronic hypoxia induces pulmonary­

vascular remodeling. Characterized by medial and adventitial thickening due to

increases in cell size and number as well as by increased extracellular matrix

protein­ accumulation, pulmonary vascular remodeling leads to pulmonary

hypertension. Progressive pulmonary hypertension­ may result in right

ventricular hypertrophy and eventually in cor pulmonale [1].The hypoxia-inducible factor-1 (HIF-1) is a heterodimeric

transcription factor composed of an a subunit (HIF-1a) and a b subunit (HIF-1b). Because it regulates

the expression­ of more than 100 genes involved in cellular adaptation and

survival under hypoxia, HIF-1 is one of the most important factors in cellular

response to decreased oxygen availability [2]. Heterozygous HIF-1a deficient

(Hif-1a+/) mice have impaired pulmonary vascular remodeling­ after exposure

to 10% O2 for 3 weeks [3]. Our previous studies showed that increased HIF-1a plays a

critical during the development of rat hypoxia-induced pulmonary hypertension

(HPH) by transactivating its target­ genes, such as inducible nitric oxide

synthase, heme oxygenase­-1, vascular endothelial growth factor (VEGF)

and transforming growth factor-b1 [47].HIF-1b is a constitutive nuclear subunit, whereas HIF-1a is an

oxygen-sensitive subunit. Under normoxia, hydroxylation­ of two proline

residues in the oxygen-dependent­ degradation domain of HIF-1a mediated by

prolyl hydroxylases (PHD) triggers an association with the von Hippel-Lindau

ubiquitin E3 ligase complex, which results in HIF-1a degradation through

ubiquitin-proteasome pathway. However, stabilization of HIF-1a declines in

hypoxia due to PHD inactivation. Subsequently, HIF-1a translocates from the

cytoplasm to the nucleus, where it dimerizes with HIF-1b and binds hypoxia response

elements in its target genes promoters. The binding of HIF-1a and HIF-1b to hypoxia

response elements assists in the recruitment of transcriptional coactivator

p300/CBP, which forms transcription initiation complexes to increase the

transactivation of HIF-1a target genes [8].Factor inhibiting HIF-1 (FIH), also known as asparaginyl­

hydroxylase [9], is involved in hydroxylated activity in which a conserved

asparagine residue within the C-terminal­ transactivation domain (C-TAD) of

HIF-1a suppresses HIF-1a transactivating activity by blocking the binding of the p300/CBP to

HIF-1a C-TAD [10]. In contrast to PHD, FIH can retain its hydroxylated

activity not only in normoxia but also following exposure to moderate hypoxia [11].

It has recently been shown that FIH protein expression decreases­ in a

time-dependent manner in response to hypoxia­ [12]. FIH’s dynamic expression

and role as a critical­ hydroxylase modulating HIF-1a transactivating activity­

in HPH have so far not been understood.To evaluate FIH’s expression changes and role in pulmonary­ arteries

during chronic hypoxia, we investigated­ the expression patterns of FIH and VEGF,

a well-characterized target gene of HIF-1a [13], as well as their

relationship­ to each other in the pulmonary arteries of rats at different

phases of HPH development.

Materials and Methods

Materials

The study was approved by the Animal Ethics Committee of the Hunan

Institute of Gerontology (Changsha, China), and abided by Hunan province guidelines

for the care and use of laboratory animals. Hypoxia and normoxia rat models

were set up [14]. Briefly, forty Wistar rats (male, 25020 g, 89 weeks old)

purchased from the Animal Experimental­ Center of Hunan University of

Traditional Chinese Medicine (Changsha, China) were randomly divided­ into five

groups, with eight rats in each group. Four groups of hypoxic rats were exposed

to normobaric hypoxia at 100.5% O2 for 3, 7, 14 and 21 d (8 h per

day, intermittently), respectively, in a ventilated chamber. The hypoxic

condition was established by flushing the chamber­ intermittently with a gas

mixture of room air and nitrogen from a liquid nitrogen reservoir. An MB80

oxygen analyzer­ (Zhuhai S.E.Z. Hangto Science & Tech. Company, Zhuhai,

China) was used to monitor the chamber’s environment. The chamber was

ventilated by a hole; then a dynamic balance was achieved through the

inspiration and expiration­ of the rats. CO2 was

removed using soda lime. Excess humidity was prevented using anhydrous calcium

chloride, and ammonia was kept to a minimum level using boric acid in the

chamber. The control rats were kept in a normoxic ventilated chamber (21% O2) in the same room and killed after being caged for 10 d, because

breeding duration has no significant effect on mean pulmonary arterial­

pressure (mPAP), hypoxic pulmonary artery remodeling­ or right ventricular

hypertrophy index (RVHI) [4].

mPAP measurement

mPAP was measured [14]. In brief, after rats were

intraperitoneally­ anesthetized with 40 mg/kg pentobarbital sodium, a specially

designed PE-50 single lumen catheter,(BD Biosciecnces, Sparks, USA) was

inserted into the main pulmonary artery through the right jugular vein. The

injecting­ position was confirmed by the waveform of pressure. Through this

catheter, mPAP was measured using a Medlab bio-signal operating system

(Nanjing MedEase Science and Technology, Nanjing, China).

Sample preparation and RVHI

measurement

After the measurement of mPAP, the rats were killed and bled out through

their bilateral common carotid arteries. The chest wall was opened, and four

lobes from each right lung were removed. The lobes were used for reverse

transcription-polymerase chain reaction (RT-PCR) and western blot analysis, placed in liquid nitrogen for rapid

freezing and then stored at 80 ?C. The left

lung was used for morphometry, in situ hybridization and immuno­histochemical

examination; it was removed and placed in formalin for fixation. Next, the heart was collected for RVHI measurement. For RVHI measurement,

each heart was cut open and the atria were removed. The right ventricular free

wall was dissected, and each chamber was weighed. RVHI was calculated using the

following equation:

Eq.

in which RV is the weight of the right ventricle, LV is

the weight of the left ventricle and S is the weight of the septum.

Morphometric analysis

Sections of 4 mm from each left upper lung were embedded­ with paraffin, stained

with hematoxylin-eosin and examined­ under a light microscope. Three tissue sections

were selected­ from each rat, and at least five representative pulmonary­

arteries with an external diameter about 100 mm, also called pulmonary

arterioles, chosen from each section were independently examined. To evaluate

hypoxic remodeling, we calculated the parameters of pulmonary vascular

cross-sections by measuring both the ratio of vascular wall area to total

vascular area (WA) and the ratio of vascular wall thickness to external

diameter (WT). The images of the arteries were captured and analyzed using

PIPS-2020 image software (Chongqing Tianhai Company, Chongqing, China).

In situ hybridization of HIF-1a, VEGF and FIH mRNA

In situ hybridization was carried out

using an in situ hybridization­ detection kit (Wuhan Boster Biological

Technology, Wuhan, China). The oligonucleotide probes were designed by Wuhan

Boster Biological Technology according to the sequences of rat HIF-1a, VEGF

and FIH. The sequence of probes against HIF-1a and VEGF

mRNA was the same as that described by Li and Dai [6]. Namely, the sequence of

probes against HIF-1a

 mRNA was: 5-T­T­AT­GAGCTTGCTCATCAGTTGCCACTTCC-3;

5-CT­CAGTTTGAACTAACTGGACACAGTGTGT-3; 5-GGCCGCTCAATTTATGAATATTATCATGCT-3‘.

And the sequence of probes against VEGF mRNA was: 5-GCT­C­T­A­CCTCCACCATGCCAAGTGGTCCCA-3;

5-GAC­CC­T­GGTGGACATCTTCCAGGAGTACCC-3; 5-G­­­C­AG­CTT­GAGTTAAACGAACGTACTTGCAG-3.

The sequence of probes against FIH mRNA was: 5-TT­­CTCTG­TG­TACAGTGCCAGCACCCATAAGTTCTT-3;

5-TTT­A­A­CTGGAA­CTGGATTAATAAACAA­CAGGG­G­­AA-3; and 5-CATCAGAAAGTAGCCATCATGA­GA­A­A­CA­T­T­G­A­GAA-3.

Hybridization was carried out on serial tissue sections from the

left lower lung in paraffin fixed by formalin containing­ 0.1% diethyl

pyrocarbonate (Wuhan Boster Biological­ Technology) according to the

manufacturer’s instructions. Sections were digested with pepsin for 15 min at

37 ?C. After 2 h pre-hybridization, in which sections were incubated with 20 ml

pre-hybridization solution at 38 ?C in a moist chamber, sections underwent

hybridization with digoxin-labeled, single-stranded oligonucleotide probes for

16 h at 38 ?C. In negative control studies, labeled oligonucleotide­ probes

were replaced by phosphate-buffered­ saline. After washing off unbound probes,

sections­ were incubated first with rabbit antibodies against digoxin and then

with biotinylated goat antibodies against rabbit immunoglobulin G. Sections

were then incubated with streptavidin-biotin-peroxidase. Peroxidase activity

was visualized by color reaction using diaminobenzidine (Wuhan Boster

Biological Technology) as the substrate. Brown and yellow colors indicated

positive results; more specifically, weakly positive and positive staining were

indicated by light yellow and yellow, respectively, and strongly positive­ is

shown as dark yellow or brown [15]. Negative staining is shown as background

color. Finally, the sections were counterstained with hematoxylin and mounted.

mRNA levels­ were quantified by the PIPS-2020 pathology image analysis system

based on the absorbance of positive signals­ from pulmonary arteriole walls.

Three tissue sections were selected from each rat, and at least five

representative pulmonary arterioles chosen from each section were independently­

examined.

RT-PCR analysis for FIH

gene

Total RNA from 0.1 g right upper lobe was extracted using­ TRIzol

reagent (Molecular Research Center, Cincinnati, USA). The concentration of RNA

extracted was determined­ using a DU-70 UV spectrophotometer (Beckman Coulter,

Fullerton, USA). First-strand complementary DNA (cDNA) was synthesized with

RevertAidTM first-strand cDNA synthesis­ kit (Fermentas, Vilnius, Lithuania)

according to the manufacturer’s instructions and stored at 20 ?C for

further amplification. The PCR was carried out in a DNA thermal cycler

(Eppendorf, Hamburg, Germany). Reaction­ mixtures (25 ml) consisted of cDNA (1 ml), 10 mM forward­

primer (1 ml), 10 mM reverse primer (1 ml), ddH2O (9.5 ml) and 2?Master Mix (12.5 ml) (Tiangen, Beijing, China). The PCR was performed with the following

thermal profiles: denaturation at 94 ?C for 5 min, followed by 30 cycles of 30

s at 94 ?C, 30 s at 53.5 ?C, 1 min at 72 ?C and extension at 72 ?C for 10 min.

The amplified products were electrophoretically separated with 1.5% agarose

gels. The DNA bands were scanned for optical density values with a densitometer

and quantified using the Tanon gel image system version 3.74 (Shanghai Tanon

Science and Technology, Shanghai, China). The mRNA expression was evaluated

using the ratio of the intensities of the target band to the b-actin band. The

RT-PCR analysis was independently­ performed in triplicate for each sample. The

primer sequences, as well as the predicted length of the amplified products,

are listed in Table 1. Optimum annealing temperatures are 85 ?C and

numbers of cycles are 30 cycles for amplification.

Immunohistochemistry for HIF-1a, VEGF and FIH protein

A commercial streptavidin-biotin complex kit (Wuhan Boster

Biological Technology) was used for immunohistochemistry [6]. Serial sections

of formalin-fixed, paraffin-embedded left upper lung were digested with 3% H2O2 for 20 min at room temperature, and then preincubated with 10%

non-immunized serum. Sections were incubated with goat anti-HIF-1a, anti-VEGF and

anti-FIH specific polyclonal antibodies (1:100) (Santa Cruz Biotechnology,

Santa Cruz, USA) overnight at 4 ?C. In negative control studies, the antibodies

were substituted by phosphate-buffered­ saline. After unbound antibodies were

washed off, the sections were incubated with corresponding biotinylated

secondary antibodies against goat and thereafter­ incubated with streptavidin

peroxidase. Subsequently, peroxidase activity was visualized by a color

reaction with diaminobenzidine. Brown and yellow colors indicated positive

results; more specifically, weakly positive­ and positive staining were

indicated by light yellow and yellow, respectively, and strongly positive is

shown as dark yellow or brown [15]. Negative staining is shown as background

color. Finally, the sections were counterstained with hematoxylin and mounted.

Protein levels were quantified­ using the PIPS-2020 pathology image analysis

system based on the absorbance of positive signals in pulmonary­ arteriole

walls. Three tissue sections were selected­ from each rat, and at least five

representative pulmonary­ arterioles chosen from each section were

independently­ examined.

Western blot analysis for FIH

protein in lung tissue

Proteins from 0.1 g right lower lobes were extracted using­ a total protein

extraction kit (Nanjing KeyGen Biotech, Nangjing, China) according to the

manufacturer’s instructions. Protein concentrations were determined using­ the

BCA protein assay kit (Nanjing KeyGen Biotech). Equal amounts of protein were

electrophoresed in 10% sodium dodecylsulfate-polyacrylamide gel, and

transferred to a Hybond enhanced chemiluminescence nitrocellulose membrane­

(Amersham, Piscataway, USA). The membranes­ were blocked with 5% (W/V)

instant non-fat milk in Tris-buffered saline and 0.1% Tween-20 for 1 h at room

temperature and incubated overnight at 4 ?C with the 1:1000 dilution of

specific antibodies of FIH and b-actin (Santa Cruz Biotechnology). Membranes were then incubated

with the 1:2000 dilution of peroxidase-conjugated­ anti-goat immunoglobulin G

(Wuhan Boster Biological Technology). An enhanced chemiluminescence detection

kit (Santa Cruz Biotechnology) was used for signal detection. Tanon gel image

system version 3.74 was used for quantification. Western blot analysis was

independently performed in triplicate for each sample.

Statistical analysis

Data are expressed as mean±SD. One-way ANOVA was used to determine statistically significant

differences among multiple groups, and the Student-Neuman-Keuls test was used

to analyze statistical significance between two groups. The correlations were

evaluated using the Pearson? product­-moment correlation coefficient statistical method. P<0.05 was considered a statistically significant difference.

Results

Chronic hypoxia increases mPAP

mPAP was measured as an indicator of pulmonary artery pressure in

conscious rats. mPAP in normoxic rats was 15.91.3 mmHg. As expected, mPAP in

hypoxic rats increased­ after 7 d of exposure to hypoxia (P<0.05), reached its peak after 14 d of hypoxia and then remained unchanged (Table 2).

Chronic hypoxia-induced

hypoxic pulmonary vascular­ remodeling and right ventricular hypertrophy

Pulmonary arterioles in normoxic rats were thin, whereas after

exposure to hypoxia, the wall area and wall thickness­ of pulmonary arterioles

increased (Table 2). Quantification­ of these changes, compared with

normoxic controls, revealed­ that WA increased significantly in hypoxic rats

after 7 d of hypoxia and that the increase of WT became significant after 14 d

of hypoxia. WA and WT increased further with prolonged hypoxia. Right

ventricular hypertrophy­ is a hallmark of pulmonary hypertension resulting­

from right ventricle pressure overload. After 14 d of hypoxia, RVHI was

significantly increased compared with the control, and it increased further

after 21 d of hypoxia. These data indicated that right ventricular hypertrophy­

developed after 14 d of exposure to hypoxia.

mRNA and protein levels of HIF-1a and VEGF in pulmonary­

arterial walls during normoxia and chronic hypoxia conditions

In situ hybridization showed that HIF-1a mRNA

expression­ in pulmonary arteriole walls had significantly increased after 14 d

of hypoxia and remained stable thereafter. However, there were no obvious changes

after 7 d of hypoxia or normoxia (Table 3) (Fig. 1). VEGF

mRNA expression was markedly increased in pulmonary arteriole walls after 7 d

of exposure to hypoxia, reached its peak after 14 d of hypoxia and then

remained stabile (Table 3) (Fig. 2). Expression of HIF-1a and VEGF

mRNA was mainly located in the tunica intima and tunica media.Immunohistochemical analysis showed that HIF-1a protein­ was

poorly stained in pulmonary arteriole walls of control rats. Yet, staining of

HIF-1a was markedly positive in the tunica intima and tunica media of

pulmonary arterioles­ after 3 and 7 d of hypoxia, but it then weakened (Table

3) (Fig. 3). In the tunica intima of pulmonary arterioles, VEGF

staining was lightly colored after 3 d of hypoxia and normoxia. However, VEGF

staining became stronger in the tunica intima and tunica media of pulmonary

arterioles after 7 d of hypoxia, increased in strength after 14 d of hypoxia

and then remained stable (Table 3) (Fig. 4).

mRNA and protein levels of FIH

in pulmonary arterial walls during normoxia and chronic hypoxia conditions

The result of in situ hybridization showed that FIH

mRNA was located predominantly in the tunica intima and tunica media of

pulmonary arterioles and changed little after exposure­ to hypoxia compared with

normoxia (Table 3) (Fig. 5). RT-PCR analysis revealed that FIH

mRNA was clearly expressed in rat lung under normoxic conditions and remained

unchanged in the lungs of all hypoxic rats (Fig. 6).Immunohistochemistry showed that FIH protein was strongly stained in

the tunica intima and tunica media of pulmonary arterioles in normoxic rats.

FIH staining was remarkably weakened in pulmonary arteriole walls, especially­

in the tunica media, in rats suffering hypoxic stress for 7 d compared with

controls. Subsequently, this decreased further by 14 d of hypoxia and then

remained stabile (Table 3) (Fig. 7). In western blot analysis, FIH protein levels decreased

significantly after 7 d of hypoxia and lessened further throughout the duration

of hypoxia (Fig. 8).

Analysis of linear correlation

Linear correlation analysis was carried out between different­

parameters for hypoxic rats. Linear correlation analysis showed that HIF-1a mRNA, HIF-1a protein, VEGF

mRNA and VEGF protein were positively correlated with mPAP and pulmonary artery

remodeling index (WA and WT). HIF-1a mRNA, VEGF mRNA

and VEGF protein­ were positively correlated with RVHI. VEGF mRNA and protein

showed significant positive correlations­ with HIF-1a mRNA and

HIF-1a protein. FIH protein showed significant negative correlations with VEGF

mRNA and VEGF protein. FIH protein was negatively­ correlated with mPAP,

pulmonary artery remodeling­ index and RVHI (Table 4).

Discussion

Development of pulmonary hypertension during chronic hypoxia results

from a reduction in vascular caliber because­ of pulmonary artery remodeling.

The present results­ demonstrated that hypoxic rats develop pulmonary artery

remodeling after 7 d of exposure to hypoxia, as reflected by the significant

increases in WA, and pulmonary­ hypertension after 14 d exposure, as revealed

by the rise in mPAP and right ventricular hypertrophy.By enhancing HIF-1a-mediated target genes transactivation, HIF-1a is one of the

pivotal mediators in the pathogenesis of HPH development in rat [47]. FIH is an

asparaginyl hydroxylase that regulates the transactivational activity of HIF-1a. In normoxia

and moderate hypoxia, FIH hydroxylates a conserved asparagine­ residue within

the C-TAD of HIF-1a [11]. This modification blocks binding of transcriptional

coactivator p300/CBP to the HIF-1a C-TAD and inhibits the transactivation of

HIF-1a target genes. FIH is widely expressed­ and thus potentially

available for the regulation of HIF-1a transactivational activity across a broad

range of cells [11]. As for blood vessels, FIH is mainly expressed in the

smooth muscle cell and endothelium [16]. The present study showed that, when exposed to hypoxia, mRNA and

protein expression of HIF-1a and VEGF increased significantly, and expression of VEGF persisted

for a longer time than that of HIF-1a in pulmonary­ arteries after the onset of

hypoxia. VEGF mRNA and VEGF protein showed significant positive

correlations with HIF-1a mRNA and HIF-1a protein in hypoxic rats.

These findings were consistent with previous work from our laboratory, which

suggested that HIF-1a may upregulate the expression of VEGF gene by

transactivation, and both HIF-1a and VEGF are involved in the patho­genesis­ of HPH in rats [6]. The

expression of VEGF, a well-characterized­ target gene of HIF-1a, has been shown

to be inhibited by FIH [17]. However, in pulmonary arteries­ of rats suffering

moderate hypoxia (10% O2) in which FIH is active, it is

unclear how does HIF-1a escape the inactivation­ mechanism.Prior studies have shown that FIH mRNA expression is not

influenced by hypoxia, though its protein levels decline­ in response to low

oxygen tension [12,18]. In this study, we detected steady-state expression of FIH

mRNA under hypoxia, which was mainly limited to the tunica intima and tunica

media. Nonetheless, over time, FIH protein showed a gradual decrease in hypoxic

rats compared with in controls. This decrease became significant after 7 d of

hypoxia and confirmed results from previous reports [12,18]. Linear correlation

analysis showed that VEGF mRNA and VEGF protein were negatively

correlated with FIH protein. These findings suggest that FIH protein is

downregulated in pulmonary artery under hypoxia, and they also provide a

possible explanation why HIF-1a can transactivate and upregulate the expression of target genes,

such as VEGF, under moderate hypoxia in which FIH is still active.

Moreover, FIH protein was negatively correlated­ with mPAP, pulmonary artery

remodeling index and RVHI. These results indicate that decreased FIH protein in

pulmonary­ artery under moderate hypoxia may reduce its inhibitory effect on

HIF-1a transactivational activity and thus on the promotion of

transactivation of HIF-1a target genes, such as VEGF. As a result, FIH is implicated

in the pathogenesis of HPH in rat.In summary, in the pulmonary arteries of rats exposed to moderate

hypoxia, a time-dependent decrease in FIH protein may contribute to development

of rat HPH by enhancing­ the transactivation of HIF-1a target genes, such as VEGF.

In the present study, FIH protein decreased gradually without significant

changes in the FIH mRNA after the rats were exposed to hypoxia. This

indicates that FIH may be downregulated by some post-transcriptional mechanism.

Fukuba et al recently documented that Siah-1, a member of the E3

ubiquitin ligase family with the really interesting new gene-finger protein

motif, targets­ FIH for proteasome-dependent degradation under hypoxic

conditions [12]. However, further research is needed to clarify whether Siha-1

contributes to the regulation of FIH during the development of HPH. Therefore,

based on the observations in this study, further elucidation of decreases in

FIH under moderate hypoxia might lead to potential new therapies for the

management of HPH.

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